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"content": "\u003cp>Voters in a tiny northeastern California community this week agreed to sell their bankrupt hospital — struggling like many rural facilities nationally — to a Denver entrepreneur with a \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">controversial plan for its revival\u003c/a>.\u003c/p>\n\u003cp>Beau Gertz, who owns Denver-based lab-testing and nutraceutical companies, will buy 26-bed Surprise Valley Community Hospital in Cedarville, Calif., taking over its debt of \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">at least $4 million.\u003c/a> Another out-of-town investor had managed it for a few months then “abandoned” it, according to bankruptcy documents. Gertz’s offer, already accepted by the district hospital’s board and approved by a federal bankruptcy judge, required the approval of local residents in Tuesday’s election.\u003c/p>\n\u003cp>Nearly 84 percent of those who voted backed the deal, although turnout was light.\u003c/p>\n\u003cp>The woes of Surprise Valley exemplify the brutal environment faced by America’s rural hospitals, which are disappearing by the dozens due to declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Some Surprise Valley voters felt they had little choice but to approve the sale: Had they rejected it, the hospital almost certainly would have closed immediately, since no other “white knight” has come forward with a plan to rescue it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Bonnie Madrigal, a former certified nursing assistant at the hospital, said Gertz convinced her that he could help.\u003c/p>\n\u003cp>“Now that I have children, keeping the hospital is the most important thing to me,” said Madrigal, 26, of nearby Eagleville. “I know how much improvement the hospital needs … but once I listened to Beau, I heard hope. I feel like with Beau, the debt is going to be off our shoulders, and we’ll work together as a community to make things better.”\u003c/p>\n\u003cp>Gertz has told residents he wants to create a “wellness center” offering vitamin infusions, genetic testing, personalized medicine and other health services for well-heeled patients. He has promised to keep the hospital’s nursing home wing open and preserve its emergency room and ambulance services.\u003c/p>\n\u003cp>But some in the community worry that his plans will fail and the local residents will be responsible for even more debt. Gertz said that to help Surprise Valley Community pay for it all, he would bill for lab tests on patients who’ve never set foot in the hospital. He said they will be treated through telemedicine, by doctors who connect with them through video and other technology.\u003c/p>\n\u003cp>“We felt that to vote yes would be to bail out the [hospital] board and forgive it for all the mistakes it’s made,” said Ray March, 83, of Cedarville, who owns a trade and travel publishing company with his wife, Barbara. “It’s much better in our opinion to shut the hospital down, start clean and listen to some other good advice, which they never did. Now it’s a marriage and they’ve got to figure out how in hell they are going to make it work.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">Some experts contend\u003c/a> that, in general, lab billing for faraway patients is legally questionable — and the practice has drawn lawsuits and government scrutiny in other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Gertz, who has not faced such suits, did not respond to a request for comment.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Voters in a tiny northeastern California community this week agreed to sell their bankrupt hospital — struggling like many rural facilities nationally — to a Denver entrepreneur with a \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">controversial plan for its revival\u003c/a>.\u003c/p>\n\u003cp>Beau Gertz, who owns Denver-based lab-testing and nutraceutical companies, will buy 26-bed Surprise Valley Community Hospital in Cedarville, Calif., taking over its debt of \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">at least $4 million.\u003c/a> Another out-of-town investor had managed it for a few months then “abandoned” it, according to bankruptcy documents. Gertz’s offer, already accepted by the district hospital’s board and approved by a federal bankruptcy judge, required the approval of local residents in Tuesday’s election.\u003c/p>\n\u003cp>Nearly 84 percent of those who voted backed the deal, although turnout was light.\u003c/p>\n\u003cp>The woes of Surprise Valley exemplify the brutal environment faced by America’s rural hospitals, which are disappearing by the dozens due to declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Some Surprise Valley voters felt they had little choice but to approve the sale: Had they rejected it, the hospital almost certainly would have closed immediately, since no other “white knight” has come forward with a plan to rescue it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Bonnie Madrigal, a former certified nursing assistant at the hospital, said Gertz convinced her that he could help.\u003c/p>\n\u003cp>“Now that I have children, keeping the hospital is the most important thing to me,” said Madrigal, 26, of nearby Eagleville. “I know how much improvement the hospital needs … but once I listened to Beau, I heard hope. I feel like with Beau, the debt is going to be off our shoulders, and we’ll work together as a community to make things better.”\u003c/p>\n\u003cp>Gertz has told residents he wants to create a “wellness center” offering vitamin infusions, genetic testing, personalized medicine and other health services for well-heeled patients. He has promised to keep the hospital’s nursing home wing open and preserve its emergency room and ambulance services.\u003c/p>\n\u003cp>But some in the community worry that his plans will fail and the local residents will be responsible for even more debt. Gertz said that to help Surprise Valley Community pay for it all, he would bill for lab tests on patients who’ve never set foot in the hospital. He said they will be treated through telemedicine, by doctors who connect with them through video and other technology.\u003c/p>\n\u003cp>“We felt that to vote yes would be to bail out the [hospital] board and forgive it for all the mistakes it’s made,” said Ray March, 83, of Cedarville, who owns a trade and travel publishing company with his wife, Barbara. “It’s much better in our opinion to shut the hospital down, start clean and listen to some other good advice, which they never did. Now it’s a marriage and they’ve got to figure out how in hell they are going to make it work.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">Some experts contend\u003c/a> that, in general, lab billing for faraway patients is legally questionable — and the practice has drawn lawsuits and government scrutiny in other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Gertz, who has not faced such suits, did not respond to a request for comment.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On the Ballot: The Fate of a Troubled Hospital in Modoc County",
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"content": "\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“He’s got something we haven’t got — which is money,” Bostic said.\u003c/p>\n\n",
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"excerpt": "Voters in Surprise Valley, Calif. must decide whether to sell their public hospital to an outside investor with an unusual business plan.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Choice Of Bay Area For AIDS Conference Exposes Tension Among Activists",
"title": "Choice Of Bay Area For AIDS Conference Exposes Tension Among Activists",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">International AIDS Conference in 2020\u003c/a>, he quickly \u003ca href=\"http://msmgf.org/global-networks-call-upon-ias-to-reevaluate-decision-to-bring-conference-to-us-in-2020/\">published a statement of disapproval. \u003c/a>\u003c/p>\n\u003cp>Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter.\u003c/p>\n\u003cp>His statement of opposition and a second one drafted by colleagues at other AIDS organizations have been co-signed by hundreds of organizations and individuals in the United States and around the world.\u003c/p>\n\u003cp>Their biggest concern: long-standing U.S. visa policies will prevent many of the people most affected by AIDS and HIV, including \u003ca href=\"https://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-202\">drug users and sex workers\u003c/a> who live in other countries, from attending the conference. They also worry about new restrictions affecting travel from Muslim countries.\u003c/p>\n\u003cfigure id=\"attachment_363357\" class=\"wp-caption alignnone\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-363357\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/georgeayala.jpg\" alt=\"\" width=\"400\" height=\"266\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-375x249.jpg 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Oakland-based activist George Ayala doesn't want the AIDS conference held in the Bay Area. He is executive director of the Global Forum on MSM & HIV. \u003ccite>(Photo courtesy of Nadia Rafif)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In this day and age, I have to wonder why we support big international AIDS conferences happening in places that bar anyone,” said Ayala, executive director of the Global Forum on MSM [Men who have Sex with Men] & HIV.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>HIV/AIDS is far more prevalent in many countries, \u003ca href=\"https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html\">especially in Sub-Saharan Africa\u003c/a>, than in the United States. Almost 19 percent of people ages 15 to 49 in South Africa are infected with HIV, as are more than 20 percent in some neighboring countries.\u003c/p>\n\u003cp>In the U.S., prevalence among the same demographic group hovers \u003ca href=\"https://www.reuters.com/article/us-aids-usa/under-1-percent-of-u-s-adults-have-hiv-report-idUSN2962453620080129\">around a half of 1 percent\u003c/a> — although that masks some stark disparities. Last year, the Centers for Disease Control and Prevention projected that \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html\">1 in 2 black men\u003c/a> in the U.S. who have sex with men were at risk of contracting HIV. Globally, \u003ca href=\"http://www.unaids.org/en/resources/fact-sheet\">nearly 37 million\u003c/a> people are living with HIV.\u003c/p>\n\u003cp>Ayala and other critics of the Bay Area location raise broader questions about the cost and frequency of a biennial event they say is enormously expensive and often excludes the very people it purports to represent.\u003c/p>\n\u003cp>The organizers of the conference and others who support the decision to bring it to the Bay Area say they understand these worries.\u003c/p>\n\u003cp>“Travel restrictions to the U.S. remain a significant concern for us,” said Mandy Sugrue, spokeswoman for the International AIDS Society, which organizes the conference.\u003c/p>\n\u003cp>However, Sugrue and other proponents of a San Francisco-Oakland conference venue argue that the politically liberal Bay Area offers a perfect platform for rebuking the Trump administration’s exclusionary immigration policies and its perceived retreat from leadership on AIDS policy.\u003c/p>\n\u003cp>In December, the administration \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.449b3fa38c17\">fired all remaining members\u003c/a> of the Presidential Advisory Council on HIV/AIDS, six months after a half-dozen others had resigned in protest. Trump officials have also proposed cutting national HIV/AIDS spending by more than $100 million and reducing the U.S. contribution to global funding by more than $1 billion.\u003c/p>\n\u003cp>“If there is any place in the U.S. where people can come and protest and rise up and have their voices heard … Oakland is it,” said Cynthia Carey-Grant, executive director of the Oakland-based group Women Organized to Respond to Life-Threatening Disease. She penned \u003ca href=\"http://www.womenhiv.org/why-oakland-for-iac-2020/\">a statement in support\u003c/a> of the conference location that has been signed by nearly a dozen individuals and groups.\u003c/p>\n\u003cp>Carey-Grant believes the contrast between upscale, predominantly white San Francisco and its decidedly poorer neighbor across the Bay offers a window on the disparities that pervade AIDS treatment and funding around the world – to the detriment of low-income communities of color.\u003c/p>\n\u003cp>Sofia Tobar (Courtesy of Sofia Tobar)\u003c/p>\n\u003cp>Sofia Tobar, a 50-year-old transgender woman from Oakland who was diagnosed with HIV in 1998, said the conference is an opportunity “for Oakland’s diverse humans to embrace people from other countries … and to also highlight what we’re lacking.” She is especially interested in speaking out against federal cuts to AIDS services and violence targeting the transgender community, she said.\u003c/p>\n\u003cp>Others say they are eager to honor San Francisco’s long history of battling AIDS.\u003c/p>\n\u003cp>Joe Hollendoner, CEO of \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation\u003c/a>, noted that the conference organizers have secured use of the Moscone Center, the central conference venue, free of charge. They will use the money they save to help more people attend, he said. His foundation, along with the San Francisco Travel Association, led the committee that submitted the successful conference bid.\u003c/p>\n\u003cp>The planners of the International AIDS Conference usually try to alternate venues between affluent and lower-income countries. The conference was last held in the United States in 2012 in Washington, D.C. In 2014, it was in Melbourne, Australia, and in 2016, in Durban, South Africa. This year, the conference will be in Amsterdam.\u003c/p>\n\u003cp>Conference organizers said they reached out to a number of lower-income countries to host the 2020 conference, but \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">none submitted a bid\u003c/a>. As many as 20,000 people, perhaps more, are expected to attend the conference — and many cities cannot accommodate such a large gathering, they said. Sugrue, the International AIDS Society spokeswoman, said they are not considering changing the venue.\u003c/p>\n\u003cp>She said the location of major conference donors was not a factor in the 2020 venue decision.\u003c/p>\n\u003cp>Gilead Sciences Inc., which is based 20 miles from San Francisco and makes the HIV prevention drug Truvada, is one of the \u003ca href=\"http://www.aids2018.org/Sponsors-Exhibitors/Sponsors/Conference-sponsors-supporters\">top sponsors of this year’s conference\u003c/a>, as it was in 2016. Other big industry donors are not located in the Bay Area, including Johnson & Johnson, Merck and ViiV Healthcare, which specializes in HIV drugs. Funding for the 2020 conference has not yet been confirmed, Sugrue said.\u003c/p>\n\u003cp>Naina Khanna, the executive director of the Oakland-based Positive Women’s Network, said the fact that no developing countries submitted a bid isn’t enough to assuage her concern for the people who will likely be excluded. Khanna helped draft \u003ca href=\"https://docs.google.com/forms/d/e/1FAIpQLSfYsezkCUoHWc_8Sdo8WJJGKY518VSU6rnZXLuXpIMtgiJTuw/viewform\">a separate statement\u003c/a> demanding that the conference be relocated outside the U.S. More than 100 organizations and nearly as many individuals have signed the statement.\u003c/p>\n\u003cp>“Where is our commitment to actually holding the conference where the most people are impacted?” asked Ruth Morgan Thomas, global coordinator of the \u003ca href=\"http://www.nswp.org/\">Global Network of Sex Work Projects\u003c/a>, which includes 305 organizations representing sex workers in 85 countries.\u003c/p>\n\u003cp>Prior to the Washington, D.C., conference, the U.S. had lifted a ban on people with HIV entering the country, and many were hopeful that similar prohibitions against sex workers and drug users would also end. But they didn’t, and sex workers scrambled to organize a parallel conference in Kolkata, India, Morgan Thomas said. Drug users convened one in Kiev.\u003c/p>\n\u003cp>Khanna, of the Positive Women’s Network, said that the high cost of accommodations in the Bay Area will also make the conference inaccessible to many people within the United States — especially low-income African-Americans in the South, who are disproportionately burdened with the virus.\u003c/p>\n\u003cp>Marsha Martin, coordinating director of the Global Network of Black People Working in HIV, said she would have been happy had Bangkok or South America or even Atlanta been chosen to host the conference. “But if venues don’t submit bids, there’s nothing to do about it,” she said. So she’s treating the Bay Area conference as an opportunity to grapple with the big disparities in AIDS funding and to reinvigorate efforts in the U.S. to combat the disease.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If we do bring it [to the Bay Area] and make it the best conference we can make it, then we win,” Martin said. “We show the world we are not giving up.”\u003c/p>\n\n",
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"description": "After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the International AIDS Conference in 2020, he quickly published a statement of disapproval. Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter. His",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">International AIDS Conference in 2020\u003c/a>, he quickly \u003ca href=\"http://msmgf.org/global-networks-call-upon-ias-to-reevaluate-decision-to-bring-conference-to-us-in-2020/\">published a statement of disapproval. \u003c/a>\u003c/p>\n\u003cp>Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter.\u003c/p>\n\u003cp>His statement of opposition and a second one drafted by colleagues at other AIDS organizations have been co-signed by hundreds of organizations and individuals in the United States and around the world.\u003c/p>\n\u003cp>Their biggest concern: long-standing U.S. visa policies will prevent many of the people most affected by AIDS and HIV, including \u003ca href=\"https://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-202\">drug users and sex workers\u003c/a> who live in other countries, from attending the conference. They also worry about new restrictions affecting travel from Muslim countries.\u003c/p>\n\u003cfigure id=\"attachment_363357\" class=\"wp-caption alignnone\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-363357\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/georgeayala.jpg\" alt=\"\" width=\"400\" height=\"266\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-375x249.jpg 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Oakland-based activist George Ayala doesn't want the AIDS conference held in the Bay Area. He is executive director of the Global Forum on MSM & HIV. \u003ccite>(Photo courtesy of Nadia Rafif)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In this day and age, I have to wonder why we support big international AIDS conferences happening in places that bar anyone,” said Ayala, executive director of the Global Forum on MSM [Men who have Sex with Men] & HIV.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>HIV/AIDS is far more prevalent in many countries, \u003ca href=\"https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html\">especially in Sub-Saharan Africa\u003c/a>, than in the United States. Almost 19 percent of people ages 15 to 49 in South Africa are infected with HIV, as are more than 20 percent in some neighboring countries.\u003c/p>\n\u003cp>In the U.S., prevalence among the same demographic group hovers \u003ca href=\"https://www.reuters.com/article/us-aids-usa/under-1-percent-of-u-s-adults-have-hiv-report-idUSN2962453620080129\">around a half of 1 percent\u003c/a> — although that masks some stark disparities. Last year, the Centers for Disease Control and Prevention projected that \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html\">1 in 2 black men\u003c/a> in the U.S. who have sex with men were at risk of contracting HIV. Globally, \u003ca href=\"http://www.unaids.org/en/resources/fact-sheet\">nearly 37 million\u003c/a> people are living with HIV.\u003c/p>\n\u003cp>Ayala and other critics of the Bay Area location raise broader questions about the cost and frequency of a biennial event they say is enormously expensive and often excludes the very people it purports to represent.\u003c/p>\n\u003cp>The organizers of the conference and others who support the decision to bring it to the Bay Area say they understand these worries.\u003c/p>\n\u003cp>“Travel restrictions to the U.S. remain a significant concern for us,” said Mandy Sugrue, spokeswoman for the International AIDS Society, which organizes the conference.\u003c/p>\n\u003cp>However, Sugrue and other proponents of a San Francisco-Oakland conference venue argue that the politically liberal Bay Area offers a perfect platform for rebuking the Trump administration’s exclusionary immigration policies and its perceived retreat from leadership on AIDS policy.\u003c/p>\n\u003cp>In December, the administration \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.449b3fa38c17\">fired all remaining members\u003c/a> of the Presidential Advisory Council on HIV/AIDS, six months after a half-dozen others had resigned in protest. Trump officials have also proposed cutting national HIV/AIDS spending by more than $100 million and reducing the U.S. contribution to global funding by more than $1 billion.\u003c/p>\n\u003cp>“If there is any place in the U.S. where people can come and protest and rise up and have their voices heard … Oakland is it,” said Cynthia Carey-Grant, executive director of the Oakland-based group Women Organized to Respond to Life-Threatening Disease. She penned \u003ca href=\"http://www.womenhiv.org/why-oakland-for-iac-2020/\">a statement in support\u003c/a> of the conference location that has been signed by nearly a dozen individuals and groups.\u003c/p>\n\u003cp>Carey-Grant believes the contrast between upscale, predominantly white San Francisco and its decidedly poorer neighbor across the Bay offers a window on the disparities that pervade AIDS treatment and funding around the world – to the detriment of low-income communities of color.\u003c/p>\n\u003cp>Sofia Tobar (Courtesy of Sofia Tobar)\u003c/p>\n\u003cp>Sofia Tobar, a 50-year-old transgender woman from Oakland who was diagnosed with HIV in 1998, said the conference is an opportunity “for Oakland’s diverse humans to embrace people from other countries … and to also highlight what we’re lacking.” She is especially interested in speaking out against federal cuts to AIDS services and violence targeting the transgender community, she said.\u003c/p>\n\u003cp>Others say they are eager to honor San Francisco’s long history of battling AIDS.\u003c/p>\n\u003cp>Joe Hollendoner, CEO of \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation\u003c/a>, noted that the conference organizers have secured use of the Moscone Center, the central conference venue, free of charge. They will use the money they save to help more people attend, he said. His foundation, along with the San Francisco Travel Association, led the committee that submitted the successful conference bid.\u003c/p>\n\u003cp>The planners of the International AIDS Conference usually try to alternate venues between affluent and lower-income countries. The conference was last held in the United States in 2012 in Washington, D.C. In 2014, it was in Melbourne, Australia, and in 2016, in Durban, South Africa. This year, the conference will be in Amsterdam.\u003c/p>\n\u003cp>Conference organizers said they reached out to a number of lower-income countries to host the 2020 conference, but \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">none submitted a bid\u003c/a>. As many as 20,000 people, perhaps more, are expected to attend the conference — and many cities cannot accommodate such a large gathering, they said. Sugrue, the International AIDS Society spokeswoman, said they are not considering changing the venue.\u003c/p>\n\u003cp>She said the location of major conference donors was not a factor in the 2020 venue decision.\u003c/p>\n\u003cp>Gilead Sciences Inc., which is based 20 miles from San Francisco and makes the HIV prevention drug Truvada, is one of the \u003ca href=\"http://www.aids2018.org/Sponsors-Exhibitors/Sponsors/Conference-sponsors-supporters\">top sponsors of this year’s conference\u003c/a>, as it was in 2016. Other big industry donors are not located in the Bay Area, including Johnson & Johnson, Merck and ViiV Healthcare, which specializes in HIV drugs. Funding for the 2020 conference has not yet been confirmed, Sugrue said.\u003c/p>\n\u003cp>Naina Khanna, the executive director of the Oakland-based Positive Women’s Network, said the fact that no developing countries submitted a bid isn’t enough to assuage her concern for the people who will likely be excluded. Khanna helped draft \u003ca href=\"https://docs.google.com/forms/d/e/1FAIpQLSfYsezkCUoHWc_8Sdo8WJJGKY518VSU6rnZXLuXpIMtgiJTuw/viewform\">a separate statement\u003c/a> demanding that the conference be relocated outside the U.S. More than 100 organizations and nearly as many individuals have signed the statement.\u003c/p>\n\u003cp>“Where is our commitment to actually holding the conference where the most people are impacted?” asked Ruth Morgan Thomas, global coordinator of the \u003ca href=\"http://www.nswp.org/\">Global Network of Sex Work Projects\u003c/a>, which includes 305 organizations representing sex workers in 85 countries.\u003c/p>\n\u003cp>Prior to the Washington, D.C., conference, the U.S. had lifted a ban on people with HIV entering the country, and many were hopeful that similar prohibitions against sex workers and drug users would also end. But they didn’t, and sex workers scrambled to organize a parallel conference in Kolkata, India, Morgan Thomas said. Drug users convened one in Kiev.\u003c/p>\n\u003cp>Khanna, of the Positive Women’s Network, said that the high cost of accommodations in the Bay Area will also make the conference inaccessible to many people within the United States — especially low-income African-Americans in the South, who are disproportionately burdened with the virus.\u003c/p>\n\u003cp>Marsha Martin, coordinating director of the Global Network of Black People Working in HIV, said she would have been happy had Bangkok or South America or even Atlanta been chosen to host the conference. “But if venues don’t submit bids, there’s nothing to do about it,” she said. So she’s treating the Bay Area conference as an opportunity to grapple with the big disparities in AIDS funding and to reinvigorate efforts in the U.S. to combat the disease.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If we do bring it [to the Bay Area] and make it the best conference we can make it, then we win,” Martin said. “We show the world we are not giving up.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "A Firefighter in San Diego Confronts the Trauma of the Job",
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"content": "\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" rel=\"noopener\" target=\"_blank\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>At 7:30 on a recent morning, Jeremy Forte, a firefighter in Imperial Beach, California, had just wrapped up a 48-hour shift. As the seven-member crew headed home, Forte drove right past a local bar that used to be a favorite haunt. A few years ago, he would have stopped for a drink, or two, or three — and perhaps stayed on for hours. And he would have had plenty of company.\u003c/p>\n\u003cp>“There’s nurses from the hospital there getting off work at the same time,” Forte recalled. “We’d be drinking with nurses, partying, having a good old time. And we didn’t think anything was wrong. That’s what people do, right? They get off work and have some drinks.”\u003c/p>\n\u003cp>Jeremy is tall and lanky, with a thin mustache. He’s been a firefighter for 19 years. It’s grueling work, both physically and mentally. For a long time, drinking was how he coped.\u003c/p>\n\u003cp>“Our motto was work hard, party hard,” said Forte, now 39. “We put in 16-hour days and then we’d go drink the rest of the night, and then probably get two hours of sleep. Wake up, you know, half-drunk and go back out on the fire line and fight these fires.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A few years ago, Forte’s drinking got heavier. He started dabbling in cocaine. But he felt he still had it all under control, until he failed a random drug test at work.\u003c/p>\n\u003cp>Forte’s station is part of the federal government: his crew fights fires and responds to emergencies in and around a \u003ca href=\"https://www.cnic.navy.mil/regions/cnrsw/installations/navbase_coronado.html\" target=\"_blank\" rel=\"noopener\">naval base\u003c/a> in Imperial Beach. The federal firefighting force has a zero-tolerance policy, and Forte was in danger of losing his job immediately.\u003c/p>\n\u003cp>“They really could have ended my whole life by turning their backs on me and firing me,” Forte said. “And then at that point, I would lose my wife as well, and probably be living with my parents.”\u003c/p>\n\u003cp>Forte grew up in West Covina. Two \u003ca href=\"http://www.lafd.org/\" target=\"_blank\" rel=\"noopener\">LAFD\u003c/a> firefighters lived on his block. Forte admired them, and loved seeing his next-door neighbors on the local news.\u003c/p>\n\u003cp>“Doing that sort of thing really intrigued me,” he recalled. Not only was the job itself exciting, but it also allowed the firefighters to spend plenty of time with their families when they were off-duty.\u003c/p>\n\u003cp>But not everyone believed he could do it. Forte was born with a birth defect: He’s missing some fingers on both hands, and others aren’t fully formed. His whole career, he’s had to prove that he can do everything a firefighter has to do: drive rigs, grip and haul hoses, rescue people.\u003c/p>\n\u003cp>Forte proved the doubters wrong.\u003c/p>\n\u003cfigure id=\"attachment_363270\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-363270\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, California, has been a firefighter for 19 years and struggles with PTSD and depression. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 19 years as a firefighter, it has become crucial to his identity. Losing that career would have been absolutely devastating. After the drug test, Forte hired a private lawyer and asked the department and union for a second chance. He agreed to every condition of a yearlong probation, including enrolling in a recovery program and beginning therapy.\u003c/p>\n\u003cp>“By the grace of God, I still have my job,” Forte said. “I still have people backing me.”\u003c/p>\n\u003cp>During his recovery, Jeremy was diagnosed with post-traumatic stress disorder and depression. He wasn’t surprised to hear it, and he’s not alone.\u003c/p>\n\u003cp>First responders have increased rates of PTSD, depression, substance abuse and suicide due to the stresses they are exposed to on the job. In a \u003ca href=\"http://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a>, 85 percent of first responders reported symptoms related to mental health issues, but only about a third of them sought out professional help.\u003c/p>\n\u003cp>Another \u003ca href=\"http://www.jems.com/articles/print/volume-40/issue-10/features/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-suicide.html?c=1\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> revealed 6.6 percent of first responders had attempted suicide, and more than a third had considered suicide. In both cases, those rates are 10 times the national average.\u003c/p>\n\u003cp>“I always thought, it’s a job, you go do it and you just deal with it, it goes away,” Forte said. “But it doesn’t.”\u003c/p>\n\u003cp>The pain lingers and haunts. Forte learned that when he was 22, at his first job with the forest service. His team fought fires but also rescued backpackers — and he was surprised by the violence that nature can cause.\u003c/p>\n\u003cp>“There was a gentleman out camping in the middle of the forest in New Mexico,” he recalled. “A piece of the tree broke off and hit him in the neck and broke his neck. And as he hit the ground, he broke his leg. We had to fly there in a helicopter, basically to rescue him.”\u003c/p>\n\u003cp>But by the time they got there, the hiker had died. It was the first time Forte saw a dead body on the job, a victim of a violent, random accident. The helicopter extracted the body, but then it grew too dark to come back for the hiker’s friend, who was uninjured but traumatized and covered in blood. So Forte volunteered to stay with him all night in the woods.\u003c/p>\n\u003cp>After that incident, Forte started having nightmares.\u003c/p>\n\u003cp>“The things that we see on the job aren’t what everyday people see and so they wouldn’t understand completely what we deal with, and how it can haunt us and stay with us the rest of our lives.”\u003c/p>\n\u003cfigure id=\"attachment_363276\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363276\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jeremy Forte prepares to perform drills on Jan. 9, 2018. Forte has been a firefighter for 19 years and says the job is grueling, both physically and mentally. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not that firefighters never talk about what they see. They do, but they don’t talk about the pain inside.\u003c/p>\n\u003cp>“You don’t want to be seen as weak,” he said. “So instead … we’d go have some drinks and joke about it, or, you know, talk about the situation still, but it’s over alcohol.”\u003c/p>\n\u003cp>After hitting bottom, Jeremy moved his family to a wood cabin in Lake Arrowhead. It’s quiet there, and he can decompress when he isn’t at work.\u003c/p>\n\u003cp>Jeremy is now sober and back in the firehouse full-time. He tries to set an example for younger colleagues by sharing his story, and talking about his emotions more often.\u003c/p>\n\u003cp>“The current fire crew that I work with now, we’re all very open together,” he said. “We’re very tight-knit and we talk about the stuff we see. … We’re almost like our own counselors.”\u003c/p>\n\u003cp>Often the men gather in the kitchen to make breakfast before the shift formally starts at 7:30 a.m. Some of the men set the table, while others slice mushrooms, make hash browns or scramble eggs.\u003c/p>\n\u003cp>It ends up being a slow shift, with no emergency calls, so the seven men on duty spend the day checking gear and running drills.\u003c/p>\n\u003cp>Before turning in for the night, they gather again at the kitchen table. Things get serious when the talk turns to suicide among firefighters.\u003c/p>\n\u003cp>Everyone in the room knows a firefighter who killed him or herself, or at least has heard about a recent case.\u003c/p>\n\u003cp>The shift captain, Richard Hernandez, complained that mental health information wasn’t part of the firefighter training.\u003c/p>\n\u003cp>“There really hasn’t been any direction on how to work with that if somebody is having an issue,” he said.\u003c/p>\n\u003cp>Hernandez said that his firefighters can get three visits with a counselor per year, but that’s not enough.\u003c/p>\n\u003cp>Another firefighter, Lindsey Nolan, said he wants to learn how to recognize signs or symptoms of PTSD in a co-worker.\u003c/p>\n\u003cp>“I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on” if he had some training in it, Nolan said.\u003c/p>\n\u003cp>Another firefighter, Devin Boler, admitted it’s hard to know how — or when — to intervene.\u003c/p>\n\u003cp>“Because we live together, and we’re with each other through Christmas and Thanksgiving and stuff like that, we have to be professional,” Boler said. But there’s also “a family side to it, where you kind of have to check in with guys and see what’s going on, if they’re having a rough day.”\u003c/p>\n\u003cp>Firefighters began talking about these issues more after the increase in mass public shootings, according to the \u003ca href=\"http://www.ffbha.org/\" target=\"_blank\" rel=\"noopener\">Firefighter Behavioral Health Alliance\u003c/a>, an Arizona-based nonprofit that provides mental health support and training for firefighters.\u003c/p>\n\u003ch2>A Bittersweet Milestone\u003c/h2>\n\u003cp>Forte has been making the long drive to a drug screening center, in National City, at least twice a month for the past year. It’s part of his probation: submitting to a full year of random, and frequent, drug tests.\u003c/p>\n\u003cp>Today was his last visit, though. His probation is ending. Forte will still get random drug tests, but not as often.\u003c/p>\n\u003cp>“I feel great,” he said as he drove. “Not like I’m going to go out and celebrate, if you know what I mean.”\u003c/p>\n\u003cp>During the drive, Jeremy downed two large coffees. But despite the caffeine, he’s too wound up to provide a urine sample. After a few hours, he succeeds, and finally walks out of that clinic for the last time.\u003c/p>\n\u003cp>“It was a humbling process,” he reflected, looking back at his year of probation. “Ultimately, I wanted to get back on track for my family, for my job, for myself.”\u003c/p>\n\u003cp>“The biggest reason is my kids,” he added. “I wasn’t going to allow this to keep me down, and be some deadbeat dad that didn’t seek help.”\u003c/p>\n\u003cp>Forte said the culture of silence among first responders has to end. So does the idea that emergency work is about being tough at all costs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Guys shouldn’t feel that way,” he said. He wants firefighters to think about seeking counseling or mental health assistance as “the manly thing to do.”\u003c/p>\n\u003cfigure id=\"attachment_363271\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363271\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, Calif., has been a firefighter for 19 years and struggles with PTSD and depression. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\n",
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"excerpt": "Firefighter Jeremy Forte, who has battled PTSD, depression and substance abuse, says the culture of suffering in silence among first responders has to end.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" rel=\"noopener\" target=\"_blank\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>At 7:30 on a recent morning, Jeremy Forte, a firefighter in Imperial Beach, California, had just wrapped up a 48-hour shift. As the seven-member crew headed home, Forte drove right past a local bar that used to be a favorite haunt. A few years ago, he would have stopped for a drink, or two, or three — and perhaps stayed on for hours. And he would have had plenty of company.\u003c/p>\n\u003cp>“There’s nurses from the hospital there getting off work at the same time,” Forte recalled. “We’d be drinking with nurses, partying, having a good old time. And we didn’t think anything was wrong. That’s what people do, right? They get off work and have some drinks.”\u003c/p>\n\u003cp>Jeremy is tall and lanky, with a thin mustache. He’s been a firefighter for 19 years. It’s grueling work, both physically and mentally. For a long time, drinking was how he coped.\u003c/p>\n\u003cp>“Our motto was work hard, party hard,” said Forte, now 39. “We put in 16-hour days and then we’d go drink the rest of the night, and then probably get two hours of sleep. Wake up, you know, half-drunk and go back out on the fire line and fight these fires.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A few years ago, Forte’s drinking got heavier. He started dabbling in cocaine. But he felt he still had it all under control, until he failed a random drug test at work.\u003c/p>\n\u003cp>Forte’s station is part of the federal government: his crew fights fires and responds to emergencies in and around a \u003ca href=\"https://www.cnic.navy.mil/regions/cnrsw/installations/navbase_coronado.html\" target=\"_blank\" rel=\"noopener\">naval base\u003c/a> in Imperial Beach. The federal firefighting force has a zero-tolerance policy, and Forte was in danger of losing his job immediately.\u003c/p>\n\u003cp>“They really could have ended my whole life by turning their backs on me and firing me,” Forte said. “And then at that point, I would lose my wife as well, and probably be living with my parents.”\u003c/p>\n\u003cp>Forte grew up in West Covina. Two \u003ca href=\"http://www.lafd.org/\" target=\"_blank\" rel=\"noopener\">LAFD\u003c/a> firefighters lived on his block. Forte admired them, and loved seeing his next-door neighbors on the local news.\u003c/p>\n\u003cp>“Doing that sort of thing really intrigued me,” he recalled. Not only was the job itself exciting, but it also allowed the firefighters to spend plenty of time with their families when they were off-duty.\u003c/p>\n\u003cp>But not everyone believed he could do it. Forte was born with a birth defect: He’s missing some fingers on both hands, and others aren’t fully formed. His whole career, he’s had to prove that he can do everything a firefighter has to do: drive rigs, grip and haul hoses, rescue people.\u003c/p>\n\u003cp>Forte proved the doubters wrong.\u003c/p>\n\u003cfigure id=\"attachment_363270\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-363270\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, California, has been a firefighter for 19 years and struggles with PTSD and depression. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 19 years as a firefighter, it has become crucial to his identity. Losing that career would have been absolutely devastating. After the drug test, Forte hired a private lawyer and asked the department and union for a second chance. He agreed to every condition of a yearlong probation, including enrolling in a recovery program and beginning therapy.\u003c/p>\n\u003cp>“By the grace of God, I still have my job,” Forte said. “I still have people backing me.”\u003c/p>\n\u003cp>During his recovery, Jeremy was diagnosed with post-traumatic stress disorder and depression. He wasn’t surprised to hear it, and he’s not alone.\u003c/p>\n\u003cp>First responders have increased rates of PTSD, depression, substance abuse and suicide due to the stresses they are exposed to on the job. In a \u003ca href=\"http://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a>, 85 percent of first responders reported symptoms related to mental health issues, but only about a third of them sought out professional help.\u003c/p>\n\u003cp>Another \u003ca href=\"http://www.jems.com/articles/print/volume-40/issue-10/features/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-suicide.html?c=1\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> revealed 6.6 percent of first responders had attempted suicide, and more than a third had considered suicide. In both cases, those rates are 10 times the national average.\u003c/p>\n\u003cp>“I always thought, it’s a job, you go do it and you just deal with it, it goes away,” Forte said. “But it doesn’t.”\u003c/p>\n\u003cp>The pain lingers and haunts. Forte learned that when he was 22, at his first job with the forest service. His team fought fires but also rescued backpackers — and he was surprised by the violence that nature can cause.\u003c/p>\n\u003cp>“There was a gentleman out camping in the middle of the forest in New Mexico,” he recalled. “A piece of the tree broke off and hit him in the neck and broke his neck. And as he hit the ground, he broke his leg. We had to fly there in a helicopter, basically to rescue him.”\u003c/p>\n\u003cp>But by the time they got there, the hiker had died. It was the first time Forte saw a dead body on the job, a victim of a violent, random accident. The helicopter extracted the body, but then it grew too dark to come back for the hiker’s friend, who was uninjured but traumatized and covered in blood. So Forte volunteered to stay with him all night in the woods.\u003c/p>\n\u003cp>After that incident, Forte started having nightmares.\u003c/p>\n\u003cp>“The things that we see on the job aren’t what everyday people see and so they wouldn’t understand completely what we deal with, and how it can haunt us and stay with us the rest of our lives.”\u003c/p>\n\u003cfigure id=\"attachment_363276\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363276\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jeremy Forte prepares to perform drills on Jan. 9, 2018. Forte has been a firefighter for 19 years and says the job is grueling, both physically and mentally. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not that firefighters never talk about what they see. They do, but they don’t talk about the pain inside.\u003c/p>\n\u003cp>“You don’t want to be seen as weak,” he said. “So instead … we’d go have some drinks and joke about it, or, you know, talk about the situation still, but it’s over alcohol.”\u003c/p>\n\u003cp>After hitting bottom, Jeremy moved his family to a wood cabin in Lake Arrowhead. It’s quiet there, and he can decompress when he isn’t at work.\u003c/p>\n\u003cp>Jeremy is now sober and back in the firehouse full-time. He tries to set an example for younger colleagues by sharing his story, and talking about his emotions more often.\u003c/p>\n\u003cp>“The current fire crew that I work with now, we’re all very open together,” he said. “We’re very tight-knit and we talk about the stuff we see. … We’re almost like our own counselors.”\u003c/p>\n\u003cp>Often the men gather in the kitchen to make breakfast before the shift formally starts at 7:30 a.m. Some of the men set the table, while others slice mushrooms, make hash browns or scramble eggs.\u003c/p>\n\u003cp>It ends up being a slow shift, with no emergency calls, so the seven men on duty spend the day checking gear and running drills.\u003c/p>\n\u003cp>Before turning in for the night, they gather again at the kitchen table. Things get serious when the talk turns to suicide among firefighters.\u003c/p>\n\u003cp>Everyone in the room knows a firefighter who killed him or herself, or at least has heard about a recent case.\u003c/p>\n\u003cp>The shift captain, Richard Hernandez, complained that mental health information wasn’t part of the firefighter training.\u003c/p>\n\u003cp>“There really hasn’t been any direction on how to work with that if somebody is having an issue,” he said.\u003c/p>\n\u003cp>Hernandez said that his firefighters can get three visits with a counselor per year, but that’s not enough.\u003c/p>\n\u003cp>Another firefighter, Lindsey Nolan, said he wants to learn how to recognize signs or symptoms of PTSD in a co-worker.\u003c/p>\n\u003cp>“I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on” if he had some training in it, Nolan said.\u003c/p>\n\u003cp>Another firefighter, Devin Boler, admitted it’s hard to know how — or when — to intervene.\u003c/p>\n\u003cp>“Because we live together, and we’re with each other through Christmas and Thanksgiving and stuff like that, we have to be professional,” Boler said. But there’s also “a family side to it, where you kind of have to check in with guys and see what’s going on, if they’re having a rough day.”\u003c/p>\n\u003cp>Firefighters began talking about these issues more after the increase in mass public shootings, according to the \u003ca href=\"http://www.ffbha.org/\" target=\"_blank\" rel=\"noopener\">Firefighter Behavioral Health Alliance\u003c/a>, an Arizona-based nonprofit that provides mental health support and training for firefighters.\u003c/p>\n\u003ch2>A Bittersweet Milestone\u003c/h2>\n\u003cp>Forte has been making the long drive to a drug screening center, in National City, at least twice a month for the past year. It’s part of his probation: submitting to a full year of random, and frequent, drug tests.\u003c/p>\n\u003cp>Today was his last visit, though. His probation is ending. Forte will still get random drug tests, but not as often.\u003c/p>\n\u003cp>“I feel great,” he said as he drove. “Not like I’m going to go out and celebrate, if you know what I mean.”\u003c/p>\n\u003cp>During the drive, Jeremy downed two large coffees. But despite the caffeine, he’s too wound up to provide a urine sample. After a few hours, he succeeds, and finally walks out of that clinic for the last time.\u003c/p>\n\u003cp>“It was a humbling process,” he reflected, looking back at his year of probation. “Ultimately, I wanted to get back on track for my family, for my job, for myself.”\u003c/p>\n\u003cp>“The biggest reason is my kids,” he added. “I wasn’t going to allow this to keep me down, and be some deadbeat dad that didn’t seek help.”\u003c/p>\n\u003cp>Forte said the culture of silence among first responders has to end. So does the idea that emergency work is about being tough at all costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Guys shouldn’t feel that way,” he said. He wants firefighters to think about seeking counseling or mental health assistance as “the manly thing to do.”\u003c/p>\n\u003cfigure id=\"attachment_363271\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363271\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, Calif., has been a firefighter for 19 years and struggles with PTSD and depression. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Trump Administration Relaxes Financial Penalties Against Nursing Homes",
"title": "Trump Administration Relaxes Financial Penalties Against Nursing Homes",
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"content": "\u003cp>The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.\u003c/p>\n\u003cp>The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.\u003c/p>\n\u003cp>“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.\u003c/p>\n\u003cp>Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.\u003c/p>\n\u003cp>The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.\u003c/p>\n\u003cp>The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.\u003c/p>\n\u003cp>“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.\u003c/p>\n\u003cp>Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.\u003c/p>\n\u003cp>The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Complaints Rise in California as Nursing Homes Evict Poor Patients",
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"content": "\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Wrecked And Retching: Obscure Vomiting Illness Linked To Long-Term Pot Use",
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"content": "\u003cp>For 17 years, Chalfonte LeNee Queen suffered periodic episodes of violent retching and abdominal pain that would knock her off her feet for days, sometimes leaving her writhing on the floor in pain.\u003c/p>\n\u003cp>“I’ve screamed out for death,” said Queen, 48, who lives in San Diego. “I’ve cried out for my mom who’s been dead for 20 years, mentally not realizing she can’t come to me.”\u003c/p>\n\u003cp>Queen lost a modeling job after being mistaken for an alcoholic. She racked up tens of thousands of dollars in medical bills, and her nausea interrupted her sex life. Toward the end of her illness, Queen, who stands 5-foot-9, weighed in at a frail 109 pounds.\u003c/p>\n\u003cp>Throughout the nearly two decades of pain, vomiting and mental fog, she visited the hospital about three times a year, but doctors never got to the bottom of what was ailing her. By 2016, she thought she was dying, that she “must have some sort of cancer or something they can’t detect,” Queen said.\u003c/p>\n\u003cp>But she didn’t have cancer. She had an obscure syndrome called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/\">cannabinoid hyperemesis syndrome\u003c/a>, a condition only recently acknowledged by the medical community. It affects a small population — namely, a subset of marijuana users who smoke multiple times a day for months, years or even decades.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There’s no hard data on the prevalence of the illness. But in California and Colorado, which have loosened marijuana laws in recent years, emergency physicians say they’re seeing it more often. One \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469074/\">study\u003c/a> in Colorado suggests there may be a link.\u003c/p>\n\u003cp>Dr. Aimee Moulin, an emergency room physician at UC-Davis Medical Center in Sacramento, said she has seen a rise in the number of cases since California voters legalized recreational marijuana last November. She expects to see another increase after commercial sales are permitted starting in January.\u003c/p>\n\u003cp>Doctors say it’s difficult to treat the condition. There is no cure other than to quit using marijuana, and many patients are skeptical that cannabis is making them sick, so they keep using it and their vomiting episodes continue.\u003c/p>\n\u003cp>Doctors can do little to relieve the symptoms, since traditional anti-nausea medications often don’t work and there are no pills to prevent the onset of an episode. Patients may need intravenous hydration and hospital stays until the symptoms subside.\u003c/p>\n\u003cp>“That’s really frustrating as an emergency physician,” said Moulin. “I really like to make people feel better.”\u003c/p>\n\u003cp>Diagnosing the syndrome can also be frustrating — and expensive. There is no blood test to link the stomach ailment with marijuana use, so physicians often order pricey CT scans and lab tests to rule out other medical problems.\u003c/p>\n\u003cp>Cannabinoid hyperemesis syndrome was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774264/\">first documented in Australia\u003c/a> in 2004. Physicians have historically misdiagnosed it as the more generic \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/cyclic-vomiting-syndrome/symptoms-causes/syc-20352161\">cyclic vomiting syndrome\u003c/a>, which has no identifiable cause or, as in Queen’s case, \u003ca href=\"http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP\">acute intermittent porphyria (AIP)\u003c/a>.\u003c/p>\n\u003cp>“Five years ago, this wasn’t something that [doctors] had on their radar,” said Dr. Kennon Heard, an emergency physician at the University of Colorado in Aurora, who co-authored the Colorado study showing a possible tie between the liberalization of marijuana and a surge of the vomiting illness. “We’re at least making the diagnosis more now.”\u003c/p>\n\u003cp>One surefire sign of the illness is when patients find relief in hot showers and baths. Queen said she would vomit repeatedly unless she was in a hot shower — so she’d stay in there for hours. Toxicologists say the heat may distract the brain from pain receptors in the abdomen but, like the syndrome itself, that phenomenon is \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751385/\">not well understood\u003c/a>.\u003c/p>\n\u003cp>The exact cause of the condition is still a mystery. Toxicologists say the chemical compounds in marijuana may throw off the normal function of the body’s \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/18426493\">cannabinoid receptors\u003c/a>, which help regulate the nervous system.\u003c/p>\n\u003cp>Some people may be genetically predisposed to the syndrome, or marijuana’s potency or chemical makeup may have changed over time, said Dr. Craig Smollin, medical director of the San Francisco division of the California Poison Control System, who also works as an emergency physician at Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>The vomiting link to cannabis is counterintuitive to many, because of its widely known reputation as an anti-nausea remedy for cancer patients.\u003c/p>\n\u003cp>“A lot of times, people just don’t believe you,” said Dr. John Coburn, an emergency physician at Kaiser Permanente in south Sacramento. Even after being told that quitting may help, some patients will visit the hospital multiple times before they stop smoking marijuana, Coburn said. “I can’t really tell you why. I mean, why do people ride motorcycles without helmets on?”\u003c/p>\n\u003cp>Cameron Nicole Beard, 19, of East Moline, Ill., said she struggled to believe her doctors about the link between pot and severe vomiting.\u003c/p>\n\u003cp>“Who wants to be told you can’t smoke marijuana, when you think marijuana can help?” said Beard, while recovering from a marijuana-related vomiting episode at a University of Iowa hospital in Iowa City, Iowa, last month. She said she had lost 20 pounds in 10 days.\u003c/p>\n\u003cp>Although there’s still no magic cure for a patient’s marijuana-related hyperemesis, Moulin and other doctors say \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28370228\">they’re getting better at treating\u003c/a> the symptoms, using old anti-psychotic medications and cream for muscle aches.\u003c/p>\n\u003cp>Dr. Heard said the cases in Colorado seem to have leveled off. But without hard data, and because the overall numbers are small, it’s hard to say for sure. Heard said he doesn’t believe cases of the pot syndrome increased after recreational use was legalized in 2012, because chronic users probably already had medical marijuana cards.\u003c/p>\n\u003cp>Chalfonte LeNee Queen is still struggling to completely quit marijuana, but her symptoms are down to a dull stomachache. She now smokes a couple of times a day, compared with her near-constant use in the past. She said it’s the only thing that works for her depression and anxiety.\u003c/p>\n\u003cp>Queen is back to a healthy weight and hasn’t been to the hospital in a year. She said she wouldn’t want to discourage anybody from smoking weed; she just wants people to know heavy use can bring them some serious misery.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Now, if I get sick, as sad as I’ll be and as upset and disappointed with myself as I would be, at least it’s a freaking choice,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For 17 years, Chalfonte LeNee Queen suffered periodic episodes of violent retching and abdominal pain that would knock her off her feet for days, sometimes leaving her writhing on the floor in pain.\u003c/p>\n\u003cp>“I’ve screamed out for death,” said Queen, 48, who lives in San Diego. “I’ve cried out for my mom who’s been dead for 20 years, mentally not realizing she can’t come to me.”\u003c/p>\n\u003cp>Queen lost a modeling job after being mistaken for an alcoholic. She racked up tens of thousands of dollars in medical bills, and her nausea interrupted her sex life. Toward the end of her illness, Queen, who stands 5-foot-9, weighed in at a frail 109 pounds.\u003c/p>\n\u003cp>Throughout the nearly two decades of pain, vomiting and mental fog, she visited the hospital about three times a year, but doctors never got to the bottom of what was ailing her. By 2016, she thought she was dying, that she “must have some sort of cancer or something they can’t detect,” Queen said.\u003c/p>\n\u003cp>But she didn’t have cancer. She had an obscure syndrome called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/\">cannabinoid hyperemesis syndrome\u003c/a>, a condition only recently acknowledged by the medical community. It affects a small population — namely, a subset of marijuana users who smoke multiple times a day for months, years or even decades.\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 hard data on the prevalence of the illness. But in California and Colorado, which have loosened marijuana laws in recent years, emergency physicians say they’re seeing it more often. One \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469074/\">study\u003c/a> in Colorado suggests there may be a link.\u003c/p>\n\u003cp>Dr. Aimee Moulin, an emergency room physician at UC-Davis Medical Center in Sacramento, said she has seen a rise in the number of cases since California voters legalized recreational marijuana last November. She expects to see another increase after commercial sales are permitted starting in January.\u003c/p>\n\u003cp>Doctors say it’s difficult to treat the condition. There is no cure other than to quit using marijuana, and many patients are skeptical that cannabis is making them sick, so they keep using it and their vomiting episodes continue.\u003c/p>\n\u003cp>Doctors can do little to relieve the symptoms, since traditional anti-nausea medications often don’t work and there are no pills to prevent the onset of an episode. Patients may need intravenous hydration and hospital stays until the symptoms subside.\u003c/p>\n\u003cp>“That’s really frustrating as an emergency physician,” said Moulin. “I really like to make people feel better.”\u003c/p>\n\u003cp>Diagnosing the syndrome can also be frustrating — and expensive. There is no blood test to link the stomach ailment with marijuana use, so physicians often order pricey CT scans and lab tests to rule out other medical problems.\u003c/p>\n\u003cp>Cannabinoid hyperemesis syndrome was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774264/\">first documented in Australia\u003c/a> in 2004. Physicians have historically misdiagnosed it as the more generic \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/cyclic-vomiting-syndrome/symptoms-causes/syc-20352161\">cyclic vomiting syndrome\u003c/a>, which has no identifiable cause or, as in Queen’s case, \u003ca href=\"http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP\">acute intermittent porphyria (AIP)\u003c/a>.\u003c/p>\n\u003cp>“Five years ago, this wasn’t something that [doctors] had on their radar,” said Dr. Kennon Heard, an emergency physician at the University of Colorado in Aurora, who co-authored the Colorado study showing a possible tie between the liberalization of marijuana and a surge of the vomiting illness. “We’re at least making the diagnosis more now.”\u003c/p>\n\u003cp>One surefire sign of the illness is when patients find relief in hot showers and baths. Queen said she would vomit repeatedly unless she was in a hot shower — so she’d stay in there for hours. Toxicologists say the heat may distract the brain from pain receptors in the abdomen but, like the syndrome itself, that phenomenon is \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751385/\">not well understood\u003c/a>.\u003c/p>\n\u003cp>The exact cause of the condition is still a mystery. Toxicologists say the chemical compounds in marijuana may throw off the normal function of the body’s \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/18426493\">cannabinoid receptors\u003c/a>, which help regulate the nervous system.\u003c/p>\n\u003cp>Some people may be genetically predisposed to the syndrome, or marijuana’s potency or chemical makeup may have changed over time, said Dr. Craig Smollin, medical director of the San Francisco division of the California Poison Control System, who also works as an emergency physician at Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>The vomiting link to cannabis is counterintuitive to many, because of its widely known reputation as an anti-nausea remedy for cancer patients.\u003c/p>\n\u003cp>“A lot of times, people just don’t believe you,” said Dr. John Coburn, an emergency physician at Kaiser Permanente in south Sacramento. Even after being told that quitting may help, some patients will visit the hospital multiple times before they stop smoking marijuana, Coburn said. “I can’t really tell you why. I mean, why do people ride motorcycles without helmets on?”\u003c/p>\n\u003cp>Cameron Nicole Beard, 19, of East Moline, Ill., said she struggled to believe her doctors about the link between pot and severe vomiting.\u003c/p>\n\u003cp>“Who wants to be told you can’t smoke marijuana, when you think marijuana can help?” said Beard, while recovering from a marijuana-related vomiting episode at a University of Iowa hospital in Iowa City, Iowa, last month. She said she had lost 20 pounds in 10 days.\u003c/p>\n\u003cp>Although there’s still no magic cure for a patient’s marijuana-related hyperemesis, Moulin and other doctors say \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28370228\">they’re getting better at treating\u003c/a> the symptoms, using old anti-psychotic medications and cream for muscle aches.\u003c/p>\n\u003cp>Dr. Heard said the cases in Colorado seem to have leveled off. But without hard data, and because the overall numbers are small, it’s hard to say for sure. Heard said he doesn’t believe cases of the pot syndrome increased after recreational use was legalized in 2012, because chronic users probably already had medical marijuana cards.\u003c/p>\n\u003cp>Chalfonte LeNee Queen is still struggling to completely quit marijuana, but her symptoms are down to a dull stomachache. She now smokes a couple of times a day, compared with her near-constant use in the past. She said it’s the only thing that works for her depression and anxiety.\u003c/p>\n\u003cp>Queen is back to a healthy weight and hasn’t been to the hospital in a year. She said she wouldn’t want to discourage anybody from smoking weed; she just wants people to know heavy use can bring them some serious misery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Valley Fever Surging Again In California This Year",
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"content": "\u003cp>Valley Fever is shaping up to be worse this year than in 2016, when the number of cases hit a record high.\u003c/p>\n\u003cp>Suspected cases of the fungal disease in the first 10 months of 2017 surged by more than one-third from the same period last year to 5,121, officials at the California Department of Public Health (CDPH) said Monday.\u003c/p>\n\u003cp>That puts this year on track to surpass the number of cases recorded in 2016.\u003c/p>\n\u003cp>“It is important that people living, working and travelling in California are aware of its symptoms, especially in the southern San Joaquin Valley and the Central Coast, where it is most common,” Dr. Karen Smith, CDPH director and state public health officer, said in a written statement.\u003c/p>\n\u003cp>\u003c!--/.slab-container -->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The illness, also known by the scientific name coccidioidomycosis, typically causes flu-like symptoms such as fever, chest pain and coughing — but it can be dangerous. It is most prevalent in the late summer and fall.\u003c/p>\n\u003cp>The department said it doesn’t know why there has been an apparent increase in cases again this year. But climatologists and other researchers have theorized that intensified \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/2017GL073524/full\" target=\"_blank\" rel=\"noopener\">dust storms\u003c/a> or \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" target=\"_blank\" rel=\"noopener\">heat waves\u003c/a> linked to global warming can fuel Valley Fever.\u003c/p>\n\u003cp>Many people infected by the fungus don’t show symptoms. But Valley Fever can also be confused with other respiratory infections such as influenza and pneumonia. Elderly people and those with weakened immune symptoms can develop more severe symptoms, including infections of the bone, brain or other organs.\u003c/p>\n\u003cp>State Assemblyman Rudy Salas (D-Bakersfield), who represents areas of the San Joaquin Valley where the fungus is endemic, said the increase was alarming.\u003c/p>\n\u003cp>“[This] underscores the need for a statewide approach to help the thousands of families affected across the state,” Salas said in a written statement.\u003c/p>\n\u003cp>He \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1279\" target=\"_blank\" rel=\"noopener\">authored a measure\u003c/a> earlier this year that would have required the state public health department to develop outreach programs to educate people about the illness. \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">Governor Brown vetoed\u003c/a> the bill, arguing that the state already provides fact sheets and posters to raise awareness, and that delegating more resources should be decided through state budget negotiations.\u003c/p>\n\u003cp>Agricultural communities are particularly hard hit by the fungal infection, which is contracted by breathing in spores when dust rises into the air because of weather conditions or activities such as farm work or construction.\u003c/p>\n\u003cp>Fresno and Kern County reported a notable increase in the number of cases compared with the same period last year. Los Angeles, Tulare and San Luis Obispo counties also had a large share of the cases.\u003c/p>\n\u003cp>Salas also wanted to establish an enhanced monitoring system for Valley Fever, including a working group of health officers from the five counties with the highest number of cases. Those proposals didn’t make it into the bill that Brown vetoed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Valley Fever is shaping up to be worse this year than in 2016, when the number of cases hit a record high.\u003c/p>\n\u003cp>Suspected cases of the fungal disease in the first 10 months of 2017 surged by more than one-third from the same period last year to 5,121, officials at the California Department of Public Health (CDPH) said Monday.\u003c/p>\n\u003cp>That puts this year on track to surpass the number of cases recorded in 2016.\u003c/p>\n\u003cp>“It is important that people living, working and travelling in California are aware of its symptoms, especially in the southern San Joaquin Valley and the Central Coast, where it is most common,” Dr. Karen Smith, CDPH director and state public health officer, said in a written statement.\u003c/p>\n\u003cp>\u003c!--/.slab-container -->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The illness, also known by the scientific name coccidioidomycosis, typically causes flu-like symptoms such as fever, chest pain and coughing — but it can be dangerous. It is most prevalent in the late summer and fall.\u003c/p>\n\u003cp>The department said it doesn’t know why there has been an apparent increase in cases again this year. But climatologists and other researchers have theorized that intensified \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/2017GL073524/full\" target=\"_blank\" rel=\"noopener\">dust storms\u003c/a> or \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" target=\"_blank\" rel=\"noopener\">heat waves\u003c/a> linked to global warming can fuel Valley Fever.\u003c/p>\n\u003cp>Many people infected by the fungus don’t show symptoms. But Valley Fever can also be confused with other respiratory infections such as influenza and pneumonia. Elderly people and those with weakened immune symptoms can develop more severe symptoms, including infections of the bone, brain or other organs.\u003c/p>\n\u003cp>State Assemblyman Rudy Salas (D-Bakersfield), who represents areas of the San Joaquin Valley where the fungus is endemic, said the increase was alarming.\u003c/p>\n\u003cp>“[This] underscores the need for a statewide approach to help the thousands of families affected across the state,” Salas said in a written statement.\u003c/p>\n\u003cp>He \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1279\" target=\"_blank\" rel=\"noopener\">authored a measure\u003c/a> earlier this year that would have required the state public health department to develop outreach programs to educate people about the illness. \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">Governor Brown vetoed\u003c/a> the bill, arguing that the state already provides fact sheets and posters to raise awareness, and that delegating more resources should be decided through state budget negotiations.\u003c/p>\n\u003cp>Agricultural communities are particularly hard hit by the fungal infection, which is contracted by breathing in spores when dust rises into the air because of weather conditions or activities such as farm work or construction.\u003c/p>\n\u003cp>Fresno and Kern County reported a notable increase in the number of cases compared with the same period last year. Los Angeles, Tulare and San Luis Obispo counties also had a large share of the cases.\u003c/p>\n\u003cp>Salas also wanted to establish an enhanced monitoring system for Valley Fever, including a working group of health officers from the five counties with the highest number of cases. Those proposals didn’t make it into the bill that Brown vetoed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Acute Confusion As Enrollment for Affordable Care Act Nears",
"title": "Acute Confusion As Enrollment for Affordable Care Act Nears",
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"content": "\u003cp>If the comments on Covered California’s \u003ca href=\"https://www.facebook.com/CoveredCA/\">Facebook page\u003c/a> are any indication, you’re all suffering from acute health insurance confusion:\u003c/p>\n\u003cp>\u003cem>“I wanted to sign up again this year. … I’m hesitant now because of what Trump has done. Should I still consider?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Does the removal of subsidies mean we might lose our premium tax credits during the year?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“So you’re telling me that [Trump’s] executive order didn’t do anything? I am so confused.”\u003c/em>\u003c/p>\n\u003cp>I don’t blame you. Choosing a health plan will be doubly hard this year given \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump’s recent move\u003c/a> to cut off federal payments for a key consumer subsidy, his administration’s decision to shorten exchange open-enrollment periods in most states to 45 days, Congress’ failed attempts to repeal Obamacare and the departure of some insurers from certain markets.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Let me ease your mind straightaway on three critical points:\u003c/p>\n\u003cp>1. In California, open enrollment for individuals and families who buy their 2018 plans through Covered California and in the open market lasts three months, from Nov. 1 to Jan. 31.\u003c/p>\n\u003cp>2. You won’t lose the tax credits that help you — and the vast majority of Covered California enrollees — afford your premiums, assuming you still qualify.\u003c/p>\n\u003cp>3. The same goes for the cost-sharing subsidies that reduce out-of-pocket costs for some Covered California members, despite Trump’s decision to stop funding them.\u003c/p>\n\u003cp>But shopping will be challenging. Anthem Blue Cross is pulling out of a large swath of California’s individual market, on and off the exchange, forcing hundreds of thousands of consumers to find new plans. And in addition to regular, annual rate hikes — averaging 12.3 percent statewide — silver-level plans will bear an additional \u003ca href=\"https://californiahealthline.org/news/california-slaps-surcharge-on-aca-plans-as-trump-remains-coy-on-subsidies/\">12.4 percent average surcharge\u003c/a> to make up for the loss of federal funding for the cost-sharing subsidies.\u003c/p>\n\u003cp>Remember, those are averages. Your actual premium will depend on several factors, including where you live, your income, what level of coverage you choose and which insurer you pick.\u003c/p>\n\u003cp>In an unexpected twist, some people may actually benefit from the surcharge because it could bring plans with more robust coverage within financial reach.\u003c/p>\n\u003cp>Before we get into all that, my most important piece of advice remains the same this year as before:\u003c/p>\n\u003cp>Don’t do this alone. Help from certified insurance agents and enrollment “navigators” is free. You can find local options by clicking on the “Find Help” tab on Covered California’s website, \u003ca href=\"http://www.coveredca.com/\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Silver-Plan Surcharge\u003c/strong>\u003c/p>\n\u003cp>Nearly half of Covered California enrollees qualify for cost-sharing subsidies, which lower their copays, deductibles and coinsurance. The subsidies are paid directly to insurers, and are separate from the tax credits that reduce monthly premiums.\u003c/p>\n\u003cp>These discounts are available only to silver-plan enrollees whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four. That’s why Covered California added the 12.4 percent average surcharge only to silver plans amid Trump’s threats — \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">and ultimate decision\u003c/a> — to stop funding the subsidies.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/news/\">Covered California estimates\u003c/a> that 78 percent of subsidized consumers will pay the same as — or less than — this year, despite the surcharge, because their tax credits will rise with their premiums. About half of the remaining 22 percent will see increases of less than $25 per month.\u003c/p>\n\u003cp>“This is potentially good news for both insurers and consumers,” says \u003ca href=\"http://axenehp.com/consultants/greg-fann-fsa-fca-maaa/\">Greg Fann\u003c/a>, a senior consulting actuary based in Murrieta. “And bad news for taxpayers,” who are footing the bill for the increased tax credits.\u003c/p>\n\u003cp>Fann offers advice to consumers based on their income.\u003c/p>\n\u003cp>Covered California enrollees with incomes up to roughly 200 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\">federal poverty level\u003c/a> — or about $49,200 for a family of four — should probably remain in silver plans, he advises, because they qualify for significant cost-sharing reduction subsidies.\u003c/p>\n\u003cp>Policyholders who make between 200 and 400 percent of the federal poverty level (400 percent is about $98,400 for a family of four) should consider ditching silver plans and applying their higher tax credits to gold or platinum plans, he says. \u003ca href=\"https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/\">Tax credits\u003c/a> are pegged to the cost of silver plans, which means that all subsidized enrollees will benefit from higher tax credits as silver premiums rise, regardless of which plan they ultimately purchase.\u003c/p>\n\u003cp>\u003ca href=\"https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">Gold and platinum plans\u003c/a> are more expensive than silver plans, but they offer higher levels of coverage and lower out-of-pocket costs.\u003c/p>\n\u003cp>In some cases, “the gold may be cheaper than the silver,” Fann says.\u003c/p>\n\u003cp>You could also apply your increased tax credits to bronze plans, which have lower premiums and higher out-of-pocket costs. According to Covered California, three-quarters of enrollees can sign up for bronze coverage for less than $10 a month.\u003c/p>\n\u003cp>“I suspect a lot of people are going to downgrade their plans to high-deductible plans,” says \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, an insurance agent in Playa Vista.\u003c/p>\n\u003cp>Finally, there are about 65,000 Covered California enrollees with silver plans who don’t receive premium tax credits, says exchange spokeswoman Amy Palmer.\u003c/p>\n\u003cp>People in this group must pay the entire cost of their premiums.\u003c/p>\n\u003cp>“These are the ones in the middle class that are … getting hammered,” Ruffin says.\u003c/p>\n\u003cp>If you’re in this category, avoid the surcharge by buying a bronze, gold or platinum plan. Or, opt for a newly created silver plan sold off the exchange that won’t be subject to the surcharge — if you’re confident your income will remain above the threshold to qualify for premium tax credits.\u003c/p>\n\u003cp>“There may be better options off the exchange,” Palmer says. But if your income fluctuates, “it may be better to stay on the exchange so that you can receive tax credits if you become eligible,” she adds.\u003c/p>\n\u003cp>\u003cstrong>Health Plan Departures\u003c/strong>\u003c/p>\n\u003cp>Anthem will pull out of 16 of California’s 19 pricing regions, affecting about \u003ca href=\"https://californiahealthline.org/news/anthems-retreat-leaves-californians-with-fewer-choices-more-worries/\">300,000 policyholders\u003c/a> who purchase from the individual market, both on and off the exchange.\u003c/p>\n\u003cp>Its departure will leave about 60,000 Covered California consumers \u003ca href=\"https://californiahealthline.org/news/anthems-exit-leaves-thousands-with-no-choice-of-health-plans/\">with one option\u003c/a> — Blue Shield of California. If you do not select a new plan by mid-November, Covered California will \u003ca href=\"https://www.coveredca.com/members/renewal/\">automatically enroll you\u003c/a> in one. If you’re not satisfied with its decision, you can change it before the end of open enrollment, assuming you have a choice.\u003c/p>\n\u003cp>For those of you losing your insurer, you’ll want to know whether your existing providers are in any other Covered California plan networks.\u003c/p>\n\u003cp>Unfortunately, “the doctors networks are smaller and smaller all the time,” says \u003ca href=\"http://crazyhealthinsurance.com/\">Tom Freker\u003c/a>, an insurance broker in Fountain Valley.\u003c/p>\n\u003cp>Covered California this year has debuted a revamped online directory that will allow you to search five doctors, hospitals or pediatric dentists at once.\u003c/p>\n\u003cp>It’s part of the agency’s “\u003ca href=\"https://apply.coveredca.com/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage\">Shop and Compare\u003c/a>” tool that allows you to enter your personal details to retrieve your plan choices and costs.\u003c/p>\n\u003cp>Because the directory is new, I urge you to cross-check with your plan and/or your provider.\u003c/p>\n\u003cp>Also, if you’re in the middle of treatment for a complex medical condition and lose your insurer, you may have options. \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">A new state law\u003c/a> will allow some seriously ill patients to continue seeing their current providers for a limited time.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Your new insurer may also be able to work with your existing provider to finish your treatment. Covered California advises you to call your new health plan to explain your situation.\u003c/p>\n\n",
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"excerpt": "Choosing a health plan will be doubly hard this year, after Trump made big changes to the online insurance exchanges. But Covered California responded by adding extra consumer protections for shoppers. ",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/emily-bazar/\">\u003cstrong>Emily Bazar\u003c/strong>\u003c/a>\u003cbr>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If the comments on Covered California’s \u003ca href=\"https://www.facebook.com/CoveredCA/\">Facebook page\u003c/a> are any indication, you’re all suffering from acute health insurance confusion:\u003c/p>\n\u003cp>\u003cem>“I wanted to sign up again this year. … I’m hesitant now because of what Trump has done. Should I still consider?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Does the removal of subsidies mean we might lose our premium tax credits during the year?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“So you’re telling me that [Trump’s] executive order didn’t do anything? I am so confused.”\u003c/em>\u003c/p>\n\u003cp>I don’t blame you. Choosing a health plan will be doubly hard this year given \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump’s recent move\u003c/a> to cut off federal payments for a key consumer subsidy, his administration’s decision to shorten exchange open-enrollment periods in most states to 45 days, Congress’ failed attempts to repeal Obamacare and the departure of some insurers from certain markets.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Let me ease your mind straightaway on three critical points:\u003c/p>\n\u003cp>1. In California, open enrollment for individuals and families who buy their 2018 plans through Covered California and in the open market lasts three months, from Nov. 1 to Jan. 31.\u003c/p>\n\u003cp>2. You won’t lose the tax credits that help you — and the vast majority of Covered California enrollees — afford your premiums, assuming you still qualify.\u003c/p>\n\u003cp>3. The same goes for the cost-sharing subsidies that reduce out-of-pocket costs for some Covered California members, despite Trump’s decision to stop funding them.\u003c/p>\n\u003cp>But shopping will be challenging. Anthem Blue Cross is pulling out of a large swath of California’s individual market, on and off the exchange, forcing hundreds of thousands of consumers to find new plans. And in addition to regular, annual rate hikes — averaging 12.3 percent statewide — silver-level plans will bear an additional \u003ca href=\"https://californiahealthline.org/news/california-slaps-surcharge-on-aca-plans-as-trump-remains-coy-on-subsidies/\">12.4 percent average surcharge\u003c/a> to make up for the loss of federal funding for the cost-sharing subsidies.\u003c/p>\n\u003cp>Remember, those are averages. Your actual premium will depend on several factors, including where you live, your income, what level of coverage you choose and which insurer you pick.\u003c/p>\n\u003cp>In an unexpected twist, some people may actually benefit from the surcharge because it could bring plans with more robust coverage within financial reach.\u003c/p>\n\u003cp>Before we get into all that, my most important piece of advice remains the same this year as before:\u003c/p>\n\u003cp>Don’t do this alone. Help from certified insurance agents and enrollment “navigators” is free. You can find local options by clicking on the “Find Help” tab on Covered California’s website, \u003ca href=\"http://www.coveredca.com/\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Silver-Plan Surcharge\u003c/strong>\u003c/p>\n\u003cp>Nearly half of Covered California enrollees qualify for cost-sharing subsidies, which lower their copays, deductibles and coinsurance. The subsidies are paid directly to insurers, and are separate from the tax credits that reduce monthly premiums.\u003c/p>\n\u003cp>These discounts are available only to silver-plan enrollees whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four. That’s why Covered California added the 12.4 percent average surcharge only to silver plans amid Trump’s threats — \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">and ultimate decision\u003c/a> — to stop funding the subsidies.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/news/\">Covered California estimates\u003c/a> that 78 percent of subsidized consumers will pay the same as — or less than — this year, despite the surcharge, because their tax credits will rise with their premiums. About half of the remaining 22 percent will see increases of less than $25 per month.\u003c/p>\n\u003cp>“This is potentially good news for both insurers and consumers,” says \u003ca href=\"http://axenehp.com/consultants/greg-fann-fsa-fca-maaa/\">Greg Fann\u003c/a>, a senior consulting actuary based in Murrieta. “And bad news for taxpayers,” who are footing the bill for the increased tax credits.\u003c/p>\n\u003cp>Fann offers advice to consumers based on their income.\u003c/p>\n\u003cp>Covered California enrollees with incomes up to roughly 200 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\">federal poverty level\u003c/a> — or about $49,200 for a family of four — should probably remain in silver plans, he advises, because they qualify for significant cost-sharing reduction subsidies.\u003c/p>\n\u003cp>Policyholders who make between 200 and 400 percent of the federal poverty level (400 percent is about $98,400 for a family of four) should consider ditching silver plans and applying their higher tax credits to gold or platinum plans, he says. \u003ca href=\"https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/\">Tax credits\u003c/a> are pegged to the cost of silver plans, which means that all subsidized enrollees will benefit from higher tax credits as silver premiums rise, regardless of which plan they ultimately purchase.\u003c/p>\n\u003cp>\u003ca href=\"https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">Gold and platinum plans\u003c/a> are more expensive than silver plans, but they offer higher levels of coverage and lower out-of-pocket costs.\u003c/p>\n\u003cp>In some cases, “the gold may be cheaper than the silver,” Fann says.\u003c/p>\n\u003cp>You could also apply your increased tax credits to bronze plans, which have lower premiums and higher out-of-pocket costs. According to Covered California, three-quarters of enrollees can sign up for bronze coverage for less than $10 a month.\u003c/p>\n\u003cp>“I suspect a lot of people are going to downgrade their plans to high-deductible plans,” says \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, an insurance agent in Playa Vista.\u003c/p>\n\u003cp>Finally, there are about 65,000 Covered California enrollees with silver plans who don’t receive premium tax credits, says exchange spokeswoman Amy Palmer.\u003c/p>\n\u003cp>People in this group must pay the entire cost of their premiums.\u003c/p>\n\u003cp>“These are the ones in the middle class that are … getting hammered,” Ruffin says.\u003c/p>\n\u003cp>If you’re in this category, avoid the surcharge by buying a bronze, gold or platinum plan. Or, opt for a newly created silver plan sold off the exchange that won’t be subject to the surcharge — if you’re confident your income will remain above the threshold to qualify for premium tax credits.\u003c/p>\n\u003cp>“There may be better options off the exchange,” Palmer says. But if your income fluctuates, “it may be better to stay on the exchange so that you can receive tax credits if you become eligible,” she adds.\u003c/p>\n\u003cp>\u003cstrong>Health Plan Departures\u003c/strong>\u003c/p>\n\u003cp>Anthem will pull out of 16 of California’s 19 pricing regions, affecting about \u003ca href=\"https://californiahealthline.org/news/anthems-retreat-leaves-californians-with-fewer-choices-more-worries/\">300,000 policyholders\u003c/a> who purchase from the individual market, both on and off the exchange.\u003c/p>\n\u003cp>Its departure will leave about 60,000 Covered California consumers \u003ca href=\"https://californiahealthline.org/news/anthems-exit-leaves-thousands-with-no-choice-of-health-plans/\">with one option\u003c/a> — Blue Shield of California. If you do not select a new plan by mid-November, Covered California will \u003ca href=\"https://www.coveredca.com/members/renewal/\">automatically enroll you\u003c/a> in one. If you’re not satisfied with its decision, you can change it before the end of open enrollment, assuming you have a choice.\u003c/p>\n\u003cp>For those of you losing your insurer, you’ll want to know whether your existing providers are in any other Covered California plan networks.\u003c/p>\n\u003cp>Unfortunately, “the doctors networks are smaller and smaller all the time,” says \u003ca href=\"http://crazyhealthinsurance.com/\">Tom Freker\u003c/a>, an insurance broker in Fountain Valley.\u003c/p>\n\u003cp>Covered California this year has debuted a revamped online directory that will allow you to search five doctors, hospitals or pediatric dentists at once.\u003c/p>\n\u003cp>It’s part of the agency’s “\u003ca href=\"https://apply.coveredca.com/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage\">Shop and Compare\u003c/a>” tool that allows you to enter your personal details to retrieve your plan choices and costs.\u003c/p>\n\u003cp>Because the directory is new, I urge you to cross-check with your plan and/or your provider.\u003c/p>\n\u003cp>Also, if you’re in the middle of treatment for a complex medical condition and lose your insurer, you may have options. \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">A new state law\u003c/a> will allow some seriously ill patients to continue seeing their current providers for a limited time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Your new insurer may also be able to work with your existing provider to finish your treatment. Covered California advises you to call your new health plan to explain your situation.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Gov. Brown Signs Into Law Key Health Bills, But Nixes Others",
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"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning.\u003c/p>\n\u003cp>Brown had until Sunday, Oct. 15, to approve or reject \u003ca href=\"https://californiahealthline.org/news/state-lawmakers-tackle-public-smoking-and-lead-poisoning-but-punt-on-single-payer/\">measures passed by the legislature \u003c/a>this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves.\u003c/p>\n\u003cp>One law will ensure that consumers have \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three months to shop\u003c/a> for health plans in future years, rebuffing a move by the Trump administration that cuts that time in half. Another law will help people \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">keep their health care providers \u003c/a>if insurers cancel their policy.\u003c/p>\n\u003cp>Health consumer advocates said Brown’s signatures on those and other bills will help maintain California’s role as a leader in protecting health care coverage in the face of federal threats. Last week, for instance, \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump ended\u003c/a> an important Obamacare health insurance subsidy for consumers — a move that could destabilize insurance markets across the country.\u003c/p>\n\u003cp>Californians will stay “ahead of the curve, and ahead of the federal threats” because of lawmakers’ actions this year, said Betsy Imholz, director of special projects at Consumers Union in San Francisco.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The governor’s health care actions and rhetoric have been particularly impassioned lately, especially in response to federal moves on health care policy, Imholz said.\u003c/p>\n\u003cp>“There’s a lot to be fiery about these days, and he’s using his bully pulpit well,” she said.\u003c/p>\n\u003cp>But Brown didn’t sign off on everything the legislature sent to his desk. He used his veto pen to kill some health care legislation, including a proposed statewide \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">ban on smoking\u003c/a> at state beaches and parks.\u003c/p>\n\u003cp>\u003cstrong>SIGNED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Open Enrollment\u003c/strong>🖋\u003c/p>\n\u003cp>By codifying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180AB156\">AB 156,\u003c/a> by Assemblyman Jim Wood (D-Healdsburg), Brown agreed that Californians who buy insurance for themselves should continue to have a \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three-month open enrollment period\u003c/a>, during which they can choose or switch health plans. The law exempts the Golden State from a Trump administration rule that shortens the sign-up period to 45 days, and applies to people who purchase individual market plans for 2019 and beyond. Californians already are assured a three-month open-enrollment period — Nov. 1 to Jan. 31 — for 2018 coverage.\u003c/p>\n\u003cp>\u003cstrong>Keeping Your Doctors\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed off on \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">a measure\u003c/a> to allow some seriously ill patients to continue seeing their current providers for a limited time if their insurer discontinues their plan. The bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB133\">SB 133\u003c/a>, was introduced by Sen. Ed Hernandez (D-West Covina) in response to the impending departures of Anthem Blue Cross and Cigna from portions of California’s individual insurance market next year. The law will continue an eligible patient’s coverage even if her doctors don’t contract with the new health plan, so long as the doctors are willing to accept the plan’s reimbursement rates.\u003c/p>\n\u003cp>\u003cstrong>Prescription Drug Costs\u003c/strong>🖋\u003c/p>\n\u003cp>The governor signed a \u003ca href=\"https://californiahealthline.org/news/california-drug-price-bill-sweeping-in-scope-lacking-in-muscle/\">hotly contested bill\u003c/a> by Hernandez that will require drugmakers to report and explain big price hikes. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB17\">SB 17\u003c/a> directs pharmaceutical companies to notify state agencies and insurers 60 days in advance if they plan to raise prices more than 16 percent over two years on drugs with a wholesale cost of at least $40.\u003c/p>\n\u003cp>The governor also approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB265\">AB 265\u003c/a> by Wood, which will ban pharmaceutical companies from giving consumers coupons for brand-name drugs when a generic equivalent is available, with some exceptions.\u003c/p>\n\u003cp>\u003cstrong>Childhood Lead Poisoning\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1316\">AB 1316\u003c/a> by Assemblyman Bill Quirk (D-Hayward), which calls for all California kids to be evaluated by their doctor for lead poisoning, starting next year. Currently, children who receive government assistance such as Medi-Cal must be screened for lead, but that requirement doesn’t extend to other children. Doctors will also have to consider new factors when evaluating children, such as proximity to potential sources of lead contamination. A report published last month by the Environmental Working Group showed that \u003ca href=\"http://www.ewg.org/research/one-third-california-s-high-risk-kids-not-tested-lead-poisoning#.Wd6u82hSyUk\">one-third of infants\u003c/a> who were at risk for lead poisoning had not been tested. “The current screening process is outdated and leaves many children vulnerable to lead poisoning,” Quirk said in a statement.\u003c/p>\n\u003cp>\u003cstrong>Unapproved Stem Cell Treatments\u003c/strong>🖋\u003c/p>\n\u003cp>Brown approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB512\">a bill\u003c/a> that requires doctors to warn their patients before they undergo \u003ca href=\"https://ipscell.com/2017/10/groundbreaking-california-stem-cell-law-gives-consumer-protections-on-clinics/\">unapproved stem cell therapies\u003c/a>. SB 512, also by Hernandez, says health care providers who offer such treatments must disclose to patients that the treatments have not been approved by the Food and Drug Administration, and urge them “to consult with your primary care physician prior to undergoing a stem cell therapy.” Health care providers may face fines for noncompliance.\u003c/p>\n\u003cp>\u003cstrong>VETOED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Valley Fever\u003c/strong>🚫\u003c/p>\n\u003cp>Brown nixed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180AB1279\">AB 1279\u003c/a>, which would have required the state Department of Public Health to develop additional outreach programs to educate people about Valley Fever, an infection caused by inhaling fungal spores often found in soil. The measure, by Assemblyman Rudy Salas (D-Bakersfield), had been watered down from its original form by the time it hit the governor’s desk. The original language called for a $2 million investment in research on the disease, which is common in dry regions, like Salas’ district. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said the department already provides fact sheets, brochures and other materials to educate the public about Valley Fever.\u003c/p>\n\u003cp>\u003cstrong>Smoking At State Parks\u003c/strong>🚫\u003c/p>\n\u003cp>Once again, Brown \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">vetoed legislation\u003c/a> that would have banned smoking at state beaches and parks. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\">AB 725\u003c/a>, by Assemblyman Marc Levine (D-San Rafael), would have established smoking areas at some parks and beaches. People caught smoking outside those designated spaces would have faced a $50 fine. A stricter bill by Sen. Steve Glazer (D-Orinda), \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\">SB 386\u003c/a>, proposed a fine of up to $100. Lawmakers had previously sent similar legislation to Brown, but so far they have not won him over. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said a ban would be an overreach of government power. “If people can’t smoke even on a deserted beach, where can they?” he asked.\u003c/p>\n\u003cp>\u003cstrong>Reproductive Bias\u003c/strong>🚫\u003c/p>\n\u003cp>A bill that would have prohibited institutions with religious affiliations from firing employees because of their reproductive choices, such as having abortions, failed to make it past the governor’s desk. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB569\">AB 569\u003c/a>, by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), would have barred religion-based employers such as a Christian school, from requiring workers to sign a code of conduct that waived their reproductive health rights. \u003ca href=\"https://www.gov.ca.gov/docs/AB_569_Veto_Message_2017.pdf\">In his veto message\u003c/a>, Brown said that “these types of claims should remain within the jurisdiction of the Department of Fair Employment and Housing.”\u003c/p>\n\u003cp>\u003cstrong>SEE YOU NEXT YEAR?\u003c/strong>\u003c/p>\n\u003cp>(Some significant health bills that stalled in the legislature, but may be resurrected for another attempt in 2018)\u003c/p>\n\u003cp>\u003cstrong>Regulating Dialysis Clinics\u003c/strong>🤔\u003c/p>\n\u003cp>A proposal by Sen. Ricardo Lara (D-Bell Gardens) would have required minimum staff-to-patient ratios at dialysis centers, such as one nurse for every eight patients or one technician for every three. The stalled bill, SB 349, also would have mandated more time for staff to prepare between patient appointments. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB251\">bill\u003c/a> by Assemblyman Rob Bonta (D-Oakland) would have required dialysis centers to spend at least 85 percent of their revenue primarily on direct patient care.\u003c/p>\n\u003cp>Both measures were backed by a large labor union, Service Employees International Union-United Healthcare Workers West (\u003ca href=\"http://www.seiu-uhw.org/\">SEIU-UHW\u003c/a>), which has threatened to take the issue directly to voters if the Legislature does not act.\u003c/p>\n\u003cp>\u003cstrong>Single-Payer Health Care\u003c/strong>🤔\u003c/p>\n\u003cp>The ambitious attempt to create one government-administered or “single-payer” health care system in California has been tabled until next year. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">SB 562\u003c/a> by Lara and Assemblywoman Toni Atkins (D-San Diego) would provide comprehensive health coverage to all Californians, regardless of immigration status. Private insurance companies would be barred from the system, and enrollees would not be charged copayments or premiums. A legislative committee estimated that the program would require $200 billion annually in additional tax revenue.\u003c/p>\n\u003cp>Supporters of universal health care hope to \u003ca href=\"https://oag.ca.gov/system/files/initiatives/pdfs/17-0019%20%28Healthcare%20Roadblock%20Removal%29.pdf\">put a measure\u003c/a> on the statewide ballot that would make it easier to fund a single-payer system.\u003c/p>\n\u003cp>\u003cstrong>Pediatric Dental Anesthesia \u003c/strong>🤔\u003c/p>\n\u003cp>A bill that would have required oral surgeons to have a specially trained staff member with them to monitor a child under anesthesia stalled in committee. Current law allows an oral surgeon to perform surgery and monitor the unconscious child at the same time. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB224\">AB 224\u003c/a>, by Assemblyman Tony Thurmond (D-Richmond), would have built on last year’s “\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB2235\">Caleb’s Law\u003c/a>,” named after Caleb Sears, a 6-year-old boy who died in 2015 after oral surgery under anesthesia.\u003c/p>\n\u003cp>\u003cstrong>Containing Drug Costs\u003c/strong>🤔\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/negotiating-drug-prices-should-state-agencies-band-together/\">A measure\u003c/a> by Assemblyman David Chiu (D-San Francisco) would have brought together administrators from 17 state agencies to devise ways to reduce state drug costs. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB587\">AB 587\u003c/a> would have expanded an existing state purchasing collaborative that buys drugs for a handful of public health programs, and directed the new group to develop cost controls, such as creating a uniform drug formulary for state agencies.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB790\">SB 790\u003c/a> by Sen. Mike McGuire (D-North Coast/North Bay) sought to \u003ca href=\"https://californiahealthline.org/news/bill-aims-to-loosen-drugmaker-doctor-ties-by-limiting-perks-for-promoting-meds/\">restrict the pharmaceutical industry’s\u003c/a> marketing to doctors, limiting their spending to mostly educational or scientific purposes, which McGuire said could reduce unnecessary prescriptions of pricey drugs.\u003c/p>\n\n",
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"excerpt": "Gov. Jerry Brown signed many critical health care bills sent to him by the state Legislature, cementing California’s role as a health care champion.",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/pauline-bartolone/\">\u003cstrong>Pauline Bartolone\u003c/strong>\u003c/a> and \u003ca href=\"https://californiahealthline.org/news/author/ana-b-ibarra/\">\u003cstrong>Ana B. Ibarra\u003c/strong>\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning.\u003c/p>\n\u003cp>Brown had until Sunday, Oct. 15, to approve or reject \u003ca href=\"https://californiahealthline.org/news/state-lawmakers-tackle-public-smoking-and-lead-poisoning-but-punt-on-single-payer/\">measures passed by the legislature \u003c/a>this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves.\u003c/p>\n\u003cp>One law will ensure that consumers have \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three months to shop\u003c/a> for health plans in future years, rebuffing a move by the Trump administration that cuts that time in half. Another law will help people \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">keep their health care providers \u003c/a>if insurers cancel their policy.\u003c/p>\n\u003cp>Health consumer advocates said Brown’s signatures on those and other bills will help maintain California’s role as a leader in protecting health care coverage in the face of federal threats. Last week, for instance, \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump ended\u003c/a> an important Obamacare health insurance subsidy for consumers — a move that could destabilize insurance markets across the country.\u003c/p>\n\u003cp>Californians will stay “ahead of the curve, and ahead of the federal threats” because of lawmakers’ actions this year, said Betsy Imholz, director of special projects at Consumers Union in San Francisco.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The governor’s health care actions and rhetoric have been particularly impassioned lately, especially in response to federal moves on health care policy, Imholz said.\u003c/p>\n\u003cp>“There’s a lot to be fiery about these days, and he’s using his bully pulpit well,” she said.\u003c/p>\n\u003cp>But Brown didn’t sign off on everything the legislature sent to his desk. He used his veto pen to kill some health care legislation, including a proposed statewide \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">ban on smoking\u003c/a> at state beaches and parks.\u003c/p>\n\u003cp>\u003cstrong>SIGNED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Open Enrollment\u003c/strong>🖋\u003c/p>\n\u003cp>By codifying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180AB156\">AB 156,\u003c/a> by Assemblyman Jim Wood (D-Healdsburg), Brown agreed that Californians who buy insurance for themselves should continue to have a \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three-month open enrollment period\u003c/a>, during which they can choose or switch health plans. The law exempts the Golden State from a Trump administration rule that shortens the sign-up period to 45 days, and applies to people who purchase individual market plans for 2019 and beyond. Californians already are assured a three-month open-enrollment period — Nov. 1 to Jan. 31 — for 2018 coverage.\u003c/p>\n\u003cp>\u003cstrong>Keeping Your Doctors\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed off on \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">a measure\u003c/a> to allow some seriously ill patients to continue seeing their current providers for a limited time if their insurer discontinues their plan. The bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB133\">SB 133\u003c/a>, was introduced by Sen. Ed Hernandez (D-West Covina) in response to the impending departures of Anthem Blue Cross and Cigna from portions of California’s individual insurance market next year. The law will continue an eligible patient’s coverage even if her doctors don’t contract with the new health plan, so long as the doctors are willing to accept the plan’s reimbursement rates.\u003c/p>\n\u003cp>\u003cstrong>Prescription Drug Costs\u003c/strong>🖋\u003c/p>\n\u003cp>The governor signed a \u003ca href=\"https://californiahealthline.org/news/california-drug-price-bill-sweeping-in-scope-lacking-in-muscle/\">hotly contested bill\u003c/a> by Hernandez that will require drugmakers to report and explain big price hikes. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB17\">SB 17\u003c/a> directs pharmaceutical companies to notify state agencies and insurers 60 days in advance if they plan to raise prices more than 16 percent over two years on drugs with a wholesale cost of at least $40.\u003c/p>\n\u003cp>The governor also approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB265\">AB 265\u003c/a> by Wood, which will ban pharmaceutical companies from giving consumers coupons for brand-name drugs when a generic equivalent is available, with some exceptions.\u003c/p>\n\u003cp>\u003cstrong>Childhood Lead Poisoning\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1316\">AB 1316\u003c/a> by Assemblyman Bill Quirk (D-Hayward), which calls for all California kids to be evaluated by their doctor for lead poisoning, starting next year. Currently, children who receive government assistance such as Medi-Cal must be screened for lead, but that requirement doesn’t extend to other children. Doctors will also have to consider new factors when evaluating children, such as proximity to potential sources of lead contamination. A report published last month by the Environmental Working Group showed that \u003ca href=\"http://www.ewg.org/research/one-third-california-s-high-risk-kids-not-tested-lead-poisoning#.Wd6u82hSyUk\">one-third of infants\u003c/a> who were at risk for lead poisoning had not been tested. “The current screening process is outdated and leaves many children vulnerable to lead poisoning,” Quirk said in a statement.\u003c/p>\n\u003cp>\u003cstrong>Unapproved Stem Cell Treatments\u003c/strong>🖋\u003c/p>\n\u003cp>Brown approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB512\">a bill\u003c/a> that requires doctors to warn their patients before they undergo \u003ca href=\"https://ipscell.com/2017/10/groundbreaking-california-stem-cell-law-gives-consumer-protections-on-clinics/\">unapproved stem cell therapies\u003c/a>. SB 512, also by Hernandez, says health care providers who offer such treatments must disclose to patients that the treatments have not been approved by the Food and Drug Administration, and urge them “to consult with your primary care physician prior to undergoing a stem cell therapy.” Health care providers may face fines for noncompliance.\u003c/p>\n\u003cp>\u003cstrong>VETOED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Valley Fever\u003c/strong>🚫\u003c/p>\n\u003cp>Brown nixed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180AB1279\">AB 1279\u003c/a>, which would have required the state Department of Public Health to develop additional outreach programs to educate people about Valley Fever, an infection caused by inhaling fungal spores often found in soil. The measure, by Assemblyman Rudy Salas (D-Bakersfield), had been watered down from its original form by the time it hit the governor’s desk. The original language called for a $2 million investment in research on the disease, which is common in dry regions, like Salas’ district. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said the department already provides fact sheets, brochures and other materials to educate the public about Valley Fever.\u003c/p>\n\u003cp>\u003cstrong>Smoking At State Parks\u003c/strong>🚫\u003c/p>\n\u003cp>Once again, Brown \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">vetoed legislation\u003c/a> that would have banned smoking at state beaches and parks. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\">AB 725\u003c/a>, by Assemblyman Marc Levine (D-San Rafael), would have established smoking areas at some parks and beaches. People caught smoking outside those designated spaces would have faced a $50 fine. A stricter bill by Sen. Steve Glazer (D-Orinda), \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\">SB 386\u003c/a>, proposed a fine of up to $100. Lawmakers had previously sent similar legislation to Brown, but so far they have not won him over. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said a ban would be an overreach of government power. “If people can’t smoke even on a deserted beach, where can they?” he asked.\u003c/p>\n\u003cp>\u003cstrong>Reproductive Bias\u003c/strong>🚫\u003c/p>\n\u003cp>A bill that would have prohibited institutions with religious affiliations from firing employees because of their reproductive choices, such as having abortions, failed to make it past the governor’s desk. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB569\">AB 569\u003c/a>, by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), would have barred religion-based employers such as a Christian school, from requiring workers to sign a code of conduct that waived their reproductive health rights. \u003ca href=\"https://www.gov.ca.gov/docs/AB_569_Veto_Message_2017.pdf\">In his veto message\u003c/a>, Brown said that “these types of claims should remain within the jurisdiction of the Department of Fair Employment and Housing.”\u003c/p>\n\u003cp>\u003cstrong>SEE YOU NEXT YEAR?\u003c/strong>\u003c/p>\n\u003cp>(Some significant health bills that stalled in the legislature, but may be resurrected for another attempt in 2018)\u003c/p>\n\u003cp>\u003cstrong>Regulating Dialysis Clinics\u003c/strong>🤔\u003c/p>\n\u003cp>A proposal by Sen. Ricardo Lara (D-Bell Gardens) would have required minimum staff-to-patient ratios at dialysis centers, such as one nurse for every eight patients or one technician for every three. The stalled bill, SB 349, also would have mandated more time for staff to prepare between patient appointments. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB251\">bill\u003c/a> by Assemblyman Rob Bonta (D-Oakland) would have required dialysis centers to spend at least 85 percent of their revenue primarily on direct patient care.\u003c/p>\n\u003cp>Both measures were backed by a large labor union, Service Employees International Union-United Healthcare Workers West (\u003ca href=\"http://www.seiu-uhw.org/\">SEIU-UHW\u003c/a>), which has threatened to take the issue directly to voters if the Legislature does not act.\u003c/p>\n\u003cp>\u003cstrong>Single-Payer Health Care\u003c/strong>🤔\u003c/p>\n\u003cp>The ambitious attempt to create one government-administered or “single-payer” health care system in California has been tabled until next year. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">SB 562\u003c/a> by Lara and Assemblywoman Toni Atkins (D-San Diego) would provide comprehensive health coverage to all Californians, regardless of immigration status. Private insurance companies would be barred from the system, and enrollees would not be charged copayments or premiums. A legislative committee estimated that the program would require $200 billion annually in additional tax revenue.\u003c/p>\n\u003cp>Supporters of universal health care hope to \u003ca href=\"https://oag.ca.gov/system/files/initiatives/pdfs/17-0019%20%28Healthcare%20Roadblock%20Removal%29.pdf\">put a measure\u003c/a> on the statewide ballot that would make it easier to fund a single-payer system.\u003c/p>\n\u003cp>\u003cstrong>Pediatric Dental Anesthesia \u003c/strong>🤔\u003c/p>\n\u003cp>A bill that would have required oral surgeons to have a specially trained staff member with them to monitor a child under anesthesia stalled in committee. Current law allows an oral surgeon to perform surgery and monitor the unconscious child at the same time. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB224\">AB 224\u003c/a>, by Assemblyman Tony Thurmond (D-Richmond), would have built on last year’s “\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB2235\">Caleb’s Law\u003c/a>,” named after Caleb Sears, a 6-year-old boy who died in 2015 after oral surgery under anesthesia.\u003c/p>\n\u003cp>\u003cstrong>Containing Drug Costs\u003c/strong>🤔\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/negotiating-drug-prices-should-state-agencies-band-together/\">A measure\u003c/a> by Assemblyman David Chiu (D-San Francisco) would have brought together administrators from 17 state agencies to devise ways to reduce state drug costs. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB587\">AB 587\u003c/a> would have expanded an existing state purchasing collaborative that buys drugs for a handful of public health programs, and directed the new group to develop cost controls, such as creating a uniform drug formulary for state agencies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB790\">SB 790\u003c/a> by Sen. Mike McGuire (D-North Coast/North Bay) sought to \u003ca href=\"https://californiahealthline.org/news/bill-aims-to-loosen-drugmaker-doctor-ties-by-limiting-perks-for-promoting-meds/\">restrict the pharmaceutical industry’s\u003c/a> marketing to doctors, limiting their spending to mostly educational or scientific purposes, which McGuire said could reduce unnecessary prescriptions of pricey drugs.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Will California Kick Butts Off State Beaches? Not This Year",
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"content": "\u003cp class=\"p1\">For years, state lawmakers have been trying to eliminate second-hand smoke and cigarette butts from California’s 280 illustrious beaches and natural parks.\u003c/p>\n\u003cp class=\"p1\">Once again, they have come up short.\u003c/p>\n\u003cp class=\"p1\">Late Friday, Gov. Jerry Brown vetoed two bills that would have banned or drastically curtailed smoking and vaping in parks and beaches run by the state.\u003c/p>\n\u003cp class=\"p1\">“If people can’t even smoke on a deserted beach, where can they?” Brown pondered in his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">veto \u003c/span>\u003c/a>\u003cspan class=\"s1\">message\u003c/span>. “There must be some limit to the coercive power of government.”\u003c/p>\n\u003cp class=\"p1\">Lawmakers who supported the legislation said banning smoking at state parks would protect people from health hazards associated with second-hand smoke and prevent the risks that cigarette butts pose to marine life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cimg class=\"alignnone size-medium wp-image-361399\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s2\">The author of one of the bills, \u003c/span>Assemblyman Marc Levine (D-San Rafael), said \u003cspan class=\"s2\">he was \u003c/span>disappointed by Brown’s decision. Trying to protect people and wildlife from “poisonous” cigarette butts is hardly coercive, he said in an emailed statement.\u003c/p>\n\u003cp class=\"p1\">“The common person knows these dangers too well, and flippantly dismissing them isn't cool. Even for a governor who is featured in Rolling Stone magazine,” Levine said, referring to an \u003cspan class=\"s1\">\u003ca href=\"http://www.rollingstone.com/politics/features/jerry-browns-california-dream-the-rolling-stone-interview-w507082\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with Brown \u003c/span>that ran last week in the popular culture biweekly.\u003c/p>\n\u003cp class=\"p2\">Levine’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">bill \u003c/span>\u003c/a>would have established designated smoking areas at some parks and beaches and imposed a fine of $50 on anyone caught lighting up outside of them.\u003c/p>\n\u003cp class=\"p2\">Another\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\" target=\"_blank\" rel=\"noopener\"> bill\u003c/a>, by Senator Steve Glazer (D-Orinda), would have banned smoking altogether on state beaches, and established designated smoking zones at state parks. The fine for any violation would have been $100.\u003c/p>\n\u003cp class=\"p2\">Brown and former Gov. Arnold Schwarzenegger both have vetoed similar measures in the past.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s3\">Last year, Brown \u003c/span>said a smoking ban passed by the Legislature in 2016 was \u003cspan class=\"s1\">too “broad” and “punitive\u003c/span>.”\u003c/p>\n\u003cp class=\"p1\">Beachgoers in southern California, speaking to a reporter before Brown issued Friday’s vetoes, gave mixed reviews to the idea.\u003c/p>\n\u003cp class=\"p1\">“I’m all for banning smoking on the beach. I think it's repulsive,” said MaryAnn Morton, a resident of Orange County’s Huntington Beach who regularly visits the shoreline, including a stretch of state-owned beach where smoking is permitted.\u003c/p>\n\u003cp class=\"p1\">Smoking is already prohibited on the city-controlled portion of the beach, as well as many other locally-managed beaches in California.\u003c/p>\n\u003cp class=\"p1\">Others at Huntington Beach said they didn’t think they would be harmed by second-hand smoke there.\u003c/p>\n\u003cp>\"I don't see how you can get second hand smoke from such a big public place,\" said Letty Herrera. \"I mean look at our neighbors, how they're not that close to us. If I was out here smoking a joint, I don't think they'd smell it.\"\u003c/p>\n\u003cfigure id=\"attachment_361396\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361396\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/IMG_7926-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Letty Herrera, right, enjoys the fresh air at Huntington State Beach with her friends George and Jennifer Cortez. An adjoining beach controlled by the city prohibits smoking. \u003ccite>(Pauline Bartolone/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">“Sometimes they ban things without a sole reason,\" said Jesse Miller, 24, who was drinking with friends on the city-managed stretch of beach. \"It feels more for votes.”\u003c/p>\n\u003cp class=\"p1\">Miller admitted he and his friends had just smoked on the city beach, where it is prohibited.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He said the government should focus instead on more significant contributors to poor air quality, such as a nearby industrial plant, and the offshore oil rigs that are visible from Huntington Beach.\u003c/span>\u003c/p>\n\u003cp>\"There's pollution being created,\" Miller said.\u003c/p>\n\u003cp class=\"p1\">Glen Stainer, a cigar-smoking tourist from Pennsylvania, said he could get on board with a smoking ban that allowed for designated areas. But in general, people should not smoke when others are nearby, he said.\u003c/p>\n\u003cp class=\"p1\">Stainer said can understand both sides of the issue: “It’s not fair to have smoke being blown on little children that aren’t asking for that. And yet, a beach should be a public place where I can do what I want.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Gov. Jerry Brown last week vetoed two bills that would have limited or completely banned smoking at state parks and beaches.",
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"nprByline": "\u003cstrong>\u003ca href=\"https://khn.org/news/author/pauline-bartolone/\" rel=\"noopener\" target=\"_blank\">Pauline Bartolone\u003c/a>\u003c/strong>, California Healthline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">For years, state lawmakers have been trying to eliminate second-hand smoke and cigarette butts from California’s 280 illustrious beaches and natural parks.\u003c/p>\n\u003cp class=\"p1\">Once again, they have come up short.\u003c/p>\n\u003cp class=\"p1\">Late Friday, Gov. Jerry Brown vetoed two bills that would have banned or drastically curtailed smoking and vaping in parks and beaches run by the state.\u003c/p>\n\u003cp class=\"p1\">“If people can’t even smoke on a deserted beach, where can they?” Brown pondered in his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">veto \u003c/span>\u003c/a>\u003cspan class=\"s1\">message\u003c/span>. “There must be some limit to the coercive power of government.”\u003c/p>\n\u003cp class=\"p1\">Lawmakers who supported the legislation said banning smoking at state parks would protect people from health hazards associated with second-hand smoke and prevent the risks that cigarette butts pose to marine life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cimg class=\"alignnone size-medium wp-image-361399\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s2\">The author of one of the bills, \u003c/span>Assemblyman Marc Levine (D-San Rafael), said \u003cspan class=\"s2\">he was \u003c/span>disappointed by Brown’s decision. Trying to protect people and wildlife from “poisonous” cigarette butts is hardly coercive, he said in an emailed statement.\u003c/p>\n\u003cp class=\"p1\">“The common person knows these dangers too well, and flippantly dismissing them isn't cool. Even for a governor who is featured in Rolling Stone magazine,” Levine said, referring to an \u003cspan class=\"s1\">\u003ca href=\"http://www.rollingstone.com/politics/features/jerry-browns-california-dream-the-rolling-stone-interview-w507082\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with Brown \u003c/span>that ran last week in the popular culture biweekly.\u003c/p>\n\u003cp class=\"p2\">Levine’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">bill \u003c/span>\u003c/a>would have established designated smoking areas at some parks and beaches and imposed a fine of $50 on anyone caught lighting up outside of them.\u003c/p>\n\u003cp class=\"p2\">Another\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\" target=\"_blank\" rel=\"noopener\"> bill\u003c/a>, by Senator Steve Glazer (D-Orinda), would have banned smoking altogether on state beaches, and established designated smoking zones at state parks. The fine for any violation would have been $100.\u003c/p>\n\u003cp class=\"p2\">Brown and former Gov. Arnold Schwarzenegger both have vetoed similar measures in the past.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s3\">Last year, Brown \u003c/span>said a smoking ban passed by the Legislature in 2016 was \u003cspan class=\"s1\">too “broad” and “punitive\u003c/span>.”\u003c/p>\n\u003cp class=\"p1\">Beachgoers in southern California, speaking to a reporter before Brown issued Friday’s vetoes, gave mixed reviews to the idea.\u003c/p>\n\u003cp class=\"p1\">“I’m all for banning smoking on the beach. I think it's repulsive,” said MaryAnn Morton, a resident of Orange County’s Huntington Beach who regularly visits the shoreline, including a stretch of state-owned beach where smoking is permitted.\u003c/p>\n\u003cp class=\"p1\">Smoking is already prohibited on the city-controlled portion of the beach, as well as many other locally-managed beaches in California.\u003c/p>\n\u003cp class=\"p1\">Others at Huntington Beach said they didn’t think they would be harmed by second-hand smoke there.\u003c/p>\n\u003cp>\"I don't see how you can get second hand smoke from such a big public place,\" said Letty Herrera. \"I mean look at our neighbors, how they're not that close to us. If I was out here smoking a joint, I don't think they'd smell it.\"\u003c/p>\n\u003cfigure id=\"attachment_361396\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361396\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/IMG_7926-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Letty Herrera, right, enjoys the fresh air at Huntington State Beach with her friends George and Jennifer Cortez. An adjoining beach controlled by the city prohibits smoking. \u003ccite>(Pauline Bartolone/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">“Sometimes they ban things without a sole reason,\" said Jesse Miller, 24, who was drinking with friends on the city-managed stretch of beach. \"It feels more for votes.”\u003c/p>\n\u003cp class=\"p1\">Miller admitted he and his friends had just smoked on the city beach, where it is prohibited.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He said the government should focus instead on more significant contributors to poor air quality, such as a nearby industrial plant, and the offshore oil rigs that are visible from Huntington Beach.\u003c/span>\u003c/p>\n\u003cp>\"There's pollution being created,\" Miller said.\u003c/p>\n\u003cp class=\"p1\">Glen Stainer, a cigar-smoking tourist from Pennsylvania, said he could get on board with a smoking ban that allowed for designated areas. But in general, people should not smoke when others are nearby, he said.\u003c/p>\n\u003cp class=\"p1\">Stainer said can understand both sides of the issue: “It’s not fair to have smoke being blown on little children that aren’t asking for that. And yet, a beach should be a public place where I can do what I want.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>One community health center in New York has frozen hiring. Another in Missouri can’t get a bank loan to expand.\u003c/p>\n\u003cp>The nation’s 1,400 community health centers are carefully watching expenses in case the financial rescue they hope Congress delivers this week doesn’t arrive. With four days left in the government’s fiscal year, Congress has not voted on reauthorizing billions of dollars now going to community health centers and other health programs for the 2018 budget year that starts Sunday.\u003c/p>\n\u003cp>“The anxiety level is increasing on almost a daily basis,” said Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) in Washington, D.C. “There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”\u003c/p>\n\u003cp>For the past two weeks, the GOP’s scramble to repeal the Affordable Care Act before the month ends pushed other health care matters off the congressional agenda. That effort ended Tuesday when Senate Republicans said they would not seek a vote this week because they lacked enough support to pass the bill.\u003c/p>\n\u003cp>It’s not clear if lawmakers’ lighter agenda will now leave room for funding health centers or deciding other issues, such as renewing the Children’s Health Insurance Program (CHIP), which also expires Saturday. At a hearing Monday, Senate Finance Committee Chairman Orrin Hatch (R-Utah) urged his colleagues to work with the Senate’s health committee to settle the matter. NACHC officials privately express optimism that a deal might come later in October if not by Sunday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Community health centers operate in more than 9,500 locations, serving 27 million people, according to the NACHC. They are the main source of health care for many low-income Americans — and the only source of primary care in many underserved areas.\u003c/p>\n\u003cp>Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay. A sliding fee scale based on income and family size is available to patients without insurance.\u003c/p>\n\u003cp>In 2015, nearly 1 in 6 Medicaid beneficiaries received health center services, the Kaiser Family Foundation \u003ca href=\"http://www.kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/\">reported\u003c/a> this year. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“The end result is these are people who will be locked out of health care” without new funding, Hawkins said.\u003c/p>\n\u003cp>Community health centers gained billions of dollars in federal revenue under the ACA, which created a special trust fund to support them from 2011 through 2015. The Community Health Center Fund was extended in 2015 for two years with an additional $3.6 billion annually.\u003c/p>\n\u003cp>That money represents 70 percent of all federal grants to health centers and about a fifth of their annual revenue. Medicaid reimbursements account for the largest share, about 40 percent.\u003c/p>\n\u003cp>One beneficiary is Pamela Richardson, a 60-year-old patient of Valley Community Healthcare in North Hollywood, California, who suffers from an iron absorption disorder called hereditary hemochromatosis. She was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she received long-delayed primary care, which revealed she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have Pap smears,” she \u003ca href=\"http://khn.org/news/californias-community-clinics-big-aca-beneficiaries-worry-about-their-future/\">told\u003c/a> a KHN reporter earlier this year. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cp>California has by far the most federally funded health centers and they serve 6.2 million Californians, according to CaliforniaHealth+ Advocates, which represents state clinics. They have received over $1.6 billion from 2011 through 2016 from the Community Health Center Fund, more than any other state, the Congressional Research Service \u003ca href=\"https://www.everycrsreport.com/files/20170113_R43911_852eca9ca6e96b41176e6609d8cb068ba7e770ed.pdf\">reported\u003c/a> in January.\u003c/p>\n\u003cp>If health centers receive no new funds for 2018, the ensuing financial crunch would cost 51,000 jobs, force the centers to close 2,800 locations and cause 9 million people to lose health care services, according to a budget document that the Health and Human Services Department gave Congress in July.\u003c/p>\n\u003cp>Uncertainty about what Congress will do now is already causing problems. Hawkins said his members call him and his staff every day, fretting about employment contracts, lease agreements and equipment rentals that run past Oct. 1.\u003c/p>\n\u003cp>Neighborhood Health in Nashville, Tennessee, has federal grant money that will carry it through Jan. 31, but CEO Mary Bufwack said some of her 180 staff members live paycheck to paycheck and are getting nervous about Neighborhood’s stability.\u003c/p>\n\u003cp>Bufwack is worried the health center won’t receive money it needs to replace a clinic, a project now being planned.\u003c/p>\n\u003cp>She fears that a new doctor she recruited to join Neighborhood next June will take another job before she can get his signature on an employment contract. And she doesn’t want to do that until she’s sure about her budget.\u003c/p>\n\u003cp>Mostly, she worries that whatever Congress gives her will be only for one year.\u003c/p>\n\u003cp>“We’re already worried about next Sept. 30,” Bufwack said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"excerpt": "The clinics, which serve many poor people, are tightening spending in case Congress doesn’t approve new funding for them before the government’s 2018 fiscal year starts Sunday. California has the most at stake.",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/rachel-bluth/\" rel=\"noopener\" target=\"_blank\">\u003cstrong>Rachel Bluth\u003c/strong>\u003c/a>, Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One community health center in New York has frozen hiring. Another in Missouri can’t get a bank loan to expand.\u003c/p>\n\u003cp>The nation’s 1,400 community health centers are carefully watching expenses in case the financial rescue they hope Congress delivers this week doesn’t arrive. With four days left in the government’s fiscal year, Congress has not voted on reauthorizing billions of dollars now going to community health centers and other health programs for the 2018 budget year that starts Sunday.\u003c/p>\n\u003cp>“The anxiety level is increasing on almost a daily basis,” said Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) in Washington, D.C. “There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”\u003c/p>\n\u003cp>For the past two weeks, the GOP’s scramble to repeal the Affordable Care Act before the month ends pushed other health care matters off the congressional agenda. That effort ended Tuesday when Senate Republicans said they would not seek a vote this week because they lacked enough support to pass the bill.\u003c/p>\n\u003cp>It’s not clear if lawmakers’ lighter agenda will now leave room for funding health centers or deciding other issues, such as renewing the Children’s Health Insurance Program (CHIP), which also expires Saturday. At a hearing Monday, Senate Finance Committee Chairman Orrin Hatch (R-Utah) urged his colleagues to work with the Senate’s health committee to settle the matter. NACHC officials privately express optimism that a deal might come later in October if not by Sunday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Community health centers operate in more than 9,500 locations, serving 27 million people, according to the NACHC. They are the main source of health care for many low-income Americans — and the only source of primary care in many underserved areas.\u003c/p>\n\u003cp>Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay. A sliding fee scale based on income and family size is available to patients without insurance.\u003c/p>\n\u003cp>In 2015, nearly 1 in 6 Medicaid beneficiaries received health center services, the Kaiser Family Foundation \u003ca href=\"http://www.kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/\">reported\u003c/a> this year. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“The end result is these are people who will be locked out of health care” without new funding, Hawkins said.\u003c/p>\n\u003cp>Community health centers gained billions of dollars in federal revenue under the ACA, which created a special trust fund to support them from 2011 through 2015. The Community Health Center Fund was extended in 2015 for two years with an additional $3.6 billion annually.\u003c/p>\n\u003cp>That money represents 70 percent of all federal grants to health centers and about a fifth of their annual revenue. Medicaid reimbursements account for the largest share, about 40 percent.\u003c/p>\n\u003cp>One beneficiary is Pamela Richardson, a 60-year-old patient of Valley Community Healthcare in North Hollywood, California, who suffers from an iron absorption disorder called hereditary hemochromatosis. She was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she received long-delayed primary care, which revealed she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have Pap smears,” she \u003ca href=\"http://khn.org/news/californias-community-clinics-big-aca-beneficiaries-worry-about-their-future/\">told\u003c/a> a KHN reporter earlier this year. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cp>California has by far the most federally funded health centers and they serve 6.2 million Californians, according to CaliforniaHealth+ Advocates, which represents state clinics. They have received over $1.6 billion from 2011 through 2016 from the Community Health Center Fund, more than any other state, the Congressional Research Service \u003ca href=\"https://www.everycrsreport.com/files/20170113_R43911_852eca9ca6e96b41176e6609d8cb068ba7e770ed.pdf\">reported\u003c/a> in January.\u003c/p>\n\u003cp>If health centers receive no new funds for 2018, the ensuing financial crunch would cost 51,000 jobs, force the centers to close 2,800 locations and cause 9 million people to lose health care services, according to a budget document that the Health and Human Services Department gave Congress in July.\u003c/p>\n\u003cp>Uncertainty about what Congress will do now is already causing problems. Hawkins said his members call him and his staff every day, fretting about employment contracts, lease agreements and equipment rentals that run past Oct. 1.\u003c/p>\n\u003cp>Neighborhood Health in Nashville, Tennessee, has federal grant money that will carry it through Jan. 31, but CEO Mary Bufwack said some of her 180 staff members live paycheck to paycheck and are getting nervous about Neighborhood’s stability.\u003c/p>\n\u003cp>Bufwack is worried the health center won’t receive money it needs to replace a clinic, a project now being planned.\u003c/p>\n\u003cp>She fears that a new doctor she recruited to join Neighborhood next June will take another job before she can get his signature on an employment contract. And she doesn’t want to do that until she’s sure about her budget.\u003c/p>\n\u003cp>Mostly, she worries that whatever Congress gives her will be only for one year.\u003c/p>\n\u003cp>“We’re already worried about next Sept. 30,” Bufwack said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"order": 3
},
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},
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"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
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},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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},
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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.",
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"order": 10
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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"city-arts": {
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"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",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
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},
"closealltabs": {
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"order": 1
},
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"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": {
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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",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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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",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
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"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",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
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"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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"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"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.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"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",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"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",
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"order": 18
},
"link": "/podcasts/jerrybrown",
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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/",
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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"
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},
"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": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"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": {
"site": "news",
"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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"source": "npr"
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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",
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"youthMediaReducer": {},
"checkPleaseReducer": {
"filterData": {
"region": {
"key": "Restaurant Region",
"filters": [
"Any Region"
]
},
"cuisine": {
"key": "Restaurant Cuisine",
"filters": [
"Any Cuisine"
]
}
},
"restaurantDataById": {},
"restaurantIdsSorted": [],
"error": null
},
"userAgentReducer": {
"userAgent": "CCBot/2.0 (https://commoncrawl.org/faq/)",
"isBot": true
}
}
