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"content": "\u003cp>Michael Callahan, an outgoing 43-year-old carpenter, landed in a Los Angeles County jail last September because of what he said were “bad decisions and selling drugs.”\u003c/p>\n\u003cp>He had uncontrolled diabetes and high blood pressure when he arrived, but his health was the last thing on his mind. Consumed by a meth addiction, he hadn’t taken his medications for months. “When I got here, I was a wreck,” said Callahan, who is stocky and covered in tattoos. “My legs were so swollen that if I bumped them they would break open.”\u003c/p>\n\u003cp>By January, however, his diabetes was improving and his blood pressure had dropped. Now, he takes his medications daily and sees a doctor every two months. Even as he counts the days until his release this summer, Callahan knows he is getting much-needed medical care. “I’m where I need to be, not where I want to be,” he said.\u003c/p>\n\u003cp>Callahan’s situation is counterintuitive: He may end up leaving jail healthier than when he arrived. Officials at the Los Angeles County Department of Health Services hope to see more cases like his as they embark on an ambitious effort to improve health care for jail inmates. Their project follows decades of complaints, lawsuits and reports of poor medical and mental health care at the Los Angeles County jails, which house about 18,000 inmates on any given day.\u003c/p>\n\u003cp>The county’s overhaul is designed to raise the quality of health care behind bars and better equip inmates to manage their health after they are released. But the challenges are enormous – the population is disproportionately sick, and the jails weren’t designed to be medical facilities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The innovative effort at one of the nation’s biggest jail systems is based on a logical premise: Inmates don’t stay in jail for long – the average stay is just 60 days – so it’s a crucial opportunity to diagnose and begin treating their diseases.\u003c/p>\n\u003cp>“People are there for just a blip in time, days, weeks, months … and they’re returning back to the community,” said Mark Ghaly, director of community health for the county Department of Health Services. “What happens in the jail matters.”\u003c/p>\n\u003cp>The county health agency took over medical care in the jails from the LA County Sheriff’s Department in 2015 and started revamping the system in earnest last year.\u003c/p>\n\u003cfigure id=\"attachment_362814\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362814\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg\" alt=\"The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The main health clinic at the Men’s Central Jail in downtown Los Angeles is located just inside a large metal gate. Inmates there and at all the LA county jails can get a wide variety of medical and behavioral care. “It’s a giant health system and it’s complex,” said Margarita Pereyda, chief medical officer of correctional health services for LA County. “We are a hybrid between a hospital and an ER and an outpatient kind of environment.”\u003c/p>\n\u003cp>Part of the plan is to make clinics inside the jails more like ones on the outside. That means assigning inmates to primary care doctors to manage their chronic diseases and getting them appointments and medications quickly. It also means expanding treatment for mental health and substance abuse and referring those who need advanced medical or behavioral care to specialists who work for the county.\u003c/p>\n\u003cp>It’s a monumental job: Nearly half of all inmates have at least one chronic disease, including about 450 who have HIV and 900 with diabetes. About two-thirds of inmates are addicted to drugs or alcohol, and about a quarter have serious mental illnesses.\u003c/p>\n\u003cp>“Very few people have chronic illness under good control,” Ghaly said. ”The jails have largely become treatment facilities.”\u003c/p>\n\u003cp>To improve inmates’ access to care, county officials launched a physician recruitment effort this month. They released a series of online videos featuring medical providers with the slogan “\u003ca href=\"https://missionpossible.lacounty.gov/\" target=\"_blank\" rel=\"noopener\">Mission Possible\u003c/a>.” As an incentive, they are offering to pay up to $120,000 in medical school debt for each of the new hires who need it. That strategy has been used to lure doctors to low-income communities around the United States.\u003c/p>\n\u003cp>Esther Lim, who directs the jails project at the American Civil Liberties Union of Southern California, said she is optimistic care will improve, but she still hears daily from inmates about delays in appointments and medications. And, she said, people are still dying inside the LA County jails – an average of 25 each year, according to the health department.\u003c/p>\n\u003cp>“It’s an indication that there is something wrong, that the delivery of medical care is still poor,” Lim said. Overcrowding can result in inmates’ health being neglected and deteriorating over time, she said. County health officials acknowledge the situation is not going to change overnight. The county is “making some great headway,” but “there are some things that you can change more quickly than others,” said Ed Matzen, clinical nursing director for the jails.\u003c/p>\n\u003cfigure id=\"attachment_362816\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362816\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg\" alt=\"Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lello Tesema, a primary care physician and director of population health for the county jails, said many of her patients have gone without care on the outside for a long time. As soon as she gets a new patient, Tesema takes a medical and personal history. Then she creates a plan with the patient, knowing she only has a limited amount of time to implement it.\u003c/p>\n\u003cp>One early morning in January, Tesema examined Callahan, the carpenter, on an exam table in a room just off a busy corridor around the corner from his dorm-style cell. She said the swelling in his legs had diminished and his blood sugar level was looking good. “We’re moving in the right direction,” she told him. On the way back to his bunk, Callahan stopped at a window to pick up a pill for his diabetes.\u003c/p>\n\u003cp>Tesema said she worries about the health of her patients after they get out of jail even though they leave with a referral to a county clinic and 30 days’ worth of medication – up from three days in the past. “Often I see patients come back and a lot of the successes that happened while they were here end up diminishing after they leave,” she said.\u003c/p>\n\u003cp>Tesema and other medical providers in the jail must manage the inherent tension between safety and medical care. Sometimes, doctors have to see patients in their cells or treat them when they are handcuffed, Tesema said.\u003c/p>\n\u003cp>Jason Wolak, a captain in the medical services bureau of the Sheriff’s Department, said deputies are making an effort to get more inmates to medical appointments. “We’re the Uber for medical,” he said. He added that the Sheriff’s Department needs more staff, especially for transporting inmates to outside specialists or to the county-run hospitals.\u003c/p>\n\u003cp>Since patients also are going to court, attending classes or meeting with their lawyers, scheduling medical visits can be a challenge, Ghaly said. “There’s a high no-show rate to appointments.”\u003c/p>\n\u003cp>Pereyda said the new system for providing care at the jails depends on current doctors changing their mindset – things as simple as calling people patients rather than inmates.\u003c/p>\n\u003cp>“We can figure out the logistics and we can figure out the resources, but shifting the way people think and act is going to be our biggest challenge,” she said. Hiring new doctors who believe in the mission of health care behind bars will help, she added.\u003c/p>\n\u003cp>Among some inmates, attitudes about their own health are already beginning to shift.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Callahan said he’s determined to stay sober and continue monitoring his health when he gets out. “I’m 43 years old and that’s not the age to be screwing around with diabetes,” he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Michael Callahan, an outgoing 43-year-old carpenter, landed in a Los Angeles County jail last September because of what he said were “bad decisions and selling drugs.”\u003c/p>\n\u003cp>He had uncontrolled diabetes and high blood pressure when he arrived, but his health was the last thing on his mind. Consumed by a meth addiction, he hadn’t taken his medications for months. “When I got here, I was a wreck,” said Callahan, who is stocky and covered in tattoos. “My legs were so swollen that if I bumped them they would break open.”\u003c/p>\n\u003cp>By January, however, his diabetes was improving and his blood pressure had dropped. Now, he takes his medications daily and sees a doctor every two months. Even as he counts the days until his release this summer, Callahan knows he is getting much-needed medical care. “I’m where I need to be, not where I want to be,” he said.\u003c/p>\n\u003cp>Callahan’s situation is counterintuitive: He may end up leaving jail healthier than when he arrived. Officials at the Los Angeles County Department of Health Services hope to see more cases like his as they embark on an ambitious effort to improve health care for jail inmates. Their project follows decades of complaints, lawsuits and reports of poor medical and mental health care at the Los Angeles County jails, which house about 18,000 inmates on any given day.\u003c/p>\n\u003cp>The county’s overhaul is designed to raise the quality of health care behind bars and better equip inmates to manage their health after they are released. But the challenges are enormous – the population is disproportionately sick, and the jails weren’t designed to be medical facilities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The innovative effort at one of the nation’s biggest jail systems is based on a logical premise: Inmates don’t stay in jail for long – the average stay is just 60 days – so it’s a crucial opportunity to diagnose and begin treating their diseases.\u003c/p>\n\u003cp>“People are there for just a blip in time, days, weeks, months … and they’re returning back to the community,” said Mark Ghaly, director of community health for the county Department of Health Services. “What happens in the jail matters.”\u003c/p>\n\u003cp>The county health agency took over medical care in the jails from the LA County Sheriff’s Department in 2015 and started revamping the system in earnest last year.\u003c/p>\n\u003cfigure id=\"attachment_362814\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362814\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg\" alt=\"The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The main health clinic at the Men’s Central Jail in downtown Los Angeles is located just inside a large metal gate. Inmates there and at all the LA county jails can get a wide variety of medical and behavioral care. “It’s a giant health system and it’s complex,” said Margarita Pereyda, chief medical officer of correctional health services for LA County. “We are a hybrid between a hospital and an ER and an outpatient kind of environment.”\u003c/p>\n\u003cp>Part of the plan is to make clinics inside the jails more like ones on the outside. That means assigning inmates to primary care doctors to manage their chronic diseases and getting them appointments and medications quickly. It also means expanding treatment for mental health and substance abuse and referring those who need advanced medical or behavioral care to specialists who work for the county.\u003c/p>\n\u003cp>It’s a monumental job: Nearly half of all inmates have at least one chronic disease, including about 450 who have HIV and 900 with diabetes. About two-thirds of inmates are addicted to drugs or alcohol, and about a quarter have serious mental illnesses.\u003c/p>\n\u003cp>“Very few people have chronic illness under good control,” Ghaly said. ”The jails have largely become treatment facilities.”\u003c/p>\n\u003cp>To improve inmates’ access to care, county officials launched a physician recruitment effort this month. They released a series of online videos featuring medical providers with the slogan “\u003ca href=\"https://missionpossible.lacounty.gov/\" target=\"_blank\" rel=\"noopener\">Mission Possible\u003c/a>.” As an incentive, they are offering to pay up to $120,000 in medical school debt for each of the new hires who need it. That strategy has been used to lure doctors to low-income communities around the United States.\u003c/p>\n\u003cp>Esther Lim, who directs the jails project at the American Civil Liberties Union of Southern California, said she is optimistic care will improve, but she still hears daily from inmates about delays in appointments and medications. And, she said, people are still dying inside the LA County jails – an average of 25 each year, according to the health department.\u003c/p>\n\u003cp>“It’s an indication that there is something wrong, that the delivery of medical care is still poor,” Lim said. Overcrowding can result in inmates’ health being neglected and deteriorating over time, she said. County health officials acknowledge the situation is not going to change overnight. The county is “making some great headway,” but “there are some things that you can change more quickly than others,” said Ed Matzen, clinical nursing director for the jails.\u003c/p>\n\u003cfigure id=\"attachment_362816\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362816\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg\" alt=\"Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lello Tesema, a primary care physician and director of population health for the county jails, said many of her patients have gone without care on the outside for a long time. As soon as she gets a new patient, Tesema takes a medical and personal history. Then she creates a plan with the patient, knowing she only has a limited amount of time to implement it.\u003c/p>\n\u003cp>One early morning in January, Tesema examined Callahan, the carpenter, on an exam table in a room just off a busy corridor around the corner from his dorm-style cell. She said the swelling in his legs had diminished and his blood sugar level was looking good. “We’re moving in the right direction,” she told him. On the way back to his bunk, Callahan stopped at a window to pick up a pill for his diabetes.\u003c/p>\n\u003cp>Tesema said she worries about the health of her patients after they get out of jail even though they leave with a referral to a county clinic and 30 days’ worth of medication – up from three days in the past. “Often I see patients come back and a lot of the successes that happened while they were here end up diminishing after they leave,” she said.\u003c/p>\n\u003cp>Tesema and other medical providers in the jail must manage the inherent tension between safety and medical care. Sometimes, doctors have to see patients in their cells or treat them when they are handcuffed, Tesema said.\u003c/p>\n\u003cp>Jason Wolak, a captain in the medical services bureau of the Sheriff’s Department, said deputies are making an effort to get more inmates to medical appointments. “We’re the Uber for medical,” he said. He added that the Sheriff’s Department needs more staff, especially for transporting inmates to outside specialists or to the county-run hospitals.\u003c/p>\n\u003cp>Since patients also are going to court, attending classes or meeting with their lawyers, scheduling medical visits can be a challenge, Ghaly said. “There’s a high no-show rate to appointments.”\u003c/p>\n\u003cp>Pereyda said the new system for providing care at the jails depends on current doctors changing their mindset – things as simple as calling people patients rather than inmates.\u003c/p>\n\u003cp>“We can figure out the logistics and we can figure out the resources, but shifting the way people think and act is going to be our biggest challenge,” she said. Hiring new doctors who believe in the mission of health care behind bars will help, she added.\u003c/p>\n\u003cp>Among some inmates, attitudes about their own health are already beginning to shift.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Callahan said he’s determined to stay sober and continue monitoring his health when he gets out. “I’m 43 years old and that’s not the age to be screwing around with diabetes,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Treating Domestic Violence As A Medical Problem",
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"content": "\u003cp>Fanny Ortiz, a mother of five who lives just east of downtown Los Angeles, spent nearly a decade married to a man who controlled her and frequently threatened her. Then, she said, his abuse escalated.\u003c/p>\n\u003cp>“He would physically hit me in the face, throw me on the wall,” she recalled.\u003c/p>\n\u003cp>Ortiz, 43, eventually left the marriage, taking her children with her. A few years later, she learned that the East Los Angeles Women’s Center offered domestic violence services at Los Angeles County‐USC Medical Center near her home. Now she goes to the hospital campus for weekly therapy sessions, which she said have helped stop her suicidal thoughts.\u003c/p>\n\u003cp>“I was afraid to talk,” Ortiz said. “Now I am more open to talk about things that I was holding in.”\u003c/p>\n\u003cfigure id=\"attachment_362544\" class=\"wp-caption alignnone\" style=\"max-width: 540px\">\u003cimg class=\"size-full wp-image-362544\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg\" alt=\"\" width=\"540\" height=\"405\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg 540w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-520x390.jpg 520w\" sizes=\"(max-width: 540px) 100vw, 540px\">\u003cfigcaption class=\"wp-caption-text\">Fanny Ortiz (right), who left an abusive marriage after nearly a decade, meets weekly with therapist Brittany Martinez at the East Los Angeles Women’s Center. The office is located on the campus of the Los Angeles County-USC Medical Center. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nearly 1 in 4 women have experienced serious physical violence at the hands of a partner. They often end up in the emergency room or the doctor’s office. But they don’t typically volunteer the reason for their injuries, and doctors don’t always ask about abuse in the home. That failure of communication means the patients may miss out on the help they need.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Yet a growing number of health providers and anti‐abuse agencies in California and around the country are collaborating to identify victims and get them help. More doctors now screen their patients for signs of abuse and more agencies place victims’ advocates inside health centers. Education and counseling for people experiencing violence is also more widely available in clinics and hospitals.\u003c/p>\n\u003cp>About four years ago, the East Los Angeles Women’s Center opened offices on the campus of L.A. County‐USC, a busy public hospital. Since then, center staff members have trained more than 2,500 doctors, nurses, social workers and others to identify victims of domestic violence. They also respond quickly to calls from the medical center’s emergency room, inpatient hospital and outpatient facilities to help patients in crisis.\u003c/p>\n\u003cp>Today, the women’s center has embarked on an innovative approach: In February, it plans to open a short‐term shelter for abuse victims on the medical center grounds. The 10‐bed shelter fills a serious need, said Deirdre Anglin, an emergency room physician at L.A. County‐USC.\u003c/p>\n\u003cp>“We sometimes have patients in the emergency department who don’t have a place to go, and in the evenings and nights all the shelters in L.A. will be filled,” Anglin said.\u003c/p>\n\u003cp>Victims of abuse can suffer long‐term health problems, including chronic pain, frequent headaches, depression, diabetes and asthma. And they have higher health costs than people who have not experienced abuse. So “it makes complete sense to have the health care providers acting as allies and partners in treating domestic violence,” said Peter Long, CEO of the Blue Shield of California Foundation. (The foundation provides support for KHN coverage in California).\u003c/p>\n\u003cp>The foundation has funded 19 partnerships between health centers and domestic violence agencies around the state, including the L.A. County‐USC office of the East Los Angeles Women’s Center. Similar partnerships operate in Illinois, Maryland and other states.\u003c/p>\n\u003cp>Last year, the East Los Angeles Women’s Center served 600 victims of domestic violence at the L.A. County‐USC hospital campus. Nearly one‐third were homeless or couldn’t go back home for safety reasons.\u003c/p>\n\u003cp>Advocates say that hospitals and clinics are ideal settings to respond to the needs of abused women. In the San Gabriel Valley, the YWCA sponsors domestic violence support groups at a community clinic, while the clinic offers health education for survivors of abuse at the YWCA. In Sacramento, a Native American health center works closely with a domestic violence group a few blocks away.\u003c/p>\n\u003cp>Doctors have an “unprecedented opportunity to promote prevention and to respond because they are seeing patients that may not ever reach out to a domestic violence agency or police for help,” said Lisa James, director of health for Futures Without Violence, which runs a national resource center dedicated to improving the response of medical professionals to domestic violence. “They can provide this critical lifesaving intervention.”\u003c/p>\n\u003cp>The proximity of the East Los Angeles Women’s Center to the hospital and clinic buildings on the L.A. County‐USC campus makes it easier for doctors to ask their patients about violence, said Rebeca Melendez, director of programs for the center’s office at the medical center. The medical providers know where to turn for guidance – and that the help is nearby.\u003c/p>\n\u003cp>“They don’t need to know all the answers,” she said. “They just need to call us.”\u003c/p>\n\u003cp>This growing collaboration between the medical profession and anti‐abuse agencies is driven in part by the Affordable Care Act, which requires that health plans cover domestic violence screening and counseling.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force recommends doctors routinely question women about violence in the home and refer them to services if needed. The task force concluded in 2013 that intervention could reduce violence and abuse as well as mental and physical health problems.\u003c/p>\n\u003cp>Organizations such as the American Congress of Obstetricians and Gynecologists and the American Medical Association also recommend routine screening and counseling for domestic violence.\u003c/p>\n\u003cp>In the past, patients would go to health centers with such problems, but providers did not feel comfortable asking questions about abuse at home, said Long, of the Blue Shield of California Foundation.\u003c/p>\n\u003cp>“They didn’t feel they had the time and they didn’t feel they had the resources to do something about it,” he said. Nor did they always have a place to send patients who were abuse victims.\u003c/p>\n\u003cp>Treating patients who are in abusive relationships is “very challenging,” said Anglin, the ER physician. “There is no pill to give.”\u003c/p>\n\u003cp>But asking about violence needs to be part of a physician’s job, she said. “Part of what we need to do is try to identify patients who may be in a dangerous situation… so we are not just sending these patients back to the same situation they were in only to come back worse off another time.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Health care professionals increasingly collaborate with anti‐abuse advocates to identify victims and ensure they get the help they need. In Los Angeles, a women's shelter is opening right on the campus of a large public hospital. ",
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"nprByline": "\u003cstrong>\u003ca href=\"https://khn.org/news/author/anna-gorman/\" rel=\"noopener\" target=\"_blank\">Anna Gorman\u003c/a>\u003c/strong>\u003c/br>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Fanny Ortiz, a mother of five who lives just east of downtown Los Angeles, spent nearly a decade married to a man who controlled her and frequently threatened her. Then, she said, his abuse escalated.\u003c/p>\n\u003cp>“He would physically hit me in the face, throw me on the wall,” she recalled.\u003c/p>\n\u003cp>Ortiz, 43, eventually left the marriage, taking her children with her. A few years later, she learned that the East Los Angeles Women’s Center offered domestic violence services at Los Angeles County‐USC Medical Center near her home. Now she goes to the hospital campus for weekly therapy sessions, which she said have helped stop her suicidal thoughts.\u003c/p>\n\u003cp>“I was afraid to talk,” Ortiz said. “Now I am more open to talk about things that I was holding in.”\u003c/p>\n\u003cfigure id=\"attachment_362544\" class=\"wp-caption alignnone\" style=\"max-width: 540px\">\u003cimg class=\"size-full wp-image-362544\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg\" alt=\"\" width=\"540\" height=\"405\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg 540w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-520x390.jpg 520w\" sizes=\"(max-width: 540px) 100vw, 540px\">\u003cfigcaption class=\"wp-caption-text\">Fanny Ortiz (right), who left an abusive marriage after nearly a decade, meets weekly with therapist Brittany Martinez at the East Los Angeles Women’s Center. The office is located on the campus of the Los Angeles County-USC Medical Center. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nearly 1 in 4 women have experienced serious physical violence at the hands of a partner. They often end up in the emergency room or the doctor’s office. But they don’t typically volunteer the reason for their injuries, and doctors don’t always ask about abuse in the home. That failure of communication means the patients may miss out on the help they need.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Yet a growing number of health providers and anti‐abuse agencies in California and around the country are collaborating to identify victims and get them help. More doctors now screen their patients for signs of abuse and more agencies place victims’ advocates inside health centers. Education and counseling for people experiencing violence is also more widely available in clinics and hospitals.\u003c/p>\n\u003cp>About four years ago, the East Los Angeles Women’s Center opened offices on the campus of L.A. County‐USC, a busy public hospital. Since then, center staff members have trained more than 2,500 doctors, nurses, social workers and others to identify victims of domestic violence. They also respond quickly to calls from the medical center’s emergency room, inpatient hospital and outpatient facilities to help patients in crisis.\u003c/p>\n\u003cp>Today, the women’s center has embarked on an innovative approach: In February, it plans to open a short‐term shelter for abuse victims on the medical center grounds. The 10‐bed shelter fills a serious need, said Deirdre Anglin, an emergency room physician at L.A. County‐USC.\u003c/p>\n\u003cp>“We sometimes have patients in the emergency department who don’t have a place to go, and in the evenings and nights all the shelters in L.A. will be filled,” Anglin said.\u003c/p>\n\u003cp>Victims of abuse can suffer long‐term health problems, including chronic pain, frequent headaches, depression, diabetes and asthma. And they have higher health costs than people who have not experienced abuse. So “it makes complete sense to have the health care providers acting as allies and partners in treating domestic violence,” said Peter Long, CEO of the Blue Shield of California Foundation. (The foundation provides support for KHN coverage in California).\u003c/p>\n\u003cp>The foundation has funded 19 partnerships between health centers and domestic violence agencies around the state, including the L.A. County‐USC office of the East Los Angeles Women’s Center. Similar partnerships operate in Illinois, Maryland and other states.\u003c/p>\n\u003cp>Last year, the East Los Angeles Women’s Center served 600 victims of domestic violence at the L.A. County‐USC hospital campus. Nearly one‐third were homeless or couldn’t go back home for safety reasons.\u003c/p>\n\u003cp>Advocates say that hospitals and clinics are ideal settings to respond to the needs of abused women. In the San Gabriel Valley, the YWCA sponsors domestic violence support groups at a community clinic, while the clinic offers health education for survivors of abuse at the YWCA. In Sacramento, a Native American health center works closely with a domestic violence group a few blocks away.\u003c/p>\n\u003cp>Doctors have an “unprecedented opportunity to promote prevention and to respond because they are seeing patients that may not ever reach out to a domestic violence agency or police for help,” said Lisa James, director of health for Futures Without Violence, which runs a national resource center dedicated to improving the response of medical professionals to domestic violence. “They can provide this critical lifesaving intervention.”\u003c/p>\n\u003cp>The proximity of the East Los Angeles Women’s Center to the hospital and clinic buildings on the L.A. County‐USC campus makes it easier for doctors to ask their patients about violence, said Rebeca Melendez, director of programs for the center’s office at the medical center. The medical providers know where to turn for guidance – and that the help is nearby.\u003c/p>\n\u003cp>“They don’t need to know all the answers,” she said. “They just need to call us.”\u003c/p>\n\u003cp>This growing collaboration between the medical profession and anti‐abuse agencies is driven in part by the Affordable Care Act, which requires that health plans cover domestic violence screening and counseling.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force recommends doctors routinely question women about violence in the home and refer them to services if needed. The task force concluded in 2013 that intervention could reduce violence and abuse as well as mental and physical health problems.\u003c/p>\n\u003cp>Organizations such as the American Congress of Obstetricians and Gynecologists and the American Medical Association also recommend routine screening and counseling for domestic violence.\u003c/p>\n\u003cp>In the past, patients would go to health centers with such problems, but providers did not feel comfortable asking questions about abuse at home, said Long, of the Blue Shield of California Foundation.\u003c/p>\n\u003cp>“They didn’t feel they had the time and they didn’t feel they had the resources to do something about it,” he said. Nor did they always have a place to send patients who were abuse victims.\u003c/p>\n\u003cp>Treating patients who are in abusive relationships is “very challenging,” said Anglin, the ER physician. “There is no pill to give.”\u003c/p>\n\u003cp>But asking about violence needs to be part of a physician’s job, she said. “Part of what we need to do is try to identify patients who may be in a dangerous situation… so we are not just sending these patients back to the same situation they were in only to come back worse off another time.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\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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"disqusTitle": "Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices",
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"content": "\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Fines Anthem $5 Million For Failing to Address Consumer Grievances",
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"content": "\u003cp>California’s managed-care regulator announced Wednesday it has fined insurance giant Anthem Blue Cross $5 million for repeatedly failing to resolve consumer grievances in a timely manner.\u003c/p>\n\u003cp>The state Department of Managed Health Care criticized Anthem, the nation’s second-largest health insurer, for systemic violations and a long history of flouting the law in regard to consumer complaints.\u003c/p>\n\u003cp>“Anthem Blue Cross’ failures to comply with the law surrounding grievance and appeals rights are long-standing, ongoing and unacceptable,” said Shelley Rouillard, director of the Department of Managed Health Care. “Anthem knows this is a huge problem, but they haven’t addressed it.”\u003c/p>\n\u003cp>Before this latest action, California had already fined Anthem more than $6 million collectively for grievance-system violations since 2002.\u003c/p>\n\u003cp>The state said it identified 245 grievance-system violations during this latest investigation of consumer complaints at Anthem from 2013 to 2016.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.\u003c/p>\n\u003cp>In a statement, Anthem acknowledged there are some legitimate findings in the audit, but it strongly disagreed with the state’s assertion that the problems are “systemic and ongoing.” The company said it will contest the fine.\u003c/p>\n\u003cp>“Anthem has taken responsibility for errors in the past and has made significant changes in our grievance and appeals process, as well as investments in system improvements,” the company said. “We remain committed to putting the needs of our members first.”\u003c/p>\n\u003cp>Anthem Inc., based in Indianapolis, sells Blue Cross policies in California and 13 other states.\u003c/p>\n\u003cp>California is known for having tough consumer protection laws on health coverage and for assisting policyholders when they exhaust their appeals with insurers. In other actions, the state has fined insurers for overstating the extent of their doctor networks and for denying patients timely access to mental health treatment.\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, an advocacy group in Santa Monica, Calif., said the regulatory response to these problems varies greatly by state. He singled out New York, Washington and Kansas as some of the states with good track records of holding health insurers accountable.\u003c/p>\n\u003cp>“The real problem is when states don’t act there is not a great avenue for the consumer. It’s very hard to bring legal action,” Court said. “Anthem definitely needed a wake-up call. But this will also send a message to other insurers.”\u003c/p>\n\u003cp>Nationally, consumers continue to express their displeasure with health insurers over a wide range of issues, including denials for treatment, billing disputes and the lack of in-network doctors.\u003c/p>\n\u003cp>Verified complaints related to health insurance and accident coverage rose 12 percent in 2016 compared to the previous year, totaling 53,680, according to data compiled by the National Association of Insurance Commissioners. The data only includes incidents in which state regulators confirmed there was a violation or error by the insurer involved.\u003c/p>\n\u003cp>Court and other advocates welcomed the significant fine in California and said this is just the latest example of Anthem’s failure to uphold basic consumer protections.\u003c/p>\n\u003cp>Overall, state officials said that calls to Anthem’s customer service department often led to repeated transfers and that the company failed to follow up with enrollees.\u003c/p>\n\u003cp>“If you look at the history of Anthem and the penalties assessed over the years, they are definitely an outlier compared to other health plans,” Rouillard said.\u003c/p>\n\u003cp>“All the plans have some issues with grievances, but nothing to the degree we are seeing with Anthem.”\u003c/p>\n\u003cp>The managed-care department said a health plan’s grievance program is critical, so that consumers know they have the right to pursue an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.Wgxw3mhSyUk\" target=\"_blank\" rel=\"noopener\">independent medical \u003c/a>review or file a complaint with regulators if they are dissatisfied with the insurer’s decision. The grievance system can also help insurers identify systemic problems and improve customer service, state officials said.\u003c/p>\n\u003cp>The state’s independent medical review program allows consumers to have their case heard by doctors who are not tied to their health plan. The cases often arise when an insurer denies a patient’s request for treatment or a prescription drug.\u003c/p>\n\u003cp>In 2016, insurance company denials were overturned in nearly 70 percent of medical review cases and patients received the requested treatment, according to state officials.\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\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>California’s managed-care regulator announced Wednesday it has fined insurance giant Anthem Blue Cross $5 million for repeatedly failing to resolve consumer grievances in a timely manner.\u003c/p>\n\u003cp>The state Department of Managed Health Care criticized Anthem, the nation’s second-largest health insurer, for systemic violations and a long history of flouting the law in regard to consumer complaints.\u003c/p>\n\u003cp>“Anthem Blue Cross’ failures to comply with the law surrounding grievance and appeals rights are long-standing, ongoing and unacceptable,” said Shelley Rouillard, director of the Department of Managed Health Care. “Anthem knows this is a huge problem, but they haven’t addressed it.”\u003c/p>\n\u003cp>Before this latest action, California had already fined Anthem more than $6 million collectively for grievance-system violations since 2002.\u003c/p>\n\u003cp>The state said it identified 245 grievance-system violations during this latest investigation of consumer complaints at Anthem from 2013 to 2016.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.\u003c/p>\n\u003cp>In a statement, Anthem acknowledged there are some legitimate findings in the audit, but it strongly disagreed with the state’s assertion that the problems are “systemic and ongoing.” The company said it will contest the fine.\u003c/p>\n\u003cp>“Anthem has taken responsibility for errors in the past and has made significant changes in our grievance and appeals process, as well as investments in system improvements,” the company said. “We remain committed to putting the needs of our members first.”\u003c/p>\n\u003cp>Anthem Inc., based in Indianapolis, sells Blue Cross policies in California and 13 other states.\u003c/p>\n\u003cp>California is known for having tough consumer protection laws on health coverage and for assisting policyholders when they exhaust their appeals with insurers. In other actions, the state has fined insurers for overstating the extent of their doctor networks and for denying patients timely access to mental health treatment.\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, an advocacy group in Santa Monica, Calif., said the regulatory response to these problems varies greatly by state. He singled out New York, Washington and Kansas as some of the states with good track records of holding health insurers accountable.\u003c/p>\n\u003cp>“The real problem is when states don’t act there is not a great avenue for the consumer. It’s very hard to bring legal action,” Court said. “Anthem definitely needed a wake-up call. But this will also send a message to other insurers.”\u003c/p>\n\u003cp>Nationally, consumers continue to express their displeasure with health insurers over a wide range of issues, including denials for treatment, billing disputes and the lack of in-network doctors.\u003c/p>\n\u003cp>Verified complaints related to health insurance and accident coverage rose 12 percent in 2016 compared to the previous year, totaling 53,680, according to data compiled by the National Association of Insurance Commissioners. The data only includes incidents in which state regulators confirmed there was a violation or error by the insurer involved.\u003c/p>\n\u003cp>Court and other advocates welcomed the significant fine in California and said this is just the latest example of Anthem’s failure to uphold basic consumer protections.\u003c/p>\n\u003cp>Overall, state officials said that calls to Anthem’s customer service department often led to repeated transfers and that the company failed to follow up with enrollees.\u003c/p>\n\u003cp>“If you look at the history of Anthem and the penalties assessed over the years, they are definitely an outlier compared to other health plans,” Rouillard said.\u003c/p>\n\u003cp>“All the plans have some issues with grievances, but nothing to the degree we are seeing with Anthem.”\u003c/p>\n\u003cp>The managed-care department said a health plan’s grievance program is critical, so that consumers know they have the right to pursue an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.Wgxw3mhSyUk\" target=\"_blank\" rel=\"noopener\">independent medical \u003c/a>review or file a complaint with regulators if they are dissatisfied with the insurer’s decision. The grievance system can also help insurers identify systemic problems and improve customer service, state officials said.\u003c/p>\n\u003cp>The state’s independent medical review program allows consumers to have their case heard by doctors who are not tied to their health plan. The cases often arise when an insurer denies a patient’s request for treatment or a prescription drug.\u003c/p>\n\u003cp>In 2016, insurance company denials were overturned in nearly 70 percent of medical review cases and patients received the requested treatment, according to state officials.\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\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": "California Cracks Down On Weed Killer As Lawsuits Abound",
"title": "California Cracks Down On Weed Killer As Lawsuits Abound",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Jack McCall was a fixture at the local farmers market, where he sold avocados and other fruits he grew on his 20-acre ranch in Cambria, on California’s Central Coast.\u003c/p>\n\u003cp>The U.S. postal worker and Little League coach was “very environmentally friendly,” said Teri McCall, his wife of 41 years. He avoided chemicals, using only his tractor-mower to root out the thistle and other weeds that continually sprouted on the flat areas of the ranch.\u003c/p>\n\u003cp>But he did make one exception to that rule — a fateful one, his wife now believes. For more than three decades, on the hilly parts of the ranch where he grew the avocados, and around newly planted fruit trees, Jack donned a backpack sprayer and doused weeds with the widely sold herbicide Roundup.\u003c/p>\n\u003cp>“He believed Roundup was safe,” Teri McCall said, noting that St. Louis-based Monsanto Co. has regularly touted its flagship product as \u003ca href=\"https://www.youtube.com/watch?v=vJboNdWoFws\" target=\"_blank\" rel=\"noopener\">harmless to people and pets\u003c/a>.\u003c/p>\n\u003cp>In 2012, the McCalls’ 6-year-old dog, Duke, who regularly accompanied Jack around the farm, fell ill with swollen lymph nodes in his neck and died shortly afterward of lymphoma — a type of blood cancer. Three years later, Jack discovered swollen lymph nodes in his own neck, Teri said. The diagnosis: a rare form of non-Hodgkin lymphoma, which killed him on Dec. 26, 2015.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I thought, ‘That’s kind of a coincidence that they both got lumps in their neck,’” Teri recalled. “Then I thought about all the time Duke spent sticking his nose in grass that had been sprayed with Roundup.”\u003c/p>\n\u003cp>In March 2016, McCall filed a \u003ca href=\"http://baumhedlundlaw.com/pdf/monsanto-documents/Teri-McCall-Monsanto-Roundup-Lawsuit-Complaint.pdf\" target=\"_blank\" rel=\"noopener\">wrongful death lawsuit\u003c/a> against Monsanto, alleging that the company concealed the cancer risk posed by a chemical called “glyphosate,” the active ingredient in Roundup, which she now blames for the deaths of her husband and their dog.\u003c/p>\n\u003cp>Hundreds of similar lawsuits are pending in federal and state courthouses around the United States.\u003c/p>\n\u003cp>Monsanto vigorously contests them.\u003c/p>\n\u003cp>“To be clear: The underlying science behind glyphosate is not at question,” said Scott Partridge, the company’s vice president of global strategy. “Monsanto’s glyphosate-based herbicides have a long history of safe use and have been studied in real-world application, including the largest study ever of the actual use of pesticides by farmers.”\u003c/p>\n\u003cp>Monsanto’s Partridge contended that “cherry-picking isolated documents out of context is an attempt by the plaintiffs’ attorneys in pending litigation to distract from the science, which is not on their side.”\u003c/p>\n\u003cp>The use of glyphosate has grown exponentially in the past two decades. The chemical has found its way into the food chain — and into people’s bodies. A \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2658306\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published this week in the medical journal JAMA showed that the number of Southern California adults who tested positive for glyphosate in their urine rose dramatically from 1993 to 2016, as did the amount of the chemical in those who excreted it.\u003c/p>\n\u003cp>In July, California added glyphosate to its list of cancer-causing chemicals under the \u003ca href=\"https://oehha.ca.gov/proposition-65\" target=\"_blank\" rel=\"noopener\">Safe Drinking Water and Toxic Enforcement Act of 1986.\u003c/a> The act, also known as Proposition 65, requires businesses to warn consumers if their products or facilities contain potentially unsafe amounts of any toxic substances known to cause cancer, birth defects or other reproductive harm.\u003c/p>\n\u003cp>California is the first state in the U.S. to “take regulatory action to protect our residents from this chemical,” said Olga Naidenko, senior science adviser for the Environmental Working Group, a nonprofit research and advocacy organization. The move is “a huge step and has global implications.”\u003c/p>\n\u003cp>The state’s Office of Environmental Health Hazard Assessment, which is responsible for listing chemicals under Proposition 65, has proposed a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/glyphosate032917isor.pdf\" target=\"_blank\" rel=\"noopener\">threshold\u003c/a> of 1.1 milligrams of glyphosate a day for an adult weighing 70 kilograms, or 154 pounds. That’s about 122 times more stringent than the federal Environmental Protection Agency’s safety guideline.\u003c/p>\n\u003cp>The state agency is studying more than 1,300 written public comments, along with oral testimony from a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/060717glyphosatetranscript.pdf\" target=\"_blank\" rel=\"noopener\">June hearing\u003c/a>, to decide whether it should implement or revise its proposed limit.\u003c/p>\n\u003cp>The Prop. 65 listing requires warning labels beginning next July.\u003c/p>\n\u003cp>Other companies, including Dow AgroSciences and DuPont, also sell products containing glyphosate, since Monsanto’s patent expired in 2000.\u003c/p>\n\u003cp>California’s decision to list the chemical was triggered by a 2015 \u003ca href=\"https://www.iarc.fr/en/media-centre/iarcnews/pdf/MonographVolume112.pdf\">study\u003c/a> from the World Health Organization that described the chemical as “probably carcinogenic to humans” and cited “convincing evidence that glyphosate also can cause cancer in laboratory animals.”\u003c/p>\n\u003cp>The organization’s International Agency for Research on Cancer found a “positive association” between exposure to glyphosate and malignancy in humans, though it added that other explanations could not be excluded. In particular, the international agency found a possible link to non-Hodgkin lymphoma, the type of cancer that killed Jack McCall.\u003c/p>\n\u003cp>Monsanto sued in state Superior Court to overrule the California listing but \u003ca href=\"http://www.latimes.com/business/la-fi-roundup-california-20170314-story.html\">lost in March\u003c/a>, and it has appealed that decision. Its bid to temporarily halt the cancer listing pending trial was rejected by a state appellate court and the California Supreme Court. The company says that labeling glyphosate a cancer risk is unjustified.\u003c/p>\n\u003cp>It argues that the International Agency for Research on Cancer erred by neglecting to consider data suggesting no link between glyphosate and non-Hodgkin lymphoma. That research was in an unpublished part of the multiyear and multifaceted \u003ca href=\"https://aghealth.nih.gov/\" target=\"_blank\" rel=\"noopener\">Agricultural Health Study\u003c/a>, which assesses the effects of pesticide exposure on farmers. The international cancer agency, an independent panel of scientists, said it weighs only published, peer-reviewed studies.\u003c/p>\n\u003cp>Other studies also have failed to establish a convincing link between glyphosate and cancer. Earlier this year, the European Union’s chemical safety regulator determined there was \u003ca href=\"https://echa.europa.eu/-/glyphosate-not-classified-as-a-carcinogen-by-echa\" target=\"_blank\" rel=\"noopener\">not sufficient evidence\u003c/a> to classify glyphosate as a carcinogen, though it did say the compound could cause eye damage and long-term harm to aquatic life.\u003c/p>\n\u003cp>But the international cancer agency, which said it examined about 1,000 studies, determined there was enough information to support its finding of a link between glyphosate and cancer.\u003c/p>\n\u003cp>Advocates for farmers say California’s plan to require warning labels for glyphosate-based products is wrong-headed. At a June hearing, Cynthia Cory, environmental affairs director for the nonprofit California Farm Bureau Federation, told the board of the health hazard assessment agency that the herbicide is an important tool for farmers. It ultimately benefits the environment, she said, because “it allows us to reduce our tractor passes, which means you have cleaner air.”\u003c/p>\n\u003cp>Dr. Michelle Perro, a pediatrician who treats children for glyphosate exposure, offered the board a different viewpoint. “What I am seeing is sicker kids,” she said.\u003c/p>\n\u003cp>Research suggests that Roundup and other glyphosate-based herbicides may be linked not only to cancer but to a variety of \u003ca href=\"http://www.mdpi.com/1099-4300/15/4/1416\" target=\"_blank\" rel=\"noopener\">other health problems\u003c/a>. Recent studies link the compound to DNA and chromosomal damage in human cells, kidney failure, chronic kidney disease, intestinal disorders, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/\" target=\"_blank\" rel=\"noopener\">Celiac disease\u003c/a> and autism.\u003c/p>\n\u003cp>About 250 million pounds of glyphosate were sprayed on U.S. crops in 2014, a ninefold increase in just under two decades, according to \u003ca href=\"https://enveurope.springeropen.com/articles/10.1186/s12302-016-0070-0\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> in the journal Environmental Sciences Europe. Two-thirds of all the glyphosate used in the U.S. during the 40 years from 1974 to 2014 was sprayed in the last decade.\u003c/p>\n\u003cp>And you don’t need to live next to farm fields to be exposed to it, said Dr. Paul Winchester, a clinical professor of neonatology at Indiana University School of Medicine and medical director of the neonatal unit at Franciscan St. Francis Health in Indianapolis. “It turns out it’s in almost every [non-organic] food.”\u003c/p>\n\u003cp>That concerns him in light of a \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066318\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that suggests chromosomal damage caused by pesticides has the potential to embed in DNA and get passed down to future generations.\u003c/p>\n\u003cp>Teri McCall said she applauds California’s decision to list glyphosate as a carcinogen and hopes it will help protect others from the kind of loss she’s suffered.\u003c/p>\n\u003cp>Since her husband’s death, “it’s kind of like my life of living color has gone to black-and-white,” she said. “My life with Jack was just so full of joy and laughter and fun, and this has just left a huge void. … Every day is just a series of efforts to escape the loss and there’s just no escaping it.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener\">California Health Care Foundation\u003c/a>.\u003c/em>\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>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "California has listed the active ingredient in Monsanto’s Roundup as cancer-causing.",
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"nprByline": "\u003ca href=\"https://khn.org/news/author/stephanie-oneill/\" target=\"_blank\" rel=\"noopener\">Stephanie O'Neill\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jack McCall was a fixture at the local farmers market, where he sold avocados and other fruits he grew on his 20-acre ranch in Cambria, on California’s Central Coast.\u003c/p>\n\u003cp>The U.S. postal worker and Little League coach was “very environmentally friendly,” said Teri McCall, his wife of 41 years. He avoided chemicals, using only his tractor-mower to root out the thistle and other weeds that continually sprouted on the flat areas of the ranch.\u003c/p>\n\u003cp>But he did make one exception to that rule — a fateful one, his wife now believes. For more than three decades, on the hilly parts of the ranch where he grew the avocados, and around newly planted fruit trees, Jack donned a backpack sprayer and doused weeds with the widely sold herbicide Roundup.\u003c/p>\n\u003cp>“He believed Roundup was safe,” Teri McCall said, noting that St. Louis-based Monsanto Co. has regularly touted its flagship product as \u003ca href=\"https://www.youtube.com/watch?v=vJboNdWoFws\" target=\"_blank\" rel=\"noopener\">harmless to people and pets\u003c/a>.\u003c/p>\n\u003cp>In 2012, the McCalls’ 6-year-old dog, Duke, who regularly accompanied Jack around the farm, fell ill with swollen lymph nodes in his neck and died shortly afterward of lymphoma — a type of blood cancer. Three years later, Jack discovered swollen lymph nodes in his own neck, Teri said. The diagnosis: a rare form of non-Hodgkin lymphoma, which killed him on Dec. 26, 2015.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I thought, ‘That’s kind of a coincidence that they both got lumps in their neck,’” Teri recalled. “Then I thought about all the time Duke spent sticking his nose in grass that had been sprayed with Roundup.”\u003c/p>\n\u003cp>In March 2016, McCall filed a \u003ca href=\"http://baumhedlundlaw.com/pdf/monsanto-documents/Teri-McCall-Monsanto-Roundup-Lawsuit-Complaint.pdf\" target=\"_blank\" rel=\"noopener\">wrongful death lawsuit\u003c/a> against Monsanto, alleging that the company concealed the cancer risk posed by a chemical called “glyphosate,” the active ingredient in Roundup, which she now blames for the deaths of her husband and their dog.\u003c/p>\n\u003cp>Hundreds of similar lawsuits are pending in federal and state courthouses around the United States.\u003c/p>\n\u003cp>Monsanto vigorously contests them.\u003c/p>\n\u003cp>“To be clear: The underlying science behind glyphosate is not at question,” said Scott Partridge, the company’s vice president of global strategy. “Monsanto’s glyphosate-based herbicides have a long history of safe use and have been studied in real-world application, including the largest study ever of the actual use of pesticides by farmers.”\u003c/p>\n\u003cp>Monsanto’s Partridge contended that “cherry-picking isolated documents out of context is an attempt by the plaintiffs’ attorneys in pending litigation to distract from the science, which is not on their side.”\u003c/p>\n\u003cp>The use of glyphosate has grown exponentially in the past two decades. The chemical has found its way into the food chain — and into people’s bodies. A \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2658306\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published this week in the medical journal JAMA showed that the number of Southern California adults who tested positive for glyphosate in their urine rose dramatically from 1993 to 2016, as did the amount of the chemical in those who excreted it.\u003c/p>\n\u003cp>In July, California added glyphosate to its list of cancer-causing chemicals under the \u003ca href=\"https://oehha.ca.gov/proposition-65\" target=\"_blank\" rel=\"noopener\">Safe Drinking Water and Toxic Enforcement Act of 1986.\u003c/a> The act, also known as Proposition 65, requires businesses to warn consumers if their products or facilities contain potentially unsafe amounts of any toxic substances known to cause cancer, birth defects or other reproductive harm.\u003c/p>\n\u003cp>California is the first state in the U.S. to “take regulatory action to protect our residents from this chemical,” said Olga Naidenko, senior science adviser for the Environmental Working Group, a nonprofit research and advocacy organization. The move is “a huge step and has global implications.”\u003c/p>\n\u003cp>The state’s Office of Environmental Health Hazard Assessment, which is responsible for listing chemicals under Proposition 65, has proposed a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/glyphosate032917isor.pdf\" target=\"_blank\" rel=\"noopener\">threshold\u003c/a> of 1.1 milligrams of glyphosate a day for an adult weighing 70 kilograms, or 154 pounds. That’s about 122 times more stringent than the federal Environmental Protection Agency’s safety guideline.\u003c/p>\n\u003cp>The state agency is studying more than 1,300 written public comments, along with oral testimony from a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/060717glyphosatetranscript.pdf\" target=\"_blank\" rel=\"noopener\">June hearing\u003c/a>, to decide whether it should implement or revise its proposed limit.\u003c/p>\n\u003cp>The Prop. 65 listing requires warning labels beginning next July.\u003c/p>\n\u003cp>Other companies, including Dow AgroSciences and DuPont, also sell products containing glyphosate, since Monsanto’s patent expired in 2000.\u003c/p>\n\u003cp>California’s decision to list the chemical was triggered by a 2015 \u003ca href=\"https://www.iarc.fr/en/media-centre/iarcnews/pdf/MonographVolume112.pdf\">study\u003c/a> from the World Health Organization that described the chemical as “probably carcinogenic to humans” and cited “convincing evidence that glyphosate also can cause cancer in laboratory animals.”\u003c/p>\n\u003cp>The organization’s International Agency for Research on Cancer found a “positive association” between exposure to glyphosate and malignancy in humans, though it added that other explanations could not be excluded. In particular, the international agency found a possible link to non-Hodgkin lymphoma, the type of cancer that killed Jack McCall.\u003c/p>\n\u003cp>Monsanto sued in state Superior Court to overrule the California listing but \u003ca href=\"http://www.latimes.com/business/la-fi-roundup-california-20170314-story.html\">lost in March\u003c/a>, and it has appealed that decision. Its bid to temporarily halt the cancer listing pending trial was rejected by a state appellate court and the California Supreme Court. The company says that labeling glyphosate a cancer risk is unjustified.\u003c/p>\n\u003cp>It argues that the International Agency for Research on Cancer erred by neglecting to consider data suggesting no link between glyphosate and non-Hodgkin lymphoma. That research was in an unpublished part of the multiyear and multifaceted \u003ca href=\"https://aghealth.nih.gov/\" target=\"_blank\" rel=\"noopener\">Agricultural Health Study\u003c/a>, which assesses the effects of pesticide exposure on farmers. The international cancer agency, an independent panel of scientists, said it weighs only published, peer-reviewed studies.\u003c/p>\n\u003cp>Other studies also have failed to establish a convincing link between glyphosate and cancer. Earlier this year, the European Union’s chemical safety regulator determined there was \u003ca href=\"https://echa.europa.eu/-/glyphosate-not-classified-as-a-carcinogen-by-echa\" target=\"_blank\" rel=\"noopener\">not sufficient evidence\u003c/a> to classify glyphosate as a carcinogen, though it did say the compound could cause eye damage and long-term harm to aquatic life.\u003c/p>\n\u003cp>But the international cancer agency, which said it examined about 1,000 studies, determined there was enough information to support its finding of a link between glyphosate and cancer.\u003c/p>\n\u003cp>Advocates for farmers say California’s plan to require warning labels for glyphosate-based products is wrong-headed. At a June hearing, Cynthia Cory, environmental affairs director for the nonprofit California Farm Bureau Federation, told the board of the health hazard assessment agency that the herbicide is an important tool for farmers. It ultimately benefits the environment, she said, because “it allows us to reduce our tractor passes, which means you have cleaner air.”\u003c/p>\n\u003cp>Dr. Michelle Perro, a pediatrician who treats children for glyphosate exposure, offered the board a different viewpoint. “What I am seeing is sicker kids,” she said.\u003c/p>\n\u003cp>Research suggests that Roundup and other glyphosate-based herbicides may be linked not only to cancer but to a variety of \u003ca href=\"http://www.mdpi.com/1099-4300/15/4/1416\" target=\"_blank\" rel=\"noopener\">other health problems\u003c/a>. Recent studies link the compound to DNA and chromosomal damage in human cells, kidney failure, chronic kidney disease, intestinal disorders, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/\" target=\"_blank\" rel=\"noopener\">Celiac disease\u003c/a> and autism.\u003c/p>\n\u003cp>About 250 million pounds of glyphosate were sprayed on U.S. crops in 2014, a ninefold increase in just under two decades, according to \u003ca href=\"https://enveurope.springeropen.com/articles/10.1186/s12302-016-0070-0\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> in the journal Environmental Sciences Europe. Two-thirds of all the glyphosate used in the U.S. during the 40 years from 1974 to 2014 was sprayed in the last decade.\u003c/p>\n\u003cp>And you don’t need to live next to farm fields to be exposed to it, said Dr. Paul Winchester, a clinical professor of neonatology at Indiana University School of Medicine and medical director of the neonatal unit at Franciscan St. Francis Health in Indianapolis. “It turns out it’s in almost every [non-organic] food.”\u003c/p>\n\u003cp>That concerns him in light of a \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066318\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that suggests chromosomal damage caused by pesticides has the potential to embed in DNA and get passed down to future generations.\u003c/p>\n\u003cp>Teri McCall said she applauds California’s decision to list glyphosate as a carcinogen and hopes it will help protect others from the kind of loss she’s suffered.\u003c/p>\n\u003cp>Since her husband’s death, “it’s kind of like my life of living color has gone to black-and-white,” she said. “My life with Jack was just so full of joy and laughter and fun, and this has just left a huge void. … Every day is just a series of efforts to escape the loss and there’s just no escaping it.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener\">California Health Care Foundation\u003c/a>.\u003c/em>\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>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Beyond The Shattered Lives And Bodies, Money Worries Weigh On Las Vegas Victims",
"title": "Beyond The Shattered Lives And Bodies, Money Worries Weigh On Las Vegas Victims",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp class=\"p1\">LAS VEGAS — Kurt Fowler and his wife, Trina, were celebrating their 18th wedding anniversary at a country music festival when the shooting started. Fowler, 41, knew he’d been hit in the ankle and couldn’t run. He hid under the stage until the gunfire ended.\u003c/p>\n\u003cp class=\"p1\">“I knew my foot was completely useless,” said Fowler, a firefighter from Lake Havasu City, Ariz., and a father of three. He underwent surgery, spent nearly two weeks in the hospital and still may need another operation. He also will need rehabilitation and follow-up visits with a specialist.\u003c/p>\n\u003cp class=\"p1\">Fowler has a Blue Cross Blue Shield PPO through his job, but he said he doesn’t know how much he will have to pay out of his own pocket for the care he is receiving. In an era of higher deductibles and limited choice of in-network doctors, however, he knows he could face significant medical bills.\u003c/p>\n\u003cp class=\"p1\">His insurance card says his individual deductible is $5,000 and his coinsurance 20 percent. He said he didn’t know how much his health plan would cover for out-of-state care.\u003c/p>\n\u003cp class=\"p1\">“Medical expenses are astronomical these days,” Fowler said from his bed at Sunrise Hospital & Medical Center here. “It’s a mountain that just doesn’t seem like it’s gonna be climbable, but we are gonna do our best.”\u003c/p>\n\u003cfigure id=\"attachment_361805\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361805\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kurt Fowler looks at an X-ray of his ankle as he sits in a hospital bed at Sunrise Hospital & Medical Center. Fowler, a firefighter from Arizona, got shot in the ankle and said he expects to be out of work for months as he recovers. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">As hundreds of survivors struggle to recover emotionally and physically from the Oct. 1 attack, they are beginning to come to terms with the financial toll of the violence perpetrated against them. Even those who are insured could face untold costs in a city they were only visiting.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">The total costs of medical care alone could reach into the tens of millions of dollars, said Garen Wintemute, who researches gun violence at the University of California-Davis. And that is just the beginning. Many survivors will be out of work for months, if they are able to return at all.\u003c/p>\n\u003cp class=\"p1\">“We really don’t have a good handle on the intangible costs of something like this … the ripple effects on family and friends and neighborhoods when a large number of people have been shot,” Wintemute said.\u003c/p>\n\u003cp class=\"p1\">More than 100,000 people are shot every year in the U.S., according to the Centers for Disease Control and Prevention. That generates about $2.8 billion per year in emergency room and inpatient charges alone, according to a recent study in \u003cspan class=\"s1\">Health Affairs\u003c/span>. The average emergency room bill for an individual gunshot victim is $5,254 and the average inpatient charge is $95,887, according to the study.\u003c/p>\n\u003cp class=\"p1\">The U.S. senators representing Nevada, Dean Heller and Catherine Cortez Masto, wrote a \u003cspan class=\"s1\">letter \u003c/span>to America’s Health Insurance Plans, an industry trade group, and CEO Scott Serota of Blue Cross Blue Shield requesting help with out-of-network bills, copayments and deductibles for the Las Vegas shooting victims. Many of the people who were shot had traveled from other states, including California, Iowa and Tennessee.\u003c/p>\n\u003cp class=\"p1\">California and some states protect consumers from such bills, but Nevada is not one of them, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. But Corlette said most insurers allow patients to request exceptions based on the circumstances. “In this situation, I imagine most insurers are going to want to be compassionate and work something out,” she said.\u003c/p>\n\u003cp class=\"p1\">The victims and their families aren’t the only ones who will be affected financially by the mass shooting. Taxpayers, too, pick up much of the tab for the health care costs associated with gun violence because many patients are covered by Medicaid and Medicare, two government insurance programs.\u003c/p>\n\u003cp class=\"p1\">And hospitals will also be on the hook for some of the care for patients who don’t have insurance. Hospitals in Las Vegas quickly mobilized to treat the hundreds of victims who were streaming in that night, and they don’t know yet how much of the care will be reimbursed.\u003c/p>\n\u003cp class=\"p1\">At Sunrise Hospital & Medical Center, staff treated more than 200 patients. Sunrise plans to file insurance claims and will “be extremely sensitive to the financial status” of patients when considering their out-of-pocket portions, a spokeswoman said.\u003c/p>\n\u003cp class=\"p1\">Valley Hospital Medical Center is encouraging patients to complete paperwork for a state program called Nevada Victims of Violent Crime, which would pay their balances. And Dignity Health’s St. Rose Dominican said it will bill insurers and accept donations but will not require payment from victims.\u003c/p>\n\u003cp class=\"p1\">California victims can also get help with medical expenses and income loss from the \u003cspan class=\"s1\">California \u003c/span>Victim Compensation Board.\u003c/p>\n\u003cp class=\"p1\">In addition, a GoFundMe account started by a Clark County commissioner has raised $11 million thus far. And many survivors have individual GoFundMe accounts.\u003c/p>\n\u003cp class=\"p1\">Kurt Fowler’s GoFundMe page has raised about $39,000. Fowler said he doesn’t have disability insurance so he will rely on the funds to help cover his expenses while he is recovering and missing work.\u003c/p>\n\u003cp class=\"p1\">Michael Caster, 41, who lives in Indio, Calif., has a GoFundMe account that has raised about $26,000 so far. He’s paralyzed from the waist down after a bullet lodged in his spine.\u003c/p>\n\u003cp class=\"p1\">He works in human resources at a California hospital and has a job-sponsored policy with Anthem Blue Cross. “I’ve never really dealt with injury,” he said. “I don’t want to be stuck with a bunch of bills.”\u003c/p>\n\u003cp class=\"p1\">His bills could rise further: That day, he was scheduled to be flown to a rehabilitation center in Colorado for people with spinal cord injuries.\u003c/p>\n\u003cfigure id=\"attachment_361804\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361804\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Frost-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Mary Moreland gets an update on her daughter from neurosurgeon Keith Blum at Sunrise Hospital & Medical Center. Moreland’s daughter, Tina Frost, was shot in the eye and was in a medically induced coma for two weeks. Frost has insurance through her job as an accountant in San Diego, but her mother said she knows it won’t cover everything. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Mary Moreland, whose daughter Tina Frost was shot during the country music festival, said that at first she didn’t understand why so many families were setting up fundraisers. Then, the severe financial strain the shooting would take started to dawn on her.\u003c/p>\n\u003cp class=\"p1\">Now, Moreland said she’s grateful for the nearly $580,000 raised through GoFundMe. Frost, a resident of San Diego, had emergency brain surgery the night of the shooting. A bullet had pierced her eye and exploded in her brain. As she lay in ICU earlier this month, her mother said small improvements were major milestones. “Today she squeezed my hands,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">The next night, Frost came out of a medically induced coma and was later flown to Johns Hopkins Hospital in Baltimore, near her mother’s home. Over the next weeks and months, she will need multiple operations and a slew of specialists, including neurosurgeons, plastic surgeons, occupational therapists and mental health counselors.\u003c/p>\n\u003cfigure id=\"attachment_361803\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361803\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from a GoFundMe page set up for Tina Frost, who was shot at the country music festival in Las Vegas. Frost was at Sunrise Hospital & Medical Center for two weeks and was recently flown to a hospital near her mother’s home in Maryland. \u003ccite>(Courtesy of GoFundMe)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Moreland said she cannot even begin to imagine what her daughter’s care will cost. Frost has Blue Cross insurance through her job at Ernst & Young in San Diego, but Moreland said she doesn’t know what the deductible and copayments are.\u003c/p>\n\u003cp class=\"p1\">“Being realistic, knowing what I know about costs of health care, it’s scary,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">“But she’s alive. She’s not one of the 58 other people.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp class=\"p3\">\u003cem>\u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">Kaiser Health News\u003c/span>\u003c/a>, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Many of the gunshot survivors who suffered serious injuries face not only high deductibles and out-of-network charges but also lost wages.",
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"description": "Many of the gunshot survivors who suffered serious injuries face not only high deductibles and out-of-network charges but also lost wages.",
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"nprByline": "\u003ca href=\"https://khn.org/news/author/anna-gorman/\" rel=\"noopener\" target=\"_blank\">\u003cstrong>Anna Gorman\u003c/strong>\u003c/a>\u003cbr>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">LAS VEGAS — Kurt Fowler and his wife, Trina, were celebrating their 18th wedding anniversary at a country music festival when the shooting started. Fowler, 41, knew he’d been hit in the ankle and couldn’t run. He hid under the stage until the gunfire ended.\u003c/p>\n\u003cp class=\"p1\">“I knew my foot was completely useless,” said Fowler, a firefighter from Lake Havasu City, Ariz., and a father of three. He underwent surgery, spent nearly two weeks in the hospital and still may need another operation. He also will need rehabilitation and follow-up visits with a specialist.\u003c/p>\n\u003cp class=\"p1\">Fowler has a Blue Cross Blue Shield PPO through his job, but he said he doesn’t know how much he will have to pay out of his own pocket for the care he is receiving. In an era of higher deductibles and limited choice of in-network doctors, however, he knows he could face significant medical bills.\u003c/p>\n\u003cp class=\"p1\">His insurance card says his individual deductible is $5,000 and his coinsurance 20 percent. He said he didn’t know how much his health plan would cover for out-of-state care.\u003c/p>\n\u003cp class=\"p1\">“Medical expenses are astronomical these days,” Fowler said from his bed at Sunrise Hospital & Medical Center here. “It’s a mountain that just doesn’t seem like it’s gonna be climbable, but we are gonna do our best.”\u003c/p>\n\u003cfigure id=\"attachment_361805\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361805\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kurt Fowler looks at an X-ray of his ankle as he sits in a hospital bed at Sunrise Hospital & Medical Center. Fowler, a firefighter from Arizona, got shot in the ankle and said he expects to be out of work for months as he recovers. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">As hundreds of survivors struggle to recover emotionally and physically from the Oct. 1 attack, they are beginning to come to terms with the financial toll of the violence perpetrated against them. Even those who are insured could face untold costs in a city they were only visiting.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">The total costs of medical care alone could reach into the tens of millions of dollars, said Garen Wintemute, who researches gun violence at the University of California-Davis. And that is just the beginning. Many survivors will be out of work for months, if they are able to return at all.\u003c/p>\n\u003cp class=\"p1\">“We really don’t have a good handle on the intangible costs of something like this … the ripple effects on family and friends and neighborhoods when a large number of people have been shot,” Wintemute said.\u003c/p>\n\u003cp class=\"p1\">More than 100,000 people are shot every year in the U.S., according to the Centers for Disease Control and Prevention. That generates about $2.8 billion per year in emergency room and inpatient charges alone, according to a recent study in \u003cspan class=\"s1\">Health Affairs\u003c/span>. The average emergency room bill for an individual gunshot victim is $5,254 and the average inpatient charge is $95,887, according to the study.\u003c/p>\n\u003cp class=\"p1\">The U.S. senators representing Nevada, Dean Heller and Catherine Cortez Masto, wrote a \u003cspan class=\"s1\">letter \u003c/span>to America’s Health Insurance Plans, an industry trade group, and CEO Scott Serota of Blue Cross Blue Shield requesting help with out-of-network bills, copayments and deductibles for the Las Vegas shooting victims. Many of the people who were shot had traveled from other states, including California, Iowa and Tennessee.\u003c/p>\n\u003cp class=\"p1\">California and some states protect consumers from such bills, but Nevada is not one of them, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. But Corlette said most insurers allow patients to request exceptions based on the circumstances. “In this situation, I imagine most insurers are going to want to be compassionate and work something out,” she said.\u003c/p>\n\u003cp class=\"p1\">The victims and their families aren’t the only ones who will be affected financially by the mass shooting. Taxpayers, too, pick up much of the tab for the health care costs associated with gun violence because many patients are covered by Medicaid and Medicare, two government insurance programs.\u003c/p>\n\u003cp class=\"p1\">And hospitals will also be on the hook for some of the care for patients who don’t have insurance. Hospitals in Las Vegas quickly mobilized to treat the hundreds of victims who were streaming in that night, and they don’t know yet how much of the care will be reimbursed.\u003c/p>\n\u003cp class=\"p1\">At Sunrise Hospital & Medical Center, staff treated more than 200 patients. Sunrise plans to file insurance claims and will “be extremely sensitive to the financial status” of patients when considering their out-of-pocket portions, a spokeswoman said.\u003c/p>\n\u003cp class=\"p1\">Valley Hospital Medical Center is encouraging patients to complete paperwork for a state program called Nevada Victims of Violent Crime, which would pay their balances. And Dignity Health’s St. Rose Dominican said it will bill insurers and accept donations but will not require payment from victims.\u003c/p>\n\u003cp class=\"p1\">California victims can also get help with medical expenses and income loss from the \u003cspan class=\"s1\">California \u003c/span>Victim Compensation Board.\u003c/p>\n\u003cp class=\"p1\">In addition, a GoFundMe account started by a Clark County commissioner has raised $11 million thus far. And many survivors have individual GoFundMe accounts.\u003c/p>\n\u003cp class=\"p1\">Kurt Fowler’s GoFundMe page has raised about $39,000. Fowler said he doesn’t have disability insurance so he will rely on the funds to help cover his expenses while he is recovering and missing work.\u003c/p>\n\u003cp class=\"p1\">Michael Caster, 41, who lives in Indio, Calif., has a GoFundMe account that has raised about $26,000 so far. He’s paralyzed from the waist down after a bullet lodged in his spine.\u003c/p>\n\u003cp class=\"p1\">He works in human resources at a California hospital and has a job-sponsored policy with Anthem Blue Cross. “I’ve never really dealt with injury,” he said. “I don’t want to be stuck with a bunch of bills.”\u003c/p>\n\u003cp class=\"p1\">His bills could rise further: That day, he was scheduled to be flown to a rehabilitation center in Colorado for people with spinal cord injuries.\u003c/p>\n\u003cfigure id=\"attachment_361804\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361804\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Frost-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Mary Moreland gets an update on her daughter from neurosurgeon Keith Blum at Sunrise Hospital & Medical Center. Moreland’s daughter, Tina Frost, was shot in the eye and was in a medically induced coma for two weeks. Frost has insurance through her job as an accountant in San Diego, but her mother said she knows it won’t cover everything. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Mary Moreland, whose daughter Tina Frost was shot during the country music festival, said that at first she didn’t understand why so many families were setting up fundraisers. Then, the severe financial strain the shooting would take started to dawn on her.\u003c/p>\n\u003cp class=\"p1\">Now, Moreland said she’s grateful for the nearly $580,000 raised through GoFundMe. Frost, a resident of San Diego, had emergency brain surgery the night of the shooting. A bullet had pierced her eye and exploded in her brain. As she lay in ICU earlier this month, her mother said small improvements were major milestones. “Today she squeezed my hands,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">The next night, Frost came out of a medically induced coma and was later flown to Johns Hopkins Hospital in Baltimore, near her mother’s home. Over the next weeks and months, she will need multiple operations and a slew of specialists, including neurosurgeons, plastic surgeons, occupational therapists and mental health counselors.\u003c/p>\n\u003cfigure id=\"attachment_361803\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361803\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from a GoFundMe page set up for Tina Frost, who was shot at the country music festival in Las Vegas. Frost was at Sunrise Hospital & Medical Center for two weeks and was recently flown to a hospital near her mother’s home in Maryland. \u003ccite>(Courtesy of GoFundMe)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Moreland said she cannot even begin to imagine what her daughter’s care will cost. Frost has Blue Cross insurance through her job at Ernst & Young in San Diego, but Moreland said she doesn’t know what the deductible and copayments are.\u003c/p>\n\u003cp class=\"p1\">“Being realistic, knowing what I know about costs of health care, it’s scary,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">“But she’s alive. She’s not one of the 58 other people.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p3\">\u003cem>\u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">Kaiser Health News\u003c/span>\u003c/a>, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Two Senators Reach Deal On A Health Law Fix, But Bringing Congress Along Is Tricky",
"title": "Two Senators Reach Deal On A Health Law Fix, But Bringing Congress Along Is Tricky",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>After nearly two months of negotiations, key senators said Tuesday they have reached a bipartisan deal on a proposal intended to stabilize the Affordable Care Act’s insurance market, which has been rocked by recent actions by President Donald Trump.\u003c/p>\n\u003cp>Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), respectively the chairman and the top Democrat of the Senate Health, Education, Labor and Pensions Committee, negotiated the emerging deal. The milestone agreement, they said, would guarantee payment of “cost-sharing reduction” subsidies that help some policyholders with low incomes afford their deductibles and other out-of-pocket costs for two years, 2018 and 2019.\u003c/p>\n\u003cp>Trump \u003ca href=\"https://khn.org/news/trump-acting-solo-what-you-need-to-know-about-changes-to-the-health-law/\">announced last week\u003c/a> that he would stop funding the subsidies, which have been the subject of a \u003ca href=\"https://khn.org/news/5-things-to-know-about-the-health-issue-that-could-shut-down-the-government/\">long-running lawsuit\u003c/a>. These subsidies are separate from the tax credit subsidies that help eligible consumers pay for their premiums. Those premium subsidies are not affected by Trump’s action.\u003c/p>\n\u003cp>Even if it fails to become law, the deal marks a singular achievement that has been almost completely missing in Congress for the past eight years — a bipartisan compromise on how to make the nation’s health insurance system work.\u003c/p>\n\u003cp>“This is an agreement I am proud to support,” said Murray on the Senate floor, “because of the message it sends about how to get things done.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The proposal — which will require 60 votes to pass the Senate and agreement from a still-dubious House of Representatives — would also restore $110 million in \u003ca href=\"https://khn.org/news/latest-snag-in-aca-sign-ups-those-who-guide-consumers-are-hitting-roadblocks/\">“outreach” funding\u003c/a> cut by the Trump administration. That funding would help guide eligible individuals to sign up for coverage on the health insurance exchanges during the open enrollment period that runs from Nov. 1 to Dec. 15.\u003c/p>\n\u003cp>In exchange for those provisions, urged by Democrats and \u003ca href=\"https://khn.org/news/5-governors-press-congress-for-fast-bucks-to-secure-obamacare-market-in-2018/\">state officials\u003c/a>, Republicans will win some changes to make it easier for states to apply for “waivers” that would let them experiment with alternative ways to provide and subsidize health insurance. The deal would also allow the sale of less comprehensive “catastrophic” plans in the health exchanges. Such plans currently can be sold only to those under age 30.\u003c/p>\n\u003cp>On the Senate floor Tuesday afternoon, Alexander said, “This agreement avoids chaos. I don’t know a Democrat or a Republican who benefits from chaos.”\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) reserved judgment about the deal.\u003c/p>\n\u003cp>Both parties still have some major disagreements when it comes to health care, Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters Tuesday afternoon, but “I think there’s a growing consensus that in the short term we need stability in the markets. So we’ve achieved stability if this agreement becomes law.”\u003c/p>\n\u003cp>More than 60 senators have already participated in the meetings that led to the deal, Alexander said on the Senate floor. But the path to passage in the House is uncertain — with many conservatives vehemently opposed to anything that could be construed as helping the law they call “Obamacare” succeed.\u003c/p>\n\u003cp>Tweeted Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, Tuesday: “The GOP should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable.”\u003c/p>\n\u003cp>Both Murray and Alexander said Tuesday they were still struggling over language to make sure that if the cost-sharing payments are resumed, insurers would not receive a windfall by keeping both those payments and the higher premiums that many states are allowing in anticipation of the payments being ended.\u003c/p>\n\u003cp>“We want to make sure that the cost-sharing payments go to the benefit of consumers, not the insurance companies,” Alexander said.\u003c/p>\n\u003cp>Trump, who as \u003ca href=\"https://www.whitehouse.gov/the-press-office/2017/10/16/remarks-president-trump-cabinet-meeting\">recently as Monday\u003c/a> called the cost-sharing subsidies “a payoff” to insurance companies, took credit for the negotiations. “If I didn’t cut the CSR’s, they wouldn’t be meeting,” he said. That was not, in fact, the case. The negotiations had picked up \u003ca href=\"http://www.politico.com/story/2017/09/28/alexander-murray-obamacare-plan-243258\">some weeks ago\u003c/a> after being called off earlier in September while the Senate tried for one last-ditch repeal vote.\u003c/p>\n\u003cp>On Friday, White House Budget Director Mick Mulvaney told \u003ca href=\"http://www.politico.com/story/2017/10/13/trump-opposes-bipartisan-obamacare-rescue-plan-243752\">Politico\u003c/a> that the president would not allow a short-term fix, calling a restoration of the cost-sharing reduction funds “corporate welfare and bailouts for the insurance companies.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But on Tuesday the president hailed the deal. “We think it’s going to not only save money, but give people much better health care with a very, very much smaller premium spike,” he told reporters.\u003c/p>\n\n",
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"excerpt": "The proposal is intended to stabilize the Affordable Care Act’s insurance markets, which have been rocked by recent actions by President Donald Trump.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After nearly two months of negotiations, key senators said Tuesday they have reached a bipartisan deal on a proposal intended to stabilize the Affordable Care Act’s insurance market, which has been rocked by recent actions by President Donald Trump.\u003c/p>\n\u003cp>Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), respectively the chairman and the top Democrat of the Senate Health, Education, Labor and Pensions Committee, negotiated the emerging deal. The milestone agreement, they said, would guarantee payment of “cost-sharing reduction” subsidies that help some policyholders with low incomes afford their deductibles and other out-of-pocket costs for two years, 2018 and 2019.\u003c/p>\n\u003cp>Trump \u003ca href=\"https://khn.org/news/trump-acting-solo-what-you-need-to-know-about-changes-to-the-health-law/\">announced last week\u003c/a> that he would stop funding the subsidies, which have been the subject of a \u003ca href=\"https://khn.org/news/5-things-to-know-about-the-health-issue-that-could-shut-down-the-government/\">long-running lawsuit\u003c/a>. These subsidies are separate from the tax credit subsidies that help eligible consumers pay for their premiums. Those premium subsidies are not affected by Trump’s action.\u003c/p>\n\u003cp>Even if it fails to become law, the deal marks a singular achievement that has been almost completely missing in Congress for the past eight years — a bipartisan compromise on how to make the nation’s health insurance system work.\u003c/p>\n\u003cp>“This is an agreement I am proud to support,” said Murray on the Senate floor, “because of the message it sends about how to get things done.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The proposal — which will require 60 votes to pass the Senate and agreement from a still-dubious House of Representatives — would also restore $110 million in \u003ca href=\"https://khn.org/news/latest-snag-in-aca-sign-ups-those-who-guide-consumers-are-hitting-roadblocks/\">“outreach” funding\u003c/a> cut by the Trump administration. That funding would help guide eligible individuals to sign up for coverage on the health insurance exchanges during the open enrollment period that runs from Nov. 1 to Dec. 15.\u003c/p>\n\u003cp>In exchange for those provisions, urged by Democrats and \u003ca href=\"https://khn.org/news/5-governors-press-congress-for-fast-bucks-to-secure-obamacare-market-in-2018/\">state officials\u003c/a>, Republicans will win some changes to make it easier for states to apply for “waivers” that would let them experiment with alternative ways to provide and subsidize health insurance. The deal would also allow the sale of less comprehensive “catastrophic” plans in the health exchanges. Such plans currently can be sold only to those under age 30.\u003c/p>\n\u003cp>On the Senate floor Tuesday afternoon, Alexander said, “This agreement avoids chaos. I don’t know a Democrat or a Republican who benefits from chaos.”\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) reserved judgment about the deal.\u003c/p>\n\u003cp>Both parties still have some major disagreements when it comes to health care, Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters Tuesday afternoon, but “I think there’s a growing consensus that in the short term we need stability in the markets. So we’ve achieved stability if this agreement becomes law.”\u003c/p>\n\u003cp>More than 60 senators have already participated in the meetings that led to the deal, Alexander said on the Senate floor. But the path to passage in the House is uncertain — with many conservatives vehemently opposed to anything that could be construed as helping the law they call “Obamacare” succeed.\u003c/p>\n\u003cp>Tweeted Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, Tuesday: “The GOP should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable.”\u003c/p>\n\u003cp>Both Murray and Alexander said Tuesday they were still struggling over language to make sure that if the cost-sharing payments are resumed, insurers would not receive a windfall by keeping both those payments and the higher premiums that many states are allowing in anticipation of the payments being ended.\u003c/p>\n\u003cp>“We want to make sure that the cost-sharing payments go to the benefit of consumers, not the insurance companies,” Alexander said.\u003c/p>\n\u003cp>Trump, who as \u003ca href=\"https://www.whitehouse.gov/the-press-office/2017/10/16/remarks-president-trump-cabinet-meeting\">recently as Monday\u003c/a> called the cost-sharing subsidies “a payoff” to insurance companies, took credit for the negotiations. “If I didn’t cut the CSR’s, they wouldn’t be meeting,” he said. That was not, in fact, the case. The negotiations had picked up \u003ca href=\"http://www.politico.com/story/2017/09/28/alexander-murray-obamacare-plan-243258\">some weeks ago\u003c/a> after being called off earlier in September while the Senate tried for one last-ditch repeal vote.\u003c/p>\n\u003cp>On Friday, White House Budget Director Mick Mulvaney told \u003ca href=\"http://www.politico.com/story/2017/10/13/trump-opposes-bipartisan-obamacare-rescue-plan-243752\">Politico\u003c/a> that the president would not allow a short-term fix, calling a restoration of the cost-sharing reduction funds “corporate welfare and bailouts for the insurance companies.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But on Tuesday the president hailed the deal. “We think it’s going to not only save money, but give people much better health care with a very, very much smaller premium spike,” he told reporters.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Las Vegas Faced a Massacre. Did It Have Enough Trauma Centers?",
"title": "Las Vegas Faced a Massacre. Did It Have Enough Trauma Centers?",
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"content": "\u003cp>Las Vegas is not only a glittering strip of casinos and hotels but a fast-growing region with more than 2 million residents — and one hospital designated as a highest-level trauma center.\u003c/p>\n\u003cp>The deadly shooting Sunday that killed at least 59 and sent more than 500 people to area hospitals raised questions about whether that’s enough.\u003c/p>\n\u003cp>Las Vegas is not the only big city with just one such trauma center. Seattle and Nashville, among others, also are in \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenter\" target=\"_blank\" rel=\"noopener\">this category\u003c/a>, according to the American Trauma Society, a professional and advocacy organization focused on improving trauma care.\u003c/p>\n\u003cp>Casey Nolan, a hospital consultant and managing director of Navigant Consulting in Washington, D.C., said what matters most is not the number of high-level centers, but the degrees of coordination across the area’s medical network, including the first responders.\u003c/p>\n\u003cp>“It’s how well integrated the care is and whether there is a triage system to get patients to the right place in the right time,” he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What Makes Up The Network\u003c/strong>\u003c/p>\n\u003cp>The highest-level trauma centers are equipped and staffed around-the-clock to provide care for patients who suffer from traumatic injuries such as gunshot wounds, falls and car accidents.\u003c/p>\n\u003cp>The designation “trauma center” is the result of a validation process at the state or local level. Centers are categorized by Level I, II or III, for instance, in keeping with nationally accepted standards. Centers can also seek additional approval from the American College of Surgeons.\u003c/p>\n\u003cp>Across the country, there are \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenters.\" target=\"_blank\" rel=\"noopener\">217 Level I trauma centers\u003c/a>, up from 198 in 2012, according to the trauma society. These centers must see at least 1,200 trauma patients a year and have general surgeons and other specialists immediately available at the facility.\u003c/p>\n\u003cp>There are another 310 Level II centers that face similar staffing rules, but with fewer education and training requirements. Level III centers have emergency medical staff, but will stabilize severely injured patients and often transport them to higher-level trauma centers.\u003c/p>\n\u003cp>For decades, the hospital industry viewed trauma care as a money-losing proposition because of the high costs of keeping doctors and nurses on standby 24 hours a day. Trauma centers, particularly those in inner cities, tended to attract more patients without health insurance.\u003c/p>\n\u003cp>But in recent years, hospitals have been competing to get the designation as a way to increase profits, in part because trauma centers enhance demand for surgery and ancillary services like CT scans. In addition, a trauma designation can boost a facility’s overall reputation, Nolan added.\u003c/p>\n\u003cp>“Trauma had gotten a bad rap,” explained Nolan. “But in suburban locations, where more people have insurance, you can do pretty well on trauma.”\u003c/p>\n\u003cp>Some hospitals also began charging a fee — known as a “trauma activation” fee — to help pay for the extra staffing and equipment trauma units require.\u003c/p>\n\u003cp>Those fees could range from a few hundred dollars to several thousand dollars on patients’ bills, Nolan said.\u003c/p>\n\u003cp>\u003cstrong>Trauma Care In Las Vegas\u003c/strong>\u003c/p>\n\u003cp>Despite the burgeoning population of Las Vegas and surrounding Clark County, which more than doubled to 2.2 million in the past 25 years, University Medical Center has been Las Vegas’ only Level I trauma center since 1992.\u003c/p>\n\u003cp>The metro area includes two other lower-level trauma centers. Sunrise Hospital & Medical Center in Las Vegas is a Level II facility and St. Rose Dominican Hospital in nearby Henderson, Nev., is a Level III.\u003c/p>\n\u003cp>Even the idea of expanding Las Vegas’ trauma network has stirred controversy.\u003c/p>\n\u003cp>Last year, a state agency rejected applications by three hospitals in the Las Vegas area to be designated as Level III trauma centers.\u003c/p>\n\u003cp>HCA, the national, for-profit chain that owned two of these facilities, said adding trauma centers would help ensure quicker care to patients in the growing region. The company has made adding trauma centers a strategy across the country and has met resistance from existing centers.\u003c/p>\n\u003cp>But opponents argued HCA was motivated by the opportunity to boost profits. The \u003ca href=\"http://www.tampabay.com/news/health/how-hca-turned-trauma-into-a-money-maker/2169280\" target=\"_blank\" rel=\"noopener\">Tampa Bay Times\u003c/a> reported last year that the hospital chain charged significantly higher “activation fees” than other hospitals.\u003c/p>\n\u003cp>Opponents also countered that adding trauma centers would affect University Medical Center’s ability to provide quality care and train doctors. Some experts say it could diminish the number of patients seen at each center.\u003c/p>\n\u003cp>That’s because the more trauma patients a center deals with annually, the better the results, studies show.\u003c/p>\n\u003cp>“If you can bring all the patients to one place, then those surgeons become really good at dealing with trauma, instead of spreading it out [around a number of facilities],” said Bill Bullard, senior vice president with the Abaris Group, a California-based consulting firm that advises hospitals on emergency care.\u003c/p>\n\u003cp>Ian Weston, executive director of the American Trauma Society, said the trauma system worked well in Las Vegas, which is a credit to ambulances and other first responders and their ability to triage patients to hospitals across the city.\u003c/p>\n\u003cp>Seriously ill patients have the best outcomes when treated at a Level I trauma center, said David Callaway, a professor of emergency medicine at the Carolinas Medical Center in Charlotte, N.C. But “when you have 500-plus casualties and 58 dead … if all the patients went to a Level I, mortality would not be improved, because they would be completely overwhelmed,” Callaway added.\u003c/p>\n\u003cp>Bullard agreed.\u003c/p>\n\u003cp>“In theory, the more centers you have the more people you have to deal with injuries. However, no trauma system is able to handle a tragedy of this magnitude.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\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/em>\u003c/p>\n\n",
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"excerpt": "Hospitals view adding trauma care as a potential profit tool, but experts say more centers don't necessarily improve the system’s ability to respond to a mass casualty event.",
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"nprByline": "\u003ca href=\"https://khn.org/news/author/julie-appleby/\">Julie Appleby\u003c/a> and \u003ca href=\"https://khn.org/news/author/phil-galewitz/\">Phil Galewitz\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Las Vegas is not only a glittering strip of casinos and hotels but a fast-growing region with more than 2 million residents — and one hospital designated as a highest-level trauma center.\u003c/p>\n\u003cp>The deadly shooting Sunday that killed at least 59 and sent more than 500 people to area hospitals raised questions about whether that’s enough.\u003c/p>\n\u003cp>Las Vegas is not the only big city with just one such trauma center. Seattle and Nashville, among others, also are in \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenter\" target=\"_blank\" rel=\"noopener\">this category\u003c/a>, according to the American Trauma Society, a professional and advocacy organization focused on improving trauma care.\u003c/p>\n\u003cp>Casey Nolan, a hospital consultant and managing director of Navigant Consulting in Washington, D.C., said what matters most is not the number of high-level centers, but the degrees of coordination across the area’s medical network, including the first responders.\u003c/p>\n\u003cp>“It’s how well integrated the care is and whether there is a triage system to get patients to the right place in the right time,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Makes Up The Network\u003c/strong>\u003c/p>\n\u003cp>The highest-level trauma centers are equipped and staffed around-the-clock to provide care for patients who suffer from traumatic injuries such as gunshot wounds, falls and car accidents.\u003c/p>\n\u003cp>The designation “trauma center” is the result of a validation process at the state or local level. Centers are categorized by Level I, II or III, for instance, in keeping with nationally accepted standards. Centers can also seek additional approval from the American College of Surgeons.\u003c/p>\n\u003cp>Across the country, there are \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenters.\" target=\"_blank\" rel=\"noopener\">217 Level I trauma centers\u003c/a>, up from 198 in 2012, according to the trauma society. These centers must see at least 1,200 trauma patients a year and have general surgeons and other specialists immediately available at the facility.\u003c/p>\n\u003cp>There are another 310 Level II centers that face similar staffing rules, but with fewer education and training requirements. Level III centers have emergency medical staff, but will stabilize severely injured patients and often transport them to higher-level trauma centers.\u003c/p>\n\u003cp>For decades, the hospital industry viewed trauma care as a money-losing proposition because of the high costs of keeping doctors and nurses on standby 24 hours a day. Trauma centers, particularly those in inner cities, tended to attract more patients without health insurance.\u003c/p>\n\u003cp>But in recent years, hospitals have been competing to get the designation as a way to increase profits, in part because trauma centers enhance demand for surgery and ancillary services like CT scans. In addition, a trauma designation can boost a facility’s overall reputation, Nolan added.\u003c/p>\n\u003cp>“Trauma had gotten a bad rap,” explained Nolan. “But in suburban locations, where more people have insurance, you can do pretty well on trauma.”\u003c/p>\n\u003cp>Some hospitals also began charging a fee — known as a “trauma activation” fee — to help pay for the extra staffing and equipment trauma units require.\u003c/p>\n\u003cp>Those fees could range from a few hundred dollars to several thousand dollars on patients’ bills, Nolan said.\u003c/p>\n\u003cp>\u003cstrong>Trauma Care In Las Vegas\u003c/strong>\u003c/p>\n\u003cp>Despite the burgeoning population of Las Vegas and surrounding Clark County, which more than doubled to 2.2 million in the past 25 years, University Medical Center has been Las Vegas’ only Level I trauma center since 1992.\u003c/p>\n\u003cp>The metro area includes two other lower-level trauma centers. Sunrise Hospital & Medical Center in Las Vegas is a Level II facility and St. Rose Dominican Hospital in nearby Henderson, Nev., is a Level III.\u003c/p>\n\u003cp>Even the idea of expanding Las Vegas’ trauma network has stirred controversy.\u003c/p>\n\u003cp>Last year, a state agency rejected applications by three hospitals in the Las Vegas area to be designated as Level III trauma centers.\u003c/p>\n\u003cp>HCA, the national, for-profit chain that owned two of these facilities, said adding trauma centers would help ensure quicker care to patients in the growing region. The company has made adding trauma centers a strategy across the country and has met resistance from existing centers.\u003c/p>\n\u003cp>But opponents argued HCA was motivated by the opportunity to boost profits. The \u003ca href=\"http://www.tampabay.com/news/health/how-hca-turned-trauma-into-a-money-maker/2169280\" target=\"_blank\" rel=\"noopener\">Tampa Bay Times\u003c/a> reported last year that the hospital chain charged significantly higher “activation fees” than other hospitals.\u003c/p>\n\u003cp>Opponents also countered that adding trauma centers would affect University Medical Center’s ability to provide quality care and train doctors. Some experts say it could diminish the number of patients seen at each center.\u003c/p>\n\u003cp>That’s because the more trauma patients a center deals with annually, the better the results, studies show.\u003c/p>\n\u003cp>“If you can bring all the patients to one place, then those surgeons become really good at dealing with trauma, instead of spreading it out [around a number of facilities],” said Bill Bullard, senior vice president with the Abaris Group, a California-based consulting firm that advises hospitals on emergency care.\u003c/p>\n\u003cp>Ian Weston, executive director of the American Trauma Society, said the trauma system worked well in Las Vegas, which is a credit to ambulances and other first responders and their ability to triage patients to hospitals across the city.\u003c/p>\n\u003cp>Seriously ill patients have the best outcomes when treated at a Level I trauma center, said David Callaway, a professor of emergency medicine at the Carolinas Medical Center in Charlotte, N.C. But “when you have 500-plus casualties and 58 dead … if all the patients went to a Level I, mortality would not be improved, because they would be completely overwhelmed,” Callaway added.\u003c/p>\n\u003cp>Bullard agreed.\u003c/p>\n\u003cp>“In theory, the more centers you have the more people you have to deal with injuries. However, no trauma system is able to handle a tragedy of this magnitude.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\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/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment",
"title": "Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Valerie Green is still waiting to be cured.\u003c/p>\n\u003cp>The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn’t qualify yet for the Medicaid program’s criteria for treatment with a new class of highly effective but pricey drugs. The recent approval of a less expensive drug that generally cures hepatitis C in just eight weeks may make it easier for more insurers and correctional facilities to expand treatment.\u003c/p>\n\u003cp>The drug, \u003ca href=\"https://www.mavyret.com\" target=\"_blank\" rel=\"noopener\">Mavyret\u003c/a>, is the first to be \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm570038.htm\" target=\"_blank\" rel=\"noopener\">approved by the Food and Drug Administration\u003c/a> that can cure all six genetic types of hepatitis C in about two months in patients who haven’t previously been treated. Other approved drugs generally require 12 weeks to treat the disease and often aren’t effective for all types of hepatitis C.\u003c/p>\n\u003cp>In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about \u003ca href=\"https://www.macpac.gov/wp-content/uploads/2017/03/High-Cost-HCV-Drugs-in-Medicaid-Final-Report.pdf\" target=\"_blank\" rel=\"noopener\">$55,000 to $95,000\u003c/a> to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.\u003c/p>\n\u003cp>“It certainly stands to reason that the continual march downwards on cost would lead to continual opening up of criteria,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hepatitis C is a viral liver infection spread through blood that affects an estimated 3.5 million people in the United States. It can take years to cause problems. Many baby boomers who contracted it decades ago before blood was screened for the virus don’t realize they have it until they develop liver disease. In addition, the growing heroin epidemic is adding to the problem as people become infected by sharing contaminated needles.\u003c/p>\n\u003cp>“Direct acting antiviral” therapies like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks, are much more effective than earlier treatments that required weekly interferon injections and multiple daily pills for nearly a year. But the newer regimens came at a price: $94,500, in Harvoni’s case.\u003c/p>\n\u003cp>State Medicaid programs, which cover a high proportion of people with hepatitis C, \u003ca href=\"http://www.governing.com/news/headlines/how-some-state-medicaid-programs-limit-drugs-to-only-sickest-patients.html\" target=\"_blank\" rel=\"noopener\">balked at the high prices\u003c/a>, even with the 23 percent drug discount the programs typically receive. Many threw up roadblocks to limit drug approval until the disease was advanced. Some required people to be drug- and alcohol-free for six months or more before treatment would be approved.\u003c/p>\n\u003cp>Those moves prompted advocates to push for better access, in some cases \u003ca href=\"https://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/\" target=\"_blank\" rel=\"noopener\">filing suit\u003c/a> to force the programs to cover more people.\u003c/p>\n\u003cp>Faced with a lawsuit in Delaware, the state Medicaid program began loosening up treatment criteria this year, and in January will \u003ca href=\"https://www.chlpi.org//wp-content/uploads/2016/06/DMMA-Prior-Authorization-Policy.pdf\" target=\"_blank\" rel=\"noopener\">begin approving enrollees\u003c/a> regardless of the severity of their disease.\u003c/p>\n\u003cp>The state joins more than a dozen others that no longer (or never did) restrict hepatitis C treatment based on disease severity, said Kevin Costello, director of litigation at Harvard Law School’s Center for Health Law and Policy Innovation, which has been a key player \u003ca href=\"https://www.chlpi.org/in-face-of-class-action-lawsuit-delaware-medicaid-removes-unlawful-restrictions-to-the-cure-for-the-hepatitis-c-virus/\" target=\"_blank\" rel=\"noopener\">in litigation in Delaware\u003c/a> and other states.\u003c/p>\n\u003cp>It can’t happen soon enough, said Green, 58, who believes she contracted the disease 31 years ago when she suffered complications during childbirth and required a blood transfusion. Although her liver isn’t damaged, Green said, she’s suffered with abdominal and joint pain, weight loss and fatigue for decades, symptoms that doctors attribute to the hepatitis C virus.\u003c/p>\n\u003cp>“It’s been a difficult fight for us Medicaid patients,” she said.\u003c/p>\n\u003cp>People who are incarcerated \u003ca href=\"http://content.healthaffairs.org/content/35/10/1893.abstract\" target=\"_blank\" rel=\"noopener\">face an even tougher battle\u003c/a> to get treatment for hepatitis C. Roughly 17 percent of prisoners are infected with hepatitis C, compared with about 1 percent of the general population.\u003c/p>\n\u003cp>Prisons have a duty not to be deliberately indifferent to the medical needs of incarcerated people. Prisons don’t get the price discounts that the Medicaid programs have, and their budgets are fixed.\u003c/p>\n\u003cp>“Administrators have to make do with what is there,” said Dr. Anne Spaulding, an associate professor at Emory University’s public health school who has worked as a medical director in corrections and published research on hepatitis C among prisoners.\u003c/p>\n\u003cp>Lawyers in a handful of states are pursuing class action lawsuits to force prisons to provide hepatitis C treatment. Mavyret may make a difference, said David Rudovsky, a civil rights lawyer who’s litigating a class action lawsuit against the Pennsylvania Department of Corrections.\u003c/p>\n\u003cp>“Everyone recognizes that it’s going to make it easier to cover people,” he said.\u003c/p>\n\u003cp>People with regular private insurance may face some obstacles to coverage of hepatitis C, but coverage is typically less problematic. For example, Mavyret is one of seven hepatitis C drugs that are included in the 2018 \u003ca href=\"http://lab.express-scripts.com/lab/insights/drug-options/2018-national-preferred-formulary\" target=\"_blank\" rel=\"noopener\">national preferred formulary\u003c/a> by Express Scripts, which manages the pharmacy benefits for 83 million people.\u003c/p>\n\u003cp>“The benefit to patients and payers is the additional competition, which brings down costs across the class, thus resulting in greater access and affordability,” said Jennifer Luddy, director of corporate communications at Express Scripts.\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"http://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN). 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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"excerpt": "The drug, sold under the name Mavyret, can cure all six genetic types of the liver disease in eight weeks at a cost of $26,400, well below other options.",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/michelle-andrews/\">\u003cstrong>Michelle Andrews\u003c/strong>\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Valerie Green is still waiting to be cured.\u003c/p>\n\u003cp>The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn’t qualify yet for the Medicaid program’s criteria for treatment with a new class of highly effective but pricey drugs. The recent approval of a less expensive drug that generally cures hepatitis C in just eight weeks may make it easier for more insurers and correctional facilities to expand treatment.\u003c/p>\n\u003cp>The drug, \u003ca href=\"https://www.mavyret.com\" target=\"_blank\" rel=\"noopener\">Mavyret\u003c/a>, is the first to be \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm570038.htm\" target=\"_blank\" rel=\"noopener\">approved by the Food and Drug Administration\u003c/a> that can cure all six genetic types of hepatitis C in about two months in patients who haven’t previously been treated. Other approved drugs generally require 12 weeks to treat the disease and often aren’t effective for all types of hepatitis C.\u003c/p>\n\u003cp>In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about \u003ca href=\"https://www.macpac.gov/wp-content/uploads/2017/03/High-Cost-HCV-Drugs-in-Medicaid-Final-Report.pdf\" target=\"_blank\" rel=\"noopener\">$55,000 to $95,000\u003c/a> to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.\u003c/p>\n\u003cp>“It certainly stands to reason that the continual march downwards on cost would lead to continual opening up of criteria,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hepatitis C is a viral liver infection spread through blood that affects an estimated 3.5 million people in the United States. It can take years to cause problems. Many baby boomers who contracted it decades ago before blood was screened for the virus don’t realize they have it until they develop liver disease. In addition, the growing heroin epidemic is adding to the problem as people become infected by sharing contaminated needles.\u003c/p>\n\u003cp>“Direct acting antiviral” therapies like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks, are much more effective than earlier treatments that required weekly interferon injections and multiple daily pills for nearly a year. But the newer regimens came at a price: $94,500, in Harvoni’s case.\u003c/p>\n\u003cp>State Medicaid programs, which cover a high proportion of people with hepatitis C, \u003ca href=\"http://www.governing.com/news/headlines/how-some-state-medicaid-programs-limit-drugs-to-only-sickest-patients.html\" target=\"_blank\" rel=\"noopener\">balked at the high prices\u003c/a>, even with the 23 percent drug discount the programs typically receive. Many threw up roadblocks to limit drug approval until the disease was advanced. Some required people to be drug- and alcohol-free for six months or more before treatment would be approved.\u003c/p>\n\u003cp>Those moves prompted advocates to push for better access, in some cases \u003ca href=\"https://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/\" target=\"_blank\" rel=\"noopener\">filing suit\u003c/a> to force the programs to cover more people.\u003c/p>\n\u003cp>Faced with a lawsuit in Delaware, the state Medicaid program began loosening up treatment criteria this year, and in January will \u003ca href=\"https://www.chlpi.org//wp-content/uploads/2016/06/DMMA-Prior-Authorization-Policy.pdf\" target=\"_blank\" rel=\"noopener\">begin approving enrollees\u003c/a> regardless of the severity of their disease.\u003c/p>\n\u003cp>The state joins more than a dozen others that no longer (or never did) restrict hepatitis C treatment based on disease severity, said Kevin Costello, director of litigation at Harvard Law School’s Center for Health Law and Policy Innovation, which has been a key player \u003ca href=\"https://www.chlpi.org/in-face-of-class-action-lawsuit-delaware-medicaid-removes-unlawful-restrictions-to-the-cure-for-the-hepatitis-c-virus/\" target=\"_blank\" rel=\"noopener\">in litigation in Delaware\u003c/a> and other states.\u003c/p>\n\u003cp>It can’t happen soon enough, said Green, 58, who believes she contracted the disease 31 years ago when she suffered complications during childbirth and required a blood transfusion. Although her liver isn’t damaged, Green said, she’s suffered with abdominal and joint pain, weight loss and fatigue for decades, symptoms that doctors attribute to the hepatitis C virus.\u003c/p>\n\u003cp>“It’s been a difficult fight for us Medicaid patients,” she said.\u003c/p>\n\u003cp>People who are incarcerated \u003ca href=\"http://content.healthaffairs.org/content/35/10/1893.abstract\" target=\"_blank\" rel=\"noopener\">face an even tougher battle\u003c/a> to get treatment for hepatitis C. Roughly 17 percent of prisoners are infected with hepatitis C, compared with about 1 percent of the general population.\u003c/p>\n\u003cp>Prisons have a duty not to be deliberately indifferent to the medical needs of incarcerated people. Prisons don’t get the price discounts that the Medicaid programs have, and their budgets are fixed.\u003c/p>\n\u003cp>“Administrators have to make do with what is there,” said Dr. Anne Spaulding, an associate professor at Emory University’s public health school who has worked as a medical director in corrections and published research on hepatitis C among prisoners.\u003c/p>\n\u003cp>Lawyers in a handful of states are pursuing class action lawsuits to force prisons to provide hepatitis C treatment. Mavyret may make a difference, said David Rudovsky, a civil rights lawyer who’s litigating a class action lawsuit against the Pennsylvania Department of Corrections.\u003c/p>\n\u003cp>“Everyone recognizes that it’s going to make it easier to cover people,” he said.\u003c/p>\n\u003cp>People with regular private insurance may face some obstacles to coverage of hepatitis C, but coverage is typically less problematic. For example, Mavyret is one of seven hepatitis C drugs that are included in the 2018 \u003ca href=\"http://lab.express-scripts.com/lab/insights/drug-options/2018-national-preferred-formulary\" target=\"_blank\" rel=\"noopener\">national preferred formulary\u003c/a> by Express Scripts, which manages the pharmacy benefits for 83 million people.\u003c/p>\n\u003cp>“The benefit to patients and payers is the additional competition, which brings down costs across the class, thus resulting in greater access and affordability,” said Jennifer Luddy, director of corporate communications at Express Scripts.\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"http://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN). 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": "A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’",
"title": "A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">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 noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">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 noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lag In Brain Donation Hampers Understanding Of Dementia In Blacks",
"title": "Lag In Brain Donation Hampers Understanding Of Dementia In Blacks",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>OAKLAND, Calif. — The question came as a shock to Dorothy Reeves: Would she be willing to donate her husband’s brain for research?\u003c/p>\n\u003cp>She knew dementia would steadily take Levi Reeves’ memories of their 57-year marriage, his remaining lucidity and, eventually, his life. But to let scientists take his brain after he died? That seemed too much to ask.\u003c/p>\n\u003cp>“I didn’t want to deal with the idea of his death,” said Reeves, 79. “I certainly didn’t want to deal with brain donation.”\u003c/p>\n\u003cp>As an African-American and a former schoolteacher, Reeves is keenly aware of the history of racism in health care, including callous and sometimes deadly experimentation. Reeves said she never personally has had a bad experience with doctors or the medical system. But she’s old enough to remember the infamous Tuskegee Institute syphilis study, during which hundreds of mostly illiterate black sharecroppers were assured they were being treated for “bad blood” even as doctors withheld effective treatment over decades.\u003c/p>\n\u003cp>Top researchers say such wariness, while understandable, is thwarting efforts to understand and treat Alzheimer’s disease and other forms of dementia in black patients today. African-Americans suffer from these cognitive impairments at \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/\" target=\"_blank\" rel=\"noopener noreferrer\">two to three times the rate of non-Hispanic whites\u003c/a>, yet they are less likely to take part in research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That has created a vexing challenge for scientists, who are trying to persuade more blacks to participate in studies — both while they are alive and after they die. A critical part of their efforts is asking for brain donations.\u003c/p>\n\u003cp>“There is a lot of terrible history that we have to acknowledge and move past,” said Lisa L. Barnes, a neuropsychologist at the Rush Alzheimer’s Disease Center in Chicago. “A lot of minority communities still feel that research involves being a guinea pig. Nobody wants to be used. Nobody wants to be a guinea pig.”\u003c/p>\n\u003cp>Shirley Fitch, who lives south of Chicago, said no thank you to Rush researchers on behalf of her husband, Clarence. The former university professor died last summer at age 86, seven years after being diagnosed with dementia.\u003c/p>\n\u003cp>“I’m hesitant because of distrust,” said Fitch. “Once my brain is donated for one purpose, who is to say it won’t be used for another purpose? It is out of your control.”\u003c/p>\n\u003cp>Although Shirley Fitch is participating in non-Alzheimer’s research at Rush, she said the historical abuses of black people have been “awful and hard to get over.”\u003c/p>\n\u003cp>Even today, blacks tend to get worse treatment from hospitals, she said. “It all gets stirred in the pot as to feelings about bias.”\u003c/p>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cfigure id=\"attachment_360754\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360754\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg\" alt=\"Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>The Knowledge Gap\u003c/strong>\u003c/p>\n\u003cp>The precise explanations for the disparities among blacks and whites are unknown. Until recently, most of our understanding of the pathology of dementia was largely based on studies of white patients.\u003c/p>\n\u003cp>“We have a real knowledge gap in accurately knowing if dementia is different in minorities as compared to whites,” said John Olichney, a neurologist and clinical director of the Alzheimer’s Disease Center at the University of California-Davis.\u003c/p>\n\u003cp>Scientists say blacks’ disproportionate rates of dementia may be related in part to the prevalence of disorders that raise the risk of vascular disease: diabetes and hypertension, for instance. Socioeconomic factors such as higher rates of poverty and lower levels of education also seem to play a significant role, according to \u003ca href=\"http://www.bmj.com/content/347/bmj.f7051\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> led by the University of California-San Francisco.\u003c/p>\n\u003cp>Despite advances in imaging technology that allows researchers to peer into the brains of live patients, studying the organ after death is crucial to a deeper understanding of the causes and progression of disease and to developing drug treatments, Olichney said.\u003c/p>\n\u003cp>The challenge is getting enough brains from different populations to study. It’s not just a matter of assuring potential donors that Tuskegee and other ethical debacles are in the past. To gain trust, Alzheimer’s research facilities such as UC-Davis and Rush University are also trying to diversify their staffs, collaborate with community leaders and study religious and cultural beliefs on brain donation.\u003c/p>\n\u003cp>For example, some African-Americans don’t want their brain separated from their body when they are buried, said Stephanie Monroe, director of African Americans Against Alzheimer’s, which is engaged in various efforts to educate people about the disease and its effects.\u003c/p>\n\u003cp>“Many people believe in ashes to ashes and dust to dust,” she said.\u003c/p>\n\u003cp>\u003cstrong>A Changing Mindset\u003c/strong>\u003c/p>\n\u003cp>Alzheimer’s researchers at UC-Davis recognized about 15 years ago that they needed a more representative slice of the population, especially in diverse Northern California. At the time, centers around the country were mostly studying well-educated, white people who volunteered, Olichney said.\u003c/p>\n\u003cp>So they started reaching out to both the African-American and Latino communities. “That was a real change in our mindset,” he said.\u003c/p>\n\u003cp>Today, nearly 400 patients, including about 70 African-Americans, are enrolled in its longitudinal study of the progression of dementia, and they come in yearly for memory evaluations and other tests. Of the study participants, about 270 have agreed to donate their brains after death, more than 40 of them African-American.\u003c/p>\n\u003cp>At the Rush Alzheimer’s Disease Center, doctors started following a cohort of African-Americans in 2004 and, some seven years later, began to seek brain donation for the study. Close to 500 African-Americans have signed up to donate after death, and 72 brains already have been donated, Barnes said.\u003c/p>\n\u003cp>Though she is pleased with the high rate of commitment, she noted that more works needs to be done. In another study, about 3,100 white participants agreed to brain donation, with 1,400 already donated. Recruiting African-Americans “takes a lot of effort and a lot of work,” she said. “Every year, we bring it up again and revisit it with those who are reluctant. But if someone is really firm, we don’t push the subject.”\u003c/p>\n\u003cp>Research on the donated brains has led to intriguing findings. One Rush study, published in 2015, found that blacks with Alzheimer’s disease were more likely than whites to have other disorders, such as Lewy body dementia. Twice as many blacks with Alzheimer’s as whites with the disease also had Lewy body dementia, in which protein deposits build up in nerve cells, according to the study. Blacks with dementia also had more severe disease of the arteries, the \u003ca href=\"http://europepmc.org/articles/pmc4540250\">study\u003c/a> found.\u003c/p>\n\u003cp>The number of blacks studied was relatively small — 41 compared with 81 whites — yet its findings were potentially important. That’s because the presence of other diseases in the brain means blacks may not respond as white patients do to drugs aimed specifically at Alzheimer’s.\u003c/p>\n\u003cp>Even for experienced research institutions, getting people to participate in donation remains complicated — in part, because families don’t necessarily agree about it among themselves.\u003c/p>\n\u003cfigure id=\"attachment_360755\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360755\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg\" alt=\"Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrea Gourdine remembers clearly when her mother, Gladys Brown, started behaving oddly. Once, the elder woman forgot a stove burner was on and a dish exploded. Then she stopped bathing regularly. “And she was normally fastidious,” Gourdine said. “Something was really, really wrong.”\u003c/p>\n\u003cp>Brown enrolled in the research at UC-Davis, was diagnosed with Alzheimer’s in 2005 and soon after agreed to donate her brain. It won’t help me, Brown told researchers, but it could help others. She died in 2012, at 87.\u003c/p>\n\u003cp>Gourdine also signed up for the UC-Davis study and has consented to donate her brain. She does not have Alzheimer’s, but researchers are seeking brains of those without dementia for comparison.\u003c/p>\n\u003cp>She is aware of the history of medical abuse of African-Americans but says she doesn’t see any point in focusing on the past.\u003c/p>\n\u003cp>Gourdine’s sister, India Collins, disagrees with her sister and objected to her mother’s donation.\u003c/p>\n\u003cp>“I have problems with scientific research and I get very upset with scientific data and outcomes in general,” said Collins. She questions how helpful it is to African-Americans. “Why would you want to participate in their research if it does not benefit you?”\u003c/p>\n\u003cp>\u003cstrong>Expanding The Brain Trust\u003c/strong>\u003c/p>\n\u003cp>Gwen Gates, a recruiter and research coordinator at the UC-Davis center, goes to churches, health fairs and other events to build trust and develop deeper relationships among the university and minority communities. Patients and families want to know what scientists do with the brains. They worry about how relatives will react. They fear donation will interfere with funeral arrangements or their plans for an open casket.\u003c/p>\n\u003cp>She assures them it won’t. She explains that brain donations will help future generations, perhaps even in their own family.\u003c/p>\n\u003cp>Occasionally, families readily agree. Some adamantly refuse. For others, the decision is a process.\u003c/p>\n\u003cp>Dorothy Reeves declined brain donation initially but agreed to sign up herself and Levi, 81, for observational studies. Then she saw what the disease could do. Her husband, who has Lewy body dementia, went under a table one day to get a magazine and couldn’t find his way out. He forgot her name and those of his children.\u003c/p>\n\u003cp>She thought about all the other people like Levi.\u003c/p>\n\u003cp>“It affects people in ways you can’t imagine — regardless of your race,” she said. “It’s almost unbearable.”\u003c/p>\n\u003cp>Soon the researchers had their answer. Yes, she would agree to donation — for both of them.\u003c/p>\n\u003cp>\u003cem>KHN’s coverage in California is funded in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Blue Shield of California Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">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 noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>OAKLAND, Calif. — The question came as a shock to Dorothy Reeves: Would she be willing to donate her husband’s brain for research?\u003c/p>\n\u003cp>She knew dementia would steadily take Levi Reeves’ memories of their 57-year marriage, his remaining lucidity and, eventually, his life. But to let scientists take his brain after he died? That seemed too much to ask.\u003c/p>\n\u003cp>“I didn’t want to deal with the idea of his death,” said Reeves, 79. “I certainly didn’t want to deal with brain donation.”\u003c/p>\n\u003cp>As an African-American and a former schoolteacher, Reeves is keenly aware of the history of racism in health care, including callous and sometimes deadly experimentation. Reeves said she never personally has had a bad experience with doctors or the medical system. But she’s old enough to remember the infamous Tuskegee Institute syphilis study, during which hundreds of mostly illiterate black sharecroppers were assured they were being treated for “bad blood” even as doctors withheld effective treatment over decades.\u003c/p>\n\u003cp>Top researchers say such wariness, while understandable, is thwarting efforts to understand and treat Alzheimer’s disease and other forms of dementia in black patients today. African-Americans suffer from these cognitive impairments at \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/\" target=\"_blank\" rel=\"noopener noreferrer\">two to three times the rate of non-Hispanic whites\u003c/a>, yet they are less likely to take part in research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That has created a vexing challenge for scientists, who are trying to persuade more blacks to participate in studies — both while they are alive and after they die. A critical part of their efforts is asking for brain donations.\u003c/p>\n\u003cp>“There is a lot of terrible history that we have to acknowledge and move past,” said Lisa L. Barnes, a neuropsychologist at the Rush Alzheimer’s Disease Center in Chicago. “A lot of minority communities still feel that research involves being a guinea pig. Nobody wants to be used. Nobody wants to be a guinea pig.”\u003c/p>\n\u003cp>Shirley Fitch, who lives south of Chicago, said no thank you to Rush researchers on behalf of her husband, Clarence. The former university professor died last summer at age 86, seven years after being diagnosed with dementia.\u003c/p>\n\u003cp>“I’m hesitant because of distrust,” said Fitch. “Once my brain is donated for one purpose, who is to say it won’t be used for another purpose? It is out of your control.”\u003c/p>\n\u003cp>Although Shirley Fitch is participating in non-Alzheimer’s research at Rush, she said the historical abuses of black people have been “awful and hard to get over.”\u003c/p>\n\u003cp>Even today, blacks tend to get worse treatment from hospitals, she said. “It all gets stirred in the pot as to feelings about bias.”\u003c/p>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cfigure id=\"attachment_360754\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360754\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg\" alt=\"Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>The Knowledge Gap\u003c/strong>\u003c/p>\n\u003cp>The precise explanations for the disparities among blacks and whites are unknown. Until recently, most of our understanding of the pathology of dementia was largely based on studies of white patients.\u003c/p>\n\u003cp>“We have a real knowledge gap in accurately knowing if dementia is different in minorities as compared to whites,” said John Olichney, a neurologist and clinical director of the Alzheimer’s Disease Center at the University of California-Davis.\u003c/p>\n\u003cp>Scientists say blacks’ disproportionate rates of dementia may be related in part to the prevalence of disorders that raise the risk of vascular disease: diabetes and hypertension, for instance. Socioeconomic factors such as higher rates of poverty and lower levels of education also seem to play a significant role, according to \u003ca href=\"http://www.bmj.com/content/347/bmj.f7051\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> led by the University of California-San Francisco.\u003c/p>\n\u003cp>Despite advances in imaging technology that allows researchers to peer into the brains of live patients, studying the organ after death is crucial to a deeper understanding of the causes and progression of disease and to developing drug treatments, Olichney said.\u003c/p>\n\u003cp>The challenge is getting enough brains from different populations to study. It’s not just a matter of assuring potential donors that Tuskegee and other ethical debacles are in the past. To gain trust, Alzheimer’s research facilities such as UC-Davis and Rush University are also trying to diversify their staffs, collaborate with community leaders and study religious and cultural beliefs on brain donation.\u003c/p>\n\u003cp>For example, some African-Americans don’t want their brain separated from their body when they are buried, said Stephanie Monroe, director of African Americans Against Alzheimer’s, which is engaged in various efforts to educate people about the disease and its effects.\u003c/p>\n\u003cp>“Many people believe in ashes to ashes and dust to dust,” she said.\u003c/p>\n\u003cp>\u003cstrong>A Changing Mindset\u003c/strong>\u003c/p>\n\u003cp>Alzheimer’s researchers at UC-Davis recognized about 15 years ago that they needed a more representative slice of the population, especially in diverse Northern California. At the time, centers around the country were mostly studying well-educated, white people who volunteered, Olichney said.\u003c/p>\n\u003cp>So they started reaching out to both the African-American and Latino communities. “That was a real change in our mindset,” he said.\u003c/p>\n\u003cp>Today, nearly 400 patients, including about 70 African-Americans, are enrolled in its longitudinal study of the progression of dementia, and they come in yearly for memory evaluations and other tests. Of the study participants, about 270 have agreed to donate their brains after death, more than 40 of them African-American.\u003c/p>\n\u003cp>At the Rush Alzheimer’s Disease Center, doctors started following a cohort of African-Americans in 2004 and, some seven years later, began to seek brain donation for the study. Close to 500 African-Americans have signed up to donate after death, and 72 brains already have been donated, Barnes said.\u003c/p>\n\u003cp>Though she is pleased with the high rate of commitment, she noted that more works needs to be done. In another study, about 3,100 white participants agreed to brain donation, with 1,400 already donated. Recruiting African-Americans “takes a lot of effort and a lot of work,” she said. “Every year, we bring it up again and revisit it with those who are reluctant. But if someone is really firm, we don’t push the subject.”\u003c/p>\n\u003cp>Research on the donated brains has led to intriguing findings. One Rush study, published in 2015, found that blacks with Alzheimer’s disease were more likely than whites to have other disorders, such as Lewy body dementia. Twice as many blacks with Alzheimer’s as whites with the disease also had Lewy body dementia, in which protein deposits build up in nerve cells, according to the study. Blacks with dementia also had more severe disease of the arteries, the \u003ca href=\"http://europepmc.org/articles/pmc4540250\">study\u003c/a> found.\u003c/p>\n\u003cp>The number of blacks studied was relatively small — 41 compared with 81 whites — yet its findings were potentially important. That’s because the presence of other diseases in the brain means blacks may not respond as white patients do to drugs aimed specifically at Alzheimer’s.\u003c/p>\n\u003cp>Even for experienced research institutions, getting people to participate in donation remains complicated — in part, because families don’t necessarily agree about it among themselves.\u003c/p>\n\u003cfigure id=\"attachment_360755\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360755\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg\" alt=\"Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrea Gourdine remembers clearly when her mother, Gladys Brown, started behaving oddly. Once, the elder woman forgot a stove burner was on and a dish exploded. Then she stopped bathing regularly. “And she was normally fastidious,” Gourdine said. “Something was really, really wrong.”\u003c/p>\n\u003cp>Brown enrolled in the research at UC-Davis, was diagnosed with Alzheimer’s in 2005 and soon after agreed to donate her brain. It won’t help me, Brown told researchers, but it could help others. She died in 2012, at 87.\u003c/p>\n\u003cp>Gourdine also signed up for the UC-Davis study and has consented to donate her brain. She does not have Alzheimer’s, but researchers are seeking brains of those without dementia for comparison.\u003c/p>\n\u003cp>She is aware of the history of medical abuse of African-Americans but says she doesn’t see any point in focusing on the past.\u003c/p>\n\u003cp>Gourdine’s sister, India Collins, disagrees with her sister and objected to her mother’s donation.\u003c/p>\n\u003cp>“I have problems with scientific research and I get very upset with scientific data and outcomes in general,” said Collins. She questions how helpful it is to African-Americans. “Why would you want to participate in their research if it does not benefit you?”\u003c/p>\n\u003cp>\u003cstrong>Expanding The Brain Trust\u003c/strong>\u003c/p>\n\u003cp>Gwen Gates, a recruiter and research coordinator at the UC-Davis center, goes to churches, health fairs and other events to build trust and develop deeper relationships among the university and minority communities. Patients and families want to know what scientists do with the brains. They worry about how relatives will react. They fear donation will interfere with funeral arrangements or their plans for an open casket.\u003c/p>\n\u003cp>She assures them it won’t. She explains that brain donations will help future generations, perhaps even in their own family.\u003c/p>\n\u003cp>Occasionally, families readily agree. Some adamantly refuse. For others, the decision is a process.\u003c/p>\n\u003cp>Dorothy Reeves declined brain donation initially but agreed to sign up herself and Levi, 81, for observational studies. Then she saw what the disease could do. Her husband, who has Lewy body dementia, went under a table one day to get a magazine and couldn’t find his way out. He forgot her name and those of his children.\u003c/p>\n\u003cp>She thought about all the other people like Levi.\u003c/p>\n\u003cp>“It affects people in ways you can’t imagine — regardless of your race,” she said. “It’s almost unbearable.”\u003c/p>\n\u003cp>Soon the researchers had their answer. Yes, she would agree to donation — for both of them.\u003c/p>\n\u003cp>\u003cem>KHN’s coverage in California is funded in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Blue Shield of California Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
"link": "/podcasts/closealltabs",
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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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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}
},
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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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"meta": {
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
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"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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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.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
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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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"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Political Mind of Jerry Brown",
"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
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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/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
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