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"disqusTitle": "Watsonville Nursing Home Lawsuit May Drive Effort to Reduce Overmedication",
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"content": "\u003cfigure id=\"attachment_21306\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/137165920-e1410035335722.jpg\">\u003cimg class=\"size-large wp-image-21306\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/137165920-640x429.jpg\" alt=\" (Philippe Hugue/AFP/Getty Images)\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Philippe Hugue/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Ina Jaffe,\u003c/strong>\u003ca href=\"http://www.npr.org/blogs/health/2014/09/05/346137537/feds-hope-hitting-nursing-homes-in-the-wallet-will-cut-overmedication\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>A federal lawsuit against two Watsonville nursing homes may offer a new approach to dealing with the persistent problem of such facilities overmedicating their residents.\u003c/p>\n\u003cp>\u003ca title=\"U.S. v. the Arba group, et al.\" href=\"https://s3.amazonaws.com/s3.documentcloud.org/documents/1284195/united-states-v-the-arba-group-et-al-complaint.pdf\" target=\"_blank\">The lawsuit\u003c/a> details multiple cases when the government says these drugs were inappropriately administered to patients. Watsonville is northeast of Monterey, in Santa Cruz County.\u003c/p>\n\u003cp>For instance when an 86-year-old man identified in the lawsuit as Patient 1 was admitted to Country Villa Watsonville West, he could speak clearly and walked in under his own power. Within days the facility began giving him Haldol and Risperdal, drugs used to treat schizophrenia and bipolar disorder, and he became bedridden, stopped eating and developed bedsores and infections.\u003c!--more-->\u003c/p>\n\u003cp>\"Within days he declined precipitously, to the point where he was read his last rites in the hospital,\" says Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform who represented the man and his family in a private suit that was settled out of court.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"He subsequently recovered,\" says Chicotel, \"but all this had been done without his family's knowledge, without his informed consent, without real good clinical indications for the use of the drug.\"\u003c/p>\n\u003cp>Antipsychotics like Risperdal and Haldol come with so-called black box warnings that say they could hasten death in elderly patients or people with dementia. Nevertheless, about a fifth of nursing home patients nationwide are prescribed antipsychotic drugs.\u003c/p>\n\u003cp>The U.S. attorney for Northern California declined to comment on the lawsuit, but it claims that the two nursing homes provided \"grossly inadequate, materially substandard and/or worthless services.\" Meanwhile, the nursing homes received about $20 million from Medicare and Medicaid for those services. So now the government wants its money back, and then some.\u003c/p>\n\u003cp>\"Under the False Claims Act, the government can ask for triple damages,\" explains Kelly Bagby, a senior attorney with the AARP Foundation. The nursing homes also could be fined, she says, for each incidence of filing a false report.\u003c/p>\n\u003cp>\"So every time they submitted a form that said, 'Here is Mrs. Jones' needs' and Mrs. Jones' needs were different than that, each one of those forms is a violation,\" says Bagby.\u003c/p>\n\u003cp>In a statement, the companies that own the two nursing homes called the charges \"untrue and without merit.\" They also filed their own lawsuit blaming the company they hired to manage the two facilities.\u003c/p>\n\u003cp>Deborah Pacyna, public affairs director for the California Association of Health Facilities, says that in the past couple years the federal government, in partnership with organizations like hers, has succeeded in \u003ca title=\"CMS nursing home report 2013\" href=\"http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/nursinghomedatacompendium_508.pdf#page=171\" target=\"_blank\">reducing the use of antipsychotic drugs\u003c/a> in nursing homes.\u003c/p>\n\u003cp>\"But a lot of the regulators, a lot of our critics seem to be ignoring the fact that antipsychotics are being widely prescribed to patients who have dementia \u003ca title=\"Medicare Nursing Home Compendium\" href=\"http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/nursinghomedatacompendium_508.pdf#page=190\" target=\"_blank\">who are living at home\u003c/a>, who are in the hospital or who are in assisted living settings,\" Pacyna says. \"Skilled nursing (homes) represents a fraction of those that have been impacted by this practice, yet we remain the focus.\"\u003c/p>\n\u003cp>Bagby, the AARP attorney, would like to maintain that focus, and thinks this lawsuit can help do that. \"If you're going to hit their bottom line, that's really where you change behavior.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bagby adds that with antipsychotic drugs still so widely prescribed for nursing home residents, there's the potential for more cases like this one across the country.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21306\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/137165920-e1410035335722.jpg\">\u003cimg class=\"size-large wp-image-21306\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/137165920-640x429.jpg\" alt=\" (Philippe Hugue/AFP/Getty Images)\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Philippe Hugue/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Ina Jaffe,\u003c/strong>\u003ca href=\"http://www.npr.org/blogs/health/2014/09/05/346137537/feds-hope-hitting-nursing-homes-in-the-wallet-will-cut-overmedication\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>A federal lawsuit against two Watsonville nursing homes may offer a new approach to dealing with the persistent problem of such facilities overmedicating their residents.\u003c/p>\n\u003cp>\u003ca title=\"U.S. v. the Arba group, et al.\" href=\"https://s3.amazonaws.com/s3.documentcloud.org/documents/1284195/united-states-v-the-arba-group-et-al-complaint.pdf\" target=\"_blank\">The lawsuit\u003c/a> details multiple cases when the government says these drugs were inappropriately administered to patients. Watsonville is northeast of Monterey, in Santa Cruz County.\u003c/p>\n\u003cp>For instance when an 86-year-old man identified in the lawsuit as Patient 1 was admitted to Country Villa Watsonville West, he could speak clearly and walked in under his own power. Within days the facility began giving him Haldol and Risperdal, drugs used to treat schizophrenia and bipolar disorder, and he became bedridden, stopped eating and developed bedsores and infections.\u003c!--more-->\u003c/p>\n\u003cp>\"Within days he declined precipitously, to the point where he was read his last rites in the hospital,\" says Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform who represented the man and his family in a private suit that was settled out of court.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"He subsequently recovered,\" says Chicotel, \"but all this had been done without his family's knowledge, without his informed consent, without real good clinical indications for the use of the drug.\"\u003c/p>\n\u003cp>Antipsychotics like Risperdal and Haldol come with so-called black box warnings that say they could hasten death in elderly patients or people with dementia. Nevertheless, about a fifth of nursing home patients nationwide are prescribed antipsychotic drugs.\u003c/p>\n\u003cp>The U.S. attorney for Northern California declined to comment on the lawsuit, but it claims that the two nursing homes provided \"grossly inadequate, materially substandard and/or worthless services.\" Meanwhile, the nursing homes received about $20 million from Medicare and Medicaid for those services. So now the government wants its money back, and then some.\u003c/p>\n\u003cp>\"Under the False Claims Act, the government can ask for triple damages,\" explains Kelly Bagby, a senior attorney with the AARP Foundation. The nursing homes also could be fined, she says, for each incidence of filing a false report.\u003c/p>\n\u003cp>\"So every time they submitted a form that said, 'Here is Mrs. Jones' needs' and Mrs. Jones' needs were different than that, each one of those forms is a violation,\" says Bagby.\u003c/p>\n\u003cp>In a statement, the companies that own the two nursing homes called the charges \"untrue and without merit.\" They also filed their own lawsuit blaming the company they hired to manage the two facilities.\u003c/p>\n\u003cp>Deborah Pacyna, public affairs director for the California Association of Health Facilities, says that in the past couple years the federal government, in partnership with organizations like hers, has succeeded in \u003ca title=\"CMS nursing home report 2013\" href=\"http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/nursinghomedatacompendium_508.pdf#page=171\" target=\"_blank\">reducing the use of antipsychotic drugs\u003c/a> in nursing homes.\u003c/p>\n\u003cp>\"But a lot of the regulators, a lot of our critics seem to be ignoring the fact that antipsychotics are being widely prescribed to patients who have dementia \u003ca title=\"Medicare Nursing Home Compendium\" href=\"http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/nursinghomedatacompendium_508.pdf#page=190\" target=\"_blank\">who are living at home\u003c/a>, who are in the hospital or who are in assisted living settings,\" Pacyna says. \"Skilled nursing (homes) represents a fraction of those that have been impacted by this practice, yet we remain the focus.\"\u003c/p>\n\u003cp>Bagby, the AARP attorney, would like to maintain that focus, and thinks this lawsuit can help do that. \"If you're going to hit their bottom line, that's really where you change behavior.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bagby adds that with antipsychotic drugs still so widely prescribed for nursing home residents, there's the potential for more cases like this one across the country.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Two Women on a Mission to Reform Assisted Living in California",
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"content": "\u003cfigure id=\"attachment_21273\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo.jpg\">\u003cimg class=\"size-large wp-image-21273\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo-640x480.jpg\" alt=\"Chris Murphy (L) and Christina Selder (R) of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Christina Selder and Chris Murphy of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Many of us dream of starting a revolution. Few of us make it happen. One of the most dramatic stories of the last year belongs to a loose collection of activists, working to reform assisted living oversight in California. Together with lawmakers, these activists launched 17 bills in Sacramento, 12 of which passed, 2 of which have become law, so far.\u003c/p>\n\u003cp>It’s a big story, but let’s break off one piece, involving a couple women in San Diego with a passion for raw data, strong coffee and home-baked muffins.\u003c/p>\n\u003cp>About a decade ago, Chris Murphy’s mom was suffering from Stage 4 ovarian cancer. She couldn't live on her own. Someone suggested Murphy check out an assisted living facility, and so she took a tour.\u003c/p>\n\u003cp>“This is really a cool place,\" Murphy says she thought at the time. \"Maybe my mother would like to live here. I would like to live here. I was sucked in by the chandeliers, and by the garden, and by the apparent appearance of the facility.\"\u003c/p>\n\u003cp>\u003c!--more-->Sitting in her home office today, with a fan going to hold off the summer heat, Murphy declines to go into detail about how, exactly, her mom died. Murphy eventually sued and settled.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But she continued to stew over it.\u003c/p>\n\u003cp>\"I didn’t know that there was a public record that I could review,\" she says. \"I didn’t know that the facility had had a wrongful death lawsuit against it. That was not in the public record, even when I was able to review the public record, after the lawsuit. I figured that because they were licensed that the state had some meaningful oversight of this facility, only to discover that it was haphazard, in my view, at best.\"\u003c/p>\n\u003cp>Murphy was retired from a career in defense contracting, but she decided to go back to school at San Diego State and study gerontology -- the social and psychological aspects of aging. That’s where she met Chrisy Selder. Selder was doing her thesis on the idea that people who don’t need round-the-clock, licensed nursing care would be happier in homier assisted living -- which happens to be significantly less expensive than skilled nursing care. It’s a commonly accepted idea in California, where the number of assisted living facilities has doubled in the last 25 years. But Selder's thesis fell apart after she worked in a few facilities and interned in the local ombudsman’s office. The more research she did, she says, the less she thought that assisted living really was a good alternative to nursing homes.\u003c/p>\n\u003cp>Recognizing a kindred spirit, Selder joined Murphy to launch a non-profit called \u003ca href=\"http://www.rcfereform.org/\" target=\"_blank\">Consumer Advocates for RCFE Reform\u003c/a>, or CARR. (An RCFE is regulator-speak for Residential Care Facilities for the Elderly. Most of us call them \"assisted living facilities.\")\u003c/p>\n\u003cp>\"There were a lot of things that I learned in that process,\" Murphy says, \"that if I had known at the front end, I may have made better placement choices for my mother. And then I decided I had a lot of information that could be leveraged for the consumer.\u003c/p>\n\u003cp>What CARR did was create an online database of facilities and public records to give consumers \"immediate access to a facility's public documents,\" it says\u003ca href=\"http://www.rcfereform.org/About-Us\" target=\"_blank\"> on CARR's website\u003c/a>. Before CARR, this online access did not exist.\u003c/p>\n\u003cp>There are more than 700 facilities on CARR's website today, including about 30,000 public documents \"harvested\" by Murphy, Selder and volunteer student interns from San Diego State's programs in criminal justice, gerontology, social services, and public health.\u003c/p>\n\u003cp>Except for the website administrator, everyone at CARR is a volunteer. It’s going to take them a long time to get the whole state catalogued. So far, they’ve got San Diego and Imperial Counties, parts of Orange County, and several small, rural counties in Northern California. They've also got \u003ca href=\"https://www.calvet.ca.gov/VetHomes/Pages/Residential-Care.aspx\" target=\"_blank\">CalVet\u003c/a> facilities. Given their non-existent public relations department, the database was a bit of a trade secret, until the day a health reporter named Deborah Schoch did a Google search and turned up CARR’s site. Schoch is with the \u003ca href=\"http://centerforhealthreporting.org/\" target=\"_blank\">Center for Health Reporting\u003c/a> at USC, and she spotted the raw material for a series of investigative reports.\u003c/p>\n\u003cp>\"They went in and hand scanned thousands and thousands of documents,\" Schoch says. \"We were able to use those to detect certain homes and then went in and scanned our own records, and found more homes like that. But (CARR) gave us an entry point. I have to tell you, some of these folders are 3 inches thick, and there may be two of them, and they’re very difficult to navigate. You just have to go through it page by page by page. There’s nothing that says right up front 'somebody died here.'\"\u003c/p>\n\u003cp>Schoch joined forces with \u003ca href=\"http://www.utsandiego.com/news/2013/Sep/09/deadly-neglect-assisted-living-homes-san-diego/\" target=\"_blank\">\u003cem>UT San Diego\u003c/em>\u003c/a> to detail 27 deaths in San Diego County assisted living -- deaths caused by neglect and abuse. The series they published, “\u003ca href=\"http://centerforhealthreporting.org/topics/elderly-care\" target=\"_blank\">Deadly Neglect\u003c/a>,” was one of several media exposes that inspired those 17 bills in Sacramento.\u003c/p>\n\u003cp>You might think it odd CARR collects the same data the state does, but if you want to get at state data, you have to call your local \u003ca href=\"http://www.cdss.ca.gov/cdssweb/PG12.htm\" target=\"_blank\">Department of Social Services\u003c/a> office, and wait for staffers to pull the data on the facilities you're interested in. Murphy says people don’t realize how hard it is to research -- until time is tight and the stakes are high.\u003c/p>\n\u003cp>\"You’re going to take off three days worth of work,\" Murphy says. \"You’re going to make a California records act request. The state of California is going to tell you when you can come in and look at that file.\" Meanwhile she says, your dad is leaving the gas on after he cooks. Or the facility he’s living in now has issued a discharge notice with a deadline.\u003c/p>\n\u003cp>That, and the files are edited to remove data considered \"non-public\" by somebody in Sacramento. Schoch, who put in a Public Records Act request for some facility files, discovered some of the records removed included those detailing injuries and deaths.\u003c/p>\n\u003cp>CARR’s database makes all the inspection, complaint, and civil penalty reports it collects available online for a small fee ($25 a month). Murphy says they have about 30 subscribers at any given time, including placement agencies and attorneys, as well as families looking to place their parents.\u003c/p>\n\u003cp>\"We needed a little bit of revenue. And a little bit of revenue is all we’re getting!\" Murphy says and explodes into laughter.\u003c/p>\n\u003cp>Over the years, Murphy and Selder’s jaundiced opinions have only hardened. From their vantage point, elbow deep in documents, the profit motive leads managers to cut corners. Regulations are enforced unevenly. The problems afflict facilities of all sizes, not just the big, corporate ones. Lobbyists in Sacramento will argue small facilities shouldn’t be regulated as tightly as large ones. Selder disagrees. \"There’s no cluster. [Facilities with] 6 beds are having just as much problems as the125 beds.\"\u003c/p>\n\u003cp>Murphy and Selder don’t rate facilities, because, they say, individual needs are so different. They prefer to upload raw data. This year, they did something they've never done before: sponsor a bill. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\">AB 1523\u003c/a>, now signed into law by Gov. Jerry Brown, mandates all assisted living facilities carry liability insurance. While some owners of small facilities protested they won’t be able to afford the coverage, there’s wide agreement consumers have little recourse to address serious concerns given what many describe as light oversight from state regulators.\u003c/p>\n\u003cp>In a statement CARR issued after the governor signed AB 1523 into law, Murphy and Selder wrote that they hope the law encourages insurance companies to “weed out the poor performers” the state hasn’t managed to, and lead to the closure of facilities that are “un-insurable.”\u003c/p>\n\u003cp>The legislation was co-authored by \u003ca href=\"http://asmdc.org/speaker/\" target=\"_blank\">State Assembly Speaker Toni Atkins\u003c/a>, who represents San Diego.\u003c/p>\n\u003cp>\"I was absolutely shocked to learn that facilities didn’t carry liability insurance,\" Atkins says. \"I had a hard time understanding how any business, in this day and time, and particularly a business that deals with frail, elderly people, could not have liability insurance.\"\u003c/p>\n\u003cp>Speaker Atkins says the evidence presented by “the Chrises” helped build a data-driven case in Sacramento for substantive reform. \"Typically, as a legislator, you want to see the data,\" Atkins says. Murphy and Selder, she says, \"Set about compiling that data, and putting it front of people.\"\u003c/p>\n\u003cp>For those who wanted to see substantive reform of assisted living facilities in California, it's not clear yet how many of the original 17 measures will make it into law, how many were de-fanged in 11th hour rewrites. Schoch has drawn up a handy \u003ca href=\"http://centerforhealthreporting.org/article/bill-bill-assisted-living-reform-package\" target=\"_blank\">scorecard\u003c/a>.\u003c/p>\n\u003cp>\"A lot of it had to do with cost,\" Speaker Atkins says about what killed or altered reform bills in the waning days of the legislative session. She offers up \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\">AB 1454\u003c/a> by Assemblymember Ian Calderon (D-Whittier) as an example. It would have mandated annual, unannounced inspections of all licensed community care facilities, including assisted living homes. This would require more staff at the Department of Social Services, and thus, more money in the agency's budget. The Brown Administration did approve a bigger budget for DSS this year, but it's not a given it would be enough to guarantee annual visits. Atkins holds out hope for future budget boosts, though. \"California's making a turnaround as it relates to health and human service issues, but it's taking awhile,\" she said.\u003c/p>\n\u003cp>Murphy worries about how those bills that do make it into law will be interpreted by regulators. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, and then the regulators are going to come up with whatever they come up with.\" She wants to see the California Department of Social Services set up stakeholders meetings across the state, to ask what families and activists want to see happen next.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268203311\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\n",
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"excerpt": "Two women started what the state would not: online access to unfiltered information about assisted living facilities.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21273\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo.jpg\">\u003cimg class=\"size-large wp-image-21273\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo-640x480.jpg\" alt=\"Chris Murphy (L) and Christina Selder (R) of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Christina Selder and Chris Murphy of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Many of us dream of starting a revolution. Few of us make it happen. One of the most dramatic stories of the last year belongs to a loose collection of activists, working to reform assisted living oversight in California. Together with lawmakers, these activists launched 17 bills in Sacramento, 12 of which passed, 2 of which have become law, so far.\u003c/p>\n\u003cp>It’s a big story, but let’s break off one piece, involving a couple women in San Diego with a passion for raw data, strong coffee and home-baked muffins.\u003c/p>\n\u003cp>About a decade ago, Chris Murphy’s mom was suffering from Stage 4 ovarian cancer. She couldn't live on her own. Someone suggested Murphy check out an assisted living facility, and so she took a tour.\u003c/p>\n\u003cp>“This is really a cool place,\" Murphy says she thought at the time. \"Maybe my mother would like to live here. I would like to live here. I was sucked in by the chandeliers, and by the garden, and by the apparent appearance of the facility.\"\u003c/p>\n\u003cp>\u003c!--more-->Sitting in her home office today, with a fan going to hold off the summer heat, Murphy declines to go into detail about how, exactly, her mom died. Murphy eventually sued and settled.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But she continued to stew over it.\u003c/p>\n\u003cp>\"I didn’t know that there was a public record that I could review,\" she says. \"I didn’t know that the facility had had a wrongful death lawsuit against it. That was not in the public record, even when I was able to review the public record, after the lawsuit. I figured that because they were licensed that the state had some meaningful oversight of this facility, only to discover that it was haphazard, in my view, at best.\"\u003c/p>\n\u003cp>Murphy was retired from a career in defense contracting, but she decided to go back to school at San Diego State and study gerontology -- the social and psychological aspects of aging. That’s where she met Chrisy Selder. Selder was doing her thesis on the idea that people who don’t need round-the-clock, licensed nursing care would be happier in homier assisted living -- which happens to be significantly less expensive than skilled nursing care. It’s a commonly accepted idea in California, where the number of assisted living facilities has doubled in the last 25 years. But Selder's thesis fell apart after she worked in a few facilities and interned in the local ombudsman’s office. The more research she did, she says, the less she thought that assisted living really was a good alternative to nursing homes.\u003c/p>\n\u003cp>Recognizing a kindred spirit, Selder joined Murphy to launch a non-profit called \u003ca href=\"http://www.rcfereform.org/\" target=\"_blank\">Consumer Advocates for RCFE Reform\u003c/a>, or CARR. (An RCFE is regulator-speak for Residential Care Facilities for the Elderly. Most of us call them \"assisted living facilities.\")\u003c/p>\n\u003cp>\"There were a lot of things that I learned in that process,\" Murphy says, \"that if I had known at the front end, I may have made better placement choices for my mother. And then I decided I had a lot of information that could be leveraged for the consumer.\u003c/p>\n\u003cp>What CARR did was create an online database of facilities and public records to give consumers \"immediate access to a facility's public documents,\" it says\u003ca href=\"http://www.rcfereform.org/About-Us\" target=\"_blank\"> on CARR's website\u003c/a>. Before CARR, this online access did not exist.\u003c/p>\n\u003cp>There are more than 700 facilities on CARR's website today, including about 30,000 public documents \"harvested\" by Murphy, Selder and volunteer student interns from San Diego State's programs in criminal justice, gerontology, social services, and public health.\u003c/p>\n\u003cp>Except for the website administrator, everyone at CARR is a volunteer. It’s going to take them a long time to get the whole state catalogued. So far, they’ve got San Diego and Imperial Counties, parts of Orange County, and several small, rural counties in Northern California. They've also got \u003ca href=\"https://www.calvet.ca.gov/VetHomes/Pages/Residential-Care.aspx\" target=\"_blank\">CalVet\u003c/a> facilities. Given their non-existent public relations department, the database was a bit of a trade secret, until the day a health reporter named Deborah Schoch did a Google search and turned up CARR’s site. Schoch is with the \u003ca href=\"http://centerforhealthreporting.org/\" target=\"_blank\">Center for Health Reporting\u003c/a> at USC, and she spotted the raw material for a series of investigative reports.\u003c/p>\n\u003cp>\"They went in and hand scanned thousands and thousands of documents,\" Schoch says. \"We were able to use those to detect certain homes and then went in and scanned our own records, and found more homes like that. But (CARR) gave us an entry point. I have to tell you, some of these folders are 3 inches thick, and there may be two of them, and they’re very difficult to navigate. You just have to go through it page by page by page. There’s nothing that says right up front 'somebody died here.'\"\u003c/p>\n\u003cp>Schoch joined forces with \u003ca href=\"http://www.utsandiego.com/news/2013/Sep/09/deadly-neglect-assisted-living-homes-san-diego/\" target=\"_blank\">\u003cem>UT San Diego\u003c/em>\u003c/a> to detail 27 deaths in San Diego County assisted living -- deaths caused by neglect and abuse. The series they published, “\u003ca href=\"http://centerforhealthreporting.org/topics/elderly-care\" target=\"_blank\">Deadly Neglect\u003c/a>,” was one of several media exposes that inspired those 17 bills in Sacramento.\u003c/p>\n\u003cp>You might think it odd CARR collects the same data the state does, but if you want to get at state data, you have to call your local \u003ca href=\"http://www.cdss.ca.gov/cdssweb/PG12.htm\" target=\"_blank\">Department of Social Services\u003c/a> office, and wait for staffers to pull the data on the facilities you're interested in. Murphy says people don’t realize how hard it is to research -- until time is tight and the stakes are high.\u003c/p>\n\u003cp>\"You’re going to take off three days worth of work,\" Murphy says. \"You’re going to make a California records act request. The state of California is going to tell you when you can come in and look at that file.\" Meanwhile she says, your dad is leaving the gas on after he cooks. Or the facility he’s living in now has issued a discharge notice with a deadline.\u003c/p>\n\u003cp>That, and the files are edited to remove data considered \"non-public\" by somebody in Sacramento. Schoch, who put in a Public Records Act request for some facility files, discovered some of the records removed included those detailing injuries and deaths.\u003c/p>\n\u003cp>CARR’s database makes all the inspection, complaint, and civil penalty reports it collects available online for a small fee ($25 a month). Murphy says they have about 30 subscribers at any given time, including placement agencies and attorneys, as well as families looking to place their parents.\u003c/p>\n\u003cp>\"We needed a little bit of revenue. And a little bit of revenue is all we’re getting!\" Murphy says and explodes into laughter.\u003c/p>\n\u003cp>Over the years, Murphy and Selder’s jaundiced opinions have only hardened. From their vantage point, elbow deep in documents, the profit motive leads managers to cut corners. Regulations are enforced unevenly. The problems afflict facilities of all sizes, not just the big, corporate ones. Lobbyists in Sacramento will argue small facilities shouldn’t be regulated as tightly as large ones. Selder disagrees. \"There’s no cluster. [Facilities with] 6 beds are having just as much problems as the125 beds.\"\u003c/p>\n\u003cp>Murphy and Selder don’t rate facilities, because, they say, individual needs are so different. They prefer to upload raw data. This year, they did something they've never done before: sponsor a bill. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\">AB 1523\u003c/a>, now signed into law by Gov. Jerry Brown, mandates all assisted living facilities carry liability insurance. While some owners of small facilities protested they won’t be able to afford the coverage, there’s wide agreement consumers have little recourse to address serious concerns given what many describe as light oversight from state regulators.\u003c/p>\n\u003cp>In a statement CARR issued after the governor signed AB 1523 into law, Murphy and Selder wrote that they hope the law encourages insurance companies to “weed out the poor performers” the state hasn’t managed to, and lead to the closure of facilities that are “un-insurable.”\u003c/p>\n\u003cp>The legislation was co-authored by \u003ca href=\"http://asmdc.org/speaker/\" target=\"_blank\">State Assembly Speaker Toni Atkins\u003c/a>, who represents San Diego.\u003c/p>\n\u003cp>\"I was absolutely shocked to learn that facilities didn’t carry liability insurance,\" Atkins says. \"I had a hard time understanding how any business, in this day and time, and particularly a business that deals with frail, elderly people, could not have liability insurance.\"\u003c/p>\n\u003cp>Speaker Atkins says the evidence presented by “the Chrises” helped build a data-driven case in Sacramento for substantive reform. \"Typically, as a legislator, you want to see the data,\" Atkins says. Murphy and Selder, she says, \"Set about compiling that data, and putting it front of people.\"\u003c/p>\n\u003cp>For those who wanted to see substantive reform of assisted living facilities in California, it's not clear yet how many of the original 17 measures will make it into law, how many were de-fanged in 11th hour rewrites. Schoch has drawn up a handy \u003ca href=\"http://centerforhealthreporting.org/article/bill-bill-assisted-living-reform-package\" target=\"_blank\">scorecard\u003c/a>.\u003c/p>\n\u003cp>\"A lot of it had to do with cost,\" Speaker Atkins says about what killed or altered reform bills in the waning days of the legislative session. She offers up \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\">AB 1454\u003c/a> by Assemblymember Ian Calderon (D-Whittier) as an example. It would have mandated annual, unannounced inspections of all licensed community care facilities, including assisted living homes. This would require more staff at the Department of Social Services, and thus, more money in the agency's budget. The Brown Administration did approve a bigger budget for DSS this year, but it's not a given it would be enough to guarantee annual visits. Atkins holds out hope for future budget boosts, though. \"California's making a turnaround as it relates to health and human service issues, but it's taking awhile,\" she said.\u003c/p>\n\u003cp>Murphy worries about how those bills that do make it into law will be interpreted by regulators. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, and then the regulators are going to come up with whatever they come up with.\" She wants to see the California Department of Social Services set up stakeholders meetings across the state, to ask what families and activists want to see happen next.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Judge Rules Berkeley Must Change Soda Tax Language",
"title": "Judge Rules Berkeley Must Change Soda Tax Language",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17715\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS7242_136799870-1-hpf.jpg\">\u003cimg class=\"size-full wp-image-17715\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS7242_136799870-1-hpf.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS7242_136799870-1-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS7242_136799870-1-hpf-400x250.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS7242_136799870-1-hpf-320x200.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update September 2, 6:05 p.m.:\u003c/strong> A judge ruled Tuesday that Berkeley officials must change the soda tax measure language because it is currently misleading.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Soda tax advocates say this change \"doesn't concern us at all.\" \u003c/aside>\n\u003cp>Alameda County Superior Court Judge Evelio Grillo said the city's statement that the tax would only be imposed on \"high-calorie, sugary drinks\" is \"a form of advocacy and therefore not impartial.\"\u003c/p>\n\u003cp>Grillo ordered the city to change the summary to say that the tax would apply to \"sugar-sweetened beverages,\" which he said is more neutral and less likely to create prejudice for or against Measure D.\u003c/p>\n\u003cp>Anthony Johnson and Leon Cain \u003ca href=\"http://www.berkeleyside.com/2014/08/15/lawsuit-filed-over-berkeley-soda-tax-ballot-language/\" target=\"_blank\">filed the lawsuit in August\u003c/a>. Cain has previously attended Berkeley council meetings on behalf of the No Berkeley Beverage Tax campaign.\u003c!--more-->\u003c/p>\n\u003cp>Tax opponents had also argued that ballot language that says the tax would be paid by distributors, not by consumers, is misleading because they believe distributors would pass on the extra cost to consumers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Grillo ruled against tax opponents on that issue, saying they failed to provide clear and convincing evidence based on the ballot statement that the tax won't be paid by consumers is misleading or partial.\u003c/p>\n\u003cp>The judge said tax opponents \"only speculate that it is like that such cost will be passed down to consumers, but it is unknown at this point whether or not any of the tax will eventually be passed down to consumers.\"\u003c/p>\n\u003cp>Grillo said the city correctly pointed out that distributors and retailers could choose to absorb the cost of the tax in order to better compete with other businesses.\u003c/p>\n\u003cp>Berkeley school board member Joshua Daniels, who is co-chair of the campaign in favor of Measure D, said Grillo's order that the ballot language be changed is only a \"relatively minor\" development and \"doesn't concern us at all\" because \"everyone knows that the measure is focused on preventing diabetes,\" and he thinks it will still be approved.\u003c/p>\n\u003cp>Daniels said that overall Grillo's ruling is \"a victory\" for Measure D supporters.\u003c/p>\n\u003cp>Grillo's ruling came one day before the deadline on Wednesday for the Alameda County Registrar of Voters Office to send ballot arguments to the printer so that voters can receive them well in advance of the election on Nov. 4.\u003c/p>\n\u003cp>\u003cstrong>Original Post July 2, 2014 \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>By Charles Siler\u003c/strong>, \u003ca href=\"http://www.berkeleyside.com/2014/07/02/berkeley-puts-sugar-tax-on-november-ballot-could-be-first-in-country-to-take-on-big-soda/\" target=\"_blank\">Berkeleyside\u003c/a>\u003c/p>\n\u003cp>Berkeley City Council voted unanimously Tuesday night to include a proposal that would tax distributors of sugar-sweetened beverages on the November ballot.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Voters will decide on penny-per-ounce tax on soda and other sugar-sweetened beverages.\u003c/aside>\n\u003cp>The measure, which proposes a one-cent-per-ounce charge at the distributor level, would be the first such tax passed in the country. Richmond tried to pass a similar tax in 2012, but it was voted down after a $2.7 million campaign by the soda industry.\u003c/p>\n\u003cp>Supporters of the tax point to studies linking sugary drinks to childhood obesity and diabetes. Members of community organization Berkeley vs. Big Soda gathered on the steps of city hall before the Tuesday night meeting to voice their support of the tax.\u003c/p>\n\u003cp>“We want to support our kids. We don’t want our kids to be sick with diabetes,” said Dr. Vicki Alexander, co-chair of the Berkeley Healthy Child Foundation, at the council meeting. “We know that we can change that trend.”\u003c/p>\n\u003cp>Opponents of the tax said the measure would prove ineffective.\u003c/p>\n\u003cp>“I agree that diabetes and childhood obesity are big issues. I just don’t necessarily agree that taxation on sweetened beverages or soda is the best way to deal with that,” said Jennifer Skidmore of J&J Vending. “Statistics show that purchasing of sweetened beverages is already on the decline, without taxation.”\u003c/p>\n\u003cp>Supporters also say the tax is a social justice issue, pointing to the higher rates of obesity in black and Latino communities.\u003c/p>\n\u003cp>“Research shows diabetes rates in Latino, African-American communities have reached epidemic proportions,” said Xavier Morales, executive director of the Latino Coalition for a Healthy California. “That’s not an exaggeration.”\u003c/p>\n\u003cp>“Big Soda will claim that we are attacking a product that is beloved by low-income folks,” said Councilmember Laurie Capitelli, “but those are the people who are coming to us and asking us to put this on the ballot.”\u003c/p>\n\u003cp>Ted Mundorff, CEO and president of Landmark Theaters, which owns both the Shattuck Cinemas and the California Theater, said revenue from the tax would not be earmarked for any healthy initiatives.\u003c/p>\n\u003cp>“If we could solve obesity and diabetes with a one-cent tax I’d say bring it on, let’s do two cents,” Mundorff said. “But the reality is that this cent is going into the general fund, and it is not earmarked to do anything, except to hurt business.”\u003c/p>\n\u003cp>Because the measure proposes a general tax, as opposed to a special tax, revenue from the tax would go into the general fund and cannot be reserved for any special purpose. With a special tax, the money could be designated for anti-obesity initiatives, such as nutrition programs in schools — but a special tax requires a two-thirds majority vote, while a general tax requires only 50 percent plus one.\u003c/p>\n\u003cp>The sugar tax on San Francisco’s November ballot is a special tax, and so will require a two-thirds majority to pass, unlike the Berkeley proposal. The San Francisco measure also proposes a tax of two cents per ounce, rather than Berkeley’s one.\u003c/p>\n\u003cp>Berkeley’s November ballot will read: “Shall an ordinance imposing a 1¢ per ounce general tax on the distribution of high-calorie, sugary drinks (e.g., sodas, energy drinks, presweetened teas) and sweeteners used to sweeten such drinks, but exempting: (1) sweeteners (e.g., sugar, honey,syrups) typically used by consumers and distributed to grocery stores; (2) drinks and sweeteners distributed to very small retailers; (3) diet drinks, milk products, 100% juice, baby formula, alcohol, or drinks taken for medical reasons, be adopted?” Councilmember Linda Maio proposed the new, slightly different language at the Tuesday meeting.\u003c/p>\n\u003cp>Supporters of the tax acknowledged that in the coming months, the soda industry will likely campaign heavily against the tax measure in Berkeley and in San Francisco.\u003c/p>\n\u003cp>“I don’t think even if they spent a million dollars they could confuse the people of Berkeley. So I’m not really worried about how much money they spend,” said Councilmember Kriss Worthington. “The people of Berkeley are too smart to be confused.”\u003c/p>\n\u003cp>“There’s going to be a lot of opposition, there’s going to be lot of lies,” said Mayor Tom Bates. “They’re going to be sending people door to door with distortions, with misinformation, and it’s going to be tough. So we all need to work. This is the beginning, this is not the end.”\u003c/p>\n\u003cp>\u003cem style=\"color: #4d4d4d\">KQED News Associate \u003ca style=\"color: #336699\" href=\"http://www.berkeleyside.com/\" target=\"_blank\">Berkeleyside\u003c/a> is an independently owned news website based in Berkeley, Calif. \u003ca style=\"color: #336699\" href=\"http://berkeleyside.us2.list-manage.com/subscribe?u=4851428a10883a05193b1dd6c&id=aad4b5ee64\" target=\"_blank\">Click here\u003c/a> if you would you like to receive the latest Berkeley news in your inbox once a day for free with Berkeleyside’s Daily Briefing email.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17715\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS7242_136799870-1-hpf.jpg\">\u003cimg class=\"size-full wp-image-17715\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS7242_136799870-1-hpf.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS7242_136799870-1-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS7242_136799870-1-hpf-400x250.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS7242_136799870-1-hpf-320x200.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update September 2, 6:05 p.m.:\u003c/strong> A judge ruled Tuesday that Berkeley officials must change the soda tax measure language because it is currently misleading.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Soda tax advocates say this change \"doesn't concern us at all.\" \u003c/aside>\n\u003cp>Alameda County Superior Court Judge Evelio Grillo said the city's statement that the tax would only be imposed on \"high-calorie, sugary drinks\" is \"a form of advocacy and therefore not impartial.\"\u003c/p>\n\u003cp>Grillo ordered the city to change the summary to say that the tax would apply to \"sugar-sweetened beverages,\" which he said is more neutral and less likely to create prejudice for or against Measure D.\u003c/p>\n\u003cp>Anthony Johnson and Leon Cain \u003ca href=\"http://www.berkeleyside.com/2014/08/15/lawsuit-filed-over-berkeley-soda-tax-ballot-language/\" target=\"_blank\">filed the lawsuit in August\u003c/a>. Cain has previously attended Berkeley council meetings on behalf of the No Berkeley Beverage Tax campaign.\u003c!--more-->\u003c/p>\n\u003cp>Tax opponents had also argued that ballot language that says the tax would be paid by distributors, not by consumers, is misleading because they believe distributors would pass on the extra cost to consumers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Grillo ruled against tax opponents on that issue, saying they failed to provide clear and convincing evidence based on the ballot statement that the tax won't be paid by consumers is misleading or partial.\u003c/p>\n\u003cp>The judge said tax opponents \"only speculate that it is like that such cost will be passed down to consumers, but it is unknown at this point whether or not any of the tax will eventually be passed down to consumers.\"\u003c/p>\n\u003cp>Grillo said the city correctly pointed out that distributors and retailers could choose to absorb the cost of the tax in order to better compete with other businesses.\u003c/p>\n\u003cp>Berkeley school board member Joshua Daniels, who is co-chair of the campaign in favor of Measure D, said Grillo's order that the ballot language be changed is only a \"relatively minor\" development and \"doesn't concern us at all\" because \"everyone knows that the measure is focused on preventing diabetes,\" and he thinks it will still be approved.\u003c/p>\n\u003cp>Daniels said that overall Grillo's ruling is \"a victory\" for Measure D supporters.\u003c/p>\n\u003cp>Grillo's ruling came one day before the deadline on Wednesday for the Alameda County Registrar of Voters Office to send ballot arguments to the printer so that voters can receive them well in advance of the election on Nov. 4.\u003c/p>\n\u003cp>\u003cstrong>Original Post July 2, 2014 \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>By Charles Siler\u003c/strong>, \u003ca href=\"http://www.berkeleyside.com/2014/07/02/berkeley-puts-sugar-tax-on-november-ballot-could-be-first-in-country-to-take-on-big-soda/\" target=\"_blank\">Berkeleyside\u003c/a>\u003c/p>\n\u003cp>Berkeley City Council voted unanimously Tuesday night to include a proposal that would tax distributors of sugar-sweetened beverages on the November ballot.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Voters will decide on penny-per-ounce tax on soda and other sugar-sweetened beverages.\u003c/aside>\n\u003cp>The measure, which proposes a one-cent-per-ounce charge at the distributor level, would be the first such tax passed in the country. Richmond tried to pass a similar tax in 2012, but it was voted down after a $2.7 million campaign by the soda industry.\u003c/p>\n\u003cp>Supporters of the tax point to studies linking sugary drinks to childhood obesity and diabetes. Members of community organization Berkeley vs. Big Soda gathered on the steps of city hall before the Tuesday night meeting to voice their support of the tax.\u003c/p>\n\u003cp>“We want to support our kids. We don’t want our kids to be sick with diabetes,” said Dr. Vicki Alexander, co-chair of the Berkeley Healthy Child Foundation, at the council meeting. “We know that we can change that trend.”\u003c/p>\n\u003cp>Opponents of the tax said the measure would prove ineffective.\u003c/p>\n\u003cp>“I agree that diabetes and childhood obesity are big issues. I just don’t necessarily agree that taxation on sweetened beverages or soda is the best way to deal with that,” said Jennifer Skidmore of J&J Vending. “Statistics show that purchasing of sweetened beverages is already on the decline, without taxation.”\u003c/p>\n\u003cp>Supporters also say the tax is a social justice issue, pointing to the higher rates of obesity in black and Latino communities.\u003c/p>\n\u003cp>“Research shows diabetes rates in Latino, African-American communities have reached epidemic proportions,” said Xavier Morales, executive director of the Latino Coalition for a Healthy California. “That’s not an exaggeration.”\u003c/p>\n\u003cp>“Big Soda will claim that we are attacking a product that is beloved by low-income folks,” said Councilmember Laurie Capitelli, “but those are the people who are coming to us and asking us to put this on the ballot.”\u003c/p>\n\u003cp>Ted Mundorff, CEO and president of Landmark Theaters, which owns both the Shattuck Cinemas and the California Theater, said revenue from the tax would not be earmarked for any healthy initiatives.\u003c/p>\n\u003cp>“If we could solve obesity and diabetes with a one-cent tax I’d say bring it on, let’s do two cents,” Mundorff said. “But the reality is that this cent is going into the general fund, and it is not earmarked to do anything, except to hurt business.”\u003c/p>\n\u003cp>Because the measure proposes a general tax, as opposed to a special tax, revenue from the tax would go into the general fund and cannot be reserved for any special purpose. With a special tax, the money could be designated for anti-obesity initiatives, such as nutrition programs in schools — but a special tax requires a two-thirds majority vote, while a general tax requires only 50 percent plus one.\u003c/p>\n\u003cp>The sugar tax on San Francisco’s November ballot is a special tax, and so will require a two-thirds majority to pass, unlike the Berkeley proposal. The San Francisco measure also proposes a tax of two cents per ounce, rather than Berkeley’s one.\u003c/p>\n\u003cp>Berkeley’s November ballot will read: “Shall an ordinance imposing a 1¢ per ounce general tax on the distribution of high-calorie, sugary drinks (e.g., sodas, energy drinks, presweetened teas) and sweeteners used to sweeten such drinks, but exempting: (1) sweeteners (e.g., sugar, honey,syrups) typically used by consumers and distributed to grocery stores; (2) drinks and sweeteners distributed to very small retailers; (3) diet drinks, milk products, 100% juice, baby formula, alcohol, or drinks taken for medical reasons, be adopted?” Councilmember Linda Maio proposed the new, slightly different language at the Tuesday meeting.\u003c/p>\n\u003cp>Supporters of the tax acknowledged that in the coming months, the soda industry will likely campaign heavily against the tax measure in Berkeley and in San Francisco.\u003c/p>\n\u003cp>“I don’t think even if they spent a million dollars they could confuse the people of Berkeley. So I’m not really worried about how much money they spend,” said Councilmember Kriss Worthington. “The people of Berkeley are too smart to be confused.”\u003c/p>\n\u003cp>“There’s going to be a lot of opposition, there’s going to be lot of lies,” said Mayor Tom Bates. “They’re going to be sending people door to door with distortions, with misinformation, and it’s going to be tough. So we all need to work. This is the beginning, this is not the end.”\u003c/p>\n\u003cp>\u003cem style=\"color: #4d4d4d\">KQED News Associate \u003ca style=\"color: #336699\" href=\"http://www.berkeleyside.com/\" target=\"_blank\">Berkeleyside\u003c/a> is an independently owned news website based in Berkeley, Calif. \u003ca style=\"color: #336699\" href=\"http://berkeleyside.us2.list-manage.com/subscribe?u=4851428a10883a05193b1dd6c&id=aad4b5ee64\" target=\"_blank\">Click here\u003c/a> if you would you like to receive the latest Berkeley news in your inbox once a day for free with Berkeleyside’s Daily Briefing email.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "How Will Your Hospital Fare in the Next Earthquake?",
"title": "How Will Your Hospital Fare in the Next Earthquake?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_21119\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/USGS_-_1971_San_Fernando_earthquake_-_Collapse_of_Veterans_Hospital_buildings_1_and_2-e1409427145201.jpg\">\u003cimg class=\"size-large wp-image-21119\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/USGS_-_1971_San_Fernando_earthquake_-_Collapse_of_Veterans_Hospital_buildings_1_and_2-640x433.jpg\" alt=\"Two buildings at the Veterans Hospital in San Fernando collapsed during the 1971 Sylmar quake. (Photo: USGS)\" width=\"640\" height=\"433\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Two buildings at the Veterans Hospital in San Fernando collapsed during the 1971 Sylmar quake. (Photo: USGS)\u003c/figcaption>\u003c/figure>\n\u003cp>One thing about an earthquake: It focuses the mind.\u003c/p>\n\u003cp>In the wake of the Aug. 24 South Napa Quake, I became focused on hospital safety.\u003c/p>\n\u003cp>Queen of the Valley Hospital in Napa sustained only minor damage from the earthquake -- falling items and leaks. A statement released 13 hours after the earthquake said that \"(n)\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">one of these issues have prevented the hospital from triaging and treating patients. Queen of the Valley remains operational and continues to be able to accept and treat patients.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"http://www.oshpd.ca.gov/fdd/seismic_compliance/SB1953/SB1953Overview.pdf\" target=\"_blank\">Legislation passed\u003c/a> 20 years ago, in the wake of the Northridge earthquake, seeks to make Queen of the Valley's performance the norm for hospitals statewide after a major earthquake. That 1994 legislation was itself an update to the 1973 Seismic Safety Act, which in turn was written in the wake of the Sylmar earthquake when several hospitals collapsed.\u003c!--more-->\u003c/p>\n\u003cp>The law's goal is not just that hospitals will remain structurally sound after an earthquake -- but they must also remain operational, treating patients as Queen of the Valley did.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Let's take those two parts separately: first, structural integrity. Second, what the state calls \"non-structural performance,\" or ability to operate.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.oshpd.ca.gov/fdd/seismic_compliance/SB1953/SB1953Overview.pdf\" target=\"_blank\">Seismic Safety Act\u003c/a> every hospital building in the state has been assessed for structural integrity and rated 1-5 (\"1\" being at-risk of complete collapse in an earthquake).\u003c/p>\n\u003cp>You \u003ca href=\"http://oshpd.ca.gov/FDD/seismic_compliance/SB1953/ExtensionRequests.pdf\" target=\"_blank\">can look up\u003c/a> the assessment of every building in every hospital statewide. (The\u003ca href=\"http://oshpd.ca.gov/FDD/seismic_compliance/SB1953/ExtensionRequests.pdf\" target=\"_blank\"> spreadsheet\u003c/a> is highly detailed, so give yourself some time.)\u003c/p>\n\u003cp>The greatest concern was around buildings deemed most at risk of collapse, those rated SPC 1.\u003c/p>\n\u003cp>Yes, it's been 20 years since the law was passed, and there have been rounds of delays, a wait for regulations, a significant recession and more, but today, 88 percent of the state's hospital acute care buildings with an SPC 1 rating have been upgraded, according to the Office of Statewide Health Planning and Development. OSHPD is responsible for overseeing compliance. They no longer are deemed at risk of collapse.\u003c/p>\n\u003cp>\"Some of (the hospitals) had to do minor retrofitting; others had to do a complete rebuild,\" said Jan Emerson-Shea, spokesperson with the California Hospital Association.\u003c/p>\n\u003cp>Of the SPC 1 buildings still not in compliance, some are looking at a Jan. 1, 2015 deadline, while a few more have until 2020. (SPC 2 buildings must be compliant by 2030; SPC 3-5 are considered seismically sound.)\u003c/p>\n\u003cp>\u003cstrong>At A Cost of Billions\u003c/strong>\u003c/p>\n\u003cp>Emerson-Shea stressed that the California Hospital Association \"always supported the public policy goal\" of seismically safe hospitals, but this has been an extraordinarily expensive law.\u003c/p>\n\u003cp>\"It's the most expensive unfunded mandate in the history of the state of California,\" she said. While county-owned or district-owned hospitals can seek additional money from local taxpayers, she said, \"for the majority of privately owned hospitals, there is no source of funding other than the hospital itself.\"\u003c/p>\n\u003cp>Then there's the other deadline. By 2030, all acute care hospital buildings must be engineered to be fully operational after an earthquake. For many hospitals, the path of least resistance to meet both standards appeared to be rebuilding.\u003c/p>\n\u003cp>Kaiser Permanente has been on a statewide hospital building boom for several years. Since 2007, Kaiser has built 11 hospitals to replace buildings that did not meet the state standards. A 12th is scheduled to open in December.\u003c/p>\n\u003cp>All this at a cost of roughly $7 billion.\u003c/p>\n\u003cp>\"There was an expense, but it was a commitment we made,\" said Scott Bell, Kaiser's executive director of facilities, planning and design. He said all the hospitals are designed to meet a standard referred to as a \"475 year event,\" an earthquake along the lines of the 1906 earthquake in San Francisco.\u003c/p>\n\u003cp>In addition to the seismic integrity of the building itself, the regulations \"require that we brace all our systems,\" he said. \"Even sprinkling piping has to be braced. ... If it's movable equipment, we tether it to the wall, if it's stationary, we bolt it to the ground. We have specific requirements that all the pieces are anchored.\"\u003c/p>\n\u003cp>\"I have a lot of confidence in our facilities being able to survive a major event,\" Bell said, and added that the new hospitals are all rated SPC 5, the highest level of seismic safety.\u003c/p>\n\u003cp>\u003cstrong>Jan. 1, 2015 Deadline\u003c/strong>\u003c/p>\n\u003cp>While 88 percent of the state's SPC 1 buildings are already compliant, five hospitals statewide are staring down a Jan. 1, 2015 deadline. Each hospital has at least one patient-care building assessed at SPC 1 and is close to completing a new facility.\u003c/p>\n\u003cp>But the law states that if the replacement building is not ready, the current seismically unsafe patient-care building must be shut down. There's no flexibility in the law. Extensions can only be granted by legislative action.\u003c/p>\n\u003cp>Assemblyman Richard Pan (D-Sacramento) has introduced a bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB2557\" target=\"_blank\">AB2557, to give these hospitals a short extension\u003c/a> -- nine months maximum. \"These hospitals are making a good-faith effort to build the facilities, and they just need a little more time to make sure they're up to safety standards, seismic or otherwise,\" Pan said. \"We shouldn't rush or have to discharge patients because we're going to lose a hospital.\"\u003c/p>\n\u003cp>But the Legislature wraps up its session Sunday night at midnight.\u003c/p>\n\u003cp>Friday afternoon, the bill was headed to the Senate floor, but if passed there, it still had to go back to the Assembly. If it doesn't make it out of the Legislature by Sunday night, the law requires that these five hospitals close their seismically unsafe buildings on Jan. 1. The four hospitals most affected are Sutter Sacramento, Sequoia Hospital in Redwood City, and two hospitals with Santa Barbara's Cottage Health System, one in Santa Ynez and one in Goleta. (Regional Medical Center in San Jose is the fifth, but the affected building handles only a fraction of its overall patients.)\u003c/p>\n\u003cp>Stay tuned. We'll know more after Sunday at midnight.\u003c/p>\n\u003cp>Back at Queen of the Valley, spokeswoman Vanessa de Gier says that all of the patient-care areas of the hospital were built in the 1980s and are compliant with current seismic standards. The hospital had only one building with an SPC 1 rating -- the original hospital building from 1958. Queen of the Valley opted to build a replacement for that building, rather than retrofit. That building is \"not a direct patient-care area,\" de Gier said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"We are 100 percent in compliance with the law,\" she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21119\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/USGS_-_1971_San_Fernando_earthquake_-_Collapse_of_Veterans_Hospital_buildings_1_and_2-e1409427145201.jpg\">\u003cimg class=\"size-large wp-image-21119\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/USGS_-_1971_San_Fernando_earthquake_-_Collapse_of_Veterans_Hospital_buildings_1_and_2-640x433.jpg\" alt=\"Two buildings at the Veterans Hospital in San Fernando collapsed during the 1971 Sylmar quake. (Photo: USGS)\" width=\"640\" height=\"433\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Two buildings at the Veterans Hospital in San Fernando collapsed during the 1971 Sylmar quake. (Photo: USGS)\u003c/figcaption>\u003c/figure>\n\u003cp>One thing about an earthquake: It focuses the mind.\u003c/p>\n\u003cp>In the wake of the Aug. 24 South Napa Quake, I became focused on hospital safety.\u003c/p>\n\u003cp>Queen of the Valley Hospital in Napa sustained only minor damage from the earthquake -- falling items and leaks. A statement released 13 hours after the earthquake said that \"(n)\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">one of these issues have prevented the hospital from triaging and treating patients. Queen of the Valley remains operational and continues to be able to accept and treat patients.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"http://www.oshpd.ca.gov/fdd/seismic_compliance/SB1953/SB1953Overview.pdf\" target=\"_blank\">Legislation passed\u003c/a> 20 years ago, in the wake of the Northridge earthquake, seeks to make Queen of the Valley's performance the norm for hospitals statewide after a major earthquake. That 1994 legislation was itself an update to the 1973 Seismic Safety Act, which in turn was written in the wake of the Sylmar earthquake when several hospitals collapsed.\u003c!--more-->\u003c/p>\n\u003cp>The law's goal is not just that hospitals will remain structurally sound after an earthquake -- but they must also remain operational, treating patients as Queen of the Valley did.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Let's take those two parts separately: first, structural integrity. Second, what the state calls \"non-structural performance,\" or ability to operate.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.oshpd.ca.gov/fdd/seismic_compliance/SB1953/SB1953Overview.pdf\" target=\"_blank\">Seismic Safety Act\u003c/a> every hospital building in the state has been assessed for structural integrity and rated 1-5 (\"1\" being at-risk of complete collapse in an earthquake).\u003c/p>\n\u003cp>You \u003ca href=\"http://oshpd.ca.gov/FDD/seismic_compliance/SB1953/ExtensionRequests.pdf\" target=\"_blank\">can look up\u003c/a> the assessment of every building in every hospital statewide. (The\u003ca href=\"http://oshpd.ca.gov/FDD/seismic_compliance/SB1953/ExtensionRequests.pdf\" target=\"_blank\"> spreadsheet\u003c/a> is highly detailed, so give yourself some time.)\u003c/p>\n\u003cp>The greatest concern was around buildings deemed most at risk of collapse, those rated SPC 1.\u003c/p>\n\u003cp>Yes, it's been 20 years since the law was passed, and there have been rounds of delays, a wait for regulations, a significant recession and more, but today, 88 percent of the state's hospital acute care buildings with an SPC 1 rating have been upgraded, according to the Office of Statewide Health Planning and Development. OSHPD is responsible for overseeing compliance. They no longer are deemed at risk of collapse.\u003c/p>\n\u003cp>\"Some of (the hospitals) had to do minor retrofitting; others had to do a complete rebuild,\" said Jan Emerson-Shea, spokesperson with the California Hospital Association.\u003c/p>\n\u003cp>Of the SPC 1 buildings still not in compliance, some are looking at a Jan. 1, 2015 deadline, while a few more have until 2020. (SPC 2 buildings must be compliant by 2030; SPC 3-5 are considered seismically sound.)\u003c/p>\n\u003cp>\u003cstrong>At A Cost of Billions\u003c/strong>\u003c/p>\n\u003cp>Emerson-Shea stressed that the California Hospital Association \"always supported the public policy goal\" of seismically safe hospitals, but this has been an extraordinarily expensive law.\u003c/p>\n\u003cp>\"It's the most expensive unfunded mandate in the history of the state of California,\" she said. While county-owned or district-owned hospitals can seek additional money from local taxpayers, she said, \"for the majority of privately owned hospitals, there is no source of funding other than the hospital itself.\"\u003c/p>\n\u003cp>Then there's the other deadline. By 2030, all acute care hospital buildings must be engineered to be fully operational after an earthquake. For many hospitals, the path of least resistance to meet both standards appeared to be rebuilding.\u003c/p>\n\u003cp>Kaiser Permanente has been on a statewide hospital building boom for several years. Since 2007, Kaiser has built 11 hospitals to replace buildings that did not meet the state standards. A 12th is scheduled to open in December.\u003c/p>\n\u003cp>All this at a cost of roughly $7 billion.\u003c/p>\n\u003cp>\"There was an expense, but it was a commitment we made,\" said Scott Bell, Kaiser's executive director of facilities, planning and design. He said all the hospitals are designed to meet a standard referred to as a \"475 year event,\" an earthquake along the lines of the 1906 earthquake in San Francisco.\u003c/p>\n\u003cp>In addition to the seismic integrity of the building itself, the regulations \"require that we brace all our systems,\" he said. \"Even sprinkling piping has to be braced. ... If it's movable equipment, we tether it to the wall, if it's stationary, we bolt it to the ground. We have specific requirements that all the pieces are anchored.\"\u003c/p>\n\u003cp>\"I have a lot of confidence in our facilities being able to survive a major event,\" Bell said, and added that the new hospitals are all rated SPC 5, the highest level of seismic safety.\u003c/p>\n\u003cp>\u003cstrong>Jan. 1, 2015 Deadline\u003c/strong>\u003c/p>\n\u003cp>While 88 percent of the state's SPC 1 buildings are already compliant, five hospitals statewide are staring down a Jan. 1, 2015 deadline. Each hospital has at least one patient-care building assessed at SPC 1 and is close to completing a new facility.\u003c/p>\n\u003cp>But the law states that if the replacement building is not ready, the current seismically unsafe patient-care building must be shut down. There's no flexibility in the law. Extensions can only be granted by legislative action.\u003c/p>\n\u003cp>Assemblyman Richard Pan (D-Sacramento) has introduced a bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB2557\" target=\"_blank\">AB2557, to give these hospitals a short extension\u003c/a> -- nine months maximum. \"These hospitals are making a good-faith effort to build the facilities, and they just need a little more time to make sure they're up to safety standards, seismic or otherwise,\" Pan said. \"We shouldn't rush or have to discharge patients because we're going to lose a hospital.\"\u003c/p>\n\u003cp>But the Legislature wraps up its session Sunday night at midnight.\u003c/p>\n\u003cp>Friday afternoon, the bill was headed to the Senate floor, but if passed there, it still had to go back to the Assembly. If it doesn't make it out of the Legislature by Sunday night, the law requires that these five hospitals close their seismically unsafe buildings on Jan. 1. The four hospitals most affected are Sutter Sacramento, Sequoia Hospital in Redwood City, and two hospitals with Santa Barbara's Cottage Health System, one in Santa Ynez and one in Goleta. (Regional Medical Center in San Jose is the fifth, but the affected building handles only a fraction of its overall patients.)\u003c/p>\n\u003cp>Stay tuned. We'll know more after Sunday at midnight.\u003c/p>\n\u003cp>Back at Queen of the Valley, spokeswoman Vanessa de Gier says that all of the patient-care areas of the hospital were built in the 1980s and are compliant with current seismic standards. The hospital had only one building with an SPC 1 rating -- the original hospital building from 1958. Queen of the Valley opted to build a replacement for that building, rather than retrofit. That building is \"not a direct patient-care area,\" de Gier said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "California Prisons Adopt Plan to Restrict Segregation for Mentally Ill Inmates",
"title": "California Prisons Adopt Plan to Restrict Segregation for Mentally Ill Inmates",
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"content": "\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>In response to a court order, California prison officials proposed a new approach Friday to how they treat mentally ill inmates who break rules or commit new crimes. The judge who ordered the change immediately approved the plan.\u003c/p>\n\u003cp>Right now, if a mentally ill inmate refuses to follow orders or attacks another inmate or guards, the prison sends him to a segregation unit. In segregation, prisoners spend more time confined to their cells and must submit to routine strip searches for weapons and drugs. Advocates for inmates have long insisted the conditions only worsen mental illness. Earlier this year, U.S. District Judge Lawrence Karlton unequivocally backed them up.\u003c/p>\n\u003cp>In an April ruling, \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">the judge wrote\u003c/a>, “placement of seriously mentally ill inmates in California’s segregation housing unit can and does cause serious psychological harm” by worsening symptoms, inducing psychosis and increasing suicidal urges.\u003c!--more-->\u003c/p>\n\u003cp>In a statement, Dana Simas, spokesperson with the California Department of Corrections and Rehabilitation said that \u003cspan style=\"color: #000000\">CDCR was continuing to make \"lasting cultural changes to how the Department responds to and treats mentally ill inmates.\" Simas also said that CDCR would \"continue to work with all parties to improve mental health care for inmates and to ensure that there is strong collaboration between custody and mental health staff.\" \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In\u003c/span> the response sent to Judge Karlton, CDCR said it would no longer send mentally ill inmates to segregation units.\u003c/p>\n\u003cp>Instead, they’ll create new housing designed for them that offers twice as much out-of-cell time and more psychiatric care. Corrections staff on those units will take “a collaborative approach” with mental health staff “to ensure the well-being of the inmates housed in these new units,” they wrote.\u003c/p>\n\u003cp>“This is a big, big change,” said Michael Bien, an attorney for inmates who asked the judge to intervene. Bien said the state’s plan steers these prisoners away from the harshest conditions of punishment and into treatment that could help.\u003c/p>\n\u003cp>“They’ll be in one of the new units,” Bien said, “where they’ll get much more treatment, much more out-of-cell time, and hopefully experience less stress.”\u003c/p>\n\u003cp>More than 3,000 inmates in segregation have been diagnosed with serious mental disorders.\u003c/p>\n\u003cp>Corrections will conduct a case-by-case review of those prisoners -- starting with those who have the longest segregation terms -- to decide whether to keep them in the new units or release them back into the general prison population, if they are stable.\u003c/p>\n\u003cp>Friday’s plan is the final piece of a massive overhaul of California’s treatment of mentally ill prisoners. Corrections official have also agreed to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">new restrictions on pepper-spraying \u003c/a>and strip-searching the inmates, and to more training and oversight of prison staff who interact with them.\u003c/p>\n\u003cp style=\"margin: 12px auto 6px auto;font-family: Helvetica,Arial,Sans-serif;font-style: normal;font-variant: normal;font-weight: normal;font-size: 14px;line-height: normal\">\u003ca style=\"text-decoration: underline\" title=\"View California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates on Scribd\" href=\"http://www.scribd.com/doc/238135295/California-Prisons-Adopts-Plan-to-Restrict-Segregation-for-Mentally-Ill-Inmates\">California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates\u003c/a> by \u003ca style=\"text-decoration: underline\" title=\"View KQED News's profile on Scribd\" href=\"http://www.scribd.com/KQED_News\">KQED News\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe id=\"doc_27145\" class=\"scribd_iframe_embed\" src=\"//www.scribd.com/embeds/238135295/content?start_page=1&view_mode=scroll&access_key=key-SukfPfzdeMdOF3YkzxWp&show_recommendations=false\" width=\"640\" height=\"853\" frameborder=\"0\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>In response to a court order, California prison officials proposed a new approach Friday to how they treat mentally ill inmates who break rules or commit new crimes. The judge who ordered the change immediately approved the plan.\u003c/p>\n\u003cp>Right now, if a mentally ill inmate refuses to follow orders or attacks another inmate or guards, the prison sends him to a segregation unit. In segregation, prisoners spend more time confined to their cells and must submit to routine strip searches for weapons and drugs. Advocates for inmates have long insisted the conditions only worsen mental illness. Earlier this year, U.S. District Judge Lawrence Karlton unequivocally backed them up.\u003c/p>\n\u003cp>In an April ruling, \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">the judge wrote\u003c/a>, “placement of seriously mentally ill inmates in California’s segregation housing unit can and does cause serious psychological harm” by worsening symptoms, inducing psychosis and increasing suicidal urges.\u003c!--more-->\u003c/p>\n\u003cp>In a statement, Dana Simas, spokesperson with the California Department of Corrections and Rehabilitation said that \u003cspan style=\"color: #000000\">CDCR was continuing to make \"lasting cultural changes to how the Department responds to and treats mentally ill inmates.\" Simas also said that CDCR would \"continue to work with all parties to improve mental health care for inmates and to ensure that there is strong collaboration between custody and mental health staff.\" \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In\u003c/span> the response sent to Judge Karlton, CDCR said it would no longer send mentally ill inmates to segregation units.\u003c/p>\n\u003cp>Instead, they’ll create new housing designed for them that offers twice as much out-of-cell time and more psychiatric care. Corrections staff on those units will take “a collaborative approach” with mental health staff “to ensure the well-being of the inmates housed in these new units,” they wrote.\u003c/p>\n\u003cp>“This is a big, big change,” said Michael Bien, an attorney for inmates who asked the judge to intervene. Bien said the state’s plan steers these prisoners away from the harshest conditions of punishment and into treatment that could help.\u003c/p>\n\u003cp>“They’ll be in one of the new units,” Bien said, “where they’ll get much more treatment, much more out-of-cell time, and hopefully experience less stress.”\u003c/p>\n\u003cp>More than 3,000 inmates in segregation have been diagnosed with serious mental disorders.\u003c/p>\n\u003cp>Corrections will conduct a case-by-case review of those prisoners -- starting with those who have the longest segregation terms -- to decide whether to keep them in the new units or release them back into the general prison population, if they are stable.\u003c/p>\n\u003cp>Friday’s plan is the final piece of a massive overhaul of California’s treatment of mentally ill prisoners. Corrections official have also agreed to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">new restrictions on pepper-spraying \u003c/a>and strip-searching the inmates, and to more training and oversight of prison staff who interact with them.\u003c/p>\n\u003cp style=\"margin: 12px auto 6px auto;font-family: Helvetica,Arial,Sans-serif;font-style: normal;font-variant: normal;font-weight: normal;font-size: 14px;line-height: normal\">\u003ca style=\"text-decoration: underline\" title=\"View California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates on Scribd\" href=\"http://www.scribd.com/doc/238135295/California-Prisons-Adopts-Plan-to-Restrict-Segregation-for-Mentally-Ill-Inmates\">California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates\u003c/a> by \u003ca style=\"text-decoration: underline\" title=\"View KQED News's profile on Scribd\" href=\"http://www.scribd.com/KQED_News\">KQED News\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe id=\"doc_27145\" class=\"scribd_iframe_embed\" src=\"//www.scribd.com/embeds/238135295/content?start_page=1&view_mode=scroll&access_key=key-SukfPfzdeMdOF3YkzxWp&show_recommendations=false\" width=\"640\" height=\"853\" frameborder=\"0\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "High-Priced Drug Sovaldi Coming to California Prisoners with Hepatitis C",
"title": "High-Priced Drug Sovaldi Coming to California Prisoners with Hepatitis C",
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"content": "\u003cfigure id=\"attachment_21025\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS8531_107520204-hpf.jpg\">\u003cimg class=\"size-full wp-image-21025\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS8531_107520204-hpf.jpg\" alt=\"Chino State Prison. (Kevork Djansezian/Getty Images)\" width=\"640\" height=\"432\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS8531_107520204-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS8531_107520204-hpf-400x270.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS8531_107520204-hpf-320x216.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chino State Prison. (Kevork Djansezian/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By George Lauer\u003c/strong>, \u003ca href=\"http://www.californiahealthline.org/insight/2014/highpriced-drug-makes-its-way-into-california-prisons\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>It's the drug that can cure most people with hepatitis C in 12 weeks -- but comes at a high cost: $1,000 a pill. Now, California Correctional Health Care Services, which oversees clinical care and drug prescriptions for 125,000 inmates at 34 prisons across the state, began using Sovaldi last month.\u003c/p>\n\u003cp>Made by Gilead Sciences of Foster City, Sovaldi has become part of the \"community standard\" for medical professionals treating patients with hepatitis C, according to prison officials. A full course of treatment runs about $84,000.\u003c/p>\n\u003cp>Hepatitis C, a viral infection that can lead to liver failure, cancer or other health problems, is often associated with intravenous drug use. Many of the estimated 3.2 million Americans living with hepatitis C in the U.S. are poor, imprisoned, elderly or all of the above, giving public systems a disproportionate share of hepatitis C patients.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>'A Tax on All Americans'\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A \u003ca style=\"color: #6d1618\" href=\"http://lab.express-scripts.com/insights/specialty-medications/state-governments-may-spend-%2455-billion-on-hepatitis-c-medications\" target=\"_blank\">study released last month\u003c/a> by Express Scripts Lab predicted state governments could spend more than $55 billion on hepatitis C medications.\u003c/p>\n\u003cp>\"There is no doubt that Sovaldi is a breakthrough therapy,\" the authors of the study wrote, \"but unfortunately, it is also likely to break state budgets. Since health care for so many hepatitis C patients is funded by state programs, each citizen will be shouldering the unprecedented cost burden. The unsustainable pricing of this medication has essentially become a tax on all Americans.\"\u003c/p>\n\u003cp>About 93,000 Californians in Medi-Cal and in the state prison system have chronic hepatitis C. If the state covers Sovaldi treatments for all of them, the bill would be about $6.6 billion, according to the study.\u003c/p>\n\u003cp>\u003cstrong>Impact Especially Felt in Prisons\u003c/strong>\u003c/p>\n\u003cp>While the high cost of Sovaldi could significantly increase spending in Medicare and Medicaid -- as well as by private insurers -- the impact could be especially felt in prison systems.\u003c/p>\n\u003cp>State Medicaid programs -- Medi-Cal in California -- are entitled by federal law to negotiate drug discounts, but state prison systems usually pay full retail prices. And because prisons typically have a larger percentage of hepatitis C patients than the general population, Sovaldi's high price could have a significant influence on prison system budgets.\u003c/p>\n\u003cp>The use of expensive -- but effective -- treatments takes on added significance in California where the state prison medical system is operated by a federal receiver. A federal judge in 2006 determined the state's prisoners were not getting adequate care and named a federal receiver to oversee and improve medical care.\u003c/p>\n\u003cp>An important tool in the measuring of effective health care in prisons is comparing care behind bars to the care received in the general population. If a treatment becomes a community standard on the outside, it will probably eventually become a standard in prisons. That process may be happening especially quickly in California where prison medical care is under so much scrutiny.\u003c/p>\n\u003cp>\"It's a pretty extensive process and it does take some time,\" said Liz Gransee, public information officer for the California Department of Corrections. Sovaldi went through that process and emerged as a \"community standard\" last month, Gransee said.\u003c/p>\n\u003cp>Treating hepatitis C is not inexpensive, no matter what drugs clinicians try. The cost of one course of hepatitis C treatment in the California prison system last year ranged from $13,500 to $88,800, according to California Correctional Health Care Services officials.\u003c/p>\n\u003cp>Depending on the patient's situation, expensive treatments such as Sovaldi can end up saving money in the long run, state officials said.\u003c/p>\n\u003cp>\"Even though treatment using this drug is expensive, it is more cost effective than caring for a patient with end-stage liver disease who is dying, treating a patient who develops liver cancer, or providing a liver transplant for a patient. For these reasons, the judicious and carefully monitored use of the newly available drug makes sense, both from a medical and cost effective standpoint,\" California Correctional Health Care Services wrote in an email response to questions about Sovaldi.\u003c/p>\n\u003cp>The overall cost to treat hepatitis C patients in California prisons was about $12.4 million last year, up from $9 million in 2012.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The prevalence of hepatitis C infection among prisoners is \"substantially higher than that of the general U.S. population,\" according to CDC. In the general population, 1 to 1.5 percent of people are infected, compared with 16 to 41 percent among prisoners.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21025\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS8531_107520204-hpf.jpg\">\u003cimg class=\"size-full wp-image-21025\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS8531_107520204-hpf.jpg\" alt=\"Chino State Prison. (Kevork Djansezian/Getty Images)\" width=\"640\" height=\"432\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS8531_107520204-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS8531_107520204-hpf-400x270.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS8531_107520204-hpf-320x216.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chino State Prison. (Kevork Djansezian/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By George Lauer\u003c/strong>, \u003ca href=\"http://www.californiahealthline.org/insight/2014/highpriced-drug-makes-its-way-into-california-prisons\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>It's the drug that can cure most people with hepatitis C in 12 weeks -- but comes at a high cost: $1,000 a pill. Now, California Correctional Health Care Services, which oversees clinical care and drug prescriptions for 125,000 inmates at 34 prisons across the state, began using Sovaldi last month.\u003c/p>\n\u003cp>Made by Gilead Sciences of Foster City, Sovaldi has become part of the \"community standard\" for medical professionals treating patients with hepatitis C, according to prison officials. A full course of treatment runs about $84,000.\u003c/p>\n\u003cp>Hepatitis C, a viral infection that can lead to liver failure, cancer or other health problems, is often associated with intravenous drug use. Many of the estimated 3.2 million Americans living with hepatitis C in the U.S. are poor, imprisoned, elderly or all of the above, giving public systems a disproportionate share of hepatitis C patients.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>'A Tax on All Americans'\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A \u003ca style=\"color: #6d1618\" href=\"http://lab.express-scripts.com/insights/specialty-medications/state-governments-may-spend-%2455-billion-on-hepatitis-c-medications\" target=\"_blank\">study released last month\u003c/a> by Express Scripts Lab predicted state governments could spend more than $55 billion on hepatitis C medications.\u003c/p>\n\u003cp>\"There is no doubt that Sovaldi is a breakthrough therapy,\" the authors of the study wrote, \"but unfortunately, it is also likely to break state budgets. Since health care for so many hepatitis C patients is funded by state programs, each citizen will be shouldering the unprecedented cost burden. The unsustainable pricing of this medication has essentially become a tax on all Americans.\"\u003c/p>\n\u003cp>About 93,000 Californians in Medi-Cal and in the state prison system have chronic hepatitis C. If the state covers Sovaldi treatments for all of them, the bill would be about $6.6 billion, according to the study.\u003c/p>\n\u003cp>\u003cstrong>Impact Especially Felt in Prisons\u003c/strong>\u003c/p>\n\u003cp>While the high cost of Sovaldi could significantly increase spending in Medicare and Medicaid -- as well as by private insurers -- the impact could be especially felt in prison systems.\u003c/p>\n\u003cp>State Medicaid programs -- Medi-Cal in California -- are entitled by federal law to negotiate drug discounts, but state prison systems usually pay full retail prices. And because prisons typically have a larger percentage of hepatitis C patients than the general population, Sovaldi's high price could have a significant influence on prison system budgets.\u003c/p>\n\u003cp>The use of expensive -- but effective -- treatments takes on added significance in California where the state prison medical system is operated by a federal receiver. A federal judge in 2006 determined the state's prisoners were not getting adequate care and named a federal receiver to oversee and improve medical care.\u003c/p>\n\u003cp>An important tool in the measuring of effective health care in prisons is comparing care behind bars to the care received in the general population. If a treatment becomes a community standard on the outside, it will probably eventually become a standard in prisons. That process may be happening especially quickly in California where prison medical care is under so much scrutiny.\u003c/p>\n\u003cp>\"It's a pretty extensive process and it does take some time,\" said Liz Gransee, public information officer for the California Department of Corrections. Sovaldi went through that process and emerged as a \"community standard\" last month, Gransee said.\u003c/p>\n\u003cp>Treating hepatitis C is not inexpensive, no matter what drugs clinicians try. The cost of one course of hepatitis C treatment in the California prison system last year ranged from $13,500 to $88,800, according to California Correctional Health Care Services officials.\u003c/p>\n\u003cp>Depending on the patient's situation, expensive treatments such as Sovaldi can end up saving money in the long run, state officials said.\u003c/p>\n\u003cp>\"Even though treatment using this drug is expensive, it is more cost effective than caring for a patient with end-stage liver disease who is dying, treating a patient who develops liver cancer, or providing a liver transplant for a patient. For these reasons, the judicious and carefully monitored use of the newly available drug makes sense, both from a medical and cost effective standpoint,\" California Correctional Health Care Services wrote in an email response to questions about Sovaldi.\u003c/p>\n\u003cp>The overall cost to treat hepatitis C patients in California prisons was about $12.4 million last year, up from $9 million in 2012.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The prevalence of hepatitis C infection among prisoners is \"substantially higher than that of the general U.S. population,\" according to CDC. In the general population, 1 to 1.5 percent of people are infected, compared with 16 to 41 percent among prisoners.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Some, Medi-Cal Might Mean Ultimately Losing Their Homes",
"title": "For Some, Medi-Cal Might Mean Ultimately Losing Their Homes",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_21011\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/PhotoAnne-e1408992079757.jpg\">\u003cimg class=\"size-large wp-image-21011\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/PhotoAnne-640x478.jpg\" alt=\"Anne-Louise Vernon in front of her home in Campbell. (Photo: Pauline Bartolone)\" width=\"640\" height=\"478\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anne-Louise Vernon in front of her home in Campbell. She recently enrolled in Medi-Cal then found out the state could use proceeds from her home to recover costs of her health care. (Photo: Pauline Bartolone)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Pauline Bartolone,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/28/Calif-Bill-Would-Protect-Estates-Of-Many-Receiving-Medicaid-Services.aspx\" target=\"_blank\">\u003cb>Kaiser Health News\u003c/b>\u003c/a>\u003c/p>\n\u003cp>Anne-Louise Vernon had been looking forward to signing up for health insurance under Covered California. She was hoping to save hundreds of dollars a month. But when she called to enroll, she was told her income wasn’t high enough to purchase a subsidized plan.\u003c/p>\n\u003cp>“It never even occurred to me I might be on Medi-Cal,\" she said, in reference to the state's version of Medicaid, \"and I didn’t know anything about it.\"\u003c/p>\n\u003cp>She says she asked whether there were any strings attached.\u003c/p>\n\u003cp>\"And the woman said very cheerfully, \"Oh no, no, it’s all free. There's nothing you have to worry about, this is your lucky day.'” she recounts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Vernon signed up for Medi-Cal on the phone from her home in Campbell. But months later, she learned online about a state law that allows California to take assets of people who die if they received health care through Medi-Cal after the age of 55.\u003c!--more-->\u003c/p>\n\u003cp>“So I called Medi-Cal and asked specifically, 'Does this mean what I think it means?'” she says.\u003c/p>\n\u003cp>It means Medi-Cal managers can take part of her estate later for health care costs she’s accruing now. A \u003ca href=\"http://aspe.hhs.gov/daltcp/reports/estaterec.htm\" target=\"_blank\">1993 federal law \u003c/a>requires states to recoup Medicaid money spent on institutional care, such as nursing homes, and it gives states the option to recover all health costs from people 55 and over. California took that option.\u003c/p>\n\u003cp>Vernon says she’s panicked and worried. She doesn’t get a monthly bill –- so she’s not sure what she’ll be accountable for.\u003c/p>\n\u003cp>“I feel as though right now, if I could go to do the doctor and I felt I knew where I stood, there are a number of appointments that I’d be making right now,\" says Vernon. \"But I feel so unsettled about this whole estate recovery thing, that I’m afraid to go to the doctor.\"\u003c/p>\n\u003cp>The California law has now been on the books for two decades. Elizabeth Landsberg of the Western Center on Law and Poverty says it turns what was intended to be a safety net program into a long-term loan program. It undermines the security that families might pass on to the next generation.\u003c/p>\n\u003cp>“So in most cases it's modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes, ” says Landsberg.\u003c/p>\n\u003cp>Landsberg says the law is complicating Medi-Cal enrollment. Some people have refused to sign up, or have terminated enrollment for fear of losing their estate. She says it’s unfair because people buying insurance through Covered California aren’t subject to the same rules.\u003c/p>\n\u003cp>“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publicly-subsidized health coverage have no worries, ” says Landsberg.\u003c/p>\n\u003cp>Over the past 20 years, the state of California has recovered almost a billion dollars that paid for long-term care and basic health services through Medi-Cal.\u003c/p>\n\u003cp>Norman Williams of the California Department of Health Care Services says that’s just a very small fraction of the overall Medi-Cal budget during that time.\u003c/p>\n\u003cp>“The funds are collected and returned to the state general fund and along with federal matching funds, that’s used to provide care for members beyond what we have now,\" says Williams.\u003c/p>\n\u003cp>Williams says the average claim is about $95,000.\u003c/p>\n\u003cp>“But the average amount collected is about $15,000,\" he says. \"There are many exceptions available. Hardship exemptions for instance. If there are children who are living and under 21, there is no claim against the Medi-Cal member's estate.\"\u003c/p>\n\u003cp>A bill in the California legislature, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1124\" target=\"_blank\">SB 1124\u003c/a>, would eliminate state recovery for basic Medi-Cal services for older Californians. It would also require the state to provide health claim information for free, so enrollees can keep track of their expenses.\u003c/p>\n\u003cp>That’s something Anne-Louise Vernon is advocating for.\u003c/p>\n\u003cp>“I don’t understand why someone my age, in my situation has been singled out to be a cash cow for the state of California, when this is not required by the federal government,” says Vernon.\u003c/p>\n\u003cp>If the measure is approved by lawmakers, it might have a tough time getting the governor’s signature. The California Department of Finance says it would remove $30 million in revenue that helps pay for the health care of other low-income Californians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca style=\"font-size: medium\" href=\"http://www.canhr.org/factsheets/medi-cal_fs/html/fs_medcal_recovery_FAQ.htm\" target=\"_blank\">Medi-Cal Recovery FAQ\u003c/a> (California Advocates for Nursing Home Reform)\u003c/li>\n\u003cli>\u003ca style=\"font-size: medium\" href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/E/PDF%20EstateRecoveryMediCal.pdf\" target=\"_blank\">Estate Recovery Under Medi-Cal \u003c/a>(California HealthCare Foundation)\u003c/li>\n\u003c/ul>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21011\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/PhotoAnne-e1408992079757.jpg\">\u003cimg class=\"size-large wp-image-21011\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/PhotoAnne-640x478.jpg\" alt=\"Anne-Louise Vernon in front of her home in Campbell. (Photo: Pauline Bartolone)\" width=\"640\" height=\"478\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anne-Louise Vernon in front of her home in Campbell. She recently enrolled in Medi-Cal then found out the state could use proceeds from her home to recover costs of her health care. (Photo: Pauline Bartolone)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Pauline Bartolone,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/28/Calif-Bill-Would-Protect-Estates-Of-Many-Receiving-Medicaid-Services.aspx\" target=\"_blank\">\u003cb>Kaiser Health News\u003c/b>\u003c/a>\u003c/p>\n\u003cp>Anne-Louise Vernon had been looking forward to signing up for health insurance under Covered California. She was hoping to save hundreds of dollars a month. But when she called to enroll, she was told her income wasn’t high enough to purchase a subsidized plan.\u003c/p>\n\u003cp>“It never even occurred to me I might be on Medi-Cal,\" she said, in reference to the state's version of Medicaid, \"and I didn’t know anything about it.\"\u003c/p>\n\u003cp>She says she asked whether there were any strings attached.\u003c/p>\n\u003cp>\"And the woman said very cheerfully, \"Oh no, no, it’s all free. There's nothing you have to worry about, this is your lucky day.'” she recounts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Vernon signed up for Medi-Cal on the phone from her home in Campbell. But months later, she learned online about a state law that allows California to take assets of people who die if they received health care through Medi-Cal after the age of 55.\u003c!--more-->\u003c/p>\n\u003cp>“So I called Medi-Cal and asked specifically, 'Does this mean what I think it means?'” she says.\u003c/p>\n\u003cp>It means Medi-Cal managers can take part of her estate later for health care costs she’s accruing now. A \u003ca href=\"http://aspe.hhs.gov/daltcp/reports/estaterec.htm\" target=\"_blank\">1993 federal law \u003c/a>requires states to recoup Medicaid money spent on institutional care, such as nursing homes, and it gives states the option to recover all health costs from people 55 and over. California took that option.\u003c/p>\n\u003cp>Vernon says she’s panicked and worried. She doesn’t get a monthly bill –- so she’s not sure what she’ll be accountable for.\u003c/p>\n\u003cp>“I feel as though right now, if I could go to do the doctor and I felt I knew where I stood, there are a number of appointments that I’d be making right now,\" says Vernon. \"But I feel so unsettled about this whole estate recovery thing, that I’m afraid to go to the doctor.\"\u003c/p>\n\u003cp>The California law has now been on the books for two decades. Elizabeth Landsberg of the Western Center on Law and Poverty says it turns what was intended to be a safety net program into a long-term loan program. It undermines the security that families might pass on to the next generation.\u003c/p>\n\u003cp>“So in most cases it's modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes, ” says Landsberg.\u003c/p>\n\u003cp>Landsberg says the law is complicating Medi-Cal enrollment. Some people have refused to sign up, or have terminated enrollment for fear of losing their estate. She says it’s unfair because people buying insurance through Covered California aren’t subject to the same rules.\u003c/p>\n\u003cp>“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publicly-subsidized health coverage have no worries, ” says Landsberg.\u003c/p>\n\u003cp>Over the past 20 years, the state of California has recovered almost a billion dollars that paid for long-term care and basic health services through Medi-Cal.\u003c/p>\n\u003cp>Norman Williams of the California Department of Health Care Services says that’s just a very small fraction of the overall Medi-Cal budget during that time.\u003c/p>\n\u003cp>“The funds are collected and returned to the state general fund and along with federal matching funds, that’s used to provide care for members beyond what we have now,\" says Williams.\u003c/p>\n\u003cp>Williams says the average claim is about $95,000.\u003c/p>\n\u003cp>“But the average amount collected is about $15,000,\" he says. \"There are many exceptions available. Hardship exemptions for instance. If there are children who are living and under 21, there is no claim against the Medi-Cal member's estate.\"\u003c/p>\n\u003cp>A bill in the California legislature, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1124\" target=\"_blank\">SB 1124\u003c/a>, would eliminate state recovery for basic Medi-Cal services for older Californians. It would also require the state to provide health claim information for free, so enrollees can keep track of their expenses.\u003c/p>\n\u003cp>That’s something Anne-Louise Vernon is advocating for.\u003c/p>\n\u003cp>“I don’t understand why someone my age, in my situation has been singled out to be a cash cow for the state of California, when this is not required by the federal government,” says Vernon.\u003c/p>\n\u003cp>If the measure is approved by lawmakers, it might have a tough time getting the governor’s signature. The California Department of Finance says it would remove $30 million in revenue that helps pay for the health care of other low-income Californians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca style=\"font-size: medium\" href=\"http://www.canhr.org/factsheets/medi-cal_fs/html/fs_medcal_recovery_FAQ.htm\" target=\"_blank\">Medi-Cal Recovery FAQ\u003c/a> (California Advocates for Nursing Home Reform)\u003c/li>\n\u003cli>\u003ca style=\"font-size: medium\" href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/E/PDF%20EstateRecoveryMediCal.pdf\" target=\"_blank\">Estate Recovery Under Medi-Cal \u003c/a>(California HealthCare Foundation)\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Reverses Abortion Coverage Rule for 2 Catholic Universities",
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"content": "\u003cfigure id=\"attachment_20671\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\">\u003cimg class=\"size-full wp-image-20671\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\" alt=\"Santa Clara University's employee health insurance will stop covering 'elective' abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The two universities affected by the move are Loyola Marymount and Santa Clara University, above. (Michael Zimmer/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Ted Goldberg and Lisa Aliferis\u003c/strong>\u003c/p>\n\u003cp>In a reversal, Gov. Jerry Brown's administration is barring two Catholic universities in California from offering health plans to their employees that limit abortion coverage.\u003c/p>\n\u003cp>Previously, state health officials had approved plans used by Santa Clara University and Loyola Marymount in Los Angeles that did not cover any abortion procedures, unless they were \"medically necessary\" to protect the health of the mother.\u003c/p>\n\u003cp>But earlier this month, the Department of Managed Health Care (DMHC) \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/12/california-reconsiders-letting-catholic-universities-limit-abortion-coverage/\" target=\"_blank\">said they were reviewing\u003c/a> that approval.\u003c/p>\n\u003cp>The DMHC is now sending letters to insurance companies for both universities, requiring them to cover all abortions. \u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As the \u003ca href=\"http://www.sfgate.com/news/article/State-reverses-abortion-decision-at-2-Catholic-5705008.php\" target=\"_blank\">San Francisco Chronicle reports\u003c/a>, the DMHC determined that \"the exclusions violate a 1975 state law that requires group health plans to cover all basic services -- defined by the law, as those that are 'medically necessary.'\"\u003c/p>\n\u003cp>The Chronicle said the the DMHC director, Michelle Rouillard states in the letter that \"abortion is a basic health care service,\" and that \u003cspan style=\"color: #000000\">\"the California Constitution prohibits health plans from discriminating against women who choose to terminate a pregnancy. Thus, all health plans must treat maternity services and legal abortion neutrally.\"\u003c/span>\u003c/p>\n\u003cp>The coverage limitations were announced last fall. The schools said they took the action because elective abortion is not consistent with Catholic teachings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But faculty groups at both Santa Clara and Loyola Marymount universities had protested the limited coverage, saying that the schools had professed to be open to those of all views and faiths, the Chronicle said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20671\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\">\u003cimg class=\"size-full wp-image-20671\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\" alt=\"Santa Clara University's employee health insurance will stop covering 'elective' abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The two universities affected by the move are Loyola Marymount and Santa Clara University, above. (Michael Zimmer/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Ted Goldberg and Lisa Aliferis\u003c/strong>\u003c/p>\n\u003cp>In a reversal, Gov. Jerry Brown's administration is barring two Catholic universities in California from offering health plans to their employees that limit abortion coverage.\u003c/p>\n\u003cp>Previously, state health officials had approved plans used by Santa Clara University and Loyola Marymount in Los Angeles that did not cover any abortion procedures, unless they were \"medically necessary\" to protect the health of the mother.\u003c/p>\n\u003cp>But earlier this month, the Department of Managed Health Care (DMHC) \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/12/california-reconsiders-letting-catholic-universities-limit-abortion-coverage/\" target=\"_blank\">said they were reviewing\u003c/a> that approval.\u003c/p>\n\u003cp>The DMHC is now sending letters to insurance companies for both universities, requiring them to cover all abortions. \u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As the \u003ca href=\"http://www.sfgate.com/news/article/State-reverses-abortion-decision-at-2-Catholic-5705008.php\" target=\"_blank\">San Francisco Chronicle reports\u003c/a>, the DMHC determined that \"the exclusions violate a 1975 state law that requires group health plans to cover all basic services -- defined by the law, as those that are 'medically necessary.'\"\u003c/p>\n\u003cp>The Chronicle said the the DMHC director, Michelle Rouillard states in the letter that \"abortion is a basic health care service,\" and that \u003cspan style=\"color: #000000\">\"the California Constitution prohibits health plans from discriminating against women who choose to terminate a pregnancy. Thus, all health plans must treat maternity services and legal abortion neutrally.\"\u003c/span>\u003c/p>\n\u003cp>The coverage limitations were announced last fall. The schools said they took the action because elective abortion is not consistent with Catholic teachings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But faculty groups at both Santa Clara and Loyola Marymount universities had protested the limited coverage, saying that the schools had professed to be open to those of all views and faiths, the Chronicle said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Strong Support for Proposition 45 -- Tougher Rules on Health Insurance Rates",
"title": "Strong Support for Proposition 45 -- Tougher Rules on Health Insurance Rates",
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"content": "\u003cfigure id=\"attachment_14038\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/RS5161_78770400-scr-e1375404453328.jpg\">\u003cimg class=\"size-large wp-image-14038\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/RS5161_78770400-scr-620x356.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"356\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Helen Shen,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/california-survey-health-insurance-rates-and-prop-45.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>California voters are showing strong early support for a ballot initiative that would expand the state's authority to regulate health insurance rates.\u003c/p>\n\u003cp>Nearly 7 of every 10 respondents indicated that they would vote in favor of Proposition 45, while 16 percent would vote against it, according to a \u003ca href=\"http://www.field.com/fieldpollonline/subscribers/Rls2478.pdf\" target=\"_blank\">Field poll\u003c/a> released Wednesday.\u003c/p>\n\u003cp>Proposition 45 would give California's insurance commissioner the power to veto excessive health insurance rate increases.\u003c/p>\n\u003cp>Health insurance rates in the state are currently overseen by the Department of Managed Health Care and the California Department of Insurance. Insurance companies are required to submit proposed rate increases for review each year by state regulators, who may declare rates unreasonable but cannot block them from going into effect.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is the missing piece of health reform,\" says Carmen Balber, executive director of Consumer Watchdog in Santa Monica, the advocacy group that sponsored the initiative. \"If every Californian is required to purchase health insurance and no one is overseeing what insurance companies can charge, the insurance industry will have a free pass to raise prices at will.\"\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/27/insurance-commissioner-defends-health-insurance-initiative/\" target=\"_blank\">strongly supports the proposition\u003c/a>.\u003c/p>\n\u003cp>Since 2011, insurers have proceeded at least 14 times with rate hikes deemed unreasonable by California regulators, according to the California Public Interest Research Group, a consumer advocacy group in Sacramento. Consumer Watchdog says that those rate increases have cost consumers more than $250 million.\u003c/p>\n\u003cp>Not everyone agrees that Proposition 45 will cut health insurance costs, however. Critics say that the initiative would do nothing to reduce underlying health care costs, but could add a costly bureaucracy to the state's health insurance marketplace. Some also worry that the proposition could expose insurers to legal challenges on rate increases.\u003c/p>\n\u003cp>\"It's going to drive the costs up dramatically,\" says Neil Crosby, a spokesperson for the California Association of Health Underwriters, a Sacramento-based group that represents the private health insurance industry. The campaign against Proposition 45 has received major financial backing from insurance providers such as the Kaiser Foundation Health Plan and Blue Shield of California. (Kaiser Health News is not affiliated with Kaiser Permanente or the Kaiser Foundation Health Plan.)\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, the state's health care exchange, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/02/fight-continues-over-ballot-measure-to-control-health-insurance-premiums/\" target=\"_blank\">told legislators in July\u003c/a> that the proposition could undermine the exchange's ability to negotiate rates directly with health plans. For now, the exchange wields the bargaining power of 1.4 million people having signed up for insurance through Covered California since last fall.\u003c/p>\n\u003cp>An additional layer of rate review and any potential disputes with the insurance commissioner could keep some plans from being available in time for open enrollment, Lee said, and might even cause some health plans to withdraw from certain markets.\u003c/p>\n\u003cp>Insurance laws vary widely from state to state, but more than half of states already require some health insurance rate increases to be approved by the government before they can be implemented, according to data from the National Association of Insurance Commissioners.\u003c/p>\n\u003cp>Some states that require prior approval of rates have had to plan ahead to meet open enrollment timelines under the health law, says Sabrina Corlette, a senior research fellow at the Georgetown University Health Policy Institute in Washington, D.C. But in general, she says the extra reviews have not posed a problem. \"We have not heard that plans just weren't ready to be sold when open enrollment came around,\" says Corlette.\u003c/p>\n\u003cp>The Field Poll was among the very first to survey state residents on Proposition 45, and a strong blitz by the insurance companies during the fall campaign season could affect public opinion. Insurers have donated millions of dollars to a campaign to defeat the measure.\u003c/p>\n\u003cp>Nonetheless, some observers say the proposition may not make a big difference in the short term.\u003c/p>\n\u003cp>Current market forces and the added restrictions from the health law seem to be helping to keep rate increases low in California, says Dylan Roby, a health policy professor at the University of California, Los Angeles. At the end of July, Covered California \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/31/californias-2015-obamacare-premiums-will-increase-modestly/\" target=\"_blank\">announced negotiated rate increases\u003c/a> for 2015, averaging a modest 4.2 percent across the state.\u003c/p>\n\u003cp>The additional oversight could become more relevant in the future, says Roby, if health care spending begins to increase dramatically.\u003c/p>\n\u003cp>At the same time, Roby warns that without proper foresight, the proposition could leave certain markets vulnerable to coverage disruptions. For example, he said, in areas that are costlier to insure, and especially where competition among insurers is lower, Covered California may be forced to accept higher rate increases to keep an insurer’s plan in that jurisdiction. But if the insurance commissioner were to reject those negotiated rates, the health plan could decide to pull out of that area altogether.\u003c/p>\n\u003cp>Close communication between all parties early on in rate negotiations will be key to maintaining statewide access to health insurance, if Proposition 45 passes in November, says Roby.\u003c/p>\n\u003cp>\"Balancing the needs of the insurance commissioner and Covered California could be tricky,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Field Poll, which looked at a variety of health issues including Medicaid and the Covered California exchange, was conducted through telephone interviews of more than 1,500 state residents from June 26 through July 19. It has a margin of error of plus or minus 2.6 percentage points.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14038\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/RS5161_78770400-scr-e1375404453328.jpg\">\u003cimg class=\"size-large wp-image-14038\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/RS5161_78770400-scr-620x356.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"356\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Helen Shen,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/california-survey-health-insurance-rates-and-prop-45.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>California voters are showing strong early support for a ballot initiative that would expand the state's authority to regulate health insurance rates.\u003c/p>\n\u003cp>Nearly 7 of every 10 respondents indicated that they would vote in favor of Proposition 45, while 16 percent would vote against it, according to a \u003ca href=\"http://www.field.com/fieldpollonline/subscribers/Rls2478.pdf\" target=\"_blank\">Field poll\u003c/a> released Wednesday.\u003c/p>\n\u003cp>Proposition 45 would give California's insurance commissioner the power to veto excessive health insurance rate increases.\u003c/p>\n\u003cp>Health insurance rates in the state are currently overseen by the Department of Managed Health Care and the California Department of Insurance. Insurance companies are required to submit proposed rate increases for review each year by state regulators, who may declare rates unreasonable but cannot block them from going into effect.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is the missing piece of health reform,\" says Carmen Balber, executive director of Consumer Watchdog in Santa Monica, the advocacy group that sponsored the initiative. \"If every Californian is required to purchase health insurance and no one is overseeing what insurance companies can charge, the insurance industry will have a free pass to raise prices at will.\"\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/27/insurance-commissioner-defends-health-insurance-initiative/\" target=\"_blank\">strongly supports the proposition\u003c/a>.\u003c/p>\n\u003cp>Since 2011, insurers have proceeded at least 14 times with rate hikes deemed unreasonable by California regulators, according to the California Public Interest Research Group, a consumer advocacy group in Sacramento. Consumer Watchdog says that those rate increases have cost consumers more than $250 million.\u003c/p>\n\u003cp>Not everyone agrees that Proposition 45 will cut health insurance costs, however. Critics say that the initiative would do nothing to reduce underlying health care costs, but could add a costly bureaucracy to the state's health insurance marketplace. Some also worry that the proposition could expose insurers to legal challenges on rate increases.\u003c/p>\n\u003cp>\"It's going to drive the costs up dramatically,\" says Neil Crosby, a spokesperson for the California Association of Health Underwriters, a Sacramento-based group that represents the private health insurance industry. The campaign against Proposition 45 has received major financial backing from insurance providers such as the Kaiser Foundation Health Plan and Blue Shield of California. (Kaiser Health News is not affiliated with Kaiser Permanente or the Kaiser Foundation Health Plan.)\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, the state's health care exchange, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/02/fight-continues-over-ballot-measure-to-control-health-insurance-premiums/\" target=\"_blank\">told legislators in July\u003c/a> that the proposition could undermine the exchange's ability to negotiate rates directly with health plans. For now, the exchange wields the bargaining power of 1.4 million people having signed up for insurance through Covered California since last fall.\u003c/p>\n\u003cp>An additional layer of rate review and any potential disputes with the insurance commissioner could keep some plans from being available in time for open enrollment, Lee said, and might even cause some health plans to withdraw from certain markets.\u003c/p>\n\u003cp>Insurance laws vary widely from state to state, but more than half of states already require some health insurance rate increases to be approved by the government before they can be implemented, according to data from the National Association of Insurance Commissioners.\u003c/p>\n\u003cp>Some states that require prior approval of rates have had to plan ahead to meet open enrollment timelines under the health law, says Sabrina Corlette, a senior research fellow at the Georgetown University Health Policy Institute in Washington, D.C. But in general, she says the extra reviews have not posed a problem. \"We have not heard that plans just weren't ready to be sold when open enrollment came around,\" says Corlette.\u003c/p>\n\u003cp>The Field Poll was among the very first to survey state residents on Proposition 45, and a strong blitz by the insurance companies during the fall campaign season could affect public opinion. Insurers have donated millions of dollars to a campaign to defeat the measure.\u003c/p>\n\u003cp>Nonetheless, some observers say the proposition may not make a big difference in the short term.\u003c/p>\n\u003cp>Current market forces and the added restrictions from the health law seem to be helping to keep rate increases low in California, says Dylan Roby, a health policy professor at the University of California, Los Angeles. At the end of July, Covered California \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/31/californias-2015-obamacare-premiums-will-increase-modestly/\" target=\"_blank\">announced negotiated rate increases\u003c/a> for 2015, averaging a modest 4.2 percent across the state.\u003c/p>\n\u003cp>The additional oversight could become more relevant in the future, says Roby, if health care spending begins to increase dramatically.\u003c/p>\n\u003cp>At the same time, Roby warns that without proper foresight, the proposition could leave certain markets vulnerable to coverage disruptions. For example, he said, in areas that are costlier to insure, and especially where competition among insurers is lower, Covered California may be forced to accept higher rate increases to keep an insurer’s plan in that jurisdiction. But if the insurance commissioner were to reject those negotiated rates, the health plan could decide to pull out of that area altogether.\u003c/p>\n\u003cp>Close communication between all parties early on in rate negotiations will be key to maintaining statewide access to health insurance, if Proposition 45 passes in November, says Roby.\u003c/p>\n\u003cp>\"Balancing the needs of the insurance commissioner and Covered California could be tricky,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Field Poll, which looked at a variety of health issues including Medicaid and the Covered California exchange, was conducted through telephone interviews of more than 1,500 state residents from June 26 through July 19. It has a margin of error of plus or minus 2.6 percentage points.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Diverting Mentally Ill to Treatment, Not Jail",
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"content": "\u003cfigure id=\"attachment_20935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-e1408568139344.jpg\">\u003cimg class=\"size-large wp-image-20935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-640x479.jpg\" alt=\"Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\" width=\"640\" height=\"479\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>This week, Julie Small has reported on this blog about court-ordered overhauls in caring for mentally ill inmates in California prisons. About one-fourth of California's inmates -- 37,000 people -- have mild to severe mental illness.\u003c/p>\n\u003cp>As Small reported, U.S. District Judge Lawrence Karlton ordered the California Department of Corrections and Rehabilitation (CDCR) in April to draft new policies for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/california-prisons-begin-use-of-force-reforms-for-mentally-ill-inmates/\" target=\"_blank\">use of force\u003c/a> and has signed off on CDCR's plans. Now the department is working on plans to comply with Karlton's orders to change how it \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/19/judge-orders-overhaul-in-segregation-for-californias-mentally-ill-inmates/\" target=\"_blank\">handles segregation\u003c/a> for inmates with mental illness.\u003c/p>\n\u003cp>So, I was riveted by a report this morning from \u003ca href=\"http://www.npr.org/blogs/health/2014/08/19/338895262/mental-health-cops-help-reweave-social-safety-net-in-san-antonio\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News about a different approach -- a coordinated, comprehensive approach -- to a county-run mental health system. The story was set in Texas' Bexar County, (pronouced \"bear\") home to San Antonio and the Alamo, and the program is now a model for the nation.\u003c!--more-->\u003c/p>\n\u003cp>It used to be -- as recently as 15 years ago -- that Bexar County's jail was so overcrowded with people suffering from serious mental illness that the state was getting ready to impose fines, NPR reported.\u003c/p>\n\u003cp>Then Leon Evans, took over as head of San Antonio and Bexar County's mental health systems and had a vision: For people with mental illness, treatment works. Jail does not.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Evans wanted to stop the expensive revolving door from jail back to the streets. From the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN \u003c/a>report:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">When people with a serious mental illness are released from jail, many end up living on the street, sick and often addicted. And then almost invariably, they end up back in jail for a minor nuisance crime, like panhandling (which is illegal in San Antonio), urinating in public, digging in dumpsters or sleeping on someone’s porch.\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Evans saw the most pressing problem in treatment: scattered services. The county and city agencies, the nonprofits, the jails, the hospitals -- none of them were talking to each other. \"People who fund these services only look at their little small piece of the pie and whether there is a return on investment,\" Evans told NPR.\u003c/p>\n\u003cp>It wasn't easy or fast, but Evans brought people together and, among many other things, looked at how how much money all the players were spending on mental health. They discovered enormous sums being spent to care for people -- and doing it poorly. Pooling money could offer significant savings. More from \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">The courts, the jails, the hospitals, the county government and the police department agreed to work together on the issue. Everyone provided funding– the police even contributed their drug seizure money – to build a system where people with mental illnesses could get better. \u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Today, there is one centralized complex offering services, and it's located across the street from San Antonio's \"state-of-the-art homeless shelter.\" Police officers all take a 40-hour course in handling mental health crises. The police department now has a six-person mental health squad -- officers specialize in responding to calls where mental illness may be a factor.\u003c/p>\n\u003cp>Advocates call the new approach a big success, plus it's saving money, about $10 million annually.\u003c/p>\n\u003cblockquote>\n\u003cp style=\"color: #000000\">“One thing that’s really important about the San Antonio approach is that they’ve integrated services together for mental health and substance abuse and homeless services, because most people have overlapping needs,” says Laura Usher, a program manager at the National Alliance on Mental Illness who helps set up collaborations between law enforcement agencies and mental health departments.\u003c/p>\n\u003cp style=\"color: #000000\">The center has a 48-hour inpatient psychiatric unit, sobering and detox centers, outpatient primary care and psychiatric services, a 90-day recovery program, housing for people with mental illnesses, and even job training and a program to help people transition to supported housing.\u003c/p>\n\u003cp style=\"color: #000000\">\"San Antonio realized that it’s more cost effective to provide mental health services and supports to people on the front end, rather than pay for jail beds and prison time,” says Usher.\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>As the piece wrapped up, I tried to imagine how great the savings could be in California, the most populous state in the country, if mental health care could be so coordinated and comprehensive here.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-e1408568139344.jpg\">\u003cimg class=\"size-large wp-image-20935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-640x479.jpg\" alt=\"Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\" width=\"640\" height=\"479\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>This week, Julie Small has reported on this blog about court-ordered overhauls in caring for mentally ill inmates in California prisons. About one-fourth of California's inmates -- 37,000 people -- have mild to severe mental illness.\u003c/p>\n\u003cp>As Small reported, U.S. District Judge Lawrence Karlton ordered the California Department of Corrections and Rehabilitation (CDCR) in April to draft new policies for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/california-prisons-begin-use-of-force-reforms-for-mentally-ill-inmates/\" target=\"_blank\">use of force\u003c/a> and has signed off on CDCR's plans. Now the department is working on plans to comply with Karlton's orders to change how it \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/19/judge-orders-overhaul-in-segregation-for-californias-mentally-ill-inmates/\" target=\"_blank\">handles segregation\u003c/a> for inmates with mental illness.\u003c/p>\n\u003cp>So, I was riveted by a report this morning from \u003ca href=\"http://www.npr.org/blogs/health/2014/08/19/338895262/mental-health-cops-help-reweave-social-safety-net-in-san-antonio\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News about a different approach -- a coordinated, comprehensive approach -- to a county-run mental health system. The story was set in Texas' Bexar County, (pronouced \"bear\") home to San Antonio and the Alamo, and the program is now a model for the nation.\u003c!--more-->\u003c/p>\n\u003cp>It used to be -- as recently as 15 years ago -- that Bexar County's jail was so overcrowded with people suffering from serious mental illness that the state was getting ready to impose fines, NPR reported.\u003c/p>\n\u003cp>Then Leon Evans, took over as head of San Antonio and Bexar County's mental health systems and had a vision: For people with mental illness, treatment works. Jail does not.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Evans wanted to stop the expensive revolving door from jail back to the streets. From the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN \u003c/a>report:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">When people with a serious mental illness are released from jail, many end up living on the street, sick and often addicted. And then almost invariably, they end up back in jail for a minor nuisance crime, like panhandling (which is illegal in San Antonio), urinating in public, digging in dumpsters or sleeping on someone’s porch.\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Evans saw the most pressing problem in treatment: scattered services. The county and city agencies, the nonprofits, the jails, the hospitals -- none of them were talking to each other. \"People who fund these services only look at their little small piece of the pie and whether there is a return on investment,\" Evans told NPR.\u003c/p>\n\u003cp>It wasn't easy or fast, but Evans brought people together and, among many other things, looked at how how much money all the players were spending on mental health. They discovered enormous sums being spent to care for people -- and doing it poorly. Pooling money could offer significant savings. More from \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">The courts, the jails, the hospitals, the county government and the police department agreed to work together on the issue. Everyone provided funding– the police even contributed their drug seizure money – to build a system where people with mental illnesses could get better. \u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Today, there is one centralized complex offering services, and it's located across the street from San Antonio's \"state-of-the-art homeless shelter.\" Police officers all take a 40-hour course in handling mental health crises. The police department now has a six-person mental health squad -- officers specialize in responding to calls where mental illness may be a factor.\u003c/p>\n\u003cp>Advocates call the new approach a big success, plus it's saving money, about $10 million annually.\u003c/p>\n\u003cblockquote>\n\u003cp style=\"color: #000000\">“One thing that’s really important about the San Antonio approach is that they’ve integrated services together for mental health and substance abuse and homeless services, because most people have overlapping needs,” says Laura Usher, a program manager at the National Alliance on Mental Illness who helps set up collaborations between law enforcement agencies and mental health departments.\u003c/p>\n\u003cp style=\"color: #000000\">The center has a 48-hour inpatient psychiatric unit, sobering and detox centers, outpatient primary care and psychiatric services, a 90-day recovery program, housing for people with mental illnesses, and even job training and a program to help people transition to supported housing.\u003c/p>\n\u003cp style=\"color: #000000\">\"San Antonio realized that it’s more cost effective to provide mental health services and supports to people on the front end, rather than pay for jail beds and prison time,” says Usher.\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>As the piece wrapped up, I tried to imagine how great the savings could be in California, the most populous state in the country, if mental health care could be so coordinated and comprehensive here.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Judge Orders Overhaul in Segregation for California's Mentally Ill Inmates",
"title": "Judge Orders Overhaul in Segregation for California's Mentally Ill Inmates",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_20902\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf.jpg\">\u003cimg class=\"size-full wp-image-20902\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf.jpg\" alt=\"All Inmates are shackled whenever they leave their cells. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">All Inmates are shackled whenever they leave their cells. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>Segregating prison inmates who repeatedly break the rules or turn violent against other inmates or guards is not new in California. For years the state has placed these inmates in special housing sections with multiple barriers between them and others.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Evidence that segregation 'can and does cause serious psychological harm' in inmates with serious mental illness.\u003c/aside>\n\u003cp>But the practice of isolating inmates whose bad behavior may be part of a mental illness is under fire amid a rash of suicides and attempted suicides. The focus on this type of treatment comes against a backdrop of lawsuits brought by inmates against the state over the last two decades. Those lawsuits have exposed a correctional system poorly equipped to handle their extraordinary needs.\u003c/p>\n\u003cp>Now a federal judge says that kind of punishment poses too great a risk for inmates with serious mental illness who, he says, can and do worsen in segregation. \u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Life in segregation\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Think of segregation as a prison within a prison, meant to punish and deter bad behavior.\u003c/p>\n\u003cp>Inmates in segregation spend most of their time in their cells. They’re often restrained in handcuffs and leg chains. They have to submit to constant strip searches for weapons and drugs. Family visits are restricted. They don’t get to make phone calls.\u003c/p>\n\u003cp>“Every time they walk out of their cell, they’re in restraints,” says Lt. Stephan Riley, a spokesman at the California State Prison, Sacramento, a maximum-security prison that includes a variety of segregation units, some with greater restrictions than others. On average, an inmate in segregation spends about 90 percent of his time inside a small cell, essentially a concrete box with a slat of a window. Ten hours a week is exercise in a small yard surrounded by a chain-link fence.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/163698381&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>The prison does offer psychiatric services, including group therapy. But group therapy for inmates in segregation looks far different from group therapy outside: Guards lock the inmates into metal holding cells the size of telephone booths, called therapeutic modules.\u003c/p>\n\u003cp>“There’s a metal mesh that’s welded to the frame of the module, and that’s the barrier,” explains Dr. David Wheeler, acting chief of mental health. He says the prison requires that barrier between his staff and any inmates they treat who are in segregation, whenever custody officers are out of the room.\u003c/p>\n\u003cp>For confidential one-on-one sessions, inmates sit in a locked booth with a window that faces a clinician, who is also in a locked booth.\u003c/p>\n\u003cp>But so much time alone is damaging to those with mental illness, advocates say.\u003c/p>\n\u003cp>\u003cstrong>Isolated and idle\u003c/strong>\u003c/p>\n\u003cp>“The person in the segregation cell is almost entirely isolated and idle,” says psychiatrist Terry Kupers, “and those two states are the worst thing you can do to someone with a mental illness.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"kHcNpIg2BYG9XZi1FdwblkbTorEi9abi\"]\u003c/p>\n\u003cp>Kupers, a national expert on correctional mental health care, quickly lists the effects segregation units can have on inmate patients. “High anxiety, which may take the form of panic; disordered thinking, which may become paranoid; mounting anger; problems concentrating; problems with memory; compulsive activity like cleaning their cell many times a day or pacing relentlessly.\"\u003c/p>\n\u003cp>Kupers says segregation worsens mental illness and makes those illnesses less treatable long term.\u003c/p>\n\u003cp>A court-appointed federal monitor for mental health care found that nearly half of 32 suicides in California prisons in 2012 were committed in segregation units. Nearly all of those prisoners were receiving mental health services at the time. In 2013, nearly half the 28 suicides occurred in segregation.\u003c/p>\n\u003cp>\u003cstrong>New restrictions on use of segregation\u003c/strong>\u003c/p>\n\u003cp>U.S. District Judge Lawrence Karlton appointed a special master for mental health care 20 years ago when advocates for inmates first sued the state over shoddy treatment.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">In April, Karlton found \u003c/a>that the high rate of suicides is evidence that segregation poses serious risk to mentally ill inmates:\u003c/p>\n\u003cblockquote>\u003cp>“The overwhelming weight of evidence in the record is that placement of seriously mentally ill inmates in California’s segregation housing units can and does cause serious psychological harm, including decompensation, exacerbation of mental illness, inducement of psychosis and increased risk of suicide.”\u003c/p>\u003c/blockquote>\n\u003cp>Karlton imposed a series of hurdles that prisons have to clear before they can put any mentally ill inmate into a segregation unit.\u003c/p>\n\u003cp>Officials with the California Department of Corrections and Rehabilitation declined to comment for this story, citing “sensitive” negotiations on the details of how to comply with Judge Karlton’s order.\u003c/p>\n\u003cp>But Michael Bien, the lead attorney for mentally ill inmates says Karlton’s latest ruling ends a vicious cycle for inmates in the most severe segregated housing known as Security Housing Units (SHUs).\u003c/p>\n\u003cp>“Someone is in one of these segregation units. They get very sick,” Bien says. “(Prison officials) hospitalize them; they stabilize them, but they send them back -- now to a mental health segregation unit. They get sick again, they send them back to the hospital -- that cycle -- we think the judge has ended.”\u003c/p>\n\u003cp>Judge Karlton forbade prison officials to send such an inmate back to the segregation unit where he or she deteriorated.\u003c/p>\n\u003cp>Judge Karlton also said an inmate’s psychiatrist must certify that the action for which the inmate is being segregated wasn’t the result of a mental illness and that there’s no clinical indication that segregation will worsen the inmate’s condition.\u003c/p>\n\u003cp>Bien says prison officials will have to come up with safer alternatives for people who can’t tolerate segregation, and says a start would be giving mental health staff more say over how inmates with mental illness are treated.\u003c/p>\n\u003cp>“You can turn a unit into a less dangerous place,” says Bien, “if you give power to clinicians to say: ‘I need this person to have more out-of-cell time. I want him to be treated outside of the cage;’ ‘Don’t strip search this woman, she’s reacting quite badly to that.’ The clinicians all said they’re not allowed to say any of those things.”\u003c/p>\n\u003cp>The federal judge gave prison officials until Sunday, August 24, to come up with a plan to prevent mentally ill inmates who are at serious psychological risk from being placed in segregation.\u003c/p>\n\u003cp>It’s the final piece of a massive overhaul in how California prisons treat mentally ill prisoners.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Earlier this month Karlton \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/california-prisons-begin-use-of-force-reforms-for-mentally-ill-inmates/?__utma=34673459.1803067961.1357800400.1408366357.1408487621.23&__utmb=34673459.20.10.1408487623&__utmc=34673459&__utmx=-&__utmz=34673459.1407362484.19.4.utmcsr=kqed.org%7Cutmccn=(referral)%7Cutmcmd=referral%7Cutmcct=/search/index.jsp&__utmv=-&__utmk=76842647\" target=\"_blank\">approved significant revisions\u003c/a> to policies on the use of force on mentally ill inmates.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20902\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf.jpg\">\u003cimg class=\"size-full wp-image-20902\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf.jpg\" alt=\"All Inmates are shackled whenever they leave their cells. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11518_IMG_0193_1-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">All Inmates are shackled whenever they leave their cells. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>Segregating prison inmates who repeatedly break the rules or turn violent against other inmates or guards is not new in California. For years the state has placed these inmates in special housing sections with multiple barriers between them and others.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Evidence that segregation 'can and does cause serious psychological harm' in inmates with serious mental illness.\u003c/aside>\n\u003cp>But the practice of isolating inmates whose bad behavior may be part of a mental illness is under fire amid a rash of suicides and attempted suicides. The focus on this type of treatment comes against a backdrop of lawsuits brought by inmates against the state over the last two decades. Those lawsuits have exposed a correctional system poorly equipped to handle their extraordinary needs.\u003c/p>\n\u003cp>Now a federal judge says that kind of punishment poses too great a risk for inmates with serious mental illness who, he says, can and do worsen in segregation. \u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Life in segregation\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Think of segregation as a prison within a prison, meant to punish and deter bad behavior.\u003c/p>\n\u003cp>Inmates in segregation spend most of their time in their cells. They’re often restrained in handcuffs and leg chains. They have to submit to constant strip searches for weapons and drugs. Family visits are restricted. They don’t get to make phone calls.\u003c/p>\n\u003cp>“Every time they walk out of their cell, they’re in restraints,” says Lt. Stephan Riley, a spokesman at the California State Prison, Sacramento, a maximum-security prison that includes a variety of segregation units, some with greater restrictions than others. On average, an inmate in segregation spends about 90 percent of his time inside a small cell, essentially a concrete box with a slat of a window. Ten hours a week is exercise in a small yard surrounded by a chain-link fence.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/163698381&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>The prison does offer psychiatric services, including group therapy. But group therapy for inmates in segregation looks far different from group therapy outside: Guards lock the inmates into metal holding cells the size of telephone booths, called therapeutic modules.\u003c/p>\n\u003cp>“There’s a metal mesh that’s welded to the frame of the module, and that’s the barrier,” explains Dr. David Wheeler, acting chief of mental health. He says the prison requires that barrier between his staff and any inmates they treat who are in segregation, whenever custody officers are out of the room.\u003c/p>\n\u003cp>For confidential one-on-one sessions, inmates sit in a locked booth with a window that faces a clinician, who is also in a locked booth.\u003c/p>\n\u003cp>But so much time alone is damaging to those with mental illness, advocates say.\u003c/p>\n\u003cp>\u003cstrong>Isolated and idle\u003c/strong>\u003c/p>\n\u003cp>“The person in the segregation cell is almost entirely isolated and idle,” says psychiatrist Terry Kupers, “and those two states are the worst thing you can do to someone with a mental illness.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kupers, a national expert on correctional mental health care, quickly lists the effects segregation units can have on inmate patients. “High anxiety, which may take the form of panic; disordered thinking, which may become paranoid; mounting anger; problems concentrating; problems with memory; compulsive activity like cleaning their cell many times a day or pacing relentlessly.\"\u003c/p>\n\u003cp>Kupers says segregation worsens mental illness and makes those illnesses less treatable long term.\u003c/p>\n\u003cp>A court-appointed federal monitor for mental health care found that nearly half of 32 suicides in California prisons in 2012 were committed in segregation units. Nearly all of those prisoners were receiving mental health services at the time. In 2013, nearly half the 28 suicides occurred in segregation.\u003c/p>\n\u003cp>\u003cstrong>New restrictions on use of segregation\u003c/strong>\u003c/p>\n\u003cp>U.S. District Judge Lawrence Karlton appointed a special master for mental health care 20 years ago when advocates for inmates first sued the state over shoddy treatment.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">In April, Karlton found \u003c/a>that the high rate of suicides is evidence that segregation poses serious risk to mentally ill inmates:\u003c/p>\n\u003cblockquote>\u003cp>“The overwhelming weight of evidence in the record is that placement of seriously mentally ill inmates in California’s segregation housing units can and does cause serious psychological harm, including decompensation, exacerbation of mental illness, inducement of psychosis and increased risk of suicide.”\u003c/p>\u003c/blockquote>\n\u003cp>Karlton imposed a series of hurdles that prisons have to clear before they can put any mentally ill inmate into a segregation unit.\u003c/p>\n\u003cp>Officials with the California Department of Corrections and Rehabilitation declined to comment for this story, citing “sensitive” negotiations on the details of how to comply with Judge Karlton’s order.\u003c/p>\n\u003cp>But Michael Bien, the lead attorney for mentally ill inmates says Karlton’s latest ruling ends a vicious cycle for inmates in the most severe segregated housing known as Security Housing Units (SHUs).\u003c/p>\n\u003cp>“Someone is in one of these segregation units. They get very sick,” Bien says. “(Prison officials) hospitalize them; they stabilize them, but they send them back -- now to a mental health segregation unit. They get sick again, they send them back to the hospital -- that cycle -- we think the judge has ended.”\u003c/p>\n\u003cp>Judge Karlton forbade prison officials to send such an inmate back to the segregation unit where he or she deteriorated.\u003c/p>\n\u003cp>Judge Karlton also said an inmate’s psychiatrist must certify that the action for which the inmate is being segregated wasn’t the result of a mental illness and that there’s no clinical indication that segregation will worsen the inmate’s condition.\u003c/p>\n\u003cp>Bien says prison officials will have to come up with safer alternatives for people who can’t tolerate segregation, and says a start would be giving mental health staff more say over how inmates with mental illness are treated.\u003c/p>\n\u003cp>“You can turn a unit into a less dangerous place,” says Bien, “if you give power to clinicians to say: ‘I need this person to have more out-of-cell time. I want him to be treated outside of the cage;’ ‘Don’t strip search this woman, she’s reacting quite badly to that.’ The clinicians all said they’re not allowed to say any of those things.”\u003c/p>\n\u003cp>The federal judge gave prison officials until Sunday, August 24, to come up with a plan to prevent mentally ill inmates who are at serious psychological risk from being placed in segregation.\u003c/p>\n\u003cp>It’s the final piece of a massive overhaul in how California prisons treat mentally ill prisoners.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier this month Karlton \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/california-prisons-begin-use-of-force-reforms-for-mentally-ill-inmates/?__utma=34673459.1803067961.1357800400.1408366357.1408487621.23&__utmb=34673459.20.10.1408487623&__utmc=34673459&__utmx=-&__utmz=34673459.1407362484.19.4.utmcsr=kqed.org%7Cutmccn=(referral)%7Cutmcmd=referral%7Cutmcct=/search/index.jsp&__utmv=-&__utmk=76842647\" target=\"_blank\">approved significant revisions\u003c/a> to policies on the use of force on mentally ill inmates.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fresno Considers Ending Health Services for the Undocumented",
"title": "Fresno Considers Ending Health Services for the Undocumented",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_20877\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Health4All.-e1408409981550.jpg\">\u003cimg class=\"size-large wp-image-20877\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Health4All.-640x428.jpg\" alt=\"Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)\" width=\"640\" height=\"428\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>\u003cstrong>Update\u003c/strong>: Fresno County's Board of Supervisors \u003ca href=\"http://www.fresnobee.com/2014/08/19/4077428_fresno-county-to-end-contract.html?sp=/99/217/&rh=1\" target=\"_blank\">voted 4-1\u003c/a> to end the contract providing care to the poor and to undocumented immigrants. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>Brandon Hauk’s job is about to get a lot harder. The health of about 7,000 patients he helps at Clinica Sierra Vista in Fresno is in the hands of the county board of supervisors – they are set to vote Tuesday whether or not to shut down a program that covers specialty care for the undocumented.\u003c/p>\n\u003cp>Hauk doesn’t want to think about how he’s going to explain that to people when their primary care doctor says they need to see a cardiologist, pulmonologist, or endocrinologist.\u003c/p>\n\u003cp>“What do you say to somebody that has chronic illness and we can’t refer them out? Sorry?” says Hauk. “I mean, how can you tell someone that has abdominal bleeds, I’m sorry, but we can’t help you.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Fresno’s Medically Indigent Services Program was set up decades ago to provide health coverage for the poor, and later, the undocumented. But now that the Affordable Care Act has gone into effect, the county says it doesn’t need the program anymore. Now tens of thousands of uninsured Fresnans have health coverage through Obamacare. More than that, the county says it can’t afford to keep the program going. \u003c!--more-->\u003c/p>\n\u003cp>“With the reduction in the number of individuals who need to seek services in the Medically Indigent Services Program, there’s also a reduction in funding used to support that program,” says David Pomaville, director of Fresno county’s department of public health.\u003c/p>\n\u003cp>Closing or restricting the program could leave 6,000 undocumented Fresnans without care. The Affordable Care Act does not cover the undocumented. And, after a recent court battle, the county no longer has a legal obligation to cover them.\u003c/p>\n\u003cp>Pomaville says it would cost the county up to $21 million to continue coverage for the undocumented, but the county is short about $10 million. He says his department has already trimmed everywhere else possible.\u003c/p>\n\u003cp>“It is a balancing act,” he says. “The communicable disease investigators that are out investigating cases and trying to identify sources, we are stretched. The public health laboratory that we operate here; the sexually transmitted disease programs are really stretched as far as we can stretch them.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/163862246&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Most counties in California do not provide health care services to the undocumented. Only about half a dozen do, mainly in urban areas like the Bay Area and Los Angeles. When the recession hit in 2008, Sacramento and Yolo counties dropped their coverage for the undocumented, and Contra Costa discontinued it for undocumented adults.\u003c/p>\n\u003cp>“In Fresno county, we’ve been able to hold on and deliver those services for longer than most counties have been able to,” Pomaville says.\u003c/p>\n\u003cp>But health care advocates say Fresno isn’t like most other counties. The economy depends on undocumented farm workers. Advocates say canceling the program ignores the contributions farm workers have made to the community.\u003c/p>\n\u003cp>“The question has become, does Fresno County value their farm workers?” says Sandra Celedon-Castro, manager of the advocacy group Fresno Building Healthy Communities. “Disease does not know immigration status. We’re going to be left with a population of folks in our community that are really sick, that are left to fend for themselves. What kind of community are we if we’re okay with that happening?”\u003c/p>\n\u003cp>The group organized a \"Health4All\" event earlier this month, where two hundred people gathered to protest the closure of the health program to undocumented immigrants.\u003c/p>\n\u003cp>“It would be really, really bad news,” says Grisanti Valencia. Her mother, who is undocumented, has terrible pain and numbness in her leg from a series of work injuries. Her neighbor is recovering from leukemia. “My mother, she’s already scared. She knows a lot of people, and those people are scared.”\u003c/p>\n\u003cp>Undocumented people can still get some care at Fresno’s community clinics, or the Emergency Room. But it’s the specialty care that gets lost if this program shuts down. That means no neurological consults, no cancer treatment.\u003c/p>\n\u003cp>“To me, it’s committing murder – getting rid of this program,” Valencia says. “Because you’re just letting these people die.”\u003c/p>\n\u003cp>The final decision rests with the county’s five supervisors. Most of them do not see it as the county’s responsibility to pay for care for the undocumented.\u003c/p>\n\u003cp>“If we are having a difficult time providing social services and a safety net for individuals that are documented American citizens, what allows individuals who are here illegally to derive and obtain that benefit?” says Andreas Borgeas, chairman of the board.\u003c/p>\n\u003cp>He asks why Fresno should do what Congress refused to.\u003c/p>\n\u003cp>“The onus seems to be on the county to provide undocumented coverage when the Affordable Care Act does not. It specifically does not,” he says.\u003c/p>\n\u003cp>He acknowledged that health care for farm workers is a good idea, in theory. It makes economic sense for Fresno. But farmers and lawmakers at every level point at each other when it comes down to who should pay for it.\u003c/p>\n\u003cp>Borgeas says community clinics that receive federal funding, like Clinica Sierra Vista, should be the ones to pick up the slack.\u003c/p>\n\u003cp>“I would be willing to explore that,” says Schilling, Sierra’s CEO. “It’s an issue of who would work for the kind of compensation I can offer?”\u003c/p>\n\u003cp>Fresno, like many other rural counties, has a shortage of specialist doctors in the area. Getting them to work for the reimbursement rates provided by state and federal programs is an even bigger challenge, Schilling says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If $125 or $150 buys a surgical consult, or a neurological consult, I’m game. Come on over,” he says. “The problem is, no one’s going to come work for me for that kind of money. They want substantially more than that.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20877\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Health4All.-e1408409981550.jpg\">\u003cimg class=\"size-large wp-image-20877\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Health4All.-640x428.jpg\" alt=\"Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)\" width=\"640\" height=\"428\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>\u003cstrong>Update\u003c/strong>: Fresno County's Board of Supervisors \u003ca href=\"http://www.fresnobee.com/2014/08/19/4077428_fresno-county-to-end-contract.html?sp=/99/217/&rh=1\" target=\"_blank\">voted 4-1\u003c/a> to end the contract providing care to the poor and to undocumented immigrants. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>Brandon Hauk’s job is about to get a lot harder. The health of about 7,000 patients he helps at Clinica Sierra Vista in Fresno is in the hands of the county board of supervisors – they are set to vote Tuesday whether or not to shut down a program that covers specialty care for the undocumented.\u003c/p>\n\u003cp>Hauk doesn’t want to think about how he’s going to explain that to people when their primary care doctor says they need to see a cardiologist, pulmonologist, or endocrinologist.\u003c/p>\n\u003cp>“What do you say to somebody that has chronic illness and we can’t refer them out? Sorry?” says Hauk. “I mean, how can you tell someone that has abdominal bleeds, I’m sorry, but we can’t help you.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Fresno’s Medically Indigent Services Program was set up decades ago to provide health coverage for the poor, and later, the undocumented. But now that the Affordable Care Act has gone into effect, the county says it doesn’t need the program anymore. Now tens of thousands of uninsured Fresnans have health coverage through Obamacare. More than that, the county says it can’t afford to keep the program going. \u003c!--more-->\u003c/p>\n\u003cp>“With the reduction in the number of individuals who need to seek services in the Medically Indigent Services Program, there’s also a reduction in funding used to support that program,” says David Pomaville, director of Fresno county’s department of public health.\u003c/p>\n\u003cp>Closing or restricting the program could leave 6,000 undocumented Fresnans without care. The Affordable Care Act does not cover the undocumented. And, after a recent court battle, the county no longer has a legal obligation to cover them.\u003c/p>\n\u003cp>Pomaville says it would cost the county up to $21 million to continue coverage for the undocumented, but the county is short about $10 million. He says his department has already trimmed everywhere else possible.\u003c/p>\n\u003cp>“It is a balancing act,” he says. “The communicable disease investigators that are out investigating cases and trying to identify sources, we are stretched. The public health laboratory that we operate here; the sexually transmitted disease programs are really stretched as far as we can stretch them.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/163862246&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Most counties in California do not provide health care services to the undocumented. Only about half a dozen do, mainly in urban areas like the Bay Area and Los Angeles. When the recession hit in 2008, Sacramento and Yolo counties dropped their coverage for the undocumented, and Contra Costa discontinued it for undocumented adults.\u003c/p>\n\u003cp>“In Fresno county, we’ve been able to hold on and deliver those services for longer than most counties have been able to,” Pomaville says.\u003c/p>\n\u003cp>But health care advocates say Fresno isn’t like most other counties. The economy depends on undocumented farm workers. Advocates say canceling the program ignores the contributions farm workers have made to the community.\u003c/p>\n\u003cp>“The question has become, does Fresno County value their farm workers?” says Sandra Celedon-Castro, manager of the advocacy group Fresno Building Healthy Communities. “Disease does not know immigration status. We’re going to be left with a population of folks in our community that are really sick, that are left to fend for themselves. What kind of community are we if we’re okay with that happening?”\u003c/p>\n\u003cp>The group organized a \"Health4All\" event earlier this month, where two hundred people gathered to protest the closure of the health program to undocumented immigrants.\u003c/p>\n\u003cp>“It would be really, really bad news,” says Grisanti Valencia. Her mother, who is undocumented, has terrible pain and numbness in her leg from a series of work injuries. Her neighbor is recovering from leukemia. “My mother, she’s already scared. She knows a lot of people, and those people are scared.”\u003c/p>\n\u003cp>Undocumented people can still get some care at Fresno’s community clinics, or the Emergency Room. But it’s the specialty care that gets lost if this program shuts down. That means no neurological consults, no cancer treatment.\u003c/p>\n\u003cp>“To me, it’s committing murder – getting rid of this program,” Valencia says. “Because you’re just letting these people die.”\u003c/p>\n\u003cp>The final decision rests with the county’s five supervisors. Most of them do not see it as the county’s responsibility to pay for care for the undocumented.\u003c/p>\n\u003cp>“If we are having a difficult time providing social services and a safety net for individuals that are documented American citizens, what allows individuals who are here illegally to derive and obtain that benefit?” says Andreas Borgeas, chairman of the board.\u003c/p>\n\u003cp>He asks why Fresno should do what Congress refused to.\u003c/p>\n\u003cp>“The onus seems to be on the county to provide undocumented coverage when the Affordable Care Act does not. It specifically does not,” he says.\u003c/p>\n\u003cp>He acknowledged that health care for farm workers is a good idea, in theory. It makes economic sense for Fresno. But farmers and lawmakers at every level point at each other when it comes down to who should pay for it.\u003c/p>\n\u003cp>Borgeas says community clinics that receive federal funding, like Clinica Sierra Vista, should be the ones to pick up the slack.\u003c/p>\n\u003cp>“I would be willing to explore that,” says Schilling, Sierra’s CEO. “It’s an issue of who would work for the kind of compensation I can offer?”\u003c/p>\n\u003cp>Fresno, like many other rural counties, has a shortage of specialist doctors in the area. Getting them to work for the reimbursement rates provided by state and federal programs is an even bigger challenge, Schilling says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If $125 or $150 buys a surgical consult, or a neurological consult, I’m game. Come on over,” he says. “The problem is, no one’s going to come work for me for that kind of money. They want substantially more than that.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"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.",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"perspectives": {
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
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},
"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
"airtime": "SUN 12am-1am, SAT 2pm-3pm",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png",
"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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"source": "npr"
},
"link": "/radio/program/reveal",
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"rss": "http://feeds.revealradio.org/revealpodcast"
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"source": "kqed",
"order": 16
},
"link": "/podcasts/rightnowish",
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