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"disqusTitle": "California's Breast Density Notification Law Goes Into Effect",
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"content": "\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/05/01/new-research-for-women-in-their-40s-on-mammograms/080922-n-2688m-004/\" rel=\"attachment wp-att-5549\">\u003cimg class=\"size-medium wp-image-5549\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\u003c/p>\n\u003cp>Starting Monday, \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/sen/sb_1501-1550/sb_1538_bill_20120922_chaptered.html\" target=\"_blank\">a new California law\u003c/a> will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>Former state Sen. Joe Simitian (D-Palo Alto) introduced the law last year. It grew out of his concern that while doctors were aware of a patient's breast density, the patient herself was not, preventing women from talking with their doctors about how they might want to address their potential increased risk. He wanted to change that.\u003c/p>\n\u003cp>\"The fundamental premise of the legislation,\" he said in a recent call with reporters, \"is that absent this information, these conversations weren't going to take place.\"\u003c/p>\n\u003cp>Some background: breast tissue is graded from 1 (not dense) to 4 (extremely dense). The law requires that women graded either a 3 or a 4 be notified.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Here's the specific notification required by the law:\u003c/p>\n\u003cblockquote>\u003cp>Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the \u003c!--more-->results of your mammogram and may also be associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.\u003c/p>\u003c/blockquote>\n\u003cp>But here's where the law and medical data collide: while there's fairly solid scientific evidence about the increased breast cancer risk for women with a \"4\" rating, there's not for women with a \"3\" rating. Yet, women with a \"3\" rating will be notified.\u003c/p>\n\u003cp>To put the increased risk in perspective, a woman in her 40s with \"extremely dense breasts\" has roughly the same risk of breast cancer as an average-risk woman in her 50s, according to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/mammograms-which-women-how-often/\" target=\"_blank\">a study of nearly 1 million women\u003c/a> published earlier this month by researchers from UCSF. About 12 to 15 percent of women in their 40s have \"extremely dense breasts.\"\u003c/p>\n\u003cp>So, what's a woman who receives the notification to do? The law simply suggests women decide on a course of action with their doctors.\u003c/p>\n\u003cp>The UCSF study looked specifically at the issue of breast density and found that women in their 40s with \"extremely dense breasts\" should have a mammogram every year. Major guidelines conflict as to the frequency of mammograms for women in their 40s. \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">One says annually\u003c/a>; \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">another says \u003c/a>it's a woman's individual choice.\u003c/p>\n\u003cp>But this most recent study from UCSF suggests that women in their 40s with extremely dense breasts will reduce their risk of being diagnosed with advanced disease if they have a digital mammogram every year. For women in their 50s, the researchers found no increased risk of late- stage disease if a woman had a mammogram every two years -- no matter how dense the breast tissue is.\u003c/p>\n\u003cp>So, that's some of the most up-to-date research on mammography.\u003c/p>\n\u003cp>But the new law also mentions deciding \"which screening options are right for you.\" The press call with Simitian included a radiologist and a nurse. Both discussed ultrasound screening for breast cancer. But Karla Kerlikowske, biostatistician and lead researcher of the UCSF study, said that while she supports women having information, in this case, the law may be ahead of the science \"because we don't know that women need additional imaging tests beyond digital mammography if they fall into one of those (breast density) categories.\"\u003c/p>\n\u003cp>In a subsequent email, Kerlikowske said that there are no studies of what's known as \"whole breast ultrasound\" to determine cancer detection and whether detection makes a difference in cancer staging.\u003c/p>\n\u003cp>Women with higher breast density are also at higher risk of false positives and might need to go through additional imaging and unnecessary biopsies. As Otis Brawley, chief medical officer of the American Cancer Society, noted, \"The thing that increases risk also makes screening more difficult to do. God is not fair here.\"\u003c/p>\n\u003cp>Perhaps that is what's most worth remembering: that life is not fair. At a time when people in general -- not just women -- want certainty in the face of a possible disease, medical science cannot yet provide it.\u003c/p>\n\u003cp>Again, what should you do if you get a notification of high breast density? Talk to your doctor.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003cbr>\n\u003ca href=\"http://www.kqed.org/news/story/2013/04/01/118772/breast_density_notification_law_goes_into_effect?category=bay+area\" target=\"_blank\">Listen to the story.\u003c/a>\u003c/p>\n\n",
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"excerpt": "As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\r\n\r\nStarting Monday, a new California law will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.",
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"description": "As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\r\n\r\nStarting Monday, a new California law will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.",
"title": "California's Breast Density Notification Law Goes Into Effect | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/05/01/new-research-for-women-in-their-40s-on-mammograms/080922-n-2688m-004/\" rel=\"attachment wp-att-5549\">\u003cimg class=\"size-medium wp-image-5549\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\u003c/p>\n\u003cp>Starting Monday, \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/sen/sb_1501-1550/sb_1538_bill_20120922_chaptered.html\" target=\"_blank\">a new California law\u003c/a> will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>Former state Sen. Joe Simitian (D-Palo Alto) introduced the law last year. It grew out of his concern that while doctors were aware of a patient's breast density, the patient herself was not, preventing women from talking with their doctors about how they might want to address their potential increased risk. He wanted to change that.\u003c/p>\n\u003cp>\"The fundamental premise of the legislation,\" he said in a recent call with reporters, \"is that absent this information, these conversations weren't going to take place.\"\u003c/p>\n\u003cp>Some background: breast tissue is graded from 1 (not dense) to 4 (extremely dense). The law requires that women graded either a 3 or a 4 be notified.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Here's the specific notification required by the law:\u003c/p>\n\u003cblockquote>\u003cp>Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the \u003c!--more-->results of your mammogram and may also be associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.\u003c/p>\u003c/blockquote>\n\u003cp>But here's where the law and medical data collide: while there's fairly solid scientific evidence about the increased breast cancer risk for women with a \"4\" rating, there's not for women with a \"3\" rating. Yet, women with a \"3\" rating will be notified.\u003c/p>\n\u003cp>To put the increased risk in perspective, a woman in her 40s with \"extremely dense breasts\" has roughly the same risk of breast cancer as an average-risk woman in her 50s, according to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/mammograms-which-women-how-often/\" target=\"_blank\">a study of nearly 1 million women\u003c/a> published earlier this month by researchers from UCSF. About 12 to 15 percent of women in their 40s have \"extremely dense breasts.\"\u003c/p>\n\u003cp>So, what's a woman who receives the notification to do? The law simply suggests women decide on a course of action with their doctors.\u003c/p>\n\u003cp>The UCSF study looked specifically at the issue of breast density and found that women in their 40s with \"extremely dense breasts\" should have a mammogram every year. Major guidelines conflict as to the frequency of mammograms for women in their 40s. \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">One says annually\u003c/a>; \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">another says \u003c/a>it's a woman's individual choice.\u003c/p>\n\u003cp>But this most recent study from UCSF suggests that women in their 40s with extremely dense breasts will reduce their risk of being diagnosed with advanced disease if they have a digital mammogram every year. For women in their 50s, the researchers found no increased risk of late- stage disease if a woman had a mammogram every two years -- no matter how dense the breast tissue is.\u003c/p>\n\u003cp>So, that's some of the most up-to-date research on mammography.\u003c/p>\n\u003cp>But the new law also mentions deciding \"which screening options are right for you.\" The press call with Simitian included a radiologist and a nurse. Both discussed ultrasound screening for breast cancer. But Karla Kerlikowske, biostatistician and lead researcher of the UCSF study, said that while she supports women having information, in this case, the law may be ahead of the science \"because we don't know that women need additional imaging tests beyond digital mammography if they fall into one of those (breast density) categories.\"\u003c/p>\n\u003cp>In a subsequent email, Kerlikowske said that there are no studies of what's known as \"whole breast ultrasound\" to determine cancer detection and whether detection makes a difference in cancer staging.\u003c/p>\n\u003cp>Women with higher breast density are also at higher risk of false positives and might need to go through additional imaging and unnecessary biopsies. As Otis Brawley, chief medical officer of the American Cancer Society, noted, \"The thing that increases risk also makes screening more difficult to do. God is not fair here.\"\u003c/p>\n\u003cp>Perhaps that is what's most worth remembering: that life is not fair. At a time when people in general -- not just women -- want certainty in the face of a possible disease, medical science cannot yet provide it.\u003c/p>\n\u003cp>Again, what should you do if you get a notification of high breast density? Talk to your doctor.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003cbr>\n\u003ca href=\"http://www.kqed.org/news/story/2013/04/01/118772/breast_density_notification_law_goes_into_effect?category=bay+area\" target=\"_blank\">Listen to the story.\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Seeks Return to Full Control over Prison System Mental Health Care",
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"content": "\u003cp>By \u003ca href=\"http://www.scpr.org/about/people/staff/julie-small\" target=\"_blank\">Julie Small\u003c/a>, KPCC\u003c/p>\n\u003cfigure id=\"attachment_11720\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/26/state-seeks-return-to-full-control-over-prison-system-mental-health-care/rs2383_pelicanbayexterior/\" rel=\"attachment wp-att-11720\">\u003cimg class=\"size-medium wp-image-11720\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-300x225.jpg\" alt=\"Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>More than a decade ago, a federal judge appointed a special master to oversee mental health care in the California state prison system. Since then, California has spent billions of dollars to improve psychiatric care for inmates. On Wednesday, the state will formally ask to have that oversight ended. But a high suicide rate among inmates is complicating the state's petition.\u003c/p>\n\u003cp>Experts hired by the state and by the court say there are fundamental problems with how the Department of Corrections and Rehabilitation handles suicidal prisoners.\u003c/p>\n\u003cp>The experts say things go wrong as soon as an inmate is labeled suicidal. While waiting for a psychiatric assessment, the prisoner is placed in a holding cell the size of a telephone booth.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Despite the billions spent overall on mental health care, the suicide rate in California’s prisons has been going up.\u003c/aside>\n\u003cp>Jane Kahn, a lawyer who represent inmates in lawsuits against the prison system, says male prisoners are often stripped \"and left just in their boxers.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The biggest concern is that prisoners will not report that they’re feeling suicidal if they’re held in these kind of settings,\" Kahn adds. \"We think it’s one of the many factors that explains this high rate of suicide within our system.\"\u003c/p>\n\u003cp>And despite the billions spent overall on mental health care, the suicide rate in California’s prisons has been going up. Over the past 14 years an average of 31 prisoners a year have killed themselves -– a rate higher than the national averages for federal and state prisons as a whole.\u003c!--more-->\u003c/p>\n\u003cp>Ask any psychiatrist who works in a California prison about suicide prevention, and he’ll tell you he follows a strict protocol: assess the inmate’s risk, move him to a cell where he can’t harm himself, send him for treatment, and closely monitor him throughout. But records show things don’t always work out that way. Dr. Alan Abrams recently retired from his job as chief psychiatrist at the California Medical Facility in Vacaville.\u003c/p>\n\u003cp>He described one case in particular.\u003c/p>\n\u003cp>\"We had a patient who had every reason for suicide, severely depressed,\" he said.\u003c/p>\n\u003cp>Abrams said staff sent the inmate to the acute care facility at the prison.\u003c/p>\n\u003cp>They said he was malingering, kicked him out without telling us, and he hung himself within 3 hours,\" Abrams said.\u003c/p>\n\u003cp>That suicide seemed to be tied at least in part to bureaucratic bungling. But Kahn says that the high rate of suicide overall is a marker of how \"bad the care is.\"\u003c/p>\n\u003cp>In a court filing, the state's corrections department said its system saves thousands of lives every year. Focusing on the handful of suicides distorts the overall picture, the state says.\u003c/p>\n\u003cp>But the court’s expert, Raymond Patterson, found the treatment of suicidal prisoners to be routinely deficient. Patterson said that in nearly half of the suicides last year, prison staff failed to assess the inmates for suicide risk or assessed them incorrectly.\u003c/p>\n\u003cp>The state accused Patterson of “second guessing and conjecture.”\u003c/p>\n\u003cp>Corrections Secretary Jeff Beard says it’s time for the federal court to end its oversight of the prisons’ mental health system.\u003c/p>\n\u003cp>\"I’ve been around this system and visited over 20 institutions, and I can assure you there is not a deliberate indifference to the needs,\" Beard said. \"People are being identified; people are being properly placed, and people are given the level of care that they need.\"\u003c/p>\n\u003cp>But the question remains: why has the rate of suicide in state prisons not fallen?\u003c/p>\n\u003cp>Terry Kupers, a forensic psychiatrist and prisons consultant, says California has gutted rehabilitation and education programs for inmates in recent years. He says prisons resorted to more lockdowns and isolation of inmates to deal with overcrowding and violence. Taken together, Kupers says, it can all lead to despair.\u003c/p>\n\u003cp>\"In fact, a lot of the suicides that I’m asked to investigate will be of someone housed in solitary confinement,\" Kupers says. \"There will be on the record that they’ve been to the observation area three or four times, and they return to their cell -- and that’s where they kill themselves.\"\u003c/p>\n\u003cp>But former chief prison psychiatrist Alan Abrams says even if the state restored its education and rehabilitation programs, and had the best psychiatric care available, some prisoners would still kill themselves. Because, he says, not all suicidal inmates are mentally ill.\u003c/p>\n\u003cp>\"People finally understanding that they’re going to spend the rest of their lives in prison and not wanting to. Who’s to say that it isn’t an acceptable solution to a failed life?” Abrams said.\u003c/p>\n\u003cp>After the state makes its case tomorrow, the federal judge is expected to rule within two weeks whether California is ready to once again assume sole control over mental health care in its prisons.\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://blogs.kqed.org/lowdown/2012/08/31/who-do-we-lock-up-in-california-four-key-characteristics-of-our-prison-population/\" target=\"_blank\">California's Prisons \u003c/a>(The Lowdown)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Listen to Julie Small's story:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201303260850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201303260850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "More than a decade ago, a federal judge appointed a special master to oversee mental health care in the California state prison system. Since then, California has spent billions of dollars to improve psychiatric care for inmates. On Wednesday, the state will formally ask to have that oversight ended. But a high suicide rate among inmates is complicating the state's petition.",
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"description": "More than a decade ago, a federal judge appointed a special master to oversee mental health care in the California state prison system. Since then, California has spent billions of dollars to improve psychiatric care for inmates. On Wednesday, the state will formally ask to have that oversight ended. But a high suicide rate among inmates is complicating the state's petition.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.scpr.org/about/people/staff/julie-small\" target=\"_blank\">Julie Small\u003c/a>, KPCC\u003c/p>\n\u003cfigure id=\"attachment_11720\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/26/state-seeks-return-to-full-control-over-prison-system-mental-health-care/rs2383_pelicanbayexterior/\" rel=\"attachment wp-att-11720\">\u003cimg class=\"size-medium wp-image-11720\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-300x225.jpg\" alt=\"Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>More than a decade ago, a federal judge appointed a special master to oversee mental health care in the California state prison system. Since then, California has spent billions of dollars to improve psychiatric care for inmates. On Wednesday, the state will formally ask to have that oversight ended. But a high suicide rate among inmates is complicating the state's petition.\u003c/p>\n\u003cp>Experts hired by the state and by the court say there are fundamental problems with how the Department of Corrections and Rehabilitation handles suicidal prisoners.\u003c/p>\n\u003cp>The experts say things go wrong as soon as an inmate is labeled suicidal. While waiting for a psychiatric assessment, the prisoner is placed in a holding cell the size of a telephone booth.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Despite the billions spent overall on mental health care, the suicide rate in California’s prisons has been going up.\u003c/aside>\n\u003cp>Jane Kahn, a lawyer who represent inmates in lawsuits against the prison system, says male prisoners are often stripped \"and left just in their boxers.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The biggest concern is that prisoners will not report that they’re feeling suicidal if they’re held in these kind of settings,\" Kahn adds. \"We think it’s one of the many factors that explains this high rate of suicide within our system.\"\u003c/p>\n\u003cp>And despite the billions spent overall on mental health care, the suicide rate in California’s prisons has been going up. Over the past 14 years an average of 31 prisoners a year have killed themselves -– a rate higher than the national averages for federal and state prisons as a whole.\u003c!--more-->\u003c/p>\n\u003cp>Ask any psychiatrist who works in a California prison about suicide prevention, and he’ll tell you he follows a strict protocol: assess the inmate’s risk, move him to a cell where he can’t harm himself, send him for treatment, and closely monitor him throughout. But records show things don’t always work out that way. Dr. Alan Abrams recently retired from his job as chief psychiatrist at the California Medical Facility in Vacaville.\u003c/p>\n\u003cp>He described one case in particular.\u003c/p>\n\u003cp>\"We had a patient who had every reason for suicide, severely depressed,\" he said.\u003c/p>\n\u003cp>Abrams said staff sent the inmate to the acute care facility at the prison.\u003c/p>\n\u003cp>They said he was malingering, kicked him out without telling us, and he hung himself within 3 hours,\" Abrams said.\u003c/p>\n\u003cp>That suicide seemed to be tied at least in part to bureaucratic bungling. But Kahn says that the high rate of suicide overall is a marker of how \"bad the care is.\"\u003c/p>\n\u003cp>In a court filing, the state's corrections department said its system saves thousands of lives every year. Focusing on the handful of suicides distorts the overall picture, the state says.\u003c/p>\n\u003cp>But the court’s expert, Raymond Patterson, found the treatment of suicidal prisoners to be routinely deficient. Patterson said that in nearly half of the suicides last year, prison staff failed to assess the inmates for suicide risk or assessed them incorrectly.\u003c/p>\n\u003cp>The state accused Patterson of “second guessing and conjecture.”\u003c/p>\n\u003cp>Corrections Secretary Jeff Beard says it’s time for the federal court to end its oversight of the prisons’ mental health system.\u003c/p>\n\u003cp>\"I’ve been around this system and visited over 20 institutions, and I can assure you there is not a deliberate indifference to the needs,\" Beard said. \"People are being identified; people are being properly placed, and people are given the level of care that they need.\"\u003c/p>\n\u003cp>But the question remains: why has the rate of suicide in state prisons not fallen?\u003c/p>\n\u003cp>Terry Kupers, a forensic psychiatrist and prisons consultant, says California has gutted rehabilitation and education programs for inmates in recent years. He says prisons resorted to more lockdowns and isolation of inmates to deal with overcrowding and violence. Taken together, Kupers says, it can all lead to despair.\u003c/p>\n\u003cp>\"In fact, a lot of the suicides that I’m asked to investigate will be of someone housed in solitary confinement,\" Kupers says. \"There will be on the record that they’ve been to the observation area three or four times, and they return to their cell -- and that’s where they kill themselves.\"\u003c/p>\n\u003cp>But former chief prison psychiatrist Alan Abrams says even if the state restored its education and rehabilitation programs, and had the best psychiatric care available, some prisoners would still kill themselves. Because, he says, not all suicidal inmates are mentally ill.\u003c/p>\n\u003cp>\"People finally understanding that they’re going to spend the rest of their lives in prison and not wanting to. Who’s to say that it isn’t an acceptable solution to a failed life?” Abrams said.\u003c/p>\n\u003cp>After the state makes its case tomorrow, the federal judge is expected to rule within two weeks whether California is ready to once again assume sole control over mental health care in its prisons.\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://blogs.kqed.org/lowdown/2012/08/31/who-do-we-lock-up-in-california-four-key-characteristics-of-our-prison-population/\" target=\"_blank\">California's Prisons \u003c/a>(The Lowdown)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Listen to Julie Small's story:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201303260850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201303260850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Put That Baby Spoon Down: Doctors Say Infants Fed Solid Food Too Soon",
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"content": "\u003cfigure id=\"attachment_11670\" class=\"wp-caption alignleft\" style=\"max-width: 283px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/25/put-that-baby-spoon-down-infants-fed-solid-food-too-soon/baby2_andypeters_flickr-copy/\" rel=\"attachment wp-att-11670\">\u003cimg class=\"size-medium wp-image-11670\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/baby2_AndyPeters_Flickr-copy-300x317.jpg\" alt=\"Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\" width=\"283\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A new survey from the Centers for Disease Control finds that mothers (the CDC surveyed only mothers) are giving their babies solid food too early, despite guidelines from the American Academy of Pediatrics.\u003c/p>\n\u003cp>In \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2012-2265\" target=\"_blank\">the survey\u003c/a>, or more than 1,334 women, just over 40 percent of mothers gave their babies solid food before they were four months old.\u003c/p>\n\u003cp>For years, the AAP had recommended that babies be at least four months old before being given solid food. But last year, it recommended that babies be \u003ca href=\"http://www.healthychildren.org/English/news/Pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx\" target=\"_blank\">breastfed -- exclusively -- for six months\u003c/a>, before \"complementary\" foods are given. Now we see that many mothers are not even waiting the full four months.\u003c/p>\n\u003cp>From \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/03/25/infants-feeding-solids-formula/2006725/\" target=\"_blank\">USA Today\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Understanding parents' motivations is important, because a number of health problems are associated with the early introduction of solid foods, says study co-author Kelley Scanlon, an epidemiologist with the Centers for Disease Control and Prevention. These findings \"don't offer a full understanding why, but they give us some insight,\" she says.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The moms cited reasons such as, \"My baby was old enough,\" and, \"It would help my baby sleep longer at night.\"\u003c/p>\n\u003cp>According to the American Academy of Pediatrics, the head and neck control and overall coordination that infants need to safely eat solids does not develop until around 4 months. In addition, the early introduction of solids may increase the risk of some chronic diseases, such as diabetes, obesity, eczema and celiac disease, the study notes.\u003c/p>\n\u003cp>Giving solids too soon also ends exclusive breast-feeding, which the AAP recommends for about the first 6 months because of numerous health benefits for infants, including reduced risk of respiratory and ear infections, diarrhea, diabetes, obesity and sudden infant death syndrome.\u003c/p>\n\u003cp>A bit of cereal added to a bottle of formula is sometimes recommended by physicians for babies with reflux, says Lana Gagin, a pediatrician at the Helen DeVos Children's Hospital in Grand Rapids, Mich. She was not involved in the study. From a medical standpoint, however, \"There is no good, solid evidence that it helps a baby sleep,\" she says. ...\u003c/p>\n\u003cp>\"We didn't expect to see so many (give solids) before 4 months,\" says Scanlon. She says the finding in this study that 40.4% do so is higher than previous findings that range from 19% to 29%. Unlike most past studies, which surveyed mothers two or three years after they first introduced solids, the new study asked moms to recall what was fed during the previous seven days.\u003c/p>\n\u003cp> \u003c/p>\u003c/blockquote>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "A new survey from the Centers for Disease Control finds that mothers (the CDC surveyed only mothers) are giving their babies solid food too early, despite guidelines from the American Academy of Pediatrics. \r\n\r\nIn the survey, or more than 1,334 women, just over 40 percent of mothers gave their babies solid food before they were four months old.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11670\" class=\"wp-caption alignleft\" style=\"max-width: 283px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/25/put-that-baby-spoon-down-infants-fed-solid-food-too-soon/baby2_andypeters_flickr-copy/\" rel=\"attachment wp-att-11670\">\u003cimg class=\"size-medium wp-image-11670\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/baby2_AndyPeters_Flickr-copy-300x317.jpg\" alt=\"Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\" width=\"283\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A new survey from the Centers for Disease Control finds that mothers (the CDC surveyed only mothers) are giving their babies solid food too early, despite guidelines from the American Academy of Pediatrics.\u003c/p>\n\u003cp>In \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2012-2265\" target=\"_blank\">the survey\u003c/a>, or more than 1,334 women, just over 40 percent of mothers gave their babies solid food before they were four months old.\u003c/p>\n\u003cp>For years, the AAP had recommended that babies be at least four months old before being given solid food. But last year, it recommended that babies be \u003ca href=\"http://www.healthychildren.org/English/news/Pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx\" target=\"_blank\">breastfed -- exclusively -- for six months\u003c/a>, before \"complementary\" foods are given. Now we see that many mothers are not even waiting the full four months.\u003c/p>\n\u003cp>From \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/03/25/infants-feeding-solids-formula/2006725/\" target=\"_blank\">USA Today\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Understanding parents' motivations is important, because a number of health problems are associated with the early introduction of solid foods, says study co-author Kelley Scanlon, an epidemiologist with the Centers for Disease Control and Prevention. These findings \"don't offer a full understanding why, but they give us some insight,\" she says.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The moms cited reasons such as, \"My baby was old enough,\" and, \"It would help my baby sleep longer at night.\"\u003c/p>\n\u003cp>According to the American Academy of Pediatrics, the head and neck control and overall coordination that infants need to safely eat solids does not develop until around 4 months. In addition, the early introduction of solids may increase the risk of some chronic diseases, such as diabetes, obesity, eczema and celiac disease, the study notes.\u003c/p>\n\u003cp>Giving solids too soon also ends exclusive breast-feeding, which the AAP recommends for about the first 6 months because of numerous health benefits for infants, including reduced risk of respiratory and ear infections, diarrhea, diabetes, obesity and sudden infant death syndrome.\u003c/p>\n\u003cp>A bit of cereal added to a bottle of formula is sometimes recommended by physicians for babies with reflux, says Lana Gagin, a pediatrician at the Helen DeVos Children's Hospital in Grand Rapids, Mich. She was not involved in the study. From a medical standpoint, however, \"There is no good, solid evidence that it helps a baby sleep,\" she says. ...\u003c/p>\n\u003cp>\"We didn't expect to see so many (give solids) before 4 months,\" says Scanlon. She says the finding in this study that 40.4% do so is higher than previous findings that range from 19% to 29%. Unlike most past studies, which surveyed mothers two or three years after they first introduced solids, the new study asked moms to recall what was fed during the previous seven days.\u003c/p>\n\u003cp> \u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "E.R. Docs and Gun Violence: Emotional Stories of Fatalities 'Hard to Forget'",
"title": "E.R. Docs and Gun Violence: Emotional Stories of Fatalities 'Hard to Forget'",
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"content": "\u003cp>By Eric Whitney for Colorado Public Radio and \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/21/colorado-doctors-and-guns.aspx\" target=\"_blank\">Kaiser Health News \u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11618\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/22/e-r-doctors-and-gun-violence-emotional-stories-of-fatalities-hard-to-forget/chris-colwell/\" rel=\"attachment wp-att-11618\">\u003cimg class=\"size-full wp-image-11618\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/ChrisColwell_KHN03222013.jpg\" alt=\"Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>In Colorado, where more people \u003ca href=\"http://www.suicidepreventioncolorado.org/uploads/8/7/8/4/8784346/firearms_deaths_in_co_2004_2011.pdf\" target=\"_blank\">die from gunshots than car crashes\u003c/a>, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.\u003c/p>\n\u003cp>Dr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.\u003c/p>\n\u003cp>\"These are the injuries that the [patients] will come in, and they'll look at me, and they'll talk to me, and then they'll die,\" says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"These are the injuries that the (patients) will come in, and they'll look at me, and they'll talk to me, and then they'll die.\"\u003c/aside>\n\u003cp>Colwell also treated casualties from two of the deadliest mass shootings in American history. He responded to the scene during the 1999 massacre at Columbine High School where 15 people died. He also treated victims of last July's movie theater shooting in\u003ca href=\"http://www.acep.org/sa/videos/\" target=\"_blank\"> Aurora\u003c/a>, where a dozen were killed and 58 wounded.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Often, Colwell will treat a shooting victim, and then treat the shooter after he or she has been caught by police. Colwell describes a case from a few months ago in which he treated a woman who later died -- and then her husband, who fired the gun.\u003c!--more-->\u003c/p>\n\u003cp>\"They had had a fight. He had caught her in what he felt was cheating, and he had lost his temper,\" he says. \"He went and grabbed the pistol that he had for home defense at his bedside, and he made a snap decision.\" Now, he adds, \"his life will never be the same, and hers was gone.\"\u003c/p>\n\u003cp>Colwell says it's remarkable how often people who pull the trigger are surprised at the consequences of their actions. And he's deeply disturbed by how easy guns are to get.\u003c/p>\n\u003cp>\"I see patients every day that are right on the edge of being unstable. … They describe problems with access to medications; problems with access to psychiatric care or substance abuse care; problems with access to homes or to shelter,\" says Colwell. \"But they don't describe problems with access to guns.\"\u003c/p>\n\u003cp>Dr. Katie Bakes, who has worked with Colwell in the emergency department for 10 years, also says it's the gunshot victims that she can't shake.\u003c/p>\n\u003cp>A few weeks ago she treated a three-year-old who'd been shot in the head. Her mother had shot each of her three children and then committed suicide. \"Our patient was the only one who was \u003ca href=\"http://www.denverpost.com/breakingnews/ci_22646862/doctors-say-condition-denver-girl-shot-by-mother?IADID=Search-www.denverpost.com-www.denverpost.com\" target=\"_blank\">a survivor\u003c/a>,\" Bakes says.\u003c/p>\n\u003cp>Such experiences have made Bakes unequivocal in her opposition to guns.\u003c/p>\n\u003cp>\"I hate guns. If I could snap my finger and get rid of all the guns I would. I think they're evil,\" Bakes says, \"I don't really care what the other side of the argument is. I just don't want to see another 3-year-old come in and be shot in the head.\"\u003c/p>\n\u003cp>Bakes and Colwell say gun injuries feel much more deliberate than any other kind of trauma they see.\u003c/p>\n\u003cp>\"It's so senseless,\" Bakes says. \"You know, it's not an accident, somebody intentionally pulled the trigger for whatever reason.\"\u003c/p>\n\u003cp>But not all physicians share this perspective.\u003c/p>\n\u003cp>Dr. Jack Cletcher, a retired orthopedic surgeon, has treated his share of gunshot victims, too, from the streets of Chicago, and, decades ago, he took care of wounded soldiers just off the plane from Vietnam. He can sympathize with Bakes and Colwell, but he doesn't agree that laws need to change.\u003c/p>\n\u003cp>\"This is the kind of emotional reaction that occurs with these horrible catastrophes that happen,\" Cletcher says. \"The gun is only the instrument. It's not something that happens because the gun does it. There has to be somebody holding the gun to do it.\"\u003c/p>\n\u003cp>Cletcher is opposed to most of the new gun restrictions lawmakers are talking about in Denver and Washington.\u003c/p>\n\u003cp>\"I don't think we need new laws, we just need to make the ones we have work better,\" says Cletcher, who would rather see lawmakers focus on better treatment for the mentally ill, and keeping guns out of their hands.\u003c/p>\n\u003cp>Recently, leaders of the Colorado Medical Society went to Washington to \u003ca href=\"http://www.denvermedsociety.org/newsletters/DENVER%20MEDICAL%20BULLETIN%202013%2003.pdf\">lobby\u003c/a> for measures to help prevent gun violence. Strengthening mental health care was on their agenda, and they support President Barack Obama's executive action for increased research into gun violence.\u003c/p>\n\u003cp>Dr. John Bender, the organization's president-elect, showed Rep. Ed Perlmutter, D- Colo., the results of a recent survey of the medical society's members in which about two-thirds want to see gun regulations strengthened and about a third don't.\u003c/p>\n\u003cp>No similar survey exists for doctors nationwide, but a majority of AMA delegates have \u003ca href=\"https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/ama1/pub/upload/mm/PolicyFinder/policyfiles/HnE/H-145.985.HTM\" target=\"_blank\">endorsed\u003c/a> tighter restrictions on guns. \u003ca href=\"http://www.drgo.us/?tag=doctors-for-responsible-gun-ownership\">Not all doctors agree\u003c/a>, but among those calling for stricter gun control laws are the \u003ca href=\"http://www.ama-assn.org/resources/doc/washington/2013-01-29-feinstein-assault-weapons-ban.pdf\">AMA\u003c/a> and several groups of specialists, including the \u003ca href=\"http://www.acep.org/Physician-Resources/Policies/Policy-statements/Firearm-Injury-Prevention/\" target=\"_blank\">American College of Emergency Physicians\u003c/a>, the \u003ca href=\"http://blogs.aafp.org/cfr/leadervoices/entry/time_for_a_national_conversation\" target=\"_blank\">American Academy of Family Physicians\u003c/a> and the \u003ca href=\"http://pediatrics.aappublications.org/content/130/5/e1416.full?sid=0fd76a3f-2ca9-4069-9960-8c889def313a\" target=\"_blank\">American Academy of Pediatrics\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Kaiser Health News, \u003ca href=\"http://www.cpr.org/#load_category_page%7Cnews\" target=\"_blank\">Colorado Public Radio\u003c/a>, and \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">\u003cem>NPR\u003c/em>\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "In Colorado, where more people die from gunshots than car crashes, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.\r\n\r\nDr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.\r\n\r\n\"These are the injuries that the [patients] will come in, and they'll look at me, and they'll talk to me, and then they'll die,\" says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Eric Whitney for Colorado Public Radio and \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/21/colorado-doctors-and-guns.aspx\" target=\"_blank\">Kaiser Health News \u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11618\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/22/e-r-doctors-and-gun-violence-emotional-stories-of-fatalities-hard-to-forget/chris-colwell/\" rel=\"attachment wp-att-11618\">\u003cimg class=\"size-full wp-image-11618\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/ChrisColwell_KHN03222013.jpg\" alt=\"Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>In Colorado, where more people \u003ca href=\"http://www.suicidepreventioncolorado.org/uploads/8/7/8/4/8784346/firearms_deaths_in_co_2004_2011.pdf\" target=\"_blank\">die from gunshots than car crashes\u003c/a>, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.\u003c/p>\n\u003cp>Dr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.\u003c/p>\n\u003cp>\"These are the injuries that the [patients] will come in, and they'll look at me, and they'll talk to me, and then they'll die,\" says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"These are the injuries that the (patients) will come in, and they'll look at me, and they'll talk to me, and then they'll die.\"\u003c/aside>\n\u003cp>Colwell also treated casualties from two of the deadliest mass shootings in American history. He responded to the scene during the 1999 massacre at Columbine High School where 15 people died. He also treated victims of last July's movie theater shooting in\u003ca href=\"http://www.acep.org/sa/videos/\" target=\"_blank\"> Aurora\u003c/a>, where a dozen were killed and 58 wounded.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Often, Colwell will treat a shooting victim, and then treat the shooter after he or she has been caught by police. Colwell describes a case from a few months ago in which he treated a woman who later died -- and then her husband, who fired the gun.\u003c!--more-->\u003c/p>\n\u003cp>\"They had had a fight. He had caught her in what he felt was cheating, and he had lost his temper,\" he says. \"He went and grabbed the pistol that he had for home defense at his bedside, and he made a snap decision.\" Now, he adds, \"his life will never be the same, and hers was gone.\"\u003c/p>\n\u003cp>Colwell says it's remarkable how often people who pull the trigger are surprised at the consequences of their actions. And he's deeply disturbed by how easy guns are to get.\u003c/p>\n\u003cp>\"I see patients every day that are right on the edge of being unstable. … They describe problems with access to medications; problems with access to psychiatric care or substance abuse care; problems with access to homes or to shelter,\" says Colwell. \"But they don't describe problems with access to guns.\"\u003c/p>\n\u003cp>Dr. Katie Bakes, who has worked with Colwell in the emergency department for 10 years, also says it's the gunshot victims that she can't shake.\u003c/p>\n\u003cp>A few weeks ago she treated a three-year-old who'd been shot in the head. Her mother had shot each of her three children and then committed suicide. \"Our patient was the only one who was \u003ca href=\"http://www.denverpost.com/breakingnews/ci_22646862/doctors-say-condition-denver-girl-shot-by-mother?IADID=Search-www.denverpost.com-www.denverpost.com\" target=\"_blank\">a survivor\u003c/a>,\" Bakes says.\u003c/p>\n\u003cp>Such experiences have made Bakes unequivocal in her opposition to guns.\u003c/p>\n\u003cp>\"I hate guns. If I could snap my finger and get rid of all the guns I would. I think they're evil,\" Bakes says, \"I don't really care what the other side of the argument is. I just don't want to see another 3-year-old come in and be shot in the head.\"\u003c/p>\n\u003cp>Bakes and Colwell say gun injuries feel much more deliberate than any other kind of trauma they see.\u003c/p>\n\u003cp>\"It's so senseless,\" Bakes says. \"You know, it's not an accident, somebody intentionally pulled the trigger for whatever reason.\"\u003c/p>\n\u003cp>But not all physicians share this perspective.\u003c/p>\n\u003cp>Dr. Jack Cletcher, a retired orthopedic surgeon, has treated his share of gunshot victims, too, from the streets of Chicago, and, decades ago, he took care of wounded soldiers just off the plane from Vietnam. He can sympathize with Bakes and Colwell, but he doesn't agree that laws need to change.\u003c/p>\n\u003cp>\"This is the kind of emotional reaction that occurs with these horrible catastrophes that happen,\" Cletcher says. \"The gun is only the instrument. It's not something that happens because the gun does it. There has to be somebody holding the gun to do it.\"\u003c/p>\n\u003cp>Cletcher is opposed to most of the new gun restrictions lawmakers are talking about in Denver and Washington.\u003c/p>\n\u003cp>\"I don't think we need new laws, we just need to make the ones we have work better,\" says Cletcher, who would rather see lawmakers focus on better treatment for the mentally ill, and keeping guns out of their hands.\u003c/p>\n\u003cp>Recently, leaders of the Colorado Medical Society went to Washington to \u003ca href=\"http://www.denvermedsociety.org/newsletters/DENVER%20MEDICAL%20BULLETIN%202013%2003.pdf\">lobby\u003c/a> for measures to help prevent gun violence. Strengthening mental health care was on their agenda, and they support President Barack Obama's executive action for increased research into gun violence.\u003c/p>\n\u003cp>Dr. John Bender, the organization's president-elect, showed Rep. Ed Perlmutter, D- Colo., the results of a recent survey of the medical society's members in which about two-thirds want to see gun regulations strengthened and about a third don't.\u003c/p>\n\u003cp>No similar survey exists for doctors nationwide, but a majority of AMA delegates have \u003ca href=\"https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/ama1/pub/upload/mm/PolicyFinder/policyfiles/HnE/H-145.985.HTM\" target=\"_blank\">endorsed\u003c/a> tighter restrictions on guns. \u003ca href=\"http://www.drgo.us/?tag=doctors-for-responsible-gun-ownership\">Not all doctors agree\u003c/a>, but among those calling for stricter gun control laws are the \u003ca href=\"http://www.ama-assn.org/resources/doc/washington/2013-01-29-feinstein-assault-weapons-ban.pdf\">AMA\u003c/a> and several groups of specialists, including the \u003ca href=\"http://www.acep.org/Physician-Resources/Policies/Policy-statements/Firearm-Injury-Prevention/\" target=\"_blank\">American College of Emergency Physicians\u003c/a>, the \u003ca href=\"http://blogs.aafp.org/cfr/leadervoices/entry/time_for_a_national_conversation\" target=\"_blank\">American Academy of Family Physicians\u003c/a> and the \u003ca href=\"http://pediatrics.aappublications.org/content/130/5/e1416.full?sid=0fd76a3f-2ca9-4069-9960-8c889def313a\" target=\"_blank\">American Academy of Pediatrics\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Kaiser Health News, \u003ca href=\"http://www.cpr.org/#load_category_page%7Cnews\" target=\"_blank\">Colorado Public Radio\u003c/a>, and \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">\u003cem>NPR\u003c/em>\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Settlement Called 'Less Harmful' for In-Home Support Recipients",
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"content": "\u003cp>By David Gorn, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/3/state-settles-suit-over-inhome-service-cuts.aspx\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>California officials and disability rights advocates yesterday announced a settlement of a lawsuit challenging a 20 percent budget trigger cut in In-Home Supportive Services care.\u003c/p>\n\u003cp>The settlement allows an 8 percent reduction this year and a 7 percent reduction in 2014. It also changes the cuts from permanent to temporary.\u003c/p>\n\u003cp>The size and timing of the cuts are based, in part, on a current 3.6 percent IHSS cut established in 2009. That reduction will remain in effect, and an additional 4.4 percent cut will be added onto that this year followed by a 3.4 percent additional cut next year, bringing the totals to 8 percent this year and 7 percent next year.\u003c!--more-->\u003c/p>\n\u003cp>\"As a package deal, it's not as simple as saying it's 20 percent down to 8 percent,\" said Elissa Gershon, attorney for one of the plaintiffs, Disability Rights California. \"What we're looking at is small cuts this year and the following year, and hopefully full restoration of benefits in 2015.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Michael Weston, spokesperson for the Department of Social Services, which was named in the suit along with the Department of Health Care Services, said the budget included the 20 percent cut over only seven months, so the 8 percent cut over the full 12 months actually achieves budgeted savings, while helping beneficiaries and eliminating a costly lawsuit.\u003c/p>\n\u003cp>\"The agreement still captures budgeted savings, that's really the gist of it,\" Weston said. \"And we're creating stability for IHSS recipients, ensuring that these individuals remain safely in the community.\"\u003c/p>\n\u003cp>IHSS aid allows some recipients to avoid hospitalization or nursing home care, which \"would be far more costly than the current IHSS program,\" according to Weston.\u003c/p>\n\u003cp>In addition to settling the issue of the 20 percent trigger cuts, the settlement covers several other key points:\u003c/p>\n\u003cul>\n\u003cli>The agreement resolves earlier cuts based on beneficiaries' functional index score;\u003c/li>\n\u003cli>It ensures IHSS beneficiaries will have the right to request a reassessment based on a change in circumstances. Now they won't need a medical certification, as is currently required;\u003c/li>\n\u003cli>The agreement not only resolves the Oster v. Lightbourne lawsuit (formerly known as V.L. v. Wagner), but it also settles another IHSS case, Dominguez v. Schwarzenegger; and\u003c/li>\n\u003cli>The agreement restores the hours lost from the 7% cut as early as the spring of 2015, as long as California is able to obtain federal approval of a provider fee to bring new federal revenue to California, according to advocates.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>\"The gradual nature of the cuts is less harmful,\" Gershon said. \"It means the uncertainty of the past four years is gone, and there is hope for full restoration of hours in 2015. People depend on these services to remain in their home. We don't want to minimize the impact [of these cuts], but under the circumstances, we're doing it in the hopes that the stability outweighs the harm for the next two years.\"\u003c/p>\n\n",
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"excerpt": "California officials and disability rights advocates yesterday announced a settlement of a lawsuit challenging a 20 percent budget trigger cut in In-Home Supportive Services care.\r\n\r\nThe settlement allows an 8 percent reduction this year and a 7 percent reduction in 2014. It also changes the cuts from permanent to temporary.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By David Gorn, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/3/state-settles-suit-over-inhome-service-cuts.aspx\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>California officials and disability rights advocates yesterday announced a settlement of a lawsuit challenging a 20 percent budget trigger cut in In-Home Supportive Services care.\u003c/p>\n\u003cp>The settlement allows an 8 percent reduction this year and a 7 percent reduction in 2014. It also changes the cuts from permanent to temporary.\u003c/p>\n\u003cp>The size and timing of the cuts are based, in part, on a current 3.6 percent IHSS cut established in 2009. That reduction will remain in effect, and an additional 4.4 percent cut will be added onto that this year followed by a 3.4 percent additional cut next year, bringing the totals to 8 percent this year and 7 percent next year.\u003c!--more-->\u003c/p>\n\u003cp>\"As a package deal, it's not as simple as saying it's 20 percent down to 8 percent,\" said Elissa Gershon, attorney for one of the plaintiffs, Disability Rights California. \"What we're looking at is small cuts this year and the following year, and hopefully full restoration of benefits in 2015.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Michael Weston, spokesperson for the Department of Social Services, which was named in the suit along with the Department of Health Care Services, said the budget included the 20 percent cut over only seven months, so the 8 percent cut over the full 12 months actually achieves budgeted savings, while helping beneficiaries and eliminating a costly lawsuit.\u003c/p>\n\u003cp>\"The agreement still captures budgeted savings, that's really the gist of it,\" Weston said. \"And we're creating stability for IHSS recipients, ensuring that these individuals remain safely in the community.\"\u003c/p>\n\u003cp>IHSS aid allows some recipients to avoid hospitalization or nursing home care, which \"would be far more costly than the current IHSS program,\" according to Weston.\u003c/p>\n\u003cp>In addition to settling the issue of the 20 percent trigger cuts, the settlement covers several other key points:\u003c/p>\n\u003cul>\n\u003cli>The agreement resolves earlier cuts based on beneficiaries' functional index score;\u003c/li>\n\u003cli>It ensures IHSS beneficiaries will have the right to request a reassessment based on a change in circumstances. Now they won't need a medical certification, as is currently required;\u003c/li>\n\u003cli>The agreement not only resolves the Oster v. Lightbourne lawsuit (formerly known as V.L. v. Wagner), but it also settles another IHSS case, Dominguez v. Schwarzenegger; and\u003c/li>\n\u003cli>The agreement restores the hours lost from the 7% cut as early as the spring of 2015, as long as California is able to obtain federal approval of a provider fee to bring new federal revenue to California, according to advocates.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>\"The gradual nature of the cuts is less harmful,\" Gershon said. \"It means the uncertainty of the past four years is gone, and there is hope for full restoration of hours in 2015. People depend on these services to remain in their home. We don't want to minimize the impact [of these cuts], but under the circumstances, we're doing it in the hopes that the stability outweighs the harm for the next two years.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Investigation Reprimands Kaiser Over Mental Health Services",
"title": "State Investigation Reprimands Kaiser Over Mental Health Services",
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"content": "\u003cp>By \u003ca href=\"http://www.kqed.org/radio/about/staff/mina-kim.jsp\" target=\"_blank\">Mina Kim\u003c/a>, KQED\u003c/p>\n\u003cfigure id=\"attachment_21359\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-e1410283672646.jpg\">\u003cimg class=\"size-medium wp-image-21359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-300x183.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"183\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a \u003ca href=\"http://nuhw.squarespace.com/storage/docs/kaiser-docs/DMHC-FinalReportKaiserMentalHlthSvces3-18-13.pdf\" target=\"_blank\">recent report\u003c/a> by the Department of Managed Health Care.\u003c/p>\n\u003cp>The report says Kaiser's mental health services are deficient in key areas.\u003c/p>\n\u003cp>State regulators found insufficient staffing at some clinics across the state -- with patients waiting longer than the legal limit of 10 days for appointments. The report also says some patients were being misled due to inaccurate information about Kaiser's mental health services. Regulators also found that at Northern California facilities staff members were not accurately tracking and reporting how long patients had to wait to get initial appointments or follow ups.\u003c!--more-->\u003c/p>\n\u003cp>Shelly Rouillard, chief deputy director at the department, says the agency will be taking the unusual step of conducting a follow-up survey in six months rather than the normal 18 months.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"These are significant deficiencies, and we're concerned that consumers aren't getting the care that they need when they need it,\" she said \"and particularly when they are in distress.\"\u003c/p>\n\u003cp>Kaiser employees affiliated with the National Union of Healthcare Workers are calling the report a vindication of concerns they laid out in 2011. Clement Papazian is a social worker with Kaiser Oakland and a chapter officer for the union that represents more than 2000 clinicians and psychologists. Papazian says delays have been hard on patients.\u003c/p>\n\u003cp>\"Some of them will drop out of care,\" he described. \"Some of them will seek medication only -- or the services that are available to them: group services.\"\u003c/p>\n\u003cp>But Kaiser Permanente officials say the problems occurred at a limited number of sites and did not effect the quality of mental health care. Mason Turner is assistant director of regional mental health for Kaiser Permanente Northern California. He says the agency has been working hard to correct problems since it received a draft of the report last August.\u003c/p>\n\u003cp>\"We have hired more staff,\" he said. \"We have provided more appointments for our patients, and we're very committed to correcting these issues and providing the highest quality of care that we possibly can.\"\u003c/p>\n\u003cp>Kaiser also issued a \u003ca href=\"http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bhplanresponse031813.pdf\" target=\"_blank\">complete response\u003c/a> to all its members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Department of Managed Health Care's enforcement office is now evaluating options for penalties, including fines.\u003c/p>\n\n",
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"excerpt": "Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a recent report by the Department of Managed Health Care.\r\n\r\nThe report says Kaiser's mental health services are deficient in key areas.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.kqed.org/radio/about/staff/mina-kim.jsp\" target=\"_blank\">Mina Kim\u003c/a>, KQED\u003c/p>\n\u003cfigure id=\"attachment_21359\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-e1410283672646.jpg\">\u003cimg class=\"size-medium wp-image-21359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-300x183.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"183\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a \u003ca href=\"http://nuhw.squarespace.com/storage/docs/kaiser-docs/DMHC-FinalReportKaiserMentalHlthSvces3-18-13.pdf\" target=\"_blank\">recent report\u003c/a> by the Department of Managed Health Care.\u003c/p>\n\u003cp>The report says Kaiser's mental health services are deficient in key areas.\u003c/p>\n\u003cp>State regulators found insufficient staffing at some clinics across the state -- with patients waiting longer than the legal limit of 10 days for appointments. The report also says some patients were being misled due to inaccurate information about Kaiser's mental health services. Regulators also found that at Northern California facilities staff members were not accurately tracking and reporting how long patients had to wait to get initial appointments or follow ups.\u003c!--more-->\u003c/p>\n\u003cp>Shelly Rouillard, chief deputy director at the department, says the agency will be taking the unusual step of conducting a follow-up survey in six months rather than the normal 18 months.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"These are significant deficiencies, and we're concerned that consumers aren't getting the care that they need when they need it,\" she said \"and particularly when they are in distress.\"\u003c/p>\n\u003cp>Kaiser employees affiliated with the National Union of Healthcare Workers are calling the report a vindication of concerns they laid out in 2011. Clement Papazian is a social worker with Kaiser Oakland and a chapter officer for the union that represents more than 2000 clinicians and psychologists. Papazian says delays have been hard on patients.\u003c/p>\n\u003cp>\"Some of them will drop out of care,\" he described. \"Some of them will seek medication only -- or the services that are available to them: group services.\"\u003c/p>\n\u003cp>But Kaiser Permanente officials say the problems occurred at a limited number of sites and did not effect the quality of mental health care. Mason Turner is assistant director of regional mental health for Kaiser Permanente Northern California. He says the agency has been working hard to correct problems since it received a draft of the report last August.\u003c/p>\n\u003cp>\"We have hired more staff,\" he said. \"We have provided more appointments for our patients, and we're very committed to correcting these issues and providing the highest quality of care that we possibly can.\"\u003c/p>\n\u003cp>Kaiser also issued a \u003ca href=\"http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bhplanresponse031813.pdf\" target=\"_blank\">complete response\u003c/a> to all its members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Department of Managed Health Care's enforcement office is now evaluating options for penalties, including fines.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hospital Ratings Are In The Eye Of The Beholder",
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"content": "\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/18/expanding-number-of-groups-offer-hospital-ratings.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11485\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/hospital-ratings-are-in-the-eye-of-the-beholder/ratings-300_khn/\" rel=\"attachment wp-att-11485\">\u003cimg class=\"size-full wp-image-11485\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Ratings-300_KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\u003c/p>\n\u003cp>The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\u003c/p>\n\u003cp>But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/21/medicare-hospitals-value-based-purchasing.aspx\" target=\"_blank\">rewarding hospitals\u003c/a> for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\u003c/p>\n\u003cp>Is your head spinning yet?\u003c/p>\n\u003caside class=\"pullquote alignleft\">As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals won at least one distinction from a major rating group or company.\u003c/aside>\n\u003cp>Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as \"\u003ca href=\"http://health.usnews.com/best-hospitals\" target=\"_blank\">Best Hospitals Honor Roll\u003c/a>,\" \"\u003ca href=\"http://www.healthgrades.com/quality/top-hospitals-2013\" target=\"_blank\">America's Best Hospitals\u003c/a>\" and \"\u003ca href=\"http://www.100tophospitals.com/\" target=\"_blank\">100 Top Hospitals\u003c/a>.\" Some states have created their own report cards. In California there are more than a dozen organizations offering assessments on hospital quality.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers.\u003c!--more-->\u003c/p>\n\u003cp>\"We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,\" said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.\u003c/p>\n\u003cp>And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Pages/APCountySanFrancisco.aspx\" target=\"_blank\">California public health officials\u003c/a> have fined it $425,000 repeatedly for endangering patients.\u003c/p>\n\u003cp>As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals — more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.\u003c/p>\n\u003cp>\"I worry a lot about these ratings,\" said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. \"They're all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.\"\u003c/p>\n\u003cp>\u003cstrong>Not A 'Complete Picture Of The Care'\u003c/strong>\u003c/p>\n\u003cp>There are so many report cards on hospitals that the Informed Patient Institute \u003ca href=\"http://www.informedpatientinstitute.org/index.html\" target=\"_blank\">runs a website\u003c/a> that grades the raters. Carol Cronin, its executive director, said most report cards are not easy for consumers to use. \"A lot of them don’t help users quickly understand which hospital is better than another,\" she said.\u003c/p>\n\u003cp>But many hospitals are eager to trump these distinctions in their marketing. Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. \"A hospital cannot buy an award, they must achieve it,\" Healthgrades said in a statement.\u003c/p>\n\u003cp>Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. \"Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don't do that,\" he said. \"U.S. News is in the $50,000 range. Leapfrog is $12,500.\"\u003c/p>\n\u003cp>Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. (Others generally provide free access to ratings on their sites.) The Joint Commission does not charge hospitals that make its top quality list.\u003c/p>\n\u003cp>The calculations that go into these ratings are complex. Most hospital assessments synthesize dozens of pieces of data Medicare publishes on its \u003ca href=\"http://www.medicare.gov/hospitalcompare/\" target=\"_blank\">Hospital Compare website\u003c/a>, including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.\u003c/p>\n\u003cp>Here's a snapshot of what different ratings measure:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.jointcommission.org/accreditation/top_performers.aspx\" target=\"_blank\">The Joint Commission\u003c/a> looks at how frequently patients received recommended treatments, such as flu shots for those with pneumonia.\u003c/li>\n\u003cli>Consumer Reports examines the numbers of patients who die or are readmitted, infection rates and Medicare patient surveys of their experiences.\u003c/li>\n\u003cli>Leapfrog looks at data from its surveys of hospitals, the consistency with which hospitals followed safe surgical practices and frequencies of infections and some types of patient harm.\u003c/li>\n\u003cli>Healthgrades analyzes detailed Medicare records to find death and complication rates for 27 procedures and conditions.\u003c/li>\n\u003cli>Truven considers profitability along with quality in its assessments.\u003c/li>\n\u003cli>U.S. News surveys physicians about which places they think are the best, and those reputation ratings account for a third of most of its assessments. U.S. News ranks hospitals by geography and singles out hospitals that do well in 16 specialties, including cancer, neurology and orthopedics.\u003c/li>\n\u003c/ul>\n\u003cp>\"Ratings and ranking programs certainly offer people information they can use to make their hospital selections, but we don’t recommend relying on any one of them completely,\" Jennifer Kennedy, a spokeswoman for St. Mary Mercy, said in an e-mail. \"None are able to tell the whole story or paint a complete picture of the care that is delivered.\"\u003c/p>\n\u003cp>Patient safety rankings are based on how frequently correct procedures or errors occur, so hospitals can get good grades even if they have made some egregious errors. \u003ca href=\"http://leapfrog-hss.web01.atlasworks.com/hospital-details?location_id=298\" target=\"_blank\">Leapfrog gave\u003c/a> a \"B\" to UCSF Medical Center in San Francisco even though California regulators have penalized UCSF eight times for infractions since 2008, most recently for \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-V65C11-SanFran.pdf\" target=\"_blank\">leaving a sponge\u003c/a> in one patient and a \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-CW9Y11-SanFran.pdf\" target=\"_blank\">plastic clip in the skull\u003c/a> of another. Those errors cost UCSF $200,000 in fines.\u003c/p>\n\u003cp>Dr. Josh Adler, the chief medical officer at UCSF, said penalties were partly a result of the hospital's policy to make sure that all errors are reported to authorities. \"The key is that we constantly strive to deliver the highest quality, safest, and most satisfying care, and that we are a learning organization,\" he said in an e-mail.\u003c/p>\n\u003cp>The ratings groups believe the public benefits from the multitude of ratings. Dr. John Santa, who directs Consumer Reports' health ratings, said consumers benefit from different vantages just as they do for cars or electronic devices, and the competition spurs each rating group to get better. \"We think that’s consistent with good science,\" Santa said.\u003c/p>\n\u003cp>\u003cstrong>Constant Turnover\u003c/strong>\u003c/p>\n\u003cp>Much of the quality data is rudimentary, as the science of evaluating hospitals is still in its adolescence. Adding to the confusion is that hospitals can rise and fall from year to year as groups tweak their methods of assessment and as hospital performance shifts, even slightly.\u003c/p>\n\u003cp>In some cases, hospitals that have won awards are being penalized financially by Medicare for falling short on the government's quality assessment. Saint Francis Hospital in Tulsa, Okla., which is losing 0.54 percent of its Medicare payments this year under the government's quality program, is a Healthgrades Distinguished Hospital for Clinical Excellence and was ranked the second best hospital in Oklahoma by U.S. News.\u003c/p>\n\u003cp>Some of the hospitals that do the best in the rankings have limited respect for them. Advocate Christ Medical Center in Oak Lawn, Ill., last year received praise from Leapfrog, U.S. News, the Joint Commission, Truven and Healthgrades. But Dr. William Adair, vice president for clinical transformation, says the hospital doesn't license any of the distinctions. \"We're all made a little bit uneasy, to be frank about it,\" Adair says. \"Some of these organizations are looking for revenue. It blurs the effectiveness of the ratings processes.\"\u003c/p>\n\u003cp>Still, many hospitals are happy to use the praise. Dr. Brotman from NYU said: \"Even though there's not a hospital executive who won't tell you that they have a great deal of skepticism about a lot of the methodology, there’s not one who will tell you they don't want to be on the lists.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\r\n\r\nThe Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\r\n\r\nBut the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\r\n\r\nIs your head spinning yet?",
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"description": "How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\r\n\r\nThe Leapfrog Group, a respected nonprofit that promotes patient safety, gave an "A" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\r\n\r\nBut the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\r\n\r\nIs your head spinning yet?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/18/expanding-number-of-groups-offer-hospital-ratings.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11485\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/hospital-ratings-are-in-the-eye-of-the-beholder/ratings-300_khn/\" rel=\"attachment wp-att-11485\">\u003cimg class=\"size-full wp-image-11485\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Ratings-300_KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\u003c/p>\n\u003cp>The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\u003c/p>\n\u003cp>But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/21/medicare-hospitals-value-based-purchasing.aspx\" target=\"_blank\">rewarding hospitals\u003c/a> for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\u003c/p>\n\u003cp>Is your head spinning yet?\u003c/p>\n\u003caside class=\"pullquote alignleft\">As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals won at least one distinction from a major rating group or company.\u003c/aside>\n\u003cp>Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as \"\u003ca href=\"http://health.usnews.com/best-hospitals\" target=\"_blank\">Best Hospitals Honor Roll\u003c/a>,\" \"\u003ca href=\"http://www.healthgrades.com/quality/top-hospitals-2013\" target=\"_blank\">America's Best Hospitals\u003c/a>\" and \"\u003ca href=\"http://www.100tophospitals.com/\" target=\"_blank\">100 Top Hospitals\u003c/a>.\" Some states have created their own report cards. In California there are more than a dozen organizations offering assessments on hospital quality.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers.\u003c!--more-->\u003c/p>\n\u003cp>\"We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,\" said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.\u003c/p>\n\u003cp>And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Pages/APCountySanFrancisco.aspx\" target=\"_blank\">California public health officials\u003c/a> have fined it $425,000 repeatedly for endangering patients.\u003c/p>\n\u003cp>As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals — more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.\u003c/p>\n\u003cp>\"I worry a lot about these ratings,\" said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. \"They're all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.\"\u003c/p>\n\u003cp>\u003cstrong>Not A 'Complete Picture Of The Care'\u003c/strong>\u003c/p>\n\u003cp>There are so many report cards on hospitals that the Informed Patient Institute \u003ca href=\"http://www.informedpatientinstitute.org/index.html\" target=\"_blank\">runs a website\u003c/a> that grades the raters. Carol Cronin, its executive director, said most report cards are not easy for consumers to use. \"A lot of them don’t help users quickly understand which hospital is better than another,\" she said.\u003c/p>\n\u003cp>But many hospitals are eager to trump these distinctions in their marketing. Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. \"A hospital cannot buy an award, they must achieve it,\" Healthgrades said in a statement.\u003c/p>\n\u003cp>Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. \"Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don't do that,\" he said. \"U.S. News is in the $50,000 range. Leapfrog is $12,500.\"\u003c/p>\n\u003cp>Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. (Others generally provide free access to ratings on their sites.) The Joint Commission does not charge hospitals that make its top quality list.\u003c/p>\n\u003cp>The calculations that go into these ratings are complex. Most hospital assessments synthesize dozens of pieces of data Medicare publishes on its \u003ca href=\"http://www.medicare.gov/hospitalcompare/\" target=\"_blank\">Hospital Compare website\u003c/a>, including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.\u003c/p>\n\u003cp>Here's a snapshot of what different ratings measure:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.jointcommission.org/accreditation/top_performers.aspx\" target=\"_blank\">The Joint Commission\u003c/a> looks at how frequently patients received recommended treatments, such as flu shots for those with pneumonia.\u003c/li>\n\u003cli>Consumer Reports examines the numbers of patients who die or are readmitted, infection rates and Medicare patient surveys of their experiences.\u003c/li>\n\u003cli>Leapfrog looks at data from its surveys of hospitals, the consistency with which hospitals followed safe surgical practices and frequencies of infections and some types of patient harm.\u003c/li>\n\u003cli>Healthgrades analyzes detailed Medicare records to find death and complication rates for 27 procedures and conditions.\u003c/li>\n\u003cli>Truven considers profitability along with quality in its assessments.\u003c/li>\n\u003cli>U.S. News surveys physicians about which places they think are the best, and those reputation ratings account for a third of most of its assessments. U.S. News ranks hospitals by geography and singles out hospitals that do well in 16 specialties, including cancer, neurology and orthopedics.\u003c/li>\n\u003c/ul>\n\u003cp>\"Ratings and ranking programs certainly offer people information they can use to make their hospital selections, but we don’t recommend relying on any one of them completely,\" Jennifer Kennedy, a spokeswoman for St. Mary Mercy, said in an e-mail. \"None are able to tell the whole story or paint a complete picture of the care that is delivered.\"\u003c/p>\n\u003cp>Patient safety rankings are based on how frequently correct procedures or errors occur, so hospitals can get good grades even if they have made some egregious errors. \u003ca href=\"http://leapfrog-hss.web01.atlasworks.com/hospital-details?location_id=298\" target=\"_blank\">Leapfrog gave\u003c/a> a \"B\" to UCSF Medical Center in San Francisco even though California regulators have penalized UCSF eight times for infractions since 2008, most recently for \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-V65C11-SanFran.pdf\" target=\"_blank\">leaving a sponge\u003c/a> in one patient and a \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-CW9Y11-SanFran.pdf\" target=\"_blank\">plastic clip in the skull\u003c/a> of another. Those errors cost UCSF $200,000 in fines.\u003c/p>\n\u003cp>Dr. Josh Adler, the chief medical officer at UCSF, said penalties were partly a result of the hospital's policy to make sure that all errors are reported to authorities. \"The key is that we constantly strive to deliver the highest quality, safest, and most satisfying care, and that we are a learning organization,\" he said in an e-mail.\u003c/p>\n\u003cp>The ratings groups believe the public benefits from the multitude of ratings. Dr. John Santa, who directs Consumer Reports' health ratings, said consumers benefit from different vantages just as they do for cars or electronic devices, and the competition spurs each rating group to get better. \"We think that’s consistent with good science,\" Santa said.\u003c/p>\n\u003cp>\u003cstrong>Constant Turnover\u003c/strong>\u003c/p>\n\u003cp>Much of the quality data is rudimentary, as the science of evaluating hospitals is still in its adolescence. Adding to the confusion is that hospitals can rise and fall from year to year as groups tweak their methods of assessment and as hospital performance shifts, even slightly.\u003c/p>\n\u003cp>In some cases, hospitals that have won awards are being penalized financially by Medicare for falling short on the government's quality assessment. Saint Francis Hospital in Tulsa, Okla., which is losing 0.54 percent of its Medicare payments this year under the government's quality program, is a Healthgrades Distinguished Hospital for Clinical Excellence and was ranked the second best hospital in Oklahoma by U.S. News.\u003c/p>\n\u003cp>Some of the hospitals that do the best in the rankings have limited respect for them. Advocate Christ Medical Center in Oak Lawn, Ill., last year received praise from Leapfrog, U.S. News, the Joint Commission, Truven and Healthgrades. But Dr. William Adair, vice president for clinical transformation, says the hospital doesn't license any of the distinctions. \"We're all made a little bit uneasy, to be frank about it,\" Adair says. \"Some of these organizations are looking for revenue. It blurs the effectiveness of the ratings processes.\"\u003c/p>\n\u003cp>Still, many hospitals are happy to use the praise. Dr. Brotman from NYU said: \"Even though there's not a hospital executive who won't tell you that they have a great deal of skepticism about a lot of the methodology, there’s not one who will tell you they don't want to be on the lists.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Diego Emergency Departments Consider New Guidelines to Crack Down on Painkiller Abuse",
"title": "San Diego Emergency Departments Consider New Guidelines to Crack Down on Painkiller Abuse",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By Kenny Goldberg, \u003ca href=\"http://www.kpbs.org/news/2013/mar/05/san-diego-emergency-departments-crack-down-painkil/\" target=\"_blank\">KPBS\u003c/a>\u003c/p>\n\u003cp>More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to \u003ca href=\"http://wiki.answers.com/Q/List_of_prescription_pain_killers_by_trade_names\">prescription painkillers\u003c/a> like Oxycontin and Percocet.\u003c/p>\n\u003cp>Hospital emergency departments in San Diego are now reevaluating their role in dispensing these medications.\u003c/p>\n\u003cp>Bobby Stevens, not his real name, first started popping Oxycontin when he was in high school in northern San Diego county. His classmates used to hand it out at parties.\u003c/p>\n\u003cp>Stevens soon became hooked. At the height of his addiction, he was taking up to 20 Oxycontin pills a day, plus the anti-anxiety drug Xanax and the amphetamine Adderall. He was spending $1500 a week on his habit.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Stevens used to get his a lot of his drugs from hospital emergency rooms. He had a few standard lies he would tell the doctors.\u003c/p>\n\u003cp>\"That I either had lower back pain, or I did something to my knee, running,\" Stevens recalls. \"It pretty much was the same story every time. I would go to different doctors, I wouldn’t go to the same ER. So I could pretty much use the same story.\"\u003c/p>\n\u003cp>Most of the time, ER doctors would give Stevens a prescription for at least a month’s worth of pills. He said he didn't have to do much acting.\u003c/p>\n\u003cp>\"I would just explain the pain I had. But they were so busy, it seemed that they took you for your word, and wrote you the prescription,\" Stevens said. \"I mean I didn’t have to do x-rays, I didn’t have to do an MRI, or any of that type of stuff. They just asked what I was there for, and they wrote me the scrip.\"\u003c/p>\n\u003cp>Sales of prescriptions opiates have skyrocketed in recent years. So have \u003ca href=\"http://www.kpbs.org/news/2011/dec/15/prescription-drugs-san-diegos-leading-cause-accide/\">drug-related deaths\u003c/a>.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/homeandrecreationalsafety/rxbrief/\">Centers for Disease Control\u003c/a> says hospital emergency departments are the biggest source of these drugs.\u003c/p>\n\u003cp>Dr. Kevin Kelly, director of the ED at La Mesa’s Alvarado Hospital, said many patients are asking for them.\u003c/p>\n\u003cp>\"I think all the emergency departments are experiencing an incredible influx of opiate requests, and opiate-related emergencies,\" he explained.\u003c/p>\n\u003cp>Dr. Kelly said physicians can’t always tell when someone is really in pain -- or just faking it.\u003c/p>\n\u003cp>\"Our goal, first of all, is we want to help,\" Kelly explained. \"So, each case we look at and we say, 'How can I help this person?' and then second, we really want to do no harm. And that’s where a lot of narcotic issues come up; there’s a lot of harm related to the use and misuse of these medications.\"\u003c/p>\n\u003cp>The emergency department at \u003ca href=\"http://www.scripps.org/locations/hospitals__scripps-mercy-hospital\">Scripps Mercy Hospital\u003c/a> in Hillcrest is one of San Diego’s busiest. More than 57,000 patients were treated there last year.\u003c/p>\n\u003cp>Scripps' \u003ca href=\"http://www.scripps.org/physicians/4598-roneet-lev-md\">Dr. Roneet Lev\u003c/a> said these days, about one out of five patients in her ED are taking narcotics.\u003c/p>\n\u003cp>\"When you talk about cocaine or heroin, you talk about the drug lords in Columbia,\" Dr. Lev said. \"But prescription drug abuse and deaths usually are given by well-intentioned, well-meaning physicians, and we need to kind of change the way we practice and get a hold of this epidemic.\"\u003c/p>\n\u003cp>To that end, Dr. Lev is leading an effort to change the way local emergency departments dispense painkillers. With the help of some other ED doctors in San Diego, Lev has come up with a set of guidelines.\u003c/p>\n\u003cp>Under the new rules, people who come to the ED for chronic pain will be directed to visit their primary care doctor.\u003c/p>\n\u003cp>\"Someone who has pain for more than three months, or needs any long-acting pain medications that last in the body for a long time, those are the people who need to get all there prescriptions coordinated by one prescriber and one pharmacy,\" Dr. Lev explained.\u003c/p>\n\u003cp>These changes will not affect people with acute or sudden pain, from say a broken arm or a kidney stone. The new guidelines will only apply to those complaining of chronic pain.\u003c/p>\n\u003cp>\"That’s the population at risk, who die unintentionally,\" Dr. Lev said. \"They don’t know that they’re taking all these medicines from different providers, different prescribers. They got something from the ER, something from the psychiatrist, something from the primary care doctor. And people die from that. That’s what we want to get a grasp on and prevent.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthgrades.com/physician/dr-michele-lamantia-2q2cd\">Dr. Michele Lamantia\u003c/a> directs the chronic pain program at the \u003ca href=\"http://www.syhc.org/\">San Ysidro Health Center\u003c/a>, a network of community clinics in southern San Diego County.\u003c/p>\n\u003cp>She said there are some non-narcotic prescription drugs that are quite effective for chronic pain. Lamantia thinks doctors who prescribe narcotic painkillers need to be more careful.\u003c/p>\n\u003cp>“I think sometimes we feel it’s only a percent of people who might have a problem with the drugs and that we as physicians are going to easily be able to pick them up. But that’s really not the case,\" she said.\u003c/p>\n\u003cp>All hospitals in San Diego and Imperial County have tentatively agreed to the new narcotic guidelines. They could be rolled out sometime this spring.\u003c/p>\n\u003cp>After eight years of abusing narcotics, Bobby Stevens has finally quit. He’s been in recovery now for four months.\u003c/p>\n\u003cp>Stevens says he wishes those emergency room guidelines had been in place back when he got hooked on painkillers.\u003c/p>\n\u003cp>\"I don’t personally feel like I would be where I’m at today, if they weren’t so easily available,\" Stevens lamented.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In 2010, more than 16,000 Americans died from an \u003ca href=\"http://abcnews.go.com/Health/Drugs/drug-deaths-exceed-traffic-deaths/story?id=14554903\">overdose of prescription narcotics\u003c/a>.\u003c/p>\n\n",
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"excerpt": "More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to prescription painkillers like Oxycontin and Percocet.\r\n\r\nHospital emergency departments in San Diego are now reevaluating their role in dispensing these medications.\r\n\r\nBobby Stevens, not his real name, first started popping Oxycontin when he was in high school in northern San Diego county. His classmates used to hand it out at parties.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Kenny Goldberg, \u003ca href=\"http://www.kpbs.org/news/2013/mar/05/san-diego-emergency-departments-crack-down-painkil/\" target=\"_blank\">KPBS\u003c/a>\u003c/p>\n\u003cp>More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to \u003ca href=\"http://wiki.answers.com/Q/List_of_prescription_pain_killers_by_trade_names\">prescription painkillers\u003c/a> like Oxycontin and Percocet.\u003c/p>\n\u003cp>Hospital emergency departments in San Diego are now reevaluating their role in dispensing these medications.\u003c/p>\n\u003cp>Bobby Stevens, not his real name, first started popping Oxycontin when he was in high school in northern San Diego county. His classmates used to hand it out at parties.\u003c/p>\n\u003cp>Stevens soon became hooked. At the height of his addiction, he was taking up to 20 Oxycontin pills a day, plus the anti-anxiety drug Xanax and the amphetamine Adderall. He was spending $1500 a week on his habit.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Stevens used to get his a lot of his drugs from hospital emergency rooms. He had a few standard lies he would tell the doctors.\u003c/p>\n\u003cp>\"That I either had lower back pain, or I did something to my knee, running,\" Stevens recalls. \"It pretty much was the same story every time. I would go to different doctors, I wouldn’t go to the same ER. So I could pretty much use the same story.\"\u003c/p>\n\u003cp>Most of the time, ER doctors would give Stevens a prescription for at least a month’s worth of pills. He said he didn't have to do much acting.\u003c/p>\n\u003cp>\"I would just explain the pain I had. But they were so busy, it seemed that they took you for your word, and wrote you the prescription,\" Stevens said. \"I mean I didn’t have to do x-rays, I didn’t have to do an MRI, or any of that type of stuff. They just asked what I was there for, and they wrote me the scrip.\"\u003c/p>\n\u003cp>Sales of prescriptions opiates have skyrocketed in recent years. So have \u003ca href=\"http://www.kpbs.org/news/2011/dec/15/prescription-drugs-san-diegos-leading-cause-accide/\">drug-related deaths\u003c/a>.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/homeandrecreationalsafety/rxbrief/\">Centers for Disease Control\u003c/a> says hospital emergency departments are the biggest source of these drugs.\u003c/p>\n\u003cp>Dr. Kevin Kelly, director of the ED at La Mesa’s Alvarado Hospital, said many patients are asking for them.\u003c/p>\n\u003cp>\"I think all the emergency departments are experiencing an incredible influx of opiate requests, and opiate-related emergencies,\" he explained.\u003c/p>\n\u003cp>Dr. Kelly said physicians can’t always tell when someone is really in pain -- or just faking it.\u003c/p>\n\u003cp>\"Our goal, first of all, is we want to help,\" Kelly explained. \"So, each case we look at and we say, 'How can I help this person?' and then second, we really want to do no harm. And that’s where a lot of narcotic issues come up; there’s a lot of harm related to the use and misuse of these medications.\"\u003c/p>\n\u003cp>The emergency department at \u003ca href=\"http://www.scripps.org/locations/hospitals__scripps-mercy-hospital\">Scripps Mercy Hospital\u003c/a> in Hillcrest is one of San Diego’s busiest. More than 57,000 patients were treated there last year.\u003c/p>\n\u003cp>Scripps' \u003ca href=\"http://www.scripps.org/physicians/4598-roneet-lev-md\">Dr. Roneet Lev\u003c/a> said these days, about one out of five patients in her ED are taking narcotics.\u003c/p>\n\u003cp>\"When you talk about cocaine or heroin, you talk about the drug lords in Columbia,\" Dr. Lev said. \"But prescription drug abuse and deaths usually are given by well-intentioned, well-meaning physicians, and we need to kind of change the way we practice and get a hold of this epidemic.\"\u003c/p>\n\u003cp>To that end, Dr. Lev is leading an effort to change the way local emergency departments dispense painkillers. With the help of some other ED doctors in San Diego, Lev has come up with a set of guidelines.\u003c/p>\n\u003cp>Under the new rules, people who come to the ED for chronic pain will be directed to visit their primary care doctor.\u003c/p>\n\u003cp>\"Someone who has pain for more than three months, or needs any long-acting pain medications that last in the body for a long time, those are the people who need to get all there prescriptions coordinated by one prescriber and one pharmacy,\" Dr. Lev explained.\u003c/p>\n\u003cp>These changes will not affect people with acute or sudden pain, from say a broken arm or a kidney stone. The new guidelines will only apply to those complaining of chronic pain.\u003c/p>\n\u003cp>\"That’s the population at risk, who die unintentionally,\" Dr. Lev said. \"They don’t know that they’re taking all these medicines from different providers, different prescribers. They got something from the ER, something from the psychiatrist, something from the primary care doctor. And people die from that. That’s what we want to get a grasp on and prevent.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthgrades.com/physician/dr-michele-lamantia-2q2cd\">Dr. Michele Lamantia\u003c/a> directs the chronic pain program at the \u003ca href=\"http://www.syhc.org/\">San Ysidro Health Center\u003c/a>, a network of community clinics in southern San Diego County.\u003c/p>\n\u003cp>She said there are some non-narcotic prescription drugs that are quite effective for chronic pain. Lamantia thinks doctors who prescribe narcotic painkillers need to be more careful.\u003c/p>\n\u003cp>“I think sometimes we feel it’s only a percent of people who might have a problem with the drugs and that we as physicians are going to easily be able to pick them up. But that’s really not the case,\" she said.\u003c/p>\n\u003cp>All hospitals in San Diego and Imperial County have tentatively agreed to the new narcotic guidelines. They could be rolled out sometime this spring.\u003c/p>\n\u003cp>After eight years of abusing narcotics, Bobby Stevens has finally quit. He’s been in recovery now for four months.\u003c/p>\n\u003cp>Stevens says he wishes those emergency room guidelines had been in place back when he got hooked on painkillers.\u003c/p>\n\u003cp>\"I don’t personally feel like I would be where I’m at today, if they weren’t so easily available,\" Stevens lamented.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In 2010, more than 16,000 Americans died from an \u003ca href=\"http://abcnews.go.com/Health/Drugs/drug-deaths-exceed-traffic-deaths/story?id=14554903\">overdose of prescription narcotics\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What Will California's Health Benefit Exchange Application Look Like?",
"title": "What Will California's Health Benefit Exchange Application Look Like?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/15/what-will-californias-health-benefit-exchange-application-look-like/draft/\" rel=\"attachment wp-att-11419\">\u003cimg class=\"alignleft size-medium wp-image-11419\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Draft-300x260.jpg\" alt=\"Draft\" width=\"300\" height=\"260\">\u003c/a>Immediately following the Supreme Court's decision on the Affordable Care Act, the head of California's Health Benefit Exchange \u003ca href=\"http://www.sfgate.com/health/article/Health-care-exchange-will-offer-policies-3675063.php\">laid out his vision\u003c/a> for revolutionizing the health insurance market.\u003c/p>\n\u003cp>\"We know buying insurance is really complicated. We want to make it as easy as buying a book on Amazon,\" said Peter Lee, executive director of the \u003ca href=\"http://www.healthexchange.ca.gov/Pages/Default.aspx\" target=\"_blank\">California Health Benefit Exchange\u003c/a>.\u003c/p>\n\u003cp>But as the state has worked to create the actual application for health insurance, the idea of a one-click purchase is far from the reality.\u003c/p>\n\u003cp>“This is a brand new law and it’s complicated,” says Sam Karp, vice president of programs at the California HealthCare Foundation (CHCF). “It’s reasonable to expect the implementation will take not just a year. It will take a few years.”\u003c!--more-->\u003c/p>\n\u003cp>Karp says CHCF has been working on modernizing enrollment in health and social service programs for the last 15 years. Recently they partnered with others to create a model, called UX2014, that can be used as a standard for online health insurance enrollment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The contract for California’s application was awarded to \u003ca href=\"http://newsroom.accenture.com/news/accenture-chosen-to-implement-california-health-insurance-exchange.htm\" target=\"_blank\">Accenture\u003c/a> last summer. While a draft of the federal application was just released, stakeholders have yet to see a version of California’s application, which, like the federal model is being based on the \u003ca href=\"http://www.ux2014.org/\" target=\"_blank\">UX2014\u003c/a> work.\u003c/p>\n\u003cp>The new federal draft application is 15 pages long for a 3-person family. A single applicant is only required to fill out 6 pages. Meanwhile a YouTube video shows what to expect from the online federal version:\u003c/p>\n\u003cp>\u003ciframe src=\"http://www.youtube.com/embed/BB1QOUoYFQQ\" frameborder=\"0\" width=\"420\" height=\"315\">\u003c/iframe>\u003c/p>\n\u003cp>Karp says after early promises that this would be like buying an airline ticket online, it’s important to set the right expectations.\u003c/p>\n\u003cp>“The law says we should have a consumer friendly process ... it should be better than what people are experiencing today and we should go to lots of lengths to make it easier for people,” Karp says.\u003c/p>\n\u003cp>The law requires the application be available online, in person, by mail or by telephone.\u003c/p>\n\u003cp>Karp says he has a few concerns about California's process so far.\u003c/p>\n\u003cp>\"I’m concerned the premiums will be high and people will have sticker shock,\" says Karp. And he says unlike the federal system which will be a streamlined workflow, California will be integrating its application with some county websites and program.\u003c/p>\n\u003cp>\"Service may not be as smooth as it could be because of this hand off to counties,\" says Karp.\u003c/p>\n\u003cp>Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty, says she has been involved in some of the recent talks about the application flow. She says there are some aspects of the proposed California application she applauds.\u003c/p>\n\u003cp>\"If you’ve gone through this whole process of applying for health benefits,\" she says, \"you can have the information transferred to get other public benefits too – including CalWorks and Cal Fresh [food stamps].\"\u003c/p>\n\u003cp>But she says she'll be keeping an eye on certain aspects of its development.\u003c/p>\n\u003cp>“The income is going to be especially tricky for people. People have different ideas about this. Certain income counts and certain other things don’t,” says Landsberg. “I think very few of us know what our adjusted gross income is. So there is going to have to be a lot of help and guidance to define these terms and give accurate information.”\u003c/p>\n\u003cp>Landsberg says she also thinks the proposed application organization requires a social security number too soon.\u003c/p>\n\u003cp>“We have a lot of families with mixed immigration status,” Landsberg says. “We may have a parent without a social security number applying for child who does have a social security number… You can’t require a non-applicant to give a social security and it might dissuade someone from moving forward.”\u003c/p>\n\u003cp>Landsberg says a draft of the California application is expected in April, to allow group testing in the spring and summer.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The application is due to go live online in October.\u003c/p>\n\n",
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"excerpt": "Immediately following the Supreme Court's decision on the Affordable Care Act, the head of California's Health Benefit Exchange laid out his vision for revolutionizing the health insurance market.\r\n\r\n\"We know buying insurance is really complicated. We want to make it as easy as buying a book on Amazon,\" said Peter Lee, executive director of the California Health Benefit Exchange.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/15/what-will-californias-health-benefit-exchange-application-look-like/draft/\" rel=\"attachment wp-att-11419\">\u003cimg class=\"alignleft size-medium wp-image-11419\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Draft-300x260.jpg\" alt=\"Draft\" width=\"300\" height=\"260\">\u003c/a>Immediately following the Supreme Court's decision on the Affordable Care Act, the head of California's Health Benefit Exchange \u003ca href=\"http://www.sfgate.com/health/article/Health-care-exchange-will-offer-policies-3675063.php\">laid out his vision\u003c/a> for revolutionizing the health insurance market.\u003c/p>\n\u003cp>\"We know buying insurance is really complicated. We want to make it as easy as buying a book on Amazon,\" said Peter Lee, executive director of the \u003ca href=\"http://www.healthexchange.ca.gov/Pages/Default.aspx\" target=\"_blank\">California Health Benefit Exchange\u003c/a>.\u003c/p>\n\u003cp>But as the state has worked to create the actual application for health insurance, the idea of a one-click purchase is far from the reality.\u003c/p>\n\u003cp>“This is a brand new law and it’s complicated,” says Sam Karp, vice president of programs at the California HealthCare Foundation (CHCF). “It’s reasonable to expect the implementation will take not just a year. It will take a few years.”\u003c!--more-->\u003c/p>\n\u003cp>Karp says CHCF has been working on modernizing enrollment in health and social service programs for the last 15 years. Recently they partnered with others to create a model, called UX2014, that can be used as a standard for online health insurance enrollment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The contract for California’s application was awarded to \u003ca href=\"http://newsroom.accenture.com/news/accenture-chosen-to-implement-california-health-insurance-exchange.htm\" target=\"_blank\">Accenture\u003c/a> last summer. While a draft of the federal application was just released, stakeholders have yet to see a version of California’s application, which, like the federal model is being based on the \u003ca href=\"http://www.ux2014.org/\" target=\"_blank\">UX2014\u003c/a> work.\u003c/p>\n\u003cp>The new federal draft application is 15 pages long for a 3-person family. A single applicant is only required to fill out 6 pages. Meanwhile a YouTube video shows what to expect from the online federal version:\u003c/p>\n\u003cp>\u003ciframe src=\"http://www.youtube.com/embed/BB1QOUoYFQQ\" frameborder=\"0\" width=\"420\" height=\"315\">\u003c/iframe>\u003c/p>\n\u003cp>Karp says after early promises that this would be like buying an airline ticket online, it’s important to set the right expectations.\u003c/p>\n\u003cp>“The law says we should have a consumer friendly process ... it should be better than what people are experiencing today and we should go to lots of lengths to make it easier for people,” Karp says.\u003c/p>\n\u003cp>The law requires the application be available online, in person, by mail or by telephone.\u003c/p>\n\u003cp>Karp says he has a few concerns about California's process so far.\u003c/p>\n\u003cp>\"I’m concerned the premiums will be high and people will have sticker shock,\" says Karp. And he says unlike the federal system which will be a streamlined workflow, California will be integrating its application with some county websites and program.\u003c/p>\n\u003cp>\"Service may not be as smooth as it could be because of this hand off to counties,\" says Karp.\u003c/p>\n\u003cp>Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty, says she has been involved in some of the recent talks about the application flow. She says there are some aspects of the proposed California application she applauds.\u003c/p>\n\u003cp>\"If you’ve gone through this whole process of applying for health benefits,\" she says, \"you can have the information transferred to get other public benefits too – including CalWorks and Cal Fresh [food stamps].\"\u003c/p>\n\u003cp>But she says she'll be keeping an eye on certain aspects of its development.\u003c/p>\n\u003cp>“The income is going to be especially tricky for people. People have different ideas about this. Certain income counts and certain other things don’t,” says Landsberg. “I think very few of us know what our adjusted gross income is. So there is going to have to be a lot of help and guidance to define these terms and give accurate information.”\u003c/p>\n\u003cp>Landsberg says she also thinks the proposed application organization requires a social security number too soon.\u003c/p>\n\u003cp>“We have a lot of families with mixed immigration status,” Landsberg says. “We may have a parent without a social security number applying for child who does have a social security number… You can’t require a non-applicant to give a social security and it might dissuade someone from moving forward.”\u003c/p>\n\u003cp>Landsberg says a draft of the California application is expected in April, to allow group testing in the spring and summer.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The application is due to go live online in October.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones announced the approval of \u003ca href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2013/upload/nr027AutismReg.pdf\" target=\"_blank\">emergency rules\u003c/a> this week, which take effect immediately.\u003c/p>\n\u003cp>“Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities,\" Jones wrote in a statement.\u003c/p>\n\u003cp>Insurers have already been required to comply with medically necessary treatment by the state's Mental Health Parity Law and SB 946, which reinforced the mandate for private insurers to provide behavioral treatment for autism.\u003c/p>\n\u003cp>However Karen Fessel, executive director of the Northern California-based \u003ca href=\"http://www.autismhealthinsurance.org/\" target=\"_blank\">Autism Health Insurance Project\u003c/a>, says these emergency regulations were needed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is an example how even with the right laws in place you still need vigilant regulators who will help interpret the law in ways that they were intended,\" says Fessel \"Because the health plans often twist things around so much people don’t get the care they need even with the laws.\"\u003c!--more-->\u003c/p>\n\u003cp>Fessel says even with the laws her organization heard from many people getting frivolous denials.\u003c/p>\n\u003cp>\"They were denied by insurers saying your child is too low functioning to benefit from the therapy,\" says Fessel. \"And if they were high functioning they’d say 'your child doesn’t need the treatment,'\" even though the child was having behavioral issues in the community.\u003c/p>\n\u003cp>One specific change is banning visit limits or cost limits on coverage unless limits apply equally to all benefits under the policy. Fessel says until now the limits were way too low.\u003c/p>\n\u003cp>\"On average a lot of these policies were limited to 30 sessions a year for speech and occupational therapy,\" Fessel says. \"Whereas what is needed is 2 a week of speech and one a week of occupational therapy.\"\u003c/p>\n\u003cp>One of the other issues addressed by the emergency regulations were consumer complaints about undue delays. Bryna Siegel, retired Professor and Director of the UCSF Autism Clinic, says the new rules are sensitive to the fact that many insurers are requiring patients to get IQ tests before they can get treatment.\u003c/p>\n\u003cp>“I have been getting a large number of calls from parents saying they need intelligence testing to go forward with insurance companies,” says Siegel. Siegel says the insurance companies may be using the results as a way to set expectations for treatment. But she says in this case, “I think it is being thrown up as a barrier, you have to wait to get it done, submitted, looked at.”\u003c/p>\n\u003cp>The president of the Association of California Life and Health Insurance Companies (ACLHIC), Brad Wenger, said in a statement that the organization had been interested in getting clarification on these topics but hoped for a public comment period.\u003c/p>\n\u003cp>\"'Emergency' regulations shortcut the public comment process and deny stakeholders an opportunity to contribute their expertise and viewpoints,\" said Wenger.\u003c/p>\n\u003cp>Wenger added, \"A patient who is denied coverage on the basis of medical necessity, whether it is related to a mental health condition or a medical condition, can appeal that decision to an independent medical review board comprised of independent medical experts whose decisions are binding on insurers.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There is a financial element to the rules as well. This emergency regulation is expected to save California taxpayers approximately $138.8 million to $197.8 million over the next year by shifting some of the costs for the therapy from the state to private insurers.\u003c/p>\n\n",
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"excerpt": "California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.\r\n\r\nInsurance Commissioner Dave Jones announced the approval of emergency rules this week, which take effect immediately.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones announced the approval of \u003ca href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2013/upload/nr027AutismReg.pdf\" target=\"_blank\">emergency rules\u003c/a> this week, which take effect immediately.\u003c/p>\n\u003cp>“Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities,\" Jones wrote in a statement.\u003c/p>\n\u003cp>Insurers have already been required to comply with medically necessary treatment by the state's Mental Health Parity Law and SB 946, which reinforced the mandate for private insurers to provide behavioral treatment for autism.\u003c/p>\n\u003cp>However Karen Fessel, executive director of the Northern California-based \u003ca href=\"http://www.autismhealthinsurance.org/\" target=\"_blank\">Autism Health Insurance Project\u003c/a>, says these emergency regulations were needed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is an example how even with the right laws in place you still need vigilant regulators who will help interpret the law in ways that they were intended,\" says Fessel \"Because the health plans often twist things around so much people don’t get the care they need even with the laws.\"\u003c!--more-->\u003c/p>\n\u003cp>Fessel says even with the laws her organization heard from many people getting frivolous denials.\u003c/p>\n\u003cp>\"They were denied by insurers saying your child is too low functioning to benefit from the therapy,\" says Fessel. \"And if they were high functioning they’d say 'your child doesn’t need the treatment,'\" even though the child was having behavioral issues in the community.\u003c/p>\n\u003cp>One specific change is banning visit limits or cost limits on coverage unless limits apply equally to all benefits under the policy. Fessel says until now the limits were way too low.\u003c/p>\n\u003cp>\"On average a lot of these policies were limited to 30 sessions a year for speech and occupational therapy,\" Fessel says. \"Whereas what is needed is 2 a week of speech and one a week of occupational therapy.\"\u003c/p>\n\u003cp>One of the other issues addressed by the emergency regulations were consumer complaints about undue delays. Bryna Siegel, retired Professor and Director of the UCSF Autism Clinic, says the new rules are sensitive to the fact that many insurers are requiring patients to get IQ tests before they can get treatment.\u003c/p>\n\u003cp>“I have been getting a large number of calls from parents saying they need intelligence testing to go forward with insurance companies,” says Siegel. Siegel says the insurance companies may be using the results as a way to set expectations for treatment. But she says in this case, “I think it is being thrown up as a barrier, you have to wait to get it done, submitted, looked at.”\u003c/p>\n\u003cp>The president of the Association of California Life and Health Insurance Companies (ACLHIC), Brad Wenger, said in a statement that the organization had been interested in getting clarification on these topics but hoped for a public comment period.\u003c/p>\n\u003cp>\"'Emergency' regulations shortcut the public comment process and deny stakeholders an opportunity to contribute their expertise and viewpoints,\" said Wenger.\u003c/p>\n\u003cp>Wenger added, \"A patient who is denied coverage on the basis of medical necessity, whether it is related to a mental health condition or a medical condition, can appeal that decision to an independent medical review board comprised of independent medical experts whose decisions are binding on insurers.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There is a financial element to the rules as well. This emergency regulation is expected to save California taxpayers approximately $138.8 million to $197.8 million over the next year by shifting some of the costs for the therapy from the state to private insurers.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Born Again After Trying To End It All",
"title": "Born Again After Trying To End It All",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>\u003c/strong>By Lauren M. Whaley, CHCF Center for Health Reporting\u003c/p>\n\u003cfigure id=\"attachment_11371\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/14/born-again-after-trying-to-end-it-all/suicide-preventionwhaley/\" rel=\"attachment wp-att-11371\">\u003cimg class=\"size-medium wp-image-11371\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Suicide-PreventionWhaley-300x257.jpg\" alt=\"Hotline information for suicide prevention efforts (Photo: Lauren Whaley)\" width=\"300\" height=\"257\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hotline information for suicide prevention efforts (Photo: Lauren Whaley)\u003c/figcaption>\u003c/figure>\n\u003cp>John survived his suicide attempt.\u003c/p>\n\u003cp>Martina Castillo threatened to take her own life.\u003c/p>\n\u003cp>Both ended up in \u003ca href=\"http://www.suttermedicalcenter.org/\">Sutter General’s Emergency Department\u003c/a> in Sacramento. And both signed up for a unique suicide prevention program that would change their lives.\u003c/p>\n\u003cp>After being discharged from the hospital, each was matched with a suicide prevention specialist from \u003ca href=\"http://www.theeffort.org/suicide_prevention.htm\">WellSpace Health\u003c/a>. The specialist would call each participant every few days for a month just to check in.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A phone call? Sounds kind of simple. Kind of small. Kind of obvious. A number popping up on someone’s cell phone who just left the ER after a suicide attempt.\u003c/p>\n\u003caside class=\"pullquote alignright\">“When they call you, it’s like you’re getting a call from someone who really wants to know how your day is going.”\u003c/aside>\n\u003cp>“They walk away from this Emergency Department Follow Up program with some coping skills, a safe plan, some ideas about how they can take care of themselves, what they can do when they’re feeling this way again because we know that there will be a higher risk,” said Liseanne Wick, Program Manager of Suicide Prevention & Crisis Services at WellSpace Health (until recently called \u003ca href=\"http://www.wellspacehealth.org/pdfs/130219-name-change-rancho-opening.pdf\">The Effort\u003c/a>).\u003c!--more-->\u003c/p>\n\u003cp>And, after speaking with both John and Martina, I heard in them the kind of tone that one hears in religious converts or new mothers. Awe. Even elation.\u003c/p>\n\u003cp>“When they call you, it’s like you’re getting a call from someone who really wants to know how your day is going,” said Martina. “And they’re not going to sit there and talk about themselves, about how hard their day is. They’re listening to you.”\u003c/p>\n\u003cp>You can hear what Martina told me about the time leading up to her suicide attempt and why the calls are so important to her here:\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=http%3A%2F%2Fapi.soundcloud.com%2Ftracks%2F82973934&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>In addition to Martina, those phone calls made a huge difference to John and about 300 others who have been through the program over the past two years.\u003c/p>\n\u003cp>John requested that we use only his first name because of the shame associated with suicide. Martina was nervous about using her last name as well.\u003c/p>\n\u003cp>“It’s a little scary ‘cause [of] how shameful depression is and suicide and mental hospitals and all that. There’s just shame around it and nobody wants to talk about it,” she said. “But, I can’t be ashamed about it anymore. This is who I am. It was a part of me. It is. It’s just who I am.”\u003c/p>\n\u003cp>Another surprise for me. I assumed that program participants would want to spread their good news; that suicide survivors would want to get the word out and help others. I didn’t expect to face barriers similar to those \u003ca href=\"http://centerforhealthreporting.org/blog/what-mental-illness-looks917\">I encountered while photographing and reporting a story on mental illness\u003c/a> and access to care.\u003c/p>\n\u003cp>“Some people are relieved that they’re alive, and others are really not so happy that they survived the attempt,” said WellSpace Health’s Wick. “So we’re there in the midst of all that to provide emotional support, linkages to treatment that’s really needed and to address those mixed feelings of both wanting to be dead and wanting to be alive or being disappointed that the attempt that you made didn’t work and having to deal with the consequences of that.”\u003c/p>\n\u003cp>But, the two people who did agree to talk to me both said they’re happy to be alive, and thank the program for that result.\u003c/p>\n\u003cp>John said suicide prevention specialist Roop Dhillon is “one of those truly wonderful people that you don’t often get to meet in the world.”\u003c/p>\n\u003cp>“Sometimes there’s this one person that can actually make a connection with you to make things alright and that you feel comfortable that what you tell them is just going to stay with them,” said John. “That there’s going to be no judgment. That you can be open and honest ‘cause they’re sincere about their efforts to try to get you into a better place.”\u003c/p>\n\u003cp>\u003cstrong>Listen to the audio:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201303140850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201303140850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "John survived his suicide attempt.\r\n\r\nMartina Castillo threatened to take her own life.\r\n\r\nBoth ended up in Sutter General’s Emergency Department in Sacramento. And both signed up for a unique suicide prevention program that would change their lives.\r\n\r\nAfter being discharged from the hospital, each was matched with a suicide prevention specialist from WellSpace Health. The specialist would call each participant every few days for a month just to check in.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>\u003c/strong>By Lauren M. Whaley, CHCF Center for Health Reporting\u003c/p>\n\u003cfigure id=\"attachment_11371\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/14/born-again-after-trying-to-end-it-all/suicide-preventionwhaley/\" rel=\"attachment wp-att-11371\">\u003cimg class=\"size-medium wp-image-11371\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Suicide-PreventionWhaley-300x257.jpg\" alt=\"Hotline information for suicide prevention efforts (Photo: Lauren Whaley)\" width=\"300\" height=\"257\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hotline information for suicide prevention efforts (Photo: Lauren Whaley)\u003c/figcaption>\u003c/figure>\n\u003cp>John survived his suicide attempt.\u003c/p>\n\u003cp>Martina Castillo threatened to take her own life.\u003c/p>\n\u003cp>Both ended up in \u003ca href=\"http://www.suttermedicalcenter.org/\">Sutter General’s Emergency Department\u003c/a> in Sacramento. And both signed up for a unique suicide prevention program that would change their lives.\u003c/p>\n\u003cp>After being discharged from the hospital, each was matched with a suicide prevention specialist from \u003ca href=\"http://www.theeffort.org/suicide_prevention.htm\">WellSpace Health\u003c/a>. The specialist would call each participant every few days for a month just to check in.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A phone call? Sounds kind of simple. Kind of small. Kind of obvious. A number popping up on someone’s cell phone who just left the ER after a suicide attempt.\u003c/p>\n\u003caside class=\"pullquote alignright\">“When they call you, it’s like you’re getting a call from someone who really wants to know how your day is going.”\u003c/aside>\n\u003cp>“They walk away from this Emergency Department Follow Up program with some coping skills, a safe plan, some ideas about how they can take care of themselves, what they can do when they’re feeling this way again because we know that there will be a higher risk,” said Liseanne Wick, Program Manager of Suicide Prevention & Crisis Services at WellSpace Health (until recently called \u003ca href=\"http://www.wellspacehealth.org/pdfs/130219-name-change-rancho-opening.pdf\">The Effort\u003c/a>).\u003c!--more-->\u003c/p>\n\u003cp>And, after speaking with both John and Martina, I heard in them the kind of tone that one hears in religious converts or new mothers. Awe. Even elation.\u003c/p>\n\u003cp>“When they call you, it’s like you’re getting a call from someone who really wants to know how your day is going,” said Martina. “And they’re not going to sit there and talk about themselves, about how hard their day is. They’re listening to you.”\u003c/p>\n\u003cp>You can hear what Martina told me about the time leading up to her suicide attempt and why the calls are so important to her here:\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=http%3A%2F%2Fapi.soundcloud.com%2Ftracks%2F82973934&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>In addition to Martina, those phone calls made a huge difference to John and about 300 others who have been through the program over the past two years.\u003c/p>\n\u003cp>John requested that we use only his first name because of the shame associated with suicide. Martina was nervous about using her last name as well.\u003c/p>\n\u003cp>“It’s a little scary ‘cause [of] how shameful depression is and suicide and mental hospitals and all that. There’s just shame around it and nobody wants to talk about it,” she said. “But, I can’t be ashamed about it anymore. This is who I am. It was a part of me. It is. It’s just who I am.”\u003c/p>\n\u003cp>Another surprise for me. I assumed that program participants would want to spread their good news; that suicide survivors would want to get the word out and help others. I didn’t expect to face barriers similar to those \u003ca href=\"http://centerforhealthreporting.org/blog/what-mental-illness-looks917\">I encountered while photographing and reporting a story on mental illness\u003c/a> and access to care.\u003c/p>\n\u003cp>“Some people are relieved that they’re alive, and others are really not so happy that they survived the attempt,” said WellSpace Health’s Wick. “So we’re there in the midst of all that to provide emotional support, linkages to treatment that’s really needed and to address those mixed feelings of both wanting to be dead and wanting to be alive or being disappointed that the attempt that you made didn’t work and having to deal with the consequences of that.”\u003c/p>\n\u003cp>But, the two people who did agree to talk to me both said they’re happy to be alive, and thank the program for that result.\u003c/p>\n\u003cp>John said suicide prevention specialist Roop Dhillon is “one of those truly wonderful people that you don’t often get to meet in the world.”\u003c/p>\n\u003cp>“Sometimes there’s this one person that can actually make a connection with you to make things alright and that you feel comfortable that what you tell them is just going to stay with them,” said John. “That there’s going to be no judgment. That you can be open and honest ‘cause they’re sincere about their efforts to try to get you into a better place.”\u003c/p>\n\u003cp>\u003cstrong>Listen to the audio:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201303140850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201303140850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>By Lauren M. Whaley\u003c/strong>, \u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cp>Every day in California, nine people die by suicide. Both in California and nationwide, suicide is the 10th leading cause of death. According to \u003ca href=\"http://newsroom.ucla.edu/portal/ucla/more-than-half-a-million-california-241841.aspx\">a recent study\u003c/a>, in 2009, more than a half-million adults in California seriously thought about killing themselves. Last fall, the California Mental Health Services Authority launched a statewide campaign called \u003ca href=\"http://www.suicideispreventable.org/\">Know the Signs\u003c/a> as part of a larger suicide prevention initiative.\u003c/p>\n\u003cp>One of the highest risk groups for suicide is people who have previously attempted suicide. In Sacramento, an innovative program seeks to reach that group directly and easily: through the simple phone call.\u003c/p>\n\u003cp>One of the program’s clients is John, a 29-year-old student at Sacramento’s American River College. Today, he describes himself as happy-go-lucky. But a year ago, he had lost two jobs, was facing bankruptcy and had to move in with friends.\u003c/p>\n\u003cp>Already feeling “emotionally and mentally stripped,” he was then was diagnosed with HIV. “That took away pretty much the last thing that I had, which I thought was my health,” he recalls.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One day last August, he reached an end. Feeling he was “tired of doing this,” he decided to take his own life.\u003c/p>\n\u003cp>“In my room, I wrote out my note,” he remembered. “I got all my medication out on my bed and I just started taking it. And … All of a sudden, what I just realized is here I am laying here on my floor. … I think, ‘Oh My God, what am I doing? What am I doing?’”\u003c/p>\n\u003cp>He called out for help, and his roommates called 9-1-1.\u003c/p>\n\u003cp>He woke up in downtown Sacramento at Sutter General Hospital's emergency department with nurses pumping his stomach. He recovered. But before he was discharged, he was visited by a social worker, who told him about a unique program that would match him with a suicide prevention specialist. John signed up. That person would give him a call every few days for a month just to check in.\u003c/p>\n\u003cp>“Ultimately, I knew that I had a cushion for support,” John said about receiving those calls. “I knew that if I was having a hard time, I absolutely had somebody available there.”\u003c!--more-->\u003c/p>\n\u003cp>The program is a partnership between Sutter Medical Center and WellSpace Health. Calls are made from a \u003ca href=\"http://www.theeffort.org/suicide_prevention.htm\">WellSpace Health\u003c/a> clinic in South Sacramento. It’s Roop Dhillon’s job to call people like John who have recently been to the ER for thinking about suicide or attempting it.\u003c/p>\n\u003cp>“A lot of times that [ER] visit alone could be a pretty overwhelming experience,” said Dhillon. “What we’ve heard from a lot of participants is their hardest part of leaving the emergency room was feeling alone once they got home.”\u003c/p>\n\u003cp>What makes the ED Follow Up Program innovative is that it is proactive. Dhillon calls people who have just gotten been discharged. People who are vulnerable. People who are most likely to try to take their own lives again.\u003c/p>\n\u003cp>Dhillon calls her clients from the same room where the clinic runs \u003ca href=\"http://www.theeffort.org/suicide_prevention.htm\">a more traditional 24-hour crisis hotline\u003c/a>. The outreach program has served about 300 people so far, and none have died from suicide.\u003c/p>\n\u003cp>Liseanne Wick, who manages suicide prevention and crisis services at the clinic, was drawn to suicide prevention over a decade ago after her brother took his own life.\u003c/p>\n\u003cp>“Personally, it will never bring my brother back, but it really brings meaning to that experience knowing that we’ve affected the lives of thousands, literally, over the last 10 years, probably tens of thousands,” she said.\u003c/p>\n\u003cp>Wick can’t know if a crisis hotline or the Follow Up Program would have helped her brother, but she’s sure the clinic is helping people now. “We know that statistically; we know that anecdotally from our experience,” she says. “I can’t speak for my brother, if he would have called or if he had knowledge of suicide hotlines. I wish he would have, though, because I know that it makes a difference, and we save lives on a daily basis.”\u003c/p>\n\u003cp>Indeed, John sounds like a convert when talking about how the follow-up program helped him. He said when he would see the number pop-up on his cell phone, it would remind him to pause. To assess how he was doing. And to realize he wasn’t alone in the world.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“So if you’re at a point where it just makes more sense to end it all because it’s not worth bothering anymore,” he said, speaking to those who may be considering hurting themselves. “Just pick up a phone and reach out to somebody for help. Let them tell you why it’s worth the bother.”\u003cem>\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"excerpt": "Every day in California, nine people die by suicide. Both in California and nationwide, suicide is the 10th leading cause of death. According to a recent study, more than half a million adults in California seriously thought about killing themselves in 2009. Last fall, the California Mental Health Services Authority launched a statewide campaign called Know the Signs as part of a larger suicide prevention initiative.\r\n\r\nOne of the highest risk groups for suicide is people who have previously attempted suicide. In Sacramento, a new program seeks to reach that group directly and easily: through the simple phone call.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Lauren M. Whaley\u003c/strong>, \u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cp>Every day in California, nine people die by suicide. Both in California and nationwide, suicide is the 10th leading cause of death. According to \u003ca href=\"http://newsroom.ucla.edu/portal/ucla/more-than-half-a-million-california-241841.aspx\">a recent study\u003c/a>, in 2009, more than a half-million adults in California seriously thought about killing themselves. Last fall, the California Mental Health Services Authority launched a statewide campaign called \u003ca href=\"http://www.suicideispreventable.org/\">Know the Signs\u003c/a> as part of a larger suicide prevention initiative.\u003c/p>\n\u003cp>One of the highest risk groups for suicide is people who have previously attempted suicide. In Sacramento, an innovative program seeks to reach that group directly and easily: through the simple phone call.\u003c/p>\n\u003cp>One of the program’s clients is John, a 29-year-old student at Sacramento’s American River College. Today, he describes himself as happy-go-lucky. But a year ago, he had lost two jobs, was facing bankruptcy and had to move in with friends.\u003c/p>\n\u003cp>Already feeling “emotionally and mentally stripped,” he was then was diagnosed with HIV. “That took away pretty much the last thing that I had, which I thought was my health,” he recalls.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One day last August, he reached an end. Feeling he was “tired of doing this,” he decided to take his own life.\u003c/p>\n\u003cp>“In my room, I wrote out my note,” he remembered. “I got all my medication out on my bed and I just started taking it. And … All of a sudden, what I just realized is here I am laying here on my floor. … I think, ‘Oh My God, what am I doing? What am I doing?’”\u003c/p>\n\u003cp>He called out for help, and his roommates called 9-1-1.\u003c/p>\n\u003cp>He woke up in downtown Sacramento at Sutter General Hospital's emergency department with nurses pumping his stomach. He recovered. But before he was discharged, he was visited by a social worker, who told him about a unique program that would match him with a suicide prevention specialist. John signed up. That person would give him a call every few days for a month just to check in.\u003c/p>\n\u003cp>“Ultimately, I knew that I had a cushion for support,” John said about receiving those calls. “I knew that if I was having a hard time, I absolutely had somebody available there.”\u003c!--more-->\u003c/p>\n\u003cp>The program is a partnership between Sutter Medical Center and WellSpace Health. Calls are made from a \u003ca href=\"http://www.theeffort.org/suicide_prevention.htm\">WellSpace Health\u003c/a> clinic in South Sacramento. It’s Roop Dhillon’s job to call people like John who have recently been to the ER for thinking about suicide or attempting it.\u003c/p>\n\u003cp>“A lot of times that [ER] visit alone could be a pretty overwhelming experience,” said Dhillon. “What we’ve heard from a lot of participants is their hardest part of leaving the emergency room was feeling alone once they got home.”\u003c/p>\n\u003cp>What makes the ED Follow Up Program innovative is that it is proactive. Dhillon calls people who have just gotten been discharged. People who are vulnerable. People who are most likely to try to take their own lives again.\u003c/p>\n\u003cp>Dhillon calls her clients from the same room where the clinic runs \u003ca href=\"http://www.theeffort.org/suicide_prevention.htm\">a more traditional 24-hour crisis hotline\u003c/a>. The outreach program has served about 300 people so far, and none have died from suicide.\u003c/p>\n\u003cp>Liseanne Wick, who manages suicide prevention and crisis services at the clinic, was drawn to suicide prevention over a decade ago after her brother took his own life.\u003c/p>\n\u003cp>“Personally, it will never bring my brother back, but it really brings meaning to that experience knowing that we’ve affected the lives of thousands, literally, over the last 10 years, probably tens of thousands,” she said.\u003c/p>\n\u003cp>Wick can’t know if a crisis hotline or the Follow Up Program would have helped her brother, but she’s sure the clinic is helping people now. “We know that statistically; we know that anecdotally from our experience,” she says. “I can’t speak for my brother, if he would have called or if he had knowledge of suicide hotlines. I wish he would have, though, because I know that it makes a difference, and we save lives on a daily basis.”\u003c/p>\n\u003cp>Indeed, John sounds like a convert when talking about how the follow-up program helped him. He said when he would see the number pop-up on his cell phone, it would remind him to pause. To assess how he was doing. And to realize he wasn’t alone in the world.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“So if you’re at a point where it just makes more sense to end it all because it’s not worth bothering anymore,” he said, speaking to those who may be considering hurting themselves. “Just pick up a phone and reach out to somebody for help. Let them tell you why it’s worth the bother.”\u003cem>\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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