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"disqusTitle": "Put Off by Colonoscopy? Home Screening Test is Good Alternative, Study Shows",
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"content": "\u003cp>An annual screening test for colon cancer that can be done at home showed strong effectiveness over several years, and patients who were sent the kits in the mail were very likely to participate year after year, \u003ca href=\"http://annals.org/article.aspx?articleid=2484289\" target=\"_blank\">a large study\u003c/a> from Kaiser in both Northern and Southern California found.\u003c/p>\n\u003cp>Colorectal cancer is the third-leading cause of death from cancer in the United States, with about 50,000 deaths and 130,000 new cases annually. Current screening guidelines recommend either colonoscopy, where a flexible tube is threaded into the colon, or a stool sample test, which can be done at home and mailed to a lab.\u003c/p>\n\u003cp>The home test, fecal immunochemical test or \"FIT,\" is recommended to be done annually but no study had looked at its performance over many years. The test detects blood in the stool, a warning sign of cancer.\u003c/p>\n\u003cp>In 2007 Kaiser began sending FIT tests to all members who were supposed to be screened for colorectal cancer but had not been. In the first year of analysis, more than 300,000 people completed the test and mailed it back.\u003c/p>\n\u003cp>In subsequent years, 75 to 86 percent of people sent back their tests, said study author Douglas Corley, a Kaiser gastroenterologist. Kaiser completed four total rounds of the test (stretching over more than four years, depending on when the first mailing to members happened).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the analysis, the test was associated with \"high sensitivity\" for colorectal cancer, picking 84.5 percent of cancers in the first year of the study and 73 to 78 percent in subsequent years. (It's common for the first round of a screening program to detect more cancers.)\u003c/p>\n\u003cp>\"This study provides additional support,\" said Corley, \"that FIT can be an important tool for getting people screened that is both sensitive for picking up cancer and that people can comply with.\"\u003c/p>\n\u003cp>The study was published in the Annals of Internal Medicine and funded by a program of the National Cancer Institute.\u003c/p>\n\u003cp>National advocacy groups generally recommend that a person at average risk begin colorectal cancer screening at age 50. While colonoscopy is commonly referred to as a gold standard, it is not infallible. Both the colonoscopy and FIT have benefits and drawbacks.\u003c/p>\n\u003cp>Colonoscopy is an invasive test done once every 10 years for screening purposes. Many people find it unpleasant. The day before the procedure, the patient must cleanse the bowel by drinking a gallon or more of special solution. On the flip side, cancer can be prevented through colonoscopy, because non-cancerous polyps can be identified and removed. It is thought that many colon cancers begin as these polyps.\u003c/p>\n\u003cp>Because FIT is a non-invasive test, patients who choose this option forgo removal of non-cancerous polyps. Colon cancer is generally very slow-growing. While a single colonoscopy is more sensitive than a single FIT test, if a cancer is missed in the first year of FIT screening, it is likely to be picked up the next year. In addition, some colon cancers are very rapid-growing. It's possible that someone with a clean colonoscopy may develop a rapid-growing cancer in the 10 years before the next screening test. An annual FIT test would likely catch it.\u003c/p>\n\u003cp>If you opt for screening through the annual FIT, and you have a positive result, you'll need follow-up care, which is likely to include a colonoscopy.\u003c/p>\n\u003cp>But the big question is: How do the two tests compare in outcomes?\u003c/p>\n\u003cp>\"The studies that have looked at how well (FIT) does compared to colonoscopy,\" said Corley, \"suggest that they're fairly similar in preventing deaths from colon cancer.\"\u003c/p>\n\u003cp>While many people have heard of a colonoscopy, fewer patients and doctors are aware of FIT, said Robert Smith, vice president of cancer screening for the American Cancer Society, who was not affiliated with the study.\u003c/p>\n\u003cp>A \"significant fraction\" of people avoid colonoscopy, he said, but \"when you give people options to screen, when you offer them a stool test or colonoscopy, a sizable fraction will choose stool test and complete it,\" he said.\u003c/p>\n\u003cp>This study demonstrates that an organized home-screening program was successful in screening many people who might otherwise not have come in for a colonoscopy.\u003c/p>\n\u003cp>\"They're both very good tests,\" said Smith. Each has strength and limitations, but the stool testing should not be regarded as a second-class test as opposed to colonoscopy.\u003c/p>\n\u003cp>Kaiser's overall colon cancer screening rate is above 80 percent, Corley said, well above the national average of about 60 percent. \"That's because we offer a variety of different tests so that people can complete the ones that are acceptable and work for them.\"\u003c/p>\n\u003cp>If the rest of the country reached an 80 percent screening rate for colorectal cancer, 200,000 deaths and 280,000 new colorectal cancer cases would be avoided by 2030, \u003ca href=\"http://Public%20Health%20Impact%20of%20Achieving%2080%%20Colorectal%20Cancer%20Screening%20Rates%20in%20the%20United%20States%20by%202018\" target=\"_blank\">a previous study found. \u003c/a>A national effort is underway to\u003ca href=\"http://nccrt.org/tools/80-percent-by-2018/\" target=\"_blank\"> increase screening rates\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The takeaway is, if you are 50 years of age and older, you need to be screened for colon cancer,\" Smith said. \"If you are put off by colonoscopy, then (FIT) might be the right test for you.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An annual screening test for colon cancer that can be done at home showed strong effectiveness over several years, and patients who were sent the kits in the mail were very likely to participate year after year, \u003ca href=\"http://annals.org/article.aspx?articleid=2484289\" target=\"_blank\">a large study\u003c/a> from Kaiser in both Northern and Southern California found.\u003c/p>\n\u003cp>Colorectal cancer is the third-leading cause of death from cancer in the United States, with about 50,000 deaths and 130,000 new cases annually. Current screening guidelines recommend either colonoscopy, where a flexible tube is threaded into the colon, or a stool sample test, which can be done at home and mailed to a lab.\u003c/p>\n\u003cp>The home test, fecal immunochemical test or \"FIT,\" is recommended to be done annually but no study had looked at its performance over many years. The test detects blood in the stool, a warning sign of cancer.\u003c/p>\n\u003cp>In 2007 Kaiser began sending FIT tests to all members who were supposed to be screened for colorectal cancer but had not been. In the first year of analysis, more than 300,000 people completed the test and mailed it back.\u003c/p>\n\u003cp>In subsequent years, 75 to 86 percent of people sent back their tests, said study author Douglas Corley, a Kaiser gastroenterologist. Kaiser completed four total rounds of the test (stretching over more than four years, depending on when the first mailing to members happened).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the analysis, the test was associated with \"high sensitivity\" for colorectal cancer, picking 84.5 percent of cancers in the first year of the study and 73 to 78 percent in subsequent years. (It's common for the first round of a screening program to detect more cancers.)\u003c/p>\n\u003cp>\"This study provides additional support,\" said Corley, \"that FIT can be an important tool for getting people screened that is both sensitive for picking up cancer and that people can comply with.\"\u003c/p>\n\u003cp>The study was published in the Annals of Internal Medicine and funded by a program of the National Cancer Institute.\u003c/p>\n\u003cp>National advocacy groups generally recommend that a person at average risk begin colorectal cancer screening at age 50. While colonoscopy is commonly referred to as a gold standard, it is not infallible. Both the colonoscopy and FIT have benefits and drawbacks.\u003c/p>\n\u003cp>Colonoscopy is an invasive test done once every 10 years for screening purposes. Many people find it unpleasant. The day before the procedure, the patient must cleanse the bowel by drinking a gallon or more of special solution. On the flip side, cancer can be prevented through colonoscopy, because non-cancerous polyps can be identified and removed. It is thought that many colon cancers begin as these polyps.\u003c/p>\n\u003cp>Because FIT is a non-invasive test, patients who choose this option forgo removal of non-cancerous polyps. Colon cancer is generally very slow-growing. While a single colonoscopy is more sensitive than a single FIT test, if a cancer is missed in the first year of FIT screening, it is likely to be picked up the next year. In addition, some colon cancers are very rapid-growing. It's possible that someone with a clean colonoscopy may develop a rapid-growing cancer in the 10 years before the next screening test. An annual FIT test would likely catch it.\u003c/p>\n\u003cp>If you opt for screening through the annual FIT, and you have a positive result, you'll need follow-up care, which is likely to include a colonoscopy.\u003c/p>\n\u003cp>But the big question is: How do the two tests compare in outcomes?\u003c/p>\n\u003cp>\"The studies that have looked at how well (FIT) does compared to colonoscopy,\" said Corley, \"suggest that they're fairly similar in preventing deaths from colon cancer.\"\u003c/p>\n\u003cp>While many people have heard of a colonoscopy, fewer patients and doctors are aware of FIT, said Robert Smith, vice president of cancer screening for the American Cancer Society, who was not affiliated with the study.\u003c/p>\n\u003cp>A \"significant fraction\" of people avoid colonoscopy, he said, but \"when you give people options to screen, when you offer them a stool test or colonoscopy, a sizable fraction will choose stool test and complete it,\" he said.\u003c/p>\n\u003cp>This study demonstrates that an organized home-screening program was successful in screening many people who might otherwise not have come in for a colonoscopy.\u003c/p>\n\u003cp>\"They're both very good tests,\" said Smith. Each has strength and limitations, but the stool testing should not be regarded as a second-class test as opposed to colonoscopy.\u003c/p>\n\u003cp>Kaiser's overall colon cancer screening rate is above 80 percent, Corley said, well above the national average of about 60 percent. \"That's because we offer a variety of different tests so that people can complete the ones that are acceptable and work for them.\"\u003c/p>\n\u003cp>If the rest of the country reached an 80 percent screening rate for colorectal cancer, 200,000 deaths and 280,000 new colorectal cancer cases would be avoided by 2030, \u003ca href=\"http://Public%20Health%20Impact%20of%20Achieving%2080%%20Colorectal%20Cancer%20Screening%20Rates%20in%20the%20United%20States%20by%202018\" target=\"_blank\">a previous study found. \u003c/a>A national effort is underway to\u003ca href=\"http://nccrt.org/tools/80-percent-by-2018/\" target=\"_blank\"> increase screening rates\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The takeaway is, if you are 50 years of age and older, you need to be screened for colon cancer,\" Smith said. \"If you are put off by colonoscopy, then (FIT) might be the right test for you.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Vaccination Rates Are Up Across California",
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"content": "\u003cp>Vaccination rates are up in 49 out of 58 counties in California, according to \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx\" target=\"_blank\">data released Tuesday \u003c/a>by state health officials.\u003c/p>\n\u003cp>The California Department of Public Health annually reports vaccination data for kindergartners at virtually all public and private schools statewide. For the 2015-2016 school year, 92.9 percent of kindergartners were up-to-date on their vaccines, an increase of 2.5 percentage points from last year.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242982475\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>In California, 2015 was the year of heated debate around vaccines. It started last January with the first reports of a measles outbreak tied to Disneyland. Then, in early February, lawmakers introduced a bill to eliminate the \"personal belief exemption\" (PBE) which allows parents to refuse vaccines on behalf of their children.\u003c/p>\n\u003cp>The law takes effect in July, but this school year the PBE rate declined slightly -- it's now 2.38 percent, down from 2.54 percent last year. It's the second straight year of declines.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While no one can say for sure exactly what's driving the increasing vaccination rates, it seems reasonable that all the focus on vaccinations -- and those who choose not to vaccinate -- last year had an impact.\u003c/p>\n\u003cp>But James Watt, chief of the division of communicable diseases with the state's department of public health, says another big factor is \"conditional admissions.\" These are children who arrive at school with some vaccines, but are not up to date.\u003c/p>\n\u003cp>This school year, 4.4 percent -- about 24,000 -- of the state's 550,000 kindergartners were admitted conditionally.\u003c/p>\n\u003cp>[contextly_sidebar id=\"S07THKkVXvpUeGb2IhP48ymUxbk2OH1q\"]The problem, Watt explained to me in an interview, is that the\u003ca href=\"http://www.shotsforschool.org/laws/conditional-admission/\" target=\"_blank\"> rules around conditional entry are actually quite strict\u003c/a>. It's not simply that a child has some vaccines and will get the rest at a later date. In other words, \"conditional entry\" is not for children whose parents haven't gotten them to the doctor's office or clinic for a shot.\u003c/p>\n\u003cp>\"If those children could get a dose 'today,' they're not supposed to be admitted to school,\" Watt says.\u003c/p>\n\u003cp>To say it in reverse -- conditional entry is for children who cannot be vaccinated \"today.\"\u003c/p>\n\u003cp>Why couldn't you be vaccinated \"today\"? Here's one example: Children are supposed to receive two doses of the measles, mumps, rubella (MMR) vaccine. But the second dose can only be given starting one month after the first dose. If school starts less than one month after the child has had the first MMR dose, then the child is eligible for \"conditional entry\" to school, until the month has passed and the second dose can be given.\u003c/p>\n\u003cp>Department of public health estimates show that more than 90 percent of those 24,000 children with conditional entry do not meet the \u003ca href=\"http://eziz.org/assets/docs/IMM-1080_Conditional.pdf\" target=\"_blank\">requirements\u003c/a> of the policy and should not have been admitted to school.\u003c/p>\n\u003cp>Watt says the criteria have been misunderstood and \"can be confusing,\" so the state's health department has been working with local health departments to inform them about correct use of conditional entry. In addition, schools financial and compliance audits for the current school year \"will scrutinize reimbursements for attendance at schools with higher rates of conditional entrance.\"\u003c/p>\n\u003cp>The department said it turned to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/19/alameda-county-vaccinations-surge-in-wake-of-enforcement/\" target=\"_blank\">approaches used successfully \u003c/a>by the Alameda County Public Health Department. The state says Alameda had the biggest decrease -- 7.2 percent -- of any California county in its conditional entry rate. Statewide, the rate declined 2.5 percent.\u003c/p>\n\u003cp>Watt acknowledged \"there is a tension\" between health requirements and school attendance, but even if children need vaccinations, there's \"no need to be out of school for more than a day,\" Watt said. \"There should not be prolonged absences from school because of the immunization requirement.\"\u003c/p>\n\u003cp>Despite the increases in the rate of kindergartners now fully vaccinated \"a number of schools and communities remain at risk of contagion,\" the state says. For the current school year, 20 of California's 58 counties have rates of fully-vaccinated kindergartners below 90 percent.\u003c/p>\n\u003cp>Here are the counties with the lowest rates of fully vaccinated kindergartners this year:\u003c/p>\n\u003cul>\n\u003cli>Trinity 77.0 percent\u003c/li>\n\u003cli>Nevada 77.1 percent\u003c/li>\n\u003cli>Tuolumne 77.7 percent\u003c/li>\n\u003cli>Mariposa 81.5 percent\u003c/li>\n\u003cli>Humboldt 82.0 percent\u003c/li>\n\u003cli>Siskiyou 83.8 percent\u003c/li>\n\u003c/ul>\n\u003cp>Many of those counties also have high rates of personal belief exemptions. But individual schools even within counties with high fully vaccinated rates may have high personal belief exemption rates.\u003c/p>\n\u003cp>You can look up the personal belief exemption rate at your own school below.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"http://projects1.kqed.org/vaccines/pbe2015.html\" width=\"100%\" height=\"700px\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>You can also see the \u003ca href=\"http://projects1.kqed.org/vaccines/pbe2015.html\" target=\"_blank\">school search tool on its own page\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Vaccination rates are up in 49 out of 58 counties in California, according to \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx\" target=\"_blank\">data released Tuesday \u003c/a>by state health officials.\u003c/p>\n\u003cp>The California Department of Public Health annually reports vaccination data for kindergartners at virtually all public and private schools statewide. For the 2015-2016 school year, 92.9 percent of kindergartners were up-to-date on their vaccines, an increase of 2.5 percentage points from last year.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/242982475&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/242982475'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In California, 2015 was the year of heated debate around vaccines. It started last January with the first reports of a measles outbreak tied to Disneyland. Then, in early February, lawmakers introduced a bill to eliminate the \"personal belief exemption\" (PBE) which allows parents to refuse vaccines on behalf of their children.\u003c/p>\n\u003cp>The law takes effect in July, but this school year the PBE rate declined slightly -- it's now 2.38 percent, down from 2.54 percent last year. It's the second straight year of declines.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While no one can say for sure exactly what's driving the increasing vaccination rates, it seems reasonable that all the focus on vaccinations -- and those who choose not to vaccinate -- last year had an impact.\u003c/p>\n\u003cp>But James Watt, chief of the division of communicable diseases with the state's department of public health, says another big factor is \"conditional admissions.\" These are children who arrive at school with some vaccines, but are not up to date.\u003c/p>\n\u003cp>This school year, 4.4 percent -- about 24,000 -- of the state's 550,000 kindergartners were admitted conditionally.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The problem, Watt explained to me in an interview, is that the\u003ca href=\"http://www.shotsforschool.org/laws/conditional-admission/\" target=\"_blank\"> rules around conditional entry are actually quite strict\u003c/a>. It's not simply that a child has some vaccines and will get the rest at a later date. In other words, \"conditional entry\" is not for children whose parents haven't gotten them to the doctor's office or clinic for a shot.\u003c/p>\n\u003cp>\"If those children could get a dose 'today,' they're not supposed to be admitted to school,\" Watt says.\u003c/p>\n\u003cp>To say it in reverse -- conditional entry is for children who cannot be vaccinated \"today.\"\u003c/p>\n\u003cp>Why couldn't you be vaccinated \"today\"? Here's one example: Children are supposed to receive two doses of the measles, mumps, rubella (MMR) vaccine. But the second dose can only be given starting one month after the first dose. If school starts less than one month after the child has had the first MMR dose, then the child is eligible for \"conditional entry\" to school, until the month has passed and the second dose can be given.\u003c/p>\n\u003cp>Department of public health estimates show that more than 90 percent of those 24,000 children with conditional entry do not meet the \u003ca href=\"http://eziz.org/assets/docs/IMM-1080_Conditional.pdf\" target=\"_blank\">requirements\u003c/a> of the policy and should not have been admitted to school.\u003c/p>\n\u003cp>Watt says the criteria have been misunderstood and \"can be confusing,\" so the state's health department has been working with local health departments to inform them about correct use of conditional entry. In addition, schools financial and compliance audits for the current school year \"will scrutinize reimbursements for attendance at schools with higher rates of conditional entrance.\"\u003c/p>\n\u003cp>The department said it turned to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/19/alameda-county-vaccinations-surge-in-wake-of-enforcement/\" target=\"_blank\">approaches used successfully \u003c/a>by the Alameda County Public Health Department. The state says Alameda had the biggest decrease -- 7.2 percent -- of any California county in its conditional entry rate. Statewide, the rate declined 2.5 percent.\u003c/p>\n\u003cp>Watt acknowledged \"there is a tension\" between health requirements and school attendance, but even if children need vaccinations, there's \"no need to be out of school for more than a day,\" Watt said. \"There should not be prolonged absences from school because of the immunization requirement.\"\u003c/p>\n\u003cp>Despite the increases in the rate of kindergartners now fully vaccinated \"a number of schools and communities remain at risk of contagion,\" the state says. For the current school year, 20 of California's 58 counties have rates of fully-vaccinated kindergartners below 90 percent.\u003c/p>\n\u003cp>Here are the counties with the lowest rates of fully vaccinated kindergartners this year:\u003c/p>\n\u003cul>\n\u003cli>Trinity 77.0 percent\u003c/li>\n\u003cli>Nevada 77.1 percent\u003c/li>\n\u003cli>Tuolumne 77.7 percent\u003c/li>\n\u003cli>Mariposa 81.5 percent\u003c/li>\n\u003cli>Humboldt 82.0 percent\u003c/li>\n\u003cli>Siskiyou 83.8 percent\u003c/li>\n\u003c/ul>\n\u003cp>Many of those counties also have high rates of personal belief exemptions. But individual schools even within counties with high fully vaccinated rates may have high personal belief exemption rates.\u003c/p>\n\u003cp>You can look up the personal belief exemption rate at your own school below.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"http://projects1.kqed.org/vaccines/pbe2015.html\" width=\"100%\" height=\"700px\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>You can also see the \u003ca href=\"http://projects1.kqed.org/vaccines/pbe2015.html\" target=\"_blank\">school search tool on its own page\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When it comes to vaccination rates, Alameda County made the comeback of the year in California.\u003c/p>\n\u003cp>The county was named by state officials as the “most improved” for raising the rate of kindergartners with “up-to-date” immunizations, said Amy Pine, immunization director of the Alameda County Public Health Department.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We made it our mission to say, 'No shots, no records, no school,'” \u003ccite>Amy Pine, Alameda County Public Health Department \u003c/cite>\u003c/aside>\n\u003cp>About 97 percent of kindergartners in Alameda had up-to-date vaccinations this school year, compared to 89 percent a year ago, according to the county’s records.\u003c/p>\n\u003cp>“We made it our mission to say, 'No shots, no records, no school,' ” Pine said. “The school personnel ... worked so hard. They are the heroes.\"\u003c/p>\n\u003cp>The countywide turnaround is due in large part to improvement in vaccination rates recorded in the Oakland Unified School District. The district lifted its rates of kindergartners with up-to-date vaccinations from only 75 percent in 2014-15 to 97 percent this year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Individual schools had major improvement, like Thornhill Elementary School in Oakland's Montclair district, which saw its up-to-date vaccination rate skyrocket from 14 percent last year to 96 percent this year.\u003c/p>\n\u003cp>“We doubled down on this issue, and we're glad to see our efforts are paying off, because what it's really about is the health of all of our children,” said Oakland Unified School District spokesman Isaac Kos-Read.\u003c/p>\n\u003cp>[contextly_sidebar id=\"HqMgQuu17xblX9gtajhD70E32Vqa4p4X\"]Even though it’s an issue that gets a lot of attention in the media, the number of parents choosing not to vaccinate their children due to personal beliefs was actually not a major phenomenon in Alameda. Only 1.5 percent of kindergartners in the county had such exemptions in 2014-2015 and it fell to 1 percent this year.\u003c/p>\n\u003cp>All children are required to be vaccinated against a range of diseases in order to attend school -- unless they have filed a \"personal belief exemption\" or a medical exemption with their school.\u003c/p>\n\u003cp>Last summer, California Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">signed a law \u003c/a>abolishing the personal belief exemption. The law takes effect in July, and in the next school year all students must be vaccinated unless they have a medical exemption.\u003c/p>\n\u003cp>Alameda County's major challenge was students with incomplete vaccination records who were allowed “conditional entry” to school. The rate of such admissions was 9.7 percent last year, and this year it has plummeted to 2 percent.\u003c/p>\n\u003cp>In Oakland, conditional entrants represented 25 percent of kindergartners last year, and that dropped to about 2 percent, Pine said.\u003c/p>\n\u003cp>The high rate of conditional entrants at some schools was in part because those exemptions were used inappropriately, she said. Some school personnel interpreted “conditional entry” to mean that students were allowed to enter school as long as their parents promised to get them the shots in the future.\u003c/p>\n\u003cp>But conditional entry is meant for kids who were recently vaccinated and aren’t due for the next shot in the series yet or those who have a temporary medical exemption.\u003c/p>\n\u003cp>\u003cstrong>Fixing the problem\u003c/strong>\u003c/p>\n\u003cp>Schools with low vaccination rates aren’t necessarily filled with unvaccinated children, Pine said. It’s often due to poor record keeping and administrative challenges.\u003c/p>\n\u003cp>School support staffers struggle to enter complete vaccination records because of turnover, lack of training and inadequate time to enter the data or follow up with parents, she said.\u003c/p>\n\u003cp>Also, schools have been reluctant to turn away kids just because they don’t have complete vaccinations. There was a financial disincentive to exclude children as schools get funding based on attendance, but the state has taken steps to change that, Pine said.\u003c/p>\n\u003cp>Schools with problematic vaccination rates in 2014-2015 received a letter saying they would be audited if their Fall 2015 rates didn’t improve, she said.\u003c/p>\n\u003cp>To help boost vaccination rates, Pine said, the county department ranked schools on a “community immunity” honor society based on their vaccination rates and sent \u003ca href=\"http://www.acphd.org/media/398838/community-immunity-honor-society.pdf\" target=\"_blank\">the listing\u003c/a> to school personnel. She said seeing the information displayed like that encouraged officials from schools that were ranked low to ask the county health department how they could turn that around.\u003c/p>\n\u003cp>The county health department worked with schools to train staff, she said. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">A measles outbreak tied to Disneyland\u003c/a>, which was first reported last January, helped to boost public awareness about the importance of vaccines, encouraging parents and schools to put a priority on immunizations, Pine said.\u003c/p>\n\u003cp>“Schools really have to give protected and focused time to staff to do it, where they won’t be interrupted,” Pine said.\u003c/p>\n\u003cp>It’s challenging for front desk staff to enter data when students and parents are constantly coming up to them and signing in and out of school.\u003c/p>\n\u003cp>“Much of what we needed was in the records,” said Thornhill Elementary School’s secretary, Sheila Smith. “It wasn't a matter of obtaining it. It was a matter of finding the time.”\u003c/p>\n\u003cp>She said entering immunization data is complicated for school staff because not all medical records look alike and the office environment is constantly distracting.\u003c/p>\n\u003cp>She said she asked for some dedicated time to work on the project and used personal hours as well, she said.\u003c/p>\n\u003cp>The principal, Steven Daubenspeck, said when he learned the school’s rate was so low last year, he began holding weekly meetings to check in with staff to increase accountability on vaccination record keeping. A lot of the information hadn’t been entered on time, he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I was shocked,” he said. “I got the staff to really rally around, and focus on it. I do have immune-compromised kids here, and it's a life-and-death issue.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When it comes to vaccination rates, Alameda County made the comeback of the year in California.\u003c/p>\n\u003cp>The county was named by state officials as the “most improved” for raising the rate of kindergartners with “up-to-date” immunizations, said Amy Pine, immunization director of the Alameda County Public Health Department.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We made it our mission to say, 'No shots, no records, no school,'” \u003ccite>Amy Pine, Alameda County Public Health Department \u003c/cite>\u003c/aside>\n\u003cp>About 97 percent of kindergartners in Alameda had up-to-date vaccinations this school year, compared to 89 percent a year ago, according to the county’s records.\u003c/p>\n\u003cp>“We made it our mission to say, 'No shots, no records, no school,' ” Pine said. “The school personnel ... worked so hard. They are the heroes.\"\u003c/p>\n\u003cp>The countywide turnaround is due in large part to improvement in vaccination rates recorded in the Oakland Unified School District. The district lifted its rates of kindergartners with up-to-date vaccinations from only 75 percent in 2014-15 to 97 percent this year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Individual schools had major improvement, like Thornhill Elementary School in Oakland's Montclair district, which saw its up-to-date vaccination rate skyrocket from 14 percent last year to 96 percent this year.\u003c/p>\n\u003cp>“We doubled down on this issue, and we're glad to see our efforts are paying off, because what it's really about is the health of all of our children,” said Oakland Unified School District spokesman Isaac Kos-Read.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Even though it’s an issue that gets a lot of attention in the media, the number of parents choosing not to vaccinate their children due to personal beliefs was actually not a major phenomenon in Alameda. Only 1.5 percent of kindergartners in the county had such exemptions in 2014-2015 and it fell to 1 percent this year.\u003c/p>\n\u003cp>All children are required to be vaccinated against a range of diseases in order to attend school -- unless they have filed a \"personal belief exemption\" or a medical exemption with their school.\u003c/p>\n\u003cp>Last summer, California Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">signed a law \u003c/a>abolishing the personal belief exemption. The law takes effect in July, and in the next school year all students must be vaccinated unless they have a medical exemption.\u003c/p>\n\u003cp>Alameda County's major challenge was students with incomplete vaccination records who were allowed “conditional entry” to school. The rate of such admissions was 9.7 percent last year, and this year it has plummeted to 2 percent.\u003c/p>\n\u003cp>In Oakland, conditional entrants represented 25 percent of kindergartners last year, and that dropped to about 2 percent, Pine said.\u003c/p>\n\u003cp>The high rate of conditional entrants at some schools was in part because those exemptions were used inappropriately, she said. Some school personnel interpreted “conditional entry” to mean that students were allowed to enter school as long as their parents promised to get them the shots in the future.\u003c/p>\n\u003cp>But conditional entry is meant for kids who were recently vaccinated and aren’t due for the next shot in the series yet or those who have a temporary medical exemption.\u003c/p>\n\u003cp>\u003cstrong>Fixing the problem\u003c/strong>\u003c/p>\n\u003cp>Schools with low vaccination rates aren’t necessarily filled with unvaccinated children, Pine said. It’s often due to poor record keeping and administrative challenges.\u003c/p>\n\u003cp>School support staffers struggle to enter complete vaccination records because of turnover, lack of training and inadequate time to enter the data or follow up with parents, she said.\u003c/p>\n\u003cp>Also, schools have been reluctant to turn away kids just because they don’t have complete vaccinations. There was a financial disincentive to exclude children as schools get funding based on attendance, but the state has taken steps to change that, Pine said.\u003c/p>\n\u003cp>Schools with problematic vaccination rates in 2014-2015 received a letter saying they would be audited if their Fall 2015 rates didn’t improve, she said.\u003c/p>\n\u003cp>To help boost vaccination rates, Pine said, the county department ranked schools on a “community immunity” honor society based on their vaccination rates and sent \u003ca href=\"http://www.acphd.org/media/398838/community-immunity-honor-society.pdf\" target=\"_blank\">the listing\u003c/a> to school personnel. She said seeing the information displayed like that encouraged officials from schools that were ranked low to ask the county health department how they could turn that around.\u003c/p>\n\u003cp>The county health department worked with schools to train staff, she said. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">A measles outbreak tied to Disneyland\u003c/a>, which was first reported last January, helped to boost public awareness about the importance of vaccines, encouraging parents and schools to put a priority on immunizations, Pine said.\u003c/p>\n\u003cp>“Schools really have to give protected and focused time to staff to do it, where they won’t be interrupted,” Pine said.\u003c/p>\n\u003cp>It’s challenging for front desk staff to enter data when students and parents are constantly coming up to them and signing in and out of school.\u003c/p>\n\u003cp>“Much of what we needed was in the records,” said Thornhill Elementary School’s secretary, Sheila Smith. “It wasn't a matter of obtaining it. It was a matter of finding the time.”\u003c/p>\n\u003cp>She said entering immunization data is complicated for school staff because not all medical records look alike and the office environment is constantly distracting.\u003c/p>\n\u003cp>She said she asked for some dedicated time to work on the project and used personal hours as well, she said.\u003c/p>\n\u003cp>The principal, Steven Daubenspeck, said when he learned the school’s rate was so low last year, he began holding weekly meetings to check in with staff to increase accountability on vaccination record keeping. A lot of the information hadn’t been entered on time, he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I was shocked,” he said. “I got the staff to really rally around, and focus on it. I do have immune-compromised kids here, and it's a life-and-death issue.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Kaiser Program, Hospital Care Comes to the Patient's Home",
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"content": "\u003cp>Frequent medical visits had become a way of life earlier this year for John and Audrey Stanton.\u003c/p>\n\u003cp>John, 86, suffered from serious eye problems, a painful skin infection called cellulitis and, more recently, repeated shortness of breath — all of which kept landing him in the hospital.\u003c/p>\n\u003cp>\"It was one thing after another. Like the doctor said, 'Somebody is after you!' \" Stanton laughs.\u003c/p>\n\u003cp>And for his 81-year-old wife, Audrey, the nearly two-hour drive each way to Kaiser in Riverside from their home in Hemet was a tough haul.\u003c/p>\n\u003cp>\"I’m not a long-distance driver so I had to be real careful,\" she says. \"It was stressful.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242752789\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>But that stress dissipated last summer when John was admitted to the hospital -- without leaving home.\u003c/p>\n\u003cp>\"I thought, 'Wow! This is amazing. I love this!' \" John Stanton says. \"This is what people need!\"\u003c/p>\n\u003cp>\u003cstrong>Pneumonia, Cellulitis or Congestive Heart Failure\u003c/strong>\u003c/p>\n\u003cp>Stanton is one of about 125 patients who have been enrolled in an experimental \"hospital at home\" program run out of Kaiser’s Permanente’s Riverside Medical Center.\u003c/p>\n\u003cp>Launched two years ago, the program is designed for people who need treatment -- typically only given in the hospital -- for one of three conditions: pneumonia, cellulitis or congestive heart failure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/11/25/55860/kaiser-program-brings-hospital-care-to-the-patient/\" target=\"_blank\">Read the rest of the story at KPCC.org.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Frequent medical visits had become a way of life earlier this year for John and Audrey Stanton.\u003c/p>\n\u003cp>John, 86, suffered from serious eye problems, a painful skin infection called cellulitis and, more recently, repeated shortness of breath — all of which kept landing him in the hospital.\u003c/p>\n\u003cp>\"It was one thing after another. Like the doctor said, 'Somebody is after you!' \" Stanton laughs.\u003c/p>\n\u003cp>And for his 81-year-old wife, Audrey, the nearly two-hour drive each way to Kaiser in Riverside from their home in Hemet was a tough haul.\u003c/p>\n\u003cp>\"I’m not a long-distance driver so I had to be real careful,\" she says. \"It was stressful.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Judge Rules Catholic Hospital Can Deny Tubal Ligation to Redding Woman",
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"content": "\u003cp>\u003cstrong>Update, 4 p.m. Thursday:\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>A San Francisco judge has denied a woman's request that he require a Catholic hospital to perform a tubal ligation to prevent pregnancy.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith on Thursday upheld his previous tentative ruling that Mercy Medical Center in Redding was not engaging in sex discrimination by denying Rebecca Chamorro the procedure.\u003c/p>\n\u003cp>The judge said the hospital's policy against sterilization also applies to men and that Chamorro could get the procedure at another hospital.\u003c/p>\n\u003cp>Mercy Medical Center said the procedure conflicts with the hospital's religious beliefs against sterilization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Attorneys for Chamorro appeared before Goldsmith on Thursday seeking a preliminary injunction.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical, also says the tubal ligation Chamorro seeks is not medically necessary.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>A Northern California Catholic hospital is not engaging in sex discrimination by denying a woman's request for the sterilization procedure known as tubal ligation, a San Francisco judge said in a tentative ruling.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith said in his decision Wednesday that Rebecca Chamorro could get the procedure at another hospital, and that Mercy Medical Center's policy against sterilization on religious ground also applies to men.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical and 38 other hospitals in California, Nevada and Arizona, says the tubal ligation sought by Chamorro is not medically necessary and would violate the hospital's right to freedom of religion.\u003c/p>\n\u003cp>\"The jurisprudence is unequivocal: A Catholic hospital may prohibit sterilization procedures that violate the core principles of the hospital's faith,\" attorneys for Dignity Health wrote in a court filing.\u003c/p>\n\u003cp>The judge issued the ruling in advance of a hearing on the matter. Attorneys representing Chamorro in her lawsuit were set to appear before Goldsmith on Thursday to try to change his mind and issue a preliminary injunction.\u003c/p>\n\u003cp>Chamorro is currently on bedrest at her home and scheduled to deliver by cesarean section later this month. The ideal time, medically, for a woman to have a tubal ligation, commonly known as having one's \"tubes tied,\" is at the point of delivery. The next nearest hospital where Chamorro could have the procedure done is in Chico, 70 miles from her home.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242148103\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\nChamorro's suit is part of a growing clash over birth control and abortion health care coverage. Dozens of U.S. Roman Catholic dioceses, charities and colleges have sued in federal court over the contraceptive coverage required under the federal Affordable Care Act.\u003c/p>\n\u003cp>Several evangelical nonprofits have also sued, arguing some of the birth control methods covered under the law are tantamount to abortion.\u003c/p>\n\u003cp>Last June, the U.S. Supreme Court ruled that the Hobby Lobby chain and other closely held private businesses with religious objections could opt out of the birth control mandate.\u003c/p>\n\u003cp>The ACLU has filed a complaint against a Michigan Catholic hospital that also refused to perform tubal ligation, according to Brigitte Amiri, a senior staff attorney with the ACLU. She said the woman in that case was able to go to another hospital.\u003c/p>\n\u003cp>Chamorro sued to get the procedure done immediately following her scheduled cesarean section on Jan. 28 because she and her husband do not want more children.\u003c/p>\n\u003cp>Chamorro's attorneys, including the American Civil Liberties Union, say the procedure is safest when performed immediately after birth, and Chamorro has no choice but to use Mercy Medical Center because Redding is about 200 miles north of San Francisco and the next closest hospital she could go to is more than 70 miles away.\u003c/p>\n\u003cp>The lawsuit accuses Dignity Health of violating California laws against sex discrimination and the practice of medicine by corporations, pointing out that Chamorro's obstetrician had sought permission from Mercy Medical to perform the procedure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The ACLU says the hospital allowed another woman to undergo a tubal ligation after the ACLU threatened a lawsuit.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update, 4 p.m. Thursday:\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>A San Francisco judge has denied a woman's request that he require a Catholic hospital to perform a tubal ligation to prevent pregnancy.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith on Thursday upheld his previous tentative ruling that Mercy Medical Center in Redding was not engaging in sex discrimination by denying Rebecca Chamorro the procedure.\u003c/p>\n\u003cp>The judge said the hospital's policy against sterilization also applies to men and that Chamorro could get the procedure at another hospital.\u003c/p>\n\u003cp>Mercy Medical Center said the procedure conflicts with the hospital's religious beliefs against sterilization.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Attorneys for Chamorro appeared before Goldsmith on Thursday seeking a preliminary injunction.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical, also says the tubal ligation Chamorro seeks is not medically necessary.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>A Northern California Catholic hospital is not engaging in sex discrimination by denying a woman's request for the sterilization procedure known as tubal ligation, a San Francisco judge said in a tentative ruling.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith said in his decision Wednesday that Rebecca Chamorro could get the procedure at another hospital, and that Mercy Medical Center's policy against sterilization on religious ground also applies to men.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical and 38 other hospitals in California, Nevada and Arizona, says the tubal ligation sought by Chamorro is not medically necessary and would violate the hospital's right to freedom of religion.\u003c/p>\n\u003cp>\"The jurisprudence is unequivocal: A Catholic hospital may prohibit sterilization procedures that violate the core principles of the hospital's faith,\" attorneys for Dignity Health wrote in a court filing.\u003c/p>\n\u003cp>The judge issued the ruling in advance of a hearing on the matter. Attorneys representing Chamorro in her lawsuit were set to appear before Goldsmith on Thursday to try to change his mind and issue a preliminary injunction.\u003c/p>\n\u003cp>Chamorro is currently on bedrest at her home and scheduled to deliver by cesarean section later this month. The ideal time, medically, for a woman to have a tubal ligation, commonly known as having one's \"tubes tied,\" is at the point of delivery. The next nearest hospital where Chamorro could have the procedure done is in Chico, 70 miles from her home.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/242148103&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/242148103'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\nChamorro's suit is part of a growing clash over birth control and abortion health care coverage. Dozens of U.S. Roman Catholic dioceses, charities and colleges have sued in federal court over the contraceptive coverage required under the federal Affordable Care Act.\u003c/p>\n\u003cp>Several evangelical nonprofits have also sued, arguing some of the birth control methods covered under the law are tantamount to abortion.\u003c/p>\n\u003cp>Last June, the U.S. Supreme Court ruled that the Hobby Lobby chain and other closely held private businesses with religious objections could opt out of the birth control mandate.\u003c/p>\n\u003cp>The ACLU has filed a complaint against a Michigan Catholic hospital that also refused to perform tubal ligation, according to Brigitte Amiri, a senior staff attorney with the ACLU. She said the woman in that case was able to go to another hospital.\u003c/p>\n\u003cp>Chamorro sued to get the procedure done immediately following her scheduled cesarean section on Jan. 28 because she and her husband do not want more children.\u003c/p>\n\u003cp>Chamorro's attorneys, including the American Civil Liberties Union, say the procedure is safest when performed immediately after birth, and Chamorro has no choice but to use Mercy Medical Center because Redding is about 200 miles north of San Francisco and the next closest hospital she could go to is more than 70 miles away.\u003c/p>\n\u003cp>The lawsuit accuses Dignity Health of violating California laws against sex discrimination and the practice of medicine by corporations, pointing out that Chamorro's obstetrician had sought permission from Mercy Medical to perform the procedure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The ACLU says the hospital allowed another woman to undergo a tubal ligation after the ACLU threatened a lawsuit.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Sick Newborn, A Loving Family and A Litany of Wrenching Choices",
"title": "A Sick Newborn, A Loving Family and A Litany of Wrenching Choices",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Anne and Omar Shamiyeh first learned something was wrong with one of their twins during an ultrasound, when Anne was 18 weeks pregnant.\u003c/p>\n\u003cp>\"The technician was, like, 'Well, there's no visualization of his stomach,'\" says Anne. \"And I was like, 'How does our baby have no stomach?' \"\u003c/p>\n\u003cp>It turned out that the baby's esophagus was not connected to his stomach. He also had a heart defect. At the very least, he was likely to face surgeries and a long stay in intensive care. He might have lifelong disabilities.\u003c/p>\n\u003cp>This was only the start of an eight-month ordeal for the Shamiyeh family.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/241060950\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Decisions about how much care to offer very sick family members are always challenging. But they can be particularly wrenching for parents like the Shamiyehs, who face harrowing choices during what is supposed to be a wonderful time — the start of a life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As doctors and families consider how far to push medical care, a chasm can open between the parents' hopes and what providers consider realistic.\u003c/p>\n\u003cp>For the Shamiyehs, the first major decision was whether to \"selectively reduce,\" the clinical term for aborting one fetus in a multiple pregnancy. \"Omar and I were very uncomfortable with that,\" Anne says. \"We really wanted to see what he was going to be like, and what life had to offer.\"\u003c/p>\n\u003cp>That decision meant the twins, a boy and a girl, would likely be born prematurely. As it turned out, they were delivered by cesarean section at 30 weeks — about two months early — at UCSF Benioff Children's Hospital, in San Francisco.\u003c/p>\n\u003cp>The boy was named Kai, the girl Malia. Each weighed about 3 pounds. They were rushed immediately to the neonatal intensive care unit. That night Kai had his first surgery.\u003c/p>\n\u003cp>Malia went home after about five weeks. But Kai was far from ready. He was on a ventilator, had to be fed through a tube directly into his stomach and was still struggling to survive. Eventually, he was diagnosed with \u003ca href=\"http://www.chargesyndrome.org/about-charge.asp\" target=\"_blank\">CHARGE syndrome\u003c/a> — a rare genetic condition that can result in severe cognitive and physical disabilities.\u003c/p>\n\u003cfigure id=\"attachment_136337\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136337 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg\" alt=\"Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>About the time Malia went home, the doctors and nurses sat down with the Shamiyehs to discuss Kai's treatment. They needed to know whether the family wanted a tracheostomy — surgeons would insert a breathing tube directly into Kai's neck to ease passage of air into his lungs.\u003c/p>\n\u003cp>\"It seemed awful,\" Anne recalls. \"We were both really unhappy with that, but we understood it wasn't a choice. It was something we had to do.\"\u003c/p>\n\u003cp>But \u003ca href=\"https://www.ucsfbenioffchildrens.org/elizabeth.rogers\" target=\"_blank\">Dr. Liz Rogers\u003c/a>, a UCSF neonatologist who cared for Kai, saw it as a significant decision.\u003c/p>\n\u003cp>\"To be very honest,\" Rogers says, \"for many, many of our families, the point of decision around a tracheostomy is a major, major time when families say, 'This has gone on for too long, and it's not what I want for him.' \"\u003c/p>\n\u003cp>Anne had real hope for Kai's future, despite the pessimism of some doctors.\u003c/p>\n\u003cp>\"I kept thinking, maybe that doctor's view of quality of life is different from mine. And maybe, for me, loving my child and having him feel love is enough,\" Anne says. \"And it's OK if he can't talk. Maybe he'll wear a diaper until he's 5, and maybe he'll be in a wheelchair, but that's OK. Because he'll be alive, and he'll be my child.\"\u003c/p>\n\u003cp>Studies \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10359387\">suggest\u003c/a> that health care providers do tend to have a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24112219\">different view\u003c/a> of quality of life than parents do. In Kai's case, many of his day-to-day caregivers — the nurses — felt Kai was suffering unnecessarily.\u003c/p>\n\u003cfigure id=\"attachment_136368\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-136368 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/kai-13-400x267.jpg\" alt=\"Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13.jpg 770w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Deidre Miller, a registered nurse in the NICU, says she was one of just a handful of nurses willing to be part of his primary care team. It was clear to all of them, she says, that Kai wasn't going to make it. Miller says she felt comfortable caring for Kai, but faced pressure from other nurses.\u003c/p>\n\u003cp>\"A lot of people thought, 'OK, well, let's just offer the Shamiyehs the opportunity to withdraw care today.' And, as a primary nurse, you knew that the Shamiyehs were never going to agree to that, and you knew that he had joy in his life,\" she recalls. \"But you go into the break room, and everybody wants to talk about it, and everyone wants \u003cem>you\u003c/em> to be the person to tell the Shamiyehs.\"\u003c/p>\n\u003cp>There's often a lag between when health care providers and parents sense a child isn't going to make it. In \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=193278\" target=\"_blank\">one study\u003c/a>, for instance, oncologists realized that their young patients would not recover months before the parents recognized it.\u003c/p>\n\u003cp>\"As easy as it is to \u003cem>say\u003c/em> we knew Kai was going to die, and we knew he was going to have a difficult life — gosh, what if we had been wrong?\" Miller says.\u003c/p>\n\u003cp>From Anne's and Omar's perspective, Kai had many happy moments. They visited every day, always with Malia in tow. He smiled, cooed and connected with them. But he wasn't getting better.\u003c/p>\n\u003cp>In May 2013, five months into Kai's stay in the NICU, the Shamiyehs and their doctors sat down to talk about whether they wanted to go forward with the heart surgery that had been on the calendar since his birth. It would have to be done if Kai was ever to leave the hospital.\u003c/p>\n\u003cp>The surgery wouldn't help, doctors explained, and Kai might die during the procedure. This time, Anne and Omar decided not to go forward.\u003c/p>\n\u003cp>\"So that was the day we found out we wouldn't ever be bringing Kai home,\" Anne says.\u003c/p>\n\u003cp>Two weeks later, Kai developed an infection the doctors couldn't treat. On June 5, 2013, he died in his mother's arms.\u003c/p>\n\u003cp>There were real costs to Kai's long stay in the NICU. Based on billing statements, the Shamiyehs calculate that the charges for Kai's care added up to more than $11 million, though their insurer very likely negotiated a lower rate.\u003c/p>\n\u003cp>There were also consequences for Kai's twin sister, Malia, whose parents were mostly focused on her brother during her first six months of life. Born two months prematurely herself, she had physical and speech delays; although at age 3, she's already caught up.\u003c/p>\n\u003cfigure id=\"attachment_136339\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136339 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg\" alt=\"Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Looking back, Omar says he wonders if they went too far. \"It's really hard to think — for five months he was going through all this pain and all this stress,\" Omar says. \"You wonder if you made the right decision in keeping it going, you know?\"\u003c/p>\n\u003cp>But Anne, who is now studying to become a nurse in the NICU, says she does not regret giving their son the best possible chance at life.\u003c/p>\n\u003cp>She's at peace with both their decisions — to try to save Kai, and to let him go.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jenny Gold is a reporter with \u003c/em>\u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003cem> and completed this story while participating in the \u003c/em>\u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars\" target=\"_blank\">California Health Journalism Fellowship\u003c/a>,\u003cem> a program of USC's Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"excerpt": "As families consider how far to push an infant's medical care, a chasm can open between the parents' hopes and what doctors and nurses consider realistic. How do you measure a baby's quality of life?",
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"description": "As families consider how far to push an infant's medical care, a chasm can open between the parents' hopes and what doctors and nurses consider realistic. How do you measure a baby's quality of life?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anne and Omar Shamiyeh first learned something was wrong with one of their twins during an ultrasound, when Anne was 18 weeks pregnant.\u003c/p>\n\u003cp>\"The technician was, like, 'Well, there's no visualization of his stomach,'\" says Anne. \"And I was like, 'How does our baby have no stomach?' \"\u003c/p>\n\u003cp>It turned out that the baby's esophagus was not connected to his stomach. He also had a heart defect. At the very least, he was likely to face surgeries and a long stay in intensive care. He might have lifelong disabilities.\u003c/p>\n\u003cp>This was only the start of an eight-month ordeal for the Shamiyeh family.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/241060950&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/241060950'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Decisions about how much care to offer very sick family members are always challenging. But they can be particularly wrenching for parents like the Shamiyehs, who face harrowing choices during what is supposed to be a wonderful time — the start of a life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As doctors and families consider how far to push medical care, a chasm can open between the parents' hopes and what providers consider realistic.\u003c/p>\n\u003cp>For the Shamiyehs, the first major decision was whether to \"selectively reduce,\" the clinical term for aborting one fetus in a multiple pregnancy. \"Omar and I were very uncomfortable with that,\" Anne says. \"We really wanted to see what he was going to be like, and what life had to offer.\"\u003c/p>\n\u003cp>That decision meant the twins, a boy and a girl, would likely be born prematurely. As it turned out, they were delivered by cesarean section at 30 weeks — about two months early — at UCSF Benioff Children's Hospital, in San Francisco.\u003c/p>\n\u003cp>The boy was named Kai, the girl Malia. Each weighed about 3 pounds. They were rushed immediately to the neonatal intensive care unit. That night Kai had his first surgery.\u003c/p>\n\u003cp>Malia went home after about five weeks. But Kai was far from ready. He was on a ventilator, had to be fed through a tube directly into his stomach and was still struggling to survive. Eventually, he was diagnosed with \u003ca href=\"http://www.chargesyndrome.org/about-charge.asp\" target=\"_blank\">CHARGE syndrome\u003c/a> — a rare genetic condition that can result in severe cognitive and physical disabilities.\u003c/p>\n\u003cfigure id=\"attachment_136337\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136337 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg\" alt=\"Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>About the time Malia went home, the doctors and nurses sat down with the Shamiyehs to discuss Kai's treatment. They needed to know whether the family wanted a tracheostomy — surgeons would insert a breathing tube directly into Kai's neck to ease passage of air into his lungs.\u003c/p>\n\u003cp>\"It seemed awful,\" Anne recalls. \"We were both really unhappy with that, but we understood it wasn't a choice. It was something we had to do.\"\u003c/p>\n\u003cp>But \u003ca href=\"https://www.ucsfbenioffchildrens.org/elizabeth.rogers\" target=\"_blank\">Dr. Liz Rogers\u003c/a>, a UCSF neonatologist who cared for Kai, saw it as a significant decision.\u003c/p>\n\u003cp>\"To be very honest,\" Rogers says, \"for many, many of our families, the point of decision around a tracheostomy is a major, major time when families say, 'This has gone on for too long, and it's not what I want for him.' \"\u003c/p>\n\u003cp>Anne had real hope for Kai's future, despite the pessimism of some doctors.\u003c/p>\n\u003cp>\"I kept thinking, maybe that doctor's view of quality of life is different from mine. And maybe, for me, loving my child and having him feel love is enough,\" Anne says. \"And it's OK if he can't talk. Maybe he'll wear a diaper until he's 5, and maybe he'll be in a wheelchair, but that's OK. Because he'll be alive, and he'll be my child.\"\u003c/p>\n\u003cp>Studies \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10359387\">suggest\u003c/a> that health care providers do tend to have a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24112219\">different view\u003c/a> of quality of life than parents do. In Kai's case, many of his day-to-day caregivers — the nurses — felt Kai was suffering unnecessarily.\u003c/p>\n\u003cfigure id=\"attachment_136368\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-136368 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/kai-13-400x267.jpg\" alt=\"Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13.jpg 770w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Deidre Miller, a registered nurse in the NICU, says she was one of just a handful of nurses willing to be part of his primary care team. It was clear to all of them, she says, that Kai wasn't going to make it. Miller says she felt comfortable caring for Kai, but faced pressure from other nurses.\u003c/p>\n\u003cp>\"A lot of people thought, 'OK, well, let's just offer the Shamiyehs the opportunity to withdraw care today.' And, as a primary nurse, you knew that the Shamiyehs were never going to agree to that, and you knew that he had joy in his life,\" she recalls. \"But you go into the break room, and everybody wants to talk about it, and everyone wants \u003cem>you\u003c/em> to be the person to tell the Shamiyehs.\"\u003c/p>\n\u003cp>There's often a lag between when health care providers and parents sense a child isn't going to make it. In \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=193278\" target=\"_blank\">one study\u003c/a>, for instance, oncologists realized that their young patients would not recover months before the parents recognized it.\u003c/p>\n\u003cp>\"As easy as it is to \u003cem>say\u003c/em> we knew Kai was going to die, and we knew he was going to have a difficult life — gosh, what if we had been wrong?\" Miller says.\u003c/p>\n\u003cp>From Anne's and Omar's perspective, Kai had many happy moments. They visited every day, always with Malia in tow. He smiled, cooed and connected with them. But he wasn't getting better.\u003c/p>\n\u003cp>In May 2013, five months into Kai's stay in the NICU, the Shamiyehs and their doctors sat down to talk about whether they wanted to go forward with the heart surgery that had been on the calendar since his birth. It would have to be done if Kai was ever to leave the hospital.\u003c/p>\n\u003cp>The surgery wouldn't help, doctors explained, and Kai might die during the procedure. This time, Anne and Omar decided not to go forward.\u003c/p>\n\u003cp>\"So that was the day we found out we wouldn't ever be bringing Kai home,\" Anne says.\u003c/p>\n\u003cp>Two weeks later, Kai developed an infection the doctors couldn't treat. On June 5, 2013, he died in his mother's arms.\u003c/p>\n\u003cp>There were real costs to Kai's long stay in the NICU. Based on billing statements, the Shamiyehs calculate that the charges for Kai's care added up to more than $11 million, though their insurer very likely negotiated a lower rate.\u003c/p>\n\u003cp>There were also consequences for Kai's twin sister, Malia, whose parents were mostly focused on her brother during her first six months of life. Born two months prematurely herself, she had physical and speech delays; although at age 3, she's already caught up.\u003c/p>\n\u003cfigure id=\"attachment_136339\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136339 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg\" alt=\"Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Looking back, Omar says he wonders if they went too far. \"It's really hard to think — for five months he was going through all this pain and all this stress,\" Omar says. \"You wonder if you made the right decision in keeping it going, you know?\"\u003c/p>\n\u003cp>But Anne, who is now studying to become a nurse in the NICU, says she does not regret giving their son the best possible chance at life.\u003c/p>\n\u003cp>She's at peace with both their decisions — to try to save Kai, and to let him go.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jenny Gold is a reporter with \u003c/em>\u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003cem> and completed this story while participating in the \u003c/em>\u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars\" target=\"_blank\">California Health Journalism Fellowship\u003c/a>,\u003cem> a program of USC's Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Must Special Ed Students Comply with Vaccine Law? It Varies by District",
"title": "Must Special Ed Students Comply with Vaccine Law? It Varies by District",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>California now has one of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">strictest vaccination laws\u003c/a> in the country, but ambiguity in its wording has left school districts deciding on their own whether to grant special education students a de facto exemption.\u003c/p>\n\u003caside class=\"pullquote alignright\">'School districts are grappling with how they want to approach this right now.'\u003cbr>\n\u003ccite>Jonathan Read, attorney\u003c/cite>\u003c/aside>\n\u003cp>The California Department of Public Health and the California Department of Education have not yet issued guidance on how to apply \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">the vaccination law \u003c/a>to special education students. Under the federal \u003ca href=\"http://idea.ed.gov/\" target=\"_blank\">Individuals with Disabilities Education Act\u003c/a>, students who qualify for special education services, such as speech therapy or small-group instruction, must receive those services. Failure to comply leaves districts vulnerable to lawsuits from parents.\u003c/p>\n\u003cp>At the same time, beginning July 1, the state law will require all kindergarten, transitional kindergarten and seventh-grade students to be vaccinated against 10 communicable diseases before they are allowed to attend school, unless they have a medical condition that makes them unable to do so. Under the new law, parents can no longer refuse to vaccinate their children in public or private schools and child-care centers based on their personal beliefs.\u003c/p>\n\u003cp>With kindergarten enrollment beginning this month in the Sacramento City Unified School District and continuing through the spring in districts around the state, school lawyers are parsing the law on their own.\u003c/p>\n\u003cp>The intent of the new law is “to increase community immunity,” said Shannan Martinez, a spokeswoman for state Sen. Richard Pan, D-Sacramento, who co-authored the legislation, Senate Bill 277. Pan said he acted to address rising numbers of unvaccinated children and a corresponding increase in outbreaks of diseases once considered obliterated in the U.S., including the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">measles outbreak tied to Disneyland last year\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the law appears to have unwittingly created a loophole that could be used to exempt the 10 percent of students who are enrolled in special education, a number far greater than the 2.5 percent of kindergarten students who opted out of vaccinations during the 2014-2015 school year through personal belief exemptions.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are not holding anyone to vaccination requirements that would interfere with access to special education programs.'\u003cbr>\n\u003ccite>Dr. Kimberly Uyeda, L.A. Unified School District\u003c/cite>\u003c/aside>\n\u003cp>The Los Angeles Unified School District, which serves more than 640,000 K-12 students and is the largest district in the state, has decided not to require students in special education to comply with required immunizations if that requirement would prevent them from getting services, including instruction in general education classrooms, to which they are legally entitled, said Dr. Kimberly Uyeda, director of student medical services for the district.\u003c/p>\n\u003cp>“We are not holding anyone to vaccination requirements that would interfere with access to special education programs,” Uyeda said. The decision was based on advice from district legal counsel, she said. The district serves about 73,000 special education students, but only “a very small number” are not fully vaccinated, she said.\u003c/p>\n\u003cp>“The broadest way the law can be interpreted is that special education students get access to everything, regardless of immunization status,” said Jennifer Nix, an attorney with School and College Legal Services of California. In terms of the risk of lawsuits from special education parents, “it is the safest route, but I don’t know if it’s the right route,” Nix said.\u003c/p>\n\u003cp>While the immunization law specifically exempts students who are home-schooled or who are enrolled in independent study with no classroom attendance, it does not use the word “exempt” to describe the status of students in special education. Instead, the law states that it does not “prohibit” special education students from access to services. Special education students wouldn’t necessarily be attending school, Martinez said.\u003c/p>\n\u003cp>Unlike students who are home-schooled or studying independently outside of classrooms, students who receive special education services -– they number one in 10 students in California, according to \u003ca href=\"http://www.lao.ca.gov/handouts/education/2015/Overview-of-Special-Education-in-California050715.pdf\" target=\"_blank\">a 2015 report from the Legislative Analyst’s Office\u003c/a> -– are in school buildings and almost always spend time in general education classrooms, physical education classes or cafeterias.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IJg8DasAtRTB1SNDndbXhRlaoqNX6euf\"]Jonathan Read, who specializes in special education law at the San Diego firm Fagen Friedman & Fulfrost, said that in the absence of guidance from the state, the immunization law is being interpreted in two ways. The first is that special education students are required by federal law to be educated in the least restrictive environment, which often means spending time in general education classrooms, and that right cannot be limited by a state law requiring them to be vaccinated to obtain access.\u003c/p>\n\u003cp>The second interpretation is that immunizations are a health and safety concern. While districts are obligated to make inclusive special education environments available, according to this line of reasoning, Read said, it is up to parents to decide whether they want their child to have access to those environments by having their child vaccinated.\u003c/p>\n\u003cp>“School districts are grappling with how they want to approach this right now,” Read said.\u003c/p>\n\u003cp>“There are going to be some conflicts,” said Maggie Roberts, associate managing attorney at Disability Rights California, the state’s watchdog group. “School districts will feel they have the right to keep out kids” who are not immunized, she said, while parents will press schools to fulfill their obligation to provide special education services, even if their children are not vaccinated.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/24/orange-county-says-special-ed-students-must-also-comply-with-vaccination-law/\" target=\"_blank\">Orange County has made the strongest public statement\u003c/a>, insisting that special education students be vaccinated along with all other students on campus, except those with medical exemptions. “If you exempt all special education kids, you’re going to decrease the vaccination rate by 11 or 12 percent,” said Ronald Wenkart, general counsel for the Orange County Office of Education. “I don’t see how you can interpret the law that way.”\u003c/p>\n\u003cp>Wenkart has advised school districts in the county that special education students must be vaccinated.\u003c/p>\n\u003cp>Other districts are planning for scenarios that could include providing special education services at home for unvaccinated students or meeting with the students in separate facilities at or near school grounds.\u003c/p>\n\u003cp>In the Sacramento City Unified School District, Terri Fox, lead district nurse, said one plan could be to refuse to admit an unvaccinated special education student who requires only an hour or two a week of speech therapy, for instance, and instead provide services to the student offsite. The student would be home-schooled for the remainder of his or her instruction.\u003c/p>\n\u003cp>But unvaccinated students who require extensive academic, behavioral and therapeutic assistance all day in a special education classroom “will probably have to be admitted,” Fox said.\u003c/p>\n\u003cp>In the Long Beach Unified School District, Joyce Cox, program specialist for student health services, said a formal policy has not been adopted. But one idea might be to offer temporary home instruction for students in special education, she said. “That is a way you could still deliver services to the child, and still comply with the state law -- but that decision has not been made,” she said.\u003c/p>\n\u003cp>Gail Williams, director of health services at Fresno Unified, said she will meet with parents of special education students to encourage them to vaccinate their children. If that fails, the path is not clear, she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Our numbers are small,” she said. “We will handle it on a case-by-case basis.”\u003c/p>\n\n",
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"excerpt": "Under federal law, students who qualify must receive special ed services. But school districts differ as to whether they will require vaccination for those students.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California now has one of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">strictest vaccination laws\u003c/a> in the country, but ambiguity in its wording has left school districts deciding on their own whether to grant special education students a de facto exemption.\u003c/p>\n\u003caside class=\"pullquote alignright\">'School districts are grappling with how they want to approach this right now.'\u003cbr>\n\u003ccite>Jonathan Read, attorney\u003c/cite>\u003c/aside>\n\u003cp>The California Department of Public Health and the California Department of Education have not yet issued guidance on how to apply \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">the vaccination law \u003c/a>to special education students. Under the federal \u003ca href=\"http://idea.ed.gov/\" target=\"_blank\">Individuals with Disabilities Education Act\u003c/a>, students who qualify for special education services, such as speech therapy or small-group instruction, must receive those services. Failure to comply leaves districts vulnerable to lawsuits from parents.\u003c/p>\n\u003cp>At the same time, beginning July 1, the state law will require all kindergarten, transitional kindergarten and seventh-grade students to be vaccinated against 10 communicable diseases before they are allowed to attend school, unless they have a medical condition that makes them unable to do so. Under the new law, parents can no longer refuse to vaccinate their children in public or private schools and child-care centers based on their personal beliefs.\u003c/p>\n\u003cp>With kindergarten enrollment beginning this month in the Sacramento City Unified School District and continuing through the spring in districts around the state, school lawyers are parsing the law on their own.\u003c/p>\n\u003cp>The intent of the new law is “to increase community immunity,” said Shannan Martinez, a spokeswoman for state Sen. Richard Pan, D-Sacramento, who co-authored the legislation, Senate Bill 277. Pan said he acted to address rising numbers of unvaccinated children and a corresponding increase in outbreaks of diseases once considered obliterated in the U.S., including the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">measles outbreak tied to Disneyland last year\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the law appears to have unwittingly created a loophole that could be used to exempt the 10 percent of students who are enrolled in special education, a number far greater than the 2.5 percent of kindergarten students who opted out of vaccinations during the 2014-2015 school year through personal belief exemptions.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are not holding anyone to vaccination requirements that would interfere with access to special education programs.'\u003cbr>\n\u003ccite>Dr. Kimberly Uyeda, L.A. Unified School District\u003c/cite>\u003c/aside>\n\u003cp>The Los Angeles Unified School District, which serves more than 640,000 K-12 students and is the largest district in the state, has decided not to require students in special education to comply with required immunizations if that requirement would prevent them from getting services, including instruction in general education classrooms, to which they are legally entitled, said Dr. Kimberly Uyeda, director of student medical services for the district.\u003c/p>\n\u003cp>“We are not holding anyone to vaccination requirements that would interfere with access to special education programs,” Uyeda said. The decision was based on advice from district legal counsel, she said. The district serves about 73,000 special education students, but only “a very small number” are not fully vaccinated, she said.\u003c/p>\n\u003cp>“The broadest way the law can be interpreted is that special education students get access to everything, regardless of immunization status,” said Jennifer Nix, an attorney with School and College Legal Services of California. In terms of the risk of lawsuits from special education parents, “it is the safest route, but I don’t know if it’s the right route,” Nix said.\u003c/p>\n\u003cp>While the immunization law specifically exempts students who are home-schooled or who are enrolled in independent study with no classroom attendance, it does not use the word “exempt” to describe the status of students in special education. Instead, the law states that it does not “prohibit” special education students from access to services. Special education students wouldn’t necessarily be attending school, Martinez said.\u003c/p>\n\u003cp>Unlike students who are home-schooled or studying independently outside of classrooms, students who receive special education services -– they number one in 10 students in California, according to \u003ca href=\"http://www.lao.ca.gov/handouts/education/2015/Overview-of-Special-Education-in-California050715.pdf\" target=\"_blank\">a 2015 report from the Legislative Analyst’s Office\u003c/a> -– are in school buildings and almost always spend time in general education classrooms, physical education classes or cafeterias.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Jonathan Read, who specializes in special education law at the San Diego firm Fagen Friedman & Fulfrost, said that in the absence of guidance from the state, the immunization law is being interpreted in two ways. The first is that special education students are required by federal law to be educated in the least restrictive environment, which often means spending time in general education classrooms, and that right cannot be limited by a state law requiring them to be vaccinated to obtain access.\u003c/p>\n\u003cp>The second interpretation is that immunizations are a health and safety concern. While districts are obligated to make inclusive special education environments available, according to this line of reasoning, Read said, it is up to parents to decide whether they want their child to have access to those environments by having their child vaccinated.\u003c/p>\n\u003cp>“School districts are grappling with how they want to approach this right now,” Read said.\u003c/p>\n\u003cp>“There are going to be some conflicts,” said Maggie Roberts, associate managing attorney at Disability Rights California, the state’s watchdog group. “School districts will feel they have the right to keep out kids” who are not immunized, she said, while parents will press schools to fulfill their obligation to provide special education services, even if their children are not vaccinated.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/24/orange-county-says-special-ed-students-must-also-comply-with-vaccination-law/\" target=\"_blank\">Orange County has made the strongest public statement\u003c/a>, insisting that special education students be vaccinated along with all other students on campus, except those with medical exemptions. “If you exempt all special education kids, you’re going to decrease the vaccination rate by 11 or 12 percent,” said Ronald Wenkart, general counsel for the Orange County Office of Education. “I don’t see how you can interpret the law that way.”\u003c/p>\n\u003cp>Wenkart has advised school districts in the county that special education students must be vaccinated.\u003c/p>\n\u003cp>Other districts are planning for scenarios that could include providing special education services at home for unvaccinated students or meeting with the students in separate facilities at or near school grounds.\u003c/p>\n\u003cp>In the Sacramento City Unified School District, Terri Fox, lead district nurse, said one plan could be to refuse to admit an unvaccinated special education student who requires only an hour or two a week of speech therapy, for instance, and instead provide services to the student offsite. The student would be home-schooled for the remainder of his or her instruction.\u003c/p>\n\u003cp>But unvaccinated students who require extensive academic, behavioral and therapeutic assistance all day in a special education classroom “will probably have to be admitted,” Fox said.\u003c/p>\n\u003cp>In the Long Beach Unified School District, Joyce Cox, program specialist for student health services, said a formal policy has not been adopted. But one idea might be to offer temporary home instruction for students in special education, she said. “That is a way you could still deliver services to the child, and still comply with the state law -- but that decision has not been made,” she said.\u003c/p>\n\u003cp>Gail Williams, director of health services at Fresno Unified, said she will meet with parents of special education students to encourage them to vaccinate their children. If that fails, the path is not clear, she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Our numbers are small,” she said. “We will handle it on a case-by-case basis.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How A Simple Bump Can Cause An Insidious Brain Injury",
"title": "How A Simple Bump Can Cause An Insidious Brain Injury",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>It's not just football players or troops who fought in the wars who suffer from brain injuries. Researchers estimate that hundreds of thousands of ordinary people in the U.S. get potentially serious brain injuries every year, too. Yet they and even their doctors often don't know it.\u003c/p>\n\u003cp>One such doctor is \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/10000041/Bryan-Arling\" target=\"_blank\">Bryan Arling\u003c/a>, an internist in Washington, D.C. His peers often vote to put him on those lists of \"top doctors,\" published by glossy magazines.\u003c/p>\n\u003cp>So it's ironic that the brain injury he failed to diagnose was his own. And he could have died from it.\u003c/p>\n\u003cp>Last spring, Arling went looking for some files in his walk-up attic. It was jammed with boxes of Christmas tree ornaments, old clothes and other odds and ends that define decades of family life. After an hour of searching, he found the files in a box, grabbed the folders and stood up. He then felt a shooting pain in the center of his back.\u003c/p>\n\u003cp>\"It's a pain I've had before,\" says Arling, who has battled back problems for years. \"But it was more intense than I've ever had it before.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He took painkillers and went back to work. Weeks went by, and his back was still hurting him.\u003c/p>\n\u003cp>\"Then I began noticing that I was shuffling. I was so weak I couldn't carry my plate out to the back deck. I would just drop things. And everybody commented on how I seemed different,\" he says.\u003c/p>\n\u003cp>And gradually, Arling says, his thinking seemed different, too.\u003c/p>\n\u003cp>\"I could make sense of things, I could get things done, I could make decisions,\" he says. \"But I was slower at what I did.\"\u003c/p>\n\u003cp>Arling thought he was having trouble focusing because his back pain was so intense. So a neurosurgeon, who had treated Arling's back problems before, ordered an MRI of Arling's spine — and also his brain. When the MRI technician saw Arling's pictures taking shape on his screen, he called the radiologist and said, \"You need to see this right away.\"\u003c/p>\n\u003cp>The images showed a big, white, lake-like shape where Arling's brain should have been, inside the top right side of his skull. It was a pool of blood that was pushing down on the brain, causing it to shift from right to left.\u003c/p>\n\u003cp>They sent Arling straight from the MRI to the emergency room at Georgetown University Medical Center. He says as they started prepping him for open brain surgery, the medical staff kept asking about his fall.\u003c/p>\n\u003cp>\"And I said, 'I haven't fallen,' \" Arling says.\u003c/p>\n\u003cp>Then, just as they were wheeling him into the operating room, Arling remembered: The day he stood up in the attic and threw out his back, he had forgotten he was under the eaves, and had knocked the top of his head against a wood beam. But he didn't even get a cut, so he forgot about it.\u003c/p>\n\u003cp>Everybody knows you can get hurt if you fall off a ladder, or slip and bash your head on the ice. But Arling got a kind of brain injury that's usually more insidious — a \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000713.htm\" target=\"_blank\">subdural hematoma\u003c/a>.\u003c/p>\n\u003cp>A subdural hematoma is different from the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=129726135\" target=\"_blank\">typical blast injuries\u003c/a> that affected hundreds of thousands of U.S. troops in Iraq and Afghanistan. In those cases, shock waves rattled their brains and caused microscopic damage that's hard or impossible to detect. It's also different from the usual football concussions, in which blows to the head damage the brain's electrical wiring.\u003c/p>\n\u003cp>The main population at risk for a subdural hematoma is the elderly. To understand why, it helps to picture an aging brain. The brain is wrapped and protected by a membrane called the dura mater. Inside the dura, there's a network of veins that connect it to the surface of the brain.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-135431 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png\" alt=\"Screen Shot 2016-01-06 at 3.19.26 PM\" width=\"400\" height=\"324\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM.png 423w\" sizes=\"(max-width: 400px) 100vw, 400px\">Studies suggest that as you get older, your brain shrinks and pulls away from the dura, especially after you're 60 or 70 years old. But the veins keep holding on to both the dura and the brain. So as your brain pulls away, some of those veins become more exposed and more vulnerable.\u003c/p>\n\u003cp>Researchers say if you simply bump your head on the eaves of your attic, as Arling did, or if you simply start to fall and then catch yourself — so your head doesn't strike anything, but it jerks in the air — that can be enough force to jostle your shrinking brain.\u003c/p>\n\u003cp>\"And those veins stretch, and you'll get tearing in those veins,\" says \u003ca href=\"http://www.pmr.vcu.edu/Department/Directory/faculty/dcifu/dcifu.aspx\" target=\"_blank\">Dr. David Cifu\u003c/a>, who runs a joint research project studying brain injuries for the departments of Defense and Veterans Affairs.\u003c/p>\n\u003cp>And because blood from veins tends to ooze, instead of pump as it does from arteries, Cifu says, \"when the veins tear, we get a very low-pressure ribbon of blood that's layering on top of the surface of the brain.\"\u003c/p>\n\u003cp>As that blood starts to pool over days or weeks, it irritates the brain cells. And if the pool's big enough, it presses on the brain and damages it, much like a tumor.\u003c/p>\n\u003cp>Researchers studied the problem a few years ago at a sample of 20 percent of the nation's hospitals. As they \u003ca href=\"http://www.npr.org/documents/2016/jan/rates-of-traumatic-subdural-hematoma.pdf\" target=\"_blank\">reported in the Journal of Neurosurgery\u003c/a>, those hospitals alone diagnosed almost 44,000 subdural hematomas in one year. So the researchers estimate there could be more than 200,000 subdural hematoma injuries diagnosed annually at all the hospitals across the country.\u003c/p>\n\u003cp>They say an unknown additional number of subdural hematomas are misdiagnosed, or simply missed: Half the patients studied have trouble remembering they hit their heads at all.\u003c/p>\n\u003cp>Like Arling. And like Tom Feild, a retired computer systems analyst who used to work for the VA.\u003c/p>\n\u003cfigure id=\"attachment_135405\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-135405\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/tbi-at-home1-2bfc90dd1b879b954a1f0aa6ac297c5c1a7d10da-e1452122149567.jpg\" alt=\"Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving. \u003ccite>(Matailong Du for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Feild says his own medical mystery began with headaches.\u003c/p>\n\u003cp>\"It wasn't a constant headache — it was a low-grade headache. But it wouldn't go away,\" he says.\u003c/p>\n\u003cp>Then he was driving his wife on an errand, and he kept drifting across the yellow line.\u003c/p>\n\u003cp>\"I said, 'Tom, you're going on their side of the road.' He said, 'I know ... I can't seem to help it,' \" Jody Feild says.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Tom Feild made an appointment with his local doctor. And the next thing he knew, a helicopter was rushing him to Virginia Commonwealth University Medical Center in Richmond. Neurosurgeon Bill Broaddus drilled three holes into Feild's skull and vacuumed out roughly 8 ounces of blood that had pooled since he developed a subdural hematoma.\u003cstrong>\u003cem>\u003cbr>\n\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Broaddus says before the surgery, he asked Feild what type of accident had injured his head. It took awhile before Feild could remember. He had put a sprinkler away under his porch two months earlier and bumped his head against the floorboards when he stood up before backing out all the way.\u003c/p>\n\u003cp>\"We may see 50 to 100 [similar subdural hematomas] here at this institution every year,\" says Broaddus.\u003c/p>\n\u003cp>Brain specialists say it's important to view these injuries in perspective: Most people who get a subdural hematoma will never know it. The brain will reabsorb the blood, the victim's symptoms will disappear, and life will go on as normal. But for tens of thousands of others, it's serious. Doctors say they often see families who think loved ones are getting dementia, and it turns out they hit their heads and have a bleed. Some victims die.\u003c/p>\n\u003cp>Researchers like Cifu say you don't need to consult a doctor the second you get a headache. But they say it's sensible, and responsible, to follow some simple guidelines: Consult a physician as soon as possible if the headaches don't go away, or if you begin to have trouble with your balance or feel weakness in your legs or arms. Also, if the way you think starts to seem \"different,\" Cifu says.\u003c/p>\n\u003cp>Internist Arling says even if it turns out that you do have a bleed, he's living proof that these brain injuries can be cured if you catch them in time.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"It's so easy to come away from a story like mine, and to feel fragile, and so to worry unnecessarily,\" Arling says. \"The body is phenomenally well-designed, and it has a phenomenal ability to heal itself.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+A+Simple+Bump+Can+Cause+An+Insidious+Brain+Injury&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"excerpt": "Hundreds of thousands of people suffer brain injuries each year. Sometimes the damage is caused by something that seems innocuous, like a stumble or a bump on the head. When should you see a doctor?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's not just football players or troops who fought in the wars who suffer from brain injuries. Researchers estimate that hundreds of thousands of ordinary people in the U.S. get potentially serious brain injuries every year, too. Yet they and even their doctors often don't know it.\u003c/p>\n\u003cp>One such doctor is \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/10000041/Bryan-Arling\" target=\"_blank\">Bryan Arling\u003c/a>, an internist in Washington, D.C. His peers often vote to put him on those lists of \"top doctors,\" published by glossy magazines.\u003c/p>\n\u003cp>So it's ironic that the brain injury he failed to diagnose was his own. And he could have died from it.\u003c/p>\n\u003cp>Last spring, Arling went looking for some files in his walk-up attic. It was jammed with boxes of Christmas tree ornaments, old clothes and other odds and ends that define decades of family life. After an hour of searching, he found the files in a box, grabbed the folders and stood up. He then felt a shooting pain in the center of his back.\u003c/p>\n\u003cp>\"It's a pain I've had before,\" says Arling, who has battled back problems for years. \"But it was more intense than I've ever had it before.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He took painkillers and went back to work. Weeks went by, and his back was still hurting him.\u003c/p>\n\u003cp>\"Then I began noticing that I was shuffling. I was so weak I couldn't carry my plate out to the back deck. I would just drop things. And everybody commented on how I seemed different,\" he says.\u003c/p>\n\u003cp>And gradually, Arling says, his thinking seemed different, too.\u003c/p>\n\u003cp>\"I could make sense of things, I could get things done, I could make decisions,\" he says. \"But I was slower at what I did.\"\u003c/p>\n\u003cp>Arling thought he was having trouble focusing because his back pain was so intense. So a neurosurgeon, who had treated Arling's back problems before, ordered an MRI of Arling's spine — and also his brain. When the MRI technician saw Arling's pictures taking shape on his screen, he called the radiologist and said, \"You need to see this right away.\"\u003c/p>\n\u003cp>The images showed a big, white, lake-like shape where Arling's brain should have been, inside the top right side of his skull. It was a pool of blood that was pushing down on the brain, causing it to shift from right to left.\u003c/p>\n\u003cp>They sent Arling straight from the MRI to the emergency room at Georgetown University Medical Center. He says as they started prepping him for open brain surgery, the medical staff kept asking about his fall.\u003c/p>\n\u003cp>\"And I said, 'I haven't fallen,' \" Arling says.\u003c/p>\n\u003cp>Then, just as they were wheeling him into the operating room, Arling remembered: The day he stood up in the attic and threw out his back, he had forgotten he was under the eaves, and had knocked the top of his head against a wood beam. But he didn't even get a cut, so he forgot about it.\u003c/p>\n\u003cp>Everybody knows you can get hurt if you fall off a ladder, or slip and bash your head on the ice. But Arling got a kind of brain injury that's usually more insidious — a \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000713.htm\" target=\"_blank\">subdural hematoma\u003c/a>.\u003c/p>\n\u003cp>A subdural hematoma is different from the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=129726135\" target=\"_blank\">typical blast injuries\u003c/a> that affected hundreds of thousands of U.S. troops in Iraq and Afghanistan. In those cases, shock waves rattled their brains and caused microscopic damage that's hard or impossible to detect. It's also different from the usual football concussions, in which blows to the head damage the brain's electrical wiring.\u003c/p>\n\u003cp>The main population at risk for a subdural hematoma is the elderly. To understand why, it helps to picture an aging brain. The brain is wrapped and protected by a membrane called the dura mater. Inside the dura, there's a network of veins that connect it to the surface of the brain.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-135431 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png\" alt=\"Screen Shot 2016-01-06 at 3.19.26 PM\" width=\"400\" height=\"324\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM.png 423w\" sizes=\"(max-width: 400px) 100vw, 400px\">Studies suggest that as you get older, your brain shrinks and pulls away from the dura, especially after you're 60 or 70 years old. But the veins keep holding on to both the dura and the brain. So as your brain pulls away, some of those veins become more exposed and more vulnerable.\u003c/p>\n\u003cp>Researchers say if you simply bump your head on the eaves of your attic, as Arling did, or if you simply start to fall and then catch yourself — so your head doesn't strike anything, but it jerks in the air — that can be enough force to jostle your shrinking brain.\u003c/p>\n\u003cp>\"And those veins stretch, and you'll get tearing in those veins,\" says \u003ca href=\"http://www.pmr.vcu.edu/Department/Directory/faculty/dcifu/dcifu.aspx\" target=\"_blank\">Dr. David Cifu\u003c/a>, who runs a joint research project studying brain injuries for the departments of Defense and Veterans Affairs.\u003c/p>\n\u003cp>And because blood from veins tends to ooze, instead of pump as it does from arteries, Cifu says, \"when the veins tear, we get a very low-pressure ribbon of blood that's layering on top of the surface of the brain.\"\u003c/p>\n\u003cp>As that blood starts to pool over days or weeks, it irritates the brain cells. And if the pool's big enough, it presses on the brain and damages it, much like a tumor.\u003c/p>\n\u003cp>Researchers studied the problem a few years ago at a sample of 20 percent of the nation's hospitals. As they \u003ca href=\"http://www.npr.org/documents/2016/jan/rates-of-traumatic-subdural-hematoma.pdf\" target=\"_blank\">reported in the Journal of Neurosurgery\u003c/a>, those hospitals alone diagnosed almost 44,000 subdural hematomas in one year. So the researchers estimate there could be more than 200,000 subdural hematoma injuries diagnosed annually at all the hospitals across the country.\u003c/p>\n\u003cp>They say an unknown additional number of subdural hematomas are misdiagnosed, or simply missed: Half the patients studied have trouble remembering they hit their heads at all.\u003c/p>\n\u003cp>Like Arling. And like Tom Feild, a retired computer systems analyst who used to work for the VA.\u003c/p>\n\u003cfigure id=\"attachment_135405\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-135405\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/tbi-at-home1-2bfc90dd1b879b954a1f0aa6ac297c5c1a7d10da-e1452122149567.jpg\" alt=\"Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving. \u003ccite>(Matailong Du for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Feild says his own medical mystery began with headaches.\u003c/p>\n\u003cp>\"It wasn't a constant headache — it was a low-grade headache. But it wouldn't go away,\" he says.\u003c/p>\n\u003cp>Then he was driving his wife on an errand, and he kept drifting across the yellow line.\u003c/p>\n\u003cp>\"I said, 'Tom, you're going on their side of the road.' He said, 'I know ... I can't seem to help it,' \" Jody Feild says.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Tom Feild made an appointment with his local doctor. And the next thing he knew, a helicopter was rushing him to Virginia Commonwealth University Medical Center in Richmond. Neurosurgeon Bill Broaddus drilled three holes into Feild's skull and vacuumed out roughly 8 ounces of blood that had pooled since he developed a subdural hematoma.\u003cstrong>\u003cem>\u003cbr>\n\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Broaddus says before the surgery, he asked Feild what type of accident had injured his head. It took awhile before Feild could remember. He had put a sprinkler away under his porch two months earlier and bumped his head against the floorboards when he stood up before backing out all the way.\u003c/p>\n\u003cp>\"We may see 50 to 100 [similar subdural hematomas] here at this institution every year,\" says Broaddus.\u003c/p>\n\u003cp>Brain specialists say it's important to view these injuries in perspective: Most people who get a subdural hematoma will never know it. The brain will reabsorb the blood, the victim's symptoms will disappear, and life will go on as normal. But for tens of thousands of others, it's serious. Doctors say they often see families who think loved ones are getting dementia, and it turns out they hit their heads and have a bleed. Some victims die.\u003c/p>\n\u003cp>Researchers like Cifu say you don't need to consult a doctor the second you get a headache. But they say it's sensible, and responsible, to follow some simple guidelines: Consult a physician as soon as possible if the headaches don't go away, or if you begin to have trouble with your balance or feel weakness in your legs or arms. Also, if the way you think starts to seem \"different,\" Cifu says.\u003c/p>\n\u003cp>Internist Arling says even if it turns out that you do have a bleed, he's living proof that these brain injuries can be cured if you catch them in time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It's so easy to come away from a story like mine, and to feel fragile, and so to worry unnecessarily,\" Arling says. \"The body is phenomenally well-designed, and it has a phenomenal ability to heal itself.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+A+Simple+Bump+Can+Cause+An+Insidious+Brain+Injury&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Spanish Website Features Telenovelas to Inform Latinos About Kidney Donation",
"title": "Spanish Website Features Telenovelas to Inform Latinos About Kidney Donation",
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"content": "\u003cp>\u003cem>Will Roberto be able to carry the heavy boxes his job requires if he donates a kidney to his brother, Jorge? How will his family pay their bills if Roberto has to take several weeks off from work to recover from the surgery?\u003c/em>\u003c/p>\n\u003cp>\u003cem>Will Mama consider a kidney donation from her daughter, Carla, or turn her down, worried the procedure will keep Carla from having another baby?\u003c/em>\u003c/p>\n\u003caside class=\"pullquote alignright\">'Right now, Latino patients often don’t learn about live kidney donation until they are in crisis.' \u003ccite> Dr. Junichiro Sageshima, UC, Davis transplant surgeon\u003c/cite>\u003c/aside>\n\u003cp>These two telenovela plots have gripped viewers in the past few months. But don’t expect to see the Spanish-language dramas on a network or streaming service. They’re customized for \u003ca href=\"http://informate.org/\" target=\"_blank\">Infórmate\u003c/a>, a new bilingual website dedicated to educating Latinos about options for living kidney donation.\u003c/p>\n\u003cp>The marketing strategy is intended to address a growing need among Latinos. Kidney failure in this population has increased by more than 70 percent since 2000, and more than 23,000 Latinos are on the kidney transplant list, according to federal statistics. But too often, researchers and doctors say, families are not aware of the transplant regimen involving a live donor and have unfounded fears about what could happen if they volunteer to offer a kidney to a relative or friend.\u003c/p>\n\u003cp>“Right now, Latino patients often don’t learn about live kidney donation until they are in crisis, and that is a bad time to be learning about something complex and somewhat foreign to their culture,” said Junichiro Sageshima, a transplant surgeon at UC Davis.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Twenty percent of U.S. kidney disease patients on the current United Network for Organ Sharing (UNOS) transplant waiting list are Latino, but in California that rate is twice that, about 40 percent, which roughly matches the percentage of Latinos in the state, said Charlene Zettel, CEO of Donate Life California, the parent organization of Living Donation California, a San Diego-based nonprofit that offers referrals and resources for living kidney donations.\u003c/p>\n\u003cp>While researchers aren’t fully sure why Latinos are so severely affected by kidney disease, rates of high blood pressure and diabetes are also elevated among Latinos, and both conditions are key contributing factors. In addition, large numbers of Latinos lack health insurance, which can prevent getting timely care and can aggravate chronic diseases.\u003c/p>\n\u003cp>\u003cstrong>Need For Live Donors\u003c/strong>\u003c/p>\n\u003cp>Yet Latinos are less than half as likely as non-Latino whites to get a transplanted kidney from a live donor. That’s an important distinction because almost 6,000 kidney transplants annually are from live donors, close to a third of all kidney transplants, according to UNOS.\u003c/p>\n\u003cp>Part of that discrepancy is because of cultural concerns about transplants — and especially about live donor kidney transplants, researchers say.\u003c/p>\n\u003cp>Elisa Gordon, an associate professor of surgery at Northwestern University, led the development and testing of Infórmate. She said many Latino families are afraid that donation can decrease virility and fertility. Other believe the Catholic Church opposes it or that becoming a donor could trigger a report to immigration officials. None of those are true.\u003c/p>\n\u003cp>In addition, many Latinos worry about related costs and don’t know that insurance generally covers most of the expenses for both the donor and recipient.\u003c/p>\n\u003cp>Infórmate deals with all those issues. Besides the telenovelas, the site includes quizzes and games to help dispel cultural and religious myths and video testimonials in English and Spanish from donors and recipients. It also has information on financial issues and links to help patients find transplant centers.\u003c/p>\n\u003cp>Dr. Elena Rios, CEO of the National Hispanic Medical Association, said the telenovelas are an especially important feature of the site because they are “familiar.” Many Latino families watch television together so the stories are likely to generate conversation, she said.\u003c/p>\n\u003cp>Zettel said her group has added a link to Infórmate on the site’s resources page. “We’ve long needed more targeted information health care professionals can use to better inform their Latino patients about live kidney donation,” she said.\u003c/p>\n\u003cp>Both UC Davis and Northwestern University transplant centers also have added Infórmate to the resources that they offer Latino patients. Researchers at the centers conducted a study that found the website increased knowledge about live kidney donation among Latino patients and their family members.\u003c/p>\n\u003cp>Javier Oregel, 34, of Yuba City, north of Sacramento, undergoes daily dialysis and said he learned of the site from the staff at UC Davis. Oregel became too sick to work in his job as a farmworker and receives medical benefits through Medicare and Medi-Cal, California's version of Medicaid. Through a translator, Oregel explained that before scrolling through Infórmate, all the information he had on kidney transplants came from talking with the transplant center staff. Infórmate allows him to get information himself, in Spanish.\u003c/p>\n\u003cp>He is on the UNOS list for a kidney transplant and is worried about what expenses will fall to him. Although his insurance will pick up much of the medical costs, he learned on Infórmate about some of the out-of-pocket spending that a surgery would entail. The site provided him with links to organizations that take applications to help cover those costs — even the bill for the hotel room his wife will need if he gets the transplant.\u003c/p>\n\u003cp>“If a transplant become available, I know I can go back to the Infórmate site to follow up on those resources,” Oregel said.\u003c/p>\n\u003cp>\u003cstrong>Paying For A Transplant\u003c/strong>\u003c/p>\n\u003cp>Kidney transplants cost $150,000 to $250,000, according to information on Infórmate, not including about $20,000 per year for medication and other expenses necessary for the rest of a recipient’s life. Health plans usually cover dialysis and transplants, as does Medi-Cal.\u003c/p>\n\u003cp>Immigrants living in the country illegally who don't have insurance are generally eligible only for emergency treatment in hospitals. A handful of states, including California, offer coverage of dialysis on an outpatient basis under certain circumstances.\u003c/p>\n\u003cp>Yet dialysis is just a stopgap measure until a donated kidney — either from a live person or from someone who has died — can be found. The average wait for a deceased person’s kidney is 3½ years.\u003c/p>\n\u003cp>Kidney transplants save money over the cost of dialysis, but that’s not why medical officials favor them, said Luke Preczewski, executive director of the kidney transplant center at UC Davis. “We do them because research shows that transplants offer a longer and better quality life.”\u003c/p>\n\u003cp>“Live kidney donations generally come from family members, who are the most likely to be a genetic match, but [they] often come from spouses, friends and even strangers,” said Juan Caicedo, director of the Hispanic Transplant Program at Northwestern Memorial Hospital and a co-developer of the Infórmate site.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“The bottom line,” Caicedo said, “is we have learned that there is a lot of lack of knowledge about live kidney donation among communities, clinicians, priests, grandparents and others, and everyone has different concerns or misconceptions because of that lack of knowledge. We are trying to solve that with this website.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Will Roberto be able to carry the heavy boxes his job requires if he donates a kidney to his brother, Jorge? How will his family pay their bills if Roberto has to take several weeks off from work to recover from the surgery?\u003c/em>\u003c/p>\n\u003cp>\u003cem>Will Mama consider a kidney donation from her daughter, Carla, or turn her down, worried the procedure will keep Carla from having another baby?\u003c/em>\u003c/p>\n\u003caside class=\"pullquote alignright\">'Right now, Latino patients often don’t learn about live kidney donation until they are in crisis.' \u003ccite> Dr. Junichiro Sageshima, UC, Davis transplant surgeon\u003c/cite>\u003c/aside>\n\u003cp>These two telenovela plots have gripped viewers in the past few months. But don’t expect to see the Spanish-language dramas on a network or streaming service. They’re customized for \u003ca href=\"http://informate.org/\" target=\"_blank\">Infórmate\u003c/a>, a new bilingual website dedicated to educating Latinos about options for living kidney donation.\u003c/p>\n\u003cp>The marketing strategy is intended to address a growing need among Latinos. Kidney failure in this population has increased by more than 70 percent since 2000, and more than 23,000 Latinos are on the kidney transplant list, according to federal statistics. But too often, researchers and doctors say, families are not aware of the transplant regimen involving a live donor and have unfounded fears about what could happen if they volunteer to offer a kidney to a relative or friend.\u003c/p>\n\u003cp>“Right now, Latino patients often don’t learn about live kidney donation until they are in crisis, and that is a bad time to be learning about something complex and somewhat foreign to their culture,” said Junichiro Sageshima, a transplant surgeon at UC Davis.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Twenty percent of U.S. kidney disease patients on the current United Network for Organ Sharing (UNOS) transplant waiting list are Latino, but in California that rate is twice that, about 40 percent, which roughly matches the percentage of Latinos in the state, said Charlene Zettel, CEO of Donate Life California, the parent organization of Living Donation California, a San Diego-based nonprofit that offers referrals and resources for living kidney donations.\u003c/p>\n\u003cp>While researchers aren’t fully sure why Latinos are so severely affected by kidney disease, rates of high blood pressure and diabetes are also elevated among Latinos, and both conditions are key contributing factors. In addition, large numbers of Latinos lack health insurance, which can prevent getting timely care and can aggravate chronic diseases.\u003c/p>\n\u003cp>\u003cstrong>Need For Live Donors\u003c/strong>\u003c/p>\n\u003cp>Yet Latinos are less than half as likely as non-Latino whites to get a transplanted kidney from a live donor. That’s an important distinction because almost 6,000 kidney transplants annually are from live donors, close to a third of all kidney transplants, according to UNOS.\u003c/p>\n\u003cp>Part of that discrepancy is because of cultural concerns about transplants — and especially about live donor kidney transplants, researchers say.\u003c/p>\n\u003cp>Elisa Gordon, an associate professor of surgery at Northwestern University, led the development and testing of Infórmate. She said many Latino families are afraid that donation can decrease virility and fertility. Other believe the Catholic Church opposes it or that becoming a donor could trigger a report to immigration officials. None of those are true.\u003c/p>\n\u003cp>In addition, many Latinos worry about related costs and don’t know that insurance generally covers most of the expenses for both the donor and recipient.\u003c/p>\n\u003cp>Infórmate deals with all those issues. Besides the telenovelas, the site includes quizzes and games to help dispel cultural and religious myths and video testimonials in English and Spanish from donors and recipients. It also has information on financial issues and links to help patients find transplant centers.\u003c/p>\n\u003cp>Dr. Elena Rios, CEO of the National Hispanic Medical Association, said the telenovelas are an especially important feature of the site because they are “familiar.” Many Latino families watch television together so the stories are likely to generate conversation, she said.\u003c/p>\n\u003cp>Zettel said her group has added a link to Infórmate on the site’s resources page. “We’ve long needed more targeted information health care professionals can use to better inform their Latino patients about live kidney donation,” she said.\u003c/p>\n\u003cp>Both UC Davis and Northwestern University transplant centers also have added Infórmate to the resources that they offer Latino patients. Researchers at the centers conducted a study that found the website increased knowledge about live kidney donation among Latino patients and their family members.\u003c/p>\n\u003cp>Javier Oregel, 34, of Yuba City, north of Sacramento, undergoes daily dialysis and said he learned of the site from the staff at UC Davis. Oregel became too sick to work in his job as a farmworker and receives medical benefits through Medicare and Medi-Cal, California's version of Medicaid. Through a translator, Oregel explained that before scrolling through Infórmate, all the information he had on kidney transplants came from talking with the transplant center staff. Infórmate allows him to get information himself, in Spanish.\u003c/p>\n\u003cp>He is on the UNOS list for a kidney transplant and is worried about what expenses will fall to him. Although his insurance will pick up much of the medical costs, he learned on Infórmate about some of the out-of-pocket spending that a surgery would entail. The site provided him with links to organizations that take applications to help cover those costs — even the bill for the hotel room his wife will need if he gets the transplant.\u003c/p>\n\u003cp>“If a transplant become available, I know I can go back to the Infórmate site to follow up on those resources,” Oregel said.\u003c/p>\n\u003cp>\u003cstrong>Paying For A Transplant\u003c/strong>\u003c/p>\n\u003cp>Kidney transplants cost $150,000 to $250,000, according to information on Infórmate, not including about $20,000 per year for medication and other expenses necessary for the rest of a recipient’s life. Health plans usually cover dialysis and transplants, as does Medi-Cal.\u003c/p>\n\u003cp>Immigrants living in the country illegally who don't have insurance are generally eligible only for emergency treatment in hospitals. A handful of states, including California, offer coverage of dialysis on an outpatient basis under certain circumstances.\u003c/p>\n\u003cp>Yet dialysis is just a stopgap measure until a donated kidney — either from a live person or from someone who has died — can be found. The average wait for a deceased person’s kidney is 3½ years.\u003c/p>\n\u003cp>Kidney transplants save money over the cost of dialysis, but that’s not why medical officials favor them, said Luke Preczewski, executive director of the kidney transplant center at UC Davis. “We do them because research shows that transplants offer a longer and better quality life.”\u003c/p>\n\u003cp>“Live kidney donations generally come from family members, who are the most likely to be a genetic match, but [they] often come from spouses, friends and even strangers,” said Juan Caicedo, director of the Hispanic Transplant Program at Northwestern Memorial Hospital and a co-developer of the Infórmate site.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The bottom line,” Caicedo said, “is we have learned that there is a lot of lack of knowledge about live kidney donation among communities, clinicians, priests, grandparents and others, and everyone has different concerns or misconceptions because of that lack of knowledge. We are trying to solve that with this website.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Coming Soon to A Hospital Near You: Fewer Cesarean Sections",
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"content": "\u003cp>California is preparing to launch an ambitious plan to reduce C-sections rates. If successful, that reduction will save taxpayer money and keep both mothers and babies healthier.\u003c/p>\n\u003cp>Kicking off in early 2016, \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20ReducingCSectionsFlier.pdf\" target=\"_blank\">the plan\u003c/a> funded by the Oakland-based California HealthCare Foundation is meant to financially reward hospitals for vaginal births and reduce the pressure on doctors and laboring mothers to deliver quickly.\u003c/p>\n\u003cp>Last year, amid increasing attention to maternal care by health advocates, CHCF released \u003ca href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">an alarming report\u003c/a>. A healthy pregnant woman's chances of giving birth by C-section are uncomfortably dependent upon where she delivers her baby.\u003c/p>\n\u003cp>Overall, just over 27 percent of healthy women in California deliver their babies by C-section. But that's an average. At hospitals across the state, the C-section rate ranges from 10 to a whopping 70 percent.\u003c/p>\n\u003cp>That’s a problem because C-sections are \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/cmqcc-publications/white-paper-cesarean-deliveries\" target=\"_blank\">major surgeries that carry risks\u003c/a> of infection, uncontrolled bleeding, blood transfusions, blood clots, and postpartum depression. They’re also correlated with a lower breastfeeding rate, which is detrimental both to mother and baby.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It doesn't have to be this way. Other developed countries have far lower C-section rates. Only about one in five —or 20 percent—of Finnish, French and Swedish babies are born this way.\u003c/p>\n\u003cp>Earlier this year the World Health Organization \u003ca href=\"http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/\" target=\"_blank\">released a statement\u003c/a> saying the \"ideal rate\" for C-sections is between 10 and 15 percent, about half the average rate in California. While C-sections can save lives both for mothers and babies, that's only true up to a point. The WHO says globally the number of maternal and newborn deaths go down as C-section rates rise towards 10 percent. After that, there is no improvement.\u003c/p>\n\u003cp>Beyond being risky, C-sections — the \u003ca href=\"http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm\" target=\"_blank\">most commonly performed \u003c/a>surgery in the U.S. — are expensive, about $15,000-$20,000 per birth. Both nationally and in California, Medicaid pays for roughly half of all births.\u003c/p>\n\u003cp>Policymakers see lowering the C-section rates as wins both for patient health and state coffers. The U.S. government has set a national target of 23.9 percent as part of its \u003ca href=\"http://www.healthypeople.gov/2020/topics-objectives/objective/mich-71\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. To meet that benchmark, 60 percent of California hospitals need to reduce their C-section rates.\u003c/p>\n\u003cp>\u003cstrong>One route: Using Nurse Midwives \u003c/strong>\u003c/p>\n\u003cp>If any woman has tried hard to have a vaginal birth, it has been Edwina Brown. Brown moved to California from the U.K. with her husband last year. The couple was expecting their first child, who was born last September.\u003c/p>\n\u003cp>For several months she saw an obstetrician. She chose to switch to nurse midwives. The preference was partially cultural, she says. In her native England midwives attend 80 percent of all births. In the U.S. they are present for just 8 percent.\u003c/p>\n\u003cp>\"At the obstetrician's I felt that there was less room for questions and discussion about the testing they were doing, and how the birth would be,\" says Brown from her home in Petaluma, cradling Lily in her arms.\u003c/p>\n\u003cp>\"With the midwives, I felt it was much more supportive. They wanted to listen and understand what you wanted and---while keeping baby and mum safe---find a way to respect your wishes.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"WPmIYP70LrUKZEjJkcHPyr8TEsXjYxw6\"]Brown delivered at Marin General Hospital, where, several years ago, the hospital changed staffing protocols in an effort to reduce C-sections. (The change was independent of any direction from CHCF.)\u003c/p>\n\u003cp>Years of data had shown two populations of women within in the hospital consistently maintained significantly different C-section rates. Privately insured women averaged 32 percent, while publicly insured women averaged only 16. A similar discrepancy is seen in many other hospitals.\u003c/p>\n\u003cp>Nurse midwives provided most of the care for publicly-insured women. A 24-hour laborist -- a doctor who specializes in delivering babies -- was always on hand to operate or give assistance if needed. Privately insured women followed the more traditional U.S model. Their private physicians would leave busy practices and lives to deliver at the hospital when the baby was expected.\u003c/p>\n\u003cp>In 2011 the hospital revamped its staffing so that all expecting mothers would have access to 24-hour midwives and a 24-hour laborist. The change caught the attention of Melissa Rosenstein with UC, San Francisco's Center for Reproductive Science.\u003c/p>\n\u003cp>\"Laborists are becoming more popular, but there isn’t a ton of data on what the outcomes are,\" she says. \"And it's the same with midwives. There is plenty of data about how safe and effective midwifery is, but not as much as research on what the effect is on cesarean delivery rates, so we thought this would be an excellent natural experiment since this practice change was going to happen.\"\u003c/p>\n\u003cp>In a study published last September in \u003ca href=\"http://journals.lww.com/greenjournal/Fulltext/2015/10000/The_Association_of_Expanded_Access_to_a.5.aspx\" target=\"_blank\">Obstetrics & Gynecology\u003c/a>, Rosenstein and her colleagues reported a significant drop in privately insured women's C-section rates -- from 31.7 to 25 percent -- between 2011 and 2014.\u003c/p>\n\u003cp>\"It was our working hypothesis that we would see a decrease,\" she says, \"but it was more dramatic than we expected.\"\u003c/p>\n\u003cp>Though every C-section seems necessary in the moment, Rosenstein says, \"the truth is there are very few indications that a woman really needs one, there is usually a little wiggle room.\" If physicians work on labor and delivery exclusively, then they can be \"a little bit more patient,\" she added, and wait for a vaginal delivery.\u003c/p>\n\u003cp>Sherri Matteo, one of the certified nurse midwives at Marin General Hospital, says women and doctors don't always know what women are capable of.\u003c/p>\n\u003cp>\"Even when they think, 'Oh! You’re going to have a 12-pound baby? You can’t possibly have this baby vaginally.' I can tell you from experience that some women can. Until you allow a trial of labor, and allow a woman’s body to do what it’s supposed to do, we don’t know for sure.\"\u003c/p>\n\u003cp>There are clear exceptions. When a baby is in a breech position -- when the bottom or feet, rather than the head, will be the first to come out -- is not supported for vaginal delivery by most U.S. doctors and hospitals.\u003c/p>\n\u003cp>That's what happened to Brown's baby and she was desperate for the baby to turn head down.\u003c/p>\n\u003cp>\"I didn’t want a cesarean but I knew it was a possibility from week 32,\" she says. Brown had bad dreams about waking up on an operating table, but says her relationship with hospital staff helped allay her anxiety. In the end she did have a C-section -- efforts to manually turn Lily in the hospital prior to delivery weren't successful -- but she feels the birth was a better experience than it would have been if led by a physician.\u003c/p>\n\u003cp>\"I felt so supported the entire time,\" Brown says.\u003c/p>\n\u003cp>\u003cstrong>Carrots and Sticks\u003c/strong>\u003c/p>\n\u003cp>Hospitals don't have to embrace the nurse midwife model to reduce their C-section rates, however. In fact, with so few midwives and midwife training programs in California, there would not be enough to meet the needs of the state, says Stephanie Teleki, who is overseeing the CHCF effort to reduce c-sections.\u003c/p>\n\u003cp>\"You need to pull a lot of different levers to make these changes,\" she says. \"Nurse midwives could be part of the long-term solution, but in the short-term we'll need to be creative about how to get this done.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"Y9SYFgtQLgVTVLaiPzqUNatniraxX0gv\"]Hoag Memorial Hospital Presbyterian in Orange County, under pressure from large employers and groups like the Pacific Business Group on Health, \u003ca href=\"http://pbgh.org/storage/documents/TMC_Case_Study_Oct_2015.pdf\" target=\"_blank\">reduced C-section rates by 20 percent \u003c/a>over 15 months through a suite of measures, some carrots, some sticks. Administrators shared the C-section rates of individual doctors. Large insurance buyers like Disney and Blue Shield altered payments so that hospitals didn't earn more from elective C-sections than from vaginal births. And nurses received end-of-the-year bonuses if they helped the hospital reach its goals. Hoag became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/10/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry/\" target=\"_blank\"> a test case for measures\u003c/a> that will be taken around the state, under the CHCF's initiative.\u003c/p>\n\u003cp>One key aspect of the CHCF's plan is to fund a \"\u003ca href=\"https://www.cmqcc.org/projects/support-vaginal-birth-and-reduce-primary-cesarean-delivery)\" target=\"_blank\">toolkit\u003c/a>,\" prepared by the California Maternal Quality Care Collaborative, a nonprofit group comprised of several dozen public and private agencies and funded by CHCF and the Centers for Disease Control, among others. It's due out in March 2016. The California HealthCare Foundation is also funding medical professionals to assist about 60 hospitals in implementing the guidelines.\u003c/p>\n\u003cp>Teleki says they're particularly interested in reaching hospitals in Los Angeles, San Diego and Orange counties. \"(T)hat is where the birth rate is the highest and C-section rates are also very high,\" she says. \"If we double down in some of those markets it's a real opportunity to not only impact those areas but to move the needle statewide.\"\u003c/p>\n\u003cp>In what will perhaps be the most impactful step, the foundation plans to work with groups of health care purchasers to make C-sections less profitable.\u003c/p>\n\u003cp>This could mean the wider use of \"bundled payments,\" where hospitals are paid a per-birth rate, instead of being paid a higher rate for C-sections, as they are now. At a flat rate, hospitals should preferentially slant toward vaginal births.\u003c/p>\n\u003cp>Ultimately, says Teleki, it will be critical to financially reward providers for promoting vaginal birth.\u003c/p>\n\u003cp>\"There might be some do-gooders right now,\" she says. \"But if hospitals earn more money to do C-sections, it's hard to then say, 'Now please lower your c-sections.'\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>\u003cem>This post was updated to clarify the range of C-section rates at California hospitals. The rates at individual hospitals range from 10 to 70 percent.\u003c/em>\u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California is preparing to launch an ambitious plan to reduce C-sections rates. If successful, that reduction will save taxpayer money and keep both mothers and babies healthier.\u003c/p>\n\u003cp>Kicking off in early 2016, \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20ReducingCSectionsFlier.pdf\" target=\"_blank\">the plan\u003c/a> funded by the Oakland-based California HealthCare Foundation is meant to financially reward hospitals for vaginal births and reduce the pressure on doctors and laboring mothers to deliver quickly.\u003c/p>\n\u003cp>Last year, amid increasing attention to maternal care by health advocates, CHCF released \u003ca href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">an alarming report\u003c/a>. A healthy pregnant woman's chances of giving birth by C-section are uncomfortably dependent upon where she delivers her baby.\u003c/p>\n\u003cp>Overall, just over 27 percent of healthy women in California deliver their babies by C-section. But that's an average. At hospitals across the state, the C-section rate ranges from 10 to a whopping 70 percent.\u003c/p>\n\u003cp>That’s a problem because C-sections are \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/cmqcc-publications/white-paper-cesarean-deliveries\" target=\"_blank\">major surgeries that carry risks\u003c/a> of infection, uncontrolled bleeding, blood transfusions, blood clots, and postpartum depression. They’re also correlated with a lower breastfeeding rate, which is detrimental both to mother and baby.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It doesn't have to be this way. Other developed countries have far lower C-section rates. Only about one in five —or 20 percent—of Finnish, French and Swedish babies are born this way.\u003c/p>\n\u003cp>Earlier this year the World Health Organization \u003ca href=\"http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/\" target=\"_blank\">released a statement\u003c/a> saying the \"ideal rate\" for C-sections is between 10 and 15 percent, about half the average rate in California. While C-sections can save lives both for mothers and babies, that's only true up to a point. The WHO says globally the number of maternal and newborn deaths go down as C-section rates rise towards 10 percent. After that, there is no improvement.\u003c/p>\n\u003cp>Beyond being risky, C-sections — the \u003ca href=\"http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm\" target=\"_blank\">most commonly performed \u003c/a>surgery in the U.S. — are expensive, about $15,000-$20,000 per birth. Both nationally and in California, Medicaid pays for roughly half of all births.\u003c/p>\n\u003cp>Policymakers see lowering the C-section rates as wins both for patient health and state coffers. The U.S. government has set a national target of 23.9 percent as part of its \u003ca href=\"http://www.healthypeople.gov/2020/topics-objectives/objective/mich-71\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. To meet that benchmark, 60 percent of California hospitals need to reduce their C-section rates.\u003c/p>\n\u003cp>\u003cstrong>One route: Using Nurse Midwives \u003c/strong>\u003c/p>\n\u003cp>If any woman has tried hard to have a vaginal birth, it has been Edwina Brown. Brown moved to California from the U.K. with her husband last year. The couple was expecting their first child, who was born last September.\u003c/p>\n\u003cp>For several months she saw an obstetrician. She chose to switch to nurse midwives. The preference was partially cultural, she says. In her native England midwives attend 80 percent of all births. In the U.S. they are present for just 8 percent.\u003c/p>\n\u003cp>\"At the obstetrician's I felt that there was less room for questions and discussion about the testing they were doing, and how the birth would be,\" says Brown from her home in Petaluma, cradling Lily in her arms.\u003c/p>\n\u003cp>\"With the midwives, I felt it was much more supportive. They wanted to listen and understand what you wanted and---while keeping baby and mum safe---find a way to respect your wishes.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Brown delivered at Marin General Hospital, where, several years ago, the hospital changed staffing protocols in an effort to reduce C-sections. (The change was independent of any direction from CHCF.)\u003c/p>\n\u003cp>Years of data had shown two populations of women within in the hospital consistently maintained significantly different C-section rates. Privately insured women averaged 32 percent, while publicly insured women averaged only 16. A similar discrepancy is seen in many other hospitals.\u003c/p>\n\u003cp>Nurse midwives provided most of the care for publicly-insured women. A 24-hour laborist -- a doctor who specializes in delivering babies -- was always on hand to operate or give assistance if needed. Privately insured women followed the more traditional U.S model. Their private physicians would leave busy practices and lives to deliver at the hospital when the baby was expected.\u003c/p>\n\u003cp>In 2011 the hospital revamped its staffing so that all expecting mothers would have access to 24-hour midwives and a 24-hour laborist. The change caught the attention of Melissa Rosenstein with UC, San Francisco's Center for Reproductive Science.\u003c/p>\n\u003cp>\"Laborists are becoming more popular, but there isn’t a ton of data on what the outcomes are,\" she says. \"And it's the same with midwives. There is plenty of data about how safe and effective midwifery is, but not as much as research on what the effect is on cesarean delivery rates, so we thought this would be an excellent natural experiment since this practice change was going to happen.\"\u003c/p>\n\u003cp>In a study published last September in \u003ca href=\"http://journals.lww.com/greenjournal/Fulltext/2015/10000/The_Association_of_Expanded_Access_to_a.5.aspx\" target=\"_blank\">Obstetrics & Gynecology\u003c/a>, Rosenstein and her colleagues reported a significant drop in privately insured women's C-section rates -- from 31.7 to 25 percent -- between 2011 and 2014.\u003c/p>\n\u003cp>\"It was our working hypothesis that we would see a decrease,\" she says, \"but it was more dramatic than we expected.\"\u003c/p>\n\u003cp>Though every C-section seems necessary in the moment, Rosenstein says, \"the truth is there are very few indications that a woman really needs one, there is usually a little wiggle room.\" If physicians work on labor and delivery exclusively, then they can be \"a little bit more patient,\" she added, and wait for a vaginal delivery.\u003c/p>\n\u003cp>Sherri Matteo, one of the certified nurse midwives at Marin General Hospital, says women and doctors don't always know what women are capable of.\u003c/p>\n\u003cp>\"Even when they think, 'Oh! You’re going to have a 12-pound baby? You can’t possibly have this baby vaginally.' I can tell you from experience that some women can. Until you allow a trial of labor, and allow a woman’s body to do what it’s supposed to do, we don’t know for sure.\"\u003c/p>\n\u003cp>There are clear exceptions. When a baby is in a breech position -- when the bottom or feet, rather than the head, will be the first to come out -- is not supported for vaginal delivery by most U.S. doctors and hospitals.\u003c/p>\n\u003cp>That's what happened to Brown's baby and she was desperate for the baby to turn head down.\u003c/p>\n\u003cp>\"I didn’t want a cesarean but I knew it was a possibility from week 32,\" she says. Brown had bad dreams about waking up on an operating table, but says her relationship with hospital staff helped allay her anxiety. In the end she did have a C-section -- efforts to manually turn Lily in the hospital prior to delivery weren't successful -- but she feels the birth was a better experience than it would have been if led by a physician.\u003c/p>\n\u003cp>\"I felt so supported the entire time,\" Brown says.\u003c/p>\n\u003cp>\u003cstrong>Carrots and Sticks\u003c/strong>\u003c/p>\n\u003cp>Hospitals don't have to embrace the nurse midwife model to reduce their C-section rates, however. In fact, with so few midwives and midwife training programs in California, there would not be enough to meet the needs of the state, says Stephanie Teleki, who is overseeing the CHCF effort to reduce c-sections.\u003c/p>\n\u003cp>\"You need to pull a lot of different levers to make these changes,\" she says. \"Nurse midwives could be part of the long-term solution, but in the short-term we'll need to be creative about how to get this done.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Hoag Memorial Hospital Presbyterian in Orange County, under pressure from large employers and groups like the Pacific Business Group on Health, \u003ca href=\"http://pbgh.org/storage/documents/TMC_Case_Study_Oct_2015.pdf\" target=\"_blank\">reduced C-section rates by 20 percent \u003c/a>over 15 months through a suite of measures, some carrots, some sticks. Administrators shared the C-section rates of individual doctors. Large insurance buyers like Disney and Blue Shield altered payments so that hospitals didn't earn more from elective C-sections than from vaginal births. And nurses received end-of-the-year bonuses if they helped the hospital reach its goals. Hoag became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/10/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry/\" target=\"_blank\"> a test case for measures\u003c/a> that will be taken around the state, under the CHCF's initiative.\u003c/p>\n\u003cp>One key aspect of the CHCF's plan is to fund a \"\u003ca href=\"https://www.cmqcc.org/projects/support-vaginal-birth-and-reduce-primary-cesarean-delivery)\" target=\"_blank\">toolkit\u003c/a>,\" prepared by the California Maternal Quality Care Collaborative, a nonprofit group comprised of several dozen public and private agencies and funded by CHCF and the Centers for Disease Control, among others. It's due out in March 2016. The California HealthCare Foundation is also funding medical professionals to assist about 60 hospitals in implementing the guidelines.\u003c/p>\n\u003cp>Teleki says they're particularly interested in reaching hospitals in Los Angeles, San Diego and Orange counties. \"(T)hat is where the birth rate is the highest and C-section rates are also very high,\" she says. \"If we double down in some of those markets it's a real opportunity to not only impact those areas but to move the needle statewide.\"\u003c/p>\n\u003cp>In what will perhaps be the most impactful step, the foundation plans to work with groups of health care purchasers to make C-sections less profitable.\u003c/p>\n\u003cp>This could mean the wider use of \"bundled payments,\" where hospitals are paid a per-birth rate, instead of being paid a higher rate for C-sections, as they are now. At a flat rate, hospitals should preferentially slant toward vaginal births.\u003c/p>\n\u003cp>Ultimately, says Teleki, it will be critical to financially reward providers for promoting vaginal birth.\u003c/p>\n\u003cp>\"There might be some do-gooders right now,\" she says. \"But if hospitals earn more money to do C-sections, it's hard to then say, 'Now please lower your c-sections.'\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003cem>This post was updated to clarify the range of C-section rates at California hospitals. The rates at individual hospitals range from 10 to 70 percent.\u003c/em>\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New California Database to Help Doctors Spot Prescription Drug Abuse",
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"content": "\u003cp>Long plagued by technical problems, the state’s prescription drug database has finally been overhauled. State officials will fully launch the new system Friday, Jan. 8, when all doctors will be automatically upgraded to the new system.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We had a single patient go to 116 prescribers over four years, and got 45,000 dosage units of controlled substances worth at least $850,000 on the street.'\u003ccite> Virginia Herold, state Board of Pharmacy \u003c/cite>\u003c/aside>\n\u003cp>Health officials now refer to prescription drug addiction as an epidemic. More Americans die from \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">prescription opioid overdose \u003c/a>than in \u003ca href=\"http://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html\" target=\"_blank\">drunken-driving car crashes,\u003c/a> according to data from the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>California regulators have been preoccupied for years with doctor shoppers.\u003c/p>\n\u003cp>“We had a single patient go to 116 prescribers over four years, and went to 58 pharmacies and got 45,000 dosage units of controlled substances worth at least $850,000 on the street,” said Virginia Herold, executive officer of the state Board of Pharmacy.\u003c/p>\n\u003cp>Pharmacists are required to report all drugs they dispense in the state’s prescription drug database, known as the Controlled Substance Utilization Review and Evaluation System, or CURES.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But neither pharmacists nor doctors are required to check the database before dispensing or writing new prescriptions.\u003c/p>\n\u003cp>\"If any of those 58 pharmacies or 116 practitioners would have checked, they would have seen that the patient in front of them, that may have only been in there once every 30 days, was actually going to other places and to multiple prescribers to get the medication,\" Herold said.\u003c/p>\n\u003cp>Pharmacists and doctors have complained for years that the reason they don’t use the system is because of a long history of technical glitches. In the past, for example, doctors had to submit paper registration materials to the Department of Justice just to get a login and password, a process that took as long as six months for some doctors.\u003c/p>\n\u003cp>“There’s been a huge backlog at the DOJ,” said Molly Weedn, spokeswoman for the California Medical Association. “People want it to be a usable system, but in the past few years, it’s been severely understaffed and underfunded.”\u003c/p>\n\u003cp>Funding for the database was slashed in 2009 when the economic recession hit, leaving the technical problems to linger. \u003ca href=\"http://audio.californiareport.org/archive/R201202140850/a\" target=\"_blank\">More cuts followed in 2012\u003c/a>.\u003c/p>\n\u003cp>In 2013, the state Legislature passed SB809, which charged doctors a $6 annual fee when renewing their medical license to provide funds for database improvements. The state slowly began rolling out CURES 2.0 this past summer, and after fixing a Web browser compatibility problem, will do so universally in the new year.\u003c/p>\n\u003cp>“The new system is more user-friendly,” said Deputy Attorney General Robert Sumner, who oversees IT projects for the Department of Justice. “It’s faster, it’s more responsive, it’s more intuitive.”\u003c/p>\n\u003cp>It also allows doctors to delegate searches to nurses, so a nurse can cue up a patient’s prescription drug record for the doctor prior to a consultation, and includes a number of patient alerts.\u003c/p>\n\u003cp>\"Physicians will automatically be told if, based on their prescription history, the algorithm has picked up that the patient might be at risk for doctor shopping,” Sumner said. “Whether or not you’ve gone to a number of different prescribers, whether or not you’ve been given a number of different prescriptions in volumes, and also the frequency at which you’ve been receiving prescriptions.”\u003c/p>\n\u003cp>Despite the improvements, safety advocate Bob Pack is still not satisfied. He says the only way the database will really work is if doctors are required to use it.\u003c/p>\n\u003cp>“I’ve been disappointed all along,” he said. “I’ve always believed it needed to be a mandatory requirement.”\u003c/p>\n\u003cp>In 2003, Pack’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/30/prop-46-was-inspired-by-tragic-accident-pits-doctors-against-lawyers/\" target=\"_blank\">two children were killed by a driver \u003c/a>who was high on prescription drugs, which she had obtained from multiple doctors. Ever since, Pack has pushed for redevelopment of the database, convincing his local representatives to write various bills, including SB809, which provided the funding to update the database, and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/13/should-california-doctors-be-required-to-use-drug-monitoring-database/\" target=\"_blank\">a pending bill\u003c/a>, SB482, which would require doctors to consult a patient’s medical history before prescribing narcotics for the first time.\u003c/p>\n\u003cp>“I wanted this thing to be mandatory for the last nine years,” Pack said. “But the medical lobby keeps fighting this.”\u003c/p>\n\u003cp>The California Medical Association says it will wait to see how well the new system works before agreeing to any requirements.\u003c/p>\n\u003cp>“Before we make the system mandatory, let’s make sure it’s functional,” said Weedn.\u003c/p>\n\u003cp>While 49 states have a prescription drug database in one form or another, only about 10 states require doctors and pharmacists to check it before writing new prescriptions, including Kentucky and New York. Some studies show that the number of narcotic prescriptions written in those states went down after the mandate, and enrollment in addiction treatment went up, though it is unclear if some drug abusers may have turned to street drugs instead.\u003c/p>\n\u003cp>Congressman Mark DeSaulnier, D-California, who authored SB809 when he was a state assemblyman representing Walnut Creek, says he wants to bring some of these reforms to the national level, starting with incentivizing states to upgrade their systems.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>These can be wonderful drugs,” he said, “but they're disastrous if not used right.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Long plagued by technical problems, the state’s prescription drug database has finally been overhauled. State officials will fully launch the new system Friday, Jan. 8, when all doctors will be automatically upgraded to the new system.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We had a single patient go to 116 prescribers over four years, and got 45,000 dosage units of controlled substances worth at least $850,000 on the street.'\u003ccite> Virginia Herold, state Board of Pharmacy \u003c/cite>\u003c/aside>\n\u003cp>Health officials now refer to prescription drug addiction as an epidemic. More Americans die from \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">prescription opioid overdose \u003c/a>than in \u003ca href=\"http://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html\" target=\"_blank\">drunken-driving car crashes,\u003c/a> according to data from the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>California regulators have been preoccupied for years with doctor shoppers.\u003c/p>\n\u003cp>“We had a single patient go to 116 prescribers over four years, and went to 58 pharmacies and got 45,000 dosage units of controlled substances worth at least $850,000 on the street,” said Virginia Herold, executive officer of the state Board of Pharmacy.\u003c/p>\n\u003cp>Pharmacists are required to report all drugs they dispense in the state’s prescription drug database, known as the Controlled Substance Utilization Review and Evaluation System, or CURES.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But neither pharmacists nor doctors are required to check the database before dispensing or writing new prescriptions.\u003c/p>\n\u003cp>\"If any of those 58 pharmacies or 116 practitioners would have checked, they would have seen that the patient in front of them, that may have only been in there once every 30 days, was actually going to other places and to multiple prescribers to get the medication,\" Herold said.\u003c/p>\n\u003cp>Pharmacists and doctors have complained for years that the reason they don’t use the system is because of a long history of technical glitches. In the past, for example, doctors had to submit paper registration materials to the Department of Justice just to get a login and password, a process that took as long as six months for some doctors.\u003c/p>\n\u003cp>“There’s been a huge backlog at the DOJ,” said Molly Weedn, spokeswoman for the California Medical Association. “People want it to be a usable system, but in the past few years, it’s been severely understaffed and underfunded.”\u003c/p>\n\u003cp>Funding for the database was slashed in 2009 when the economic recession hit, leaving the technical problems to linger. \u003ca href=\"http://audio.californiareport.org/archive/R201202140850/a\" target=\"_blank\">More cuts followed in 2012\u003c/a>.\u003c/p>\n\u003cp>In 2013, the state Legislature passed SB809, which charged doctors a $6 annual fee when renewing their medical license to provide funds for database improvements. The state slowly began rolling out CURES 2.0 this past summer, and after fixing a Web browser compatibility problem, will do so universally in the new year.\u003c/p>\n\u003cp>“The new system is more user-friendly,” said Deputy Attorney General Robert Sumner, who oversees IT projects for the Department of Justice. “It’s faster, it’s more responsive, it’s more intuitive.”\u003c/p>\n\u003cp>It also allows doctors to delegate searches to nurses, so a nurse can cue up a patient’s prescription drug record for the doctor prior to a consultation, and includes a number of patient alerts.\u003c/p>\n\u003cp>\"Physicians will automatically be told if, based on their prescription history, the algorithm has picked up that the patient might be at risk for doctor shopping,” Sumner said. “Whether or not you’ve gone to a number of different prescribers, whether or not you’ve been given a number of different prescriptions in volumes, and also the frequency at which you’ve been receiving prescriptions.”\u003c/p>\n\u003cp>Despite the improvements, safety advocate Bob Pack is still not satisfied. He says the only way the database will really work is if doctors are required to use it.\u003c/p>\n\u003cp>“I’ve been disappointed all along,” he said. “I’ve always believed it needed to be a mandatory requirement.”\u003c/p>\n\u003cp>In 2003, Pack’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/30/prop-46-was-inspired-by-tragic-accident-pits-doctors-against-lawyers/\" target=\"_blank\">two children were killed by a driver \u003c/a>who was high on prescription drugs, which she had obtained from multiple doctors. Ever since, Pack has pushed for redevelopment of the database, convincing his local representatives to write various bills, including SB809, which provided the funding to update the database, and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/13/should-california-doctors-be-required-to-use-drug-monitoring-database/\" target=\"_blank\">a pending bill\u003c/a>, SB482, which would require doctors to consult a patient’s medical history before prescribing narcotics for the first time.\u003c/p>\n\u003cp>“I wanted this thing to be mandatory for the last nine years,” Pack said. “But the medical lobby keeps fighting this.”\u003c/p>\n\u003cp>The California Medical Association says it will wait to see how well the new system works before agreeing to any requirements.\u003c/p>\n\u003cp>“Before we make the system mandatory, let’s make sure it’s functional,” said Weedn.\u003c/p>\n\u003cp>While 49 states have a prescription drug database in one form or another, only about 10 states require doctors and pharmacists to check it before writing new prescriptions, including Kentucky and New York. Some studies show that the number of narcotic prescriptions written in those states went down after the mandate, and enrollment in addiction treatment went up, though it is unclear if some drug abusers may have turned to street drugs instead.\u003c/p>\n\u003cp>Congressman Mark DeSaulnier, D-California, who authored SB809 when he was a state assemblyman representing Walnut Creek, says he wants to bring some of these reforms to the national level, starting with incentivizing states to upgrade their systems.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>These can be wonderful drugs,” he said, “but they're disastrous if not used right.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "redding-woman-sues-over-tubal-ligation-denial-by-catholic-hospital",
"title": "Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation",
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"headTitle": "Judge to Consider Emergency Appeal for Redding Woman’s Tubal Ligation | KQED",
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"content": "\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman’s contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical — part of Dignity Health — does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. “We shouldn’t allow religion or any hospital to decide what is best for a patient and her family,” said Dr. Pratima Gupta, a fellow with the organization. “It really should be in consultation with her doctor.”\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/240534476″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n",
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"headline": "Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman’s contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical — part of Dignity Health — does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. “We shouldn’t allow religion or any hospital to decide what is best for a patient and her family,” said Dr. Pratima Gupta, a fellow with the organization. “It really should be in consultation with her doctor.”\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/240534476″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/240534476″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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"radiolab": {
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"reveal": {
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},
"rightnowish": {
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"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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},
"science-friday": {
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"info": "Science Friday is a weekly science talk show, broadcast live over public radio stations nationwide. Each week, the show focuses on science topics that are in the news and tries to bring an educated, balanced discussion to bear on the scientific issues at hand. Panels of expert guests join host Ira Flatow, a veteran science journalist, to discuss science and to take questions from listeners during the call-in portion of the program.",
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"snap-judgment": {
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"title": "Snap Judgment",
"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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},
"soldout": {
"id": "soldout",
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