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"content": "\u003cp>It was late May when the body of the last person to die in the guest house of the \u003ca href=\"https://www.zenhospice.org/\" target=\"_blank\" rel=\"noopener\">Zen Hospice Project\u003c/a> was carried down the stairs and through the back garden, then sprinkled with flower petals.\u003c/p>\n\u003cp>The San Francisco institution was founded during the height of the AIDS crisis, a time when sick men were left to die alone in the hallways of county hospitals because staff were afraid to touch them. Buddhist practitioners bought the Victorian on Page Street to create a place where men could get compassionate care and die with dignity.\u003c/p>\n\u003cp>Now, after 30 years of caring for people with all kinds of illnesses, the house is closing its doors. The organization no longer has enough money to keep the program going.\u003c/p>\n\u003cp>“It’s a little chaotic in here,” says George Kellar, the executive director of the last two and a half years, as we walk through the foyer of the house. “It’s in total transition.”\u003c/p>\n\u003cp>All the furniture is gone. The floors are covered with canvas tarps. Blue tape lines the perimeter of the living room. Men in jumpsuits and face masks are painting the fireplace, tearing up the carpet on the stairway and power washing the windows.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the hospice issued its press release last week about this turn in the nonprofit’s fortunes, I noted the careful wording — that the guest house was “suspending” caregiving services, that they hoped they could “offer them again, at some point.” The implication was clear: Maybe a local tech billionaire could step in with a Hail Mary donation.\u003c/p>\n\u003cp>But this is a house that’s being primed for a realtor to stage it and put it up for sale.\u003c/p>\n\u003cp>“Five bedrooms, three bathrooms. It has a boarding house feel to it,” Kellar says as he gives me a tour of the upstairs. “It probably has that kind of history.”\u003c/p>\n\u003cp>Before the beds were cleared out, before all the nurses were laid off, the guest house had room for six residents. They called them “residents” not “patients.” This was their home, not a hospice. And they came here not to die, but to live fully until the end of their lives.\u003c/p>\n\u003cp>A corps of volunteers would sit with patients, sometimes for hours — just holding their hand, telling stories, singing songs. Kitchen staff prepared three meals a day to order for each resident, even when they could no longer eat.\u003c/p>\n\u003cp>“They can smell it, they can see it, if they want to taste that they can,\" Kellar says, adding that it's about letting the residents know \"they’re not discarded and ignored and not important.\"\u003c/p>\n\u003cp>The organization became a pioneer in what it means to die well. It helped shape a national movement away from sterile hospital deaths — hooked up to machines — to a mindful, aesthetic end that emphasized being present with what was happening.\u003c/p>\n\u003cp>Donors loved the mission and they were generous. Until the 2016 election.\u003c/p>\n\u003cp>“We’ve been struggling through 2017,” Kellar says.\u003c/p>\n\u003cp>This year, they’re more than $1 million short on their $2 million annual budget. Donors have been telling Kellar they have to cut back on their gifts to the hospice because they need to support issues that have come under attack during the Trump administration.\u003c/p>\n\u003cp>“Voting rights, or women in politics, or immigration help,” Kellar lists the other causes drawing donations instead of his organization. “And homeless, there’s a lot of interest in helping the homeless situation.”\u003c/p>\n\u003cfigure id=\"attachment_364227\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364227\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/George-Kellar-looks-at-ZHP-art-book-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Kellar flips through a binder of art and embroidery pieces created by residents who died at the Zen Hospice Project's guest house. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nationally, philanthropy experts are waiting to see if this is a broader trend. The economy is strong right now and charitable giving has increased since the 2016 election, says Stacy Palmer, editor of the Chronicle of Philanthropy. But it’s unclear if people are giving more overall or shifting their dollars to issues that are in the news a lot.\u003c/p>\n\u003cp>“People really have to make choices about which charities they care about the most,” Palmer says, and in a time of shifting priorities, it can be harder to get people to open their wallets when it comes to end-of-life issues.\u003c/p>\n\u003cp>“People don’t really like to hear about death, even though what hospices do is really make death so much easier. It’s a tough conversation,” she says. “Sometimes really important causes are the ones that suffer just because they are dealing with difficult subjects.”\u003c/p>\n\u003cp>But some of the blame sits with the Zen Hospice Project itself. It relied too much on loyal donors, and didn’t cultivate enough new ones, Kellar says. And, for all these years, the hospice has declined to get licensed under the government’s Medicare and Medicaid programs, closing the door on a steady stream of reimbursement payments.\u003c/p>\n\u003cp>“We don’t want to compromise our commitment to this compassionate model,” Kellar explains. “And if that commitment is compromised by the reporting requirements or by the regulatory requirements, we don’t want to go there.”\u003c/p>\n\u003cp>But idealism doesn’t pay the bills. And that’s one of the reasons Kellar was brought in four years ago: to bring some business savvy to the nonprofit. He’s a Zen Buddhist, and he’s also a Silicon Valley guy — a software engineer with a background in sales and operations.\u003c/p>\n\u003cp>At first, he became right-hand man to the executive director at the time, BJ Miller, a doctor and a charismatic visionary who put the Zen Hospice Project in the national conscience through a high-profile New York Times \u003ca href=\"https://www.nytimes.com/2017/01/03/magazine/one-mans-quest-to-change-the-way-we-die.html\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> and a \u003ca href=\"https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life\">TED talk\u003c/a> that’s been viewed more than 7.5 million times. In it, Miller talks about the importance of “sensuous, aesthetic gratification” at the end of life and how the Zen Hospice Project wants to help people enjoy the last of their time by way of the five senses.\u003c/p>\n\u003cp>“Seriously, with all the heavy-duty stuff happening under our roof, one of the most tried and true interventions we know of is to bake cookies,” he said, the smell providing sustenance on so many levels. “As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.”\u003c/p>\n\u003cfigure id=\"attachment_364225\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364225\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/ZHP-Cookie-Book-close-up-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Zen Hospice Project's cookie recipe book sits with other nostalgic items moved out of the guest house as it is readied for sale. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kellar, on the other hand, talks about marketing and distribution and “scaling” operations.\u003c/p>\n\u003cp>“I am using businesslike terms to talk about it, but I think you have to,” he says.\u003c/p>\n\u003cp>When he took over the executive director position, the budget troubles were officially his responsibility.\u003c/p>\n\u003cp>One strategy he pursued was negotiating a partnership with some private insurance companies to have them reimburse for some of the hospice’s services. It’s an appealing value proposition for insurers: It costs $850 a day to care for each patient at the hospice, compared to the thousands and thousands of dollars in daily costs for someone to die in an ICU.\u003c/p>\n\u003cp>But after 18 months, there was still no agreement.\u003c/p>\n\u003cp>“We could no longer wait,” Kellar says.\u003c/p>\n\u003cp>Kellar presented the numbers to the board of directors, and they agreed they could no longer afford to keep the guest house going.\u003c/p>\n\u003cp>“As difficult and sad as it is, which it is, we’re letting it go,” Kellar says. “And that will create another space for something else to present itself. And maybe that something else is this massive opportunity.”\u003c/p>\n\u003cp>That could be an opportunity presented by the \u003ca href=\"https://www.caregiver.org/caregiver-statistics-demographics\" target=\"_blank\" rel=\"noopener\">43 million\u003c/a> informal caregivers in the U.S. — people taking care of their own ailing parents, spouses, or children — who need help. Kellar says if Zen Hospice Project sells the guest house, the organization can reinvest that money into its other programs: the volunteer program, which sends people to sit with the dying in the hospice floor of Laguna Honda Hospital, and the\u003ca href=\"https://www.zenhospice.org/education-training/mce/\" target=\"_blank\" rel=\"noopener\">Mindful Caregiver Education program\u003c/a>, which emphasizes caregivers taking care of themselves so they can take better care of others.\u003c/p>\n\u003cp>“Our mission is to transform the experience of dying and caregiving,” Kellar says. “And while we started at the bedside and continue at the bedside at Laguna Honda, it is now a time to focus on helping other people at the bedside by training and education.”\u003c/p>\n\u003cp>But selling this iconic San Francisco institution to as a private residence for 5 or 6 million dollars?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It’s not what I expected,” Kellar says, shifting from business guy to Zen guy. “I guess it’s a lesson in impermanence. And a lesson in ‘things change' and to not get as attached as we are because everybody here is very attached to this.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was late May when the body of the last person to die in the guest house of the \u003ca href=\"https://www.zenhospice.org/\" target=\"_blank\" rel=\"noopener\">Zen Hospice Project\u003c/a> was carried down the stairs and through the back garden, then sprinkled with flower petals.\u003c/p>\n\u003cp>The San Francisco institution was founded during the height of the AIDS crisis, a time when sick men were left to die alone in the hallways of county hospitals because staff were afraid to touch them. Buddhist practitioners bought the Victorian on Page Street to create a place where men could get compassionate care and die with dignity.\u003c/p>\n\u003cp>Now, after 30 years of caring for people with all kinds of illnesses, the house is closing its doors. The organization no longer has enough money to keep the program going.\u003c/p>\n\u003cp>“It’s a little chaotic in here,” says George Kellar, the executive director of the last two and a half years, as we walk through the foyer of the house. “It’s in total transition.”\u003c/p>\n\u003cp>All the furniture is gone. The floors are covered with canvas tarps. Blue tape lines the perimeter of the living room. Men in jumpsuits and face masks are painting the fireplace, tearing up the carpet on the stairway and power washing the windows.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the hospice issued its press release last week about this turn in the nonprofit’s fortunes, I noted the careful wording — that the guest house was “suspending” caregiving services, that they hoped they could “offer them again, at some point.” The implication was clear: Maybe a local tech billionaire could step in with a Hail Mary donation.\u003c/p>\n\u003cp>But this is a house that’s being primed for a realtor to stage it and put it up for sale.\u003c/p>\n\u003cp>“Five bedrooms, three bathrooms. It has a boarding house feel to it,” Kellar says as he gives me a tour of the upstairs. “It probably has that kind of history.”\u003c/p>\n\u003cp>Before the beds were cleared out, before all the nurses were laid off, the guest house had room for six residents. They called them “residents” not “patients.” This was their home, not a hospice. And they came here not to die, but to live fully until the end of their lives.\u003c/p>\n\u003cp>A corps of volunteers would sit with patients, sometimes for hours — just holding their hand, telling stories, singing songs. Kitchen staff prepared three meals a day to order for each resident, even when they could no longer eat.\u003c/p>\n\u003cp>“They can smell it, they can see it, if they want to taste that they can,\" Kellar says, adding that it's about letting the residents know \"they’re not discarded and ignored and not important.\"\u003c/p>\n\u003cp>The organization became a pioneer in what it means to die well. It helped shape a national movement away from sterile hospital deaths — hooked up to machines — to a mindful, aesthetic end that emphasized being present with what was happening.\u003c/p>\n\u003cp>Donors loved the mission and they were generous. Until the 2016 election.\u003c/p>\n\u003cp>“We’ve been struggling through 2017,” Kellar says.\u003c/p>\n\u003cp>This year, they’re more than $1 million short on their $2 million annual budget. Donors have been telling Kellar they have to cut back on their gifts to the hospice because they need to support issues that have come under attack during the Trump administration.\u003c/p>\n\u003cp>“Voting rights, or women in politics, or immigration help,” Kellar lists the other causes drawing donations instead of his organization. “And homeless, there’s a lot of interest in helping the homeless situation.”\u003c/p>\n\u003cfigure id=\"attachment_364227\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364227\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/George-Kellar-looks-at-ZHP-art-book-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Kellar flips through a binder of art and embroidery pieces created by residents who died at the Zen Hospice Project's guest house. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nationally, philanthropy experts are waiting to see if this is a broader trend. The economy is strong right now and charitable giving has increased since the 2016 election, says Stacy Palmer, editor of the Chronicle of Philanthropy. But it’s unclear if people are giving more overall or shifting their dollars to issues that are in the news a lot.\u003c/p>\n\u003cp>“People really have to make choices about which charities they care about the most,” Palmer says, and in a time of shifting priorities, it can be harder to get people to open their wallets when it comes to end-of-life issues.\u003c/p>\n\u003cp>“People don’t really like to hear about death, even though what hospices do is really make death so much easier. It’s a tough conversation,” she says. “Sometimes really important causes are the ones that suffer just because they are dealing with difficult subjects.”\u003c/p>\n\u003cp>But some of the blame sits with the Zen Hospice Project itself. It relied too much on loyal donors, and didn’t cultivate enough new ones, Kellar says. And, for all these years, the hospice has declined to get licensed under the government’s Medicare and Medicaid programs, closing the door on a steady stream of reimbursement payments.\u003c/p>\n\u003cp>“We don’t want to compromise our commitment to this compassionate model,” Kellar explains. “And if that commitment is compromised by the reporting requirements or by the regulatory requirements, we don’t want to go there.”\u003c/p>\n\u003cp>But idealism doesn’t pay the bills. And that’s one of the reasons Kellar was brought in four years ago: to bring some business savvy to the nonprofit. He’s a Zen Buddhist, and he’s also a Silicon Valley guy — a software engineer with a background in sales and operations.\u003c/p>\n\u003cp>At first, he became right-hand man to the executive director at the time, BJ Miller, a doctor and a charismatic visionary who put the Zen Hospice Project in the national conscience through a high-profile New York Times \u003ca href=\"https://www.nytimes.com/2017/01/03/magazine/one-mans-quest-to-change-the-way-we-die.html\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> and a \u003ca href=\"https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life\">TED talk\u003c/a> that’s been viewed more than 7.5 million times. In it, Miller talks about the importance of “sensuous, aesthetic gratification” at the end of life and how the Zen Hospice Project wants to help people enjoy the last of their time by way of the five senses.\u003c/p>\n\u003cp>“Seriously, with all the heavy-duty stuff happening under our roof, one of the most tried and true interventions we know of is to bake cookies,” he said, the smell providing sustenance on so many levels. “As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.”\u003c/p>\n\u003cfigure id=\"attachment_364225\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364225\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/ZHP-Cookie-Book-close-up-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Zen Hospice Project's cookie recipe book sits with other nostalgic items moved out of the guest house as it is readied for sale. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kellar, on the other hand, talks about marketing and distribution and “scaling” operations.\u003c/p>\n\u003cp>“I am using businesslike terms to talk about it, but I think you have to,” he says.\u003c/p>\n\u003cp>When he took over the executive director position, the budget troubles were officially his responsibility.\u003c/p>\n\u003cp>One strategy he pursued was negotiating a partnership with some private insurance companies to have them reimburse for some of the hospice’s services. It’s an appealing value proposition for insurers: It costs $850 a day to care for each patient at the hospice, compared to the thousands and thousands of dollars in daily costs for someone to die in an ICU.\u003c/p>\n\u003cp>But after 18 months, there was still no agreement.\u003c/p>\n\u003cp>“We could no longer wait,” Kellar says.\u003c/p>\n\u003cp>Kellar presented the numbers to the board of directors, and they agreed they could no longer afford to keep the guest house going.\u003c/p>\n\u003cp>“As difficult and sad as it is, which it is, we’re letting it go,” Kellar says. “And that will create another space for something else to present itself. And maybe that something else is this massive opportunity.”\u003c/p>\n\u003cp>That could be an opportunity presented by the \u003ca href=\"https://www.caregiver.org/caregiver-statistics-demographics\" target=\"_blank\" rel=\"noopener\">43 million\u003c/a> informal caregivers in the U.S. — people taking care of their own ailing parents, spouses, or children — who need help. Kellar says if Zen Hospice Project sells the guest house, the organization can reinvest that money into its other programs: the volunteer program, which sends people to sit with the dying in the hospice floor of Laguna Honda Hospital, and the\u003ca href=\"https://www.zenhospice.org/education-training/mce/\" target=\"_blank\" rel=\"noopener\">Mindful Caregiver Education program\u003c/a>, which emphasizes caregivers taking care of themselves so they can take better care of others.\u003c/p>\n\u003cp>“Our mission is to transform the experience of dying and caregiving,” Kellar says. “And while we started at the bedside and continue at the bedside at Laguna Honda, it is now a time to focus on helping other people at the bedside by training and education.”\u003c/p>\n\u003cp>But selling this iconic San Francisco institution to as a private residence for 5 or 6 million dollars?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s not what I expected,” Kellar says, shifting from business guy to Zen guy. “I guess it’s a lesson in impermanence. And a lesson in ‘things change' and to not get as attached as we are because everybody here is very attached to this.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Bartenders Learn How to Spot – and Reverse – Opioid Overdoses",
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"content": "\u003cp>Health educator Kristen Marshall made herself comfortable on a bright red, pleather sofa at St. Mary’s Pub in San Francisco. She welcomed a group of 10 people who trickled inside from the midday sun. Some wore funky glasses, others had sleeve tattoos.\u003c/p>\n\u003cp>Marshall unloaded a few items from a shoulder bag onto a two-top table in front of her, including a nasal sprayer of the drug Narcan – the brand name for naloxone, a drug that reverses opioid overdoses.\u003c/p>\n\u003cp>Typically, Marshall educates an audience of people who use drugs. But as the opioid crisis continues to devastate communities, Marshall and her colleagues from the \u003ca href=\"http://harmreduction.org/\" target=\"_blank\" rel=\"noopener\">Harm Reduction Coalition\u003c/a> are getting more creative in their approach to saving lives. At this training, Marshall’s assembled a group of bartenders and club and festival employees.\u003c/p>\n\u003cp>Immediately, Marshall fielded a question about a famous scene from the movie “Pulp Fiction,” in which actress Uma Thurman's character overdoses on drugs and is dramatically revived. Instead of naloxone, her rescuers stab her directly in the heart with a large needle full of adrenaline.\u003c/p>\n\u003cp>“Two things,” Marshall said to the group. “Adrenaline doesn’t work to reverse an opioid overdose, and please don’t stab anybody in the heart with anything.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The audience laughed as Marshall raised her hand in a fist and yelled, “Quentin Tarantino!” in a feigned rage.\u003c/p>\n\u003cfigure id=\"attachment_363843\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363843\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg\" alt=\"A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection.\" width=\"800\" height=\"525\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-160x105.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-768x504.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1020x670.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1200x788.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1180x775.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-960x630.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-240x158.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-375x246.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-520x341.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marshall then moved into more serious territory, speaking from her years of experience working at a needle exchange and sometimes administering naloxone to reverse an overdose.\u003c/p>\n\u003cp>She described telltale signs of what it looks like when someone is overdosing on opioids, such as heroin or fentanyl.\u003c/p>\n\u003cp>“Unable to maintain consciousness,” Marshall said. “Or they’re gonna be real hard to wake up, especially if alcohol is involved. And they’re not going to be breathing enough.”\u003c/p>\n\u003cp>A person’s body will droop, their skin will become ashen or bluish gray, she said.\u003c/p>\n\u003cp>Marshall instructed her pupils to call 911 as soon as they suspect an opioid overdose, and to use pain to try to wake an overdosing individual, like a knuckle rub to the sternum.\u003c/p>\n\u003cp>“If they go right back out or they just are not responsive, the next thing is the Narcan,” she instructed while picking up her Narcan nasal sprayer.\u003c/p>\n\u003cp>“Then you’re going to take this all the way up their nose,” Marshall said, pointing to a white plastic tip at the top of the tool. “One click. That’s it.”\u003c/p>\n\u003cp>Each attendee left with a box of Narcan to take to their next work shift.\u003c/p>\n\u003cfigure id=\"attachment_363842\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363842\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8660-800x600.jpg\" alt=\"Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This training was Marshall’s tenth for the nightlife industry, including one for the entire staff of \u003ca href=\"https://www.facebook.com/HUSHconcerts/\" target=\"_blank\" rel=\"noopener\">HUSH Concerts\u003c/a>, a music production company in San Francisco. The initiative is funded by \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco’s Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>At the HUSH offices on Treasure Island, creative director Robbie Kowal pointed to a photo on the wall of a good friend and DJ he worked with a lot.\u003c/p>\n\u003cp>“You can just see how effervescent a person he was,” Kowal said.\u003c/p>\n\u003cp>Kowal's friend died three years ago, and his colleagues still don’t know the cause.\u003c/p>\n\u003cp>After Kowal took a Narcan training, however, he began to suspect his friend died from an opioid overdose.\u003c/p>\n\u003cp>The signs were really all there, Kowal said. “Had people on that site had that kind of training, they might have been able to intervene.”\u003c/p>\n\u003cfigure id=\"attachment_363865\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363865 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg\" alt=\"Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced.\" width=\"800\" height=\"565\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-160x113.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-768x542.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1020x720.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1200x848.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1180x833.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-960x678.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-240x170.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-375x265.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-520x367.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At many events, Kowal’s employees are often the only sober people present, working the after-hours shift from midnight to six or seven in the morning. Lots of patrons experiment with new substances, sometimes not knowing what’s in them.\u003c/p>\n\u003cp>That’s why Kowal had Kristen Marshall train his company. He hopes that someday, if needed, they can save a life.\u003c/p>\n\u003cp>HUSH Concerts has always sent emergency bags to each event they staff. Inside, there are adapters, plugs, anything a DJ may forget. Now, the first aid kit they carry includes two doses of Narcan.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We, who are of the after-hours community, who live this beautiful life that's very undersung, can actually make a difference for people,” Kowal said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health educator Kristen Marshall made herself comfortable on a bright red, pleather sofa at St. Mary’s Pub in San Francisco. She welcomed a group of 10 people who trickled inside from the midday sun. Some wore funky glasses, others had sleeve tattoos.\u003c/p>\n\u003cp>Marshall unloaded a few items from a shoulder bag onto a two-top table in front of her, including a nasal sprayer of the drug Narcan – the brand name for naloxone, a drug that reverses opioid overdoses.\u003c/p>\n\u003cp>Typically, Marshall educates an audience of people who use drugs. But as the opioid crisis continues to devastate communities, Marshall and her colleagues from the \u003ca href=\"http://harmreduction.org/\" target=\"_blank\" rel=\"noopener\">Harm Reduction Coalition\u003c/a> are getting more creative in their approach to saving lives. At this training, Marshall’s assembled a group of bartenders and club and festival employees.\u003c/p>\n\u003cp>Immediately, Marshall fielded a question about a famous scene from the movie “Pulp Fiction,” in which actress Uma Thurman's character overdoses on drugs and is dramatically revived. Instead of naloxone, her rescuers stab her directly in the heart with a large needle full of adrenaline.\u003c/p>\n\u003cp>“Two things,” Marshall said to the group. “Adrenaline doesn’t work to reverse an opioid overdose, and please don’t stab anybody in the heart with anything.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The audience laughed as Marshall raised her hand in a fist and yelled, “Quentin Tarantino!” in a feigned rage.\u003c/p>\n\u003cfigure id=\"attachment_363843\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363843\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg\" alt=\"A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection.\" width=\"800\" height=\"525\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-800x525.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-160x105.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-768x504.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1020x670.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1200x788.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-1180x775.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-960x630.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-240x158.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-375x246.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8287-e1528757591523-520x341.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A dose of Narcan, the brand name of naloxone, a drug that can reverse opioid overdoses. Narcan also comes as an injection. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marshall then moved into more serious territory, speaking from her years of experience working at a needle exchange and sometimes administering naloxone to reverse an overdose.\u003c/p>\n\u003cp>She described telltale signs of what it looks like when someone is overdosing on opioids, such as heroin or fentanyl.\u003c/p>\n\u003cp>“Unable to maintain consciousness,” Marshall said. “Or they’re gonna be real hard to wake up, especially if alcohol is involved. And they’re not going to be breathing enough.”\u003c/p>\n\u003cp>A person’s body will droop, their skin will become ashen or bluish gray, she said.\u003c/p>\n\u003cp>Marshall instructed her pupils to call 911 as soon as they suspect an opioid overdose, and to use pain to try to wake an overdosing individual, like a knuckle rub to the sternum.\u003c/p>\n\u003cp>“If they go right back out or they just are not responsive, the next thing is the Narcan,” she instructed while picking up her Narcan nasal sprayer.\u003c/p>\n\u003cp>“Then you’re going to take this all the way up their nose,” Marshall said, pointing to a white plastic tip at the top of the tool. “One click. That’s it.”\u003c/p>\n\u003cp>Each attendee left with a box of Narcan to take to their next work shift.\u003c/p>\n\u003cfigure id=\"attachment_363842\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363842\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8660-800x600.jpg\" alt=\"Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8660-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Amy Rothbauer, a bartender at St. Marys Pub, poses with the box of Narcan that she keeps behind the bar, next to the first aid kit. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This training was Marshall’s tenth for the nightlife industry, including one for the entire staff of \u003ca href=\"https://www.facebook.com/HUSHconcerts/\" target=\"_blank\" rel=\"noopener\">HUSH Concerts\u003c/a>, a music production company in San Francisco. The initiative is funded by \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco’s Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>At the HUSH offices on Treasure Island, creative director Robbie Kowal pointed to a photo on the wall of a good friend and DJ he worked with a lot.\u003c/p>\n\u003cp>“You can just see how effervescent a person he was,” Kowal said.\u003c/p>\n\u003cp>Kowal's friend died three years ago, and his colleagues still don’t know the cause.\u003c/p>\n\u003cp>After Kowal took a Narcan training, however, he began to suspect his friend died from an opioid overdose.\u003c/p>\n\u003cp>The signs were really all there, Kowal said. “Had people on that site had that kind of training, they might have been able to intervene.”\u003c/p>\n\u003cfigure id=\"attachment_363865\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363865 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg\" alt=\"Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced.\" width=\"800\" height=\"565\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-800x565.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-160x113.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-768x542.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1020x720.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1200x848.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-1180x833.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-960x678.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-240x170.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-375x265.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/IMG_8767-e1528937107471-520x367.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Robbie Kowal, creative director of HUSH Concerts in San Francisco, stands in front of a wall of concerts his company's produced. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At many events, Kowal’s employees are often the only sober people present, working the after-hours shift from midnight to six or seven in the morning. Lots of patrons experiment with new substances, sometimes not knowing what’s in them.\u003c/p>\n\u003cp>That’s why Kowal had Kristen Marshall train his company. He hopes that someday, if needed, they can save a life.\u003c/p>\n\u003cp>HUSH Concerts has always sent emergency bags to each event they staff. Inside, there are adapters, plugs, anything a DJ may forget. Now, the first aid kit they carry includes two doses of Narcan.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We, who are of the after-hours community, who live this beautiful life that's very undersung, can actually make a difference for people,” Kowal said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On the Ballot: The Fate of a Troubled Hospital in Modoc County",
"title": "On the Ballot: The Fate of a Troubled Hospital in Modoc County",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“He’s got something we haven’t got — which is money,” Bostic said.\u003c/p>\n\n",
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"excerpt": "Voters in Surprise Valley, Calif. must decide whether to sell their public hospital to an outside investor with an unusual business plan.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "California Deaths From Powerful Opioid Fentanyl Rise in 2017",
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"content": "\u003cp>\u003cem>Updated June 18.\u003c/em>\u003c/p>\n\u003cp>Preliminary numbers show California's overdose deaths from the synthetic opioid fentanyl increased by 57% in 2017, according to the state's \u003ca href=\"https://discovery.cdph.ca.gov/CDIC/ODdash/\" target=\"_blank\" rel=\"noopener\">Opioid Overdose Surveillance Dashboard\u003c/a>.\u003c/p>\n\u003cp>Fentanyl overdoses claimed 373 Californians, according to the Dashboard, an online tool that gathers data from the \u003ca href=\"https://www.cdph.ca.gov/\" target=\"_blank\" rel=\"noopener\">California Department of Public Health\u003c/a>, the \u003ca href=\"https://www.oshpd.ca.gov/\" target=\"_blank\" rel=\"noopener\">Office of Statewide Health Planning and Development\u003c/a>, and the \u003ca href=\"https://oag.ca.gov/cures\" target=\"_blank\" rel=\"noopener\">Controlled Substance Utilization Review and Evaluation System\u003c/a>.\u003c/p>\n\u003cp>Fentanyl is up to 50 times more powerful than heroin and can be 100 times more potent than morphine. It's often added to other street drugs, and can overwhelm and kill someone who has no tolerance.\u003c/p>\n\u003cp>The number of overdose deaths last year could rise, however, according to \u003ca href=\"http://cfar.ucsf.edu/people/phillip-coffin\" target=\"_blank\" rel=\"noopener\">Dr. Phillip Coffin\u003c/a> of the \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco Department of Public Health\u003c/a>. He said determinations on causes of death are still being closed in some 2017 cases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Fentanyl has long been behind high rates of opioid deaths in the eastern U.S., but the potent drug has not brought the same crisis to the West, including California, Coffin said. But that's changing.\u003c/p>\n\u003cp>\"We're definitely seeing a change in the market. We definitely are seeing fentanyl sold as fentanyl on the street. And that's new over the last couple of years,\" Coffin said.\u003c/p>\n\u003cp>The number of total opioid deaths -- including from heroin, prescription pain medication, morphine and fentanyl -- is down slightly from 2016.\u003c/p>\n\u003cp>Coffin attributes this to prevention efforts across the state, which include distribution of naloxone, a drug that reverses opioid overdoses, \u003ca href=\"https://www.kqed.org/stateofhealth/363143/san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations\" target=\"_blank\" rel=\"noopener\">fentanyl test strips\u003c/a>, and safer prescribing practices by doctors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The number of overdose deaths from fentanyl has been changed to reflect the latest information released from the California Department of Public Health. Their original numbers erroneously stated that 746 people had died from fentanyl overdoses. The actual number is 373. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated June 18.\u003c/em>\u003c/p>\n\u003cp>Preliminary numbers show California's overdose deaths from the synthetic opioid fentanyl increased by 57% in 2017, according to the state's \u003ca href=\"https://discovery.cdph.ca.gov/CDIC/ODdash/\" target=\"_blank\" rel=\"noopener\">Opioid Overdose Surveillance Dashboard\u003c/a>.\u003c/p>\n\u003cp>Fentanyl overdoses claimed 373 Californians, according to the Dashboard, an online tool that gathers data from the \u003ca href=\"https://www.cdph.ca.gov/\" target=\"_blank\" rel=\"noopener\">California Department of Public Health\u003c/a>, the \u003ca href=\"https://www.oshpd.ca.gov/\" target=\"_blank\" rel=\"noopener\">Office of Statewide Health Planning and Development\u003c/a>, and the \u003ca href=\"https://oag.ca.gov/cures\" target=\"_blank\" rel=\"noopener\">Controlled Substance Utilization Review and Evaluation System\u003c/a>.\u003c/p>\n\u003cp>Fentanyl is up to 50 times more powerful than heroin and can be 100 times more potent than morphine. It's often added to other street drugs, and can overwhelm and kill someone who has no tolerance.\u003c/p>\n\u003cp>The number of overdose deaths last year could rise, however, according to \u003ca href=\"http://cfar.ucsf.edu/people/phillip-coffin\" target=\"_blank\" rel=\"noopener\">Dr. Phillip Coffin\u003c/a> of the \u003ca href=\"https://www.sfdph.org/dph/default.asp\" target=\"_blank\" rel=\"noopener\">San Francisco Department of Public Health\u003c/a>. He said determinations on causes of death are still being closed in some 2017 cases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Fentanyl has long been behind high rates of opioid deaths in the eastern U.S., but the potent drug has not brought the same crisis to the West, including California, Coffin said. But that's changing.\u003c/p>\n\u003cp>\"We're definitely seeing a change in the market. We definitely are seeing fentanyl sold as fentanyl on the street. And that's new over the last couple of years,\" Coffin said.\u003c/p>\n\u003cp>The number of total opioid deaths -- including from heroin, prescription pain medication, morphine and fentanyl -- is down slightly from 2016.\u003c/p>\n\u003cp>Coffin attributes this to prevention efforts across the state, which include distribution of naloxone, a drug that reverses opioid overdoses, \u003ca href=\"https://www.kqed.org/stateofhealth/363143/san-franciscos-newest-tool-to-prevent-opioid-overdoses-tests-drugs-starts-conversations\" target=\"_blank\" rel=\"noopener\">fentanyl test strips\u003c/a>, and safer prescribing practices by doctors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The number of overdose deaths from fentanyl has been changed to reflect the latest information released from the California Department of Public Health. Their original numbers erroneously stated that 746 people had died from fentanyl overdoses. The actual number is 373. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In the Land of Legal Weed, Drug Education Moves From ‘Don’t’ to ‘Delay’",
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"content": "\u003cp>Californians legalized marijuana in 2016, with 57 percent of the vote. But the momentousness of that decision was somewhat lost in the drama of Donald Trump’s victory. Voters also had to wait over a year for full implementation, while state agencies crafted new regulations for quality, safety and marketing.\u003c/p>\n\u003cp>But the social significance of the vote finally burst into view this Jan. 1, when eager customers -- who had lined up in the darkness outside medical marijuana dispensaries across the state -- streamed through the doors at the stroke of midnight.\u003c/p>\n\u003cp>But the change hasn’t been confined to the cannabis cash register. Everyone has seen the advertising or heard the chatter -- and that includes minors, although marijuana remains illegal for those under 21.\u003c/p>\n\u003cp>“Coming out of SFO airport, there are billboards for \u003ca href=\"https://www.eaze.com/\" target=\"_blank\" rel=\"noopener\">Eaze\u003c/a> that say ‘Marijuana is here,’ ” said \u003ca href=\"http://profiles.ucsf.edu/danielle.ramo-larios\" target=\"_blank\" rel=\"noopener\">Danielle Ramo\u003c/a>, a psychologist who conducts research at UCSF on adolescent drug use.\u003c/p>\n\u003cp>“I'm not sure parents were expecting to see so many images of cannabis all over,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Public schools in California are required by law to provide anti-drug abuse education, although experts say the quality of the instruction varies widely from district to district, and there’s little enforcement.\u003c/p>\n\u003cp>I was curious to know how marijuana legalization was being discussed in schools, so I embedded with \u003ca href=\"http://livingadept.org/beingadept/\" target=\"_blank\" rel=\"noopener\">Being Adept\u003c/a>, an evidence-based curriculum that has been used in about 20 schools in the Bay Area.\u003c/p>\n\u003cp>To my surprise, I discovered that the rollout of legal recreational marijuana in California and other states hasn’t led to any big changes in substance abuse prevention. Drug educators have always covered both legal substances (alcohol, tobacco, prescription drugs) and illicit ones (pot, ecstasy, cocaine, LSD, heroin, meth … ). Students have accessed, and abused, both categories of drugs for decades.\u003c/p>\n\u003cp>But I was more struck by the evolution of drug education since the 1980s. Today, drug abuse education is an advanced pedagogy, drawing on decades of rigorous effectiveness research and the newest teaching techniques.\u003c/p>\n\u003cp>The “Just Say No” approach, popularized by Nancy Reagan, has been discredited. The PSAs that Gen-Xers may remember -- the egg in a frying pan (“\u003ca href=\"https://www.youtube.com/watch?v=GOnENVylxPI\" target=\"_blank\" rel=\"noopener\">this is your brain on drugs\u003c/a>”), or the boy calling out his dad’s drug use (“\u003ca href=\"https://www.youtube.com/watch?v=MkxCcXHwRkk\" target=\"_blank\" rel=\"noopener\">I learned it by watching you!\u003c/a>”) -- live on as memes, but they’re no longer used as messages.\u003c/p>\n\u003cp>“Those scare-tactic-based programs have tended to quite clearly not work, based on most of the research that evaluated its effectiveness,” Ramo said. “Today there is an entirely different mindset about school-based prevention.”\u003c/p>\n\u003cp>In a nutshell, the focus now is on facts, not fear. Also conspicuously absent are simplistic dictates like “just say no.” Instead, teachers spur students to examine data, speculate on motives, discuss risks, and deliberate on their own goals and values.\u003c/p>\n\u003cp>Ashley Brady, a Being Adept instructor, was completely open about her method when she stood in front of the eighth-graders at Marin Primary and Middle School, a private school in Larkspur.\u003c/p>\n\u003cp>“I'm not here to tell you what to do today. Not at all,” she began. “I'm here to give you the most up-to-date information possible so that you can make your own healthy, informed decisions.”\u003c/p>\n\u003cp>Brady then jump-started a fast-paced, fact-filled discussion on brain chemistry and physiology. There was an animated video about how marijuana affects dopamine pathways in the brain. Then a discussion about marijuana “edibles” and how they are metabolized by the liver.\u003c/p>\n\u003cp>“It can take up to 30 minutes to maybe even an hour or two before it really hits you,” she said. “When somebody eats an edible and they don't really feel the effects, what do you think happens?”\u003c/p>\n\u003cp>“They eat more!” a student called out.\u003c/p>\n\u003cp>“They eat more,” Brady nodded. “Yeah, an hour, an hour and a half later? Boom! Like a freight train, they've been hit, and, you know, can barely move or can barely talk. That kind of thing. So they may have to go to the hospital.”\u003c/p>\n\u003cp>True, that sounds a \u003cem>little\u003c/em> scary, but it’s presented neutrally, as a consequence at the end of a sequence of decisions.\u003c/p>\n\u003cfigure id=\"attachment_363549\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363549\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-900x1200.jpg 900w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ashley Brady explains the increase over time in marijuana potency to a class of eighth-graders at Marin Primary and Secondary School in Larkspur. \u003ccite>(KQED/Carrie Feibel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Where the legalization of the marijuana industry \u003cem>has\u003c/em> affected the content of these lessons is on the subject of potency. Brady tells the students that legalization has spurred competition and innovation among suppliers, to the point where they’re now churning out extremely potent and precisely calibrated forms of pot called “concentrates,” which comes in various forms.\u003c/p>\n\u003cp>Brady runs through their names: oil, bubble, shatter, wax and dabs.\u003c/p>\n\u003cp>“They call it a ‘dab’ because one tiny little nail head [of it] -- I mean I'm talking like the end of my pinky -- one tiny little nail head is the same as three joints hitting the system all at once. So it’s a lot stronger than it used to be.”\u003c/p>\n\u003cp>Tests of THC levels in marijuana samples over the years back this up. Whereas a typical joint in the '70s probably had a THC level of 4-5 percent, at best, growers are now breeding strains of cannabis that produce buds with THC levels as high as 20-30 percent.\u003c/p>\n\u003cp>But the concentrates are in another category altogether. Processed concentrates sold at dispensaries now regularly test at 80, even 90 percent.\u003c/p>\n\u003cp>“It's not the same drug,” Brady tells them. People sometimes vomit from concentrates. Some people hallucinate and have even become psychotic.\u003c/p>\n\u003cp>And yes, she adds, it can be addictive. Not just psychologically, but physically. People do go into THC withdrawal and do go to rehab for pot addiction.\u003c/p>\n\u003cp>Still, as she describes the transformation of marijuana from a relatively mild intoxicant to a potentially debilitating one, Brady never once says “that’s why you shouldn’t” or even “so please be careful.”\u003c/p>\n\u003cp>Afterward, the students applauded this approach.\u003c/p>\n\u003cp>“It made you feel more mature, and that you're in control,\" said Devon Soofer, 13. “This [class] was actually telling you the long-term effects and what it can actually do to you. So it actually made you feel like ‘Wow, this is actually really bad,’ and not just being \u003cem>forced\u003c/em> not to do it.”\u003c/p>\n\u003cp>Later units in the Being Adept curriculum give students concrete tools: They rehearse what to do or say at parties, and talk about better ways to cope than using cannabis -- or any substance.\u003c/p>\n\u003cp>Ramo, who serves as a scientific advisor to Being Adept, decried “the overwhelming stress, anxiety, depression, suicidality that is so pervasive among teens in the United States today, especially in high-intensity educational areas, like a lot of schools in the Bay Area are.”\u003c/p>\n\u003cp>“Addressing that problem is key,” she added, as is “having teens come up with solutions to manage their stress, that they actually would use.”\u003c/p>\n\u003cp>\u003cstrong>“Delay, Delay, Delay” \u003c/strong>\u003c/p>\n\u003cp>So if drug educators aren’t telling students “Don’t!” anymore, what exactly are they telling them to \u003cem>do\u003c/em>? As I observed, they’re not overtly telling them to do anything, because teens are naturally resistant to the authoritarian approach -- and some of them may resist to the point of doing the opposite.\u003c/p>\n\u003cp>The underlying goal of drug education remains the same as before: keep children safe. The dangers of intoxicated driving, sexual assault, academic or athletic failure, social humiliation, social media embarrassment -- all of these do come up in the lessons.\u003c/p>\n\u003cp>But the instructors put a special emphasis on a less visible risk: the potential damage to their brains. And the science backs them up.\u003c/p>\n\u003cp>“More research is coming out looking at the ways in which all different kinds of substances can hijack normal brain functioning, and particularly so in adolescence,” Danielle Ramo explained.\u003c/p>\n\u003cp>“In heavily cannabis-using teens, there are some particularly important implications of using cannabis on the frontal lobe, and that interrupts a type of thinking called ‘executive functioning.’ ”\u003c/p>\n\u003cp>Also worrisome is a substantial body of research showing that using any potentially addictive substance while the brain is still developing -- whether alcohol, marijuana, nicotine, or other drug -- triggers neurological changes that can lead to addiction.\u003c/p>\n\u003cp>“The earlier teens start using, the more heavily they use in adolescence, the more likely it is that they'll go on to have problems throughout their adulthood,” said Ramo.\u003c/p>\n\u003cp>Being Adept instructors don’t say it outright, but the message is clear: If you’re not going to abstain, just push it off for a while. \u003cem>Your brain is too vulnerable right now.\u003c/em>\u003c/p>\n\u003cp>Jennifer Grellman, a \u003ca href=\"http://www.jennifergrellman.com/index.html\" target=\"_blank\" rel=\"noopener\">psychotherapist\u003c/a> in Kentfield and the founder of Being Adept, sums up the strategy in three words, just like the “Just Say No” campaign: “Delay, delay, delay.”\u003c/p>\n\u003cp>“The way to handle that with your kids is to say: ‘You know, you don't have to use this now. Maybe you want to use it someday, but not today, not now. It will always be there.’ Just tell them to \u003cem>wait\u003c/em>.”\u003c/p>\n\u003cp>Grellman said that advice may be more palatable for some teens, and therefore easier for parents to deliver.\u003c/p>\n\u003cp>They’re not forbidding something (and possibly making it more enticing). They’re not saying “never.”\u003c/p>\n\u003cp>\u003cstrong>The Role of Parents\u003c/strong>\u003c/p>\n\u003cp>Grellman said parents should talk about drugs and alcohol with their kids often -- as early as fourth grade. Use the new billboards or marijuana ads as an excuse to bring up the topic. Broach the subject obliquely: \u003cem>What do people at your school think about those ads? Do any of your friends know what a dab actually is? Did you see this article on the seventh-grader getting expelled for pot in his locker? What do you think about that? \u003c/em>\u003c/p>\n\u003cp>Listen to what they say and discuss it. Don’t lecture, but be clear about your expectations, and your values around drugs and alcohol.\u003c/p>\n\u003cp>At every school where Being Adept is taught, Grellman offers a “Parents Night” where parents can learn how to navigate those conversations. Some are encouraged when Grellman tells them that seemingly taboo subjects should be aired:\u003c/p>\n\u003cp>“Don't hide Uncle Harry, who is the old drinker, you know? Don't be ashamed to talk. You talk about Uncle Harry all the time,” Grellman said.\u003c/p>\n\u003cp>“Because these kids need to know ‘If I have alcohol, it could be, like, I may have the alcoholic gene,’ ” she added. “It doesn't mean they're going to for sure, but they sure need a heads-up about that.”\u003c/p>\n\u003cp>The same approach can be used for mental illness: “You know, I have anxiety. Your father has this issue. So chances are you might be a little anxious at times, so how are you going to deal with this?”\u003c/p>\n\u003cp>But it’s not just what parents say, it’s what they do, according to Grellman. Children are always watching how their parents use substances.\u003c/p>\n\u003cp>“Don’t glamorize it,” she advised. “It doesn't mean you have to become a monk and never have a drop of alcohol, but please drink responsibly. Never use it for stress control.”\u003c/p>\n\u003cp>“This idea of coming home from the office and saying ‘I've got to have my glass of wine’ ... if you want to have your glass of wine, have your glass of wine, but don't announce it! That you're just at wit's end, and you have to have this drink. “\u003c/p>\n\u003cp>Grellman said the modeling part becomes tricky when kids ask parents about their past: Did \u003cem>you\u003c/em> party? What drugs did you use?\u003c/p>\n\u003cp>When she led the Parents Night in March at Marin Primary and Secondary, she advised the parents to get ready for that moment, and have answers prepared.\u003c/p>\n\u003cp>\u003cem>But what if we did party in high school?\u003c/em> Several parents ask. \u003cem>Should we lie?\u003c/em>\u003c/p>\n\u003cp>Absolutely not, Grellman said, because if a kid senses dishonesty or hypocrisy, they’ll shut down. The most important thing is to keep the conversations going. If your child knows they can talk to you, no matter what, they will create a \"safety plan” with you. They will reach out to you when trouble comes.\u003c/p>\n\u003cp>\u003cem>But what do we tell them then?\u003c/em> \u003cem>How can we be honest, without encouraging them?\u003c/em>\u003c/p>\n\u003cp>“You don't have to tell the full story,” Grellman said. “You could say: ‘You know, I did smoke and I did drink when I was 13.' And if you loved it, I don't know if I would advertise that.\u003c/p>\n\u003cp>“You could say, ‘I did smoke, or I did drink, when I was 13. And you know, frankly? It was too early for me, man. I made some stupid decisions and I got in trouble.’ You can give them the consequences of it.”\u003c/p>\n\u003cp>Afterward, parents said they felt relieved to have concrete suggestions about how to talk with their kids, and how much was OK to bring up.\u003c/p>\n\u003cp>“It's much more prevalent than it was when I was growing up in the '80s,” said Joseph Sullivan, a physician from Larkspur.\u003c/p>\n\u003cp>“This is a different time, and so it's nice to hear that we're almost given permission to be talking about these different aspects of drug experimentation at different ages,” he added.\u003c/p>\n\u003cp>His wife, Dr. Sara Sullivan, said she’s glad that the “Just Say No” paradigm is dead.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Just to give the kids more information, I think, is such a different way to approach it and I really appreciate that. And we've kind of started to have conversations in our family because of that,” she explained. “To really kind of take that approach and not be like ‘You're kind of out there on your own.’ ”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Californians legalized marijuana in 2016, with 57 percent of the vote. But the momentousness of that decision was somewhat lost in the drama of Donald Trump’s victory. Voters also had to wait over a year for full implementation, while state agencies crafted new regulations for quality, safety and marketing.\u003c/p>\n\u003cp>But the social significance of the vote finally burst into view this Jan. 1, when eager customers -- who had lined up in the darkness outside medical marijuana dispensaries across the state -- streamed through the doors at the stroke of midnight.\u003c/p>\n\u003cp>But the change hasn’t been confined to the cannabis cash register. Everyone has seen the advertising or heard the chatter -- and that includes minors, although marijuana remains illegal for those under 21.\u003c/p>\n\u003cp>“Coming out of SFO airport, there are billboards for \u003ca href=\"https://www.eaze.com/\" target=\"_blank\" rel=\"noopener\">Eaze\u003c/a> that say ‘Marijuana is here,’ ” said \u003ca href=\"http://profiles.ucsf.edu/danielle.ramo-larios\" target=\"_blank\" rel=\"noopener\">Danielle Ramo\u003c/a>, a psychologist who conducts research at UCSF on adolescent drug use.\u003c/p>\n\u003cp>“I'm not sure parents were expecting to see so many images of cannabis all over,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Public schools in California are required by law to provide anti-drug abuse education, although experts say the quality of the instruction varies widely from district to district, and there’s little enforcement.\u003c/p>\n\u003cp>I was curious to know how marijuana legalization was being discussed in schools, so I embedded with \u003ca href=\"http://livingadept.org/beingadept/\" target=\"_blank\" rel=\"noopener\">Being Adept\u003c/a>, an evidence-based curriculum that has been used in about 20 schools in the Bay Area.\u003c/p>\n\u003cp>To my surprise, I discovered that the rollout of legal recreational marijuana in California and other states hasn’t led to any big changes in substance abuse prevention. Drug educators have always covered both legal substances (alcohol, tobacco, prescription drugs) and illicit ones (pot, ecstasy, cocaine, LSD, heroin, meth … ). Students have accessed, and abused, both categories of drugs for decades.\u003c/p>\n\u003cp>But I was more struck by the evolution of drug education since the 1980s. Today, drug abuse education is an advanced pedagogy, drawing on decades of rigorous effectiveness research and the newest teaching techniques.\u003c/p>\n\u003cp>The “Just Say No” approach, popularized by Nancy Reagan, has been discredited. The PSAs that Gen-Xers may remember -- the egg in a frying pan (“\u003ca href=\"https://www.youtube.com/watch?v=GOnENVylxPI\" target=\"_blank\" rel=\"noopener\">this is your brain on drugs\u003c/a>”), or the boy calling out his dad’s drug use (“\u003ca href=\"https://www.youtube.com/watch?v=MkxCcXHwRkk\" target=\"_blank\" rel=\"noopener\">I learned it by watching you!\u003c/a>”) -- live on as memes, but they’re no longer used as messages.\u003c/p>\n\u003cp>“Those scare-tactic-based programs have tended to quite clearly not work, based on most of the research that evaluated its effectiveness,” Ramo said. “Today there is an entirely different mindset about school-based prevention.”\u003c/p>\n\u003cp>In a nutshell, the focus now is on facts, not fear. Also conspicuously absent are simplistic dictates like “just say no.” Instead, teachers spur students to examine data, speculate on motives, discuss risks, and deliberate on their own goals and values.\u003c/p>\n\u003cp>Ashley Brady, a Being Adept instructor, was completely open about her method when she stood in front of the eighth-graders at Marin Primary and Middle School, a private school in Larkspur.\u003c/p>\n\u003cp>“I'm not here to tell you what to do today. Not at all,” she began. “I'm here to give you the most up-to-date information possible so that you can make your own healthy, informed decisions.”\u003c/p>\n\u003cp>Brady then jump-started a fast-paced, fact-filled discussion on brain chemistry and physiology. There was an animated video about how marijuana affects dopamine pathways in the brain. Then a discussion about marijuana “edibles” and how they are metabolized by the liver.\u003c/p>\n\u003cp>“It can take up to 30 minutes to maybe even an hour or two before it really hits you,” she said. “When somebody eats an edible and they don't really feel the effects, what do you think happens?”\u003c/p>\n\u003cp>“They eat more!” a student called out.\u003c/p>\n\u003cp>“They eat more,” Brady nodded. “Yeah, an hour, an hour and a half later? Boom! Like a freight train, they've been hit, and, you know, can barely move or can barely talk. That kind of thing. So they may have to go to the hospital.”\u003c/p>\n\u003cp>True, that sounds a \u003cem>little\u003c/em> scary, but it’s presented neutrally, as a consequence at the end of a sequence of decisions.\u003c/p>\n\u003cfigure id=\"attachment_363549\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363549\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-900x1200.jpg 900w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/05/IMG_8238-e1526427780998-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ashley Brady explains the increase over time in marijuana potency to a class of eighth-graders at Marin Primary and Secondary School in Larkspur. \u003ccite>(KQED/Carrie Feibel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Where the legalization of the marijuana industry \u003cem>has\u003c/em> affected the content of these lessons is on the subject of potency. Brady tells the students that legalization has spurred competition and innovation among suppliers, to the point where they’re now churning out extremely potent and precisely calibrated forms of pot called “concentrates,” which comes in various forms.\u003c/p>\n\u003cp>Brady runs through their names: oil, bubble, shatter, wax and dabs.\u003c/p>\n\u003cp>“They call it a ‘dab’ because one tiny little nail head [of it] -- I mean I'm talking like the end of my pinky -- one tiny little nail head is the same as three joints hitting the system all at once. So it’s a lot stronger than it used to be.”\u003c/p>\n\u003cp>Tests of THC levels in marijuana samples over the years back this up. Whereas a typical joint in the '70s probably had a THC level of 4-5 percent, at best, growers are now breeding strains of cannabis that produce buds with THC levels as high as 20-30 percent.\u003c/p>\n\u003cp>But the concentrates are in another category altogether. Processed concentrates sold at dispensaries now regularly test at 80, even 90 percent.\u003c/p>\n\u003cp>“It's not the same drug,” Brady tells them. People sometimes vomit from concentrates. Some people hallucinate and have even become psychotic.\u003c/p>\n\u003cp>And yes, she adds, it can be addictive. Not just psychologically, but physically. People do go into THC withdrawal and do go to rehab for pot addiction.\u003c/p>\n\u003cp>Still, as she describes the transformation of marijuana from a relatively mild intoxicant to a potentially debilitating one, Brady never once says “that’s why you shouldn’t” or even “so please be careful.”\u003c/p>\n\u003cp>Afterward, the students applauded this approach.\u003c/p>\n\u003cp>“It made you feel more mature, and that you're in control,\" said Devon Soofer, 13. “This [class] was actually telling you the long-term effects and what it can actually do to you. So it actually made you feel like ‘Wow, this is actually really bad,’ and not just being \u003cem>forced\u003c/em> not to do it.”\u003c/p>\n\u003cp>Later units in the Being Adept curriculum give students concrete tools: They rehearse what to do or say at parties, and talk about better ways to cope than using cannabis -- or any substance.\u003c/p>\n\u003cp>Ramo, who serves as a scientific advisor to Being Adept, decried “the overwhelming stress, anxiety, depression, suicidality that is so pervasive among teens in the United States today, especially in high-intensity educational areas, like a lot of schools in the Bay Area are.”\u003c/p>\n\u003cp>“Addressing that problem is key,” she added, as is “having teens come up with solutions to manage their stress, that they actually would use.”\u003c/p>\n\u003cp>\u003cstrong>“Delay, Delay, Delay” \u003c/strong>\u003c/p>\n\u003cp>So if drug educators aren’t telling students “Don’t!” anymore, what exactly are they telling them to \u003cem>do\u003c/em>? As I observed, they’re not overtly telling them to do anything, because teens are naturally resistant to the authoritarian approach -- and some of them may resist to the point of doing the opposite.\u003c/p>\n\u003cp>The underlying goal of drug education remains the same as before: keep children safe. The dangers of intoxicated driving, sexual assault, academic or athletic failure, social humiliation, social media embarrassment -- all of these do come up in the lessons.\u003c/p>\n\u003cp>But the instructors put a special emphasis on a less visible risk: the potential damage to their brains. And the science backs them up.\u003c/p>\n\u003cp>“More research is coming out looking at the ways in which all different kinds of substances can hijack normal brain functioning, and particularly so in adolescence,” Danielle Ramo explained.\u003c/p>\n\u003cp>“In heavily cannabis-using teens, there are some particularly important implications of using cannabis on the frontal lobe, and that interrupts a type of thinking called ‘executive functioning.’ ”\u003c/p>\n\u003cp>Also worrisome is a substantial body of research showing that using any potentially addictive substance while the brain is still developing -- whether alcohol, marijuana, nicotine, or other drug -- triggers neurological changes that can lead to addiction.\u003c/p>\n\u003cp>“The earlier teens start using, the more heavily they use in adolescence, the more likely it is that they'll go on to have problems throughout their adulthood,” said Ramo.\u003c/p>\n\u003cp>Being Adept instructors don’t say it outright, but the message is clear: If you’re not going to abstain, just push it off for a while. \u003cem>Your brain is too vulnerable right now.\u003c/em>\u003c/p>\n\u003cp>Jennifer Grellman, a \u003ca href=\"http://www.jennifergrellman.com/index.html\" target=\"_blank\" rel=\"noopener\">psychotherapist\u003c/a> in Kentfield and the founder of Being Adept, sums up the strategy in three words, just like the “Just Say No” campaign: “Delay, delay, delay.”\u003c/p>\n\u003cp>“The way to handle that with your kids is to say: ‘You know, you don't have to use this now. Maybe you want to use it someday, but not today, not now. It will always be there.’ Just tell them to \u003cem>wait\u003c/em>.”\u003c/p>\n\u003cp>Grellman said that advice may be more palatable for some teens, and therefore easier for parents to deliver.\u003c/p>\n\u003cp>They’re not forbidding something (and possibly making it more enticing). They’re not saying “never.”\u003c/p>\n\u003cp>\u003cstrong>The Role of Parents\u003c/strong>\u003c/p>\n\u003cp>Grellman said parents should talk about drugs and alcohol with their kids often -- as early as fourth grade. Use the new billboards or marijuana ads as an excuse to bring up the topic. Broach the subject obliquely: \u003cem>What do people at your school think about those ads? Do any of your friends know what a dab actually is? Did you see this article on the seventh-grader getting expelled for pot in his locker? What do you think about that? \u003c/em>\u003c/p>\n\u003cp>Listen to what they say and discuss it. Don’t lecture, but be clear about your expectations, and your values around drugs and alcohol.\u003c/p>\n\u003cp>At every school where Being Adept is taught, Grellman offers a “Parents Night” where parents can learn how to navigate those conversations. Some are encouraged when Grellman tells them that seemingly taboo subjects should be aired:\u003c/p>\n\u003cp>“Don't hide Uncle Harry, who is the old drinker, you know? Don't be ashamed to talk. You talk about Uncle Harry all the time,” Grellman said.\u003c/p>\n\u003cp>“Because these kids need to know ‘If I have alcohol, it could be, like, I may have the alcoholic gene,’ ” she added. “It doesn't mean they're going to for sure, but they sure need a heads-up about that.”\u003c/p>\n\u003cp>The same approach can be used for mental illness: “You know, I have anxiety. Your father has this issue. So chances are you might be a little anxious at times, so how are you going to deal with this?”\u003c/p>\n\u003cp>But it’s not just what parents say, it’s what they do, according to Grellman. Children are always watching how their parents use substances.\u003c/p>\n\u003cp>“Don’t glamorize it,” she advised. “It doesn't mean you have to become a monk and never have a drop of alcohol, but please drink responsibly. Never use it for stress control.”\u003c/p>\n\u003cp>“This idea of coming home from the office and saying ‘I've got to have my glass of wine’ ... if you want to have your glass of wine, have your glass of wine, but don't announce it! That you're just at wit's end, and you have to have this drink. “\u003c/p>\n\u003cp>Grellman said the modeling part becomes tricky when kids ask parents about their past: Did \u003cem>you\u003c/em> party? What drugs did you use?\u003c/p>\n\u003cp>When she led the Parents Night in March at Marin Primary and Secondary, she advised the parents to get ready for that moment, and have answers prepared.\u003c/p>\n\u003cp>\u003cem>But what if we did party in high school?\u003c/em> Several parents ask. \u003cem>Should we lie?\u003c/em>\u003c/p>\n\u003cp>Absolutely not, Grellman said, because if a kid senses dishonesty or hypocrisy, they’ll shut down. The most important thing is to keep the conversations going. If your child knows they can talk to you, no matter what, they will create a \"safety plan” with you. They will reach out to you when trouble comes.\u003c/p>\n\u003cp>\u003cem>But what do we tell them then?\u003c/em> \u003cem>How can we be honest, without encouraging them?\u003c/em>\u003c/p>\n\u003cp>“You don't have to tell the full story,” Grellman said. “You could say: ‘You know, I did smoke and I did drink when I was 13.' And if you loved it, I don't know if I would advertise that.\u003c/p>\n\u003cp>“You could say, ‘I did smoke, or I did drink, when I was 13. And you know, frankly? It was too early for me, man. I made some stupid decisions and I got in trouble.’ You can give them the consequences of it.”\u003c/p>\n\u003cp>Afterward, parents said they felt relieved to have concrete suggestions about how to talk with their kids, and how much was OK to bring up.\u003c/p>\n\u003cp>“It's much more prevalent than it was when I was growing up in the '80s,” said Joseph Sullivan, a physician from Larkspur.\u003c/p>\n\u003cp>“This is a different time, and so it's nice to hear that we're almost given permission to be talking about these different aspects of drug experimentation at different ages,” he added.\u003c/p>\n\u003cp>His wife, Dr. Sara Sullivan, said she’s glad that the “Just Say No” paradigm is dead.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Just to give the kids more information, I think, is such a different way to approach it and I really appreciate that. And we've kind of started to have conversations in our family because of that,” she explained. “To really kind of take that approach and not be like ‘You're kind of out there on your own.’ ”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Where Do You Go When You Leave the Hospital But Are Homeless?",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Suzanne Adams stood outside \u003ca href=\"http://www.catsinc.org/a-woman-s-place.html\" target=\"_blank\" rel=\"noopener\">A Woman’s Place\u003c/a>, a homeless drop-in center in San Francisco. Adams, who works there as a psychologist, pointed to the curb near the front entrance. It's where taxis regularly drop off homeless patients who have just been discharged from the hospital. \u003c/span>\u003c/p>\n\u003cp>\"Generally speaking the driver is kind enough to assist some of these women in exiting the vehicle and grabbing some of their belongings,\" Adams said. \"The patient or client enters in through our door sometimes bewildered and confused as to why they’re here.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Many of the women are elderly. Some have never been to A Woman's Place before the taxi drops them off, while others are regulars. Whatever the case, the center just isn’t prepared to take in medically fragile patients straight from the hospital, according to Adams. It’s not a clinic, and it’s not even a shelter. Women and families can stop in to take showers, do laundry or get counseling. There aren’t any beds, just a television set and lots of chairs. \u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1152\" target=\"_blank\" rel=\"noopener\">A bill\u003c/a> under consideration in Sacramento aims to address this practice, which some advocates call \"patient dumping.\" They say hospitals commonly discharge homeless patients by sending them to social service agencies or other nonprofits, and they do this without contacting those locations first.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams said this “dumping” happens at least once a week at A Woman's Place. One of the cases that haunts her involves an elderly woman who has a serious mental illness. Recently, the client had deteriorated so much that she couldn’t use the toilet alone. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"She wasn’t leaving the building under her own accord,\" Adams said. \"She wasn’t accessing food or water without the assistance of other people. She tried to pay me a dollar the other day to go buy her some ramen so that she could eat.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams sent the woman to the hospital, hoping psychiatric services would help. \u003c/span>\u003c/p>\n\u003cp>\"Unfortunately, less than 24 hours later, she returned here,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The same client was resting at the center on the day a KQED reporter visited, sitting in a black chair that she favors. Adams said the woman’s mental illness still wasn't well-controlled, so she couldn't speak coherently or consent to an interview. \u003c/span>\u003c/p>\n\u003cp>\"In an ideal world, she would be transferred to a 'board and care' or an assisted living facility, where they could manage her mental health as well as her medical health in a fashion that we simply don’t have the infrastructure for,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation moving through the state Senate would require that patients be discharged to one of four \"safe and appropriate\" locations: their primary dwelling (as identified by the homeless patient), another health center or hospital, a nonprofit or social service agency that has given written consent to accept the patient, or an alternative spot that the patient has consented to go to, in writing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://sd22.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Sen. Ed Hernandez\u003c/a>, D-West Covina, introduced the bill. He said hospitals, as part of society, have obligations to homeless Californians. \u003c/span>\u003c/p>\n\u003cp>\"If they fall down and have a heart attack, and somebody sends them to the hospital, we’re required by law -- which is the humane thing to do -- to treat those individuals,\" said Hernandez, who is an optometrist and chair of the Senate Health Committee. He was referring to a federal law called \u003ca href=\"https://www.acep.org/news-media-top-banner/emtala/#sm.000005tj0xf3geeirxddg2ghqr9qa\" target=\"_blank\" rel=\"noopener\">EMTALA\u003c/a>, which mandates that emergency rooms accept and treat everyone, regardless of ability to pay.\u003c/p>\n\u003cp>But EMTALA doesn't address how patients are discharged from ERs. \"Once they’re treated, the humane thing is to figure out where we’re going to place them, as opposed to just leaving them out in the street immediately,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">His bill would require some additional work on the part of ER staffers at California hospitals, such as getting consent from a shelter where the hospital wants to send the patient. \u003c/span>\u003c/p>\n\u003cp>\"I can’t imagine that it’s going to be that costly to pick up the phone,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation also lays out a checklist of things to do before discharge. For example, the patient must be hydrated, have recently eaten and be dressed in weather-appropriate clothing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But hospitals are pushing back, saying the list is too specific, and doesn’t give hospital workers enough flexibility to decide what’s right for each patient. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.calhospital.org/profile/peggy-broussard-wheeler\" target=\"_blank\" rel=\"noopener\">Peggy Wheeler\u003c/a> is the vice president for rural health and governance for the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>. She said the bill would put yet another burden on emergency care. \u003c/span>\u003c/p>\n\u003cp>\"Hospital ERs are overcrowded,\" Wheeler said. \"If we had to hold on to a patient in a bed in the ER, that’s one less bed, two less beds, three less beds that would be available for other members of the community that need to come in and use the ER.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams, the psychologist at A Woman’s Place, thinks the bill is a good step. But she said it doesn’t get at the \u003c/span>\u003cspan style=\"font-weight: 400\">root \u003c/span>\u003cspan style=\"font-weight: 400\">problem, which is that the Bay Area doesn’t have enough options for patients who still need help \u003c/span>\u003cspan style=\"font-weight: 400\">after\u003c/span>\u003cspan style=\"font-weight: 400\"> they leave the hospital. There aren’t enough nursing homes, rehabilitation units or assisted care programs for elderly, low-income or disabled patients. \u003c/span>\u003c/p>\n\u003cp>\"It’s a health insurance issue, it’s an aging issue, it’s a lack of infrastructure and funding,\" Adams said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Until that gets fixed, Adams fears many patients will continue to shuttle between hospitals, the shelter system and the street. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Suzanne Adams stood outside \u003ca href=\"http://www.catsinc.org/a-woman-s-place.html\" target=\"_blank\" rel=\"noopener\">A Woman’s Place\u003c/a>, a homeless drop-in center in San Francisco. Adams, who works there as a psychologist, pointed to the curb near the front entrance. It's where taxis regularly drop off homeless patients who have just been discharged from the hospital. \u003c/span>\u003c/p>\n\u003cp>\"Generally speaking the driver is kind enough to assist some of these women in exiting the vehicle and grabbing some of their belongings,\" Adams said. \"The patient or client enters in through our door sometimes bewildered and confused as to why they’re here.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Many of the women are elderly. Some have never been to A Woman's Place before the taxi drops them off, while others are regulars. Whatever the case, the center just isn’t prepared to take in medically fragile patients straight from the hospital, according to Adams. It’s not a clinic, and it’s not even a shelter. Women and families can stop in to take showers, do laundry or get counseling. There aren’t any beds, just a television set and lots of chairs. \u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1152\" target=\"_blank\" rel=\"noopener\">A bill\u003c/a> under consideration in Sacramento aims to address this practice, which some advocates call \"patient dumping.\" They say hospitals commonly discharge homeless patients by sending them to social service agencies or other nonprofits, and they do this without contacting those locations first.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams said this “dumping” happens at least once a week at A Woman's Place. One of the cases that haunts her involves an elderly woman who has a serious mental illness. Recently, the client had deteriorated so much that she couldn’t use the toilet alone. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"She wasn’t leaving the building under her own accord,\" Adams said. \"She wasn’t accessing food or water without the assistance of other people. She tried to pay me a dollar the other day to go buy her some ramen so that she could eat.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams sent the woman to the hospital, hoping psychiatric services would help. \u003c/span>\u003c/p>\n\u003cp>\"Unfortunately, less than 24 hours later, she returned here,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The same client was resting at the center on the day a KQED reporter visited, sitting in a black chair that she favors. Adams said the woman’s mental illness still wasn't well-controlled, so she couldn't speak coherently or consent to an interview. \u003c/span>\u003c/p>\n\u003cp>\"In an ideal world, she would be transferred to a 'board and care' or an assisted living facility, where they could manage her mental health as well as her medical health in a fashion that we simply don’t have the infrastructure for,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation moving through the state Senate would require that patients be discharged to one of four \"safe and appropriate\" locations: their primary dwelling (as identified by the homeless patient), another health center or hospital, a nonprofit or social service agency that has given written consent to accept the patient, or an alternative spot that the patient has consented to go to, in writing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://sd22.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Sen. Ed Hernandez\u003c/a>, D-West Covina, introduced the bill. He said hospitals, as part of society, have obligations to homeless Californians. \u003c/span>\u003c/p>\n\u003cp>\"If they fall down and have a heart attack, and somebody sends them to the hospital, we’re required by law -- which is the humane thing to do -- to treat those individuals,\" said Hernandez, who is an optometrist and chair of the Senate Health Committee. He was referring to a federal law called \u003ca href=\"https://www.acep.org/news-media-top-banner/emtala/#sm.000005tj0xf3geeirxddg2ghqr9qa\" target=\"_blank\" rel=\"noopener\">EMTALA\u003c/a>, which mandates that emergency rooms accept and treat everyone, regardless of ability to pay.\u003c/p>\n\u003cp>But EMTALA doesn't address how patients are discharged from ERs. \"Once they’re treated, the humane thing is to figure out where we’re going to place them, as opposed to just leaving them out in the street immediately,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">His bill would require some additional work on the part of ER staffers at California hospitals, such as getting consent from a shelter where the hospital wants to send the patient. \u003c/span>\u003c/p>\n\u003cp>\"I can’t imagine that it’s going to be that costly to pick up the phone,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation also lays out a checklist of things to do before discharge. For example, the patient must be hydrated, have recently eaten and be dressed in weather-appropriate clothing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But hospitals are pushing back, saying the list is too specific, and doesn’t give hospital workers enough flexibility to decide what’s right for each patient. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.calhospital.org/profile/peggy-broussard-wheeler\" target=\"_blank\" rel=\"noopener\">Peggy Wheeler\u003c/a> is the vice president for rural health and governance for the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>. She said the bill would put yet another burden on emergency care. \u003c/span>\u003c/p>\n\u003cp>\"Hospital ERs are overcrowded,\" Wheeler said. \"If we had to hold on to a patient in a bed in the ER, that’s one less bed, two less beds, three less beds that would be available for other members of the community that need to come in and use the ER.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams, the psychologist at A Woman’s Place, thinks the bill is a good step. But she said it doesn’t get at the \u003c/span>\u003cspan style=\"font-weight: 400\">root \u003c/span>\u003cspan style=\"font-weight: 400\">problem, which is that the Bay Area doesn’t have enough options for patients who still need help \u003c/span>\u003cspan style=\"font-weight: 400\">after\u003c/span>\u003cspan style=\"font-weight: 400\"> they leave the hospital. There aren’t enough nursing homes, rehabilitation units or assisted care programs for elderly, low-income or disabled patients. \u003c/span>\u003c/p>\n\u003cp>\"It’s a health insurance issue, it’s an aging issue, it’s a lack of infrastructure and funding,\" Adams said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Until that gets fixed, Adams fears many patients will continue to shuttle between hospitals, the shelter system and the street. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Choice Of Bay Area For AIDS Conference Exposes Tension Among Activists",
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"content": "\u003cp>After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">International AIDS Conference in 2020\u003c/a>, he quickly \u003ca href=\"http://msmgf.org/global-networks-call-upon-ias-to-reevaluate-decision-to-bring-conference-to-us-in-2020/\">published a statement of disapproval. \u003c/a>\u003c/p>\n\u003cp>Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter.\u003c/p>\n\u003cp>His statement of opposition and a second one drafted by colleagues at other AIDS organizations have been co-signed by hundreds of organizations and individuals in the United States and around the world.\u003c/p>\n\u003cp>Their biggest concern: long-standing U.S. visa policies will prevent many of the people most affected by AIDS and HIV, including \u003ca href=\"https://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-202\">drug users and sex workers\u003c/a> who live in other countries, from attending the conference. They also worry about new restrictions affecting travel from Muslim countries.\u003c/p>\n\u003cfigure id=\"attachment_363357\" class=\"wp-caption alignnone\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-363357\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/georgeayala.jpg\" alt=\"\" width=\"400\" height=\"266\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-375x249.jpg 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Oakland-based activist George Ayala doesn't want the AIDS conference held in the Bay Area. He is executive director of the Global Forum on MSM & HIV. \u003ccite>(Photo courtesy of Nadia Rafif)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In this day and age, I have to wonder why we support big international AIDS conferences happening in places that bar anyone,” said Ayala, executive director of the Global Forum on MSM [Men who have Sex with Men] & HIV.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>HIV/AIDS is far more prevalent in many countries, \u003ca href=\"https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html\">especially in Sub-Saharan Africa\u003c/a>, than in the United States. Almost 19 percent of people ages 15 to 49 in South Africa are infected with HIV, as are more than 20 percent in some neighboring countries.\u003c/p>\n\u003cp>In the U.S., prevalence among the same demographic group hovers \u003ca href=\"https://www.reuters.com/article/us-aids-usa/under-1-percent-of-u-s-adults-have-hiv-report-idUSN2962453620080129\">around a half of 1 percent\u003c/a> — although that masks some stark disparities. Last year, the Centers for Disease Control and Prevention projected that \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html\">1 in 2 black men\u003c/a> in the U.S. who have sex with men were at risk of contracting HIV. Globally, \u003ca href=\"http://www.unaids.org/en/resources/fact-sheet\">nearly 37 million\u003c/a> people are living with HIV.\u003c/p>\n\u003cp>Ayala and other critics of the Bay Area location raise broader questions about the cost and frequency of a biennial event they say is enormously expensive and often excludes the very people it purports to represent.\u003c/p>\n\u003cp>The organizers of the conference and others who support the decision to bring it to the Bay Area say they understand these worries.\u003c/p>\n\u003cp>“Travel restrictions to the U.S. remain a significant concern for us,” said Mandy Sugrue, spokeswoman for the International AIDS Society, which organizes the conference.\u003c/p>\n\u003cp>However, Sugrue and other proponents of a San Francisco-Oakland conference venue argue that the politically liberal Bay Area offers a perfect platform for rebuking the Trump administration’s exclusionary immigration policies and its perceived retreat from leadership on AIDS policy.\u003c/p>\n\u003cp>In December, the administration \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.449b3fa38c17\">fired all remaining members\u003c/a> of the Presidential Advisory Council on HIV/AIDS, six months after a half-dozen others had resigned in protest. Trump officials have also proposed cutting national HIV/AIDS spending by more than $100 million and reducing the U.S. contribution to global funding by more than $1 billion.\u003c/p>\n\u003cp>“If there is any place in the U.S. where people can come and protest and rise up and have their voices heard … Oakland is it,” said Cynthia Carey-Grant, executive director of the Oakland-based group Women Organized to Respond to Life-Threatening Disease. She penned \u003ca href=\"http://www.womenhiv.org/why-oakland-for-iac-2020/\">a statement in support\u003c/a> of the conference location that has been signed by nearly a dozen individuals and groups.\u003c/p>\n\u003cp>Carey-Grant believes the contrast between upscale, predominantly white San Francisco and its decidedly poorer neighbor across the Bay offers a window on the disparities that pervade AIDS treatment and funding around the world – to the detriment of low-income communities of color.\u003c/p>\n\u003cp>Sofia Tobar (Courtesy of Sofia Tobar)\u003c/p>\n\u003cp>Sofia Tobar, a 50-year-old transgender woman from Oakland who was diagnosed with HIV in 1998, said the conference is an opportunity “for Oakland’s diverse humans to embrace people from other countries … and to also highlight what we’re lacking.” She is especially interested in speaking out against federal cuts to AIDS services and violence targeting the transgender community, she said.\u003c/p>\n\u003cp>Others say they are eager to honor San Francisco’s long history of battling AIDS.\u003c/p>\n\u003cp>Joe Hollendoner, CEO of \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation\u003c/a>, noted that the conference organizers have secured use of the Moscone Center, the central conference venue, free of charge. They will use the money they save to help more people attend, he said. His foundation, along with the San Francisco Travel Association, led the committee that submitted the successful conference bid.\u003c/p>\n\u003cp>The planners of the International AIDS Conference usually try to alternate venues between affluent and lower-income countries. The conference was last held in the United States in 2012 in Washington, D.C. In 2014, it was in Melbourne, Australia, and in 2016, in Durban, South Africa. This year, the conference will be in Amsterdam.\u003c/p>\n\u003cp>Conference organizers said they reached out to a number of lower-income countries to host the 2020 conference, but \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">none submitted a bid\u003c/a>. As many as 20,000 people, perhaps more, are expected to attend the conference — and many cities cannot accommodate such a large gathering, they said. Sugrue, the International AIDS Society spokeswoman, said they are not considering changing the venue.\u003c/p>\n\u003cp>She said the location of major conference donors was not a factor in the 2020 venue decision.\u003c/p>\n\u003cp>Gilead Sciences Inc., which is based 20 miles from San Francisco and makes the HIV prevention drug Truvada, is one of the \u003ca href=\"http://www.aids2018.org/Sponsors-Exhibitors/Sponsors/Conference-sponsors-supporters\">top sponsors of this year’s conference\u003c/a>, as it was in 2016. Other big industry donors are not located in the Bay Area, including Johnson & Johnson, Merck and ViiV Healthcare, which specializes in HIV drugs. Funding for the 2020 conference has not yet been confirmed, Sugrue said.\u003c/p>\n\u003cp>Naina Khanna, the executive director of the Oakland-based Positive Women’s Network, said the fact that no developing countries submitted a bid isn’t enough to assuage her concern for the people who will likely be excluded. Khanna helped draft \u003ca href=\"https://docs.google.com/forms/d/e/1FAIpQLSfYsezkCUoHWc_8Sdo8WJJGKY518VSU6rnZXLuXpIMtgiJTuw/viewform\">a separate statement\u003c/a> demanding that the conference be relocated outside the U.S. More than 100 organizations and nearly as many individuals have signed the statement.\u003c/p>\n\u003cp>“Where is our commitment to actually holding the conference where the most people are impacted?” asked Ruth Morgan Thomas, global coordinator of the \u003ca href=\"http://www.nswp.org/\">Global Network of Sex Work Projects\u003c/a>, which includes 305 organizations representing sex workers in 85 countries.\u003c/p>\n\u003cp>Prior to the Washington, D.C., conference, the U.S. had lifted a ban on people with HIV entering the country, and many were hopeful that similar prohibitions against sex workers and drug users would also end. But they didn’t, and sex workers scrambled to organize a parallel conference in Kolkata, India, Morgan Thomas said. Drug users convened one in Kiev.\u003c/p>\n\u003cp>Khanna, of the Positive Women’s Network, said that the high cost of accommodations in the Bay Area will also make the conference inaccessible to many people within the United States — especially low-income African-Americans in the South, who are disproportionately burdened with the virus.\u003c/p>\n\u003cp>Marsha Martin, coordinating director of the Global Network of Black People Working in HIV, said she would have been happy had Bangkok or South America or even Atlanta been chosen to host the conference. “But if venues don’t submit bids, there’s nothing to do about it,” she said. So she’s treating the Bay Area conference as an opportunity to grapple with the big disparities in AIDS funding and to reinvigorate efforts in the U.S. to combat the disease.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If we do bring it [to the Bay Area] and make it the best conference we can make it, then we win,” Martin said. “We show the world we are not giving up.”\u003c/p>\n\n",
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"description": "After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the International AIDS Conference in 2020, he quickly published a statement of disapproval. Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter. His",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">International AIDS Conference in 2020\u003c/a>, he quickly \u003ca href=\"http://msmgf.org/global-networks-call-upon-ias-to-reevaluate-decision-to-bring-conference-to-us-in-2020/\">published a statement of disapproval. \u003c/a>\u003c/p>\n\u003cp>Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter.\u003c/p>\n\u003cp>His statement of opposition and a second one drafted by colleagues at other AIDS organizations have been co-signed by hundreds of organizations and individuals in the United States and around the world.\u003c/p>\n\u003cp>Their biggest concern: long-standing U.S. visa policies will prevent many of the people most affected by AIDS and HIV, including \u003ca href=\"https://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-202\">drug users and sex workers\u003c/a> who live in other countries, from attending the conference. They also worry about new restrictions affecting travel from Muslim countries.\u003c/p>\n\u003cfigure id=\"attachment_363357\" class=\"wp-caption alignnone\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-363357\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/georgeayala.jpg\" alt=\"\" width=\"400\" height=\"266\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-375x249.jpg 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Oakland-based activist George Ayala doesn't want the AIDS conference held in the Bay Area. He is executive director of the Global Forum on MSM & HIV. \u003ccite>(Photo courtesy of Nadia Rafif)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In this day and age, I have to wonder why we support big international AIDS conferences happening in places that bar anyone,” said Ayala, executive director of the Global Forum on MSM [Men who have Sex with Men] & HIV.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>HIV/AIDS is far more prevalent in many countries, \u003ca href=\"https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html\">especially in Sub-Saharan Africa\u003c/a>, than in the United States. Almost 19 percent of people ages 15 to 49 in South Africa are infected with HIV, as are more than 20 percent in some neighboring countries.\u003c/p>\n\u003cp>In the U.S., prevalence among the same demographic group hovers \u003ca href=\"https://www.reuters.com/article/us-aids-usa/under-1-percent-of-u-s-adults-have-hiv-report-idUSN2962453620080129\">around a half of 1 percent\u003c/a> — although that masks some stark disparities. Last year, the Centers for Disease Control and Prevention projected that \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html\">1 in 2 black men\u003c/a> in the U.S. who have sex with men were at risk of contracting HIV. Globally, \u003ca href=\"http://www.unaids.org/en/resources/fact-sheet\">nearly 37 million\u003c/a> people are living with HIV.\u003c/p>\n\u003cp>Ayala and other critics of the Bay Area location raise broader questions about the cost and frequency of a biennial event they say is enormously expensive and often excludes the very people it purports to represent.\u003c/p>\n\u003cp>The organizers of the conference and others who support the decision to bring it to the Bay Area say they understand these worries.\u003c/p>\n\u003cp>“Travel restrictions to the U.S. remain a significant concern for us,” said Mandy Sugrue, spokeswoman for the International AIDS Society, which organizes the conference.\u003c/p>\n\u003cp>However, Sugrue and other proponents of a San Francisco-Oakland conference venue argue that the politically liberal Bay Area offers a perfect platform for rebuking the Trump administration’s exclusionary immigration policies and its perceived retreat from leadership on AIDS policy.\u003c/p>\n\u003cp>In December, the administration \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.449b3fa38c17\">fired all remaining members\u003c/a> of the Presidential Advisory Council on HIV/AIDS, six months after a half-dozen others had resigned in protest. Trump officials have also proposed cutting national HIV/AIDS spending by more than $100 million and reducing the U.S. contribution to global funding by more than $1 billion.\u003c/p>\n\u003cp>“If there is any place in the U.S. where people can come and protest and rise up and have their voices heard … Oakland is it,” said Cynthia Carey-Grant, executive director of the Oakland-based group Women Organized to Respond to Life-Threatening Disease. She penned \u003ca href=\"http://www.womenhiv.org/why-oakland-for-iac-2020/\">a statement in support\u003c/a> of the conference location that has been signed by nearly a dozen individuals and groups.\u003c/p>\n\u003cp>Carey-Grant believes the contrast between upscale, predominantly white San Francisco and its decidedly poorer neighbor across the Bay offers a window on the disparities that pervade AIDS treatment and funding around the world – to the detriment of low-income communities of color.\u003c/p>\n\u003cp>Sofia Tobar (Courtesy of Sofia Tobar)\u003c/p>\n\u003cp>Sofia Tobar, a 50-year-old transgender woman from Oakland who was diagnosed with HIV in 1998, said the conference is an opportunity “for Oakland’s diverse humans to embrace people from other countries … and to also highlight what we’re lacking.” She is especially interested in speaking out against federal cuts to AIDS services and violence targeting the transgender community, she said.\u003c/p>\n\u003cp>Others say they are eager to honor San Francisco’s long history of battling AIDS.\u003c/p>\n\u003cp>Joe Hollendoner, CEO of \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation\u003c/a>, noted that the conference organizers have secured use of the Moscone Center, the central conference venue, free of charge. They will use the money they save to help more people attend, he said. His foundation, along with the San Francisco Travel Association, led the committee that submitted the successful conference bid.\u003c/p>\n\u003cp>The planners of the International AIDS Conference usually try to alternate venues between affluent and lower-income countries. The conference was last held in the United States in 2012 in Washington, D.C. In 2014, it was in Melbourne, Australia, and in 2016, in Durban, South Africa. This year, the conference will be in Amsterdam.\u003c/p>\n\u003cp>Conference organizers said they reached out to a number of lower-income countries to host the 2020 conference, but \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">none submitted a bid\u003c/a>. As many as 20,000 people, perhaps more, are expected to attend the conference — and many cities cannot accommodate such a large gathering, they said. Sugrue, the International AIDS Society spokeswoman, said they are not considering changing the venue.\u003c/p>\n\u003cp>She said the location of major conference donors was not a factor in the 2020 venue decision.\u003c/p>\n\u003cp>Gilead Sciences Inc., which is based 20 miles from San Francisco and makes the HIV prevention drug Truvada, is one of the \u003ca href=\"http://www.aids2018.org/Sponsors-Exhibitors/Sponsors/Conference-sponsors-supporters\">top sponsors of this year’s conference\u003c/a>, as it was in 2016. Other big industry donors are not located in the Bay Area, including Johnson & Johnson, Merck and ViiV Healthcare, which specializes in HIV drugs. Funding for the 2020 conference has not yet been confirmed, Sugrue said.\u003c/p>\n\u003cp>Naina Khanna, the executive director of the Oakland-based Positive Women’s Network, said the fact that no developing countries submitted a bid isn’t enough to assuage her concern for the people who will likely be excluded. Khanna helped draft \u003ca href=\"https://docs.google.com/forms/d/e/1FAIpQLSfYsezkCUoHWc_8Sdo8WJJGKY518VSU6rnZXLuXpIMtgiJTuw/viewform\">a separate statement\u003c/a> demanding that the conference be relocated outside the U.S. More than 100 organizations and nearly as many individuals have signed the statement.\u003c/p>\n\u003cp>“Where is our commitment to actually holding the conference where the most people are impacted?” asked Ruth Morgan Thomas, global coordinator of the \u003ca href=\"http://www.nswp.org/\">Global Network of Sex Work Projects\u003c/a>, which includes 305 organizations representing sex workers in 85 countries.\u003c/p>\n\u003cp>Prior to the Washington, D.C., conference, the U.S. had lifted a ban on people with HIV entering the country, and many were hopeful that similar prohibitions against sex workers and drug users would also end. But they didn’t, and sex workers scrambled to organize a parallel conference in Kolkata, India, Morgan Thomas said. Drug users convened one in Kiev.\u003c/p>\n\u003cp>Khanna, of the Positive Women’s Network, said that the high cost of accommodations in the Bay Area will also make the conference inaccessible to many people within the United States — especially low-income African-Americans in the South, who are disproportionately burdened with the virus.\u003c/p>\n\u003cp>Marsha Martin, coordinating director of the Global Network of Black People Working in HIV, said she would have been happy had Bangkok or South America or even Atlanta been chosen to host the conference. “But if venues don’t submit bids, there’s nothing to do about it,” she said. So she’s treating the Bay Area conference as an opportunity to grapple with the big disparities in AIDS funding and to reinvigorate efforts in the U.S. to combat the disease.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If we do bring it [to the Bay Area] and make it the best conference we can make it, then we win,” Martin said. “We show the world we are not giving up.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco's Newest Tool to Prevent Opioid Overdoses Tests Drugs, Starts Conversations",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">The only way you’d know you’re passing by a needle exchange at Sixth and Mission streets in San Francisco is a black poster with white lettering that reads, \"Syringe Access Services.\" The words are topped with a rebellious-looking image of a skull with hypodermic needles as the crossbones.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If you pause here, at the \u003c/span>\u003ca href=\"http://sfaf.org/client-services/syringe-access/\">\u003cspan style=\"font-weight: 400\">6th Street Harm Reduction Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, and look closer, you may also see a smaller sign with red and black lettering. It warns people who use methamphetamine and speed that there may be something unexpected in their drugs: the opioid fentanyl. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In February, three men were found dead outside a high school in San Francisco’s Haight-Ashbury neighborhood. They had been smoking meth, and city health officials believe the men did not know their drugs were laced with fentanyl. They died from opioid overdoses caused by the drug.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While \u003c/span>\u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\">\u003cspan style=\"font-weight: 400\">California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has made some positive strides in the fight against opioids (the latest data show that prescriptions in the state are down), deaths from one particularly powerful opioid,\u003c/span>\u003ca href=\"https://www.cdc.gov/drugoverdose/opioids/fentanyl.html\"> \u003cspan style=\"font-weight: 400\">fentanyl\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, are up. As this opioid increasingly shows up in street drugs, California is fighting back with a new tool: easy-to-use test strips that can detect the presence of fentanyl in other drugs or substances.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While the front room of the Harm Reduction Center in the South of Market looks like a standard needle exchange -- offering syringes, cotton balls and other accessories for injection drug use -- the rest of the center offers much more. Staffers give out Narcan (naloxone), a rescue drug that can reverse an opioid overdose and save a life. They also train clients how to properly use it. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There are individual rooms for counseling and for medical care, and a larger lounge for group meetings or even movie nights. The center is a project of the\u003c/span>\u003ca href=\"http://sfaf.org/\"> \u003cspan style=\"font-weight: 400\">San Francisco AIDS Foundation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363185\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363185 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg\" alt=\"Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">I met a woman who goes by the name Jade, 31, in a back room at the center. She has light hair, and pink and green eyeshadow. Jade was there for the \"Opiate User Lounge.\" Since Jade buys and uses illegal opioids, KQED is not identifying her legal name. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The lounge is a welcoming, nonjudgmental place where people who use opioids can access medical and mental health care. Staff also teach clients about overdoses and other health conditions associated with drug use. The idea is that eventually the lounge becomes a stop on the pathway for people who want to reduce or cease their opioid use. For Jade, though, the lounge simply feels like a place where she can hang out, read and rest, without anybody trying to fix her. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade was a teenager living with her family in Los Angeles when she was diagnosed with lupus, a disease in which the body’s immune system attacks its own organs and tissues. Lupus can cause intense joint pain.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Shortly after her diagnosis, her pain got so bad that she landed in the emergency room. Her treatment there was the first time she felt significant relief.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"They gave me some morphine,\" she said. \"And I was like 'Wow, I don’t want to die anymore.' Because I couldn’t escape the pain.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Jade said it became hard to alleviate her pain through prescriptions, and by her late teens, she had turned to heroin. She also liked the euphoria. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You don’t feel pain at all, you really don’t,\" Jade said. \"As long as you are in that space, everything is not just copacetic but beautiful.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She first came to the 6th Street Harm Reduction Center seven years ago to get supplies from the needle exchange. Gradually, Jade became more involved with the center.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She did a training on how to use naloxone, and now carries it regularly. Jade said she has used it to revive four people.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">These days, Jade keeps coming back to the center for the sense of community. After our interview, she helped pick up dirty needles on the streets outside, and then stayed afterward for pizza.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade still struggles with pain, and has legal prescriptions for opioids like morphine and methadone. But she supplements them with street drugs like heroin and fentanyl.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Fentanyl’s recent arrival in California is raising alarms across the state. Overdosing on any opioid is dangerous because the drug can slow or even stop a person's breathing. But Fentanyl is 30 to 50 times more powerful than heroin, making the overdose risk extremely high. Fentanyl was found in the bodies of both Prince and Tom Petty after they died. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">What makes fentanyl even more dangerous is that it is now being mixed into all kinds of drugs, often without the users' knowledge. It's been found in heroin, but also anti-anxiety medications like counterfeit Xanax, and illegal stimulants like cocaine and meth.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That’s when it becomes scary,\" said Kristen Marshall, who runs overdose prevention and naloxone distribution for the\u003c/span>\u003ca href=\"http://harmreduction.org/\"> \u003cspan style=\"font-weight: 400\">Harm Reduction Coalition\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \"People aren’t expecting an opioid overdose and may not know what they’re seeing,\" she said. This is especially true for people who use drugs that are not opioids, because they have less tolerance for opioids’ effect on the body, and can overdose on a smaller amount.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Those are people that are not prepared,\" Marshall said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363146\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363146\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg\" alt=\"Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade said she has seen the same thing happen with cocaine: \"People have been dying or overdosing because they are expecting cocaine and it’s not just cocaine. And they don’t have any tolerance.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So if fentanyl is often hidden in other drugs, how can you detect it?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Terry Morris runs the Sixth Street center where Jade hangs out. In a counseling room at the center, she demonstrated how to use a fentanyl test strip.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"It's a really simple process, if anybody's ever used a home pregnancy test,\" Morris said, holding a slender 3-inch strip of paper.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Morris added water to a small metal cap. If she were testing with actual drugs, and not just demonstrating, she would mix drug residue into the water. Then Morris submerged one end of the test strip for 15 seconds, removed it and waited another 15 seconds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"One line means fentanyl and two lines mean no fentanyl is present,\" she explained.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since this was just a demonstration, two lines appeared, meaning the water she practiced with was fentanyl-free.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Each strip costs a dollar, but Morris gets them for free from the state. Last May, \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/\">\u003cspan style=\"font-weight: 400\">the \u003c/span>\u003cspan style=\"font-weight: 400\">California Department of Public Health\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> began buying the strips and distributing them statewide to harm reduction centers like this one. It has spent $46,381 on the effort so far. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In San Francisco, five sites have been\u003c/span>\u003ca href=\"http://harmreduction.org/issues/fentanyl/\">\u003cspan style=\"font-weight: 400\"> trying out \u003c/span>\u003cspan style=\"font-weight: 400\">the test strips\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> since August 2017.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So what happens if the test shows the presence of fentanyl? The strips don’t tell a drug user \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">how much \u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">fentanyl is there, just that it’s present.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some people will not use drugs laced with fentanyl, Terry Morris said. But others will go ahead and use the drugs, she said. They’ll be able to use them differently, though, taking steps to reduce the risks.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You can choose to use less of the drug,\" Morris said. \"You can choose to use a tiny bit of the drug and see how it affects you. You can choose to stagger your use\" -- meaning people in a group take turns and watch out for each other. Some people make sure that they have naloxone nearby, in case of an overdose.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the test strips offer more than a safety check, according to the staff members. The process requires users to simply \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">pause\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">: while waiting for results, they often sit down and end up talking with counselors. Morris says those conversations are a way to encourage clients to check out other resources here, and perhaps to eventually stop using.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">The only way you’d know you’re passing by a needle exchange at Sixth and Mission streets in San Francisco is a black poster with white lettering that reads, \"Syringe Access Services.\" The words are topped with a rebellious-looking image of a skull with hypodermic needles as the crossbones.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If you pause here, at the \u003c/span>\u003ca href=\"http://sfaf.org/client-services/syringe-access/\">\u003cspan style=\"font-weight: 400\">6th Street Harm Reduction Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, and look closer, you may also see a smaller sign with red and black lettering. It warns people who use methamphetamine and speed that there may be something unexpected in their drugs: the opioid fentanyl. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In February, three men were found dead outside a high school in San Francisco’s Haight-Ashbury neighborhood. They had been smoking meth, and city health officials believe the men did not know their drugs were laced with fentanyl. They died from opioid overdoses caused by the drug.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While \u003c/span>\u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\">\u003cspan style=\"font-weight: 400\">California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has made some positive strides in the fight against opioids (the latest data show that prescriptions in the state are down), deaths from one particularly powerful opioid,\u003c/span>\u003ca href=\"https://www.cdc.gov/drugoverdose/opioids/fentanyl.html\"> \u003cspan style=\"font-weight: 400\">fentanyl\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, are up. As this opioid increasingly shows up in street drugs, California is fighting back with a new tool: easy-to-use test strips that can detect the presence of fentanyl in other drugs or substances.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While the front room of the Harm Reduction Center in the South of Market looks like a standard needle exchange -- offering syringes, cotton balls and other accessories for injection drug use -- the rest of the center offers much more. Staffers give out Narcan (naloxone), a rescue drug that can reverse an opioid overdose and save a life. They also train clients how to properly use it. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There are individual rooms for counseling and for medical care, and a larger lounge for group meetings or even movie nights. The center is a project of the\u003c/span>\u003ca href=\"http://sfaf.org/\"> \u003cspan style=\"font-weight: 400\">San Francisco AIDS Foundation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363185\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-363185 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg\" alt=\"Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30265_IMG_8494-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Many clients first come to the 6th Street Harm Reduction Center to get supplies for drug use. Often clients will become more involved with groups, start seeking medical care, and eventually assistance in stopping drug use. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">I met a woman who goes by the name Jade, 31, in a back room at the center. She has light hair, and pink and green eyeshadow. Jade was there for the \"Opiate User Lounge.\" Since Jade buys and uses illegal opioids, KQED is not identifying her legal name. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The lounge is a welcoming, nonjudgmental place where people who use opioids can access medical and mental health care. Staff also teach clients about overdoses and other health conditions associated with drug use. The idea is that eventually the lounge becomes a stop on the pathway for people who want to reduce or cease their opioid use. For Jade, though, the lounge simply feels like a place where she can hang out, read and rest, without anybody trying to fix her. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade was a teenager living with her family in Los Angeles when she was diagnosed with lupus, a disease in which the body’s immune system attacks its own organs and tissues. Lupus can cause intense joint pain.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Shortly after her diagnosis, her pain got so bad that she landed in the emergency room. Her treatment there was the first time she felt significant relief.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"They gave me some morphine,\" she said. \"And I was like 'Wow, I don’t want to die anymore.' Because I couldn’t escape the pain.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Jade said it became hard to alleviate her pain through prescriptions, and by her late teens, she had turned to heroin. She also liked the euphoria. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You don’t feel pain at all, you really don’t,\" Jade said. \"As long as you are in that space, everything is not just copacetic but beautiful.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She first came to the 6th Street Harm Reduction Center seven years ago to get supplies from the needle exchange. Gradually, Jade became more involved with the center.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She did a training on how to use naloxone, and now carries it regularly. Jade said she has used it to revive four people.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">These days, Jade keeps coming back to the center for the sense of community. After our interview, she helped pick up dirty needles on the streets outside, and then stayed afterward for pizza.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade still struggles with pain, and has legal prescriptions for opioids like morphine and methadone. But she supplements them with street drugs like heroin and fentanyl.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Fentanyl’s recent arrival in California is raising alarms across the state. Overdosing on any opioid is dangerous because the drug can slow or even stop a person's breathing. But Fentanyl is 30 to 50 times more powerful than heroin, making the overdose risk extremely high. Fentanyl was found in the bodies of both Prince and Tom Petty after they died. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">What makes fentanyl even more dangerous is that it is now being mixed into all kinds of drugs, often without the users' knowledge. It's been found in heroin, but also anti-anxiety medications like counterfeit Xanax, and illegal stimulants like cocaine and meth.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That’s when it becomes scary,\" said Kristen Marshall, who runs overdose prevention and naloxone distribution for the\u003c/span>\u003ca href=\"http://harmreduction.org/\"> \u003cspan style=\"font-weight: 400\">Harm Reduction Coalition\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \"People aren’t expecting an opioid overdose and may not know what they’re seeing,\" she said. This is especially true for people who use drugs that are not opioids, because they have less tolerance for opioids’ effect on the body, and can overdose on a smaller amount.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Those are people that are not prepared,\" Marshall said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_363146\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363146\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg\" alt=\"Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/RS30260_Kristen-Marshall-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Marshall leads overdose prevention and education for San Francisco's Department of Public Health. She stands outside the 6th Street Harm Reduction Center. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jade said she has seen the same thing happen with cocaine: \"People have been dying or overdosing because they are expecting cocaine and it’s not just cocaine. And they don’t have any tolerance.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So if fentanyl is often hidden in other drugs, how can you detect it?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Terry Morris runs the Sixth Street center where Jade hangs out. In a counseling room at the center, she demonstrated how to use a fentanyl test strip.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"It's a really simple process, if anybody's ever used a home pregnancy test,\" Morris said, holding a slender 3-inch strip of paper.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Morris added water to a small metal cap. If she were testing with actual drugs, and not just demonstrating, she would mix drug residue into the water. Then Morris submerged one end of the test strip for 15 seconds, removed it and waited another 15 seconds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"One line means fentanyl and two lines mean no fentanyl is present,\" she explained.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since this was just a demonstration, two lines appeared, meaning the water she practiced with was fentanyl-free.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Each strip costs a dollar, but Morris gets them for free from the state. Last May, \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/\">\u003cspan style=\"font-weight: 400\">the \u003c/span>\u003cspan style=\"font-weight: 400\">California Department of Public Health\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> began buying the strips and distributing them statewide to harm reduction centers like this one. It has spent $46,381 on the effort so far. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In San Francisco, five sites have been\u003c/span>\u003ca href=\"http://harmreduction.org/issues/fentanyl/\">\u003cspan style=\"font-weight: 400\"> trying out \u003c/span>\u003cspan style=\"font-weight: 400\">the test strips\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> since August 2017.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So what happens if the test shows the presence of fentanyl? The strips don’t tell a drug user \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">how much \u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">fentanyl is there, just that it’s present.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some people will not use drugs laced with fentanyl, Terry Morris said. But others will go ahead and use the drugs, she said. They’ll be able to use them differently, though, taking steps to reduce the risks.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"You can choose to use less of the drug,\" Morris said. \"You can choose to use a tiny bit of the drug and see how it affects you. You can choose to stagger your use\" -- meaning people in a group take turns and watch out for each other. Some people make sure that they have naloxone nearby, in case of an overdose.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the test strips offer more than a safety check, according to the staff members. The process requires users to simply \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">pause\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">: while waiting for results, they often sit down and end up talking with counselors. Morris says those conversations are a way to encourage clients to check out other resources here, and perhaps to eventually stop using.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "a-firefighter-in-san-diego-confronts-the-trauma-of-the-job",
"title": "A Firefighter in San Diego Confronts the Trauma of the Job",
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"headTitle": "A Firefighter in San Diego Confronts the Trauma of the Job | KQED",
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"content": "\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" rel=\"noopener\" target=\"_blank\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>At 7:30 on a recent morning, Jeremy Forte, a firefighter in Imperial Beach, California, had just wrapped up a 48-hour shift. As the seven-member crew headed home, Forte drove right past a local bar that used to be a favorite haunt. A few years ago, he would have stopped for a drink, or two, or three — and perhaps stayed on for hours. And he would have had plenty of company.\u003c/p>\n\u003cp>“There’s nurses from the hospital there getting off work at the same time,” Forte recalled. “We’d be drinking with nurses, partying, having a good old time. And we didn’t think anything was wrong. That’s what people do, right? They get off work and have some drinks.”\u003c/p>\n\u003cp>Jeremy is tall and lanky, with a thin mustache. He’s been a firefighter for 19 years. It’s grueling work, both physically and mentally. For a long time, drinking was how he coped.\u003c/p>\n\u003cp>“Our motto was work hard, party hard,” said Forte, now 39. “We put in 16-hour days and then we’d go drink the rest of the night, and then probably get two hours of sleep. Wake up, you know, half-drunk and go back out on the fire line and fight these fires.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A few years ago, Forte’s drinking got heavier. He started dabbling in cocaine. But he felt he still had it all under control, until he failed a random drug test at work.\u003c/p>\n\u003cp>Forte’s station is part of the federal government: his crew fights fires and responds to emergencies in and around a \u003ca href=\"https://www.cnic.navy.mil/regions/cnrsw/installations/navbase_coronado.html\" target=\"_blank\" rel=\"noopener\">naval base\u003c/a> in Imperial Beach. The federal firefighting force has a zero-tolerance policy, and Forte was in danger of losing his job immediately.\u003c/p>\n\u003cp>“They really could have ended my whole life by turning their backs on me and firing me,” Forte said. “And then at that point, I would lose my wife as well, and probably be living with my parents.”\u003c/p>\n\u003cp>Forte grew up in West Covina. Two \u003ca href=\"http://www.lafd.org/\" target=\"_blank\" rel=\"noopener\">LAFD\u003c/a> firefighters lived on his block. Forte admired them, and loved seeing his next-door neighbors on the local news.\u003c/p>\n\u003cp>“Doing that sort of thing really intrigued me,” he recalled. Not only was the job itself exciting, but it also allowed the firefighters to spend plenty of time with their families when they were off-duty.\u003c/p>\n\u003cp>But not everyone believed he could do it. Forte was born with a birth defect: He’s missing some fingers on both hands, and others aren’t fully formed. His whole career, he’s had to prove that he can do everything a firefighter has to do: drive rigs, grip and haul hoses, rescue people.\u003c/p>\n\u003cp>Forte proved the doubters wrong.\u003c/p>\n\u003cfigure id=\"attachment_363270\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-363270\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, California, has been a firefighter for 19 years and struggles with PTSD and depression. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 19 years as a firefighter, it has become crucial to his identity. Losing that career would have been absolutely devastating. After the drug test, Forte hired a private lawyer and asked the department and union for a second chance. He agreed to every condition of a yearlong probation, including enrolling in a recovery program and beginning therapy.\u003c/p>\n\u003cp>“By the grace of God, I still have my job,” Forte said. “I still have people backing me.”\u003c/p>\n\u003cp>During his recovery, Jeremy was diagnosed with post-traumatic stress disorder and depression. He wasn’t surprised to hear it, and he’s not alone.\u003c/p>\n\u003cp>First responders have increased rates of PTSD, depression, substance abuse and suicide due to the stresses they are exposed to on the job. In a \u003ca href=\"http://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a>, 85 percent of first responders reported symptoms related to mental health issues, but only about a third of them sought out professional help.\u003c/p>\n\u003cp>Another \u003ca href=\"http://www.jems.com/articles/print/volume-40/issue-10/features/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-suicide.html?c=1\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> revealed 6.6 percent of first responders had attempted suicide, and more than a third had considered suicide. In both cases, those rates are 10 times the national average.\u003c/p>\n\u003cp>“I always thought, it’s a job, you go do it and you just deal with it, it goes away,” Forte said. “But it doesn’t.”\u003c/p>\n\u003cp>The pain lingers and haunts. Forte learned that when he was 22, at his first job with the forest service. His team fought fires but also rescued backpackers — and he was surprised by the violence that nature can cause.\u003c/p>\n\u003cp>“There was a gentleman out camping in the middle of the forest in New Mexico,” he recalled. “A piece of the tree broke off and hit him in the neck and broke his neck. And as he hit the ground, he broke his leg. We had to fly there in a helicopter, basically to rescue him.”\u003c/p>\n\u003cp>But by the time they got there, the hiker had died. It was the first time Forte saw a dead body on the job, a victim of a violent, random accident. The helicopter extracted the body, but then it grew too dark to come back for the hiker’s friend, who was uninjured but traumatized and covered in blood. So Forte volunteered to stay with him all night in the woods.\u003c/p>\n\u003cp>After that incident, Forte started having nightmares.\u003c/p>\n\u003cp>“The things that we see on the job aren’t what everyday people see and so they wouldn’t understand completely what we deal with, and how it can haunt us and stay with us the rest of our lives.”\u003c/p>\n\u003cfigure id=\"attachment_363276\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363276\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jeremy Forte prepares to perform drills on Jan. 9, 2018. Forte has been a firefighter for 19 years and says the job is grueling, both physically and mentally. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not that firefighters never talk about what they see. They do, but they don’t talk about the pain inside.\u003c/p>\n\u003cp>“You don’t want to be seen as weak,” he said. “So instead … we’d go have some drinks and joke about it, or, you know, talk about the situation still, but it’s over alcohol.”\u003c/p>\n\u003cp>After hitting bottom, Jeremy moved his family to a wood cabin in Lake Arrowhead. It’s quiet there, and he can decompress when he isn’t at work.\u003c/p>\n\u003cp>Jeremy is now sober and back in the firehouse full-time. He tries to set an example for younger colleagues by sharing his story, and talking about his emotions more often.\u003c/p>\n\u003cp>“The current fire crew that I work with now, we’re all very open together,” he said. “We’re very tight-knit and we talk about the stuff we see. … We’re almost like our own counselors.”\u003c/p>\n\u003cp>Often the men gather in the kitchen to make breakfast before the shift formally starts at 7:30 a.m. Some of the men set the table, while others slice mushrooms, make hash browns or scramble eggs.\u003c/p>\n\u003cp>It ends up being a slow shift, with no emergency calls, so the seven men on duty spend the day checking gear and running drills.\u003c/p>\n\u003cp>Before turning in for the night, they gather again at the kitchen table. Things get serious when the talk turns to suicide among firefighters.\u003c/p>\n\u003cp>Everyone in the room knows a firefighter who killed him or herself, or at least has heard about a recent case.\u003c/p>\n\u003cp>The shift captain, Richard Hernandez, complained that mental health information wasn’t part of the firefighter training.\u003c/p>\n\u003cp>“There really hasn’t been any direction on how to work with that if somebody is having an issue,” he said.\u003c/p>\n\u003cp>Hernandez said that his firefighters can get three visits with a counselor per year, but that’s not enough.\u003c/p>\n\u003cp>Another firefighter, Lindsey Nolan, said he wants to learn how to recognize signs or symptoms of PTSD in a co-worker.\u003c/p>\n\u003cp>“I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on” if he had some training in it, Nolan said.\u003c/p>\n\u003cp>Another firefighter, Devin Boler, admitted it’s hard to know how — or when — to intervene.\u003c/p>\n\u003cp>“Because we live together, and we’re with each other through Christmas and Thanksgiving and stuff like that, we have to be professional,” Boler said. But there’s also “a family side to it, where you kind of have to check in with guys and see what’s going on, if they’re having a rough day.”\u003c/p>\n\u003cp>Firefighters began talking about these issues more after the increase in mass public shootings, according to the \u003ca href=\"http://www.ffbha.org/\" target=\"_blank\" rel=\"noopener\">Firefighter Behavioral Health Alliance\u003c/a>, an Arizona-based nonprofit that provides mental health support and training for firefighters.\u003c/p>\n\u003ch2>A Bittersweet Milestone\u003c/h2>\n\u003cp>Forte has been making the long drive to a drug screening center, in National City, at least twice a month for the past year. It’s part of his probation: submitting to a full year of random, and frequent, drug tests.\u003c/p>\n\u003cp>Today was his last visit, though. His probation is ending. Forte will still get random drug tests, but not as often.\u003c/p>\n\u003cp>“I feel great,” he said as he drove. “Not like I’m going to go out and celebrate, if you know what I mean.”\u003c/p>\n\u003cp>During the drive, Jeremy downed two large coffees. But despite the caffeine, he’s too wound up to provide a urine sample. After a few hours, he succeeds, and finally walks out of that clinic for the last time.\u003c/p>\n\u003cp>“It was a humbling process,” he reflected, looking back at his year of probation. “Ultimately, I wanted to get back on track for my family, for my job, for myself.”\u003c/p>\n\u003cp>“The biggest reason is my kids,” he added. “I wasn’t going to allow this to keep me down, and be some deadbeat dad that didn’t seek help.”\u003c/p>\n\u003cp>Forte said the culture of silence among first responders has to end. So does the idea that emergency work is about being tough at all costs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Guys shouldn’t feel that way,” he said. He wants firefighters to think about seeking counseling or mental health assistance as “the manly thing to do.”\u003c/p>\n\u003cfigure id=\"attachment_363271\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363271\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, Calif., has been a firefighter for 19 years and struggles with PTSD and depression. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\n",
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"excerpt": "Firefighter Jeremy Forte, who has battled PTSD, depression and substance abuse, says the culture of suffering in silence among first responders has to end.",
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"title": "A Firefighter in San Diego Confronts the Trauma of the Job",
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"nprByline": "\u003cstrong>\u003ca href=\"https://khn.org/news/author/heidi-de-marco/\">Heidi de Marco\u003c/a>\u003c/strong>\u003cbr>California Healthline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" rel=\"noopener\" target=\"_blank\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>At 7:30 on a recent morning, Jeremy Forte, a firefighter in Imperial Beach, California, had just wrapped up a 48-hour shift. As the seven-member crew headed home, Forte drove right past a local bar that used to be a favorite haunt. A few years ago, he would have stopped for a drink, or two, or three — and perhaps stayed on for hours. And he would have had plenty of company.\u003c/p>\n\u003cp>“There’s nurses from the hospital there getting off work at the same time,” Forte recalled. “We’d be drinking with nurses, partying, having a good old time. And we didn’t think anything was wrong. That’s what people do, right? They get off work and have some drinks.”\u003c/p>\n\u003cp>Jeremy is tall and lanky, with a thin mustache. He’s been a firefighter for 19 years. It’s grueling work, both physically and mentally. For a long time, drinking was how he coped.\u003c/p>\n\u003cp>“Our motto was work hard, party hard,” said Forte, now 39. “We put in 16-hour days and then we’d go drink the rest of the night, and then probably get two hours of sleep. Wake up, you know, half-drunk and go back out on the fire line and fight these fires.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A few years ago, Forte’s drinking got heavier. He started dabbling in cocaine. But he felt he still had it all under control, until he failed a random drug test at work.\u003c/p>\n\u003cp>Forte’s station is part of the federal government: his crew fights fires and responds to emergencies in and around a \u003ca href=\"https://www.cnic.navy.mil/regions/cnrsw/installations/navbase_coronado.html\" target=\"_blank\" rel=\"noopener\">naval base\u003c/a> in Imperial Beach. The federal firefighting force has a zero-tolerance policy, and Forte was in danger of losing his job immediately.\u003c/p>\n\u003cp>“They really could have ended my whole life by turning their backs on me and firing me,” Forte said. “And then at that point, I would lose my wife as well, and probably be living with my parents.”\u003c/p>\n\u003cp>Forte grew up in West Covina. Two \u003ca href=\"http://www.lafd.org/\" target=\"_blank\" rel=\"noopener\">LAFD\u003c/a> firefighters lived on his block. Forte admired them, and loved seeing his next-door neighbors on the local news.\u003c/p>\n\u003cp>“Doing that sort of thing really intrigued me,” he recalled. Not only was the job itself exciting, but it also allowed the firefighters to spend plenty of time with their families when they were off-duty.\u003c/p>\n\u003cp>But not everyone believed he could do it. Forte was born with a birth defect: He’s missing some fingers on both hands, and others aren’t fully formed. His whole career, he’s had to prove that he can do everything a firefighter has to do: drive rigs, grip and haul hoses, rescue people.\u003c/p>\n\u003cp>Forte proved the doubters wrong.\u003c/p>\n\u003cfigure id=\"attachment_363270\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-363270\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, California, has been a firefighter for 19 years and struggles with PTSD and depression. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 19 years as a firefighter, it has become crucial to his identity. Losing that career would have been absolutely devastating. After the drug test, Forte hired a private lawyer and asked the department and union for a second chance. He agreed to every condition of a yearlong probation, including enrolling in a recovery program and beginning therapy.\u003c/p>\n\u003cp>“By the grace of God, I still have my job,” Forte said. “I still have people backing me.”\u003c/p>\n\u003cp>During his recovery, Jeremy was diagnosed with post-traumatic stress disorder and depression. He wasn’t surprised to hear it, and he’s not alone.\u003c/p>\n\u003cp>First responders have increased rates of PTSD, depression, substance abuse and suicide due to the stresses they are exposed to on the job. In a \u003ca href=\"http://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a>, 85 percent of first responders reported symptoms related to mental health issues, but only about a third of them sought out professional help.\u003c/p>\n\u003cp>Another \u003ca href=\"http://www.jems.com/articles/print/volume-40/issue-10/features/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-suicide.html?c=1\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> revealed 6.6 percent of first responders had attempted suicide, and more than a third had considered suicide. In both cases, those rates are 10 times the national average.\u003c/p>\n\u003cp>“I always thought, it’s a job, you go do it and you just deal with it, it goes away,” Forte said. “But it doesn’t.”\u003c/p>\n\u003cp>The pain lingers and haunts. Forte learned that when he was 22, at his first job with the forest service. His team fought fires but also rescued backpackers — and he was surprised by the violence that nature can cause.\u003c/p>\n\u003cp>“There was a gentleman out camping in the middle of the forest in New Mexico,” he recalled. “A piece of the tree broke off and hit him in the neck and broke his neck. And as he hit the ground, he broke his leg. We had to fly there in a helicopter, basically to rescue him.”\u003c/p>\n\u003cp>But by the time they got there, the hiker had died. It was the first time Forte saw a dead body on the job, a victim of a violent, random accident. The helicopter extracted the body, but then it grew too dark to come back for the hiker’s friend, who was uninjured but traumatized and covered in blood. So Forte volunteered to stay with him all night in the woods.\u003c/p>\n\u003cp>After that incident, Forte started having nightmares.\u003c/p>\n\u003cp>“The things that we see on the job aren’t what everyday people see and so they wouldn’t understand completely what we deal with, and how it can haunt us and stay with us the rest of our lives.”\u003c/p>\n\u003cfigure id=\"attachment_363276\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363276\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jeremy Forte prepares to perform drills on Jan. 9, 2018. Forte has been a firefighter for 19 years and says the job is grueling, both physically and mentally. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not that firefighters never talk about what they see. They do, but they don’t talk about the pain inside.\u003c/p>\n\u003cp>“You don’t want to be seen as weak,” he said. “So instead … we’d go have some drinks and joke about it, or, you know, talk about the situation still, but it’s over alcohol.”\u003c/p>\n\u003cp>After hitting bottom, Jeremy moved his family to a wood cabin in Lake Arrowhead. It’s quiet there, and he can decompress when he isn’t at work.\u003c/p>\n\u003cp>Jeremy is now sober and back in the firehouse full-time. He tries to set an example for younger colleagues by sharing his story, and talking about his emotions more often.\u003c/p>\n\u003cp>“The current fire crew that I work with now, we’re all very open together,” he said. “We’re very tight-knit and we talk about the stuff we see. … We’re almost like our own counselors.”\u003c/p>\n\u003cp>Often the men gather in the kitchen to make breakfast before the shift formally starts at 7:30 a.m. Some of the men set the table, while others slice mushrooms, make hash browns or scramble eggs.\u003c/p>\n\u003cp>It ends up being a slow shift, with no emergency calls, so the seven men on duty spend the day checking gear and running drills.\u003c/p>\n\u003cp>Before turning in for the night, they gather again at the kitchen table. Things get serious when the talk turns to suicide among firefighters.\u003c/p>\n\u003cp>Everyone in the room knows a firefighter who killed him or herself, or at least has heard about a recent case.\u003c/p>\n\u003cp>The shift captain, Richard Hernandez, complained that mental health information wasn’t part of the firefighter training.\u003c/p>\n\u003cp>“There really hasn’t been any direction on how to work with that if somebody is having an issue,” he said.\u003c/p>\n\u003cp>Hernandez said that his firefighters can get three visits with a counselor per year, but that’s not enough.\u003c/p>\n\u003cp>Another firefighter, Lindsey Nolan, said he wants to learn how to recognize signs or symptoms of PTSD in a co-worker.\u003c/p>\n\u003cp>“I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on” if he had some training in it, Nolan said.\u003c/p>\n\u003cp>Another firefighter, Devin Boler, admitted it’s hard to know how — or when — to intervene.\u003c/p>\n\u003cp>“Because we live together, and we’re with each other through Christmas and Thanksgiving and stuff like that, we have to be professional,” Boler said. But there’s also “a family side to it, where you kind of have to check in with guys and see what’s going on, if they’re having a rough day.”\u003c/p>\n\u003cp>Firefighters began talking about these issues more after the increase in mass public shootings, according to the \u003ca href=\"http://www.ffbha.org/\" target=\"_blank\" rel=\"noopener\">Firefighter Behavioral Health Alliance\u003c/a>, an Arizona-based nonprofit that provides mental health support and training for firefighters.\u003c/p>\n\u003ch2>A Bittersweet Milestone\u003c/h2>\n\u003cp>Forte has been making the long drive to a drug screening center, in National City, at least twice a month for the past year. It’s part of his probation: submitting to a full year of random, and frequent, drug tests.\u003c/p>\n\u003cp>Today was his last visit, though. His probation is ending. Forte will still get random drug tests, but not as often.\u003c/p>\n\u003cp>“I feel great,” he said as he drove. “Not like I’m going to go out and celebrate, if you know what I mean.”\u003c/p>\n\u003cp>During the drive, Jeremy downed two large coffees. But despite the caffeine, he’s too wound up to provide a urine sample. After a few hours, he succeeds, and finally walks out of that clinic for the last time.\u003c/p>\n\u003cp>“It was a humbling process,” he reflected, looking back at his year of probation. “Ultimately, I wanted to get back on track for my family, for my job, for myself.”\u003c/p>\n\u003cp>“The biggest reason is my kids,” he added. “I wasn’t going to allow this to keep me down, and be some deadbeat dad that didn’t seek help.”\u003c/p>\n\u003cp>Forte said the culture of silence among first responders has to end. So does the idea that emergency work is about being tough at all costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Guys shouldn’t feel that way,” he said. He wants firefighters to think about seeking counseling or mental health assistance as “the manly thing to do.”\u003c/p>\n\u003cfigure id=\"attachment_363271\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363271\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-768x513.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1200x801.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-1180x788.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, Calif., has been a firefighter for 19 years and struggles with PTSD and depression. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\n\u003c/div>\u003c/p>",
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"title": "Trauma Surgeon Who Treated YouTube Victims: 'Every Day There are People Who are Getting Shot and Hurt'",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Gun violence clamored for our attention again earlier this week, when a woman shot three people and then killed herself Tuesday at the YouTube headquarters in San Bruno. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The three victims were sent to \u003ca href=\"https://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener\">Zuckerberg San Francisco General Hospital (ZSFG)\u003c/a>, and landed in the care of a team that included trauma surgeon \u003ca href=\"https://surgery.ucsf.edu/faculty/general-surgery/andre-campbell,-md.aspx\" target=\"_blank\" rel=\"noopener\">Dr. Andre Campbell\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Campbell surfaced from the emergency room to talk to the press on Tuesday afternoon, emphasizing that gun violence happens daily in the Bay Area and across the United States, whether a scrum of reporters is there to cover it or not. \u003c/span>\u003c/p>\n\u003cp>“I’d like to make sure that people know that we got a serious problem that we need to address,” he said.\u003c/p>\n\u003cp>KQED spoke to Campbell, a professor of surgery at the University of California, San Francisco.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>This interview has been edited for brevity and clarity.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>At the press conference outside the hospital on Tuesday, you talked about the frequency of gun violence, but the lack of consistent media interest. What were you thinking as you said that? \u003c/strong>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Dr. Andre Campbell:\u003c/strong> There is an epidemic of violent crime involving guns in the United States. So the thing that I was expressing is that on a daily basis we have folks who were shot. I was wondering out loud if this is related to the fact it’s a YouTube situation versus a situation where we have the poor folks: the homeless, people who are maybe not so well off and don’t work at YouTube. They get hurt because every day there are people who are getting shot and hurt.\u003c/p>\n\u003cp>\u003cstrong>Can you tell us about a typical day in the emergency room at ZSFG?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> We work in a very busy Level I trauma center at the Zuckerberg San Francisco General Hospital. Probably 80 percent of people we see are blunt trauma — that means related to car accidents, falls and bike accidents, those kind of things. And about 15 to 20 percent are penetrating trauma — that’s stab wounds and gunshot wounds and those kind of things.\u003c/p>\n\u003cp>\u003cstrong>How do you process what you do every day when you’re seeing that kind of literal trauma?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> First of all, let me just say it is an honor and a privilege to be a physician. People allow us to do things to make them better. \u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003cem>O\u003c/em>f course I see tough things. So the first thing I do when someone dies and it’s not expected is, I’ll stop for a moment and I’ll have everybody pause and I say, ‘Let’s have a moment of silence honoring the life that we just lost.’ The second thing I usually do then is talk to the social worker, and the social worker will put me in contact with the family. Then I’ll sit down in a quiet room and I’ll describe to them what happened. I describe to them I’ve done everything I had to do to save the life with the whole team and we could not save their relative.\u003c/p>\n\u003cp>When you do what I do, see people die fairly regularly, you recognize how fortunate it is to be alive and to be able to make people better.\u003c/p>\n\u003cp>\u003cstrong>What about when you go home and you’ve had a day like that? What do you do?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> I go on home, I listen to some jazz music, or turn on the TV and look at an old movie. The other day I had a bad day and I was watching “Space Cowboys,” or I’ll watch a James Bond movie.\u003c/p>\n\u003cp>But it’s hard. I mean there are times that you cry. It hurts. You know, we are human beings like everybody else.\u003c/p>\n\u003cp>\u003cstrong>I think a lot of people are frustrated with seeing this level of violence and feel helpless as to what they can do about it. What are you doing as a hospital to address it?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> We have a support system that has been built into the framework of the hospital that includes a trauma recovery center. There’s actually a great program started by one of my partners called \u003ca href=\"https://www.kqed.org/news/11178938/how-an-intervention-program-stops-the-revolving-door-of-violent-injuries\" target=\"_blank\" rel=\"noopener\">the Wraparound Project\u003c/a>, where victims of violent crimes are enrolled and given support services.\u003c/p>\n\u003cp>There are all kinds of violence intervention programs that go on around the country. There are social workers involved, there are therapists involved, there are counselors involved.\u003c/p>\n\u003cp>Out of the Sandy Hook massacre there was a program that was started through the \u003ca href=\"https://www.facs.org/\" target=\"_blank\" rel=\"noopener\">American College of Surgeons\u003c/a> called \u003ca href=\"https://www.kqed.org/stateofhealth/362695/after-mass-shootings-this-training-can-save-lives\" target=\"_blank\" rel=\"noopener\">Stop the Bleed\u003c/a>. We activate innocent bystanders of gunshots or incidents of trauma where they can have the basic skills to [stop major bleeding]. The course takes an hour to teach: It’s putting pressure on bleeding, packing a wound and applying a tourniquet. Right now, we’ve trained over 200,000 people. We’ve trained about 20,000 teachers to do that, and our job is really to train the entire population of the United States. There have been classes all over the city and county of San Francisco.\u003c/p>\n\u003cp>\u003cstrong>Anything else you’d like to add?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> I want to thank your listeners for being interested in this problem, and to help us. This is going to be a problem that not only trauma surgeons need to speak up about, but other types of people from all walks of life. We need teachers, we need police officers, we need firemen, we need the politicians. This is a terrible thing that happened. My heart goes out to the victims. We need to change the discussion. We need to move this forward, and we need to make a difference.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Gun violence clamored for our attention again earlier this week, when a woman shot three people and then killed herself Tuesday at the YouTube headquarters in San Bruno. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The three victims were sent to \u003ca href=\"https://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener\">Zuckerberg San Francisco General Hospital (ZSFG)\u003c/a>, and landed in the care of a team that included trauma surgeon \u003ca href=\"https://surgery.ucsf.edu/faculty/general-surgery/andre-campbell,-md.aspx\" target=\"_blank\" rel=\"noopener\">Dr. Andre Campbell\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Campbell surfaced from the emergency room to talk to the press on Tuesday afternoon, emphasizing that gun violence happens daily in the Bay Area and across the United States, whether a scrum of reporters is there to cover it or not. \u003c/span>\u003c/p>\n\u003cp>“I’d like to make sure that people know that we got a serious problem that we need to address,” he said.\u003c/p>\n\u003cp>KQED spoke to Campbell, a professor of surgery at the University of California, San Francisco.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This interview has been edited for brevity and clarity.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>At the press conference outside the hospital on Tuesday, you talked about the frequency of gun violence, but the lack of consistent media interest. What were you thinking as you said that? \u003c/strong>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Dr. Andre Campbell:\u003c/strong> There is an epidemic of violent crime involving guns in the United States. So the thing that I was expressing is that on a daily basis we have folks who were shot. I was wondering out loud if this is related to the fact it’s a YouTube situation versus a situation where we have the poor folks: the homeless, people who are maybe not so well off and don’t work at YouTube. They get hurt because every day there are people who are getting shot and hurt.\u003c/p>\n\u003cp>\u003cstrong>Can you tell us about a typical day in the emergency room at ZSFG?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> We work in a very busy Level I trauma center at the Zuckerberg San Francisco General Hospital. Probably 80 percent of people we see are blunt trauma — that means related to car accidents, falls and bike accidents, those kind of things. And about 15 to 20 percent are penetrating trauma — that’s stab wounds and gunshot wounds and those kind of things.\u003c/p>\n\u003cp>\u003cstrong>How do you process what you do every day when you’re seeing that kind of literal trauma?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> First of all, let me just say it is an honor and a privilege to be a physician. People allow us to do things to make them better. \u003cem> \u003c/em>\u003c/p>\n\u003cp>\u003cem>O\u003c/em>f course I see tough things. So the first thing I do when someone dies and it’s not expected is, I’ll stop for a moment and I’ll have everybody pause and I say, ‘Let’s have a moment of silence honoring the life that we just lost.’ The second thing I usually do then is talk to the social worker, and the social worker will put me in contact with the family. Then I’ll sit down in a quiet room and I’ll describe to them what happened. I describe to them I’ve done everything I had to do to save the life with the whole team and we could not save their relative.\u003c/p>\n\u003cp>When you do what I do, see people die fairly regularly, you recognize how fortunate it is to be alive and to be able to make people better.\u003c/p>\n\u003cp>\u003cstrong>What about when you go home and you’ve had a day like that? What do you do?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> I go on home, I listen to some jazz music, or turn on the TV and look at an old movie. The other day I had a bad day and I was watching “Space Cowboys,” or I’ll watch a James Bond movie.\u003c/p>\n\u003cp>But it’s hard. I mean there are times that you cry. It hurts. You know, we are human beings like everybody else.\u003c/p>\n\u003cp>\u003cstrong>I think a lot of people are frustrated with seeing this level of violence and feel helpless as to what they can do about it. What are you doing as a hospital to address it?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> We have a support system that has been built into the framework of the hospital that includes a trauma recovery center. There’s actually a great program started by one of my partners called \u003ca href=\"https://www.kqed.org/news/11178938/how-an-intervention-program-stops-the-revolving-door-of-violent-injuries\" target=\"_blank\" rel=\"noopener\">the Wraparound Project\u003c/a>, where victims of violent crimes are enrolled and given support services.\u003c/p>\n\u003cp>There are all kinds of violence intervention programs that go on around the country. There are social workers involved, there are therapists involved, there are counselors involved.\u003c/p>\n\u003cp>Out of the Sandy Hook massacre there was a program that was started through the \u003ca href=\"https://www.facs.org/\" target=\"_blank\" rel=\"noopener\">American College of Surgeons\u003c/a> called \u003ca href=\"https://www.kqed.org/stateofhealth/362695/after-mass-shootings-this-training-can-save-lives\" target=\"_blank\" rel=\"noopener\">Stop the Bleed\u003c/a>. We activate innocent bystanders of gunshots or incidents of trauma where they can have the basic skills to [stop major bleeding]. The course takes an hour to teach: It’s putting pressure on bleeding, packing a wound and applying a tourniquet. Right now, we’ve trained over 200,000 people. We’ve trained about 20,000 teachers to do that, and our job is really to train the entire population of the United States. There have been classes all over the city and county of San Francisco.\u003c/p>\n\u003cp>\u003cstrong>Anything else you’d like to add?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Campbell:\u003c/strong> I want to thank your listeners for being interested in this problem, and to help us. This is going to be a problem that not only trauma surgeons need to speak up about, but other types of people from all walks of life. We need teachers, we need police officers, we need firemen, we need the politicians. This is a terrible thing that happened. My heart goes out to the victims. We need to change the discussion. We need to move this forward, and we need to make a difference.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks",
"title": "A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly listed the quality-care targets hospitals would have to meet to be included in Covered California insurance plans. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Do you ever wonder what your couples’ therapist's own marriage is like? Do they fight over silly stuff, like the rest of us?\u003c/p>\n\u003cp>Harville Hendrix and Helen Hunt have been married for more than 30 years. They work as a \u003ca href=\"http://harvilleandhelen.com/\" target=\"_blank\" rel=\"noopener\">therapeutic team\u003c/a> and, now that their six kids are grown, they’ve been traveling the country teaching a course called \u003ca href=\"https://relationshipsfirst.org/\" target=\"_blank\" rel=\"noopener\">Safe Conversations\u003c/a>.\u003c/p>\n\u003cp>“Talking is the most dangerous thing people do,” Hendrix said during their presentation at a \u003ca href=\"https://lifespanlearn.org/conferences\" target=\"_blank\" rel=\"noopener\">couples’ counseling conference\u003c/a> in Los Angeles. “Listening is the most infrequent.”\u003c/p>\n\u003cp>Instead of calling their work therapy, they prefer “relationship education.” They teach people to look in each others’ eyes and take three deep breaths before talking. And to say things like, “Is now a good time to give you an appreciation?”\u003c/p>\n\u003cp>When they ask the audience in LA to find a partner and try this, people are \u003cem>into\u003c/em> it. It’s a room full of 500 couples’ therapists after all. But Hunt says they do get pushback when they try it with churches at home in Dallas.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Most people think, ‘Oh well, it’s easy for Harville and Helen to talk about it, but they’re not married to a jerk. I’m married to a jerk,’” Hunt said. “That stuff’s never going to work on my marriage.”\u003c/p>\n\u003cp>But Hunt says, she and Hendrix could be jerks, too. For years, they were on the brink of divorce. They griped at each other all the time.\u003c/p>\n\u003cp>They sat on a panel together at the conference with four other couples, all in the relationship therapy business, talking about how they managed to turn things around.\u003c/p>\n\u003cp>“What we finally decided to do was Go Zero Negative,” said Hendrix, quoting one of the catch-phrases from their presentation.\u003c/p>\n\u003cp>“We ended the offhand comments like ‘What? Where’d you get an idea like that?’ Or the stare – like, ‘how could you possibly?’” he said. “And what we discovered was that put downs are endemic in human conversation. I didn’t know that we were being so – like everybody else.”\u003c/p>\n\u003cp>Stopping the negativity is just the start, Hendrix said. Couples have to say nice things to each other, too.\u003c/p>\n\u003cp>“It’s like a garden,” he said. “You can get the weeds out of the garden, you still don’t get any tomatoes. You have to put stuff in.”\u003c/p>\n\u003cp>A lot of therapists laugh when people say, “you must never fight with your spouse.” Psychologist Stan Tatkin and his wife run a therapy institute near LA called the \u003ca href=\"https://thepactinstitute.com/\" target=\"_blank\" rel=\"noopener\">Psychobiological Approach to Couples Therapy (PACT) Institute\u003c/a>.\u003c/p>\n\u003cp>“My daughter will say, “you’re a so-called relationship expert, do you really want to be doing \u003cem>that\u003c/em>?” said Tatkin, his wife sitting next to him on the panel.\u003c/p>\n\u003cp>“That,” for Tatkin, means acting like a three-year old when he’s angry. Getting irritable over his wife’s driving, or generally, taking her for granted.\u003c/p>\n\u003cp>“The patients that I work with are also inspiring to me. And many times I sit through a session and think, ‘I’m going to go home and apologize,’” he said.\u003c/p>\n\u003cp>He and his wife do have fights, he said, but the key is to resolve them quickly. Don’t let things fester.\u003c/p>\n\u003cp>\u003ca href=\"http://drmarionsolomon.com/\" target=\"_blank\" rel=\"noopener\">Marion Solomon\u003c/a>, a psychologist who sees couples in West Hollywood, said she learned from watching her patients \u003cem>what\u003c/em> to fight about.\u003c/p>\n\u003cp>“They argue about things like what restaurant to go to for dinner,” she said. “And after they’ve finished arguing and they agree on it, they argue about ‘How do we get there? What route do we take?’”\u003c/p>\n\u003cp>She studied attachment theory, and learned that people aren’t really fighting over those little things. They’re stuck in dynamics they had with their mother or father that they’ve recreated with their partner.\u003c/p>\n\u003cp>Solomon learned to control her reactions when the little things didn’t matter. If something was really important to her husband and not a big deal to her, she gave in. He did the same for her.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If your partner is under stress, that’s the time to get strong and to get my cortex in line and say I can’t be upset when he’s upset,” she said. In other words, “a good marriage is a partnership where only one partner goes crazy at a time.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Do you ever wonder what your couples’ therapist's own marriage is like? Do they fight over silly stuff, like the rest of us?\u003c/p>\n\u003cp>Harville Hendrix and Helen Hunt have been married for more than 30 years. They work as a \u003ca href=\"http://harvilleandhelen.com/\" target=\"_blank\" rel=\"noopener\">therapeutic team\u003c/a> and, now that their six kids are grown, they’ve been traveling the country teaching a course called \u003ca href=\"https://relationshipsfirst.org/\" target=\"_blank\" rel=\"noopener\">Safe Conversations\u003c/a>.\u003c/p>\n\u003cp>“Talking is the most dangerous thing people do,” Hendrix said during their presentation at a \u003ca href=\"https://lifespanlearn.org/conferences\" target=\"_blank\" rel=\"noopener\">couples’ counseling conference\u003c/a> in Los Angeles. “Listening is the most infrequent.”\u003c/p>\n\u003cp>Instead of calling their work therapy, they prefer “relationship education.” They teach people to look in each others’ eyes and take three deep breaths before talking. And to say things like, “Is now a good time to give you an appreciation?”\u003c/p>\n\u003cp>When they ask the audience in LA to find a partner and try this, people are \u003cem>into\u003c/em> it. It’s a room full of 500 couples’ therapists after all. But Hunt says they do get pushback when they try it with churches at home in Dallas.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Most people think, ‘Oh well, it’s easy for Harville and Helen to talk about it, but they’re not married to a jerk. I’m married to a jerk,’” Hunt said. “That stuff’s never going to work on my marriage.”\u003c/p>\n\u003cp>But Hunt says, she and Hendrix could be jerks, too. For years, they were on the brink of divorce. They griped at each other all the time.\u003c/p>\n\u003cp>They sat on a panel together at the conference with four other couples, all in the relationship therapy business, talking about how they managed to turn things around.\u003c/p>\n\u003cp>“What we finally decided to do was Go Zero Negative,” said Hendrix, quoting one of the catch-phrases from their presentation.\u003c/p>\n\u003cp>“We ended the offhand comments like ‘What? Where’d you get an idea like that?’ Or the stare – like, ‘how could you possibly?’” he said. “And what we discovered was that put downs are endemic in human conversation. I didn’t know that we were being so – like everybody else.”\u003c/p>\n\u003cp>Stopping the negativity is just the start, Hendrix said. Couples have to say nice things to each other, too.\u003c/p>\n\u003cp>“It’s like a garden,” he said. “You can get the weeds out of the garden, you still don’t get any tomatoes. You have to put stuff in.”\u003c/p>\n\u003cp>A lot of therapists laugh when people say, “you must never fight with your spouse.” Psychologist Stan Tatkin and his wife run a therapy institute near LA called the \u003ca href=\"https://thepactinstitute.com/\" target=\"_blank\" rel=\"noopener\">Psychobiological Approach to Couples Therapy (PACT) Institute\u003c/a>.\u003c/p>\n\u003cp>“My daughter will say, “you’re a so-called relationship expert, do you really want to be doing \u003cem>that\u003c/em>?” said Tatkin, his wife sitting next to him on the panel.\u003c/p>\n\u003cp>“That,” for Tatkin, means acting like a three-year old when he’s angry. Getting irritable over his wife’s driving, or generally, taking her for granted.\u003c/p>\n\u003cp>“The patients that I work with are also inspiring to me. And many times I sit through a session and think, ‘I’m going to go home and apologize,’” he said.\u003c/p>\n\u003cp>He and his wife do have fights, he said, but the key is to resolve them quickly. Don’t let things fester.\u003c/p>\n\u003cp>\u003ca href=\"http://drmarionsolomon.com/\" target=\"_blank\" rel=\"noopener\">Marion Solomon\u003c/a>, a psychologist who sees couples in West Hollywood, said she learned from watching her patients \u003cem>what\u003c/em> to fight about.\u003c/p>\n\u003cp>“They argue about things like what restaurant to go to for dinner,” she said. “And after they’ve finished arguing and they agree on it, they argue about ‘How do we get there? What route do we take?’”\u003c/p>\n\u003cp>She studied attachment theory, and learned that people aren’t really fighting over those little things. They’re stuck in dynamics they had with their mother or father that they’ve recreated with their partner.\u003c/p>\n\u003cp>Solomon learned to control her reactions when the little things didn’t matter. If something was really important to her husband and not a big deal to her, she gave in. He did the same for her.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If your partner is under stress, that’s the time to get strong and to get my cortex in line and say I can’t be upset when he’s upset,” she said. In other words, “a good marriage is a partnership where only one partner goes crazy at a time.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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