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"disqusTitle": "Labor Union Pressures Kaiser Permanente with Protests Across the State",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Ever since Dwayne Ealy was a kid, he really wanted to work for \u003ca href=\"https://healthy.kaiserpermanente.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Permanente\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\"I grew up right here by Kaiser Oakland, in this neighborhood, so I’d walk by Kaiser every day,\" he said while rallying outside Kaiser's \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/facilities/Oakland-Medical-Center-100344\" target=\"_blank\" rel=\"noopener\">Oakland Medical Center\u003c/a>. \"I went to Oakland Technical High School, it’s right down the street. I wanted to work at Kaiser a long time.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After burning out on his first career as a youth counselor, Ealy finally did get a Kaiser job, as an Integrated Courier at a distribution center in Livermore. He delivers medications to Kaiser Permanente hospitals and pharmacies.\u003c/span>\u003c/p>\n\u003cp>\"It’s a good job, and I can do things for my family, and be successful in my community,\" Ealy said. \"People are happy to work for Kaiser.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy's enjoyed the work so much that he's been at Kaiser Permanente for 13 years, his longest stint with any one employer. Since the fall, however, Ealy senses his position is on shaky ground. His fears that his work will be outsourced led him to this protest outside the hospital two weeks ago. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Union workers employed by Kaiser Permanente are staging a series of protests across California. They say the health care provider is thriving financially, but still plans to outsource some jobs, and cut wages for some new hires.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy joined more than a hundred other employees who chanted and marched. Some dressed in hospital scrubs, others in street clothes, and many in the deep purple color associated with their union, Service Employees International Union - United Healthcare Workers West (SEIU-UHW). They chanted \"Who's got the power? We got the power! What kind of power? Union power!\" The rally was one of 32 demonstrations that SEIU-UHW is organizing around California between Feb. 14 - Mar. 9. \u003c/span>\u003c/p>\n\u003cp>SEIU-UHW\u003cspan style=\"font-weight: 400\"> represents roughly 55,000 positions at Kaiser facilities across the state, including medical assistants, housekeeping aides, and pharmacy clerks. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The union's contract with the health care provider expires in September, and union representatives say Kaiser is considering 20 percent wage cuts for new hires in the Central Valley, and ten percent cuts in the Sacramento area. The union points out that in 2017 Kaiser made $3.8 billion, after expenses. \u003c/span>\u003c/p>\n\u003cp>\"We work hard for Kaiser, Kaiser you’re making a lot of money,\" Ealy said. \"Don’t be unfair to us.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser plans to hire an outside company to take over storage and distribution of pharmaceuticals in Oakland, and representatives say they fear the loss of 55 jobs there. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But John Nelson, Vice President of Communications at Kaiser Permanente, wrote in a statement that \"The exact number of positions affected by this decision has not yet been determined.\" \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He called the union's claims \"premature\" and potentially wrong. Nelson also wrote that when there are job changes, Kaiser works to \"reassign and retain our employees first.\"\u003c/span>\u003c/p>\n\u003cp>Union members say they have information that more than 700 other jobs around the state are threatened too, including positions at call centers in Southern California, and warehouse jobs like Ealy’s in Livermore.\u003c/p>\n\u003cp>Nelson stated that Kaiser will not be laying off 700 call center workers, but will \"improve our call center agents' ability to manage member calls and schedule appointments across Southern California.\" He added that the health care provider will make \"additional improvements and changes in the future,\" but will communicate those ahead of time.\u003c/p>\n\u003cp>Nelson also wrote that the union's claims about outsourcing of jobs in the Livermore distribution center are wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Contract negotiations between SEIU-UHW and Kaiser Permanente begin at the end of March, ahead of the current contract's expiration in September. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Ever since Dwayne Ealy was a kid, he really wanted to work for \u003ca href=\"https://healthy.kaiserpermanente.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Permanente\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\"I grew up right here by Kaiser Oakland, in this neighborhood, so I’d walk by Kaiser every day,\" he said while rallying outside Kaiser's \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/facilities/Oakland-Medical-Center-100344\" target=\"_blank\" rel=\"noopener\">Oakland Medical Center\u003c/a>. \"I went to Oakland Technical High School, it’s right down the street. I wanted to work at Kaiser a long time.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After burning out on his first career as a youth counselor, Ealy finally did get a Kaiser job, as an Integrated Courier at a distribution center in Livermore. He delivers medications to Kaiser Permanente hospitals and pharmacies.\u003c/span>\u003c/p>\n\u003cp>\"It’s a good job, and I can do things for my family, and be successful in my community,\" Ealy said. \"People are happy to work for Kaiser.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy's enjoyed the work so much that he's been at Kaiser Permanente for 13 years, his longest stint with any one employer. Since the fall, however, Ealy senses his position is on shaky ground. His fears that his work will be outsourced led him to this protest outside the hospital two weeks ago. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Union workers employed by Kaiser Permanente are staging a series of protests across California. They say the health care provider is thriving financially, but still plans to outsource some jobs, and cut wages for some new hires.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy joined more than a hundred other employees who chanted and marched. Some dressed in hospital scrubs, others in street clothes, and many in the deep purple color associated with their union, Service Employees International Union - United Healthcare Workers West (SEIU-UHW). They chanted \"Who's got the power? We got the power! What kind of power? Union power!\" The rally was one of 32 demonstrations that SEIU-UHW is organizing around California between Feb. 14 - Mar. 9. \u003c/span>\u003c/p>\n\u003cp>SEIU-UHW\u003cspan style=\"font-weight: 400\"> represents roughly 55,000 positions at Kaiser facilities across the state, including medical assistants, housekeeping aides, and pharmacy clerks. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The union's contract with the health care provider expires in September, and union representatives say Kaiser is considering 20 percent wage cuts for new hires in the Central Valley, and ten percent cuts in the Sacramento area. The union points out that in 2017 Kaiser made $3.8 billion, after expenses. \u003c/span>\u003c/p>\n\u003cp>\"We work hard for Kaiser, Kaiser you’re making a lot of money,\" Ealy said. \"Don’t be unfair to us.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser plans to hire an outside company to take over storage and distribution of pharmaceuticals in Oakland, and representatives say they fear the loss of 55 jobs there. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But John Nelson, Vice President of Communications at Kaiser Permanente, wrote in a statement that \"The exact number of positions affected by this decision has not yet been determined.\" \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He called the union's claims \"premature\" and potentially wrong. Nelson also wrote that when there are job changes, Kaiser works to \"reassign and retain our employees first.\"\u003c/span>\u003c/p>\n\u003cp>Union members say they have information that more than 700 other jobs around the state are threatened too, including positions at call centers in Southern California, and warehouse jobs like Ealy’s in Livermore.\u003c/p>\n\u003cp>Nelson stated that Kaiser will not be laying off 700 call center workers, but will \"improve our call center agents' ability to manage member calls and schedule appointments across Southern California.\" He added that the health care provider will make \"additional improvements and changes in the future,\" but will communicate those ahead of time.\u003c/p>\n\u003cp>Nelson also wrote that the union's claims about outsourcing of jobs in the Livermore distribution center are wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Contract negotiations between SEIU-UHW and Kaiser Permanente begin at the end of March, ahead of the current contract's expiration in September. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Care Revamp At The L.A. County Jails",
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"content": "\u003cp>Michael Callahan, an outgoing 43-year-old carpenter, landed in a Los Angeles County jail last September because of what he said were “bad decisions and selling drugs.”\u003c/p>\n\u003cp>He had uncontrolled diabetes and high blood pressure when he arrived, but his health was the last thing on his mind. Consumed by a meth addiction, he hadn’t taken his medications for months. “When I got here, I was a wreck,” said Callahan, who is stocky and covered in tattoos. “My legs were so swollen that if I bumped them they would break open.”\u003c/p>\n\u003cp>By January, however, his diabetes was improving and his blood pressure had dropped. Now, he takes his medications daily and sees a doctor every two months. Even as he counts the days until his release this summer, Callahan knows he is getting much-needed medical care. “I’m where I need to be, not where I want to be,” he said.\u003c/p>\n\u003cp>Callahan’s situation is counterintuitive: He may end up leaving jail healthier than when he arrived. Officials at the Los Angeles County Department of Health Services hope to see more cases like his as they embark on an ambitious effort to improve health care for jail inmates. Their project follows decades of complaints, lawsuits and reports of poor medical and mental health care at the Los Angeles County jails, which house about 18,000 inmates on any given day.\u003c/p>\n\u003cp>The county’s overhaul is designed to raise the quality of health care behind bars and better equip inmates to manage their health after they are released. But the challenges are enormous – the population is disproportionately sick, and the jails weren’t designed to be medical facilities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The innovative effort at one of the nation’s biggest jail systems is based on a logical premise: Inmates don’t stay in jail for long – the average stay is just 60 days – so it’s a crucial opportunity to diagnose and begin treating their diseases.\u003c/p>\n\u003cp>“People are there for just a blip in time, days, weeks, months … and they’re returning back to the community,” said Mark Ghaly, director of community health for the county Department of Health Services. “What happens in the jail matters.”\u003c/p>\n\u003cp>The county health agency took over medical care in the jails from the LA County Sheriff’s Department in 2015 and started revamping the system in earnest last year.\u003c/p>\n\u003cfigure id=\"attachment_362814\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362814\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg\" alt=\"The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The main health clinic at the Men’s Central Jail in downtown Los Angeles is located just inside a large metal gate. Inmates there and at all the LA county jails can get a wide variety of medical and behavioral care. “It’s a giant health system and it’s complex,” said Margarita Pereyda, chief medical officer of correctional health services for LA County. “We are a hybrid between a hospital and an ER and an outpatient kind of environment.”\u003c/p>\n\u003cp>Part of the plan is to make clinics inside the jails more like ones on the outside. That means assigning inmates to primary care doctors to manage their chronic diseases and getting them appointments and medications quickly. It also means expanding treatment for mental health and substance abuse and referring those who need advanced medical or behavioral care to specialists who work for the county.\u003c/p>\n\u003cp>It’s a monumental job: Nearly half of all inmates have at least one chronic disease, including about 450 who have HIV and 900 with diabetes. About two-thirds of inmates are addicted to drugs or alcohol, and about a quarter have serious mental illnesses.\u003c/p>\n\u003cp>“Very few people have chronic illness under good control,” Ghaly said. ”The jails have largely become treatment facilities.”\u003c/p>\n\u003cp>To improve inmates’ access to care, county officials launched a physician recruitment effort this month. They released a series of online videos featuring medical providers with the slogan “\u003ca href=\"https://missionpossible.lacounty.gov/\" target=\"_blank\" rel=\"noopener\">Mission Possible\u003c/a>.” As an incentive, they are offering to pay up to $120,000 in medical school debt for each of the new hires who need it. That strategy has been used to lure doctors to low-income communities around the United States.\u003c/p>\n\u003cp>Esther Lim, who directs the jails project at the American Civil Liberties Union of Southern California, said she is optimistic care will improve, but she still hears daily from inmates about delays in appointments and medications. And, she said, people are still dying inside the LA County jails – an average of 25 each year, according to the health department.\u003c/p>\n\u003cp>“It’s an indication that there is something wrong, that the delivery of medical care is still poor,” Lim said. Overcrowding can result in inmates’ health being neglected and deteriorating over time, she said. County health officials acknowledge the situation is not going to change overnight. The county is “making some great headway,” but “there are some things that you can change more quickly than others,” said Ed Matzen, clinical nursing director for the jails.\u003c/p>\n\u003cfigure id=\"attachment_362816\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362816\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg\" alt=\"Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lello Tesema, a primary care physician and director of population health for the county jails, said many of her patients have gone without care on the outside for a long time. As soon as she gets a new patient, Tesema takes a medical and personal history. Then she creates a plan with the patient, knowing she only has a limited amount of time to implement it.\u003c/p>\n\u003cp>One early morning in January, Tesema examined Callahan, the carpenter, on an exam table in a room just off a busy corridor around the corner from his dorm-style cell. She said the swelling in his legs had diminished and his blood sugar level was looking good. “We’re moving in the right direction,” she told him. On the way back to his bunk, Callahan stopped at a window to pick up a pill for his diabetes.\u003c/p>\n\u003cp>Tesema said she worries about the health of her patients after they get out of jail even though they leave with a referral to a county clinic and 30 days’ worth of medication – up from three days in the past. “Often I see patients come back and a lot of the successes that happened while they were here end up diminishing after they leave,” she said.\u003c/p>\n\u003cp>Tesema and other medical providers in the jail must manage the inherent tension between safety and medical care. Sometimes, doctors have to see patients in their cells or treat them when they are handcuffed, Tesema said.\u003c/p>\n\u003cp>Jason Wolak, a captain in the medical services bureau of the Sheriff’s Department, said deputies are making an effort to get more inmates to medical appointments. “We’re the Uber for medical,” he said. He added that the Sheriff’s Department needs more staff, especially for transporting inmates to outside specialists or to the county-run hospitals.\u003c/p>\n\u003cp>Since patients also are going to court, attending classes or meeting with their lawyers, scheduling medical visits can be a challenge, Ghaly said. “There’s a high no-show rate to appointments.”\u003c/p>\n\u003cp>Pereyda said the new system for providing care at the jails depends on current doctors changing their mindset – things as simple as calling people patients rather than inmates.\u003c/p>\n\u003cp>“We can figure out the logistics and we can figure out the resources, but shifting the way people think and act is going to be our biggest challenge,” she said. Hiring new doctors who believe in the mission of health care behind bars will help, she added.\u003c/p>\n\u003cp>Among some inmates, attitudes about their own health are already beginning to shift.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Callahan said he’s determined to stay sober and continue monitoring his health when he gets out. “I’m 43 years old and that’s not the age to be screwing around with diabetes,” he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Michael Callahan, an outgoing 43-year-old carpenter, landed in a Los Angeles County jail last September because of what he said were “bad decisions and selling drugs.”\u003c/p>\n\u003cp>He had uncontrolled diabetes and high blood pressure when he arrived, but his health was the last thing on his mind. Consumed by a meth addiction, he hadn’t taken his medications for months. “When I got here, I was a wreck,” said Callahan, who is stocky and covered in tattoos. “My legs were so swollen that if I bumped them they would break open.”\u003c/p>\n\u003cp>By January, however, his diabetes was improving and his blood pressure had dropped. Now, he takes his medications daily and sees a doctor every two months. Even as he counts the days until his release this summer, Callahan knows he is getting much-needed medical care. “I’m where I need to be, not where I want to be,” he said.\u003c/p>\n\u003cp>Callahan’s situation is counterintuitive: He may end up leaving jail healthier than when he arrived. Officials at the Los Angeles County Department of Health Services hope to see more cases like his as they embark on an ambitious effort to improve health care for jail inmates. Their project follows decades of complaints, lawsuits and reports of poor medical and mental health care at the Los Angeles County jails, which house about 18,000 inmates on any given day.\u003c/p>\n\u003cp>The county’s overhaul is designed to raise the quality of health care behind bars and better equip inmates to manage their health after they are released. But the challenges are enormous – the population is disproportionately sick, and the jails weren’t designed to be medical facilities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The innovative effort at one of the nation’s biggest jail systems is based on a logical premise: Inmates don’t stay in jail for long – the average stay is just 60 days – so it’s a crucial opportunity to diagnose and begin treating their diseases.\u003c/p>\n\u003cp>“People are there for just a blip in time, days, weeks, months … and they’re returning back to the community,” said Mark Ghaly, director of community health for the county Department of Health Services. “What happens in the jail matters.”\u003c/p>\n\u003cp>The county health agency took over medical care in the jails from the LA County Sheriff’s Department in 2015 and started revamping the system in earnest last year.\u003c/p>\n\u003cfigure id=\"attachment_362814\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362814\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg\" alt=\"The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-1_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The health clinic at a Los Angeles County jail on January 17, 2018. Inmates wait on a bench to get medications or see medical providers. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The main health clinic at the Men’s Central Jail in downtown Los Angeles is located just inside a large metal gate. Inmates there and at all the LA county jails can get a wide variety of medical and behavioral care. “It’s a giant health system and it’s complex,” said Margarita Pereyda, chief medical officer of correctional health services for LA County. “We are a hybrid between a hospital and an ER and an outpatient kind of environment.”\u003c/p>\n\u003cp>Part of the plan is to make clinics inside the jails more like ones on the outside. That means assigning inmates to primary care doctors to manage their chronic diseases and getting them appointments and medications quickly. It also means expanding treatment for mental health and substance abuse and referring those who need advanced medical or behavioral care to specialists who work for the county.\u003c/p>\n\u003cp>It’s a monumental job: Nearly half of all inmates have at least one chronic disease, including about 450 who have HIV and 900 with diabetes. About two-thirds of inmates are addicted to drugs or alcohol, and about a quarter have serious mental illnesses.\u003c/p>\n\u003cp>“Very few people have chronic illness under good control,” Ghaly said. ”The jails have largely become treatment facilities.”\u003c/p>\n\u003cp>To improve inmates’ access to care, county officials launched a physician recruitment effort this month. They released a series of online videos featuring medical providers with the slogan “\u003ca href=\"https://missionpossible.lacounty.gov/\" target=\"_blank\" rel=\"noopener\">Mission Possible\u003c/a>.” As an incentive, they are offering to pay up to $120,000 in medical school debt for each of the new hires who need it. That strategy has been used to lure doctors to low-income communities around the United States.\u003c/p>\n\u003cp>Esther Lim, who directs the jails project at the American Civil Liberties Union of Southern California, said she is optimistic care will improve, but she still hears daily from inmates about delays in appointments and medications. And, she said, people are still dying inside the LA County jails – an average of 25 each year, according to the health department.\u003c/p>\n\u003cp>“It’s an indication that there is something wrong, that the delivery of medical care is still poor,” Lim said. Overcrowding can result in inmates’ health being neglected and deteriorating over time, she said. County health officials acknowledge the situation is not going to change overnight. The county is “making some great headway,” but “there are some things that you can change more quickly than others,” said Ed Matzen, clinical nursing director for the jails.\u003c/p>\n\u003cfigure id=\"attachment_362816\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362816\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg\" alt=\"Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-800x534.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-160x107.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-768x513.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1020x681.jpeg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-1180x788.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-960x641.jpeg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-240x160.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-375x250.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/jail-health-17_preview-520x347.jpeg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Public health nurse Martha Tadesse speaks with a patient at a Los Angeles County jail on January 17, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lello Tesema, a primary care physician and director of population health for the county jails, said many of her patients have gone without care on the outside for a long time. As soon as she gets a new patient, Tesema takes a medical and personal history. Then she creates a plan with the patient, knowing she only has a limited amount of time to implement it.\u003c/p>\n\u003cp>One early morning in January, Tesema examined Callahan, the carpenter, on an exam table in a room just off a busy corridor around the corner from his dorm-style cell. She said the swelling in his legs had diminished and his blood sugar level was looking good. “We’re moving in the right direction,” she told him. On the way back to his bunk, Callahan stopped at a window to pick up a pill for his diabetes.\u003c/p>\n\u003cp>Tesema said she worries about the health of her patients after they get out of jail even though they leave with a referral to a county clinic and 30 days’ worth of medication – up from three days in the past. “Often I see patients come back and a lot of the successes that happened while they were here end up diminishing after they leave,” she said.\u003c/p>\n\u003cp>Tesema and other medical providers in the jail must manage the inherent tension between safety and medical care. Sometimes, doctors have to see patients in their cells or treat them when they are handcuffed, Tesema said.\u003c/p>\n\u003cp>Jason Wolak, a captain in the medical services bureau of the Sheriff’s Department, said deputies are making an effort to get more inmates to medical appointments. “We’re the Uber for medical,” he said. He added that the Sheriff’s Department needs more staff, especially for transporting inmates to outside specialists or to the county-run hospitals.\u003c/p>\n\u003cp>Since patients also are going to court, attending classes or meeting with their lawyers, scheduling medical visits can be a challenge, Ghaly said. “There’s a high no-show rate to appointments.”\u003c/p>\n\u003cp>Pereyda said the new system for providing care at the jails depends on current doctors changing their mindset – things as simple as calling people patients rather than inmates.\u003c/p>\n\u003cp>“We can figure out the logistics and we can figure out the resources, but shifting the way people think and act is going to be our biggest challenge,” she said. Hiring new doctors who believe in the mission of health care behind bars will help, she added.\u003c/p>\n\u003cp>Among some inmates, attitudes about their own health are already beginning to shift.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Callahan said he’s determined to stay sober and continue monitoring his health when he gets out. “I’m 43 years old and that’s not the age to be screwing around with diabetes,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Nurses Warn That Losing Supreme Court Case Could Gut Unions",
"title": "California Nurses Warn That Losing Supreme Court Case Could Gut Unions",
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"content": "\u003cp>Nurses protested outside \u003ca href=\"https://www.smchealth.org/san-mateo-medical-center\" target=\"_blank\" rel=\"noopener\">San Mateo Medical Center\u003c/a> in front of a sign that read “Patient safety comes from union strength\" last week. They wore the characteristic bright red shirts of their own union: the \u003ca href=\"https://www.nationalnursesunited.org/california-nurses-association\" target=\"_blank\" rel=\"noopener\">California Nurses Association (CNA)\u003c/a>.\u003c/p>\n\u003cp>They were calling attention to the U.S. Supreme Court case \u003ca style=\"color: #41a62a\" href=\"https://ww2.kqed.org/forum/2018/02/20/u-s-supreme-court-hearing-on-union-dues-has-california-labor-leaders-on-edge/\" target=\"_blank\" rel=\"noopener\">Janus vs. American Federation of State, County and Municipal Employees.\u003c/a> The outcome of the case could dramatically weaken public sector unions if the court overturns a rule that requires non-union employees at union-affiliated workplaces to pay \"fair share\" fees.\u003c/p>\n\u003cp>Public sector employees who are not union members are required to pay these fees because the union's collective bargaining is meant to benefit all employees equally, whether they're full-fledged union members or not. Opponents of this rule say mandatory union fees violate First Amendment rights.\u003c/p>\n\u003cp>In addition to San Mateo Medical Center, nurses demonstrated at six other hospitals around the state to advocate for the preservation of the current union rule.\u003c/p>\n\u003cp>Margarita Harrington is a nurse with the \u003ca href=\"https://www.smchealth.org/\" target=\"_blank\" rel=\"noopener\">San Mateo County Health System\u003c/a>. She thinks that if people do not have to pay \"fair share\" fees, they probably won't. And that will squeeze unions like hers, despite CNA's 86,000-person member base.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"If suddenly people just stop paying dues, then how will the union be able to sustain itself?\" Harrington asked. \"It’s sort of like they’re gonna starve the union. And then it eventually impacts us.\"\u003c/p>\n\u003cp>Harrington said having the union behind her has helped her bring up concerns with hospital management in her 22 years with the San Mateo County Health System. She said stronger unions keep patients safer because nurses can bring up problems in hospitals without fear of retaliation. For example, unions set limits on nurses' workloads and work hours. Without those, nurses could be unable to adequately attend to patients.\u003c/p>\n\u003cp>The Supreme Court heard a similar case in 2016: \u003ca href=\"https://ww2.kqed.org/forum/2016/01/12/supreme-court-justices-skeptical-of-union-arguments-in-friedrichs-v-california-teachers-association/\" target=\"_blank\" rel=\"noopener\">Friedrichs v. California Teachers Association.\u003c/a>\u003c/p>\n\u003cp>The lead plaintiff was an elementary school teacher based in Orange County. When Justice Antonin Scalia died in February 2016, however, the case ended in a tie, so nothing changed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Oral arguments begin in the Supreme Court on Monday. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nurses protested outside \u003ca href=\"https://www.smchealth.org/san-mateo-medical-center\" target=\"_blank\" rel=\"noopener\">San Mateo Medical Center\u003c/a> in front of a sign that read “Patient safety comes from union strength\" last week. They wore the characteristic bright red shirts of their own union: the \u003ca href=\"https://www.nationalnursesunited.org/california-nurses-association\" target=\"_blank\" rel=\"noopener\">California Nurses Association (CNA)\u003c/a>.\u003c/p>\n\u003cp>They were calling attention to the U.S. Supreme Court case \u003ca style=\"color: #41a62a\" href=\"https://ww2.kqed.org/forum/2018/02/20/u-s-supreme-court-hearing-on-union-dues-has-california-labor-leaders-on-edge/\" target=\"_blank\" rel=\"noopener\">Janus vs. American Federation of State, County and Municipal Employees.\u003c/a> The outcome of the case could dramatically weaken public sector unions if the court overturns a rule that requires non-union employees at union-affiliated workplaces to pay \"fair share\" fees.\u003c/p>\n\u003cp>Public sector employees who are not union members are required to pay these fees because the union's collective bargaining is meant to benefit all employees equally, whether they're full-fledged union members or not. Opponents of this rule say mandatory union fees violate First Amendment rights.\u003c/p>\n\u003cp>In addition to San Mateo Medical Center, nurses demonstrated at six other hospitals around the state to advocate for the preservation of the current union rule.\u003c/p>\n\u003cp>Margarita Harrington is a nurse with the \u003ca href=\"https://www.smchealth.org/\" target=\"_blank\" rel=\"noopener\">San Mateo County Health System\u003c/a>. She thinks that if people do not have to pay \"fair share\" fees, they probably won't. And that will squeeze unions like hers, despite CNA's 86,000-person member base.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"If suddenly people just stop paying dues, then how will the union be able to sustain itself?\" Harrington asked. \"It’s sort of like they’re gonna starve the union. And then it eventually impacts us.\"\u003c/p>\n\u003cp>Harrington said having the union behind her has helped her bring up concerns with hospital management in her 22 years with the San Mateo County Health System. She said stronger unions keep patients safer because nurses can bring up problems in hospitals without fear of retaliation. For example, unions set limits on nurses' workloads and work hours. Without those, nurses could be unable to adequately attend to patients.\u003c/p>\n\u003cp>The Supreme Court heard a similar case in 2016: \u003ca href=\"https://ww2.kqed.org/forum/2016/01/12/supreme-court-justices-skeptical-of-union-arguments-in-friedrichs-v-california-teachers-association/\" target=\"_blank\" rel=\"noopener\">Friedrichs v. California Teachers Association.\u003c/a>\u003c/p>\n\u003cp>The lead plaintiff was an elementary school teacher based in Orange County. When Justice Antonin Scalia died in February 2016, however, the case ended in a tie, so nothing changed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Oral arguments begin in the Supreme Court on Monday. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Now That Pot Is Legal, Should You Worry About Secondhand Smoke? California Scientist Says Yes",
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"content": "\u003cp>Commercial sales of cannabis to recreational users began Jan. 1 in California. It hasn't been even two months in this brave new world, but new questions about marijuana's health impacts are already popping up. Is smoking cannabis bad for your health? If so, how bad? And are we talking physically or mentally? What about secondhand smoke?\u003c/p>\n\u003cp>One scientist at University of California San Francisco decided to tackle that last question after attending a Paul McCartney concert a few years ago.\u003c/p>\n\u003cp>Matthew Springer doesn't remember what song the former Beatle was playing when he had a research epiphany, but he does remember that it happened when dozens of fans decided it was that time during the concert when it might be good to \"toke up.\"\u003c/p>\n\u003cp>A visible haze of pot smoke rose above the audience.\u003c/p>\n\u003cp>\"People in front of me started lighting up and then other people started lighting up. And for a few naive split seconds I was thinking to myself, 'Hey, they can't smoke in the AT&T Park! I'm sure that's not allowed.' And then I realized that it was all marijuana.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Paul McCartney actually stopped between numbers and sniffed the air and said, ‘There's something in the air — must be San Francisco!’ ” he recalled.\u003c/p>\n\u003cp>And that’s when Springer started thinking: San Franciscans would \u003cem>never \u003c/em>tolerate those levels of cigarette smoke anymore. So why were they OK with pot smoke? Did people just assume that cannabis smoke isn’t harmful the way tobacco smoke is?\u003c/p>\n\u003cp>Like any good scientist, he wondered: Is that true? Or is secondhand smoke from cannabis bad for us?\u003c/p>\n\u003cp>While anyone might have been able to ask these questions, Dr. Springer is one of the few people in the world who could actually answer them.\u003c/p>\n\u003cp>He’s a pre-eminent researcher on the \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm\" target=\"_blank\" rel=\"noopener\">health effects of secondhand tobacco smoke\u003c/a>. He was already running tests on rats, using cigarettes, at \u003ca href=\"http://cardiolab.ucsf.edu/molcardiolab/lab.html\" target=\"_blank\" rel=\"noopener\">his lab\u003c/a> at UCSF. Maybe he could run the same tests using joints.\u003c/p>\n\u003cp>“By the time I left the concert, I was resolved to at least try to make this happen,” he said.\u003c/p>\n\u003cp>He knew it wouldn’t be easy. Because pot is still illegal under federal law, and Springer's research uses federal funds, he can’t just stroll down the hill and buy some from a dispensary, or from someone in Golden Gate Park. He has to purchase specially approved government cannabis and he can’t test on humans; hence, the rats.\u003c/p>\n\u003cp>In the lab, Springer puts a cigarette or joint in a plexiglass box. Then he lights it, and the chamber fills with smoke. An anesthetized rat, laying with its head sticking just inside the chamber, is exposed to the smoke.\u003c/p>\n\u003cp>(If you’re wondering if the rodents ever get stoned, Springer said he doesn’t know, and anyway, they're asleep.)\u003c/p>\n\u003cp>So far, Springer and his colleagues have published research demonstrating that secondhand smoke makes it harder for the rats’ arteries to expand and allow a healthy flow of blood.\u003c/p>\n\u003cp>With tobacco products, this effect lasts about 30 minutes, and then the arteries recover their normal function. But if it happens over and over, because a person is smoking cigarette after cigarette, the arterial walls can become permanently damaged, and that damage can cause blood clots, heart attack or stroke.\u003c/p>\n\u003cp>Springer demonstrated that the exact same physiological effect occurs after inhaling secondhand smoke from marijuana. Not only that, the arteries take 90 minutes to recover -- \u003cem>three times as long\u003c/em>, compared to the 30 minutes with cigarette smoke.\u003c/p>\n\u003cp>Springer's discovery describes just one harmful impact for non-smokers exposed to marijuana smoke. Statewide sampling surveys of cannabis products sold in marijuana dispensaries have shown that cannabis products may contain \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article131391629.html\" target=\"_blank\" rel=\"noopener\">dangerous bacteria or mold\u003c/a>, or residues from \u003ca href=\"http://www.montereyherald.com/article/NF/20170926/NEWS/170929857\" target=\"_blank\" rel=\"noopener\">pesticides and solvents\u003c/a>.\u003c/p>\n\u003cp>California law does requires testing for these contaminants, but the regulations are being rolled out in \u003ca href=\"http://bcc.ca.gov/about_us/documents/17-261_required_testing_chart.pdf\" target=\"_blank\" rel=\"noopener\">three phases\u003c/a> over the course of 2018. And since much of the marijuana being sold now was harvested last fall, consumers will have to wait until early 2019 before they can purchase products that have been fully tested according to state standards.\u003c/p>\n\u003cp>“People think cannabis is fine because it's 'natural,' ” Springer said. “I hear this a lot. I don't know what it means.” He concedes that tightly regulated marijuana, which has been fully tested, doesn’t have as many chemical additives as cigarettes.\u003c/p>\n\u003cp>But even if the cannabis tests clean, you’re still inhaling smoke, Spring emphasized, and smoke itself is bad for your lungs, heart and blood vessels. And that's just cardiovascular effects -- other researchers are still exploring the relationship between marijuana smoke and long-term cancer risk.\u003c/p>\n\u003cp>“People should think of this not as an anti-THC conclusion, but an anti-smoke conclusion,” Springer said.\u003c/p>\n\u003cp>So is the solution simply to avoid smoke from combustion \u003cem>per se\u003c/em>, by eating cannabis-infused products, or using \"smokeless\" e-cigarette or vaping devices?\u003c/p>\n\u003cp>Springer still urges caution, because vaping can have its own health effects. Even though vaping devices don’t produce smoke from combustion, they do release a cloud of aerosolized chemicals. Springer is studying the health effects of those chemicals, too.\u003c/p>\n\u003cp>All this research takes time. Meanwhile, Springer worries that people might come to the wrong conclusion, that \"no news is good news.\"\u003c/p>\n\u003cp>“We in the public health community have been telling them for decades to avoid inhaling secondhand smoke from tobacco,” Springer says. “We have not been telling them to avoid inhaling secondhand smoke for marijuana, and that's not because it's not bad for you, it's because we just haven't known. The experiments haven't been done.”\u003c/p>\n\u003cp>Anti-smoking campaigners say we can’t afford to wait until the research is complete. Recreational pot is already a reality.\u003c/p>\n\u003cp>Cynthia Hallett is the president of \u003ca href=\"http://Americans%20for%20Nonsmokers%20Rights\" target=\"_blank\" rel=\"noopener\">Americans for Nonsmokers' Rights\u003c/a>, based in Berkeley. The organization was established in 1976, before there was a lot known about the health effects of secondhand smoke from tobacco.\u003c/p>\n\u003cp>Now that cannabis is becoming more common across the country, her organization is taking it on.\u003c/p>\n\u003cp>Hallett said some of the arguments being made in support of cannabis remind her of the arguments made on behalf of tobacco decades ago.\u003c/p>\n\u003cp>“I'm seeing a parallel between this argument that, ‘Gee, we just don't have a lot of science and so therefore let's wait and see,’ ” Hallett told me. “The tobacco companies used to say the same thing about tobacco cigarettes.”\u003c/p>\n\u003cp>In California, you are prohibited from smoking cannabis anywhere where you’re not allowed to smoke tobacco -- that includes schools, airplanes and most workplaces. But Hallett is worried that the legalization of pot could be used to erode those rules.\u003c/p>\n\u003cp>“It starts on the premise of decriminalization,” she said, and then over time there’s “a chipping away at strong policies.”\u003c/p>\n\u003cp>A lot of cannabis advocates want to see pot regulated like alcohol. They want cities to issue permits for specialized smoking lounges, similar to wine bars.\u003c/p>\n\u003cp>But Hallett pointed out that smoke drifts and affects workers in a way that alcohol doesn’t.\u003c/p>\n\u003cp>\"The difference is, if I were to spill my beer on you in a bar, it wouldn’t affect your long-term health. If I choose to smoke, it can affect the health of the person near me.\"\u003c/p>\n\u003cp>Pot is more like tobacco in that respect — and Hallett said it should be regulated that way, at all times.\u003c/p>\n\u003cp>Hallett believes many pot smokers are still in denial -- after fighting so hard for legalization, it’s hard to admit there are potential harms. She said this time in California culture brings to mind a similar time in the 1970s and '80s, when Americans started demanding more regulations for secondhand smoke, and a new etiquette around smoking took form.\u003c/p>\n\u003cp>When it comes to marijuana, Hallett said, “it is \u003cem>still\u003c/em> polite for you to say: ‘Would you mind not smoking around me?' \"\u003c/p>\n\u003cp>At \u003ca href=\"http://www.magnoliawellness.org/menu\" target=\"_blank\" rel=\"noopener\">Magnolia\u003c/a>, a cannabis dispensary in Oakland, a reporter asked some regular pot smokers about what responsibilities -- if any -- they should have when it came to nearby nonsmokers.\u003c/p>\n\u003cp>“This is the first time that I have heard secondhand smoke in reference to cannabis,” admitted Lee Crow, a patient-services clerk at Magnolia. “I’ve tried to be courteous, just common courtesy like with anything.”\u003c/p>\n\u003cp>That was the case for most of the people I talked to at Magnolia. Even the dispensary’s director of clinical services, Barbara Blaser, admits she thinks a lot about secondhand smoke from cigarettes, but not pot.\u003c/p>\n\u003cp>“Both of my parents died of lung cancer!” she said. “I will stop a stranger and say, 'You shouldn’t be smoking. My dad died of that!' ”\u003c/p>\n\u003cp>But Blaser, like many cannabis consumers, hasn't really started thinking about the health impacts of cannabis smoke -- much less its secondhand smoke -- in quite the same way.\u003c/p>\n\u003cp>Proposition 64 calls for some of the state tax revenue from the sale of pot to be distributed to cannabis researchers. In addition, the state Occupational Safety and Health Standards Board is examining workplace hazards that are specific to the cannabis industry.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Californians might have already legalized pot, but have only just begun to explore the science behind the smoke and to create a new etiquette for how to handle it. \u003c/span>\u003c/p>\n\u003cp>\u003cem>Additional reporting by KQED Health Editor Carrie Feibel. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>A version of this story first aired on \u003ca href=\"http://kalw.org/programs/crosscurrents\" target=\"_blank\" rel=\"noopener\">KALW’s Crosscurrents.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Commercial sales of cannabis to recreational users began Jan. 1 in California. It hasn't been even two months in this brave new world, but new questions about marijuana's health impacts are already popping up. Is smoking cannabis bad for your health? If so, how bad? And are we talking physically or mentally? What about secondhand smoke?\u003c/p>\n\u003cp>One scientist at University of California San Francisco decided to tackle that last question after attending a Paul McCartney concert a few years ago.\u003c/p>\n\u003cp>Matthew Springer doesn't remember what song the former Beatle was playing when he had a research epiphany, but he does remember that it happened when dozens of fans decided it was that time during the concert when it might be good to \"toke up.\"\u003c/p>\n\u003cp>A visible haze of pot smoke rose above the audience.\u003c/p>\n\u003cp>\"People in front of me started lighting up and then other people started lighting up. And for a few naive split seconds I was thinking to myself, 'Hey, they can't smoke in the AT&T Park! I'm sure that's not allowed.' And then I realized that it was all marijuana.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Paul McCartney actually stopped between numbers and sniffed the air and said, ‘There's something in the air — must be San Francisco!’ ” he recalled.\u003c/p>\n\u003cp>And that’s when Springer started thinking: San Franciscans would \u003cem>never \u003c/em>tolerate those levels of cigarette smoke anymore. So why were they OK with pot smoke? Did people just assume that cannabis smoke isn’t harmful the way tobacco smoke is?\u003c/p>\n\u003cp>Like any good scientist, he wondered: Is that true? Or is secondhand smoke from cannabis bad for us?\u003c/p>\n\u003cp>While anyone might have been able to ask these questions, Dr. Springer is one of the few people in the world who could actually answer them.\u003c/p>\n\u003cp>He’s a pre-eminent researcher on the \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm\" target=\"_blank\" rel=\"noopener\">health effects of secondhand tobacco smoke\u003c/a>. He was already running tests on rats, using cigarettes, at \u003ca href=\"http://cardiolab.ucsf.edu/molcardiolab/lab.html\" target=\"_blank\" rel=\"noopener\">his lab\u003c/a> at UCSF. Maybe he could run the same tests using joints.\u003c/p>\n\u003cp>“By the time I left the concert, I was resolved to at least try to make this happen,” he said.\u003c/p>\n\u003cp>He knew it wouldn’t be easy. Because pot is still illegal under federal law, and Springer's research uses federal funds, he can’t just stroll down the hill and buy some from a dispensary, or from someone in Golden Gate Park. He has to purchase specially approved government cannabis and he can’t test on humans; hence, the rats.\u003c/p>\n\u003cp>In the lab, Springer puts a cigarette or joint in a plexiglass box. Then he lights it, and the chamber fills with smoke. An anesthetized rat, laying with its head sticking just inside the chamber, is exposed to the smoke.\u003c/p>\n\u003cp>(If you’re wondering if the rodents ever get stoned, Springer said he doesn’t know, and anyway, they're asleep.)\u003c/p>\n\u003cp>So far, Springer and his colleagues have published research demonstrating that secondhand smoke makes it harder for the rats’ arteries to expand and allow a healthy flow of blood.\u003c/p>\n\u003cp>With tobacco products, this effect lasts about 30 minutes, and then the arteries recover their normal function. But if it happens over and over, because a person is smoking cigarette after cigarette, the arterial walls can become permanently damaged, and that damage can cause blood clots, heart attack or stroke.\u003c/p>\n\u003cp>Springer demonstrated that the exact same physiological effect occurs after inhaling secondhand smoke from marijuana. Not only that, the arteries take 90 minutes to recover -- \u003cem>three times as long\u003c/em>, compared to the 30 minutes with cigarette smoke.\u003c/p>\n\u003cp>Springer's discovery describes just one harmful impact for non-smokers exposed to marijuana smoke. Statewide sampling surveys of cannabis products sold in marijuana dispensaries have shown that cannabis products may contain \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article131391629.html\" target=\"_blank\" rel=\"noopener\">dangerous bacteria or mold\u003c/a>, or residues from \u003ca href=\"http://www.montereyherald.com/article/NF/20170926/NEWS/170929857\" target=\"_blank\" rel=\"noopener\">pesticides and solvents\u003c/a>.\u003c/p>\n\u003cp>California law does requires testing for these contaminants, but the regulations are being rolled out in \u003ca href=\"http://bcc.ca.gov/about_us/documents/17-261_required_testing_chart.pdf\" target=\"_blank\" rel=\"noopener\">three phases\u003c/a> over the course of 2018. And since much of the marijuana being sold now was harvested last fall, consumers will have to wait until early 2019 before they can purchase products that have been fully tested according to state standards.\u003c/p>\n\u003cp>“People think cannabis is fine because it's 'natural,' ” Springer said. “I hear this a lot. I don't know what it means.” He concedes that tightly regulated marijuana, which has been fully tested, doesn’t have as many chemical additives as cigarettes.\u003c/p>\n\u003cp>But even if the cannabis tests clean, you’re still inhaling smoke, Spring emphasized, and smoke itself is bad for your lungs, heart and blood vessels. And that's just cardiovascular effects -- other researchers are still exploring the relationship between marijuana smoke and long-term cancer risk.\u003c/p>\n\u003cp>“People should think of this not as an anti-THC conclusion, but an anti-smoke conclusion,” Springer said.\u003c/p>\n\u003cp>So is the solution simply to avoid smoke from combustion \u003cem>per se\u003c/em>, by eating cannabis-infused products, or using \"smokeless\" e-cigarette or vaping devices?\u003c/p>\n\u003cp>Springer still urges caution, because vaping can have its own health effects. Even though vaping devices don’t produce smoke from combustion, they do release a cloud of aerosolized chemicals. Springer is studying the health effects of those chemicals, too.\u003c/p>\n\u003cp>All this research takes time. Meanwhile, Springer worries that people might come to the wrong conclusion, that \"no news is good news.\"\u003c/p>\n\u003cp>“We in the public health community have been telling them for decades to avoid inhaling secondhand smoke from tobacco,” Springer says. “We have not been telling them to avoid inhaling secondhand smoke for marijuana, and that's not because it's not bad for you, it's because we just haven't known. The experiments haven't been done.”\u003c/p>\n\u003cp>Anti-smoking campaigners say we can’t afford to wait until the research is complete. Recreational pot is already a reality.\u003c/p>\n\u003cp>Cynthia Hallett is the president of \u003ca href=\"http://Americans%20for%20Nonsmokers%20Rights\" target=\"_blank\" rel=\"noopener\">Americans for Nonsmokers' Rights\u003c/a>, based in Berkeley. The organization was established in 1976, before there was a lot known about the health effects of secondhand smoke from tobacco.\u003c/p>\n\u003cp>Now that cannabis is becoming more common across the country, her organization is taking it on.\u003c/p>\n\u003cp>Hallett said some of the arguments being made in support of cannabis remind her of the arguments made on behalf of tobacco decades ago.\u003c/p>\n\u003cp>“I'm seeing a parallel between this argument that, ‘Gee, we just don't have a lot of science and so therefore let's wait and see,’ ” Hallett told me. “The tobacco companies used to say the same thing about tobacco cigarettes.”\u003c/p>\n\u003cp>In California, you are prohibited from smoking cannabis anywhere where you’re not allowed to smoke tobacco -- that includes schools, airplanes and most workplaces. But Hallett is worried that the legalization of pot could be used to erode those rules.\u003c/p>\n\u003cp>“It starts on the premise of decriminalization,” she said, and then over time there’s “a chipping away at strong policies.”\u003c/p>\n\u003cp>A lot of cannabis advocates want to see pot regulated like alcohol. They want cities to issue permits for specialized smoking lounges, similar to wine bars.\u003c/p>\n\u003cp>But Hallett pointed out that smoke drifts and affects workers in a way that alcohol doesn’t.\u003c/p>\n\u003cp>\"The difference is, if I were to spill my beer on you in a bar, it wouldn’t affect your long-term health. If I choose to smoke, it can affect the health of the person near me.\"\u003c/p>\n\u003cp>Pot is more like tobacco in that respect — and Hallett said it should be regulated that way, at all times.\u003c/p>\n\u003cp>Hallett believes many pot smokers are still in denial -- after fighting so hard for legalization, it’s hard to admit there are potential harms. She said this time in California culture brings to mind a similar time in the 1970s and '80s, when Americans started demanding more regulations for secondhand smoke, and a new etiquette around smoking took form.\u003c/p>\n\u003cp>When it comes to marijuana, Hallett said, “it is \u003cem>still\u003c/em> polite for you to say: ‘Would you mind not smoking around me?' \"\u003c/p>\n\u003cp>At \u003ca href=\"http://www.magnoliawellness.org/menu\" target=\"_blank\" rel=\"noopener\">Magnolia\u003c/a>, a cannabis dispensary in Oakland, a reporter asked some regular pot smokers about what responsibilities -- if any -- they should have when it came to nearby nonsmokers.\u003c/p>\n\u003cp>“This is the first time that I have heard secondhand smoke in reference to cannabis,” admitted Lee Crow, a patient-services clerk at Magnolia. “I’ve tried to be courteous, just common courtesy like with anything.”\u003c/p>\n\u003cp>That was the case for most of the people I talked to at Magnolia. Even the dispensary’s director of clinical services, Barbara Blaser, admits she thinks a lot about secondhand smoke from cigarettes, but not pot.\u003c/p>\n\u003cp>“Both of my parents died of lung cancer!” she said. “I will stop a stranger and say, 'You shouldn’t be smoking. My dad died of that!' ”\u003c/p>\n\u003cp>But Blaser, like many cannabis consumers, hasn't really started thinking about the health impacts of cannabis smoke -- much less its secondhand smoke -- in quite the same way.\u003c/p>\n\u003cp>Proposition 64 calls for some of the state tax revenue from the sale of pot to be distributed to cannabis researchers. In addition, the state Occupational Safety and Health Standards Board is examining workplace hazards that are specific to the cannabis industry.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Californians might have already legalized pot, but have only just begun to explore the science behind the smoke and to create a new etiquette for how to handle it. \u003c/span>\u003c/p>\n\u003cp>\u003cem>Additional reporting by KQED Health Editor Carrie Feibel. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>A version of this story first aired on \u003ca href=\"http://kalw.org/programs/crosscurrents\" target=\"_blank\" rel=\"noopener\">KALW’s Crosscurrents.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "After Mass Shootings, This Training Can Save Lives",
"title": "After Mass Shootings, This Training Can Save Lives",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Nurse practitioner Tina Quon clicked through a gory slideshow with images of wounds and squirting blood. She paused, looking to her roughly 25 trainees at Oakland's \u003ca href=\"http://www.alamedahealthsystem.org/\" target=\"_blank\" rel=\"noopener\">Highland Hospital\u003c/a>. She asked for ideas about what to use as a makeshift tourniquet.\u003c/p>\n\u003cp>Someone called out, \"a belt!\" Another voice said, \"shoe strings!\"\u003c/p>\n\u003cp>In her mint-green scrubs and bright blue sneakers, Quon nodded her head in approval. She moved on, getting into the specifics and techniques for how to use tourniquets correctly and how to apply pressure to serious wounds.\u003c/p>\n\u003cp>\u003ca href=\"https://www.bleedingcontrol.org/\" target=\"_blank\" rel=\"noopener\">Stop the Bleed \u003c/a>began as part of a federally supported effort to teach civilian bystanders critical medical skills they can use during a shooting or other disasters. The idea is that bystanders can save lives by preventing victims from bleeding to death. That can happen in minutes, long before the ambulance arrives and even before someone has the chance to call 911.\u003c/p>\n\u003cp>Stop the Bleed started in 2013, in response to the December 2012 Sandy Hook school shooting. The \u003ca href=\"https://www.facs.org/\" target=\"_blank\" rel=\"noopener\">American College of Surgeons\u003c/a>, working closely with federal agencies, developed a simple, step-by-step training focused on hemorrhage control. The goal is to make the techniques as accessible and widespread as basic first aid, CPR, or the Heimlich maneuver.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"With all these mass casualties,\" Quon said, \"there were a lot of people that had extremity injuries who could have had their lives saved or had their limbs saved by having a tourniquet placed.\"\u003c/p>\n\u003cfigure id=\"attachment_362710\" class=\"wp-caption alignright\" style=\"max-width: 687px\">\u003cimg class=\"wp-image-362710 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/STB.jpg\" alt='An archived page on the Department of Homeland Security website displays an informational \"Stop the Bleed\" flier.' width=\"687\" height=\"857\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB.jpg 687w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-160x200.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-240x299.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-375x468.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-520x649.jpg 520w\" sizes=\"(max-width: 687px) 100vw, 687px\">\u003cfigcaption class=\"wp-caption-text\">An archived page on the Department of Homeland Security website displays an informational Stop the Bleed flier. \u003ccite>(Department of Homeland Security)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Obama administration furthered these initiatives by launching a \u003ca href=\"https://www.dhs.gov/stopthebleed\" target=\"_blank\" rel=\"noopener\">Stop the Bleed\u003c/a> campaign in 2015, then under the Department of Homeland Security.\u003c/p>\n\u003cp>At Highland Hospital, where Quon works in trauma surgery, the nurse has led this training many times for staff. But this class, held at the end of January, was the first offered to members of the public. This workshop helps the hospital do community outreach around the subject of trauma prevention -- something that is required of Level 1 trauma centers like Highland. Level 1 centers offer the highest level of lifesaving trauma treatment.\u003c/p>\n\u003cp>After Quon's presentation, class members practiced applying pressure to mannequin legs, and lightly twisted tourniquets on each other's arms.\u003c/p>\n\u003cp>Kevin Grant, along with some of the other attendees, works for \u003ca href=\"http://oaklandunite.org/\" target=\"_blank\" rel=\"noopener\">Oakland Unite\u003c/a>, an organization with the goal of interrupting and preventing violence in the city. While Grant hasn’t seen a mass shooting, he said he has seen more than his share of individual homicides in Oakland.\u003c/p>\n\u003cp>\"Oakland has a steady drumbeat of violence that will match the Vegas shooting in a year,\" Grant said.\u003c/p>\n\u003cp>For more than a decade, Grant has responded to Oakland shootings by racing to the scene. One of his goals is to de-escalate any retaliatory violence that could happen. When he arrives, he often finds a victim.\u003c/p>\n\u003cp>He recalled one incident in East Oakland, when he knelt on the pavement next to a young man who was shot in the legs.\u003c/p>\n\u003cp>\"One of the last things he said to me is, 'Kev, don't let me die,' \" Grant remembered. \"I said 'I got you. Stay woke.' I didn't have training on that.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That young man survived, but Grant knows many others who did not. After the Stop the Bleed training, Grant said he feels like there’s more he can do to save a person, and not just comfort them.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nurse practitioner Tina Quon clicked through a gory slideshow with images of wounds and squirting blood. She paused, looking to her roughly 25 trainees at Oakland's \u003ca href=\"http://www.alamedahealthsystem.org/\" target=\"_blank\" rel=\"noopener\">Highland Hospital\u003c/a>. She asked for ideas about what to use as a makeshift tourniquet.\u003c/p>\n\u003cp>Someone called out, \"a belt!\" Another voice said, \"shoe strings!\"\u003c/p>\n\u003cp>In her mint-green scrubs and bright blue sneakers, Quon nodded her head in approval. She moved on, getting into the specifics and techniques for how to use tourniquets correctly and how to apply pressure to serious wounds.\u003c/p>\n\u003cp>\u003ca href=\"https://www.bleedingcontrol.org/\" target=\"_blank\" rel=\"noopener\">Stop the Bleed \u003c/a>began as part of a federally supported effort to teach civilian bystanders critical medical skills they can use during a shooting or other disasters. The idea is that bystanders can save lives by preventing victims from bleeding to death. That can happen in minutes, long before the ambulance arrives and even before someone has the chance to call 911.\u003c/p>\n\u003cp>Stop the Bleed started in 2013, in response to the December 2012 Sandy Hook school shooting. The \u003ca href=\"https://www.facs.org/\" target=\"_blank\" rel=\"noopener\">American College of Surgeons\u003c/a>, working closely with federal agencies, developed a simple, step-by-step training focused on hemorrhage control. The goal is to make the techniques as accessible and widespread as basic first aid, CPR, or the Heimlich maneuver.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"With all these mass casualties,\" Quon said, \"there were a lot of people that had extremity injuries who could have had their lives saved or had their limbs saved by having a tourniquet placed.\"\u003c/p>\n\u003cfigure id=\"attachment_362710\" class=\"wp-caption alignright\" style=\"max-width: 687px\">\u003cimg class=\"wp-image-362710 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/02/STB.jpg\" alt='An archived page on the Department of Homeland Security website displays an informational \"Stop the Bleed\" flier.' width=\"687\" height=\"857\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB.jpg 687w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-160x200.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-240x299.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-375x468.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/02/STB-520x649.jpg 520w\" sizes=\"(max-width: 687px) 100vw, 687px\">\u003cfigcaption class=\"wp-caption-text\">An archived page on the Department of Homeland Security website displays an informational Stop the Bleed flier. \u003ccite>(Department of Homeland Security)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Obama administration furthered these initiatives by launching a \u003ca href=\"https://www.dhs.gov/stopthebleed\" target=\"_blank\" rel=\"noopener\">Stop the Bleed\u003c/a> campaign in 2015, then under the Department of Homeland Security.\u003c/p>\n\u003cp>At Highland Hospital, where Quon works in trauma surgery, the nurse has led this training many times for staff. But this class, held at the end of January, was the first offered to members of the public. This workshop helps the hospital do community outreach around the subject of trauma prevention -- something that is required of Level 1 trauma centers like Highland. Level 1 centers offer the highest level of lifesaving trauma treatment.\u003c/p>\n\u003cp>After Quon's presentation, class members practiced applying pressure to mannequin legs, and lightly twisted tourniquets on each other's arms.\u003c/p>\n\u003cp>Kevin Grant, along with some of the other attendees, works for \u003ca href=\"http://oaklandunite.org/\" target=\"_blank\" rel=\"noopener\">Oakland Unite\u003c/a>, an organization with the goal of interrupting and preventing violence in the city. While Grant hasn’t seen a mass shooting, he said he has seen more than his share of individual homicides in Oakland.\u003c/p>\n\u003cp>\"Oakland has a steady drumbeat of violence that will match the Vegas shooting in a year,\" Grant said.\u003c/p>\n\u003cp>For more than a decade, Grant has responded to Oakland shootings by racing to the scene. One of his goals is to de-escalate any retaliatory violence that could happen. When he arrives, he often finds a victim.\u003c/p>\n\u003cp>He recalled one incident in East Oakland, when he knelt on the pavement next to a young man who was shot in the legs.\u003c/p>\n\u003cp>\"One of the last things he said to me is, 'Kev, don't let me die,' \" Grant remembered. \"I said 'I got you. Stay woke.' I didn't have training on that.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That young man survived, but Grant knows many others who did not. After the Stop the Bleed training, Grant said he feels like there’s more he can do to save a person, and not just comfort them.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors Prepare for Possible Immigration Enforcement Visits At Hospitals",
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"content": "\u003cp>Pediatricians across California are calling on Congress to pass legislation protecting immigrants brought to the U.S. as children, saying their patients are skipping appointments because they’re afraid a visit to the hospital will get them deported.\u003c/p>\n\u003cp>Doctors and hospital administrators have started formulating protocols so that staff members will know what to do if immigration agents enter hospitals or clinics to search for, or arrest, people who are in the country illegally.\u003c/p>\n\u003cp>“We want to be prepared if agents do show up and say ‘I need to see the father of the child in Bed Four,’” said Dr. Michael Anderson, president of UCSF Benioff Children’s Hospitals in Oakland and San Francisco. “Legally, we can ask the agents to leave and say ‘This is a place where we care for kids and families. This is not a place for these sorts of interactions.’”\u003c/p>\n\u003cp>Anderson was one of about 50 doctors, and a handful of students, lawyers and politicians, including the city’s mayor, who rallied outside the Oakland hospital on Tuesday, carrying signs that read: “We Stand With Dreamers” and “You Are Welcome Here.”\u003c/p>\n\u003cp>Similar rallies were held at hospitals in San Francisco and Los Angeles, with the goal of urging national lawmakers to come up with an immigration fix by the end of the day February 8, when Congress must pass a spending bill to keep the government running. But Democrats agreed that they will not force a shutdown, as they did last month, because of \u003ca href=\"https://www.vox.com/policy-and-politics/2018/2/6/16973762/senate-democrats-daca-shutdown-february-8\" target=\"_blank\" rel=\"noopener\">a commitment from Republicans\u003c/a> to debate an immigration bill separately from the budget.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Oakland Mayor Libby Schaff criticized the aggressive tactics taken by Immigration and Customs Enforcement (ICE) under the Trump administration: “We have heard from officials that ICE is going to purposely target communities like Oakland that are standing up for our families, standing up for our valued immigrant communities. This is vindictive. It is not befitting of a democratic society.”\u003c/p>\n\u003cp>ICE did not respond to requests for comment, but the agency does have a policy against making arrests at “sensitive locations,” including hospitals, schools, or churches. There are exceptions for \"exigent circumstances,\" or when other law enforcement actions have led agents to the sensitive location.\u003c/p>\n\u003cp>For example, last October, agents in Texas \u003ca href=\"https://www.nytimes.com/2017/10/25/us/girl-cerebral-palsy-detained-immigration.html?_r=0\" target=\"_blank\" rel=\"noopener\">detained\u003c/a> an undocumented 10-year old girl with cerebral palsy at a San Antonio hospital. Border Patrol agents first encountered her when they stopped her hospital-bound ambulance at a security checkpoint. After discovering her immigration status, the agents followed the ambulance to the hospital and waited while the girl had emergency gallbladder surgery. When she was ready for medical discharge, the agents detained her and sent her to a facility for migrant children. The girl was later allowed to return to her parents in Laredo.\u003c/p>\n\u003cp>Doctors say even isolated stories like this one stoke fear in immigrant communities, making families too scared to seek medical care when they need it.\u003c/p>\n\u003cp>Children who are sick and don’t get care could become even sicker, said Anderson. They could die from a preventable or curable disease, or not get a vaccine that protects them, and the community at large, from infection.\u003c/p>\n\u003cp>California and the rest of the country are right now experiencing the worst flu season of the last decade.\u003c/p>\n\u003cp>“Our clinics and emergency departments have just been overwhelmed with the number of sick patients,” Anderson said. “If you think a child is ill, the last thing on your mind should be ‘Is it safe for me to go to that hospital?’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But hospitals only have so much power. Staff can ask immigration agents to leave - unless they have a warrant. That’s why the doctors held signs at the rally that said “You Are Welcome Here,\" because they cannot completely guarantee, “You Are Safe Here.”\u003c/p>\n\n",
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"excerpt": "At rallies in Oakland, SF and Los Angeles, health care workers call on Congress to help the \"Dreamers\" and rein in immigration enforcement",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Pediatricians across California are calling on Congress to pass legislation protecting immigrants brought to the U.S. as children, saying their patients are skipping appointments because they’re afraid a visit to the hospital will get them deported.\u003c/p>\n\u003cp>Doctors and hospital administrators have started formulating protocols so that staff members will know what to do if immigration agents enter hospitals or clinics to search for, or arrest, people who are in the country illegally.\u003c/p>\n\u003cp>“We want to be prepared if agents do show up and say ‘I need to see the father of the child in Bed Four,’” said Dr. Michael Anderson, president of UCSF Benioff Children’s Hospitals in Oakland and San Francisco. “Legally, we can ask the agents to leave and say ‘This is a place where we care for kids and families. This is not a place for these sorts of interactions.’”\u003c/p>\n\u003cp>Anderson was one of about 50 doctors, and a handful of students, lawyers and politicians, including the city’s mayor, who rallied outside the Oakland hospital on Tuesday, carrying signs that read: “We Stand With Dreamers” and “You Are Welcome Here.”\u003c/p>\n\u003cp>Similar rallies were held at hospitals in San Francisco and Los Angeles, with the goal of urging national lawmakers to come up with an immigration fix by the end of the day February 8, when Congress must pass a spending bill to keep the government running. But Democrats agreed that they will not force a shutdown, as they did last month, because of \u003ca href=\"https://www.vox.com/policy-and-politics/2018/2/6/16973762/senate-democrats-daca-shutdown-february-8\" target=\"_blank\" rel=\"noopener\">a commitment from Republicans\u003c/a> to debate an immigration bill separately from the budget.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Oakland Mayor Libby Schaff criticized the aggressive tactics taken by Immigration and Customs Enforcement (ICE) under the Trump administration: “We have heard from officials that ICE is going to purposely target communities like Oakland that are standing up for our families, standing up for our valued immigrant communities. This is vindictive. It is not befitting of a democratic society.”\u003c/p>\n\u003cp>ICE did not respond to requests for comment, but the agency does have a policy against making arrests at “sensitive locations,” including hospitals, schools, or churches. There are exceptions for \"exigent circumstances,\" or when other law enforcement actions have led agents to the sensitive location.\u003c/p>\n\u003cp>For example, last October, agents in Texas \u003ca href=\"https://www.nytimes.com/2017/10/25/us/girl-cerebral-palsy-detained-immigration.html?_r=0\" target=\"_blank\" rel=\"noopener\">detained\u003c/a> an undocumented 10-year old girl with cerebral palsy at a San Antonio hospital. Border Patrol agents first encountered her when they stopped her hospital-bound ambulance at a security checkpoint. After discovering her immigration status, the agents followed the ambulance to the hospital and waited while the girl had emergency gallbladder surgery. When she was ready for medical discharge, the agents detained her and sent her to a facility for migrant children. The girl was later allowed to return to her parents in Laredo.\u003c/p>\n\u003cp>Doctors say even isolated stories like this one stoke fear in immigrant communities, making families too scared to seek medical care when they need it.\u003c/p>\n\u003cp>Children who are sick and don’t get care could become even sicker, said Anderson. They could die from a preventable or curable disease, or not get a vaccine that protects them, and the community at large, from infection.\u003c/p>\n\u003cp>California and the rest of the country are right now experiencing the worst flu season of the last decade.\u003c/p>\n\u003cp>“Our clinics and emergency departments have just been overwhelmed with the number of sick patients,” Anderson said. “If you think a child is ill, the last thing on your mind should be ‘Is it safe for me to go to that hospital?’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But hospitals only have so much power. Staff can ask immigration agents to leave - unless they have a warrant. That’s why the doctors held signs at the rally that said “You Are Welcome Here,\" because they cannot completely guarantee, “You Are Safe Here.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Rush to Get Health Insurance for 2018, Before California Deadline",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">The open enrollment period to get insurance through \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a> closes at midnight tonight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Agents like Monica Tracht are feeling the looming deadline. \u003c/span>Tracht is a certified insurance agent for Covered California, based in San Francisco. She's spent recent nights fielding calls, at home, even past 10 p.m. At her office, she's booked back-to-back appointments, between which she accommodates walk-ins.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco insurance brokers like Tracht are logging extra hours to sign up new enrollees for Covered California in 2018. These enrollment numbers, which \u003ca href=\"https://coveredcanews.blogspot.com/2018/01/covered-california-announces-continued.html\" target=\"_blank\" rel=\"noopener\">surpass last year's numbers\u003c/a>, are strong — despite actions by President Trump and Congressional Republicans that have weakened the Affordable Care Act (ACA). \u003c/span>\u003c/p>\n\u003cp>Tracht runs a \u003ca href=\"http://storefronts.coveredca.com/agent-signage/\" target=\"_blank\" rel=\"noopener\">Covered California \"Storefront,\"\u003c/a> a permanent location open to walk-in traffic with Covered California signage. The \"Storefront\" designation also means her office is prominently listed on the health care exchange website. Tracht says that's how most of her clients find her.\u003c/p>\n\u003cp>\"I'd advertised in a local magazine in Spanish,\" Tracht said, \"A couple people came because of the magazine.\" But Tracht realized she could save her advertising money, because Covered California was promoting the health care coverage for her. \"They're everywhere,\" she said. \"The TV, the radio, the newspapers.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While the Trump Administration cut advertising budgets for the ACA, Covered California officials boosted their own marketing budget, to more than $100 million.\u003c/p>\n\u003cfigure id=\"attachment_362588\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-362588 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg\" alt=\"Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marie Crinnion had an appointment with Tracht the day before the deadline. Crinnion is currently enrolled in\u003cspan style=\"font-weight: 400\"> \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\" rel=\"noopener\">Medi-Cal,\u003c/a> a government insurance program for low-income people, but thinks she will no longer qualify this year because her income will increase. Crinnion's mother died recently and now, Crinnion will collect rent from a property she inherited. \u003c/span>\u003c/p>\n\u003cp>\"I looked online for an actual person to be able to talk to, because my insurance situation is changing and it’s a little complicated,\" Crinnion said. \"I wanted to be able to explain it to a live person and get advice.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Crinnion wants to avoid a lapse in coverage because she has chronic immune problems and is partially blind. After going over her options with Tracht for a half hour, she learned her income will be too high this year to qualify for any insurance subsidies offered through Covered California. Crinnion felt she'd get a better deal by shopping outside of the Covered California exchange. She was especially interested in some of the individual plans offered by a local organization, \u003ca href=\"https://www.cchphealthplan.com/\" target=\"_blank\" rel=\"noopener\">Chinese Community Health Plan\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In many other states, where consumers are using the federally-run marketplace, enrollment ended on Dec. 15. The Trump Administration shortened the enrollment period on the federal exchange from three months to six weeks. \u003c/span>\u003c/p>\n\u003cp>But all states will be affected by another new change to the ACA -- the Congressional tax bill, which removed the penalty for not having health insurance, starting in 2019.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tracht said some consumers were a bit confused about the different deadlines, but said no one had questions about whether the penalty was still in effect. It is for 2018. \u003c/span>\u003c/p>\n\u003cp>Covered California officials are trying to accommodate last-minute sign-ups. Although the official deadline is January 31st, if consumers have started an application before midnight, but are struggling to complete it, they \"will be allowed to finish the process on Thursday or Friday with a certified enroller,\" according to James Scullary, a spokesman for Covered California.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>People who complete applications by February 2 will have coverage beginning on March 1.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">The open enrollment period to get insurance through \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a> closes at midnight tonight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Agents like Monica Tracht are feeling the looming deadline. \u003c/span>Tracht is a certified insurance agent for Covered California, based in San Francisco. She's spent recent nights fielding calls, at home, even past 10 p.m. At her office, she's booked back-to-back appointments, between which she accommodates walk-ins.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco insurance brokers like Tracht are logging extra hours to sign up new enrollees for Covered California in 2018. These enrollment numbers, which \u003ca href=\"https://coveredcanews.blogspot.com/2018/01/covered-california-announces-continued.html\" target=\"_blank\" rel=\"noopener\">surpass last year's numbers\u003c/a>, are strong — despite actions by President Trump and Congressional Republicans that have weakened the Affordable Care Act (ACA). \u003c/span>\u003c/p>\n\u003cp>Tracht runs a \u003ca href=\"http://storefronts.coveredca.com/agent-signage/\" target=\"_blank\" rel=\"noopener\">Covered California \"Storefront,\"\u003c/a> a permanent location open to walk-in traffic with Covered California signage. The \"Storefront\" designation also means her office is prominently listed on the health care exchange website. Tracht says that's how most of her clients find her.\u003c/p>\n\u003cp>\"I'd advertised in a local magazine in Spanish,\" Tracht said, \"A couple people came because of the magazine.\" But Tracht realized she could save her advertising money, because Covered California was promoting the health care coverage for her. \"They're everywhere,\" she said. \"The TV, the radio, the newspapers.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While the Trump Administration cut advertising budgets for the ACA, Covered California officials boosted their own marketing budget, to more than $100 million.\u003c/p>\n\u003cfigure id=\"attachment_362588\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-362588 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg\" alt=\"Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marie Crinnion had an appointment with Tracht the day before the deadline. Crinnion is currently enrolled in\u003cspan style=\"font-weight: 400\"> \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\" rel=\"noopener\">Medi-Cal,\u003c/a> a government insurance program for low-income people, but thinks she will no longer qualify this year because her income will increase. Crinnion's mother died recently and now, Crinnion will collect rent from a property she inherited. \u003c/span>\u003c/p>\n\u003cp>\"I looked online for an actual person to be able to talk to, because my insurance situation is changing and it’s a little complicated,\" Crinnion said. \"I wanted to be able to explain it to a live person and get advice.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Crinnion wants to avoid a lapse in coverage because she has chronic immune problems and is partially blind. After going over her options with Tracht for a half hour, she learned her income will be too high this year to qualify for any insurance subsidies offered through Covered California. Crinnion felt she'd get a better deal by shopping outside of the Covered California exchange. She was especially interested in some of the individual plans offered by a local organization, \u003ca href=\"https://www.cchphealthplan.com/\" target=\"_blank\" rel=\"noopener\">Chinese Community Health Plan\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In many other states, where consumers are using the federally-run marketplace, enrollment ended on Dec. 15. The Trump Administration shortened the enrollment period on the federal exchange from three months to six weeks. \u003c/span>\u003c/p>\n\u003cp>But all states will be affected by another new change to the ACA -- the Congressional tax bill, which removed the penalty for not having health insurance, starting in 2019.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tracht said some consumers were a bit confused about the different deadlines, but said no one had questions about whether the penalty was still in effect. It is for 2018. \u003c/span>\u003c/p>\n\u003cp>Covered California officials are trying to accommodate last-minute sign-ups. Although the official deadline is January 31st, if consumers have started an application before midnight, but are struggling to complete it, they \"will be allowed to finish the process on Thursday or Friday with a certified enroller,\" according to James Scullary, a spokesman for Covered California.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>People who complete applications by February 2 will have coverage beginning on March 1.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Fanny Ortiz, a mother of five who lives just east of downtown Los Angeles, spent nearly a decade married to a man who controlled her and frequently threatened her. Then, she said, his abuse escalated.\u003c/p>\n\u003cp>“He would physically hit me in the face, throw me on the wall,” she recalled.\u003c/p>\n\u003cp>Ortiz, 43, eventually left the marriage, taking her children with her. A few years later, she learned that the East Los Angeles Women’s Center offered domestic violence services at Los Angeles County‐USC Medical Center near her home. Now she goes to the hospital campus for weekly therapy sessions, which she said have helped stop her suicidal thoughts.\u003c/p>\n\u003cp>“I was afraid to talk,” Ortiz said. “Now I am more open to talk about things that I was holding in.”\u003c/p>\n\u003cfigure id=\"attachment_362544\" class=\"wp-caption alignnone\" style=\"max-width: 540px\">\u003cimg class=\"size-full wp-image-362544\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg\" alt=\"\" width=\"540\" height=\"405\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg 540w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-520x390.jpg 520w\" sizes=\"(max-width: 540px) 100vw, 540px\">\u003cfigcaption class=\"wp-caption-text\">Fanny Ortiz (right), who left an abusive marriage after nearly a decade, meets weekly with therapist Brittany Martinez at the East Los Angeles Women’s Center. The office is located on the campus of the Los Angeles County-USC Medical Center. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nearly 1 in 4 women have experienced serious physical violence at the hands of a partner. They often end up in the emergency room or the doctor’s office. But they don’t typically volunteer the reason for their injuries, and doctors don’t always ask about abuse in the home. That failure of communication means the patients may miss out on the help they need.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Yet a growing number of health providers and anti‐abuse agencies in California and around the country are collaborating to identify victims and get them help. More doctors now screen their patients for signs of abuse and more agencies place victims’ advocates inside health centers. Education and counseling for people experiencing violence is also more widely available in clinics and hospitals.\u003c/p>\n\u003cp>About four years ago, the East Los Angeles Women’s Center opened offices on the campus of L.A. County‐USC, a busy public hospital. Since then, center staff members have trained more than 2,500 doctors, nurses, social workers and others to identify victims of domestic violence. They also respond quickly to calls from the medical center’s emergency room, inpatient hospital and outpatient facilities to help patients in crisis.\u003c/p>\n\u003cp>Today, the women’s center has embarked on an innovative approach: In February, it plans to open a short‐term shelter for abuse victims on the medical center grounds. The 10‐bed shelter fills a serious need, said Deirdre Anglin, an emergency room physician at L.A. County‐USC.\u003c/p>\n\u003cp>“We sometimes have patients in the emergency department who don’t have a place to go, and in the evenings and nights all the shelters in L.A. will be filled,” Anglin said.\u003c/p>\n\u003cp>Victims of abuse can suffer long‐term health problems, including chronic pain, frequent headaches, depression, diabetes and asthma. And they have higher health costs than people who have not experienced abuse. So “it makes complete sense to have the health care providers acting as allies and partners in treating domestic violence,” said Peter Long, CEO of the Blue Shield of California Foundation. (The foundation provides support for KHN coverage in California).\u003c/p>\n\u003cp>The foundation has funded 19 partnerships between health centers and domestic violence agencies around the state, including the L.A. County‐USC office of the East Los Angeles Women’s Center. Similar partnerships operate in Illinois, Maryland and other states.\u003c/p>\n\u003cp>Last year, the East Los Angeles Women’s Center served 600 victims of domestic violence at the L.A. County‐USC hospital campus. Nearly one‐third were homeless or couldn’t go back home for safety reasons.\u003c/p>\n\u003cp>Advocates say that hospitals and clinics are ideal settings to respond to the needs of abused women. In the San Gabriel Valley, the YWCA sponsors domestic violence support groups at a community clinic, while the clinic offers health education for survivors of abuse at the YWCA. In Sacramento, a Native American health center works closely with a domestic violence group a few blocks away.\u003c/p>\n\u003cp>Doctors have an “unprecedented opportunity to promote prevention and to respond because they are seeing patients that may not ever reach out to a domestic violence agency or police for help,” said Lisa James, director of health for Futures Without Violence, which runs a national resource center dedicated to improving the response of medical professionals to domestic violence. “They can provide this critical lifesaving intervention.”\u003c/p>\n\u003cp>The proximity of the East Los Angeles Women’s Center to the hospital and clinic buildings on the L.A. County‐USC campus makes it easier for doctors to ask their patients about violence, said Rebeca Melendez, director of programs for the center’s office at the medical center. The medical providers know where to turn for guidance – and that the help is nearby.\u003c/p>\n\u003cp>“They don’t need to know all the answers,” she said. “They just need to call us.”\u003c/p>\n\u003cp>This growing collaboration between the medical profession and anti‐abuse agencies is driven in part by the Affordable Care Act, which requires that health plans cover domestic violence screening and counseling.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force recommends doctors routinely question women about violence in the home and refer them to services if needed. The task force concluded in 2013 that intervention could reduce violence and abuse as well as mental and physical health problems.\u003c/p>\n\u003cp>Organizations such as the American Congress of Obstetricians and Gynecologists and the American Medical Association also recommend routine screening and counseling for domestic violence.\u003c/p>\n\u003cp>In the past, patients would go to health centers with such problems, but providers did not feel comfortable asking questions about abuse at home, said Long, of the Blue Shield of California Foundation.\u003c/p>\n\u003cp>“They didn’t feel they had the time and they didn’t feel they had the resources to do something about it,” he said. Nor did they always have a place to send patients who were abuse victims.\u003c/p>\n\u003cp>Treating patients who are in abusive relationships is “very challenging,” said Anglin, the ER physician. “There is no pill to give.”\u003c/p>\n\u003cp>But asking about violence needs to be part of a physician’s job, she said. “Part of what we need to do is try to identify patients who may be in a dangerous situation… so we are not just sending these patients back to the same situation they were in only to come back worse off another time.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Fanny Ortiz, a mother of five who lives just east of downtown Los Angeles, spent nearly a decade married to a man who controlled her and frequently threatened her. Then, she said, his abuse escalated.\u003c/p>\n\u003cp>“He would physically hit me in the face, throw me on the wall,” she recalled.\u003c/p>\n\u003cp>Ortiz, 43, eventually left the marriage, taking her children with her. A few years later, she learned that the East Los Angeles Women’s Center offered domestic violence services at Los Angeles County‐USC Medical Center near her home. Now she goes to the hospital campus for weekly therapy sessions, which she said have helped stop her suicidal thoughts.\u003c/p>\n\u003cp>“I was afraid to talk,” Ortiz said. “Now I am more open to talk about things that I was holding in.”\u003c/p>\n\u003cfigure id=\"attachment_362544\" class=\"wp-caption alignnone\" style=\"max-width: 540px\">\u003cimg class=\"size-full wp-image-362544\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg\" alt=\"\" width=\"540\" height=\"405\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1.jpg 540w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/LA-Hospital-womens-shelter1-520x390.jpg 520w\" sizes=\"(max-width: 540px) 100vw, 540px\">\u003cfigcaption class=\"wp-caption-text\">Fanny Ortiz (right), who left an abusive marriage after nearly a decade, meets weekly with therapist Brittany Martinez at the East Los Angeles Women’s Center. The office is located on the campus of the Los Angeles County-USC Medical Center. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nearly 1 in 4 women have experienced serious physical violence at the hands of a partner. They often end up in the emergency room or the doctor’s office. But they don’t typically volunteer the reason for their injuries, and doctors don’t always ask about abuse in the home. That failure of communication means the patients may miss out on the help they need.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Yet a growing number of health providers and anti‐abuse agencies in California and around the country are collaborating to identify victims and get them help. More doctors now screen their patients for signs of abuse and more agencies place victims’ advocates inside health centers. Education and counseling for people experiencing violence is also more widely available in clinics and hospitals.\u003c/p>\n\u003cp>About four years ago, the East Los Angeles Women’s Center opened offices on the campus of L.A. County‐USC, a busy public hospital. Since then, center staff members have trained more than 2,500 doctors, nurses, social workers and others to identify victims of domestic violence. They also respond quickly to calls from the medical center’s emergency room, inpatient hospital and outpatient facilities to help patients in crisis.\u003c/p>\n\u003cp>Today, the women’s center has embarked on an innovative approach: In February, it plans to open a short‐term shelter for abuse victims on the medical center grounds. The 10‐bed shelter fills a serious need, said Deirdre Anglin, an emergency room physician at L.A. County‐USC.\u003c/p>\n\u003cp>“We sometimes have patients in the emergency department who don’t have a place to go, and in the evenings and nights all the shelters in L.A. will be filled,” Anglin said.\u003c/p>\n\u003cp>Victims of abuse can suffer long‐term health problems, including chronic pain, frequent headaches, depression, diabetes and asthma. And they have higher health costs than people who have not experienced abuse. So “it makes complete sense to have the health care providers acting as allies and partners in treating domestic violence,” said Peter Long, CEO of the Blue Shield of California Foundation. (The foundation provides support for KHN coverage in California).\u003c/p>\n\u003cp>The foundation has funded 19 partnerships between health centers and domestic violence agencies around the state, including the L.A. County‐USC office of the East Los Angeles Women’s Center. Similar partnerships operate in Illinois, Maryland and other states.\u003c/p>\n\u003cp>Last year, the East Los Angeles Women’s Center served 600 victims of domestic violence at the L.A. County‐USC hospital campus. Nearly one‐third were homeless or couldn’t go back home for safety reasons.\u003c/p>\n\u003cp>Advocates say that hospitals and clinics are ideal settings to respond to the needs of abused women. In the San Gabriel Valley, the YWCA sponsors domestic violence support groups at a community clinic, while the clinic offers health education for survivors of abuse at the YWCA. In Sacramento, a Native American health center works closely with a domestic violence group a few blocks away.\u003c/p>\n\u003cp>Doctors have an “unprecedented opportunity to promote prevention and to respond because they are seeing patients that may not ever reach out to a domestic violence agency or police for help,” said Lisa James, director of health for Futures Without Violence, which runs a national resource center dedicated to improving the response of medical professionals to domestic violence. “They can provide this critical lifesaving intervention.”\u003c/p>\n\u003cp>The proximity of the East Los Angeles Women’s Center to the hospital and clinic buildings on the L.A. County‐USC campus makes it easier for doctors to ask their patients about violence, said Rebeca Melendez, director of programs for the center’s office at the medical center. The medical providers know where to turn for guidance – and that the help is nearby.\u003c/p>\n\u003cp>“They don’t need to know all the answers,” she said. “They just need to call us.”\u003c/p>\n\u003cp>This growing collaboration between the medical profession and anti‐abuse agencies is driven in part by the Affordable Care Act, which requires that health plans cover domestic violence screening and counseling.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force recommends doctors routinely question women about violence in the home and refer them to services if needed. The task force concluded in 2013 that intervention could reduce violence and abuse as well as mental and physical health problems.\u003c/p>\n\u003cp>Organizations such as the American Congress of Obstetricians and Gynecologists and the American Medical Association also recommend routine screening and counseling for domestic violence.\u003c/p>\n\u003cp>In the past, patients would go to health centers with such problems, but providers did not feel comfortable asking questions about abuse at home, said Long, of the Blue Shield of California Foundation.\u003c/p>\n\u003cp>“They didn’t feel they had the time and they didn’t feel they had the resources to do something about it,” he said. Nor did they always have a place to send patients who were abuse victims.\u003c/p>\n\u003cp>Treating patients who are in abusive relationships is “very challenging,” said Anglin, the ER physician. “There is no pill to give.”\u003c/p>\n\u003cp>But asking about violence needs to be part of a physician’s job, she said. “Part of what we need to do is try to identify patients who may be in a dangerous situation… so we are not just sending these patients back to the same situation they were in only to come back worse off another time.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Woman Seeks Help for Post-Partum Depression. A Nurse Calls the Cops.",
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"content": "\u003cp>With her first daughter, everything was fine. But four months after having her second, Jessica Porten started feeling really irritable. Little things would annoy her, like her glider chair.\u003c/p>\n\u003cp>“It had started to squeak,” she said, “And so when I’m sitting there rocking the baby and it’s squeaking, I would just get so angry at that stupid chair.”\u003c/p>\n\u003cp>She read online that this could be a symptom of post-partum depression – a condition that affects up to \u003ca href=\"http://www.chcf.org/projects/2017/improving-maternal-mental-health\">one in five women\u003c/a> in California during or after pregnancy. The rates have spurred state lawmakers to introduce a package of bills to improve mental health screening and treatment for new moms.\u003c/p>\n\u003cp>Porten hopes they help women avoid what she went through.\u003c/p>\n\u003cp>She went to \u003ca href=\"http://www.capitalobgyn.com/\">Capital OB/GYN\u003c/a>, a women’s clinic in Sacramento that takes her Medi-Cal coverage, to talk about medication options and therapy. She admitted to the nurse that she was having some violent thoughts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I described maybe hitting myself or squeezing the baby too tight,” she said. “But I was very adamant through the entire appointment that I was not going to hurt myself and I was not going to hurt my children.”\u003c/p>\n\u003cp>The nurse called the police. The police escorted Porten and her baby to the Sutter Emergency Room. Hospital staff made her change into a gown and took her purse, but they let her keep her diaper bag for the baby. They put them both in a room, under constant watch.\u003c/p>\n\u003cp>\"It’s like, everybody knows I’m not crazy,\" she said. \"Everybody knows that this is normal, but they’re following protocol.\"\u003c/p>\n\u003cp>Finally, at midnight, 10 hours after she first got to the doctors’ office, a social worker sent her home. She wrote \u003ca href=\"https://www.facebook.com/permalink.php?story_fbid=10213174920945414&id=1166947031\">on Facebook\u003c/a> that the whole thing made her feel like a criminal.\u003c/p>\n\u003cp>“It was all legality,” Porten said. “Everybody was protecting their own liability instead of thinking of me.”\u003c/p>\n\u003cp>Administrators at Capital OB/GYN declined to comment. A spokesman for \u003ca href=\"https://www.sutterhealth.org/\">Sutter Health\u003c/a>, Gary Zavoral, said once a patient arrives in the emergency room for assessment, hospital staff must follow strict protocols.\u003c/p>\n\u003cp>“The process is to make sure everybody is safe: the individual’s safe, the family’s safe, the staff is safe,” he said. “The process does take some hours, so ten hours is not unusual.”\u003c/p>\n\u003cp>When patients reference violent thoughts, it forces doctors to think about things in a different way, said \u003ca href=\"http://profiles.ucsf.edu/melanie.thomas\">Melanie Thomas\u003c/a>, a psychiatrist at UC-San Francisco and Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=5150&lawCode=WIC\" target=\"_blank\" rel=\"noopener\">California law\u003c/a> allows doctors to involuntarily confine a person with a mental disorder if they are a danger to themselves or others. But Thomas says what constitutes imminent danger can be vague.\u003c/p>\n\u003cp>“You can imagine a provider, a social worker, any number of people might interpret that phrase in different ways, about what is necessary to report and what isn’t,” she said.\u003c/p>\n\u003cp>The laws and medical protocols don’t always line up, Thomas said. There have been times she felt asked to put legal reasoning over her clinical judgment.\u003c/p>\n\u003cp>“The fragmented aspects of our system of care make it difficult to get women the help that they really want,” she said.\u003c/p>\n\u003cp>That’s one reason lawmakers in Sacramento are now introducing a package of bills to address maternal mental health. Assemblyman \u003ca href=\"https://ad77.asmrc.org/\">Brian Maienschein\u003c/a>, R-San Diego, is backing two of them. One would require doctors to screen new moms for depression – under current law, it’s voluntary.\u003c/p>\n\u003cp>“The numbers here are so significant that I think it’s something that doctors really should understand and should be prepared to both diagnose and treat,” he said, adding screening also “educates a woman in that situation that this is an issue that may impact her.”\u003c/p>\n\u003cp>Maienschein's \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1893\" target=\"_blank\" rel=\"noopener\">other bill\u003c/a> would direct the state to tap into a new federal pot of money set aside for post-partum programs and awareness campaigns. It was established in the new 21\u003csup>st\u003c/sup> Century Cures Act.\u003c/p>\n\u003cp>\"Getting federal money is a great thing,\" Maienschein said. \"It’s federal money that’s available that I’d like to see California have versus another state.\"\u003c/p>\n\u003cp>The legislation has given Jessica Porten a new purpose. People have told her she should sue Capital OB/GYN for calling the police. But she says no.\u003c/p>\n\u003cp>“I walk into that waiting room and I see tons of Medi-Cal recipients, so they’re all low-income,” she said. \"If I sue, it's only going to cause monetary damages to a facility that is clearly short on resources.\"\u003c/p>\n\u003cp>Instead, Porten will advocate to get the new bills passed in California. She thinks that's the way to help the clinic's physicians and nurses do a better job helping new moms get the care they need.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I’m not going to take that away,\" she said, \"I’m going to build it up.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With her first daughter, everything was fine. But four months after having her second, Jessica Porten started feeling really irritable. Little things would annoy her, like her glider chair.\u003c/p>\n\u003cp>“It had started to squeak,” she said, “And so when I’m sitting there rocking the baby and it’s squeaking, I would just get so angry at that stupid chair.”\u003c/p>\n\u003cp>She read online that this could be a symptom of post-partum depression – a condition that affects up to \u003ca href=\"http://www.chcf.org/projects/2017/improving-maternal-mental-health\">one in five women\u003c/a> in California during or after pregnancy. The rates have spurred state lawmakers to introduce a package of bills to improve mental health screening and treatment for new moms.\u003c/p>\n\u003cp>Porten hopes they help women avoid what she went through.\u003c/p>\n\u003cp>She went to \u003ca href=\"http://www.capitalobgyn.com/\">Capital OB/GYN\u003c/a>, a women’s clinic in Sacramento that takes her Medi-Cal coverage, to talk about medication options and therapy. She admitted to the nurse that she was having some violent thoughts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I described maybe hitting myself or squeezing the baby too tight,” she said. “But I was very adamant through the entire appointment that I was not going to hurt myself and I was not going to hurt my children.”\u003c/p>\n\u003cp>The nurse called the police. The police escorted Porten and her baby to the Sutter Emergency Room. Hospital staff made her change into a gown and took her purse, but they let her keep her diaper bag for the baby. They put them both in a room, under constant watch.\u003c/p>\n\u003cp>\"It’s like, everybody knows I’m not crazy,\" she said. \"Everybody knows that this is normal, but they’re following protocol.\"\u003c/p>\n\u003cp>Finally, at midnight, 10 hours after she first got to the doctors’ office, a social worker sent her home. She wrote \u003ca href=\"https://www.facebook.com/permalink.php?story_fbid=10213174920945414&id=1166947031\">on Facebook\u003c/a> that the whole thing made her feel like a criminal.\u003c/p>\n\u003cp>“It was all legality,” Porten said. “Everybody was protecting their own liability instead of thinking of me.”\u003c/p>\n\u003cp>Administrators at Capital OB/GYN declined to comment. A spokesman for \u003ca href=\"https://www.sutterhealth.org/\">Sutter Health\u003c/a>, Gary Zavoral, said once a patient arrives in the emergency room for assessment, hospital staff must follow strict protocols.\u003c/p>\n\u003cp>“The process is to make sure everybody is safe: the individual’s safe, the family’s safe, the staff is safe,” he said. “The process does take some hours, so ten hours is not unusual.”\u003c/p>\n\u003cp>When patients reference violent thoughts, it forces doctors to think about things in a different way, said \u003ca href=\"http://profiles.ucsf.edu/melanie.thomas\">Melanie Thomas\u003c/a>, a psychiatrist at UC-San Francisco and Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=5150&lawCode=WIC\" target=\"_blank\" rel=\"noopener\">California law\u003c/a> allows doctors to involuntarily confine a person with a mental disorder if they are a danger to themselves or others. But Thomas says what constitutes imminent danger can be vague.\u003c/p>\n\u003cp>“You can imagine a provider, a social worker, any number of people might interpret that phrase in different ways, about what is necessary to report and what isn’t,” she said.\u003c/p>\n\u003cp>The laws and medical protocols don’t always line up, Thomas said. There have been times she felt asked to put legal reasoning over her clinical judgment.\u003c/p>\n\u003cp>“The fragmented aspects of our system of care make it difficult to get women the help that they really want,” she said.\u003c/p>\n\u003cp>That’s one reason lawmakers in Sacramento are now introducing a package of bills to address maternal mental health. Assemblyman \u003ca href=\"https://ad77.asmrc.org/\">Brian Maienschein\u003c/a>, R-San Diego, is backing two of them. One would require doctors to screen new moms for depression – under current law, it’s voluntary.\u003c/p>\n\u003cp>“The numbers here are so significant that I think it’s something that doctors really should understand and should be prepared to both diagnose and treat,” he said, adding screening also “educates a woman in that situation that this is an issue that may impact her.”\u003c/p>\n\u003cp>Maienschein's \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1893\" target=\"_blank\" rel=\"noopener\">other bill\u003c/a> would direct the state to tap into a new federal pot of money set aside for post-partum programs and awareness campaigns. It was established in the new 21\u003csup>st\u003c/sup> Century Cures Act.\u003c/p>\n\u003cp>\"Getting federal money is a great thing,\" Maienschein said. \"It’s federal money that’s available that I’d like to see California have versus another state.\"\u003c/p>\n\u003cp>The legislation has given Jessica Porten a new purpose. People have told her she should sue Capital OB/GYN for calling the police. But she says no.\u003c/p>\n\u003cp>“I walk into that waiting room and I see tons of Medi-Cal recipients, so they’re all low-income,” she said. \"If I sue, it's only going to cause monetary damages to a facility that is clearly short on resources.\"\u003c/p>\n\u003cp>Instead, Porten will advocate to get the new bills passed in California. She thinks that's the way to help the clinic's physicians and nurses do a better job helping new moms get the care they need.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I’m not going to take that away,\" she said, \"I’m going to build it up.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Head of Covered California: State Exchange ‘Here for the Long Haul’",
"title": "Head of Covered California: State Exchange ‘Here for the Long Haul’",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Californians have until Jan. 31 to buy a health plan through the state’s health exchange, \u003ca href=\"http://www.coveredca.com/%E2%80%8E\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>Despite ongoing uncertainty around the Affordable Care Act (ACA) on a national level, the state's insurance marketplace, Covered California, is recording higher enrollment numbers this year when compared to the same time last year. The instability around the ACA is due to several factors, including Republican attempts to repeal and replace the bill, a shortened, six-week enrollment period in other states (California decided to keep the standard three-month enrollment), and the recent passage in Congress of a \u003ca href=\"https://www.npr.org/2017/12/15/571258698/chart-how-the-new-version-of-the-republican-tax-bill-would-affect-you\" target=\"_blank\" rel=\"noopener\">tax reform bill\u003c/a>, which removed the law's penalty for people who failed to buy health coverage. That coverage \"mandate\" is still in effect this year, but will expire starting in 2019.\u003c/p>\n\u003cp>KQED spoke to Covered California's executive director, Peter V. Lee, who emphasized that despite these challenges, his program remains solid.\u003c/p>\n\u003cp>\u003cem>This interview has been edited for brevity and clarity.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Can people still sign up for health insurance through Covered California? \u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Peter V. Lee:\u003c/strong> We're in the very end of open enrollment. Many people are confused because in much of the country open enrollment ended Dec. 15. We’re open through Jan. 31 -- the end of the month. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Anyone that doesn't have insurance should come to our website and check it out. \u003c/span>Three-quarters of those eligible don't know (that they're eligible).\u003c/p>\n\u003cp>Click on “\u003ca href=\"https://www.coveredca.com/find-help/\" target=\"_blank\" rel=\"noopener\">find help near me\u003c/a>,” and you can find a local insurance agent. They're always going to be free. We have people that speak Cantonese, Spanish, and they all speak insurance.\u003c/p>\n\u003cp>\u003cstrong>Right, it feels like another language. You released numbers this past Monday showing how many people enrolled for the very first time, and those numbers are up from this time last year. Why do you think that is?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year has been sort of crazy -- a lot of roller-coaster effects. We've done everything we can to have things be stable for consumers. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">One of the reasons we've seen more people sign up is it's cheaper for many people. About 1.1 million of California consumers get financial help, which lowers their premiums. For them, their health care costs went \u003cem>down\u003c/em> 10 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For those for whom it's not cheaper, which means they don't get a subsidy, it may be on average 10 percent more expensive than last year.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">We're out there pounding the pavement, we're running ads, we're getting the word out through social media, through radio and through TV. People are getting the word out. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This is the fifth year for open enrollment, and at this point we've become a pretty well-known brand in California. People are used to hearing about us and they come back.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What percentage of people on Covered California get subsidies?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> There's two numbers. First, the individual market has about 2.5 million people. Half of them buy direct from their health plans. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">You can only get a subsidy if you buy from us. So at Covered California about 85 percent of the people that sign up with us get a subsidy. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>You released a report on Jan. 18 predicting that individual insurance markets in all states would see rate hikes in 2019 between 16 and 30 percent. And you called it a \"roller coaster for consumers.\" How will that impact California in 2019?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> First, that projection is for next year. I want to be really clear that for Californians shopping now that get subsidies, their rates went \u003cem>down\u003c/em> in 2018. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But nationally there's removal of the tax penalty [for not buying insurance]. Projections are that some healthier people will drop out of buying insurance. On average, that would increase premiums in California probably eigh,t percent on top of underlying health care costs. So we might see premiums go up next year by 15 percent in California. In other states, it could go up 30 percent or more. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What is your plan for keeping Covered California afloat in the future?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> Number one: Covered California is totally afloat. The worst case is, and this is bad, there might be a few hundred thousand fewer Californians with health insurance. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The penalty being there, or not being there, isn't the glue that holds the Affordable Care Act together. We're here for the long haul and we operate like a business. We've got hundreds of millions of dollars in reserves. We use zero state funds, and zero federal funds. So we're a going proposition. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The issue for 2019 is what this means for people that get no subsidies. They will be saying, “Holy mother of God, I got a 15 percent rate increase!\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What would you like to add?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year, there were interminable attempts to repeal and replace [the Affordable Care Act]. Didn't happen.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> One of the things that I am most surprised by is how much the health care debate has changed from six years ago before the Affordable Care Act. People took for granted that we could be in a world where, if you had diabetes or asthma or cancer, you could be denied getting health care forever. No one wants to go back to those days. That's a huge change.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Californians have until Jan. 31 to buy a health plan through the state’s health exchange, \u003ca href=\"http://www.coveredca.com/%E2%80%8E\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>Despite ongoing uncertainty around the Affordable Care Act (ACA) on a national level, the state's insurance marketplace, Covered California, is recording higher enrollment numbers this year when compared to the same time last year. The instability around the ACA is due to several factors, including Republican attempts to repeal and replace the bill, a shortened, six-week enrollment period in other states (California decided to keep the standard three-month enrollment), and the recent passage in Congress of a \u003ca href=\"https://www.npr.org/2017/12/15/571258698/chart-how-the-new-version-of-the-republican-tax-bill-would-affect-you\" target=\"_blank\" rel=\"noopener\">tax reform bill\u003c/a>, which removed the law's penalty for people who failed to buy health coverage. That coverage \"mandate\" is still in effect this year, but will expire starting in 2019.\u003c/p>\n\u003cp>KQED spoke to Covered California's executive director, Peter V. Lee, who emphasized that despite these challenges, his program remains solid.\u003c/p>\n\u003cp>\u003cem>This interview has been edited for brevity and clarity.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Can people still sign up for health insurance through Covered California? \u003c/strong>\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\">\u003cstrong>Peter V. Lee:\u003c/strong> We're in the very end of open enrollment. Many people are confused because in much of the country open enrollment ended Dec. 15. We’re open through Jan. 31 -- the end of the month. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Anyone that doesn't have insurance should come to our website and check it out. \u003c/span>Three-quarters of those eligible don't know (that they're eligible).\u003c/p>\n\u003cp>Click on “\u003ca href=\"https://www.coveredca.com/find-help/\" target=\"_blank\" rel=\"noopener\">find help near me\u003c/a>,” and you can find a local insurance agent. They're always going to be free. We have people that speak Cantonese, Spanish, and they all speak insurance.\u003c/p>\n\u003cp>\u003cstrong>Right, it feels like another language. You released numbers this past Monday showing how many people enrolled for the very first time, and those numbers are up from this time last year. Why do you think that is?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year has been sort of crazy -- a lot of roller-coaster effects. We've done everything we can to have things be stable for consumers. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">One of the reasons we've seen more people sign up is it's cheaper for many people. About 1.1 million of California consumers get financial help, which lowers their premiums. For them, their health care costs went \u003cem>down\u003c/em> 10 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For those for whom it's not cheaper, which means they don't get a subsidy, it may be on average 10 percent more expensive than last year.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">We're out there pounding the pavement, we're running ads, we're getting the word out through social media, through radio and through TV. People are getting the word out. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This is the fifth year for open enrollment, and at this point we've become a pretty well-known brand in California. People are used to hearing about us and they come back.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What percentage of people on Covered California get subsidies?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> There's two numbers. First, the individual market has about 2.5 million people. Half of them buy direct from their health plans. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">You can only get a subsidy if you buy from us. So at Covered California about 85 percent of the people that sign up with us get a subsidy. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>You released a report on Jan. 18 predicting that individual insurance markets in all states would see rate hikes in 2019 between 16 and 30 percent. And you called it a \"roller coaster for consumers.\" How will that impact California in 2019?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> First, that projection is for next year. I want to be really clear that for Californians shopping now that get subsidies, their rates went \u003cem>down\u003c/em> in 2018. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But nationally there's removal of the tax penalty [for not buying insurance]. Projections are that some healthier people will drop out of buying insurance. On average, that would increase premiums in California probably eigh,t percent on top of underlying health care costs. So we might see premiums go up next year by 15 percent in California. In other states, it could go up 30 percent or more. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What is your plan for keeping Covered California afloat in the future?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> Number one: Covered California is totally afloat. The worst case is, and this is bad, there might be a few hundred thousand fewer Californians with health insurance. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The penalty being there, or not being there, isn't the glue that holds the Affordable Care Act together. We're here for the long haul and we operate like a business. We've got hundreds of millions of dollars in reserves. We use zero state funds, and zero federal funds. So we're a going proposition. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The issue for 2019 is what this means for people that get no subsidies. They will be saying, “Holy mother of God, I got a 15 percent rate increase!\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>What would you like to add?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Lee:\u003c/strong> This last year, there were interminable attempts to repeal and replace [the Affordable Care Act]. Didn't happen.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> One of the things that I am most surprised by is how much the health care debate has changed from six years ago before the Affordable Care Act. People took for granted that we could be in a world where, if you had diabetes or asthma or cancer, you could be denied getting health care forever. No one wants to go back to those days. That's a huge change.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lead in the Drinking Fountain? California Schools Must Now Test For It",
"title": "Lead in the Drinking Fountain? California Schools Must Now Test For It",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">When a therapy dog refused to drink the water at a San Diego grade school, it was the first clue that something was wrong.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tests soon revealed why the pup turned up its nose back in early 2017 — the presence of vinyl chloride, which is used to make PVC plumbing pipes and may be released as the plastic degrades. It’s also a known carcinogen. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But further analysis of the water at the San Diego Cooperative Charter School found something else that had gone undetected by the dog, the teachers, and district officials: elevated levels of lead. The district conducted more tests last spring, and found harmful lead levels at other San Diego schools as well. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s not an isolated problem. In Los Angeles, the district has been working for years to identify contaminated fountains and lower the lead levels. And after the much-publicized toxic lead contamination of water in Flint, Mich., a 2016 \u003c/span>\u003ca href=\"http://www.reuters.com/investigates/special-report/usa-lead-testing/\">\u003cspan style=\"font-weight: 400\">Reuters\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> report revealed that children in dozens of California neighborhoods had elevated lead levels in their blood. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Lead is a neurotoxin that causes developmental disorders and brain damage. No amount of lead in humans is considered safe.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now, under a new law signed by Gov. Jerry Brown in October, public schools are required to get their drinking water sampled for lead, and notify parents if they find traces of the toxic metal. Districts now have until July 2019 to test all campuses, including charter schools. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The \u003c/span>\u003cspan style=\"font-weight: 400\">school-testing law requires districts to test for lead at least once a year, or once every three years, depending on when the buildings were constructed. If tests find that lead is higher than the state and federal threshold of 15 parts per billion, the school district must notify parents and shut down the contaminated water source until it can be fixed.\u003c/span>\u003c/p>\n\u003cp>\u003cb>“A more aggressive standard” \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Previously, California law gave school districts the option to obtain free testing from their local water supplier, but less than 10 percent of schools had taken advantage of the voluntary program. That’s what spurred \u003c/span>\u003cspan style=\"font-weight: 400\">Assemblywoman Lorena Gonzalez (D-San Diego) to sponsor the new testing bill. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“You can’t have water with anything testing above the limits that are drinkable and not follow through and fix for the solution,” she said. “We want to ensure that when you find lead, water is shut off and parents are notified so they can have their kids tested.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Diego Unified has rolled out the strongest policy in the state. Its board decided in late July to set its own threshold at 5 parts per billion, well below the state and federal standard of 15.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We said the state action level was too high, and so we thought we should have a more aggressive standard,” said district spokesman Andrew Sharp. “We wanted to be able to say ‘Look, when kids go back to school in the fall, if there was a positive test for lead on your campus you should know we will have fixed that fountain or kids won’t be drinking from that fountain.’”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Water sampling at San Diego public schools has \u003c/span>\u003ca href=\"http://sandiegounified.org/watersampling\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">revealed\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> three campuses with at least one water source above 15 parts per billion, and another 33 sites with water that showed levels between 5 and 15 parts per billion.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The district is working to fix or close the problematic fountains, Sharp said, and intends to test every drinking water source at its schools in the next three to five years. In the meantime, it’s begun a daily “flushing” of fountains at all schools — staff members open the spigot for one minute, to flush through any stagnant water in older pipes and fixtures, which can leach lead into the water overnight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Flushing water fountains has been going on for decades in the Los Angeles Unified School District.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It became evident that a particular kind of drinking fountain had lead content,” said Robert Laughton, district director for environmental health and safety. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was that old style you used to see, that was the square-mounted stainless-steel thing, that was chilled,” Laughton explained. “Well, those old drinking fountains had lead-lined water basins in them, and so in 1988 we removed all of them and began random sampling and began flushing all fountains district-wide.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Back then, the district lacked the money to replace or fix contaminated fountains, so at any school where even one water sample exceeded the lead limit of 15 parts per billion, janitors had to \u003c/span>\u003ca href=\"https://achieve.lausd.net/Page/3450\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">flush\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> every drinking source for 30 seconds each morning, said Mark Hovatter, chief facilities executive for the district. Once flushed, the fountains usually tested below the 15 ppb threshold. Those that did not were shut down.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hovatter said the district chose to “err on the side of safety” for the children, despite taking “a lot of heat during the drought for our flushing.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s because the flushing program sent 2.5 million gallons of water down the drain every year. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Moving forward from preventive flushing to a permanent fix\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2009, the district began systematically testing every single drinking fountain for lead. And in \u003c/span>\u003cspan style=\"font-weight: 400\">2015 it finally appropriated nearly $20 million to end the flushing, by repairing or closing drinking fountains that tested high for lead. Laughton said all the district’s fountains will be fixed by this fall, and two-thirds of its schools have already been cleared to stop flushing.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362369\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362369\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-800x563.jpg\" alt=\"\" width=\"800\" height=\"563\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-800x563.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-160x113.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-768x540.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-1020x718.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-1180x830.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-960x675.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-240x169.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-375x264.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-520x366.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Students at the 9th Street School in Los Angeles take turns drinking water after recess. It was pajama day at school. \u003ccite>(Elizabeth Aguilera/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Of the district’s 41,000 fountains, only four percent had lead levels exceeding the 15 ppb limit, according to Mark Cho, an operations deputy. Since the project began, his teams have removed or shut off 800 of those fountains, and fixed or replaced 672.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At the 9th Street School near downtown, children line up after recess to drink water. To move them along, a playground monitor gives each child five seconds to drink.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It tastes really good,” said Monica Marquez, 6, of the water.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It tastes like watermelon,” said Vivian Villegas, 7. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At this school, flushing has already ended for all 43 fountains. Testing showed that none of them had to be fixed or shut down.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now, officials in other school districts are calling Laughton and Hovatter, seeking advice on how to comply with the new law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This isn’t a situation where you can stick your head in the sand and say ‘If I don’t think I’m going to like the answer I’m not going to ask the question,” Laughton said. “We are responsible to know.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Yet some public health advocates still consider the new law insufficient.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">CALPIRG, a consumer advocacy group, had pushed a more stringent bill that would have required every school district to install filters and adopt a tougher lead limit for their drinking water — just one part per billion, instead of 15. But the bill died in committee. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jason Pfeifle, a \u003ca href=\"https://calpirg.org/\" target=\"_blank\" rel=\"noopener\">CALPIRG\u003c/a> health advocate, said children shouldn’t be drinking water that may have lead levels up to 15 parts per billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If a school finds a positive lead test, or finds that a drinking fountain has elevated levels of lead...then it’s already too late, and children have already been exposed,” Pfeifle said. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Screening children before they get to school\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Gov. Brown also signed into law a related bill to address lead levels in younger children, before they reach kindergarten. \u003c/span>\u003cspan style=\"font-weight: 400\">This new \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1316\">\u003cspan style=\"font-weight: 400\">law\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> requires the Department of Public Health to develop a more comprehensive set of screening questions for doctors to use when determining which children should undergo lead-exposure testing. Previously, California only required testing of one- and two-year-olds enrolled in Medi-Cal or other programs for low-income families. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The new risk-assessment questions, due in 2019, might \u003c/span>\u003cspan style=\"font-weight: 400\">include asking whether the family lives near a major highway, or near the site of a former lead or steel smelter, or whether a child might be exposed because he or she spends time in another home or building. The law also requires the state health department to report the test results more promptly, post the data online, and indicate neighborhoods with significant lead-exposure problems. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Some kids in California have more lead than kids in Flint, MI\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">How widespread is the problem? The Centers for Disease Control and Prevention found that five percent of tested children in Flint had elevated lead levels in their blood. By comparison, two percent of tested children in California, mostly those on Medi-Cal, have elevated levels.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But there are local hot spots in California where the data is alarming. In Alameda County, eight zip codes showed rates higher than or equal to Flint’s. Zip codes within Los Angeles, Monterey and Humboldt counties also showed higher rates of childhood lead exposure. In one \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/CDPH%20Document%20Library/zip_code_2012_250_tested.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Fresno \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">zip code, nearly 14 percent of the children tested had elevated levels of lead.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">State health officials caution that the numbers are not an accurate representation of all children, because only those whom health providers believe may be at risk are actually tested.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the data is a few years old. Department officials say those figures come from 2012, and that the \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/CDPH%20Document%20Library/BLL%20Counts%202012%20by%20LHD%20final.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">data\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> set is the most recent they have on hand — despite the fact that labs across the state send in 700,000 test results for blood lead levels every year. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The problem we have right now is we don’t know all the different sources of lead in the environment,” said Assemblyman Bill Quirk (D-Hayward), who sponsored the bill. “I hope it will lead to children who are at higher risk being tested, because pediatricians will ask more questions, and parents will ask more questions.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Doctors and insurers didn’t want to have to test every single child \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Quirk’s initially wanted the new law to require that all young children in children get tested for lead by their health provider. But the insurance industry, the California Medical Association and the American Academy of Pediatricians lobbied successfully to remove that requirement from the bill. The medical association objected because universal testing would override a doctor's discretion, and require costly tests even when a doctor determines there is no risk, according to CMA spokeswoman Joanne Adams.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Currently about 80 percent of children on Medi-Cal are tested, Quirk acknowledged. But he points out that while low-income children are most vulnerable to lead exposure (because they often live in old or dilapidated houses), \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">any\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> child can be exposed to lead in a variety of ways—from school water fountains to soil in playgrounds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think that every parent should think about having their child tested, period,” Quirk said. “Just ask your pediatrician to order, then you’ll know if there’s a problem. I have a grandchild that just arrived and I’m going to ask my daughter t\u003c/span>\u003cspan style=\"font-weight: 400\">o have her child tested.”\u003c/span>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Janitors in LA spent years 'flushing' fountains. San Diego got ugly news after a teacher's dog refused to drink. And legislators wanted action after Flint. ",
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"description": "Janitors in LA spent years 'flushing' fountains. San Diego got ugly news after a teacher's dog refused to drink. And legislators wanted action after Flint. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">When a therapy dog refused to drink the water at a San Diego grade school, it was the first clue that something was wrong.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tests soon revealed why the pup turned up its nose back in early 2017 — the presence of vinyl chloride, which is used to make PVC plumbing pipes and may be released as the plastic degrades. It’s also a known carcinogen. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But further analysis of the water at the San Diego Cooperative Charter School found something else that had gone undetected by the dog, the teachers, and district officials: elevated levels of lead. The district conducted more tests last spring, and found harmful lead levels at other San Diego schools as well. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s not an isolated problem. In Los Angeles, the district has been working for years to identify contaminated fountains and lower the lead levels. And after the much-publicized toxic lead contamination of water in Flint, Mich., a 2016 \u003c/span>\u003ca href=\"http://www.reuters.com/investigates/special-report/usa-lead-testing/\">\u003cspan style=\"font-weight: 400\">Reuters\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> report revealed that children in dozens of California neighborhoods had elevated lead levels in their blood. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Lead is a neurotoxin that causes developmental disorders and brain damage. No amount of lead in humans is considered safe.\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\">Now, under a new law signed by Gov. Jerry Brown in October, public schools are required to get their drinking water sampled for lead, and notify parents if they find traces of the toxic metal. Districts now have until July 2019 to test all campuses, including charter schools. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The \u003c/span>\u003cspan style=\"font-weight: 400\">school-testing law requires districts to test for lead at least once a year, or once every three years, depending on when the buildings were constructed. If tests find that lead is higher than the state and federal threshold of 15 parts per billion, the school district must notify parents and shut down the contaminated water source until it can be fixed.\u003c/span>\u003c/p>\n\u003cp>\u003cb>“A more aggressive standard” \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Previously, California law gave school districts the option to obtain free testing from their local water supplier, but less than 10 percent of schools had taken advantage of the voluntary program. That’s what spurred \u003c/span>\u003cspan style=\"font-weight: 400\">Assemblywoman Lorena Gonzalez (D-San Diego) to sponsor the new testing bill. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“You can’t have water with anything testing above the limits that are drinkable and not follow through and fix for the solution,” she said. “We want to ensure that when you find lead, water is shut off and parents are notified so they can have their kids tested.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Diego Unified has rolled out the strongest policy in the state. Its board decided in late July to set its own threshold at 5 parts per billion, well below the state and federal standard of 15.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We said the state action level was too high, and so we thought we should have a more aggressive standard,” said district spokesman Andrew Sharp. “We wanted to be able to say ‘Look, when kids go back to school in the fall, if there was a positive test for lead on your campus you should know we will have fixed that fountain or kids won’t be drinking from that fountain.’”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Water sampling at San Diego public schools has \u003c/span>\u003ca href=\"http://sandiegounified.org/watersampling\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">revealed\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> three campuses with at least one water source above 15 parts per billion, and another 33 sites with water that showed levels between 5 and 15 parts per billion.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The district is working to fix or close the problematic fountains, Sharp said, and intends to test every drinking water source at its schools in the next three to five years. In the meantime, it’s begun a daily “flushing” of fountains at all schools — staff members open the spigot for one minute, to flush through any stagnant water in older pipes and fixtures, which can leach lead into the water overnight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Flushing water fountains has been going on for decades in the Los Angeles Unified School District.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It became evident that a particular kind of drinking fountain had lead content,” said Robert Laughton, district director for environmental health and safety. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was that old style you used to see, that was the square-mounted stainless-steel thing, that was chilled,” Laughton explained. “Well, those old drinking fountains had lead-lined water basins in them, and so in 1988 we removed all of them and began random sampling and began flushing all fountains district-wide.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Back then, the district lacked the money to replace or fix contaminated fountains, so at any school where even one water sample exceeded the lead limit of 15 parts per billion, janitors had to \u003c/span>\u003ca href=\"https://achieve.lausd.net/Page/3450\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">flush\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> every drinking source for 30 seconds each morning, said Mark Hovatter, chief facilities executive for the district. Once flushed, the fountains usually tested below the 15 ppb threshold. Those that did not were shut down.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hovatter said the district chose to “err on the side of safety” for the children, despite taking “a lot of heat during the drought for our flushing.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s because the flushing program sent 2.5 million gallons of water down the drain every year. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Moving forward from preventive flushing to a permanent fix\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2009, the district began systematically testing every single drinking fountain for lead. And in \u003c/span>\u003cspan style=\"font-weight: 400\">2015 it finally appropriated nearly $20 million to end the flushing, by repairing or closing drinking fountains that tested high for lead. Laughton said all the district’s fountains will be fixed by this fall, and two-thirds of its schools have already been cleared to stop flushing.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362369\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362369\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-800x563.jpg\" alt=\"\" width=\"800\" height=\"563\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-800x563.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-160x113.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-768x540.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-1020x718.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-1180x830.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-960x675.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-240x169.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-375x264.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/20170802_CalMatters_Lea_Kids-520x366.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Students at the 9th Street School in Los Angeles take turns drinking water after recess. It was pajama day at school. \u003ccite>(Elizabeth Aguilera/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Of the district’s 41,000 fountains, only four percent had lead levels exceeding the 15 ppb limit, according to Mark Cho, an operations deputy. Since the project began, his teams have removed or shut off 800 of those fountains, and fixed or replaced 672.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At the 9th Street School near downtown, children line up after recess to drink water. To move them along, a playground monitor gives each child five seconds to drink.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It tastes really good,” said Monica Marquez, 6, of the water.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It tastes like watermelon,” said Vivian Villegas, 7. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At this school, flushing has already ended for all 43 fountains. Testing showed that none of them had to be fixed or shut down.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now, officials in other school districts are calling Laughton and Hovatter, seeking advice on how to comply with the new law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This isn’t a situation where you can stick your head in the sand and say ‘If I don’t think I’m going to like the answer I’m not going to ask the question,” Laughton said. “We are responsible to know.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Yet some public health advocates still consider the new law insufficient.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">CALPIRG, a consumer advocacy group, had pushed a more stringent bill that would have required every school district to install filters and adopt a tougher lead limit for their drinking water — just one part per billion, instead of 15. But the bill died in committee. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jason Pfeifle, a \u003ca href=\"https://calpirg.org/\" target=\"_blank\" rel=\"noopener\">CALPIRG\u003c/a> health advocate, said children shouldn’t be drinking water that may have lead levels up to 15 parts per billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If a school finds a positive lead test, or finds that a drinking fountain has elevated levels of lead...then it’s already too late, and children have already been exposed,” Pfeifle said. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Screening children before they get to school\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Gov. Brown also signed into law a related bill to address lead levels in younger children, before they reach kindergarten. \u003c/span>\u003cspan style=\"font-weight: 400\">This new \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1316\">\u003cspan style=\"font-weight: 400\">law\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> requires the Department of Public Health to develop a more comprehensive set of screening questions for doctors to use when determining which children should undergo lead-exposure testing. Previously, California only required testing of one- and two-year-olds enrolled in Medi-Cal or other programs for low-income families. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The new risk-assessment questions, due in 2019, might \u003c/span>\u003cspan style=\"font-weight: 400\">include asking whether the family lives near a major highway, or near the site of a former lead or steel smelter, or whether a child might be exposed because he or she spends time in another home or building. The law also requires the state health department to report the test results more promptly, post the data online, and indicate neighborhoods with significant lead-exposure problems. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Some kids in California have more lead than kids in Flint, MI\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">How widespread is the problem? The Centers for Disease Control and Prevention found that five percent of tested children in Flint had elevated lead levels in their blood. By comparison, two percent of tested children in California, mostly those on Medi-Cal, have elevated levels.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But there are local hot spots in California where the data is alarming. In Alameda County, eight zip codes showed rates higher than or equal to Flint’s. Zip codes within Los Angeles, Monterey and Humboldt counties also showed higher rates of childhood lead exposure. In one \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/CDPH%20Document%20Library/zip_code_2012_250_tested.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Fresno \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">zip code, nearly 14 percent of the children tested had elevated levels of lead.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">State health officials caution that the numbers are not an accurate representation of all children, because only those whom health providers believe may be at risk are actually tested.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the data is a few years old. Department officials say those figures come from 2012, and that the \u003c/span>\u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/CDPH%20Document%20Library/BLL%20Counts%202012%20by%20LHD%20final.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">data\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> set is the most recent they have on hand — despite the fact that labs across the state send in 700,000 test results for blood lead levels every year. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The problem we have right now is we don’t know all the different sources of lead in the environment,” said Assemblyman Bill Quirk (D-Hayward), who sponsored the bill. “I hope it will lead to children who are at higher risk being tested, because pediatricians will ask more questions, and parents will ask more questions.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Doctors and insurers didn’t want to have to test every single child \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Quirk’s initially wanted the new law to require that all young children in children get tested for lead by their health provider. But the insurance industry, the California Medical Association and the American Academy of Pediatricians lobbied successfully to remove that requirement from the bill. The medical association objected because universal testing would override a doctor's discretion, and require costly tests even when a doctor determines there is no risk, according to CMA spokeswoman Joanne Adams.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Currently about 80 percent of children on Medi-Cal are tested, Quirk acknowledged. But he points out that while low-income children are most vulnerable to lead exposure (because they often live in old or dilapidated houses), \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">any\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> child can be exposed to lead in a variety of ways—from school water fountains to soil in playgrounds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think that every parent should think about having their child tested, period,” Quirk said. “Just ask your pediatrician to order, then you’ll know if there’s a problem. I have a grandchild that just arrived and I’m going to ask my daughter t\u003c/span>\u003cspan style=\"font-weight: 400\">o have her child tested.”\u003c/span>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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},
"rightnowish": {
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"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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