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"content": "\u003cp>Jose Escobedo got his first taste of methamphetamine when he was 11-years-old.\u003c/p>\n\u003cp>“I was offered a smoke,\" he says. \"I was just trying to fit in with these guys, and I take the first hit of smoke off some aluminum, and once I did that, it ... took me to another world.”\u003c/p>\n\u003cp>For Escobedo, that one hit was all it took.\u003c/p>\n\u003cp>“It boosted me up, and I felt ... like I was stronger, faster,\" Escobedo says. \"Then I started hallucinating, seeing things.”\u003c/p>\n\u003cp>Escobedo moved in with a dealer. In exchange for running drugs, Escobedo had a non-stop supply of meth at his fingertips.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I would just stay drugged out, I mean for weeks, weeks. And I would sleep for a week straight. ... I was smoking drugs. Smoking, smoking, smoking.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/273347823\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Eventually, Escobedo began committing crimes to support his habit. He was sent to prison four times.\u003c/p>\n\u003cp>When Escobedo first started using more than 20 years ago, most of the meth in San Diego County came from makeshift labs. Many of them were in East County.\u003c/p>\n\u003cp>These days, it’s different.\u003c/p>\n\u003cp>The methamphetamine on San Diego's streets today is largely produced in \u003ca href=\"http://news.sky.com/story/1515628/inside-mexicos-infamous-meth-super-labs\" target=\"_blank\">Mexican super labs\u003c/a> controlled by drug cartels.\u003c/p>\n\u003cfigure id=\"attachment_211827\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-211827\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png\" alt=\"The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \" width=\"770\" height=\"442\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png 770w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-400x230.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-768x441.png 768w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \u003ccite>( Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A lot of it is smuggled through the San Ysidro border crossing -- the busiest in the western hemisphere -- where an estimated 50,000 vehicles and 25,000 pedestrians cross every day from Mexico into the U.S.\u003c/p>\n\u003cp>Sidney Aki, director of \u003ca href=\"https://www.cbp.gov/\" target=\"_blank\">U.S. Customs and Border Protection\u003c/a> at the San Ysidro Port of Entry, said his agents have found meth hidden in virtually every part of a vehicle, from the trunk to the battery. They’ve even discovered liquid meth in gas tanks.\u003c/p>\n\u003cp>And pedestrians?\u003c/p>\n\u003cp>One woman, Aki recalls, \"had a brassiere formed out of narcotics, and actually used as a brassiere, walking across our border.”\u003c/p>\n\u003cp>\u003cstrong>Meth Seizures Up at the Border\u003c/strong>\u003c/p>\n\u003cp>In 2010, customs agents seized roughly 2,500 kilos of meth at the San Ysidro border crossing.\u003c/p>\n\u003cp>In 2014, they confiscated more than double that amount -- 5,800 kilos.\u003c/p>\n\u003cp>One hit of meth is about a quarter of a gram — 5,800 kilos equals 5.8 million hits.\u003c/p>\n\u003cp>That’s how much was confiscated. Nobody knows how much is actually getting in.\u003c/p>\n\u003cp>What's worse is the methamphetamine that’s coming across from Mexico is stronger than ever, and the price on the street is lower than ever. That leads to more meth use and more meth-related problems.\u003c/p>\n\u003cp>\u003cstrong>Meth Users Filling Jail Cells\u003c/strong>\u003c/p>\n\u003cp>Meth users also are taking up a lot of space in the county's jails.\u003c/p>\n\u003cp>According to the \u003ca href=\"http://www.sandag.org/uploads/publicationid/publicationid_1977_19736.pdf\" target=\"_blank\">San Diego Association of Governments\u003c/a> (SANDAG), of the people arrested and jailed in the county in 2014, 53 percent of the women and 40 percent of the men tested positive for meth.\u003c/p>\n\u003cp>“We find that on average, arrestees report that they’ve been using meth for about 16 years,\" Burke said. \"We know that they use it for an average of five days at a time, that they’re using a gram. Many of them smoke it. About one in four report that they’ve injected it.”\u003c/p>\n\u003cfigure id=\"attachment_211828\" class=\"wp-caption aligncenter\" style=\"max-width: 615px\">\u003cimg class=\"size-full wp-image-211828\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png\" alt=\"*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG \" width=\"615\" height=\"170\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png 615w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM-400x111.png 400w\" sizes=\"(max-width: 615px) 100vw, 615px\">\u003cfigcaption class=\"wp-caption-text\">*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG\u003c/figcaption>\u003c/figure>\n\u003cp>Besides U.S. Customs and Border Protection, other law enforcement agencies involved in the fight against meth include the San Diego County Sheriff’s Department, the county District Attorney's Office and the U.S. Justice Department.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.justice.gov/usao-sdca/meet-us-attorney\" target=\"_blank\">Laura Duffy\u003c/a>, San Diego's U.S. attorney, said others also need to step up.\u003c/p>\n\u003cp>“We are not going to be able to tackle this problem through law enforcement efforts alone,\" Duffy said. \"This is a community problem. This is a health epidemic problem that we all need to come together and put resources towards.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court\u003c/strong>\u003c/p>\n\u003cp>Escobedo, the recovering meth addict, has one thing to show for his more than 20 years of using the drug: a rap sheet, which includes charges of assault with a deadly weapon, DUI, hit and run, burglary.\u003c/p>\n\u003cp>His latest arrest came in January 2014 when he was on parole.\u003c/p>\n\u003cp>The prosecutor on his case gave him a choice: go back to prison for 12 years or try to kick his habit through the county's Drug Court.\u003c/p>\n\u003cp>So Escobedo gave \u003ca href=\"http://www.sdcourt.ca.gov/portal/page?_pageid=55,1643578&_dad=portal\" target=\"_blank\">Drug Court\u003c/a> a shot.\u003c/p>\n\u003cp>[contextly_sidebar id=\"1USwXcMD0UiVMCJfrlMJbWL2ck2P4SP4\"]In March, Escobedo attended the court's 12-step meeting with other hard-core meth addicts. All of the men had criminal records. As part of the recovery process, they’re encouraged to be brutally honest about their addiction.\u003c/p>\n\u003cp>“My addiction is to heroin and methamphetamine,\" one man with heavily tattooed arms said.\u003c/p>\n\u003cp>“My focus was getting high, my focus was being around people who are getting high,\" another addict said.\u003c/p>\n\u003cp>After the men shared their stories, Arturo Molina, the lead substance abuse counselor in the Chula Vista Drug Court, weighed in.\u003c/p>\n\u003cp>“In Drug Court you want to learn how to live life without using drugs,\" he told the men. \"But not only that, OK? Drug Court is like a new way of life.”\u003c/p>\n\u003cp>Daniel Stone, the program manager at the Chula Vista court, said it's a different approach to getting people off of drugs.\u003c/p>\n\u003cp>“The concept of the Drug Court programs is a collaborative, team approach that involves a San Diego Superior Court judge, district attorney, public defender, and case management and treatment team, and law enforcement,\" Stone said.\u003c/p>\n\u003cfigure id=\"attachment_211830\" class=\"wp-caption aligncenter\" style=\"max-width: 798px\">\u003ca href=\"Members%20of%20the%20Drug%20Court%20program%20participate%20in%20a%2012-step%20meeting\">\u003cimg class=\"size-full wp-image-211830\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png\" alt=\"Members of the Drug Court program participate in a 12-step meeting.\" width=\"798\" height=\"437\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png 798w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-400x219.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-768x421.png 768w\" sizes=\"(max-width: 798px) 100vw, 798px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Members of the Drug Court program participate in a 12-step meeting. \u003ccite>(Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>People convicted of non-violent drug offenses are eligible for Drug Court. There are four of the courts in San Diego County, and more than 1,600 nationwide.\u003c/p>\n\u003cp>Addicts go through 18 months of hard work and constant supervision.\u003c/p>\n\u003cp>They’re required to go to 12-step meetings five days a week, get individual counseling and get a job. They’re frequently drug tested.\u003c/p>\n\u003cp>And if they test positive? They go to jail.\u003c/p>\n\u003cp>The length of their jail stay “depends on how many times it’s happened,\" Stone said. \"Sometimes it’s a weekend. Sometimes it’s three weeks.”\u003c/p>\n\u003cp>If they screw up enough times, addicts have to serve their original sentence.\u003c/p>\n\u003cp>County officials say 90 percent of Drug Court graduates remain arrest-free two years after completing the program.\u003c/p>\n\u003cp>Escobedo said Drug Court has given him the tools and support to clean up his act. He said there were \"a lot of things I needed to do.\"\u003c/p>\n\u003cp>\"You can’t be in denial,\" Escobedo says. \"You can’t fight the program. You can’t cheat the program, because you’re not actually cheating the program. You’re cheating yourself.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court Graduation\u003c/strong>\u003c/p>\n\u003cp>The Chula Vista Library auditorium is packed for graduation night for nine Drug Court participants. The court's judge welcomes each graduate to the stage.\u003c/p>\n\u003cp>The crowd of family members cheered loudly.\u003c/p>\n\u003cfigure id=\"attachment_211831\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-211831\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png\" alt=\"Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \" width=\"400\" height=\"223\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM.png 693w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \u003ccite>(Matthew Bowler)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some of the graduates cried, incredulous that they actually made it through the program.\u003c/p>\n\u003cp>Then Escobedo took the stage and talked about success. For the first time since he was a boy he’s gone 18 months completely clean and sober.\u003c/p>\n\u003cp>“I have my family here as a witness. I hurt them a lot,\" Escobedo said. \"I plan on staying clean and doing what I gotta do to stay clean, and just keep making them happy. They’re all here: my wife, my kids, ma, my sister Erica, Israel.\"\u003c/p>\n\u003cp>In his closing remarks, Escobedo talked about a new way of life.\u003c/p>\n\u003cp>“I’m happy with everybody who’s in the program. I was able to interact with a lot of people, you know what I mean, and make clean friends,\" he said. \"And it’s something different than going back to the old people, neighborhood, old ways, old ways of thinking. It’s a new way of life, and I plan on staying, and I will be staying clean. And I thank you guys all.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Amid thundering applause, Escobedo walked off the the stage with a big smile on his face.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I would just stay drugged out, I mean for weeks, weeks. And I would sleep for a week straight. ... I was smoking drugs. Smoking, smoking, smoking.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/273347823&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/273347823'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Eventually, Escobedo began committing crimes to support his habit. He was sent to prison four times.\u003c/p>\n\u003cp>When Escobedo first started using more than 20 years ago, most of the meth in San Diego County came from makeshift labs. Many of them were in East County.\u003c/p>\n\u003cp>These days, it’s different.\u003c/p>\n\u003cp>The methamphetamine on San Diego's streets today is largely produced in \u003ca href=\"http://news.sky.com/story/1515628/inside-mexicos-infamous-meth-super-labs\" target=\"_blank\">Mexican super labs\u003c/a> controlled by drug cartels.\u003c/p>\n\u003cfigure id=\"attachment_211827\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-211827\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png\" alt=\"The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \" width=\"770\" height=\"442\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM.png 770w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-400x230.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.29.12-AM-768x441.png 768w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">The San Ysidro Port of Entry is the busiest land border crossing in the western hemisphere, with 50,000 vehicles and 25,000 pedestrians crossing from Mexico into the U.S. every day. \u003ccite>( Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A lot of it is smuggled through the San Ysidro border crossing -- the busiest in the western hemisphere -- where an estimated 50,000 vehicles and 25,000 pedestrians cross every day from Mexico into the U.S.\u003c/p>\n\u003cp>Sidney Aki, director of \u003ca href=\"https://www.cbp.gov/\" target=\"_blank\">U.S. Customs and Border Protection\u003c/a> at the San Ysidro Port of Entry, said his agents have found meth hidden in virtually every part of a vehicle, from the trunk to the battery. They’ve even discovered liquid meth in gas tanks.\u003c/p>\n\u003cp>And pedestrians?\u003c/p>\n\u003cp>One woman, Aki recalls, \"had a brassiere formed out of narcotics, and actually used as a brassiere, walking across our border.”\u003c/p>\n\u003cp>\u003cstrong>Meth Seizures Up at the Border\u003c/strong>\u003c/p>\n\u003cp>In 2010, customs agents seized roughly 2,500 kilos of meth at the San Ysidro border crossing.\u003c/p>\n\u003cp>In 2014, they confiscated more than double that amount -- 5,800 kilos.\u003c/p>\n\u003cp>One hit of meth is about a quarter of a gram — 5,800 kilos equals 5.8 million hits.\u003c/p>\n\u003cp>That’s how much was confiscated. Nobody knows how much is actually getting in.\u003c/p>\n\u003cp>What's worse is the methamphetamine that’s coming across from Mexico is stronger than ever, and the price on the street is lower than ever. That leads to more meth use and more meth-related problems.\u003c/p>\n\u003cp>\u003cstrong>Meth Users Filling Jail Cells\u003c/strong>\u003c/p>\n\u003cp>Meth users also are taking up a lot of space in the county's jails.\u003c/p>\n\u003cp>According to the \u003ca href=\"http://www.sandag.org/uploads/publicationid/publicationid_1977_19736.pdf\" target=\"_blank\">San Diego Association of Governments\u003c/a> (SANDAG), of the people arrested and jailed in the county in 2014, 53 percent of the women and 40 percent of the men tested positive for meth.\u003c/p>\n\u003cp>“We find that on average, arrestees report that they’ve been using meth for about 16 years,\" Burke said. \"We know that they use it for an average of five days at a time, that they’re using a gram. Many of them smoke it. About one in four report that they’ve injected it.”\u003c/p>\n\u003cfigure id=\"attachment_211828\" class=\"wp-caption aligncenter\" style=\"max-width: 615px\">\u003cimg class=\"size-full wp-image-211828\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png\" alt=\"*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG \" width=\"615\" height=\"170\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM.png 615w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.42.03-AM-400x111.png 400w\" sizes=\"(max-width: 615px) 100vw, 615px\">\u003cfigcaption class=\"wp-caption-text\">*A positive opiate drug test could indicate use of opiates other than heroin, including morphine, hydrocodone, hydromorphone and Codeine. Source: 2014 Adult Arrestee Drug Use in the San Diego Region from SANDAG\u003c/figcaption>\u003c/figure>\n\u003cp>Besides U.S. Customs and Border Protection, other law enforcement agencies involved in the fight against meth include the San Diego County Sheriff’s Department, the county District Attorney's Office and the U.S. Justice Department.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.justice.gov/usao-sdca/meet-us-attorney\" target=\"_blank\">Laura Duffy\u003c/a>, San Diego's U.S. attorney, said others also need to step up.\u003c/p>\n\u003cp>“We are not going to be able to tackle this problem through law enforcement efforts alone,\" Duffy said. \"This is a community problem. This is a health epidemic problem that we all need to come together and put resources towards.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court\u003c/strong>\u003c/p>\n\u003cp>Escobedo, the recovering meth addict, has one thing to show for his more than 20 years of using the drug: a rap sheet, which includes charges of assault with a deadly weapon, DUI, hit and run, burglary.\u003c/p>\n\u003cp>His latest arrest came in January 2014 when he was on parole.\u003c/p>\n\u003cp>The prosecutor on his case gave him a choice: go back to prison for 12 years or try to kick his habit through the county's Drug Court.\u003c/p>\n\u003cp>So Escobedo gave \u003ca href=\"http://www.sdcourt.ca.gov/portal/page?_pageid=55,1643578&_dad=portal\" target=\"_blank\">Drug Court\u003c/a> a shot.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In March, Escobedo attended the court's 12-step meeting with other hard-core meth addicts. All of the men had criminal records. As part of the recovery process, they’re encouraged to be brutally honest about their addiction.\u003c/p>\n\u003cp>“My addiction is to heroin and methamphetamine,\" one man with heavily tattooed arms said.\u003c/p>\n\u003cp>“My focus was getting high, my focus was being around people who are getting high,\" another addict said.\u003c/p>\n\u003cp>After the men shared their stories, Arturo Molina, the lead substance abuse counselor in the Chula Vista Drug Court, weighed in.\u003c/p>\n\u003cp>“In Drug Court you want to learn how to live life without using drugs,\" he told the men. \"But not only that, OK? Drug Court is like a new way of life.”\u003c/p>\n\u003cp>Daniel Stone, the program manager at the Chula Vista court, said it's a different approach to getting people off of drugs.\u003c/p>\n\u003cp>“The concept of the Drug Court programs is a collaborative, team approach that involves a San Diego Superior Court judge, district attorney, public defender, and case management and treatment team, and law enforcement,\" Stone said.\u003c/p>\n\u003cfigure id=\"attachment_211830\" class=\"wp-caption aligncenter\" style=\"max-width: 798px\">\u003ca href=\"Members%20of%20the%20Drug%20Court%20program%20participate%20in%20a%2012-step%20meeting\">\u003cimg class=\"size-full wp-image-211830\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png\" alt=\"Members of the Drug Court program participate in a 12-step meeting.\" width=\"798\" height=\"437\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM.png 798w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-400x219.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.52.25-AM-768x421.png 768w\" sizes=\"(max-width: 798px) 100vw, 798px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Members of the Drug Court program participate in a 12-step meeting. \u003ccite>(Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>People convicted of non-violent drug offenses are eligible for Drug Court. There are four of the courts in San Diego County, and more than 1,600 nationwide.\u003c/p>\n\u003cp>Addicts go through 18 months of hard work and constant supervision.\u003c/p>\n\u003cp>They’re required to go to 12-step meetings five days a week, get individual counseling and get a job. They’re frequently drug tested.\u003c/p>\n\u003cp>And if they test positive? They go to jail.\u003c/p>\n\u003cp>The length of their jail stay “depends on how many times it’s happened,\" Stone said. \"Sometimes it’s a weekend. Sometimes it’s three weeks.”\u003c/p>\n\u003cp>If they screw up enough times, addicts have to serve their original sentence.\u003c/p>\n\u003cp>County officials say 90 percent of Drug Court graduates remain arrest-free two years after completing the program.\u003c/p>\n\u003cp>Escobedo said Drug Court has given him the tools and support to clean up his act. He said there were \"a lot of things I needed to do.\"\u003c/p>\n\u003cp>\"You can’t be in denial,\" Escobedo says. \"You can’t fight the program. You can’t cheat the program, because you’re not actually cheating the program. You’re cheating yourself.”\u003c/p>\n\u003cp>\u003cstrong>Drug Court Graduation\u003c/strong>\u003c/p>\n\u003cp>The Chula Vista Library auditorium is packed for graduation night for nine Drug Court participants. The court's judge welcomes each graduate to the stage.\u003c/p>\n\u003cp>The crowd of family members cheered loudly.\u003c/p>\n\u003cfigure id=\"attachment_211831\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-211831\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png\" alt=\"Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \" width=\"400\" height=\"223\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM-400x223.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-12-at-10.51.51-AM.png 693w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Jose Escobedo speaks at the Drug Court graduation ceremony in Chula Vista. \u003ccite>(Matthew Bowler)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some of the graduates cried, incredulous that they actually made it through the program.\u003c/p>\n\u003cp>Then Escobedo took the stage and talked about success. For the first time since he was a boy he’s gone 18 months completely clean and sober.\u003c/p>\n\u003cp>“I have my family here as a witness. I hurt them a lot,\" Escobedo said. \"I plan on staying clean and doing what I gotta do to stay clean, and just keep making them happy. They’re all here: my wife, my kids, ma, my sister Erica, Israel.\"\u003c/p>\n\u003cp>In his closing remarks, Escobedo talked about a new way of life.\u003c/p>\n\u003cp>“I’m happy with everybody who’s in the program. I was able to interact with a lot of people, you know what I mean, and make clean friends,\" he said. \"And it’s something different than going back to the old people, neighborhood, old ways, old ways of thinking. It’s a new way of life, and I plan on staying, and I will be staying clean. And I thank you guys all.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Amid thundering applause, Escobedo walked off the the stage with a big smile on his face.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In San Diego, Methamphetamine Deaths at Highest Level in 20 Years",
"title": "In San Diego, Methamphetamine Deaths at Highest Level in 20 Years",
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"content": "\u003cp>Methamphetamine is dangerous.\u003c/p>\n\u003cp>If you want proof, just go to the San Diego County morgue.\u003c/p>\n\u003cp>In 2014, county records show \u003ca href=\"https://www.justice.gov/usao-sdca/file/796391/download\">262\u003c/a> deaths from meth-related causes. That’s more than the number of people who died from the flu and homicides combined that year.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/273144979\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003ca href=\"http://nationalrxdrugabusesummit.org/biographies/dr-jonathan-lucas/\" target=\"_blank\">Dr. Jonathan Lucas\u003c/a>, the county's chief deputy medical examiner, said his office sees meth-related deaths almost every day.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The last couple of years have actually been records for us,\" Lucas said. \"We’ve seen more methamphetamine-related deaths in the last couple of years than we’ve ever seen in the last 20 years.”\u003c/p>\n\u003cp>He said meth abuse isn't confined to young people. It's killing people of all ages.\u003c/p>\n\u003cp>“For example, in 2014, our youngest meth-related death was a 17-year-old girl that jumped out of a second-story window while intoxicated with methamphetamine,\" Lucas said. \"Our oldest was a 70-year-old man who had heart disease, but he was intoxicated with methamphetamine.”\u003c/p>\n\u003cp>Lucas said meth can make underlying health conditions worse. People with heart problems who use the drug, for example, are at even higher risk of dying from a heart attack or a stroke.\u003c/p>\n\u003cp>But he said the high number of meth-related deaths don’t tell the whole story.\u003c/p>\n\u003cp>“The people that come to this office are really just the tip of the iceberg, a small proportion, a small piece of the pie of the methamphetamine problem,\" Lucas said.\u003c/p>\n\u003cfigure id=\"attachment_211453\" class=\"wp-caption aligncenter\" style=\"max-width: 601px\">\u003cimg class=\"size-full wp-image-211453\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.45.33-AM.png\" alt=\"The overdose death numbers do not include drug-related suicides, homicides or other causes of death in which drugs were involved.\" width=\"601\" height=\"341\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.45.33-AM.png 601w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.45.33-AM-400x227.png 400w\" sizes=\"(max-width: 601px) 100vw, 601px\">\u003cfigcaption class=\"wp-caption-text\">The overdose death numbers do not include drug-related suicides, homicides or other causes of death in which drugs were involved. \u003ccite>(Brooke Ruth/KPBS The overdose death numbers do not include drug-related suicides, homicides or other causes of death in which drugs were involved.)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>ER Visits Up Dramatically\u003c/strong>\u003c/p>\n\u003cp>In 2011, patients with meth-related problems accounted for 3,700 ER visits. That number jumped to more than 10,000 in 2014.\u003c/p>\n\u003cp>Dr. Danielle Douglas works in the county’s busiest ER, at \u003ca href=\"http://www.sharp.com/hospitals/grossmont/\">Sharp Grossmont Hospital\u003c/a> in La Mesa. She said the number of meth cases that come through there wears on doctors.\u003c/p>\n\u003cfigure id=\"attachment_211450\" class=\"wp-caption aligncenter\" style=\"max-width: 686px\">\u003cimg class=\"size-full wp-image-211450\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.28.53-AM.png\" alt=\"Dr. Danielle Douglas is in emergency room physician at Sharp Grossmont Hospital in La Mesa.\" width=\"686\" height=\"382\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.28.53-AM.png 686w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.28.53-AM-400x223.png 400w\" sizes=\"(max-width: 686px) 100vw, 686px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Danielle Douglas is in emergency room physician at Sharp Grossmont Hospital in La Mesa. \u003ccite>(Kenny Goldberg/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I mean, yeah, at the end of a shift, and I’m just beat down, and it’s another meth addict?,\" Douglas said. \"And you just kind of want to say, 'What the hell’s going on here?'”\u003c/p>\n\u003cp>What’s going on is the meth that’s being sold on the street is extremely potent and highly addictive. \u003ca href=\"https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-are-long-term-effects-methamphetamine-abuse\">Long-term meth use\u003c/a> also alters the brain, and can cause severe mood swings, violent behavior and delusions.\u003c/p>\n\u003cp>And overdoses and deaths.\u003c/p>\n\u003cp>So what’s the attraction?\u003c/p>\n\u003cp>The high from methamphetamine is incredible, said \u003ca href=\"http://www.methinsideout.com/about/about-UCLA.html\">Tom Freese\u003c/a>, director of training for UCLA's Integrated Substance Abuse Programs.\u003c/p>\n\u003cp>[contextly_sidebar id=\"KqZjdvuYE92XxbkxReZyOI7ekbnln4l6\"]“When it goes inside the brain, it stimulates a release of \u003ca href=\"https://www.psychologytoday.com/basics/dopamine\">dopamine\u003c/a>, the feel-good chemical inside the brain, that’s really unparalleled,\" Freese said. \"There’s really no other way, from either natural or chemically induced kind of phenomenon to reach that peak of dopamine.”\u003c/p>\n\u003cp>Freese said methamphetamine also affects the \u003ca href=\"http://www.medicalnewstoday.com/articles/232248.php\">serotonin\u003c/a> system, another emotional regulator in the brain.\u003c/p>\n\u003cp>Meth also alters a person’s inhibitory control.\u003c/p>\n\u003cp>“That ability to say, 'I want to do that, but I’m not gonna do that,' and to put the brakes on a particular activity,\" Freese said. \"That seems to be damaged, as well, as part of that overall prefrontal cortex, or the front part of the brain, that helps us make good decisions from bad decisions.”\u003c/p>\n\u003cp>\u003cstrong>Chasing the first high\u003c/strong>\u003c/p>\n\u003cp>Jose Escobedo of National City started smoking meth when he was 11.\u003c/p>\n\u003cp>Later on, he snorted it. But Escobedo said the best high was when he injected it.\u003c/p>\n\u003cp>“Shooting up drugs was like bouncing up and down, like it gave me like 10 times more than with smoking,\" Escobedo said. \"So it was like a new experience, like a new thing that took over my life.”\u003c/p>\n\u003cfigure id=\"attachment_211451\" class=\"wp-caption aligncenter\" style=\"max-width: 691px\">\u003cimg class=\"size-full wp-image-211451\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM.png\" alt=\"Jose Escobedo is a recovering methamphetamine addict. \" width=\"691\" height=\"390\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM.png 691w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-400x226.png 400w\" sizes=\"(max-width: 691px) 100vw, 691px\">\u003cfigcaption class=\"wp-caption-text\">Jose Escobedo is a recovering methamphetamine addict. \u003ccite>(Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Escobedo was addicted to meth for more than 20 years. At his peak, Escobedo shot up six times a day.\u003c/p>\n\u003cp>\"It wasn’t just to get high. It was just a habit,\" he said. \"I just wanted to see it being drawn into the blood, I just wanted to see it going into my veins, I just wanted to feel it. I guess I was chasing my first high.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He's now a recovering meth addict.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Methamphetamine is dangerous.\u003c/p>\n\u003cp>If you want proof, just go to the San Diego County morgue.\u003c/p>\n\u003cp>In 2014, county records show \u003ca href=\"https://www.justice.gov/usao-sdca/file/796391/download\">262\u003c/a> deaths from meth-related causes. That’s more than the number of people who died from the flu and homicides combined that year.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/273144979&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/273144979'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://nationalrxdrugabusesummit.org/biographies/dr-jonathan-lucas/\" target=\"_blank\">Dr. Jonathan Lucas\u003c/a>, the county's chief deputy medical examiner, said his office sees meth-related deaths almost every day.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The last couple of years have actually been records for us,\" Lucas said. \"We’ve seen more methamphetamine-related deaths in the last couple of years than we’ve ever seen in the last 20 years.”\u003c/p>\n\u003cp>He said meth abuse isn't confined to young people. It's killing people of all ages.\u003c/p>\n\u003cp>“For example, in 2014, our youngest meth-related death was a 17-year-old girl that jumped out of a second-story window while intoxicated with methamphetamine,\" Lucas said. \"Our oldest was a 70-year-old man who had heart disease, but he was intoxicated with methamphetamine.”\u003c/p>\n\u003cp>Lucas said meth can make underlying health conditions worse. People with heart problems who use the drug, for example, are at even higher risk of dying from a heart attack or a stroke.\u003c/p>\n\u003cp>But he said the high number of meth-related deaths don’t tell the whole story.\u003c/p>\n\u003cp>“The people that come to this office are really just the tip of the iceberg, a small proportion, a small piece of the pie of the methamphetamine problem,\" Lucas said.\u003c/p>\n\u003cfigure id=\"attachment_211453\" class=\"wp-caption aligncenter\" style=\"max-width: 601px\">\u003cimg class=\"size-full wp-image-211453\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.45.33-AM.png\" alt=\"The overdose death numbers do not include drug-related suicides, homicides or other causes of death in which drugs were involved.\" width=\"601\" height=\"341\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.45.33-AM.png 601w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.45.33-AM-400x227.png 400w\" sizes=\"(max-width: 601px) 100vw, 601px\">\u003cfigcaption class=\"wp-caption-text\">The overdose death numbers do not include drug-related suicides, homicides or other causes of death in which drugs were involved. \u003ccite>(Brooke Ruth/KPBS The overdose death numbers do not include drug-related suicides, homicides or other causes of death in which drugs were involved.)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>ER Visits Up Dramatically\u003c/strong>\u003c/p>\n\u003cp>In 2011, patients with meth-related problems accounted for 3,700 ER visits. That number jumped to more than 10,000 in 2014.\u003c/p>\n\u003cp>Dr. Danielle Douglas works in the county’s busiest ER, at \u003ca href=\"http://www.sharp.com/hospitals/grossmont/\">Sharp Grossmont Hospital\u003c/a> in La Mesa. She said the number of meth cases that come through there wears on doctors.\u003c/p>\n\u003cfigure id=\"attachment_211450\" class=\"wp-caption aligncenter\" style=\"max-width: 686px\">\u003cimg class=\"size-full wp-image-211450\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.28.53-AM.png\" alt=\"Dr. Danielle Douglas is in emergency room physician at Sharp Grossmont Hospital in La Mesa.\" width=\"686\" height=\"382\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.28.53-AM.png 686w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.28.53-AM-400x223.png 400w\" sizes=\"(max-width: 686px) 100vw, 686px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Danielle Douglas is in emergency room physician at Sharp Grossmont Hospital in La Mesa. \u003ccite>(Kenny Goldberg/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I mean, yeah, at the end of a shift, and I’m just beat down, and it’s another meth addict?,\" Douglas said. \"And you just kind of want to say, 'What the hell’s going on here?'”\u003c/p>\n\u003cp>What’s going on is the meth that’s being sold on the street is extremely potent and highly addictive. \u003ca href=\"https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-are-long-term-effects-methamphetamine-abuse\">Long-term meth use\u003c/a> also alters the brain, and can cause severe mood swings, violent behavior and delusions.\u003c/p>\n\u003cp>And overdoses and deaths.\u003c/p>\n\u003cp>So what’s the attraction?\u003c/p>\n\u003cp>The high from methamphetamine is incredible, said \u003ca href=\"http://www.methinsideout.com/about/about-UCLA.html\">Tom Freese\u003c/a>, director of training for UCLA's Integrated Substance Abuse Programs.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“When it goes inside the brain, it stimulates a release of \u003ca href=\"https://www.psychologytoday.com/basics/dopamine\">dopamine\u003c/a>, the feel-good chemical inside the brain, that’s really unparalleled,\" Freese said. \"There’s really no other way, from either natural or chemically induced kind of phenomenon to reach that peak of dopamine.”\u003c/p>\n\u003cp>Freese said methamphetamine also affects the \u003ca href=\"http://www.medicalnewstoday.com/articles/232248.php\">serotonin\u003c/a> system, another emotional regulator in the brain.\u003c/p>\n\u003cp>Meth also alters a person’s inhibitory control.\u003c/p>\n\u003cp>“That ability to say, 'I want to do that, but I’m not gonna do that,' and to put the brakes on a particular activity,\" Freese said. \"That seems to be damaged, as well, as part of that overall prefrontal cortex, or the front part of the brain, that helps us make good decisions from bad decisions.”\u003c/p>\n\u003cp>\u003cstrong>Chasing the first high\u003c/strong>\u003c/p>\n\u003cp>Jose Escobedo of National City started smoking meth when he was 11.\u003c/p>\n\u003cp>Later on, he snorted it. But Escobedo said the best high was when he injected it.\u003c/p>\n\u003cp>“Shooting up drugs was like bouncing up and down, like it gave me like 10 times more than with smoking,\" Escobedo said. \"So it was like a new experience, like a new thing that took over my life.”\u003c/p>\n\u003cfigure id=\"attachment_211451\" class=\"wp-caption aligncenter\" style=\"max-width: 691px\">\u003cimg class=\"size-full wp-image-211451\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM.png\" alt=\"Jose Escobedo is a recovering methamphetamine addict. \" width=\"691\" height=\"390\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM.png 691w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-11-at-10.29.15-AM-400x226.png 400w\" sizes=\"(max-width: 691px) 100vw, 691px\">\u003cfigcaption class=\"wp-caption-text\">Jose Escobedo is a recovering methamphetamine addict. \u003ccite>(Nicholas McVicker/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Escobedo was addicted to meth for more than 20 years. At his peak, Escobedo shot up six times a day.\u003c/p>\n\u003cp>\"It wasn’t just to get high. It was just a habit,\" he said. \"I just wanted to see it being drawn into the blood, I just wanted to see it going into my veins, I just wanted to feel it. I guess I was chasing my first high.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He's now a recovering meth addict.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Utah Patient is First Zika-Related Death in Continental U.S.",
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"content": "\u003cp>A person infected with Zika has died in Utah, and while the exact cause is unclear, authorities said Friday it marks the first death related to the virus in the continental U.S.\u003c/p>\n\u003cp>The unidentified Salt Lake County resident contracted the virus while traveling abroad to an area with a Zika outbreak, health officials said.\u003c/p>\n\u003cp>The patient who died in late June was elderly and also suffered from another health condition, according to the Salt Lake County Health Department.\u003c/p>\n\u003cp>The person had Zika symptoms — including rash, fever and conjunctivitis — but it's unclear if or how the virus contributed to the death, said Centers for Disease Control and Prevention spokesman Benjamin Haynes.\u003c/p>\n\u003cp>[contextly_sidebar id=\"i3nT6MUWwBQllVWjA4SkbgGUQV8ucFvg\"]Officials discovered the case while reviewing death certificates, and lab tests confirmed their suspicions, said Gary Edwards, executive director of the Salt Lake County Health Department.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Utah authorities refused to release additional information about the patient or where he or she traveled, citing health privacy laws.\u003c/p>\n\u003cp>The virus causes only a mild illness in most people. But during recent outbreaks in Latin America, scientists discovered that infection during pregnancy has led to severe brain-related birth defects.\u003c/p>\n\u003cp>It's spread mainly through the bite of a tropical mosquito, the Aedes aegpyti.\u003c/p>\n\u003cp>No cases of locally transmitted mosquito-borne Zika have been reported in the continental United States, according to the CDC.\u003c/p>\n\u003cp>But a 70-year-old man from the San Juan metro area in the U.S. territory of Puerto Rico \u003ca href=\"http://www.nbcnews.com/storyline/zika-virus-outbreak/u-s-records-first-zika-virus-death-puerto-rico-n564886\" target=\"_blank\">died in late February\u003c/a>. Officials said he recovered from initial Zika symptoms, but then developed a condition in which antibodies that formed in reaction to the Zika infection started attacking blood platelet cells. He died after suffering internal bleeding.\u003c/p>\n\u003cp>As of Friday, the California Department of Public Health \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\">reported 77 people\u003c/a> with Zika statewide, including 18 pregnant women. All cases except one were acquired through travel to a Zika-affected area. There is one case of confirmed infection through sexual transmission.\u003c/p>\n\u003cp>The Aedes aegypti mosquito is present in only a fraction of California's 58 counties. You can check \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/06/30/map-where-zika-mosquitoes-are-likely-found-in-california/\" target=\"_blank\">this map\u003c/a> to see if your county has had an infestation of the mosquito recently.\u003c/p>\n\u003cp>Nationwide,\u003ca href=\"http://www.cdc.gov/zika/geo/united-states.html\" target=\"_blank\"> more than 1,100 Zika illnesses \u003c/a>have been reported in the 50 states and the District of Columbia, including six in Salt Lake County, according to health officials.\u003c/p>\n\u003cp>Almost all were people who had traveled to Zika outbreak countries and caught the virus there. But 14 were people who had not traveled to Zika zones but had sex with someone who had.\u003c/p>\n\u003cp>The CDC has also been tracking pregnant women infected with Zika, and says they have five reports of pregnancy losses because of miscarriage, stillbirth or abortion.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/zika/symptoms/index.html\" target=\"_blank\">Many people\u003c/a> who are infected with Zika will show no symptoms or mild symptoms, according to the CDC, and usually do not need to be hospitalized. Many people may not even realize they are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The main risk is to pregnant women. Zika infection can cause a serious birth defect called \u003ca href=\"http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html\" target=\"_blank\">microcephaly\u003c/a> and other severe fetal brain defects.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A person infected with Zika has died in Utah, and while the exact cause is unclear, authorities said Friday it marks the first death related to the virus in the continental U.S.\u003c/p>\n\u003cp>The unidentified Salt Lake County resident contracted the virus while traveling abroad to an area with a Zika outbreak, health officials said.\u003c/p>\n\u003cp>The patient who died in late June was elderly and also suffered from another health condition, according to the Salt Lake County Health Department.\u003c/p>\n\u003cp>The person had Zika symptoms — including rash, fever and conjunctivitis — but it's unclear if or how the virus contributed to the death, said Centers for Disease Control and Prevention spokesman Benjamin Haynes.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Officials discovered the case while reviewing death certificates, and lab tests confirmed their suspicions, said Gary Edwards, executive director of the Salt Lake County Health Department.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Utah authorities refused to release additional information about the patient or where he or she traveled, citing health privacy laws.\u003c/p>\n\u003cp>The virus causes only a mild illness in most people. But during recent outbreaks in Latin America, scientists discovered that infection during pregnancy has led to severe brain-related birth defects.\u003c/p>\n\u003cp>It's spread mainly through the bite of a tropical mosquito, the Aedes aegpyti.\u003c/p>\n\u003cp>No cases of locally transmitted mosquito-borne Zika have been reported in the continental United States, according to the CDC.\u003c/p>\n\u003cp>But a 70-year-old man from the San Juan metro area in the U.S. territory of Puerto Rico \u003ca href=\"http://www.nbcnews.com/storyline/zika-virus-outbreak/u-s-records-first-zika-virus-death-puerto-rico-n564886\" target=\"_blank\">died in late February\u003c/a>. Officials said he recovered from initial Zika symptoms, but then developed a condition in which antibodies that formed in reaction to the Zika infection started attacking blood platelet cells. He died after suffering internal bleeding.\u003c/p>\n\u003cp>As of Friday, the California Department of Public Health \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\">reported 77 people\u003c/a> with Zika statewide, including 18 pregnant women. All cases except one were acquired through travel to a Zika-affected area. There is one case of confirmed infection through sexual transmission.\u003c/p>\n\u003cp>The Aedes aegypti mosquito is present in only a fraction of California's 58 counties. You can check \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/06/30/map-where-zika-mosquitoes-are-likely-found-in-california/\" target=\"_blank\">this map\u003c/a> to see if your county has had an infestation of the mosquito recently.\u003c/p>\n\u003cp>Nationwide,\u003ca href=\"http://www.cdc.gov/zika/geo/united-states.html\" target=\"_blank\"> more than 1,100 Zika illnesses \u003c/a>have been reported in the 50 states and the District of Columbia, including six in Salt Lake County, according to health officials.\u003c/p>\n\u003cp>Almost all were people who had traveled to Zika outbreak countries and caught the virus there. But 14 were people who had not traveled to Zika zones but had sex with someone who had.\u003c/p>\n\u003cp>The CDC has also been tracking pregnant women infected with Zika, and says they have five reports of pregnancy losses because of miscarriage, stillbirth or abortion.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/zika/symptoms/index.html\" target=\"_blank\">Many people\u003c/a> who are infected with Zika will show no symptoms or mild symptoms, according to the CDC, and usually do not need to be hospitalized. Many people may not even realize they are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The main risk is to pregnant women. Zika infection can cause a serious birth defect called \u003ca href=\"http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html\" target=\"_blank\">microcephaly\u003c/a> and other severe fetal brain defects.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common",
"title": "'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common",
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"content": "\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n",
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"excerpt": "See which California hospitals have the highest and lowest rates of episiotomies. ",
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"headline": "'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Fresno, Cancer Screening Advocates Reach Out to Hmong Community",
"title": "In Fresno, Cancer Screening Advocates Reach Out to Hmong Community",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>At a community center in southeast Fresno, dozens of Hmong seniors gather for a health fair. They tentatively approach tables with pamphlets in Hmong and English on breast cancer screenings, how to safely dispose medicine, and other health topics.\u003c/p>\n\u003cp>Later in the day, they'll hear presentations by doctors and nurses about understanding a doctor’s visit and the rights of patients, such as the right to seek a second opinion. The event, organized by the Hmong Cancer Coalition, aims to get seniors and other members of this community more familiar with the health care system, so they can benefit from screenings and diagnostic tests such as mammograms and biopsies to detect cancer early.\u003c/p>\n\u003cp>Older members of the Hmong community, in particular, often resist undergoing screening tests that could save their lives because of cultural beliefs, say health professionals and advocates. \u003ca href=\"http://link.springer.com/article/10.1007/s10900-010-9228-7#/page-1\">Studies\u003c/a> show the Hmong community has a higher cancer mortality rate when compared to other Asian Americans, in part because the disease is diagnosed at a later stage, which greatly reduces chances of survival.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/272617845\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Part of the issue -- low utilization of cancer screenings -- is rooted in a distrust of invasive medical procedures, says Kay Vu Lee, chair of the Hmong Cancer Coalition and one of the event's organizers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The issue hits home for Lee. Her own father, who is 71, refuses to undergo a biopsy that his doctor recommends to confirm a suspected case of prostate cancer.\u003c/p>\n\u003cp>\"He doesn’t want to do a biopsy because he’s afraid that when they intervene and go into his body, they might accidentally scrape something or break something,\" says Lee.\u003c/p>\n\u003cp>[contextly_sidebar id=\"78z35ZuIRvCGaDtvuQ35zoe4ktMLw4ss\"]Those beliefs are shared by a lot of the seniors in this community, says Lee. Many came to the U.S. as refugees from the remote mountains of Laos in the 1970s and 1980s. They prefer herbal remedies and the advice of a spiritual healer or shaman over seeing a doctor at a clinic or hospital.\u003c/p>\n\u003cp>\"Even though most have been in America for an average of 30, 40 years, going to the doctor is still very new,\" says Lee. \"They don’t believe in it like they do the shaman.\"\u003c/p>\n\u003cp>This preference for traditional healing practices poses big challenges for the early diagnosis and treatment of cancer, says Dr. Amardeep Aulakh, an oncologist in Fresno, home to the second largest Hmong community in the country with 32,000 people.\u003c/p>\n\u003cp>\"It's a barrier towards the best care I can provide,\" says Aulakh. He is currently struggling to convince a Hmong patient with a growing lump in her breast to have a biopsy. \"My hands become tied when (patients) say they don’t want to undergo a procedure to confirm it's cancer.\"\u003c/p>\n\u003cfigure id=\"attachment_209466\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-209466 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/RS20050_IMG_9748-qut.jpg\" alt=\"Dr Amardeep Aulakh, an oncologist, speaks with Va Yang as Ko Yang, a lab manager at a private oncology practice listens. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr Amardeep Aulakh, an oncologist, speaks with Va Yang at the health fair as Ko Yang, a lab manager at a private oncology practice, listens. \u003ccite>(Farida Jhabvala Romero/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Aulakh says he attends events like this to talk about the potentially life-saving options that are available to detect and treat cancer.\u003c/p>\n\u003cp>\"Cancer if caught early and treated appropriately is curable,\" he says.\u003c/p>\n\u003cp>It's a message Nao Vang Yang, 80, is now passing on to others in the Hmong community. Eight years ago, the retired truck driver woke up one morning not feeling well. He has nine children, and some of them are physicians who convinced him to get checked. He was diagnosed with an aggressive type of lymphoma.\u003c/p>\n\u003cp>\"The doctor told me I didn’t have a lot of time to live if I didn’t pursue treatment,\" says Yang in Hmong, as the Cancer Coalition's Kay Vu Lee translates.\u003c/p>\n\u003cp>Yang went through months of chemotherapy. He saw the tip of his fingers turn black and his chest get covered in a red rash after each IV treatment. But the ordeal was worth it, he says. He's been cancer free ever since.\u003c/p>\n\u003cfigure id=\"attachment_209465\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-209465 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/RS20056_IMG_9788-qut.jpg\" alt=\"Nao Vang Yang, 80, is a cancer survivor who shared his story at the health fair. He hopes other members of the Hmong community will take advantage of cancer screenings.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Nao Vang Yang, 80, is a cancer survivor who shared his story at the health fair. He hopes other members of the Hmong community will take advantage of cancer screenings and medical treatment. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now, Yang hopes sharing his story will motivate others in his community to avail themselves of screenings and treatments. He believes it's best to find cancer early, when patients still have the strength to fight the disease successfully.\u003c/p>\n\u003cp>Kay Vu Lee wants more Hmong cancer survivors like Yang to come forward with their experiences, so that skeptical members of their community learn about the potential benefits of western medicine in catching cancer early.\u003c/p>\n\u003cp>Lee now plans to bring shamans and doctors together to collaborate more, so their patients benefit from both healing practices.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"If we can get shamans and doctors on the same page to work with each patient, that would help,\" says Lee.\u003c/p>\n\n",
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"excerpt": "The Hmong people have a higher cancer mortality rate than other Asian-Americans. Many are skeptical of western medicine and avoid cancer screening tests.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At a community center in southeast Fresno, dozens of Hmong seniors gather for a health fair. They tentatively approach tables with pamphlets in Hmong and English on breast cancer screenings, how to safely dispose medicine, and other health topics.\u003c/p>\n\u003cp>Later in the day, they'll hear presentations by doctors and nurses about understanding a doctor’s visit and the rights of patients, such as the right to seek a second opinion. The event, organized by the Hmong Cancer Coalition, aims to get seniors and other members of this community more familiar with the health care system, so they can benefit from screenings and diagnostic tests such as mammograms and biopsies to detect cancer early.\u003c/p>\n\u003cp>Older members of the Hmong community, in particular, often resist undergoing screening tests that could save their lives because of cultural beliefs, say health professionals and advocates. \u003ca href=\"http://link.springer.com/article/10.1007/s10900-010-9228-7#/page-1\">Studies\u003c/a> show the Hmong community has a higher cancer mortality rate when compared to other Asian Americans, in part because the disease is diagnosed at a later stage, which greatly reduces chances of survival.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/272617845&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/272617845'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Part of the issue -- low utilization of cancer screenings -- is rooted in a distrust of invasive medical procedures, says Kay Vu Lee, chair of the Hmong Cancer Coalition and one of the event's organizers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The issue hits home for Lee. Her own father, who is 71, refuses to undergo a biopsy that his doctor recommends to confirm a suspected case of prostate cancer.\u003c/p>\n\u003cp>\"He doesn’t want to do a biopsy because he’s afraid that when they intervene and go into his body, they might accidentally scrape something or break something,\" says Lee.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Those beliefs are shared by a lot of the seniors in this community, says Lee. Many came to the U.S. as refugees from the remote mountains of Laos in the 1970s and 1980s. They prefer herbal remedies and the advice of a spiritual healer or shaman over seeing a doctor at a clinic or hospital.\u003c/p>\n\u003cp>\"Even though most have been in America for an average of 30, 40 years, going to the doctor is still very new,\" says Lee. \"They don’t believe in it like they do the shaman.\"\u003c/p>\n\u003cp>This preference for traditional healing practices poses big challenges for the early diagnosis and treatment of cancer, says Dr. Amardeep Aulakh, an oncologist in Fresno, home to the second largest Hmong community in the country with 32,000 people.\u003c/p>\n\u003cp>\"It's a barrier towards the best care I can provide,\" says Aulakh. He is currently struggling to convince a Hmong patient with a growing lump in her breast to have a biopsy. \"My hands become tied when (patients) say they don’t want to undergo a procedure to confirm it's cancer.\"\u003c/p>\n\u003cfigure id=\"attachment_209466\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-209466 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/RS20050_IMG_9748-qut.jpg\" alt=\"Dr Amardeep Aulakh, an oncologist, speaks with Va Yang as Ko Yang, a lab manager at a private oncology practice listens. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20050_IMG_9748-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr Amardeep Aulakh, an oncologist, speaks with Va Yang at the health fair as Ko Yang, a lab manager at a private oncology practice, listens. \u003ccite>(Farida Jhabvala Romero/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Aulakh says he attends events like this to talk about the potentially life-saving options that are available to detect and treat cancer.\u003c/p>\n\u003cp>\"Cancer if caught early and treated appropriately is curable,\" he says.\u003c/p>\n\u003cp>It's a message Nao Vang Yang, 80, is now passing on to others in the Hmong community. Eight years ago, the retired truck driver woke up one morning not feeling well. He has nine children, and some of them are physicians who convinced him to get checked. He was diagnosed with an aggressive type of lymphoma.\u003c/p>\n\u003cp>\"The doctor told me I didn’t have a lot of time to live if I didn’t pursue treatment,\" says Yang in Hmong, as the Cancer Coalition's Kay Vu Lee translates.\u003c/p>\n\u003cp>Yang went through months of chemotherapy. He saw the tip of his fingers turn black and his chest get covered in a red rash after each IV treatment. But the ordeal was worth it, he says. He's been cancer free ever since.\u003c/p>\n\u003cfigure id=\"attachment_209465\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-209465 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/RS20056_IMG_9788-qut.jpg\" alt=\"Nao Vang Yang, 80, is a cancer survivor who shared his story at the health fair. He hopes other members of the Hmong community will take advantage of cancer screenings.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/RS20056_IMG_9788-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Nao Vang Yang, 80, is a cancer survivor who shared his story at the health fair. He hopes other members of the Hmong community will take advantage of cancer screenings and medical treatment. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now, Yang hopes sharing his story will motivate others in his community to avail themselves of screenings and treatments. He believes it's best to find cancer early, when patients still have the strength to fight the disease successfully.\u003c/p>\n\u003cp>Kay Vu Lee wants more Hmong cancer survivors like Yang to come forward with their experiences, so that skeptical members of their community learn about the potential benefits of western medicine in catching cancer early.\u003c/p>\n\u003cp>Lee now plans to bring shamans and doctors together to collaborate more, so their patients benefit from both healing practices.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"If we can get shamans and doctors on the same page to work with each patient, that would help,\" says Lee.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Nationwide, Doctors Who Sexually Abuse Their Patients Continue to Practice",
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"content": "\u003cp>Just weeks after the California Senate refused to advance \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1033\" target=\"_blank\">a bill \u003c/a>requiring doctors to notify their patients that they were on probation for -- among other things -- sexual abuse of patients, the Atlanta Journal-Constitution has published \u003ca href=\"http://doctors.ajc.com\" target=\"_blank\">a stunning investigation\u003c/a> exposing just how easy it is for these physicians to continue practicing.\u003c/p>\n\u003cp>The series is national in scope. Reporters examined \"documents that described disturbing acts of physician sexual abuse in every state. Rapes by OB/GYNs, seductions by psychiatrists, fondling by anesthesiologists and ophthalmologists, and molestations by pediatricians and radiologists.\"\u003c/p>\n\u003cp>Atlanta Journal-Constitution reporters identified 3,100 doctors who were disciplined after being accused of sexual misconduct, and more than 2,000 of them continued to practice. But those cases \u003ca href=\"http://doctors.ajc.com/sex_abuse_numbers/?ecmp=doctorssexabuse_microsite_nav\" target=\"_blank\">may be only a fraction of the actual numbers,\u003c/a> since many violations \"never came to the attention of state regulators.\"\u003c/p>\n\u003cp>The individual examples they cite are downright chilling, including this doctor from Granite Bay, east of Sacramento:\u003c/p>\n\u003cblockquote>\u003cp>In California, a patient was leaving an appointment with \u003ca class=\"document-link\" title=\"See related documents\" href=\"http://www.documentcloud.org/documents/2925627-combined-100-pdf.html\" target=\"_blank\">Dr. Mandeep Behniwal\u003c/a>, a psychiatrist, when the doctor put his hand down her blouse, grabbed her breast out of her bra and placed his mouth on it. He then exposed himself and ejaculated on her hand.\u003c/p>\u003c/blockquote>\n\u003cp>Behniwal told the Journal-Constitution the patient initiated the sexual contact. \"For half a minute, I lost my judgment,\" Behniwal said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If you were a patient of Behniwal's and wanted to know more about him, you would need to \u003ca href=\"https://www.breeze.ca.gov/datamart/searchLicTypeByName.do?direct=true\" target=\"_blank\">look him up \u003c/a>on the Medical Board of California website, where you would see that his license is \"Renewed and Current\" but \"Secondary Status\" indicates \"Limits On Practice,\" \"Probation\" and \"Misdemeanor Conviction.\"\u003c/p>\n\u003cp>You need to scroll down within the site and click elsewhere to find that he is barred from seeing female patients during his probation. Nowhere could I find the documents explaining what he actually did, even though state law requires that documents related to a misdemeanor conviction be posted to the internet.\u003c/p>\n\u003cp>Meanwhile, if you didn't know that the Medical Board of California had this look-up tool, you would be in the dark.\u003c/p>\n\u003cp>That's the consumer blind spot that state Sen. Jerry Hill, D-San Mateo, sought to illuminate with \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1033\" target=\"_blank\">Senate Bill 1033\u003c/a>. The bill would have required that doctors notify their patients if they were on probation for serious infractions -- not only sexual misconduct, but also gross negligence, substance abuse or a felony conviction related to patient care. It's just a tiny fraction of California doctors who are on probation for these offenses -- \u003ca href=\"http://safepatientproject.org/wordpress/wp-content/uploads/2015/10/MBC-list-of-docs-on-probation-as-of-9-29-15-as-of-10-8-15.pdf\" target=\"_blank\">about 500\u003c/a> out of 137,000 licensed physicians in 2015.\u003c/p>\n\u003cp>At least some of the senators who voted against the bill were swayed by a lobbying campaign suggesting that these were unproved allegations, which Hill promptly rebutted.\u003c/p>\n\u003cp>\"That is totally false, totally inaccurate,\" Hill told me. \"There's due process after extensive investigation that requires the attorney general of California, based on clear and convincing evidence, to charge these doctors with a violation of the Medical Practices Act and the California Criminal Code.\"\u003c/p>\n\u003cp>The California Medical Association has\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\"> opposed such notification efforts\u003c/a>, saying it would \"put a burden on the physician-patient relationship.\"\u003c/p>\n\u003cp>Hill says the notification is important, because 30 percent of these physicians on probation will re-offend. He said he will reintroduce the legislation. \"No question,\" he said, \"as soon as allowed. The public has a right to know this information because their life may depend on it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Learn more about this issue by \u003ca href=\"http://doctors.ajc.com/doctors_sex_abuse/?ecmp=doctorssexabuse_microsite_nav\" target=\"_blank\">reading the Atlanta Journal-Constitution's investigation.\u003c/a>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Just weeks after the California Senate refused to advance \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1033\" target=\"_blank\">a bill \u003c/a>requiring doctors to notify their patients that they were on probation for -- among other things -- sexual abuse of patients, the Atlanta Journal-Constitution has published \u003ca href=\"http://doctors.ajc.com\" target=\"_blank\">a stunning investigation\u003c/a> exposing just how easy it is for these physicians to continue practicing.\u003c/p>\n\u003cp>The series is national in scope. Reporters examined \"documents that described disturbing acts of physician sexual abuse in every state. Rapes by OB/GYNs, seductions by psychiatrists, fondling by anesthesiologists and ophthalmologists, and molestations by pediatricians and radiologists.\"\u003c/p>\n\u003cp>Atlanta Journal-Constitution reporters identified 3,100 doctors who were disciplined after being accused of sexual misconduct, and more than 2,000 of them continued to practice. But those cases \u003ca href=\"http://doctors.ajc.com/sex_abuse_numbers/?ecmp=doctorssexabuse_microsite_nav\" target=\"_blank\">may be only a fraction of the actual numbers,\u003c/a> since many violations \"never came to the attention of state regulators.\"\u003c/p>\n\u003cp>The individual examples they cite are downright chilling, including this doctor from Granite Bay, east of Sacramento:\u003c/p>\n\u003cblockquote>\u003cp>In California, a patient was leaving an appointment with \u003ca class=\"document-link\" title=\"See related documents\" href=\"http://www.documentcloud.org/documents/2925627-combined-100-pdf.html\" target=\"_blank\">Dr. Mandeep Behniwal\u003c/a>, a psychiatrist, when the doctor put his hand down her blouse, grabbed her breast out of her bra and placed his mouth on it. He then exposed himself and ejaculated on her hand.\u003c/p>\u003c/blockquote>\n\u003cp>Behniwal told the Journal-Constitution the patient initiated the sexual contact. \"For half a minute, I lost my judgment,\" Behniwal said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If you were a patient of Behniwal's and wanted to know more about him, you would need to \u003ca href=\"https://www.breeze.ca.gov/datamart/searchLicTypeByName.do?direct=true\" target=\"_blank\">look him up \u003c/a>on the Medical Board of California website, where you would see that his license is \"Renewed and Current\" but \"Secondary Status\" indicates \"Limits On Practice,\" \"Probation\" and \"Misdemeanor Conviction.\"\u003c/p>\n\u003cp>You need to scroll down within the site and click elsewhere to find that he is barred from seeing female patients during his probation. Nowhere could I find the documents explaining what he actually did, even though state law requires that documents related to a misdemeanor conviction be posted to the internet.\u003c/p>\n\u003cp>Meanwhile, if you didn't know that the Medical Board of California had this look-up tool, you would be in the dark.\u003c/p>\n\u003cp>That's the consumer blind spot that state Sen. Jerry Hill, D-San Mateo, sought to illuminate with \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1033\" target=\"_blank\">Senate Bill 1033\u003c/a>. The bill would have required that doctors notify their patients if they were on probation for serious infractions -- not only sexual misconduct, but also gross negligence, substance abuse or a felony conviction related to patient care. It's just a tiny fraction of California doctors who are on probation for these offenses -- \u003ca href=\"http://safepatientproject.org/wordpress/wp-content/uploads/2015/10/MBC-list-of-docs-on-probation-as-of-9-29-15-as-of-10-8-15.pdf\" target=\"_blank\">about 500\u003c/a> out of 137,000 licensed physicians in 2015.\u003c/p>\n\u003cp>At least some of the senators who voted against the bill were swayed by a lobbying campaign suggesting that these were unproved allegations, which Hill promptly rebutted.\u003c/p>\n\u003cp>\"That is totally false, totally inaccurate,\" Hill told me. \"There's due process after extensive investigation that requires the attorney general of California, based on clear and convincing evidence, to charge these doctors with a violation of the Medical Practices Act and the California Criminal Code.\"\u003c/p>\n\u003cp>The California Medical Association has\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\"> opposed such notification efforts\u003c/a>, saying it would \"put a burden on the physician-patient relationship.\"\u003c/p>\n\u003cp>Hill says the notification is important, because 30 percent of these physicians on probation will re-offend. He said he will reintroduce the legislation. \"No question,\" he said, \"as soon as allowed. The public has a right to know this information because their life may depend on it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Learn more about this issue by \u003ca href=\"http://doctors.ajc.com/doctors_sex_abuse/?ecmp=doctorssexabuse_microsite_nav\" target=\"_blank\">reading the Atlanta Journal-Constitution's investigation.\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "It's Covered Now: Talking to Your Doctor About End-of-Life Care",
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"content": "\u003cp>Millions of Californians are newly eligible for a health care benefit that could determine the treatment they receive in their final days — and most don’t know it.\u003c/p>\n\u003cp>Medi-Cal, which covers more than 13 million Californians, and Medicare, \u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">with more than 5 million\u003c/a> California enrollees now pay for “advance care planning” discussions with doctors.\u003c/p>\n\u003cp>Advance care planning isn’t about long-term care options, such as nursing homes or assisted living.\u003c/p>\n\u003cp>It’s about “your wishes for your care if you are not able to speak for yourself,” said Helen McNeal, executive director of the \u003ca href=\"https://csupalliativecare.org/\" target=\"_blank\">California State University Institute for Palliative Care\u003c/a>.\u003c/p>\n\u003cp>“If you’re incapacitated, if you need someone to speak for you, who do you want to speak for you? And what would be your medical wishes?” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If, for instance, you have a stroke that leaves you unconscious and unable to communicate, with little hope for improvement, would you want to be kept alive with a feeding tube and or ventilator?\u003c/p>\n\u003cp>“These decisions may have consequences for the quality of life you have for the rest of your life. They may also have consequences for whether you live or die,” McNeal said.\u003c/p>\n\u003cp>In other words, they’re important. But many doctors and patients don’t yet realize that talking about these decisions — and possibly putting them into writing — is a covered benefit.\u003c/p>\n\u003cp>Starting in October, Medi-Cal — the state’s version of the federal Medicaid program for low-income residents — began covering advance care planning discussions between doctors (or other qualified providers) and patients (or a family member), said Tony Cava, spokesman for the state Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>Any Medi-Cal recipient can use the coverage regardless of age, he said. Doctors can bill for the conversation twice a year per patient — plus an additional 30 minutes for one of the conversations — before they have to seek authorization for more coverage.\u003c/p>\n\u003cp>Medicare, the federal health insurance program for people 65 and older, and for people younger than 65 who have certain disabilities, started covering the discussions on Jan. 1. \u003ca href=\"https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf\" target=\"_blank\">Medicare does not limit\u003c/a> the number of discussions per patient each year.\u003c/p>\n\u003cp>Some private insurance plans cover these discussions and some don’t, McNeal said. Check with your plan.\u003c/p>\n\u003cp>Both Medicare and Medi-Cal will cover the conversations even if patients don’t end up completing an “\u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000472.htm\" target=\"_blank\">advance care directive\u003c/a>” as a result. That’s a document that formalizes your wishes, which should be shared with your family and doctor.\u003c/p>\n\u003cp>McNeal believes that anyone over 18 should have this discussion and complete an advance directive.\u003c/p>\n\u003cp>But don’t expect your doctor to initiate the conversation.\u003c/p>\n\u003cp>“Many physicians may not be very comfortable having this conversation,” said Dr. Richard Thorp, president of the Paradise Medical Group near Chico, and past president of the \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">California Medical Association\u003c/a>, which represents the state’s doctors.\u003c/p>\n\u003cp>\u003ca href=\"http://www.jhartfound.org/news-events/news/advance-care-planning-poll\" target=\"_blank\">A poll of more than 700 doctors\u003c/a>, released in April, found that nearly half of them feel unsure some or much of the time about what to say when discussing end-of-life care with patients. (The poll was commissioned in part by the California Health Care Foundation. California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>Thorp’s patients are mostly older, so he incorporates advance care planning into their annual \u003ca href=\"https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html\" target=\"_blank\">Medicare Wellness exams\u003c/a>. Medicare reimburses him about $86 for the initial 30-minute discussion, and about $75 for each additional 30 minutes, he said.\u003c/p>\n\u003cp>“There’s an art to having the discussion,” he said. “There’s an art to recognizing when people are uncomfortable.”\u003c/p>\n\u003cp>McNeal’s institute, in partnership with the \u003ca href=\"http://coalitionccc.org/\" target=\"_blank\">Coalition for Compassionate Care of California\u003c/a>, offers online training for doctors about advance care planning. One course specifically focuses on \u003ca href=\"https://csupalliativecare.org/programs/advance-care-planning/fundamentals/\" target=\"_blank\">how to have an effective conversation with patients\u003c/a>.\u003c/p>\n\u003cp>Because many doctors don’t know about this benefit — or may feel uncomfortable broaching the topic — most people should start by \u003ca href=\"http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html\" target=\"_blank\">having a conversation\u003c/a> with family and loved ones, suggested Mark Beach, an AARP spokesman based in Sacramento.\u003c/p>\n\u003cp>After your discussion, write down your wishes, he said.\u003c/p>\n\u003cp>“It’s difficult to discuss, but when you’ve done it, it’s a comfort,” Beach said. “Not only will your wishes be followed, but your loved ones will know what to do.”\u003c/p>\n\u003cp>A variety of forms and templates are available to consumers. Thorp sometimes uses what’s called a “\u003ca href=\"http://www.polst.org/advance-care-planning/polst-and-advance-directives/\" target=\"_blank\">POLST\u003c/a>” form, which is \u003ca href=\"http://www.polst.org/advance-care-planning/faq/\" target=\"_blank\">a medical order\u003c/a> that must be completed and signed by a health care professional.\u003c/p>\n\u003cp>It is typically for seriously ill or frail patients, McNeal said, whereas an advance care directive is a legal document for people of any age or condition.\u003c/p>\n\u003cp>McNeal recommends the “\u003ca href=\"https://agingwithdignity.org/five-wishes\" target=\"_blank\">Five Wishes\u003c/a>” form, which can be personalized and is available online for $5 at \u003ca href=\"http://www.agingwithdignity.org/\" target=\"_blank\">www.AgingWithDignity.org\u003c/a>. Other options for advance directives can be found at \u003ca href=\"http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289\" target=\"_blank\">www.CaringInfo.org\u003c/a> or \u003ca href=\"http://bit.ly/28TtVVy\" target=\"_blank\">through AARP\u003c/a>. (A lawyer can help you prepare an advance directive, but you usually don’t need an attorney to get it done.)\u003c/p>\n\u003cp>After you have filled out your advance care directive, take it to your doctor and tell her you want to talk with her about it, McNeal said. Don’t forget to give your doctor a copy.\u003c/p>\n\u003cp>“The role of the physician is really to provide information, not to persuade one way or the other,” Beach said.\u003c/p>\n\u003cp>Thorp explains to his patients what it means to be intubated, fed artificially and kept on life-support.\u003c/p>\n\u003cp>Most are open to the discussion, he said, and their responses are mixed. Some older or sicker patients tell him they don’t want any extraordinary measures if they’re incapacitated. Others, who are younger and healthier, say they would probably want medical intervention if they might have a chance to thrive afterward.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most people don’t want to be kept on life-support indefinitely. They really don’t want that,” Thorp said. “They want to live a productive life.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Millions of Californians are newly eligible for a health care benefit that could determine the treatment they receive in their final days — and most don’t know it.\u003c/p>\n\u003cp>Medi-Cal, which covers more than 13 million Californians, and Medicare, \u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">with more than 5 million\u003c/a> California enrollees now pay for “advance care planning” discussions with doctors.\u003c/p>\n\u003cp>Advance care planning isn’t about long-term care options, such as nursing homes or assisted living.\u003c/p>\n\u003cp>It’s about “your wishes for your care if you are not able to speak for yourself,” said Helen McNeal, executive director of the \u003ca href=\"https://csupalliativecare.org/\" target=\"_blank\">California State University Institute for Palliative Care\u003c/a>.\u003c/p>\n\u003cp>“If you’re incapacitated, if you need someone to speak for you, who do you want to speak for you? And what would be your medical wishes?” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If, for instance, you have a stroke that leaves you unconscious and unable to communicate, with little hope for improvement, would you want to be kept alive with a feeding tube and or ventilator?\u003c/p>\n\u003cp>“These decisions may have consequences for the quality of life you have for the rest of your life. They may also have consequences for whether you live or die,” McNeal said.\u003c/p>\n\u003cp>In other words, they’re important. But many doctors and patients don’t yet realize that talking about these decisions — and possibly putting them into writing — is a covered benefit.\u003c/p>\n\u003cp>Starting in October, Medi-Cal — the state’s version of the federal Medicaid program for low-income residents — began covering advance care planning discussions between doctors (or other qualified providers) and patients (or a family member), said Tony Cava, spokesman for the state Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>Any Medi-Cal recipient can use the coverage regardless of age, he said. Doctors can bill for the conversation twice a year per patient — plus an additional 30 minutes for one of the conversations — before they have to seek authorization for more coverage.\u003c/p>\n\u003cp>Medicare, the federal health insurance program for people 65 and older, and for people younger than 65 who have certain disabilities, started covering the discussions on Jan. 1. \u003ca href=\"https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf\" target=\"_blank\">Medicare does not limit\u003c/a> the number of discussions per patient each year.\u003c/p>\n\u003cp>Some private insurance plans cover these discussions and some don’t, McNeal said. Check with your plan.\u003c/p>\n\u003cp>Both Medicare and Medi-Cal will cover the conversations even if patients don’t end up completing an “\u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000472.htm\" target=\"_blank\">advance care directive\u003c/a>” as a result. That’s a document that formalizes your wishes, which should be shared with your family and doctor.\u003c/p>\n\u003cp>McNeal believes that anyone over 18 should have this discussion and complete an advance directive.\u003c/p>\n\u003cp>But don’t expect your doctor to initiate the conversation.\u003c/p>\n\u003cp>“Many physicians may not be very comfortable having this conversation,” said Dr. Richard Thorp, president of the Paradise Medical Group near Chico, and past president of the \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">California Medical Association\u003c/a>, which represents the state’s doctors.\u003c/p>\n\u003cp>\u003ca href=\"http://www.jhartfound.org/news-events/news/advance-care-planning-poll\" target=\"_blank\">A poll of more than 700 doctors\u003c/a>, released in April, found that nearly half of them feel unsure some or much of the time about what to say when discussing end-of-life care with patients. (The poll was commissioned in part by the California Health Care Foundation. California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>Thorp’s patients are mostly older, so he incorporates advance care planning into their annual \u003ca href=\"https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html\" target=\"_blank\">Medicare Wellness exams\u003c/a>. Medicare reimburses him about $86 for the initial 30-minute discussion, and about $75 for each additional 30 minutes, he said.\u003c/p>\n\u003cp>“There’s an art to having the discussion,” he said. “There’s an art to recognizing when people are uncomfortable.”\u003c/p>\n\u003cp>McNeal’s institute, in partnership with the \u003ca href=\"http://coalitionccc.org/\" target=\"_blank\">Coalition for Compassionate Care of California\u003c/a>, offers online training for doctors about advance care planning. One course specifically focuses on \u003ca href=\"https://csupalliativecare.org/programs/advance-care-planning/fundamentals/\" target=\"_blank\">how to have an effective conversation with patients\u003c/a>.\u003c/p>\n\u003cp>Because many doctors don’t know about this benefit — or may feel uncomfortable broaching the topic — most people should start by \u003ca href=\"http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html\" target=\"_blank\">having a conversation\u003c/a> with family and loved ones, suggested Mark Beach, an AARP spokesman based in Sacramento.\u003c/p>\n\u003cp>After your discussion, write down your wishes, he said.\u003c/p>\n\u003cp>“It’s difficult to discuss, but when you’ve done it, it’s a comfort,” Beach said. “Not only will your wishes be followed, but your loved ones will know what to do.”\u003c/p>\n\u003cp>A variety of forms and templates are available to consumers. Thorp sometimes uses what’s called a “\u003ca href=\"http://www.polst.org/advance-care-planning/polst-and-advance-directives/\" target=\"_blank\">POLST\u003c/a>” form, which is \u003ca href=\"http://www.polst.org/advance-care-planning/faq/\" target=\"_blank\">a medical order\u003c/a> that must be completed and signed by a health care professional.\u003c/p>\n\u003cp>It is typically for seriously ill or frail patients, McNeal said, whereas an advance care directive is a legal document for people of any age or condition.\u003c/p>\n\u003cp>McNeal recommends the “\u003ca href=\"https://agingwithdignity.org/five-wishes\" target=\"_blank\">Five Wishes\u003c/a>” form, which can be personalized and is available online for $5 at \u003ca href=\"http://www.agingwithdignity.org/\" target=\"_blank\">www.AgingWithDignity.org\u003c/a>. Other options for advance directives can be found at \u003ca href=\"http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289\" target=\"_blank\">www.CaringInfo.org\u003c/a> or \u003ca href=\"http://bit.ly/28TtVVy\" target=\"_blank\">through AARP\u003c/a>. (A lawyer can help you prepare an advance directive, but you usually don’t need an attorney to get it done.)\u003c/p>\n\u003cp>After you have filled out your advance care directive, take it to your doctor and tell her you want to talk with her about it, McNeal said. Don’t forget to give your doctor a copy.\u003c/p>\n\u003cp>“The role of the physician is really to provide information, not to persuade one way or the other,” Beach said.\u003c/p>\n\u003cp>Thorp explains to his patients what it means to be intubated, fed artificially and kept on life-support.\u003c/p>\n\u003cp>Most are open to the discussion, he said, and their responses are mixed. Some older or sicker patients tell him they don’t want any extraordinary measures if they’re incapacitated. Others, who are younger and healthier, say they would probably want medical intervention if they might have a chance to thrive afterward.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most people don’t want to be kept on life-support indefinitely. They really don’t want that,” Thorp said. “They want to live a productive life.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Oakland Seeks to Ban False Advertising by Anti-Abortion Clinics",
"title": "Oakland Seeks to Ban False Advertising by Anti-Abortion Clinics",
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"content": "\u003cp>\u003cstrong>Update -- July 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>The ordinance to fine pregnancy centers that claim to offer abortion services, but don't, was passed unanimously by the Oakland City Council's Life Enrichment Committee on June 28. The full City Council will hear the measure tonight. If it passes, it must be heard again in two weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Oakland officials are considering an ordinance that would allow the city to fine pregnancy centers that claim to offer abortion services, but do not.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We believe women who need care should not be lied to.' \u003ccite>Annie Campbell Washington, Oakland Vice Mayor\u003c/cite>\u003c/aside>\n\u003cp>Officials say some anti-abortion groups' internet advertising and mass transit billboards are misleading, and intended to lure pregnant women in for counseling against abortion.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We believe women who need care should not be lied to,” said Annie Campbell Washington, vice mayor of Oakland and a proponent of the ordinance.\u003c/p>\n\u003cp>Oakland officials are particularly concerned about search advertising. For example, typing \"abortion services\" into a Google or Yahoo search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.\u003c/p>\n\u003cp>These pregnancy centers buy the search ads for terms like \"abortion\" or \"pregnancy test\" so links for their clinics will appear on users' screens when they enter searches for those terms. Their websites often say they offer \"abortion information\" or \"counseling for women seeking abortion.\"\u003c/p>\n\u003cp>Oakland officials want to prohibit them from doing this. Fines would range from $50 to $500 per violation.\u003c/p>\n\u003cp>\"When a woman is misled into believing that a clinic offers services that it does not in fact offer, she loses time crucial to her decision-making process,\" Washington says.\u003c/p>\n\u003cp>Washington says delays in care can mean women may have to get a more invasive, more expensive procedure, or may lose her right to terminate the pregnancy at all, because too much time has passed and her pregnancy is too far along to lawfully terminate.\u003c/p>\n\u003cp>“We want to send a clear message that false advertising is not acceptable in the city of Oakland,” she said.\u003c/p>\n\u003cp>Up until a few months ago, if iPhone users asked Siri to locate a nearby abortion clinic, the voice assistant would return a list of adoption agencies.\u003c/p>\n\u003cp>Apple, which is responsible for Siri search results, said it was aware of the glitch right after Siri debuted in 2011, but it was not fixed until January, 2016. The company \u003ca href=\"https://techcrunch.com/2016/01/29/apple%E2%80%A6\" target=\"_blank\">told Tech Crunch\u003c/a> that it has been \"updating its search results over time.\"\u003c/p>\n\u003cp>Crisis pregnancy centers say the marketing and counseling they do is not false advertising. It's free speech. They say this kind of ordinance is an attack on their first amendment rights.\u003c/p>\n\u003cp>“Using search terms to make women aware of your ministry and the services you provide, with regards to pregnancy alternatives, is very legitimate and would be foolhardy not to be utilized,” said Brad Dacus, an attorney with the Pacific Justice Institute, a nonprofit law firm that defends religious freedom.\u003c/p>\n\u003cp>Staff at crisis pregnancy centers do not lie, he said, adding, it’s \"insulting to women\" to assume they don't have the ability to ask questions before making an appointment to make sure the services they want are available.\u003c/p>\n\u003cp>“It’s also very presumptive to believe that those who use search terms such as ‘abortion’ are presumably seeking just an abortion,\" he said. \"They may also be open, and possibly yearning, for other options.\"\u003c/p>\n\u003cp>Some crisis pregnancy centers challenged a similar false advertising law in San Francisco, which took effect in late 2011. Last year, a district judge \u003ca href=\"http://www.sfgate.com/bayarea/article/Limits-upheld-on-ads-by-antiabortion-pregnancy-6097159.php\" target=\"_blank\">upheld the law\u003c/a>, saying false and misleading commercial speech is not protected by the First Amendment.\u003c/p>\n\u003cp>The Oakland ordinance builds on a new statewide law that was signed by Gov. Jerry Brown last fall, the \u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\">Reproductive FACT Act\u003c/a>. It requires crisis pregnancy centers to notify their clients if they are not medically licensed.\u003c/p>\n\u003cp>In addition, clinics that are medically licensed are required to post a notice in their waiting room -- or let patients know when they check in for an appointment -- that there is financial assistance available for family planning services and abortion. They must also provide the phone number for the local county health department.\u003c/p>\n\u003cp>The Pacific Justice Institute has filed one of several lawsuits challenging the state law. It is currently under review by the 9th Circuit Court of Appeals. Dacus says if the law is upheld, his group will appeal to the U.S. Supreme Court.\u003c/p>\n\u003cp>The state law did not cover issues of false advertising.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oakland’s ordinance goes before the city's Life Enrichment Committee for a vote on Tuesday, then will be reviewed and voted on by the full City Council twice in July.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update -- July 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>The ordinance to fine pregnancy centers that claim to offer abortion services, but don't, was passed unanimously by the Oakland City Council's Life Enrichment Committee on June 28. The full City Council will hear the measure tonight. If it passes, it must be heard again in two weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Oakland officials are considering an ordinance that would allow the city to fine pregnancy centers that claim to offer abortion services, but do not.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We believe women who need care should not be lied to.' \u003ccite>Annie Campbell Washington, Oakland Vice Mayor\u003c/cite>\u003c/aside>\n\u003cp>Officials say some anti-abortion groups' internet advertising and mass transit billboards are misleading, and intended to lure pregnant women in for counseling against abortion.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We believe women who need care should not be lied to,” said Annie Campbell Washington, vice mayor of Oakland and a proponent of the ordinance.\u003c/p>\n\u003cp>Oakland officials are particularly concerned about search advertising. For example, typing \"abortion services\" into a Google or Yahoo search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.\u003c/p>\n\u003cp>These pregnancy centers buy the search ads for terms like \"abortion\" or \"pregnancy test\" so links for their clinics will appear on users' screens when they enter searches for those terms. Their websites often say they offer \"abortion information\" or \"counseling for women seeking abortion.\"\u003c/p>\n\u003cp>Oakland officials want to prohibit them from doing this. Fines would range from $50 to $500 per violation.\u003c/p>\n\u003cp>\"When a woman is misled into believing that a clinic offers services that it does not in fact offer, she loses time crucial to her decision-making process,\" Washington says.\u003c/p>\n\u003cp>Washington says delays in care can mean women may have to get a more invasive, more expensive procedure, or may lose her right to terminate the pregnancy at all, because too much time has passed and her pregnancy is too far along to lawfully terminate.\u003c/p>\n\u003cp>“We want to send a clear message that false advertising is not acceptable in the city of Oakland,” she said.\u003c/p>\n\u003cp>Up until a few months ago, if iPhone users asked Siri to locate a nearby abortion clinic, the voice assistant would return a list of adoption agencies.\u003c/p>\n\u003cp>Apple, which is responsible for Siri search results, said it was aware of the glitch right after Siri debuted in 2011, but it was not fixed until January, 2016. The company \u003ca href=\"https://techcrunch.com/2016/01/29/apple%E2%80%A6\" target=\"_blank\">told Tech Crunch\u003c/a> that it has been \"updating its search results over time.\"\u003c/p>\n\u003cp>Crisis pregnancy centers say the marketing and counseling they do is not false advertising. It's free speech. They say this kind of ordinance is an attack on their first amendment rights.\u003c/p>\n\u003cp>“Using search terms to make women aware of your ministry and the services you provide, with regards to pregnancy alternatives, is very legitimate and would be foolhardy not to be utilized,” said Brad Dacus, an attorney with the Pacific Justice Institute, a nonprofit law firm that defends religious freedom.\u003c/p>\n\u003cp>Staff at crisis pregnancy centers do not lie, he said, adding, it’s \"insulting to women\" to assume they don't have the ability to ask questions before making an appointment to make sure the services they want are available.\u003c/p>\n\u003cp>“It’s also very presumptive to believe that those who use search terms such as ‘abortion’ are presumably seeking just an abortion,\" he said. \"They may also be open, and possibly yearning, for other options.\"\u003c/p>\n\u003cp>Some crisis pregnancy centers challenged a similar false advertising law in San Francisco, which took effect in late 2011. Last year, a district judge \u003ca href=\"http://www.sfgate.com/bayarea/article/Limits-upheld-on-ads-by-antiabortion-pregnancy-6097159.php\" target=\"_blank\">upheld the law\u003c/a>, saying false and misleading commercial speech is not protected by the First Amendment.\u003c/p>\n\u003cp>The Oakland ordinance builds on a new statewide law that was signed by Gov. Jerry Brown last fall, the \u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\">Reproductive FACT Act\u003c/a>. It requires crisis pregnancy centers to notify their clients if they are not medically licensed.\u003c/p>\n\u003cp>In addition, clinics that are medically licensed are required to post a notice in their waiting room -- or let patients know when they check in for an appointment -- that there is financial assistance available for family planning services and abortion. They must also provide the phone number for the local county health department.\u003c/p>\n\u003cp>The Pacific Justice Institute has filed one of several lawsuits challenging the state law. It is currently under review by the 9th Circuit Court of Appeals. Dacus says if the law is upheld, his group will appeal to the U.S. Supreme Court.\u003c/p>\n\u003cp>The state law did not cover issues of false advertising.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oakland’s ordinance goes before the city's Life Enrichment Committee for a vote on Tuesday, then will be reviewed and voted on by the full City Council twice in July.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Decades of Budget Shortfalls Frustrate L.A. County Coroner",
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"content": "\u003cp>In a refrigerated crypt at the Los Angeles County Coroner-Medical Examiner’s headquarters, the bodies lie awaiting examination on the shelves of metal racks, similar to what you might find in a Home Depot.\u003c/p>\n\u003cp>The coroner’s office is responsible for investigating violent and unusual death. With up to 80,000 deaths in Los Angeles County annually, about 20,000 are reported each year to the medical examiner’s office. The department examines from 8,000 to 9,000 bodies a year, records show.\u003c/p>\n\u003cp>Walking past the crypt’s steel shelves, you glimpse a bullet-pocked leg. There, the distended, bruised-looking belly of a corpse that lay out in the sun too long. And so on, dead person after dead person, a 160-corpse backlog.\u003c/p>\n\u003cp>In a laboratory upstairs, jars of blood are stacked in cartons.\u003c/p>\n\u003cp>“That blood backing up, for one thing, is so frightening to me, and so frustrating,” said Mark Fajardo, who quit as county coroner in April, saying he had not received the funding or staff he needed to carry out his duties.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As an example, Fajardo cites the need to investigate a surge in overdoses of the synthetic opiate fentanyl, the same drug that recently killed music icon Prince.\u003c/p>\n\u003cp>“(Public health officials) were asking coroners throughout California, ‘Hey, are you guys seeing a spike in fentanyl?’ To which I could not respond, because at the time of my resignation, we were nine months behind on toxicology tests,” Fajardo said.\u003c/p>\n\u003cp>His decision to leave the nation’s busiest coroner’s department points to a strain on public funding for death investigations that is especially severe in Los Angeles, but a growing problem throughout the state, experts say.\u003c/p>\n\u003cp>The shortage of resources has serious public health implications, such as delaying health alerts to ambulance crews and emergency room doctors when there’s a spike in overdoses such as those occurring now with fentanyl and other opioids. Likewise, we rely on pathologists’ reports to head off disease such as the tuberculosis epidemic that broke out a couple years ago on L.A.’s Skid Row. Findings by coroners’ departments help to identify trends in another public health issue, violent crime.\u003c/p>\n\u003cp>Finally, slowness in investigating questionable deaths causes additional anguish and sometimes financial hardship to friends and relatives of the deceased. Slowness in processing death certificates can substantially delay processing of life insurance policies, for example.\u003c/p>\n\u003cp>David Fowler, president of the National Association of Medical Examiners, or NAME, said many coroner’s offices nationwide are short on staff. He said some 40 forensic pathologists graduate from fellowship programs across the country annually, barely enough to keep up with retirements.\u003c/p>\n\u003cp>“This has been a slow, creeping problem, worsening over time,” Fowler said. “There was no trigger, no measurable point where you suddenly said, ‘Oh, dear!’”\u003c/p>\n\u003cp>While training programs for other specialties generally receive federal subsidies throughout their duration, the final year of a forensic pathologist’s education commonly does without such support, Fowler said.\u003c/p>\n\u003cp>Less demanding general pathology positions typically pay much better than does government work, adding to the shortage of specialists willing to work in the public sector, Fowler said.\u003c/p>\n\u003cp>Glenn Wagner, chief medical examiner for San Diego County, called staffing shortages a chronic problem.\u003c/p>\n\u003cp>With 57 employees, the San Diego medical examiner’s office evaluates some 900 deaths per month, Wagner said. Of those, from 200 to 300 bodies are unidentified. Wagner said ideally, he’d have his own DNA laboratory to help find out who these people are, but to avoid that expense his county depends on state laboratories.\u003c/p>\n\u003cp>Wagner said such a state check can take several months, during which time the body must be stored at county expense.\u003c/p>\n\u003cp>The county also struggles to keep up with requests for toxicological investigations. With 10 pathologists working around the clock, Wagner said it can take up to three months to complete test results on a case.\u003c/p>\n\u003cp>Still, Los Angeles County’s difficulties remain by far the most severe. In April, a civil grand jury report focused on chronic underfunding.\u003c/p>\n\u003cp>The report concluded that the Department of the Medical Examiner-Coroner “is significantly understaffed” in both coroner investigator and laboratory positions and has a “sobering backlog” in toxicology testing. The grand jury warned that the department is likely to lose its NAME accreditation if those issues are not addressed.\u003c/p>\n\u003cp>That “may subject Los Angeles County and (coroner’s office) to attacks on their credibility in criminal cases,” the report states.\u003c/p>\n\u003cp>Retired coroner’s investigator Vidal Herrera said the funding shortfalls go back decades. He remembers showing up at work to find no gloves available to protect workers’ hands during autopsies. Sometimes, he and his colleagues had time to buy heavy-duty dishwashing gloves at local stores, but often they did without, Herrera said.\u003c/p>\n\u003cp>“The bodies just kept coming in and coming in,” he said. “The work had to get done.”\u003c/p>\n\u003cp>As for staffing, in his last year at the head of the department, Fajardo requested funding for 80 new positions. When the draft county budget was released in April, it provided money for two.\u003c/p>\n\u003cp>Joel Sappell, a spokesman for county Chief Executive Officer Sachi Hamai, wrote in an email that Fajardo had failed to provide a sufficiently detailed justification for his request.\u003c/p>\n\u003cp>More recently, the CEO has authorized 24 temporary positions, while distributing some of the coroner’s workload to other departments, the email states. A study is underway to evaluate the coroner’s management issues, staffing requirements and technological needs, Sappell writes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fajardo said he believes that by resigning and speaking out, he helped to draw the attention of the county Board of Supervisors and the general public to his department’s plight. He’s encouraged by the temporary hires. As for a broader solution, county supervisors are legally required to respond to the grand jury report within another month, Fajardo noted.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a refrigerated crypt at the Los Angeles County Coroner-Medical Examiner’s headquarters, the bodies lie awaiting examination on the shelves of metal racks, similar to what you might find in a Home Depot.\u003c/p>\n\u003cp>The coroner’s office is responsible for investigating violent and unusual death. With up to 80,000 deaths in Los Angeles County annually, about 20,000 are reported each year to the medical examiner’s office. The department examines from 8,000 to 9,000 bodies a year, records show.\u003c/p>\n\u003cp>Walking past the crypt’s steel shelves, you glimpse a bullet-pocked leg. There, the distended, bruised-looking belly of a corpse that lay out in the sun too long. And so on, dead person after dead person, a 160-corpse backlog.\u003c/p>\n\u003cp>In a laboratory upstairs, jars of blood are stacked in cartons.\u003c/p>\n\u003cp>“That blood backing up, for one thing, is so frightening to me, and so frustrating,” said Mark Fajardo, who quit as county coroner in April, saying he had not received the funding or staff he needed to carry out his duties.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As an example, Fajardo cites the need to investigate a surge in overdoses of the synthetic opiate fentanyl, the same drug that recently killed music icon Prince.\u003c/p>\n\u003cp>“(Public health officials) were asking coroners throughout California, ‘Hey, are you guys seeing a spike in fentanyl?’ To which I could not respond, because at the time of my resignation, we were nine months behind on toxicology tests,” Fajardo said.\u003c/p>\n\u003cp>His decision to leave the nation’s busiest coroner’s department points to a strain on public funding for death investigations that is especially severe in Los Angeles, but a growing problem throughout the state, experts say.\u003c/p>\n\u003cp>The shortage of resources has serious public health implications, such as delaying health alerts to ambulance crews and emergency room doctors when there’s a spike in overdoses such as those occurring now with fentanyl and other opioids. Likewise, we rely on pathologists’ reports to head off disease such as the tuberculosis epidemic that broke out a couple years ago on L.A.’s Skid Row. Findings by coroners’ departments help to identify trends in another public health issue, violent crime.\u003c/p>\n\u003cp>Finally, slowness in investigating questionable deaths causes additional anguish and sometimes financial hardship to friends and relatives of the deceased. Slowness in processing death certificates can substantially delay processing of life insurance policies, for example.\u003c/p>\n\u003cp>David Fowler, president of the National Association of Medical Examiners, or NAME, said many coroner’s offices nationwide are short on staff. He said some 40 forensic pathologists graduate from fellowship programs across the country annually, barely enough to keep up with retirements.\u003c/p>\n\u003cp>“This has been a slow, creeping problem, worsening over time,” Fowler said. “There was no trigger, no measurable point where you suddenly said, ‘Oh, dear!’”\u003c/p>\n\u003cp>While training programs for other specialties generally receive federal subsidies throughout their duration, the final year of a forensic pathologist’s education commonly does without such support, Fowler said.\u003c/p>\n\u003cp>Less demanding general pathology positions typically pay much better than does government work, adding to the shortage of specialists willing to work in the public sector, Fowler said.\u003c/p>\n\u003cp>Glenn Wagner, chief medical examiner for San Diego County, called staffing shortages a chronic problem.\u003c/p>\n\u003cp>With 57 employees, the San Diego medical examiner’s office evaluates some 900 deaths per month, Wagner said. Of those, from 200 to 300 bodies are unidentified. Wagner said ideally, he’d have his own DNA laboratory to help find out who these people are, but to avoid that expense his county depends on state laboratories.\u003c/p>\n\u003cp>Wagner said such a state check can take several months, during which time the body must be stored at county expense.\u003c/p>\n\u003cp>The county also struggles to keep up with requests for toxicological investigations. With 10 pathologists working around the clock, Wagner said it can take up to three months to complete test results on a case.\u003c/p>\n\u003cp>Still, Los Angeles County’s difficulties remain by far the most severe. In April, a civil grand jury report focused on chronic underfunding.\u003c/p>\n\u003cp>The report concluded that the Department of the Medical Examiner-Coroner “is significantly understaffed” in both coroner investigator and laboratory positions and has a “sobering backlog” in toxicology testing. The grand jury warned that the department is likely to lose its NAME accreditation if those issues are not addressed.\u003c/p>\n\u003cp>That “may subject Los Angeles County and (coroner’s office) to attacks on their credibility in criminal cases,” the report states.\u003c/p>\n\u003cp>Retired coroner’s investigator Vidal Herrera said the funding shortfalls go back decades. He remembers showing up at work to find no gloves available to protect workers’ hands during autopsies. Sometimes, he and his colleagues had time to buy heavy-duty dishwashing gloves at local stores, but often they did without, Herrera said.\u003c/p>\n\u003cp>“The bodies just kept coming in and coming in,” he said. “The work had to get done.”\u003c/p>\n\u003cp>As for staffing, in his last year at the head of the department, Fajardo requested funding for 80 new positions. When the draft county budget was released in April, it provided money for two.\u003c/p>\n\u003cp>Joel Sappell, a spokesman for county Chief Executive Officer Sachi Hamai, wrote in an email that Fajardo had failed to provide a sufficiently detailed justification for his request.\u003c/p>\n\u003cp>More recently, the CEO has authorized 24 temporary positions, while distributing some of the coroner’s workload to other departments, the email states. A study is underway to evaluate the coroner’s management issues, staffing requirements and technological needs, Sappell writes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fajardo said he believes that by resigning and speaking out, he helped to draw the attention of the county Board of Supervisors and the general public to his department’s plight. He’s encouraged by the temporary hires. As for a broader solution, county supervisors are legally required to respond to the grand jury report within another month, Fajardo noted.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "5 Things To Consider About The Supreme Court's Decision On Texas Abortion Law",
"title": "5 Things To Consider About The Supreme Court's Decision On Texas Abortion Law",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The Supreme Court this week delivered its strongest affirmation of a women's right to abortion in years. By a margin of 5-3, it struck down two key provisions of a Texas law restricting the procedure.\u003c/p>\n\u003cp>But where does the decision in \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">Whole Woman's Health v. Hellerstedt\u003c/a> fit in the court's long history of actions abortion rights and restrictions? And what effect might the case have on similar laws in other states and this fall's elections? Here are five insights about the case that provide some context:\u003c/p>\n\u003cp>\u003cstrong>1. It's the first big win for supporters of abortion rights in a long time.\u003c/strong>\u003c/p>\n\u003cp>The last time abortion-rights supporters were on the winning side of a big case at the Supreme Court was 16 years ago, when a 5-4 ruling in \u003ca href=\"https://www.oyez.org/cases/1999/99-830\" target=\"_blank\">Stenberg v. Carhart\u003c/a> struck down a Nebraska law banning a specific procedure abortion opponents called \"partial birth abortion.\" That win was effectively reversed in 2007, however, when the court upheld a similar federal law banning the same procedure, also on a 5-4 ruling, in \u003ca href=\"https://www.oyez.org/cases/2006/05-380\" target=\"_blank\">Gonzales v. Carhart\u003c/a>. The substance hadn't changed much, but the replacement of Justice Sandra Day O'Connor with Justice Samuel Alito in 2006 gave abortion opponents an extra vote, which was enough to change the outcome.\u003c/p>\n\u003cp>After Monday's decision, many foes of abortion rights complained that there were few restrictions on abortion that would pass muster with the high court. But, in fact, in the years since the court first legalized abortion nationwide in \u003ca href=\"https://www.oyez.org/cases/1971/70-18\" target=\"_blank\">Roe v. Wade\u003c/a> in 1973, about half the major cases have been clear wins for abortion opponents, including upholding state laws requiring \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/497/502\" target=\"_blank\">parental involvement for minors\u003c/a>, \u003ca href=\"https://www.oyez.org/cases/1991/91-744\" target=\"_blank\">waiting periods\u003c/a>, and \u003ca href=\"https://www.oyez.org/cases/1979/79-1268\" target=\"_blank\">bans on the use of public funds\u003c/a> to pay for abortions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>2. It could put pro-abortion rights forces on the offensive.\u003c/strong>\u003c/p>\n\u003cp>Since Republicans took over Congress and most state legislatures after the 2010 elections, states have enacted \u003ca href=\"https://www.guttmacher.org/article/2016/01/last-five-years-account-more-one-quarter-all-abortion-restrictions-enacted-roe\" target=\"_blank\">nearly 300 separate abortion restrictions\u003c/a>; the most in any five-year period since \u003cem>Roe v. Wade\u003c/em> was decided. Many of those were the same types of \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_TRAP.pdf\" target=\"_blank\">laws claiming protections for women's health\u003c/a> that were struck down by the Supreme Court this week. Those laws include requiring doctors who perform abortions to have admitting privileges at a nearby hospital and requiring abortion clinics to meet the standards of facilities performing more involved surgical procedures.\u003c/p>\n\u003cp>The justices have already responded to petitions from some states with similar laws. Just a day after handing down the Texas ruling, they rejected appeals from \u003ca href=\"http://www.reuters.com/article/us-usa-court-abortion-idUSKCN0ZE1MJ\" target=\"_blank\">Mississippi and Wisconsin\u003c/a>, where physician admitting privilege laws had been blocked by lower court judges. Those laws are now permanently blocked. Officials in \u003ca href=\"http://www.ago.state.al.us/News-863\" target=\"_blank\">Alabama\u003c/a> also dropped their defense of a similar law.\u003c/p>\n\u003cp>But the decision doesn't automatically invalidate similar laws in other states because the effect of such statutes is different in every community. For example, what may amount to an \"undue burden\" in Texas because of the sheer size of the state might not be as burdensome in states with clinics closer together.\u003c/p>\n\u003cp>In states where lower court judges have already blocked laws, those blocks are almost certain to remain in place. But in other states opponents of the restrictions would have to work to overturn each law individually.\u003c/p>\n\u003cp>They say that is what they plan to do. \"We will now will take this fight state by state to challenge and repeal laws all across the country,\" Planned Parenthood President Cecile Richards told reporters in a conference call immediately after the ruling.\u003c/p>\n\u003cp>Planned Parenthood announced on Thursday that it would pursue efforts to block or repeal similar laws in eight states: Arizona, Florida, Michigan, Missouri, Pennsylvania, Tennessee, Texas, and Virginia.\u003c/p>\n\u003cp>Abortion-rights supporters are also taking aim at some long-standing abortion restrictions in federal law. The \u003ca href=\"https://demconvention.com/news/democratic-platform-drafting-meeting-concludes/\" target=\"_blank\">draft Democratic platform\u003c/a> that will be finalized at the party's nominating convention in late July includes a plan calling for the repeal of the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=121402281\" target=\"_blank\">Hyde Amendment\u003c/a>, which has banned most federal abortion funding since 1977. That provision was \u003ca href=\"https://www.hillaryclinton.com/briefing/statements/2016/06/25/statement-from-senior-policy-advisor-maya-harris-on-democratic-platform/\" target=\"_blank\">highlighted and praised\u003c/a> by presumptive nominee Hillary Clinton's campaign, noting that it represents the first time such an explicit vow has been included.\u003c/p>\n\u003cp>\u003cstrong>3. Opponents of abortion rights aren't likely to retreat.\u003c/strong>\u003c/p>\n\u003cp>While the latest Supreme Court ruling was definitely a setback for abortion foes, they are not giving up. For one thing, \u003ca href=\"http://www.prochoiceamerica.org/assets/download-files/2016-wd-report.pdf\" target=\"_blank\">opponents remain in control of a majority\u003c/a> of state legislatures and governorships, and that's unlikely to change following this year's national elections.\u003c/p>\n\u003cp>\"Americans United for Life will continue to fight — in legislatures and in the courts — to protect women from a dangerous and greedy abortion industry,\" said AUL Acting President and Senior Counsel Clarke Forsythe. Americans United for Life has been at the forefront of \u003ca href=\"http://www.npr.org/sections/health-shots/2016/03/04/469094346/legal-foes-in-texas-abortion-case-are-using-new-playbooks\" target=\"_blank\">developing model laws\u003c/a> restricting access to abortion.\u003c/p>\n\u003cp>The movement against abortion rights has a much larger menu to choose from than the two issues the high court addressed. For example, many states (including Texas) have passed or are considering \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">bans on abortion after roughly 20 weeks of pregnancy\u003c/a>. Many of those bans are being \u003ca href=\"http://www.latimes.com/nation/nationnow/la-na-nn-abortion-idaho-20150530-story.html\" target=\"_blank\">challenged in the courts\u003c/a> but none has yet reached the Supreme Court. Other restrictions include requiring pregnant women to have ultrasounds before an abortion, to make multiple visits to an abortion provider and banning the use of \u003ca href=\"http://www.theatlantic.com/business/archive/2014/10/the-safer-more-affordable-abortion-only-available-in-two-states/381321/\" target=\"_blank\">telemedicine\u003c/a> for medical (as opposed to surgical) abortions using the abortion pill \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a600042.html\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>Abortion opponents say they aren't giving up on pursuing health and safety standards like the ones struck down in Texas, either. \"This issue of safety standards is not over,\" said Marilyn Musgrave, vice president of government affairs at Susan B. Anthony List.\u003c/p>\n\u003cp>Even some similar laws could pass muster if they are crafted carefully enough, said Kristi Hamrick, a spokeswoman for Americans United for Life. \"We don't have a one-size-fits-all bill to send to the 50 states,\" she said. \"The law is specific and so the tools must be too.\"\u003c/p>\n\u003cp>\u003cstrong>4. The decision could shake up national politics.\u003c/strong>\u003c/p>\n\u003cp>Both sides in the long-polarized abortion debate are already pointing to the case in an effort to mobilize their supporters.\u003c/p>\n\u003cp>\"This certainly makes the November presidential election even more critical,\" said Musgrave of the Susan B. Anthony List. \"It is so obvious that we need to elect a pro-life president.\"\u003c/p>\n\u003cp>On the opposite side, Ilyse Hogue, president of NARAL Pro-Choice America, says the decision \"underscores what the election means for Supreme Court jurisprudence.\" With one vacancy already on the court and others likely in the next four years, she said, \"reproductive freedom is very much on the ballot this November.\"\u003c/p>\n\u003cp>Hillary Clinton's campaign hailed the decision. \"We need a president who will defend women's health and rights and appoint Supreme Court justices who recognize Roe v. Wade as settled law,\" said a statement from the candidate.\u003c/p>\n\u003cp>And while presumptive GOP nominee Donald Trump's campaign was silent on the issue in the immediate aftermath of the decision, Musgrave said abortion opponents are confident he is on their side. \"Say what you will about Donald Trump, his commitment to nominate pro-life justices — I've never seen another candidate do that,\" she said.\u003c/p>\n\u003cp>\u003cstrong>5. Younger generation will have a lot to say about the future of abortion rights.\u003c/strong>\u003c/p>\n\u003cp>Among the many things the two sides in the abortion debate disagree about is how the younger generation feels about abortion. Polls tend to differ dramatically depending on how the question is asked.\u003c/p>\n\u003cp>Musgrave says, \"Our polling shows more and more millennials are pro-life, particularly when you look at things like 20-week (abortion) bans.\"\u003c/p>\n\u003cp>But Dawn Laguens, executive vice president of Planned Parenthood, says they are seeing the exact opposite — that younger women are more supportive of abortion rights. \"They're so social justice oriented,\" she said.\u003c/p>\n\u003cp>And Laguens says that coming \u003ca href=\"http://www.wsj.com/articles/changing-u-s-demographics-favor-democrats-in-election-report-says-1456376460\" target=\"_blank\">demographic changes\u003c/a>, including a more diverse electorate that could tilt Democratic, are a main reason for the recent spike in anti-abortion legislating.\u003c/p>\n\u003cp>\"They feel it slipping away,\" she said. \"They can see the demographics, too, and they want to lock this stuff in.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. You can follow Julie Rovner\u003c/em>\u003cem> on Twitter:\u003c/em>\u003ca href=\"https://twitter.com/jrovner\">@jrovner\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=5+Things+To+Consider+About+The+Supreme+Court%27s+Decision+On+Texas+Abortion+Law+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Supreme Court this week delivered its strongest affirmation of a women's right to abortion in years. By a margin of 5-3, it struck down two key provisions of a Texas law restricting the procedure.\u003c/p>\n\u003cp>But where does the decision in \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">Whole Woman's Health v. Hellerstedt\u003c/a> fit in the court's long history of actions abortion rights and restrictions? And what effect might the case have on similar laws in other states and this fall's elections? Here are five insights about the case that provide some context:\u003c/p>\n\u003cp>\u003cstrong>1. It's the first big win for supporters of abortion rights in a long time.\u003c/strong>\u003c/p>\n\u003cp>The last time abortion-rights supporters were on the winning side of a big case at the Supreme Court was 16 years ago, when a 5-4 ruling in \u003ca href=\"https://www.oyez.org/cases/1999/99-830\" target=\"_blank\">Stenberg v. Carhart\u003c/a> struck down a Nebraska law banning a specific procedure abortion opponents called \"partial birth abortion.\" That win was effectively reversed in 2007, however, when the court upheld a similar federal law banning the same procedure, also on a 5-4 ruling, in \u003ca href=\"https://www.oyez.org/cases/2006/05-380\" target=\"_blank\">Gonzales v. Carhart\u003c/a>. The substance hadn't changed much, but the replacement of Justice Sandra Day O'Connor with Justice Samuel Alito in 2006 gave abortion opponents an extra vote, which was enough to change the outcome.\u003c/p>\n\u003cp>After Monday's decision, many foes of abortion rights complained that there were few restrictions on abortion that would pass muster with the high court. But, in fact, in the years since the court first legalized abortion nationwide in \u003ca href=\"https://www.oyez.org/cases/1971/70-18\" target=\"_blank\">Roe v. Wade\u003c/a> in 1973, about half the major cases have been clear wins for abortion opponents, including upholding state laws requiring \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/497/502\" target=\"_blank\">parental involvement for minors\u003c/a>, \u003ca href=\"https://www.oyez.org/cases/1991/91-744\" target=\"_blank\">waiting periods\u003c/a>, and \u003ca href=\"https://www.oyez.org/cases/1979/79-1268\" target=\"_blank\">bans on the use of public funds\u003c/a> to pay for abortions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>2. It could put pro-abortion rights forces on the offensive.\u003c/strong>\u003c/p>\n\u003cp>Since Republicans took over Congress and most state legislatures after the 2010 elections, states have enacted \u003ca href=\"https://www.guttmacher.org/article/2016/01/last-five-years-account-more-one-quarter-all-abortion-restrictions-enacted-roe\" target=\"_blank\">nearly 300 separate abortion restrictions\u003c/a>; the most in any five-year period since \u003cem>Roe v. Wade\u003c/em> was decided. Many of those were the same types of \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_TRAP.pdf\" target=\"_blank\">laws claiming protections for women's health\u003c/a> that were struck down by the Supreme Court this week. Those laws include requiring doctors who perform abortions to have admitting privileges at a nearby hospital and requiring abortion clinics to meet the standards of facilities performing more involved surgical procedures.\u003c/p>\n\u003cp>The justices have already responded to petitions from some states with similar laws. Just a day after handing down the Texas ruling, they rejected appeals from \u003ca href=\"http://www.reuters.com/article/us-usa-court-abortion-idUSKCN0ZE1MJ\" target=\"_blank\">Mississippi and Wisconsin\u003c/a>, where physician admitting privilege laws had been blocked by lower court judges. Those laws are now permanently blocked. Officials in \u003ca href=\"http://www.ago.state.al.us/News-863\" target=\"_blank\">Alabama\u003c/a> also dropped their defense of a similar law.\u003c/p>\n\u003cp>But the decision doesn't automatically invalidate similar laws in other states because the effect of such statutes is different in every community. For example, what may amount to an \"undue burden\" in Texas because of the sheer size of the state might not be as burdensome in states with clinics closer together.\u003c/p>\n\u003cp>In states where lower court judges have already blocked laws, those blocks are almost certain to remain in place. But in other states opponents of the restrictions would have to work to overturn each law individually.\u003c/p>\n\u003cp>They say that is what they plan to do. \"We will now will take this fight state by state to challenge and repeal laws all across the country,\" Planned Parenthood President Cecile Richards told reporters in a conference call immediately after the ruling.\u003c/p>\n\u003cp>Planned Parenthood announced on Thursday that it would pursue efforts to block or repeal similar laws in eight states: Arizona, Florida, Michigan, Missouri, Pennsylvania, Tennessee, Texas, and Virginia.\u003c/p>\n\u003cp>Abortion-rights supporters are also taking aim at some long-standing abortion restrictions in federal law. The \u003ca href=\"https://demconvention.com/news/democratic-platform-drafting-meeting-concludes/\" target=\"_blank\">draft Democratic platform\u003c/a> that will be finalized at the party's nominating convention in late July includes a plan calling for the repeal of the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=121402281\" target=\"_blank\">Hyde Amendment\u003c/a>, which has banned most federal abortion funding since 1977. That provision was \u003ca href=\"https://www.hillaryclinton.com/briefing/statements/2016/06/25/statement-from-senior-policy-advisor-maya-harris-on-democratic-platform/\" target=\"_blank\">highlighted and praised\u003c/a> by presumptive nominee Hillary Clinton's campaign, noting that it represents the first time such an explicit vow has been included.\u003c/p>\n\u003cp>\u003cstrong>3. Opponents of abortion rights aren't likely to retreat.\u003c/strong>\u003c/p>\n\u003cp>While the latest Supreme Court ruling was definitely a setback for abortion foes, they are not giving up. For one thing, \u003ca href=\"http://www.prochoiceamerica.org/assets/download-files/2016-wd-report.pdf\" target=\"_blank\">opponents remain in control of a majority\u003c/a> of state legislatures and governorships, and that's unlikely to change following this year's national elections.\u003c/p>\n\u003cp>\"Americans United for Life will continue to fight — in legislatures and in the courts — to protect women from a dangerous and greedy abortion industry,\" said AUL Acting President and Senior Counsel Clarke Forsythe. Americans United for Life has been at the forefront of \u003ca href=\"http://www.npr.org/sections/health-shots/2016/03/04/469094346/legal-foes-in-texas-abortion-case-are-using-new-playbooks\" target=\"_blank\">developing model laws\u003c/a> restricting access to abortion.\u003c/p>\n\u003cp>The movement against abortion rights has a much larger menu to choose from than the two issues the high court addressed. For example, many states (including Texas) have passed or are considering \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">bans on abortion after roughly 20 weeks of pregnancy\u003c/a>. Many of those bans are being \u003ca href=\"http://www.latimes.com/nation/nationnow/la-na-nn-abortion-idaho-20150530-story.html\" target=\"_blank\">challenged in the courts\u003c/a> but none has yet reached the Supreme Court. Other restrictions include requiring pregnant women to have ultrasounds before an abortion, to make multiple visits to an abortion provider and banning the use of \u003ca href=\"http://www.theatlantic.com/business/archive/2014/10/the-safer-more-affordable-abortion-only-available-in-two-states/381321/\" target=\"_blank\">telemedicine\u003c/a> for medical (as opposed to surgical) abortions using the abortion pill \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a600042.html\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>Abortion opponents say they aren't giving up on pursuing health and safety standards like the ones struck down in Texas, either. \"This issue of safety standards is not over,\" said Marilyn Musgrave, vice president of government affairs at Susan B. Anthony List.\u003c/p>\n\u003cp>Even some similar laws could pass muster if they are crafted carefully enough, said Kristi Hamrick, a spokeswoman for Americans United for Life. \"We don't have a one-size-fits-all bill to send to the 50 states,\" she said. \"The law is specific and so the tools must be too.\"\u003c/p>\n\u003cp>\u003cstrong>4. The decision could shake up national politics.\u003c/strong>\u003c/p>\n\u003cp>Both sides in the long-polarized abortion debate are already pointing to the case in an effort to mobilize their supporters.\u003c/p>\n\u003cp>\"This certainly makes the November presidential election even more critical,\" said Musgrave of the Susan B. Anthony List. \"It is so obvious that we need to elect a pro-life president.\"\u003c/p>\n\u003cp>On the opposite side, Ilyse Hogue, president of NARAL Pro-Choice America, says the decision \"underscores what the election means for Supreme Court jurisprudence.\" With one vacancy already on the court and others likely in the next four years, she said, \"reproductive freedom is very much on the ballot this November.\"\u003c/p>\n\u003cp>Hillary Clinton's campaign hailed the decision. \"We need a president who will defend women's health and rights and appoint Supreme Court justices who recognize Roe v. Wade as settled law,\" said a statement from the candidate.\u003c/p>\n\u003cp>And while presumptive GOP nominee Donald Trump's campaign was silent on the issue in the immediate aftermath of the decision, Musgrave said abortion opponents are confident he is on their side. \"Say what you will about Donald Trump, his commitment to nominate pro-life justices — I've never seen another candidate do that,\" she said.\u003c/p>\n\u003cp>\u003cstrong>5. Younger generation will have a lot to say about the future of abortion rights.\u003c/strong>\u003c/p>\n\u003cp>Among the many things the two sides in the abortion debate disagree about is how the younger generation feels about abortion. Polls tend to differ dramatically depending on how the question is asked.\u003c/p>\n\u003cp>Musgrave says, \"Our polling shows more and more millennials are pro-life, particularly when you look at things like 20-week (abortion) bans.\"\u003c/p>\n\u003cp>But Dawn Laguens, executive vice president of Planned Parenthood, says they are seeing the exact opposite — that younger women are more supportive of abortion rights. \"They're so social justice oriented,\" she said.\u003c/p>\n\u003cp>And Laguens says that coming \u003ca href=\"http://www.wsj.com/articles/changing-u-s-demographics-favor-democrats-in-election-report-says-1456376460\" target=\"_blank\">demographic changes\u003c/a>, including a more diverse electorate that could tilt Democratic, are a main reason for the recent spike in anti-abortion legislating.\u003c/p>\n\u003cp>\"They feel it slipping away,\" she said. \"They can see the demographics, too, and they want to lock this stuff in.\"\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 is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. You can follow Julie Rovner\u003c/em>\u003cem> on Twitter:\u003c/em>\u003ca href=\"https://twitter.com/jrovner\">@jrovner\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=5+Things+To+Consider+About+The+Supreme+Court%27s+Decision+On+Texas+Abortion+Law+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Northern California Has Highest Costs in the U.S. to Deliver a Baby",
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"content": "\u003cp>Sacramento and the San Francisco Bay Area ranked as the most expensive places to have a baby of 30 major metropolitan regions in the U.S. according to \u003ca href=\"http://www.castlighthealth.com/press-releases/new-study-shows-huge-cost-differences-for-having-a-baby-often-in-the-same-city/\" target=\"_blank\">an analysis\u003c/a> released Thursday.\u003c/p>\n\u003cp>Sacramento came in first (congrats to you) where a vaginal birth cost $15,420 on average. The San Francisco Bay Area was a close second at $15,204. Minneapolis trailed in third place by almost $4,000, coming in at $11,527, and the least expensive of the 30 largest metropolitan areas surveyed was Kansas City, Missouri, where a vaginal delivery costs an avery $6,075.\u003c/p>\n\u003cp>These are \"routine vaginal deliveries,\" folks. Again, those are \"average\" costs. We'll get to the variation within regions further down.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206296\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/VaginalRoutine-e1467324299747.jpg\" alt=\"VaginalRoutine\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>The numbers were crunched by San Francisco-based Castlight, a health care information company. They looked at medical claims data as well as other information. Since Castlight primarily works with self-insured large companies, it says the costs it crunched include both the employee's out-of-pocket costs and what the employer paid for the delivery.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Birth by Cesarean section typically cost more than vaginal deliveries and did in this survey as well. Sacramento was first at $27,067; the Bay Area was second at $21,799. Portland, Oregon trailed in third at $18,066. The least expensive of the metropolitan areas was Pittsburgh, Penn. at $6,891.\u003c/p>\n\u003cp>Here's the national C-section map:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206320\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/top_30_cities_delivery_maps_csection-e1467325171879.jpg\" alt=\"top_30_cities_delivery_maps_csection\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>But Castlight didn't actually stop at the 30 biggest metropolitan areas. They surveyed 190 areas across the country, including 13 in California.\u003c/p>\n\u003cp>While Sacramento and the Bay Area are the most expensive major regions to have a baby, other, smaller, California cities rank even higher.\u003c/p>\n\u003cp>Here's the list for routine vaginal deliveries in California:\u003c/p>\n\u003cp>Merced $19,191\u003cbr>\nSalinas $17,772\u003cbr>\nSacramento-Yolo $15,420\u003cbr>\nSF-Oakland-San Jose $15,204\u003cbr>\nStockton-Lodi $13,972\u003cbr>\nSan Luis Obispo-Atascadero-Paso Robles $13,926\u003cbr>\nSanta Barbara-Santa Maria-Lompoc $12,219\u003cbr>\nBakersfield $11,055\u003cbr>\nLos Angeles-Riverside-Orange $10,285\u003cbr>\nModesto $9,903\u003cbr>\nSan Diego $9,709\u003cbr>\nChico-Paradise $7,839\u003cbr>\nFresno $7,278\u003c/p>\n\u003cp>In addition to the cost difference between areas, there's tremendous cost variation within regions, too. In the Bay Area, the range for a vaginal delivery is $7,700 to $28,000, a four-fold difference. In Sacramento, it's $4,560 to $24,549, a five-fold difference.\u003c/p>\n\u003cp>Feeling ill yet?\u003c/p>\n\u003cp>If you're wondering why this happens, Kristin Torres Mowat, senior vice president at Castlight, chalked it up to the \"obscure, dysfunctional and inefficient health care market.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"smGr7FZlFDM9IcWYJVq0A3jdEsPJrPIH\"]In Northern California, consolidation on the provider side -- both doctors and hospitals -- helps them to wield market power and drive up costs.\u003c/p>\n\u003cp>The most recent evidence came earlier this month \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">in a study\u003c/a> from USC health economists who pointed, again, to the market power of Sutter Health and Dignity Health.\u003c/p>\n\u003cp>\"Over time, they have acquired physician practices, outpatient clinics, hospitals and have a disproportionate share in the market,\" Mowat said.\u003c/p>\n\u003cp>(Disclaimer that data from Kaiser Permanente was not included in the USC study.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mowat advised that consumers ask for an estimate of costs early in their pregnancy, but that estimate is not always easy to get.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sacramento and the San Francisco Bay Area ranked as the most expensive places to have a baby of 30 major metropolitan regions in the U.S. according to \u003ca href=\"http://www.castlighthealth.com/press-releases/new-study-shows-huge-cost-differences-for-having-a-baby-often-in-the-same-city/\" target=\"_blank\">an analysis\u003c/a> released Thursday.\u003c/p>\n\u003cp>Sacramento came in first (congrats to you) where a vaginal birth cost $15,420 on average. The San Francisco Bay Area was a close second at $15,204. Minneapolis trailed in third place by almost $4,000, coming in at $11,527, and the least expensive of the 30 largest metropolitan areas surveyed was Kansas City, Missouri, where a vaginal delivery costs an avery $6,075.\u003c/p>\n\u003cp>These are \"routine vaginal deliveries,\" folks. Again, those are \"average\" costs. We'll get to the variation within regions further down.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206296\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/VaginalRoutine-e1467324299747.jpg\" alt=\"VaginalRoutine\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>The numbers were crunched by San Francisco-based Castlight, a health care information company. They looked at medical claims data as well as other information. Since Castlight primarily works with self-insured large companies, it says the costs it crunched include both the employee's out-of-pocket costs and what the employer paid for the delivery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Birth by Cesarean section typically cost more than vaginal deliveries and did in this survey as well. Sacramento was first at $27,067; the Bay Area was second at $21,799. Portland, Oregon trailed in third at $18,066. The least expensive of the metropolitan areas was Pittsburgh, Penn. at $6,891.\u003c/p>\n\u003cp>Here's the national C-section map:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-206320\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/top_30_cities_delivery_maps_csection-e1467325171879.jpg\" alt=\"top_30_cities_delivery_maps_csection\" width=\"1920\" height=\"1484\">\u003c/p>\n\u003cp>But Castlight didn't actually stop at the 30 biggest metropolitan areas. They surveyed 190 areas across the country, including 13 in California.\u003c/p>\n\u003cp>While Sacramento and the Bay Area are the most expensive major regions to have a baby, other, smaller, California cities rank even higher.\u003c/p>\n\u003cp>Here's the list for routine vaginal deliveries in California:\u003c/p>\n\u003cp>Merced $19,191\u003cbr>\nSalinas $17,772\u003cbr>\nSacramento-Yolo $15,420\u003cbr>\nSF-Oakland-San Jose $15,204\u003cbr>\nStockton-Lodi $13,972\u003cbr>\nSan Luis Obispo-Atascadero-Paso Robles $13,926\u003cbr>\nSanta Barbara-Santa Maria-Lompoc $12,219\u003cbr>\nBakersfield $11,055\u003cbr>\nLos Angeles-Riverside-Orange $10,285\u003cbr>\nModesto $9,903\u003cbr>\nSan Diego $9,709\u003cbr>\nChico-Paradise $7,839\u003cbr>\nFresno $7,278\u003c/p>\n\u003cp>In addition to the cost difference between areas, there's tremendous cost variation within regions, too. In the Bay Area, the range for a vaginal delivery is $7,700 to $28,000, a four-fold difference. In Sacramento, it's $4,560 to $24,549, a five-fold difference.\u003c/p>\n\u003cp>Feeling ill yet?\u003c/p>\n\u003cp>If you're wondering why this happens, Kristin Torres Mowat, senior vice president at Castlight, chalked it up to the \"obscure, dysfunctional and inefficient health care market.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In Northern California, consolidation on the provider side -- both doctors and hospitals -- helps them to wield market power and drive up costs.\u003c/p>\n\u003cp>The most recent evidence came earlier this month \u003ca href=\"http://inq.sagepub.com/content/53/0046958016651555.full\" target=\"_blank\">in a study\u003c/a> from USC health economists who pointed, again, to the market power of Sutter Health and Dignity Health.\u003c/p>\n\u003cp>\"Over time, they have acquired physician practices, outpatient clinics, hospitals and have a disproportionate share in the market,\" Mowat said.\u003c/p>\n\u003cp>(Disclaimer that data from Kaiser Permanente was not included in the USC study.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mowat advised that consumers ask for an estimate of costs early in their pregnancy, but that estimate is not always easy to get.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "MAP: Here's Where Zika Mosquitoes Are Likely Found in California",
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"headTitle": "MAP: Here’s Where Zika Mosquitoes Are Likely Found in California | KQED",
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"content": "\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" width=\"100%\" height=\"520\" frameborder=\"0\" src=\"https://kqednews.cartodb.com/viz/a482a6ba-39a1-11e6-8dd6-0e674067d321/embed_map\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The first thing to know about the mosquito that can carry Zika is that it is not widespread in California. Most of California’s 58 counties do not have — and have never had — any infestation of the Aedes aegypti mosquito, the most worrisome carrier when it comes to Zika.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has \u003ca href=\"http://jme.oxfordjournals.org/content/early/2016/06/07/jme.tjw072\" target=\"_blank\" rel=\"noopener\">crunched data \u003c/a>from across the country and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/13/481606093/heres-really-where-zika-mosquitoes-are-likely-in-the-u-s\" target=\"_blank\" rel=\"noopener\">created a national map \u003c/a>showing where the Aedes aegypti mosquito has been found any time over the past two decades. We asked CDC for the county-specific data in California. Click on the map above to see how your county fares.\u003c/p>\n\u003cp>If your county has a faint neutral color, then Aedes aegypti has not been found there since 1995. Counties colored red mean the Aedes aegypti has been found in three or more years since 1995, orange means two years and yellow means one. Hover your mouse over the county and see all the years the mosquito has been found. In some cases, the mosquito has not been found there for several years.\u003c/p>\n\u003cp>Even if the mosquito is present in your county, that doesn’t mean it’s widespread in your county. For example, the mosquito has been found in Alameda County — but only in the city of Hayward.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Prof. Thomas Scott, a UC Davis entomologist, says that distribution of the mosquito “tends to be patchy.” Even in places where it’s very common, like Thailand, he said, “distribution will fluctuate, even through the course of a season.”\u003c/p>\n\u003cp>The Aedes aegypti mosquito was introduced to the Americas from Africa, likely on slave ships, perhaps as early as the 16th century, Georgetown historian \u003ca href=\"http://www.cnn.com/2016/02/15/health/mosquitoes-that-changed-history/\" target=\"_blank\" rel=\"noopener\">Prof. John McNeill told CNN\u003c/a>. Along with it came yellow fever, dengue, chikungunya and now Zika virus.\u003c/p>\n\u003cp>While the spread of the virus has been very rapid across much of South and Central America, Scott says it is less likely to spread as swiftly in the U.S. primarily because “our lifestyle is different than places where [many] people are infected.”\u003c/p>\n\u003cp>In the U.S. window screens or air conditioning are common, so mosquitoes are less likely to be in people’s homes. In Central and South America, people’s homes are more open, the “mosquitoes move frequently [in homes] and bite frequently,” Scott noted.\u003c/p>\n\u003cp>Case in point: the Aedes aegypti mosquito has been present across southern Arizona “for a long time,” Scott says, but the risk of dengue fever in Arizona is low. Meanwhile, just across the border in Mexico, the risk of dengue to people is much higher.\u003c/p>\n\u003cp>Zika spreads when a mosquito bites a person who is infected. Then the mosquito becomes infected itself. But Scott says it cannot spread Zika to another person right away. The virus must replicate within the mosquito first. Then the virus must travel to the insect’s salivary glands and replicate there. Only then has the mosquito moved from being infected to being infective, Scott said, and that takes awhile.\u003c/p>\n\u003cp>“That period of time is about the average life span of the mosquito, 10-14 days, for them to become infective,” Scott says. In other words, it’s possible the mosquito could die before it’s able to infect another person.\u003c/p>\n\u003cp>Zika can also be sexually transmitted and a pregnant women can transmit the virus to her fetus during pregnancy, \u003ca href=\"http://www.cdc.gov/zika/pdfs/fs-zika-basics.pdf\" target=\"_blank\" rel=\"noopener\">according to the CDC.\u003c/a>\u003c/p>\n\u003cp>The California Department of Public Health \u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/AedesDistributionMap.pdf\" target=\"_blank\" rel=\"noopener\">lists the cities\u003c/a> where Aedes aegypti has been found. It did not get back to us by deadline to tell us when the mosquito was found in these places.\u003c/p>\n\u003cp>\u003cstrong>Alameda: \u003c/strong>Hayward\u003c/p>\n\u003cp>\u003cstrong>Fresno: \u003c/strong>Clovis, Fowler, Fresno, Kerman, Mendota, Sanger\u003c/p>\n\u003cp>\u003cstrong>Imperial:\u003c/strong> Andrade, Brawley, Calexico, El Centro, Heber, Holtville, Imperial, Seeley\u003c/p>\n\u003cp>\u003cstrong>Kern\u003c/strong> Arvin\u003c/p>\n\u003cp>\u003cstrong>Los Angeles: \u003c/strong>Commerce, East Los Angeles, Florence, La Mirada,Los Angeles, Maywood, Montebello, Pico Rivera, South Gate\u003c/p>\n\u003cp>\u003cstrong>Madera: \u003c/strong>Madera, Madera Ranchos, Parkwood\u003c/p>\n\u003cp>\u003cstrong>Orange\u003c/strong> Anaheim, Costa Mesa, Garden Grove, Lake Forest, Mission Viejo, Orange, Santa Ana\u003c/p>\n\u003cp>\u003cstrong>Riverside\u003c/strong> Coachella, Riverside, San Jacinto\u003c/p>\n\u003cp>\u003cstrong>San Bernardino: \u003c/strong>Colton, Montclair\u003c/p>\n\u003cp>\u003cstrong>San Diego:\u003c/strong> Bonita, Chula Vista, El Cajon, Escondido, Imperial Beach, Oceanside, San Diego, Spring Valley, Tecate, Vista\u003c/p>\n\u003cp>\u003cstrong>San Mateo:\u003c/strong> Atherton, Menlo Park\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Tulare:\u003c/strong> Exeter\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" width=\"100%\" height=\"520\" frameborder=\"0\" src=\"https://kqednews.cartodb.com/viz/a482a6ba-39a1-11e6-8dd6-0e674067d321/embed_map\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The first thing to know about the mosquito that can carry Zika is that it is not widespread in California. Most of California’s 58 counties do not have — and have never had — any infestation of the Aedes aegypti mosquito, the most worrisome carrier when it comes to Zika.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has \u003ca href=\"http://jme.oxfordjournals.org/content/early/2016/06/07/jme.tjw072\" target=\"_blank\" rel=\"noopener\">crunched data \u003c/a>from across the country and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/13/481606093/heres-really-where-zika-mosquitoes-are-likely-in-the-u-s\" target=\"_blank\" rel=\"noopener\">created a national map \u003c/a>showing where the Aedes aegypti mosquito has been found any time over the past two decades. We asked CDC for the county-specific data in California. Click on the map above to see how your county fares.\u003c/p>\n\u003cp>If your county has a faint neutral color, then Aedes aegypti has not been found there since 1995. Counties colored red mean the Aedes aegypti has been found in three or more years since 1995, orange means two years and yellow means one. Hover your mouse over the county and see all the years the mosquito has been found. In some cases, the mosquito has not been found there for several years.\u003c/p>\n\u003cp>Even if the mosquito is present in your county, that doesn’t mean it’s widespread in your county. For example, the mosquito has been found in Alameda County — but only in the city of Hayward.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Prof. Thomas Scott, a UC Davis entomologist, says that distribution of the mosquito “tends to be patchy.” Even in places where it’s very common, like Thailand, he said, “distribution will fluctuate, even through the course of a season.”\u003c/p>\n\u003cp>The Aedes aegypti mosquito was introduced to the Americas from Africa, likely on slave ships, perhaps as early as the 16th century, Georgetown historian \u003ca href=\"http://www.cnn.com/2016/02/15/health/mosquitoes-that-changed-history/\" target=\"_blank\" rel=\"noopener\">Prof. John McNeill told CNN\u003c/a>. Along with it came yellow fever, dengue, chikungunya and now Zika virus.\u003c/p>\n\u003cp>While the spread of the virus has been very rapid across much of South and Central America, Scott says it is less likely to spread as swiftly in the U.S. primarily because “our lifestyle is different than places where [many] people are infected.”\u003c/p>\n\u003cp>In the U.S. window screens or air conditioning are common, so mosquitoes are less likely to be in people’s homes. In Central and South America, people’s homes are more open, the “mosquitoes move frequently [in homes] and bite frequently,” Scott noted.\u003c/p>\n\u003cp>Case in point: the Aedes aegypti mosquito has been present across southern Arizona “for a long time,” Scott says, but the risk of dengue fever in Arizona is low. Meanwhile, just across the border in Mexico, the risk of dengue to people is much higher.\u003c/p>\n\u003cp>Zika spreads when a mosquito bites a person who is infected. Then the mosquito becomes infected itself. But Scott says it cannot spread Zika to another person right away. The virus must replicate within the mosquito first. Then the virus must travel to the insect’s salivary glands and replicate there. Only then has the mosquito moved from being infected to being infective, Scott said, and that takes awhile.\u003c/p>\n\u003cp>“That period of time is about the average life span of the mosquito, 10-14 days, for them to become infective,” Scott says. In other words, it’s possible the mosquito could die before it’s able to infect another person.\u003c/p>\n\u003cp>Zika can also be sexually transmitted and a pregnant women can transmit the virus to her fetus during pregnancy, \u003ca href=\"http://www.cdc.gov/zika/pdfs/fs-zika-basics.pdf\" target=\"_blank\" rel=\"noopener\">according to the CDC.\u003c/a>\u003c/p>\n\u003cp>The California Department of Public Health \u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/AedesDistributionMap.pdf\" target=\"_blank\" rel=\"noopener\">lists the cities\u003c/a> where Aedes aegypti has been found. It did not get back to us by deadline to tell us when the mosquito was found in these places.\u003c/p>\n\u003cp>\u003cstrong>Alameda: \u003c/strong>Hayward\u003c/p>\n\u003cp>\u003cstrong>Fresno: \u003c/strong>Clovis, Fowler, Fresno, Kerman, Mendota, Sanger\u003c/p>\n\u003cp>\u003cstrong>Imperial:\u003c/strong> Andrade, Brawley, Calexico, El Centro, Heber, Holtville, Imperial, Seeley\u003c/p>\n\u003cp>\u003cstrong>Kern\u003c/strong> Arvin\u003c/p>\n\u003cp>\u003cstrong>Los Angeles: \u003c/strong>Commerce, East Los Angeles, Florence, La Mirada,Los Angeles, Maywood, Montebello, Pico Rivera, South Gate\u003c/p>\n\u003cp>\u003cstrong>Madera: \u003c/strong>Madera, Madera Ranchos, Parkwood\u003c/p>\n\u003cp>\u003cstrong>Orange\u003c/strong> Anaheim, Costa Mesa, Garden Grove, Lake Forest, Mission Viejo, Orange, Santa Ana\u003c/p>\n\u003cp>\u003cstrong>Riverside\u003c/strong> Coachella, Riverside, San Jacinto\u003c/p>\n\u003cp>\u003cstrong>San Bernardino: \u003c/strong>Colton, Montclair\u003c/p>\n\u003cp>\u003cstrong>San Diego:\u003c/strong> Bonita, Chula Vista, El Cajon, Escondido, Imperial Beach, Oceanside, San Diego, Spring Valley, Tecate, Vista\u003c/p>\n\u003cp>\u003cstrong>San Mateo:\u003c/strong> Atherton, Menlo Park\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Tulare:\u003c/strong> Exeter\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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"radiolab": {
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"reveal": {
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},
"rightnowish": {
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"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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},
"science-friday": {
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"info": "Science Friday is a weekly science talk show, broadcast live over public radio stations nationwide. Each week, the show focuses on science topics that are in the news and tries to bring an educated, balanced discussion to bear on the scientific issues at hand. Panels of expert guests join host Ira Flatow, a veteran science journalist, to discuss science and to take questions from listeners during the call-in portion of the program.",
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"snap-judgment": {
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"title": "Snap Judgment",
"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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},
"soldout": {
"id": "soldout",
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