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"content": "\u003cp>This is not a diagnostic of Omar Mateen. The motivations of the shooter who killed 49 people at a gay club in Orlando are complex and unclear.\u003c/p>\n\u003cp>We know that Mateen frequented the Pulse dance club many times -- perhaps \"for years,\" \u003ca href=\"http://www.usatoday.com/story/news/2016/06/13/pulse-patrons-mateen-drank-club-before/85852008/\" target=\"_blank\">USA Today reports\u003c/a> -- before making it the target of his attack, and met men through Jack’d, a gay hook-up app. But we don’t know whether those actions were strategic reconnaissance, or the conflicted psychological backdrop for a vicious attack.\u003c/p>\n\u003cp>The homophobic nature of the attack is clear. But whether Mateen was expressing some form of internalized homophobia about his own sexual attractions is not.\u003c/p>\n\u003cp>Leaving Mateen aside, researchers have found that homophobia is more pronounced in individuals with an unacknowledged attraction to the same sex, particularly people who grew up with controlling, authoritarian parents who made clear that such desires were unacceptable.\u003c/p>\n\u003cp>“When people are trying to suppress something in themselves, they can find someone else who is expressing that attitude threatening,” said Richard Ryan, a psychology professor at the University of Rochester. “It’s kind of a transfer of self-loathing to loathing of other people who are expressing what you can’t.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Ryan was one of the researchers who conducted a \u003ca href=\"http://psycnet.apa.org/journals/psp/102/4/815/\" target=\"_blank\">series of studies \u003c/a>that found empirical evidence that fear, anxiety, or hostility toward gay and lesbian people on behalf of seemingly heterosexual people can grow from their own repressed same-sex desires.\u003c/p>\n\u003cp>The researchers say this dynamic may be reflected in some high profile cases where figures like evangelical preacher\u003ca href=\"http://www.nytimes.com/2006/11/05/us/05haggard.html?rref=collection%2Ftimestopic%2FHaggard%2C%20Ted&action=click&contentCollection=timestopics®ion=stream&module=stream_unit&version=latest&contentPlacement=71&pgtype=collection\" target=\"_blank\"> Ted Haggard\u003c/a>, or former national Young Republican Federation president \u003ca href=\"http://www.wdrb.com/story/8581955/former-prominent-party-leader-sentenced-to-prison\" target=\"_blank\">Glenn Murphy, Jr\u003c/a>., who were vehemently opposed to gay marriage, but then later were involved in gay sex scandals.\u003c/p>\n\u003cp>“There’s an internal war and an external war going on,” said Will Ryan from UC Santa Barbara, another researcher from the study, and son of lead author Richard Ryan. “People are not really identifying as gay, but they need to defend against it. They have to attack others in order to do that.”\u003c/p>\n\u003cp>He says it’s possible that the Orlando shooter may have been struggling with some level of same-sex desire and feeling a deep sense of shame around that.\u003c/p>\n\u003cp>Overwhelmingly, for many people who do identify as LGBT and who experience stigma and shame from their parents or society, the internal conflict remains internal, in the form of mental health conditions or substance abuse.\u003c/p>\n\u003cp>People who are LGBT are almost three times as likely than others to experience major depression or anxiety. LGBT youth are four times as likely to attempt suicide or have suicidal thoughts. And an estimated 20-30 percent of LGBT people abuse drugs or alcohol, compared to 9 percent of the general population.\u003c/p>\n\u003cp>But there does seem to be a role that homophobia plays in many acts of mass violence.\u003c/p>\n\u003cp>In evaluating all school shootings that took place in the U.S. between 1982 and 2001, researchers found that all the shootings were committed by boys, and nearly all of the boys were persistently bullied, beat up, and “gay-baited.” That is, other students called them “faggot,” “queer,” or “homo,” grabbed them in the hallways, or spread rumors that they were in gay relationships, whether they were or not.\u003c/p>\n\u003cp>In fact, Michael Kimmel, a sociology professor at Stony Brook University and lead author of \u003ca href=\"http://abs.sagepub.com/content/46/10/1439.abstract\" target=\"_blank\">the study\u003c/a>, says there’s no evidence that any of the shooters were gay.\u003c/p>\n\u003cp>Instead, he says, they were being targeted because they didn’t measure up to American standards of masculinity. They were \"shy, bookish, honor students, artistic, musical, theatrical, non-athletic, geekish, or weird,\" the authors wrote in the study.\u003c/p>\n\u003cp>“Our society conceptualizes masculinity as being strong, tough, and not gay,\" Will Ryan says.\u003c/p>\n\u003cp>This plays a pivotal role in school shootings, Kimmel argues. In the study, the authors say that “homophobia is far less about the irrational fears of gay people, or the fears that one might actually be gay or have gay tendencies, and more the fears that \u003cem>heterosexuals \u003c/em>have that others might \u003cem>(mis)perceive them as gay\u003c/em>.” [Emphasis theirs.]\u003c/p>\n\u003cp>Kimmel says the prevalence of homophobic bullying and violence is “staggering.”\u003c/p>\n\u003cp>“For some boys, high school is a constant homophobic gauntlet and they may respond by becoming withdrawn and sullen, using drugs or alcohol, becoming depressed or suicidal, or acting out in a blaze of overcompensating violent glory.”\u003c/p>\n\u003cp>Will Ryan says it’s impossible to ignore the role of masculine and heterosexual norms in what happened in Orlando.\u003c/p>\n\u003cp>“It’s not just an individual who’s perpetrating these things,” Ryan says. “He doesn’t come out of nowhere. Smaller versions of this are playing out all the time.”\u003c/p>\n\u003cp>He sees the shooting as part of a broader backlash against LGBT people in response to recent advancements in gay marriage rights, and rules around bathroom access for transgender individuals. In the last year or so, Ryan has noticed more anti-gay speakers visiting his campus, UC Santa Barbara, more hate speech, and more LGBT students seeking mental health services.\u003c/p>\n\u003cp>For mental health clinicians who are on the front lines, treating those in the LGBT community, their main concern is how the Orlando shooting might further traumatize their patients.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“For many of my clients, they have a history of feeling not accepted, judged or devalued because of their sexual minority status,” says Keith Hermanstyne, a psychiatrist at the Alliance Health Project at UC San Francisco. “For people with any significant history of chronic trauma, this event is really reactivating those feelings of not feeling safe in the world.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>This is not a diagnostic of Omar Mateen. The motivations of the shooter who killed 49 people at a gay club in Orlando are complex and unclear.\u003c/p>\n\u003cp>We know that Mateen frequented the Pulse dance club many times -- perhaps \"for years,\" \u003ca href=\"http://www.usatoday.com/story/news/2016/06/13/pulse-patrons-mateen-drank-club-before/85852008/\" target=\"_blank\">USA Today reports\u003c/a> -- before making it the target of his attack, and met men through Jack’d, a gay hook-up app. But we don’t know whether those actions were strategic reconnaissance, or the conflicted psychological backdrop for a vicious attack.\u003c/p>\n\u003cp>The homophobic nature of the attack is clear. But whether Mateen was expressing some form of internalized homophobia about his own sexual attractions is not.\u003c/p>\n\u003cp>Leaving Mateen aside, researchers have found that homophobia is more pronounced in individuals with an unacknowledged attraction to the same sex, particularly people who grew up with controlling, authoritarian parents who made clear that such desires were unacceptable.\u003c/p>\n\u003cp>“When people are trying to suppress something in themselves, they can find someone else who is expressing that attitude threatening,” said Richard Ryan, a psychology professor at the University of Rochester. “It’s kind of a transfer of self-loathing to loathing of other people who are expressing what you can’t.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ryan was one of the researchers who conducted a \u003ca href=\"http://psycnet.apa.org/journals/psp/102/4/815/\" target=\"_blank\">series of studies \u003c/a>that found empirical evidence that fear, anxiety, or hostility toward gay and lesbian people on behalf of seemingly heterosexual people can grow from their own repressed same-sex desires.\u003c/p>\n\u003cp>The researchers say this dynamic may be reflected in some high profile cases where figures like evangelical preacher\u003ca href=\"http://www.nytimes.com/2006/11/05/us/05haggard.html?rref=collection%2Ftimestopic%2FHaggard%2C%20Ted&action=click&contentCollection=timestopics®ion=stream&module=stream_unit&version=latest&contentPlacement=71&pgtype=collection\" target=\"_blank\"> Ted Haggard\u003c/a>, or former national Young Republican Federation president \u003ca href=\"http://www.wdrb.com/story/8581955/former-prominent-party-leader-sentenced-to-prison\" target=\"_blank\">Glenn Murphy, Jr\u003c/a>., who were vehemently opposed to gay marriage, but then later were involved in gay sex scandals.\u003c/p>\n\u003cp>“There’s an internal war and an external war going on,” said Will Ryan from UC Santa Barbara, another researcher from the study, and son of lead author Richard Ryan. “People are not really identifying as gay, but they need to defend against it. They have to attack others in order to do that.”\u003c/p>\n\u003cp>He says it’s possible that the Orlando shooter may have been struggling with some level of same-sex desire and feeling a deep sense of shame around that.\u003c/p>\n\u003cp>Overwhelmingly, for many people who do identify as LGBT and who experience stigma and shame from their parents or society, the internal conflict remains internal, in the form of mental health conditions or substance abuse.\u003c/p>\n\u003cp>People who are LGBT are almost three times as likely than others to experience major depression or anxiety. LGBT youth are four times as likely to attempt suicide or have suicidal thoughts. And an estimated 20-30 percent of LGBT people abuse drugs or alcohol, compared to 9 percent of the general population.\u003c/p>\n\u003cp>But there does seem to be a role that homophobia plays in many acts of mass violence.\u003c/p>\n\u003cp>In evaluating all school shootings that took place in the U.S. between 1982 and 2001, researchers found that all the shootings were committed by boys, and nearly all of the boys were persistently bullied, beat up, and “gay-baited.” That is, other students called them “faggot,” “queer,” or “homo,” grabbed them in the hallways, or spread rumors that they were in gay relationships, whether they were or not.\u003c/p>\n\u003cp>In fact, Michael Kimmel, a sociology professor at Stony Brook University and lead author of \u003ca href=\"http://abs.sagepub.com/content/46/10/1439.abstract\" target=\"_blank\">the study\u003c/a>, says there’s no evidence that any of the shooters were gay.\u003c/p>\n\u003cp>Instead, he says, they were being targeted because they didn’t measure up to American standards of masculinity. They were \"shy, bookish, honor students, artistic, musical, theatrical, non-athletic, geekish, or weird,\" the authors wrote in the study.\u003c/p>\n\u003cp>“Our society conceptualizes masculinity as being strong, tough, and not gay,\" Will Ryan says.\u003c/p>\n\u003cp>This plays a pivotal role in school shootings, Kimmel argues. In the study, the authors say that “homophobia is far less about the irrational fears of gay people, or the fears that one might actually be gay or have gay tendencies, and more the fears that \u003cem>heterosexuals \u003c/em>have that others might \u003cem>(mis)perceive them as gay\u003c/em>.” [Emphasis theirs.]\u003c/p>\n\u003cp>Kimmel says the prevalence of homophobic bullying and violence is “staggering.”\u003c/p>\n\u003cp>“For some boys, high school is a constant homophobic gauntlet and they may respond by becoming withdrawn and sullen, using drugs or alcohol, becoming depressed or suicidal, or acting out in a blaze of overcompensating violent glory.”\u003c/p>\n\u003cp>Will Ryan says it’s impossible to ignore the role of masculine and heterosexual norms in what happened in Orlando.\u003c/p>\n\u003cp>“It’s not just an individual who’s perpetrating these things,” Ryan says. “He doesn’t come out of nowhere. Smaller versions of this are playing out all the time.”\u003c/p>\n\u003cp>He sees the shooting as part of a broader backlash against LGBT people in response to recent advancements in gay marriage rights, and rules around bathroom access for transgender individuals. In the last year or so, Ryan has noticed more anti-gay speakers visiting his campus, UC Santa Barbara, more hate speech, and more LGBT students seeking mental health services.\u003c/p>\n\u003cp>For mental health clinicians who are on the front lines, treating those in the LGBT community, their main concern is how the Orlando shooting might further traumatize their patients.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“For many of my clients, they have a history of feeling not accepted, judged or devalued because of their sexual minority status,” says Keith Hermanstyne, a psychiatrist at the Alliance Health Project at UC San Francisco. “For people with any significant history of chronic trauma, this event is really reactivating those feelings of not feeling safe in the world.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Philadelphia became the first major U.S. city with a soda tax on Thursday despite a multimillion-dollar campaign by the beverage industry to block it.\u003c/p>\n\u003cp>Only Berkeley, Calif. has a similar law, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\">approved by voters\u003c/a> 3 to 1 in 2014 -- a penny-an-ounce tax on sugar sweetened drinks. Proceeds are used to fund health programs.\u003c/p>\n\u003cp>Philadelphia took a slightly different approach. Its new tax — approved by the City Council 13-4 Thursday morning — is 1.5 cents per ounce on both sugar sweetened and artificially sweetened drinks. The bulk of the money raised, estimated to be $90 million, will be used to fund universal pre-kindergarten.\u003c/p>\n\u003cp>\"Thanks to the tireless advocacy of educators, parents, rec center volunteers and so many others,” Democratic Mayor Jim Kenney said after the vote, “Philadelphia made a historic investment in our neighborhoods and in our education system today.”\u003c/p>\n\u003cp>The soda industry spent millions of dollars in advertising against the proposal, arguing the tax would be costly to consumers. The plan also attracted national attention and dollars, with former New York Mayor Michael Bloomberg and Texas billionaires John and Laura Arnold, advocates for less consumption of sugary drinks, funding ads in support.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The American Beverage Association called the soda tax \"discriminatory and highly unpopular.”\u003c/p>\n\u003cp>\"The tax passed today is a regressive tax that unfairly singles out beverages, including low- and no-calorie choices,\" it said a statement.\u003c/p>\n\u003cp>In 2014, the beverage association spent big in the San Francisco and Berkeley efforts to pass a soda tax. While San Francisco’s effort got a majority of the vote, it did not reach the two-thirds supermajority threshold it needed and failed.\u003c/p>\n\u003cp>The passage of such a tax in Philadelphia, a major city struggling with poverty, is “really significant,” said Juliet Sims with the Oakland-based advocacy group Prevention Institute. Berkeley and Philadelphia are two “very different places. I feel that we’ve demonstrated that (a soda tax) is doable.”\u003c/p>\n\u003cp>This November, voters in Berkeley’s neighbors \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/oakland-city-council-puts-soda-tax-on-november-ballot/\" target=\"_blank\">Oakland\u003c/a> and Albany will consider a soda tax very much like the one on the books in Berkeley — a penny-per-ounce, paid on sugar sweetened drinks (and not artificially flavored ones). In each city, an advisory board will recommend to the city council health programs to fund.\u003c/p>\n\u003cp>Later this month, the San Francisco Board of Supervisors is expected to place a soda tax on the November ballot, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/12/san-francisco-soda-tax-in-jeopardy-signatures-submitted-day-late/\" target=\"_blank\">after missing a deadline\u003c/a> to deliver signatures for a voter-led ballot initiative.\u003c/p>\n\u003cp>While the passage of a soda tax in Philadelphia is a “huge boon” for local efforts, there is “already momentum and credibility in the Bay Area” for a soda tax, Sims said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Philadelphia became the first major U.S. city with a soda tax on Thursday despite a multimillion-dollar campaign by the beverage industry to block it.\u003c/p>\n\u003cp>Only Berkeley, Calif. has a similar law, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\">approved by voters\u003c/a> 3 to 1 in 2014 -- a penny-an-ounce tax on sugar sweetened drinks. Proceeds are used to fund health programs.\u003c/p>\n\u003cp>Philadelphia took a slightly different approach. Its new tax — approved by the City Council 13-4 Thursday morning — is 1.5 cents per ounce on both sugar sweetened and artificially sweetened drinks. The bulk of the money raised, estimated to be $90 million, will be used to fund universal pre-kindergarten.\u003c/p>\n\u003cp>\"Thanks to the tireless advocacy of educators, parents, rec center volunteers and so many others,” Democratic Mayor Jim Kenney said after the vote, “Philadelphia made a historic investment in our neighborhoods and in our education system today.”\u003c/p>\n\u003cp>The soda industry spent millions of dollars in advertising against the proposal, arguing the tax would be costly to consumers. The plan also attracted national attention and dollars, with former New York Mayor Michael Bloomberg and Texas billionaires John and Laura Arnold, advocates for less consumption of sugary drinks, funding ads in support.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The American Beverage Association called the soda tax \"discriminatory and highly unpopular.”\u003c/p>\n\u003cp>\"The tax passed today is a regressive tax that unfairly singles out beverages, including low- and no-calorie choices,\" it said a statement.\u003c/p>\n\u003cp>In 2014, the beverage association spent big in the San Francisco and Berkeley efforts to pass a soda tax. While San Francisco’s effort got a majority of the vote, it did not reach the two-thirds supermajority threshold it needed and failed.\u003c/p>\n\u003cp>The passage of such a tax in Philadelphia, a major city struggling with poverty, is “really significant,” said Juliet Sims with the Oakland-based advocacy group Prevention Institute. Berkeley and Philadelphia are two “very different places. I feel that we’ve demonstrated that (a soda tax) is doable.”\u003c/p>\n\u003cp>This November, voters in Berkeley’s neighbors \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/oakland-city-council-puts-soda-tax-on-november-ballot/\" target=\"_blank\">Oakland\u003c/a> and Albany will consider a soda tax very much like the one on the books in Berkeley — a penny-per-ounce, paid on sugar sweetened drinks (and not artificially flavored ones). In each city, an advisory board will recommend to the city council health programs to fund.\u003c/p>\n\u003cp>Later this month, the San Francisco Board of Supervisors is expected to place a soda tax on the November ballot, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/12/san-francisco-soda-tax-in-jeopardy-signatures-submitted-day-late/\" target=\"_blank\">after missing a deadline\u003c/a> to deliver signatures for a voter-led ballot initiative.\u003c/p>\n\u003cp>While the passage of a soda tax in Philadelphia is a “huge boon” for local efforts, there is “already momentum and credibility in the Bay Area” for a soda tax, Sims said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Budget Includes Limit on Medi-Cal Estate Recovery",
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"content": "\u003cp>California's \u003ca href=\"http://ww2.kqed.org/news/2016/06/15/legislature-approves-122-billion-general-fund-budget\" target=\"_blank\">$122 billion general fund budget\u003c/a> includes money to dramatically limit a practice advocates had long lobbied against -- the seizure of assets, after death, of people who had received health insurance coverage through the state's Medi-Cal program.\u003c/p>\n\u003cp>The federal government requires that states recover money for nursing home care. But it also gives states the option to recover costs of general medical care -- hospitalizations and doctors visits -- for people 55 and over. California had chosen to participate in this additional \"estate recovery program,\" meaning that low income people risked having their homes and other generally modest savings seized after their death.\u003c/p>\n\u003cp>Such seizure is not required in other health programs, such as Social Security, Medicare or Covered California.\u003c/p>\n\u003cp>The new budget includes $30 million to limit Medi-Cal estate recovery only to that required by federal law.\u003c/p>\n\u003cp>Pat McGinniss, executive director of California Advocates for Nursing Home Reform, called it a \"great day\" that she has been fighting for since 1993 when then-governor Republican Pete Wilson included the \"draconian bill\" in the state's budget. Most states did not pursue this optional recovery program.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Instead of destabilizing low income communities, it allows people to not worry about losing everything if they go on Medi-Cal,\" McGinniss said.\u003c/p>\n\u003cp>For three years, Sen. Ed Hernandez, D-West Covina,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/03/24/on-medi-cal-now-lose-your-house-later/\" target=\"_blank\"> had backed the effort\u003c/a> to limit the scope of California's estate recovery. Under the new budget, Medi-Cal estate recovery is limited to that required by federal law.\u003c/p>\n\u003cp>“Estate recovery forces people over age 55 who need Medi-Cal to choose between their own health care and passing on modest possessions to their heirs,” Hernandez said in a statement. “It is a huge victory that this year’s budget limits estate recovery so that people with modest family homes can pass it on to their children.”\u003c/p>\n\u003cp>The law goes into effect Jan. 1. People 55 and over who are on Medi-Cal for general health services and die this year may still face estate recovery.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Estate recovery is still required for people who receive nursing home care paid for by Medi-Cal.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California's \u003ca href=\"http://ww2.kqed.org/news/2016/06/15/legislature-approves-122-billion-general-fund-budget\" target=\"_blank\">$122 billion general fund budget\u003c/a> includes money to dramatically limit a practice advocates had long lobbied against -- the seizure of assets, after death, of people who had received health insurance coverage through the state's Medi-Cal program.\u003c/p>\n\u003cp>The federal government requires that states recover money for nursing home care. But it also gives states the option to recover costs of general medical care -- hospitalizations and doctors visits -- for people 55 and over. California had chosen to participate in this additional \"estate recovery program,\" meaning that low income people risked having their homes and other generally modest savings seized after their death.\u003c/p>\n\u003cp>Such seizure is not required in other health programs, such as Social Security, Medicare or Covered California.\u003c/p>\n\u003cp>The new budget includes $30 million to limit Medi-Cal estate recovery only to that required by federal law.\u003c/p>\n\u003cp>Pat McGinniss, executive director of California Advocates for Nursing Home Reform, called it a \"great day\" that she has been fighting for since 1993 when then-governor Republican Pete Wilson included the \"draconian bill\" in the state's budget. Most states did not pursue this optional recovery program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Instead of destabilizing low income communities, it allows people to not worry about losing everything if they go on Medi-Cal,\" McGinniss said.\u003c/p>\n\u003cp>For three years, Sen. Ed Hernandez, D-West Covina,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/03/24/on-medi-cal-now-lose-your-house-later/\" target=\"_blank\"> had backed the effort\u003c/a> to limit the scope of California's estate recovery. Under the new budget, Medi-Cal estate recovery is limited to that required by federal law.\u003c/p>\n\u003cp>“Estate recovery forces people over age 55 who need Medi-Cal to choose between their own health care and passing on modest possessions to their heirs,” Hernandez said in a statement. “It is a huge victory that this year’s budget limits estate recovery so that people with modest family homes can pass it on to their children.”\u003c/p>\n\u003cp>The law goes into effect Jan. 1. People 55 and over who are on Medi-Cal for general health services and die this year may still face estate recovery.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Estate recovery is still required for people who receive nursing home care paid for by Medi-Cal.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Stand-alone Family Planning Clinics Struggle to Survive in Age of Obamacare",
"title": "Why Stand-alone Family Planning Clinics Struggle to Survive in Age of Obamacare",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The wellness center at San Francisco's Mission High School is a busy place during lunch time. Students linger in the reception area and halls, en route to see therapists and the school's nurse, Mary-Michael Watts.\u003c/p>\n\u003cp>In her small office, Watts sees young patients with a range of concerns, from stomach aches to mental health needs. A big part of her job is counseling students on how to prevent unplanned pregnancies and sexually transmitted diseases, a major health concern in San Francisco. The county is among the highest for chlamydia and gonorrhea rates \u003ca href=\"http://www.cdph.ca.gov/data/statistics/pages/stddata.aspx\" target=\"_blank\">in the state\u003c/a>, according to the California Department of Public Health.\u003c/p>\n\u003cp>For free checkups, testing, treatment and contraceptives, Watts has referred hundreds of students -- many of whom are low income -- to the New Generation Health Center, about a mile from Mission High. The clinic has provided free reproductive health services to teens and young adults for 20 years, and Watts considers New Generation a key resource.\u003c/p>\n\u003cp>\"Everything they do is reproductive health related,\" Watts says. \"They have a heightened radar and sensitivity to any kind of abuse that might be taking place and to the general well-being of the student that might be missed in a primary health clinic.\"\u003c/p>\n\u003cfigure id=\"attachment_198168\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-198168 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19853_IMG_0008-qut.jpg\" alt=\"Mission High nurse Mary-Michael Watts listens to a patient at the school's wellness center. Watts considers New Generation a key resource for students.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mission High nurse Mary-Michael Watts listens to a patient at the school's wellness center. Watts considers New Generation a key resource for low income teens in the Mission area.\u003c/figcaption>\u003c/figure>\n\u003cp>So Watts and her young patients were shocked to learn that New Generation was supposed to close down in July due to financial troubles. The UC San Francisco family planning clinic has lost patients for years and became financially unsustainable, university officials say.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The news did not sit well with dozens of supporters who protested UCSF's closure plans and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/06/mission-save-beloved-uc-san-francisco-clinic/\">vowed to save the clinic\u003c/a>. After a growing outcry, UCSF Chancellor Sam Hawgood \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/11/uc-san-francisco-drops-plans-to-close-mission-clinic/\">agreed last month\u003c/a> to cover New Generation's budget deficit of about $400,000 -- for one year. But Hawgood stressed the clinic remains on shaky financial footing and must still find long-term solutions.\u003c/p>\n\u003cp>New Generation's troubles stem in part from the very specialization in reproductive health that has made it such a valuable resource for young patients in the Mission District, say experts. They contend that the Affordable Care Act has changed the business model for clinics like this, forcing most to transform by adding primary care services or merging with other health centers in order to remain competitive.\u003c/p>\n\u003cp>\u003cstrong>Obamacare Shifts Business Model for Family Planning Clinics\u003c/strong>\u003c/p>\n\u003cp>New Generation saw about 2,200 patients last year, 27 percent less than in 2011, says Dr. Rebecca Jackson, who supervises the clinic. Jackson took the initial decision to close New Generation after the clinic lost foundation grants -- a key source of revenue -- and dipped into the red.\u003c/p>\n\u003cp>\"Over the years, we tried everything we could think of actually to keep it open and just came up against a wall,\" says Jackson, an obstetrics and gynecology professor at UCSF.\u003c/p>\n\u003cp>Jackson attributes New Generation's loss of patients in part to the Affordable Care Act.\u003c/p>\n\u003cp>Since the Affordable Care Act was fully implemented in January, 2014, nearly five million low-income Californians have \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_December_2015_ADA.pdf\">gained Medi-Cal insurance\u003c/a>. Those newly insured can now get medical services from head to toe at primary care clinics that also offer reproductive health. That's why Jackson doesn't see New Generation getting a lot more patients back any time soon.\u003c/p>\n\u003cp>Even when patients with Medi-Cal choose New Generation for their reproductive health care, those payments are not enough to keep the clinic afloat, says Jackson, as Medi-Cal's reimbursement rates are among the lowest in the nation.\u003c/p>\n\u003cp>New Generation's main source of patient revenue had been a more generous program than Medi-Cal, the state's Family Planning, Access, Care, and Treatment program, or Family PACT. But that program has seen significant drops in enrollment as more people gained comprehensive insurance.\u003c/p>\n\u003cp>The clinic saw these changes coming, says Jackson, but wasn't able to adapt successfully.\u003c/p>\n\u003cp>\"We tried a lot of different kinds of things to keep it open, like partnering with a primary care clinic, for example, or potentially getting another clinic to take us over, and it was difficult and couldn't get anyone to do those things,\" says Jackson.\u003c/p>\n\u003cp>UCSF is now forming working groups with community members to figure out how to salvage these services for low-income teens in San Francisco, either through keeping New Generation open or through other providers.\u003c/p>\n\u003cfigure id=\"attachment_180822\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-180822 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19400_IMG_9941-qut.jpg\" alt=\"Dr. Rebecca Jackson, New Generation's main supervisor, and Dr. Valerie French (right), medical director, listen to speakers at a community forum in April about the potential closure of New Generation. After the meeting, Jackson said she was hopeful New Generation could find more funds to stay open "given the huge outpouring of concerned people." \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rebecca Jackson, (left), New Generation's main supervisor, and Dr. Valerie French, medical director, listen to speakers at a community forum in April about the potential closure of New Generation. After the meeting, Jackson said she was hopeful the clinic could find more funds to stay open \"given the huge outpouring of concerned people.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Family Planning Centers Transform\u003c/strong>\u003c/p>\n\u003cp>Other reproductive health centers, such as Planned Parenthood, have added more kinds of services or merged with other clinics in order to stay competitive in the age of Obamacare, says Amy Moy from the California Family Health Council. The agency is responsible for distributing federal funds for family planning to more than 60 health organizations. That money trickles down to 340 health centers statewide.\u003c/p>\n\u003cp>While mergers can cut down costs, adding comprehensive health services allows clinics to potentially become \u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare%E2%80%A6\" target=\"_blank\">federally qualified health centers\u003c/a>, with enhanced reimbursement from Medicare and Medi-Cal and other benefits.\u003c/p>\n\u003cp>Clinics like New Generation face a tough road to stay in business unless they change, Moy says.\u003c/p>\n\u003cp>\"The numbers of family planning health centers that are stand-alone or women's health centers that provide primarily family planning services really are dwindling,\" Moy says. \"And we anticipate that trend to continue.\"\u003c/p>\n\u003cp>Still, she says these types of clinics remain important -- especially for adolescents who value confidentiality.\u003c/p>\n\u003cp>\"A big fear is if there is a loss of those safe spaces that teens won't ... access these services that they need to stay safe and help prevent unintended pregnancy,\" Moy says.\u003c/p>\n\u003cp>\u003cstrong>Teen Patients Prefer Confidential Services\u003c/strong>\u003c/p>\n\u003cp>Mission High student Damaris Bonner says she prefers New Generation to other clinics in the area, and its potential closure is frustrating.\u003c/p>\n\u003cp>\"That’s the one clinic I felt comfortable at,\" says Bonner, 17. \"It makes no sense to close it down.\"\u003c/p>\n\u003cfigure id=\"attachment_198166\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-198166\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut.jpg\" alt=\"Mission High student Damaris Bonner, 17, at the school's wellness center. Bonner has been a patient at New Generation for nearly two years and says she prefers the clinic to others in the area.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mission High student Damaris Bonner, 17, at the school's wellness center. Bonner has been a patient at New Generation for nearly two years and says she prefers the clinic to others in the area.\u003c/figcaption>\u003c/figure>\n\u003cp>Like other patients, Bonner likes New Generation's confidential services. Because it's a space dedicated to youth, she doesn't fear running into parents or aunties there. Another plus is that the small clinic offers same-day appointments that are hard to come by elsewhere.\u003c/p>\n\u003cp>Other clinics offer reproductive health in the area, which UCSF officials say ameliorates any impact of a potential closure to patients. Still, Bonner feels local teens would face extra barriers to access reproductive health if New Generation closes. She resents that a clinic she and other young people trust could be \"taken away.\"\u003c/p>\n\u003cp>\"It's like, why? Let us youth take care of ourselves,\" says Bonner, who has been a patient at New Generation for nearly two years. \"It's crucial that we have these tools for us because when we don't that's when you start seeing unplanned pregnancies and STDs.\"\u003c/p>\n\u003cp>Mission High's nurse Watts is following closely developments about New Generation. She fears losing the clinic could translate to unplanned pregnancies and STDs among students .\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"It kind of terrifies me to think that I might not be able to pick up the phone and call them,\" says Watts. \"New Generation is an integral part of my job.\"\u003c/p>\n\n",
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"description": "Since the Affordable Care Act was fully implemented, the newly insured can now get medical services at primary care clinics that also offer reproductive health.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The wellness center at San Francisco's Mission High School is a busy place during lunch time. Students linger in the reception area and halls, en route to see therapists and the school's nurse, Mary-Michael Watts.\u003c/p>\n\u003cp>In her small office, Watts sees young patients with a range of concerns, from stomach aches to mental health needs. A big part of her job is counseling students on how to prevent unplanned pregnancies and sexually transmitted diseases, a major health concern in San Francisco. The county is among the highest for chlamydia and gonorrhea rates \u003ca href=\"http://www.cdph.ca.gov/data/statistics/pages/stddata.aspx\" target=\"_blank\">in the state\u003c/a>, according to the California Department of Public Health.\u003c/p>\n\u003cp>For free checkups, testing, treatment and contraceptives, Watts has referred hundreds of students -- many of whom are low income -- to the New Generation Health Center, about a mile from Mission High. The clinic has provided free reproductive health services to teens and young adults for 20 years, and Watts considers New Generation a key resource.\u003c/p>\n\u003cp>\"Everything they do is reproductive health related,\" Watts says. \"They have a heightened radar and sensitivity to any kind of abuse that might be taking place and to the general well-being of the student that might be missed in a primary health clinic.\"\u003c/p>\n\u003cfigure id=\"attachment_198168\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-198168 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19853_IMG_0008-qut.jpg\" alt=\"Mission High nurse Mary-Michael Watts listens to a patient at the school's wellness center. Watts considers New Generation a key resource for students.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19853_IMG_0008-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mission High nurse Mary-Michael Watts listens to a patient at the school's wellness center. Watts considers New Generation a key resource for low income teens in the Mission area.\u003c/figcaption>\u003c/figure>\n\u003cp>So Watts and her young patients were shocked to learn that New Generation was supposed to close down in July due to financial troubles. The UC San Francisco family planning clinic has lost patients for years and became financially unsustainable, university officials say.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The news did not sit well with dozens of supporters who protested UCSF's closure plans and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/06/mission-save-beloved-uc-san-francisco-clinic/\">vowed to save the clinic\u003c/a>. After a growing outcry, UCSF Chancellor Sam Hawgood \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/11/uc-san-francisco-drops-plans-to-close-mission-clinic/\">agreed last month\u003c/a> to cover New Generation's budget deficit of about $400,000 -- for one year. But Hawgood stressed the clinic remains on shaky financial footing and must still find long-term solutions.\u003c/p>\n\u003cp>New Generation's troubles stem in part from the very specialization in reproductive health that has made it such a valuable resource for young patients in the Mission District, say experts. They contend that the Affordable Care Act has changed the business model for clinics like this, forcing most to transform by adding primary care services or merging with other health centers in order to remain competitive.\u003c/p>\n\u003cp>\u003cstrong>Obamacare Shifts Business Model for Family Planning Clinics\u003c/strong>\u003c/p>\n\u003cp>New Generation saw about 2,200 patients last year, 27 percent less than in 2011, says Dr. Rebecca Jackson, who supervises the clinic. Jackson took the initial decision to close New Generation after the clinic lost foundation grants -- a key source of revenue -- and dipped into the red.\u003c/p>\n\u003cp>\"Over the years, we tried everything we could think of actually to keep it open and just came up against a wall,\" says Jackson, an obstetrics and gynecology professor at UCSF.\u003c/p>\n\u003cp>Jackson attributes New Generation's loss of patients in part to the Affordable Care Act.\u003c/p>\n\u003cp>Since the Affordable Care Act was fully implemented in January, 2014, nearly five million low-income Californians have \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_December_2015_ADA.pdf\">gained Medi-Cal insurance\u003c/a>. Those newly insured can now get medical services from head to toe at primary care clinics that also offer reproductive health. That's why Jackson doesn't see New Generation getting a lot more patients back any time soon.\u003c/p>\n\u003cp>Even when patients with Medi-Cal choose New Generation for their reproductive health care, those payments are not enough to keep the clinic afloat, says Jackson, as Medi-Cal's reimbursement rates are among the lowest in the nation.\u003c/p>\n\u003cp>New Generation's main source of patient revenue had been a more generous program than Medi-Cal, the state's Family Planning, Access, Care, and Treatment program, or Family PACT. But that program has seen significant drops in enrollment as more people gained comprehensive insurance.\u003c/p>\n\u003cp>The clinic saw these changes coming, says Jackson, but wasn't able to adapt successfully.\u003c/p>\n\u003cp>\"We tried a lot of different kinds of things to keep it open, like partnering with a primary care clinic, for example, or potentially getting another clinic to take us over, and it was difficult and couldn't get anyone to do those things,\" says Jackson.\u003c/p>\n\u003cp>UCSF is now forming working groups with community members to figure out how to salvage these services for low-income teens in San Francisco, either through keeping New Generation open or through other providers.\u003c/p>\n\u003cfigure id=\"attachment_180822\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-180822 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19400_IMG_9941-qut.jpg\" alt=\"Dr. Rebecca Jackson, New Generation's main supervisor, and Dr. Valerie French (right), medical director, listen to speakers at a community forum in April about the potential closure of New Generation. After the meeting, Jackson said she was hopeful New Generation could find more funds to stay open "given the huge outpouring of concerned people." \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19400_IMG_9941-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rebecca Jackson, (left), New Generation's main supervisor, and Dr. Valerie French, medical director, listen to speakers at a community forum in April about the potential closure of New Generation. After the meeting, Jackson said she was hopeful the clinic could find more funds to stay open \"given the huge outpouring of concerned people.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Family Planning Centers Transform\u003c/strong>\u003c/p>\n\u003cp>Other reproductive health centers, such as Planned Parenthood, have added more kinds of services or merged with other clinics in order to stay competitive in the age of Obamacare, says Amy Moy from the California Family Health Council. The agency is responsible for distributing federal funds for family planning to more than 60 health organizations. That money trickles down to 340 health centers statewide.\u003c/p>\n\u003cp>While mergers can cut down costs, adding comprehensive health services allows clinics to potentially become \u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare%E2%80%A6\" target=\"_blank\">federally qualified health centers\u003c/a>, with enhanced reimbursement from Medicare and Medi-Cal and other benefits.\u003c/p>\n\u003cp>Clinics like New Generation face a tough road to stay in business unless they change, Moy says.\u003c/p>\n\u003cp>\"The numbers of family planning health centers that are stand-alone or women's health centers that provide primarily family planning services really are dwindling,\" Moy says. \"And we anticipate that trend to continue.\"\u003c/p>\n\u003cp>Still, she says these types of clinics remain important -- especially for adolescents who value confidentiality.\u003c/p>\n\u003cp>\"A big fear is if there is a loss of those safe spaces that teens won't ... access these services that they need to stay safe and help prevent unintended pregnancy,\" Moy says.\u003c/p>\n\u003cp>\u003cstrong>Teen Patients Prefer Confidential Services\u003c/strong>\u003c/p>\n\u003cp>Mission High student Damaris Bonner says she prefers New Generation to other clinics in the area, and its potential closure is frustrating.\u003c/p>\n\u003cp>\"That’s the one clinic I felt comfortable at,\" says Bonner, 17. \"It makes no sense to close it down.\"\u003c/p>\n\u003cfigure id=\"attachment_198166\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-198166\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut.jpg\" alt=\"Mission High student Damaris Bonner, 17, at the school's wellness center. Bonner has been a patient at New Generation for nearly two years and says she prefers the clinic to others in the area.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19851_Damaris-Bonner-edit-2-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Mission High student Damaris Bonner, 17, at the school's wellness center. Bonner has been a patient at New Generation for nearly two years and says she prefers the clinic to others in the area.\u003c/figcaption>\u003c/figure>\n\u003cp>Like other patients, Bonner likes New Generation's confidential services. Because it's a space dedicated to youth, she doesn't fear running into parents or aunties there. Another plus is that the small clinic offers same-day appointments that are hard to come by elsewhere.\u003c/p>\n\u003cp>Other clinics offer reproductive health in the area, which UCSF officials say ameliorates any impact of a potential closure to patients. Still, Bonner feels local teens would face extra barriers to access reproductive health if New Generation closes. She resents that a clinic she and other young people trust could be \"taken away.\"\u003c/p>\n\u003cp>\"It's like, why? Let us youth take care of ourselves,\" says Bonner, who has been a patient at New Generation for nearly two years. \"It's crucial that we have these tools for us because when we don't that's when you start seeing unplanned pregnancies and STDs.\"\u003c/p>\n\u003cp>Mission High's nurse Watts is following closely developments about New Generation. She fears losing the clinic could translate to unplanned pregnancies and STDs among students .\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It kind of terrifies me to think that I might not be able to pick up the phone and call them,\" says Watts. \"New Generation is an integral part of my job.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Montana's 'Pain Refugees' Find Relief in California",
"title": "Montana's 'Pain Refugees' Find Relief in California",
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"content": "\u003cp>They call themselves pain refugees.\u003c/p>\n\u003cp>Every 90 days, three patients from Montana fly to California to get a prescription for opioids.\u003c/p>\n\u003caside class=\"pullquote alignright\">“I just want humanitarian care, and I get that in California.”\u003ccite> Gary Snook, Montana resident \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>As the U.S. faces an epidemic of overdose deaths from prescription painkillers, some patients with chronic pain say doctors are less likely to prescribe them opioids. Some Montana patients say the only way they can get the treatment they need is to fly out of state.\u003c/p>\n\u003cp>On a mid-afternoon flight out of Missoula, Montana, Gary Snook pauses in the aisle in front of seat 17B. He stretches with a slight wince and sits down.\u003c/p>\n\u003cp>“My pain, it is all from my waist down. It’s like being boiled in oil 24-hours a day,” Snook said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He has been in severe pain since he had surgery on his spine for a ruptured disk 14 years ago.\u003c/p>\n\u003cp>Snook says he's done all kinds of things to try to get better. “I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises,” he said. “I’ve tried everything that anyone has ever suggested me to try.”\u003c/p>\n\u003cp>He says the only thing that works is opioids. But when he tries to get them in Montana, he says the doctors treat him like a criminal.\u003c/p>\n\u003cp>“I just want humanitarian care,\" Snook says. “And I get that in California.”\u003c/p>\n\u003cp>In the last 15 years, \u003ca href=\"http://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\">the rate of overdose deaths\u003c/a> from opioids has quadrupled in the U.S.\u003c/p>\n\u003cfigure id=\"attachment_196562\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196562\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Waiting_Room-e1465662580220.jpg\" alt=\" Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\" width=\"1920\" height=\"1382\">\u003cfigcaption class=\"wp-caption-text\">Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\u003c/figcaption>\u003c/figure>\n\u003cp>The Centers for Disease Control and Prevention recently released\u003ca href=\"https://www.dea.gov/divisions/hq/2014/hq082114.shtml\" target=\"_blank\"> guidelines\u003c/a> to curb the overprescribing of opioids for chronic pain, and the Drug Enforcement Administration increased oversight and sanctions for doctors who overprescribe the drugs.\u003c/p>\n\u003cp>Some Montana doctors say these federal actions are scaring them away from taking on new pain patients.\u003c/p>\n\u003cp>“A lot of the chronic pain doctors are dropping out of the business, says Charles Farmer with the state’s medical board. \"One of the reasons is because they don't want the DEA following them around.”\u003c/p>\n\u003cp>The Montana medical board suspended the license of physician Mark Ibsen this year for overprescribing.\u003c/p>\n\u003cp>“We as physicians are terrified that we are going to go to prison or lose our license over prescribing pain pills to patients,” Ibsen said.\u003c/p>\n\u003cp>He denies he was overprescribing and is appealing the suspension of his license. But he shut down his practice in Helena anyway.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268892215\" 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>Pain management has always been hard, Ibsen says, and all the oversight is interfering with the doctor-patient relationship.\u003c/p>\n\u003cp>“The thing is there is no objective measurement of pain. If you don’t take people at their word that they are in pain, and you are suspicious of them, you can’t have a therapeutic relationship,” Ibsen says. “No miracles happen between you and me -- as a patient and a doctor -- if I suspect that you’re a scumbag.”\u003c/p>\n\u003cp>The Montana Board of Medical Examiners Executive Director Ian Marquand says he couldn’t say whether the board’s disciplinary actions have had an impact on patients’ access to opioids.\u003c/p>\n\u003cp>“The door is open in Montana for any qualified, competent physician to come in and practice,” Marquand said.\u003c/p>\n\u003cp>For some Montana pain patients, like Gary Snook, relief is only found at a strip mall clinic in suburban Los Angeles.\u003c/p>\n\u003cp>His doctor is Forest Tennant, a former army physician who opened his first pain clinic in 1975. Today, He has about 150 patients –- half of them are Californians and half are from out-of-state.\u003c/p>\n\u003cp>“The last week or two has just been unbearable,\" Tennant says. \"We hardly want to (answer) the phones, the number of people calling that want to come here.\"\u003c/p>\n\u003cfigure id=\"attachment_196563\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196563\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Tennant_Office-e1465662716555.jpg\" alt=\"Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\" width=\"1920\" height=\"1339\">\u003cfigcaption class=\"wp-caption-text\">Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\u003c/figcaption>\u003c/figure>\n\u003cp>He says California has laws that Montana and other states don’t, including the \u003ca href=\"http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=124001-125000&file=124960-124961\" target=\"_blank\">Pain Patient’s Bill of Rights\u003c/a>. It allows a patient to request or reject the use of any technique in order to relieve their pain.\u003c/p>\n\u003cp>Tennant says that’s coupled with intensive physician training in all the other ways to treat pain before turning to opioids.\u003c/p>\n\u003cp>“They are the last resort, when there is no other option. You don’t use them until everything else has failed,” Tennant said.\u003c/p>\n\u003cp>He says opioids shouldn’t be stigmatized, they should be used responsibly.\u003c/p>\n\u003cp>A recent CDC report shows that California has the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a2.htm\" target=\"_blank\">second lowest prescribing rate \u003c/a>for opioid pain relievers.\u003c/p>\n\u003cp>Tennant is now helping pain patients in Montana lobby lawmakers to guarantee more access to opioids in their home state, so people like Gary Snook don’t need to travel so far for a prescription.\u003c/p>\n\u003cp>“I mean, it’s life and death in that bottle. At least it’s my life,” Snook said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He says he just wants to visit a doctor near his home and be seen as patient, not a criminal.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>They call themselves pain refugees.\u003c/p>\n\u003cp>Every 90 days, three patients from Montana fly to California to get a prescription for opioids.\u003c/p>\n\u003caside class=\"pullquote alignright\">“I just want humanitarian care, and I get that in California.”\u003ccite> Gary Snook, Montana resident \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>As the U.S. faces an epidemic of overdose deaths from prescription painkillers, some patients with chronic pain say doctors are less likely to prescribe them opioids. Some Montana patients say the only way they can get the treatment they need is to fly out of state.\u003c/p>\n\u003cp>On a mid-afternoon flight out of Missoula, Montana, Gary Snook pauses in the aisle in front of seat 17B. He stretches with a slight wince and sits down.\u003c/p>\n\u003cp>“My pain, it is all from my waist down. It’s like being boiled in oil 24-hours a day,” Snook said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He has been in severe pain since he had surgery on his spine for a ruptured disk 14 years ago.\u003c/p>\n\u003cp>Snook says he's done all kinds of things to try to get better. “I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises,” he said. “I’ve tried everything that anyone has ever suggested me to try.”\u003c/p>\n\u003cp>He says the only thing that works is opioids. But when he tries to get them in Montana, he says the doctors treat him like a criminal.\u003c/p>\n\u003cp>“I just want humanitarian care,\" Snook says. “And I get that in California.”\u003c/p>\n\u003cp>In the last 15 years, \u003ca href=\"http://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\">the rate of overdose deaths\u003c/a> from opioids has quadrupled in the U.S.\u003c/p>\n\u003cfigure id=\"attachment_196562\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196562\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Waiting_Room-e1465662580220.jpg\" alt=\" Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\" width=\"1920\" height=\"1382\">\u003cfigcaption class=\"wp-caption-text\">Kathy Snook, Terri Anderson and Gary Snook waiting in Dr. Forest Tennant’s office in West Covina, California. Gary Snook travels from Montana to California every three months for a pain medication prescription.\u003c/figcaption>\u003c/figure>\n\u003cp>The Centers for Disease Control and Prevention recently released\u003ca href=\"https://www.dea.gov/divisions/hq/2014/hq082114.shtml\" target=\"_blank\"> guidelines\u003c/a> to curb the overprescribing of opioids for chronic pain, and the Drug Enforcement Administration increased oversight and sanctions for doctors who overprescribe the drugs.\u003c/p>\n\u003cp>Some Montana doctors say these federal actions are scaring them away from taking on new pain patients.\u003c/p>\n\u003cp>“A lot of the chronic pain doctors are dropping out of the business, says Charles Farmer with the state’s medical board. \"One of the reasons is because they don't want the DEA following them around.”\u003c/p>\n\u003cp>The Montana medical board suspended the license of physician Mark Ibsen this year for overprescribing.\u003c/p>\n\u003cp>“We as physicians are terrified that we are going to go to prison or lose our license over prescribing pain pills to patients,” Ibsen said.\u003c/p>\n\u003cp>He denies he was overprescribing and is appealing the suspension of his license. But he shut down his practice in Helena anyway.\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/268892215&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/268892215'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Pain management has always been hard, Ibsen says, and all the oversight is interfering with the doctor-patient relationship.\u003c/p>\n\u003cp>“The thing is there is no objective measurement of pain. If you don’t take people at their word that they are in pain, and you are suspicious of them, you can’t have a therapeutic relationship,” Ibsen says. “No miracles happen between you and me -- as a patient and a doctor -- if I suspect that you’re a scumbag.”\u003c/p>\n\u003cp>The Montana Board of Medical Examiners Executive Director Ian Marquand says he couldn’t say whether the board’s disciplinary actions have had an impact on patients’ access to opioids.\u003c/p>\n\u003cp>“The door is open in Montana for any qualified, competent physician to come in and practice,” Marquand said.\u003c/p>\n\u003cp>For some Montana pain patients, like Gary Snook, relief is only found at a strip mall clinic in suburban Los Angeles.\u003c/p>\n\u003cp>His doctor is Forest Tennant, a former army physician who opened his first pain clinic in 1975. Today, He has about 150 patients –- half of them are Californians and half are from out-of-state.\u003c/p>\n\u003cp>“The last week or two has just been unbearable,\" Tennant says. \"We hardly want to (answer) the phones, the number of people calling that want to come here.\"\u003c/p>\n\u003cfigure id=\"attachment_196563\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196563\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Tennant_Office-e1465662716555.jpg\" alt=\"Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\" width=\"1920\" height=\"1339\">\u003cfigcaption class=\"wp-caption-text\">Dr. Forest Tennant treats pain patients from all over the country at his practice in West Covina, California.\u003c/figcaption>\u003c/figure>\n\u003cp>He says California has laws that Montana and other states don’t, including the \u003ca href=\"http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=124001-125000&file=124960-124961\" target=\"_blank\">Pain Patient’s Bill of Rights\u003c/a>. It allows a patient to request or reject the use of any technique in order to relieve their pain.\u003c/p>\n\u003cp>Tennant says that’s coupled with intensive physician training in all the other ways to treat pain before turning to opioids.\u003c/p>\n\u003cp>“They are the last resort, when there is no other option. You don’t use them until everything else has failed,” Tennant said.\u003c/p>\n\u003cp>He says opioids shouldn’t be stigmatized, they should be used responsibly.\u003c/p>\n\u003cp>A recent CDC report shows that California has the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a2.htm\" target=\"_blank\">second lowest prescribing rate \u003c/a>for opioid pain relievers.\u003c/p>\n\u003cp>Tennant is now helping pain patients in Montana lobby lawmakers to guarantee more access to opioids in their home state, so people like Gary Snook don’t need to travel so far for a prescription.\u003c/p>\n\u003cp>“I mean, it’s life and death in that bottle. At least it’s my life,” Snook said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He says he just wants to visit a doctor near his home and be seen as patient, not a criminal.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Three women climb the stairs of a beautiful Victorian in San Francisco. They hold nothing in their hands, but they bring a precious gift. These women are members of the Threshold Choir, and the home they are visiting is the Zen Hospice Project. They sing to people at the last threshold of life, and today, when they reach the second floor, they find Luca Sager, a 38-year-old chef with terminal brain cancer.\u003c/p>\n\u003cp>Sager’s hands, tattooed with a salt and pepper shakers, rest on the top of his covers as he listens as the women sing, a cappella:\u003c/p>\n\u003cp>\u003cem>You are not alone\u003cbr>\nI am here now\u003cbr>\nWe are not alone\u003cbr>\nWe are here together\u003c/em>\u003c/p>\n\u003cp>Sager speaks slowly through medication and pain. He says peace fills him when the women sing. “It feels like a good time for me to gather my feelings about gratitude and being calm and appreciation. I just smile a lot.”\u003c/p>\n\u003cp>Kate Munger founded the Threshold Choir in Marin County and the East Bay 16 years ago. She says it grew out of her own experience of sitting with a friend of who was dying of AIDS back in the '90s.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It was very distressing to see him comatose and agitated,” Munger recalls. “I did what I did at the time when I was nervous or afraid, and I started singing -- instinctively.”\u003c/p>\n\u003cp>She says her friend “calmed, settled and got positively serene,” and her own feelings mirrored those of her dying friend. “I felt like I had discovered, or rediscovered, something -- an ancient practice that tribal humans do for one another when someone’s struggling.”\u003c/p>\n\u003cfigure id=\"attachment_196124\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196124 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg\" alt=\"Threshold Choir_Web 2\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Luca Sager, 38, who is terminally ill with brain cancer, listens to the Threshold Choir. They are \"an act of care,\" he says. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://thresholdchoir.org\" target=\"_blank\">Threshold Choir\u003c/a> has spread since then -- across North America and to other countries. It is devoted to lifting others up, to creating a place for reflection, especially for people who may be outside the traditional reaches of religion. The singers speak of the healing quality of music and the power of the human voice to soothe and to make beautiful the process of dying, which is so often accompanied by great fear.\u003c/p>\n\u003cp>Choir singer Katharine Rose Kirner says she knows what it is like to lie powerless in bed facing the fear of death. In 2001, as the country was reeling from the 9/11 attacks, Kirner faced a different kind of threat, a brain tumor the size of a grapefruit. She says she was gripped by fear of death and feelings she had not done what she needed to do in her life. She vowed to do something “important” if she recuperated.\u003c/p>\n\u003cp>When she did eventually heal, she learned of the Threshold Choir and became a devoted member singing at least once a week. She says being part of the choir has given her a chance to see how gentle dying can be.\u003c/p>\n\u003cp>“Most of us think of death as an event, but it’s a process,\" she says. \"That gave me great comfort.” Watching the process has moved her to think of what she wants at her own death, something she says she would not have contemplated without being in the choir. \"I would have sat in the fear.”\u003c/p>\n\u003cfigure id=\"attachment_196122\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196122 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg\" alt=\"Threshold Choir__Web 3\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Kate Munger, founder of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Singer Peggy Cadbury, a retired nurse, saw a fair amount of death while working in hospital settings. But as a member of the choir, she has the chance to tend to the dying with a different intention. \u003c/p>\n\u003cp>“When you're nursing at the bedside of somebody who is dying, you're constantly concerned about their physical wellbeing, their pain level, ” Cadbury says. But as a member of the choir, “I can just be there to hold space for that person in the room and create an environment of comfort and caring.”\u003c/p>\n\u003cp>Munger says the harmonies are particularly powerful in creating a sense of calm and wellbeing. “It’s a visceral experience. It’s not just the ears; it's full body absorption of vibration.”\u003c/p>\n\u003cp>Cadbury says singing quietly and softly the simple songs written by choir members is much like singing a lullaby to a child. \u003c/p>\n\u003cp>“It is like a gentle caress, and it feels right,” she says.\u003c/p>\n\u003cp>Sager, the patient, says the singing not only helps bring him emotional calm, but it also reduces the physical pain he has in his head around the tumor.\u003c/p>\n\u003cp>Research suggests that listening to live music can help reduce pain in palliative care patients. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23017609\" target=\"_blank\">2012 study\u003c/a> found that patients found that patients who had the harp played to them for 20 minutes -- along with breathing exercises and visualization -- reported a significant decrease in pain compared to a control group.\u003c/p>\n\u003cp>Registered nurse and certified music therapist Kathy Jo Gutgsell at University Hospitals in Cleveland was lead author of the study. She believes music “may awaken the body’s own endorphins\" -- those much-chased-after chemicals that make us feel better about the world.\u003c/p>\n\u003cp>The human brain \"doesn’t multitask very well,\" she explains. \"When we are paying attention to the music, we can't pay attention to the pain.” \u003c/p>\n\u003cp>Gutgsell says music is tied to memories and can connect us to times of great joy and sadness. “I think humans are hardwired for music. Some people think we were singing before we were speaking back at the beginning of humanity.”\u003c/p>\n\u003cp>The Threshold Choir singers say they, too, are helped by the act of singing together and for a person in need. “You see them calm, and then you calm, and it’s a reciprocal thing,” Cadbury says.\u003c/p>\n\u003cp>Kirner says singing in the choir is one of the best things in her life. “I get a sense of purpose.” Choir singers may benefit in other ways. A growing body of research finds that people who take part in choral singing have a better sense of wellbeing than those who don’t sing.\u003c/p>\n\u003cfigure id=\"attachment_196125\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196125 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg\" alt=\"Threshold Choir_Web 1-1\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left, Peggy Cadbury, Katharine Rose Kirner and Karen Mooney, members of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The research suggests that singing itself can raise levels of oxytocin, the hormone associated with trust and bonding. So people who sing in chorus may feel a strong bond with those they sing with together. Right now in San Francisco, a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/20/in-san-francisco-seniors-are-singing-for-science/\" target=\"_blank\"> five-year study is underway\u003c/a> looking at both the possible physical and emotional benefits of choral singing for seniors.\u003c/p>\n\u003cp>Munger says songs are “ethereal, evanescent, and mysterious” and she believes they can serve as a bridge “from the purely physical, temporal, body experience ... to what lies beyond.”\u003c/p>\n\u003cp>As for Cadbury, she says watching others die has helped her frame her daily life and what she hopes for her death. “Singing at the bedside of people who are dying has helped me appreciate being alive, has made more feel more alive and more into being the moment and enjoy life. I hope that when I am on the threshold someone will come and sing to me these beautiful, peaceful songs of comfort.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Sager, the patient, says he believes as human beings our purpose in life is to be givers however we can. He says he did that as a chef, serving homemade nourishing food. He says he is proud of the Threshold Choir for offering their songs as a gift, “to receive that gift is an act of love and support, an act of care, which is what I need most in my life right now.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three women climb the stairs of a beautiful Victorian in San Francisco. They hold nothing in their hands, but they bring a precious gift. These women are members of the Threshold Choir, and the home they are visiting is the Zen Hospice Project. They sing to people at the last threshold of life, and today, when they reach the second floor, they find Luca Sager, a 38-year-old chef with terminal brain cancer.\u003c/p>\n\u003cp>Sager’s hands, tattooed with a salt and pepper shakers, rest on the top of his covers as he listens as the women sing, a cappella:\u003c/p>\n\u003cp>\u003cem>You are not alone\u003cbr>\nI am here now\u003cbr>\nWe are not alone\u003cbr>\nWe are here together\u003c/em>\u003c/p>\n\u003cp>Sager speaks slowly through medication and pain. He says peace fills him when the women sing. “It feels like a good time for me to gather my feelings about gratitude and being calm and appreciation. I just smile a lot.”\u003c/p>\n\u003cp>Kate Munger founded the Threshold Choir in Marin County and the East Bay 16 years ago. She says it grew out of her own experience of sitting with a friend of who was dying of AIDS back in the '90s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It was very distressing to see him comatose and agitated,” Munger recalls. “I did what I did at the time when I was nervous or afraid, and I started singing -- instinctively.”\u003c/p>\n\u003cp>She says her friend “calmed, settled and got positively serene,” and her own feelings mirrored those of her dying friend. “I felt like I had discovered, or rediscovered, something -- an ancient practice that tribal humans do for one another when someone’s struggling.”\u003c/p>\n\u003cfigure id=\"attachment_196124\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196124 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg\" alt=\"Threshold Choir_Web 2\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Luca Sager, 38, who is terminally ill with brain cancer, listens to the Threshold Choir. They are \"an act of care,\" he says. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://thresholdchoir.org\" target=\"_blank\">Threshold Choir\u003c/a> has spread since then -- across North America and to other countries. It is devoted to lifting others up, to creating a place for reflection, especially for people who may be outside the traditional reaches of religion. The singers speak of the healing quality of music and the power of the human voice to soothe and to make beautiful the process of dying, which is so often accompanied by great fear.\u003c/p>\n\u003cp>Choir singer Katharine Rose Kirner says she knows what it is like to lie powerless in bed facing the fear of death. In 2001, as the country was reeling from the 9/11 attacks, Kirner faced a different kind of threat, a brain tumor the size of a grapefruit. She says she was gripped by fear of death and feelings she had not done what she needed to do in her life. She vowed to do something “important” if she recuperated.\u003c/p>\n\u003cp>When she did eventually heal, she learned of the Threshold Choir and became a devoted member singing at least once a week. She says being part of the choir has given her a chance to see how gentle dying can be.\u003c/p>\n\u003cp>“Most of us think of death as an event, but it’s a process,\" she says. \"That gave me great comfort.” Watching the process has moved her to think of what she wants at her own death, something she says she would not have contemplated without being in the choir. \"I would have sat in the fear.”\u003c/p>\n\u003cfigure id=\"attachment_196122\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196122 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg\" alt=\"Threshold Choir__Web 3\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Kate Munger, founder of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Singer Peggy Cadbury, a retired nurse, saw a fair amount of death while working in hospital settings. But as a member of the choir, she has the chance to tend to the dying with a different intention. \u003c/p>\n\u003cp>“When you're nursing at the bedside of somebody who is dying, you're constantly concerned about their physical wellbeing, their pain level, ” Cadbury says. But as a member of the choir, “I can just be there to hold space for that person in the room and create an environment of comfort and caring.”\u003c/p>\n\u003cp>Munger says the harmonies are particularly powerful in creating a sense of calm and wellbeing. “It’s a visceral experience. It’s not just the ears; it's full body absorption of vibration.”\u003c/p>\n\u003cp>Cadbury says singing quietly and softly the simple songs written by choir members is much like singing a lullaby to a child. \u003c/p>\n\u003cp>“It is like a gentle caress, and it feels right,” she says.\u003c/p>\n\u003cp>Sager, the patient, says the singing not only helps bring him emotional calm, but it also reduces the physical pain he has in his head around the tumor.\u003c/p>\n\u003cp>Research suggests that listening to live music can help reduce pain in palliative care patients. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23017609\" target=\"_blank\">2012 study\u003c/a> found that patients found that patients who had the harp played to them for 20 minutes -- along with breathing exercises and visualization -- reported a significant decrease in pain compared to a control group.\u003c/p>\n\u003cp>Registered nurse and certified music therapist Kathy Jo Gutgsell at University Hospitals in Cleveland was lead author of the study. She believes music “may awaken the body’s own endorphins\" -- those much-chased-after chemicals that make us feel better about the world.\u003c/p>\n\u003cp>The human brain \"doesn’t multitask very well,\" she explains. \"When we are paying attention to the music, we can't pay attention to the pain.” \u003c/p>\n\u003cp>Gutgsell says music is tied to memories and can connect us to times of great joy and sadness. “I think humans are hardwired for music. Some people think we were singing before we were speaking back at the beginning of humanity.”\u003c/p>\n\u003cp>The Threshold Choir singers say they, too, are helped by the act of singing together and for a person in need. “You see them calm, and then you calm, and it’s a reciprocal thing,” Cadbury says.\u003c/p>\n\u003cp>Kirner says singing in the choir is one of the best things in her life. “I get a sense of purpose.” Choir singers may benefit in other ways. A growing body of research finds that people who take part in choral singing have a better sense of wellbeing than those who don’t sing.\u003c/p>\n\u003cfigure id=\"attachment_196125\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196125 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg\" alt=\"Threshold Choir_Web 1-1\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left, Peggy Cadbury, Katharine Rose Kirner and Karen Mooney, members of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The research suggests that singing itself can raise levels of oxytocin, the hormone associated with trust and bonding. So people who sing in chorus may feel a strong bond with those they sing with together. Right now in San Francisco, a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/20/in-san-francisco-seniors-are-singing-for-science/\" target=\"_blank\"> five-year study is underway\u003c/a> looking at both the possible physical and emotional benefits of choral singing for seniors.\u003c/p>\n\u003cp>Munger says songs are “ethereal, evanescent, and mysterious” and she believes they can serve as a bridge “from the purely physical, temporal, body experience ... to what lies beyond.”\u003c/p>\n\u003cp>As for Cadbury, she says watching others die has helped her frame her daily life and what she hopes for her death. “Singing at the bedside of people who are dying has helped me appreciate being alive, has made more feel more alive and more into being the moment and enjoy life. I hope that when I am on the threshold someone will come and sing to me these beautiful, peaceful songs of comfort.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sager, the patient, says he believes as human beings our purpose in life is to be givers however we can. He says he did that as a chef, serving homemade nourishing food. He says he is proud of the Threshold Choir for offering their songs as a gift, “to receive that gift is an act of love and support, an act of care, which is what I need most in my life right now.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Terminally Ill San Diego Woman Plans To Take Advantage Of Aid-In-Dying Law",
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"content": "\u003cp>Eurika Strotto has always led an active life.\u003c/p>\n\u003cp>Growing up in South Africa, Eurika played field hockey for her high school and college teams. She also became a judo champion.\u003c/p>\n\u003cp>So her wife, Nita, wasn’t surprised that when it came time to remodel their University Heights home, Eurika did most of the work herself — starting with the kitchen.\u003c/p>\n\u003cp>“She decided she wanted to knock out the load-bearing wall, but we had to leave the post,\" Nita Strotto said. \"So she figured out, well, why don’t we just put the post in the middle of the bar counter, and it ended up looking really good.”\u003c/p>\n\u003cp>Then Eurika tackled a bathroom.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“And she actually, herself, tore out all the old bathroom, and then rebuilt the walls up to the sheetrock,\" Nita said.\u003c/p>\n\u003cp>It was during this project in 2013 that Eurika suddenly had problems with one of her feet.\u003c/p>\n\u003cp>\"We really thought that it was just a sprain, or some sort of weakness thing,\" Nita said. \"We finished the bathroom, and got married. And then a week later she was diagnosed with \u003ca href=\"http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/detail_ALS.htm\" target=\"_blank\">ALS (amyotrophic lateral sclerosis)\u003c/a>.”\u003c/p>\n\u003cfigure id=\"attachment_196485\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-196485\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-400x201.png\" alt=\"Juanita and Eurika Strotto hold hands. \" width=\"400\" height=\"201\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-400x201.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-800x402.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-768x386.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-1180x593.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-960x482.png 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM.png 1270w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Juanita and Eurika Strotto hold hands. \u003ccite>(Katie Schoolov/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When we first \u003ca href=\"http://www.kpbs.org/news/2015/dec/09/aid-dying-law-comes-california-2016/\" target=\"_blank\">profiled\u003c/a> Eurika last fall, she was living in a wheelchair. But she had no trouble breathing.\u003c/p>\n\u003cp>These days, because her diaphragm muscles are so weak, Eurika needs a machine to help her breathe most of the time. The way she figures, it won’t be long before she’ll lose the ability to swallow.\u003c/p>\n\u003cp>At an appointment with Eurika's physician, Dr. Sunita Shailam, the Strottos listen intently as Shailam fills a requirement of the new law by reading them a statement that Eurika will have to sign before she can get a prescription for a lethal dose of drugs. Sitting in Shailam's office, the couple hold hands as the family medicine doctor describes the different medications Strotto will be advised to take on that final day: an anti-nausea drug, an anti-anxiety pill, and then a handful of barbiturates crushed up and dissolved in a glass of water.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268520673\" 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>Eurika was planning to take advantage of California’s End of Life Option Act as soon as it went into effect. But some close friends are getting married June 11.\u003c/p>\n\u003cp>“If it wasn’t ... if it wasn’t for their wedding,\" Eurika says, through tears, \"I probably would have exercised my right sooner. But I don’t want to spoil their wedding.”\u003c/p>\n\u003cp>Right after that, Eurika says she will fill the prescription and take her own life.\u003c/p>\n\u003cp>Nita said they never really talked about death before Eurika was diagnosed with ALS. Since then, the topic has been unavoidable.\u003c/p>\n\u003cp>“And it’s weird, how it hasn’t diminished the beauty of life at all,\" Nita said. \"In fact, if anything, it’s highlighted how awesome our lives have been, independently and together.”\u003c/p>\n\u003cfigure id=\"attachment_196487\" class=\"wp-caption aligncenter\" style=\"max-width: 1258px\">\u003cimg class=\"size-full wp-image-196487\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM.png\" alt=\"Eurika's wife, Nita Strotto. \" width=\"1258\" height=\"624\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM.png 1258w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-400x198.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-800x397.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-768x381.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-1180x585.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-960x476.png 960w\" sizes=\"(max-width: 1258px) 100vw, 1258px\">\u003cfigcaption class=\"wp-caption-text\">Eurika's wife, Nita Strotto. \u003ccite>(Katie Schoolov/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nita said even though her father is dying in an assisted living center, she just doesn’t have the emotional bandwidth to deal with that right now.\u003c/p>\n\u003cp>“I’m full-time taking on the passing of my life partner, my wife, the love of my life, my best friend,\" Nita said. \"And it’s really becoming close to the end now, and I’m still not really thinking about her dying. I’m thinking about her being alive right now and in the living room. And that that’s where I want to be.”\u003c/p>\n\u003cp>So that’s where they’re spending a lot of their remaining time together — in the living room in the house that Eurika remodeled herself.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Yeah, I’ve done a lot in my life, and we’ve done a lot since we’ve been together,\" Eurika said. \"And I don’t regret any of it. It’s been cut a little short,\" she says, crying. \"But it’s been fantastic.”\u003c/p>\n\n",
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"excerpt": "Eurika Strotto, of San Diego, is terminally ill with ALS and plans to take her own life now that California's End of Life Option Act has taken effect.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Eurika Strotto has always led an active life.\u003c/p>\n\u003cp>Growing up in South Africa, Eurika played field hockey for her high school and college teams. She also became a judo champion.\u003c/p>\n\u003cp>So her wife, Nita, wasn’t surprised that when it came time to remodel their University Heights home, Eurika did most of the work herself — starting with the kitchen.\u003c/p>\n\u003cp>“She decided she wanted to knock out the load-bearing wall, but we had to leave the post,\" Nita Strotto said. \"So she figured out, well, why don’t we just put the post in the middle of the bar counter, and it ended up looking really good.”\u003c/p>\n\u003cp>Then Eurika tackled a bathroom.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“And she actually, herself, tore out all the old bathroom, and then rebuilt the walls up to the sheetrock,\" Nita said.\u003c/p>\n\u003cp>It was during this project in 2013 that Eurika suddenly had problems with one of her feet.\u003c/p>\n\u003cp>\"We really thought that it was just a sprain, or some sort of weakness thing,\" Nita said. \"We finished the bathroom, and got married. And then a week later she was diagnosed with \u003ca href=\"http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/detail_ALS.htm\" target=\"_blank\">ALS (amyotrophic lateral sclerosis)\u003c/a>.”\u003c/p>\n\u003cfigure id=\"attachment_196485\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-196485\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-400x201.png\" alt=\"Juanita and Eurika Strotto hold hands. \" width=\"400\" height=\"201\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-400x201.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-800x402.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-768x386.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-1180x593.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM-960x482.png 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.38.24-AM.png 1270w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Juanita and Eurika Strotto hold hands. \u003ccite>(Katie Schoolov/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When we first \u003ca href=\"http://www.kpbs.org/news/2015/dec/09/aid-dying-law-comes-california-2016/\" target=\"_blank\">profiled\u003c/a> Eurika last fall, she was living in a wheelchair. But she had no trouble breathing.\u003c/p>\n\u003cp>These days, because her diaphragm muscles are so weak, Eurika needs a machine to help her breathe most of the time. The way she figures, it won’t be long before she’ll lose the ability to swallow.\u003c/p>\n\u003cp>At an appointment with Eurika's physician, Dr. Sunita Shailam, the Strottos listen intently as Shailam fills a requirement of the new law by reading them a statement that Eurika will have to sign before she can get a prescription for a lethal dose of drugs. Sitting in Shailam's office, the couple hold hands as the family medicine doctor describes the different medications Strotto will be advised to take on that final day: an anti-nausea drug, an anti-anxiety pill, and then a handful of barbiturates crushed up and dissolved in a glass of water.\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/268520673&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/268520673'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Eurika was planning to take advantage of California’s End of Life Option Act as soon as it went into effect. But some close friends are getting married June 11.\u003c/p>\n\u003cp>“If it wasn’t ... if it wasn’t for their wedding,\" Eurika says, through tears, \"I probably would have exercised my right sooner. But I don’t want to spoil their wedding.”\u003c/p>\n\u003cp>Right after that, Eurika says she will fill the prescription and take her own life.\u003c/p>\n\u003cp>Nita said they never really talked about death before Eurika was diagnosed with ALS. Since then, the topic has been unavoidable.\u003c/p>\n\u003cp>“And it’s weird, how it hasn’t diminished the beauty of life at all,\" Nita said. \"In fact, if anything, it’s highlighted how awesome our lives have been, independently and together.”\u003c/p>\n\u003cfigure id=\"attachment_196487\" class=\"wp-caption aligncenter\" style=\"max-width: 1258px\">\u003cimg class=\"size-full wp-image-196487\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM.png\" alt=\"Eurika's wife, Nita Strotto. \" width=\"1258\" height=\"624\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM.png 1258w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-400x198.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-800x397.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-768x381.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-1180x585.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Screen-Shot-2016-06-10-at-11.42.15-AM-960x476.png 960w\" sizes=\"(max-width: 1258px) 100vw, 1258px\">\u003cfigcaption class=\"wp-caption-text\">Eurika's wife, Nita Strotto. \u003ccite>(Katie Schoolov/KPBS)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nita said even though her father is dying in an assisted living center, she just doesn’t have the emotional bandwidth to deal with that right now.\u003c/p>\n\u003cp>“I’m full-time taking on the passing of my life partner, my wife, the love of my life, my best friend,\" Nita said. \"And it’s really becoming close to the end now, and I’m still not really thinking about her dying. I’m thinking about her being alive right now and in the living room. And that that’s where I want to be.”\u003c/p>\n\u003cp>So that’s where they’re spending a lot of their remaining time together — in the living room in the house that Eurika remodeled herself.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Yeah, I’ve done a lot in my life, and we’ve done a lot since we’ve been together,\" Eurika said. \"And I don’t regret any of it. It’s been cut a little short,\" she says, crying. \"But it’s been fantastic.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Buying Tobacco or E-Cigarettes in California? You Need to be 21",
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"content": "\u003cp>Effective today, the legal age to buy tobacco products-- including e-cigarettes -- in California is now 21 years old.\u003c/p>\n\u003cp>For 144 years the legal age to buy tobacco in California was 18. But a package of anti-tobacco bills moved through the legislature and Gov. Jerry Brown\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/gov-brown-signs-major-tobacco-bills-raises-legal-age-to-21/\" target=\"_blank\"> signed five of them\u003c/a> last month.\u003c/p>\n\u003cp>The intent of the higher age is to get tobacco products out of the hands of teenagers. Many 18-year-olds are in high school and can share their lawfully-purchased cigarettes with those too young to buy.\u003c/p>\n\u003cp>Moving the tobacco age to 21 moves legal purchasers out of the orbit of teens. An Institute of Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Activities/PublicHealth/TobaccoMinimumAge.aspx\" target=\"_blank\">analysis \u003c/a>last year concluded that raising the tobacco age to 21 nationwide would result in a 12 percent drop in the number of teen and young adult smokers.\u003c/p>\n\u003cp>An estimated 240,000 18- to 20-year-olds use tobacco products.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a press conference Thursday morning, the California Department of Public Health announced an education program targeted at vape shops and tobacco retailers.\u003c/p>\n\u003cp>[contextly_sidebar id=\"aaK9djuMZIqMps7F1Q0KzQpISKHWwGXB\"]\"Our goal is to help retailers comply with these important new laws governing the sale of tobacco products,\" said Dr. Karen Smith, director of the health department.\u003c/p>\n\u003cp>Smith also pointed out that 70 percent of tobacco retailers also sell alcohol, and now the age of sale for tobacco matches that of alcohol products.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/Pages/FDB.aspx\" target=\"_blank\">food and drug branch\u003c/a> of the health department oversees enforcement of tobacco control. The Stop Tobacco Access to Kids Enforcement Act, commonly known as the Stake Act, has netted a significant drop in illegal sales of tobacco to minors.\u003c/p>\n\u003cp>Smith said that in 1995 one in three California stores illegally sold tobacco products to minors under age 18. \"In 2015, it was just one in 13 stores violating the law,\" Smith said.\u003c/p>\n\u003cp>Active members of the United States military are exempt from the new law and can still purchase tobacco at 18 with military-issued ID.\u003c/p>\n\u003cp>Also effective today -- e-cigarettes are subject to the same smoke-free laws traditional cigarettes are. So, wherever cigarettes can't be smoked, e-cigarettes can't be used either. This includes hookah products as well.\u003c/p>\n\u003cp>The only indoor places where smoking is allowed are \"tobacco-only retailers.\" These are businesses that sell only tobacco. Use of tobacco products would not be permitted, for example, in a business that sells tobacco along with food and drinks.\u003c/p>\n\u003cp>Smith said that success in the implementation of the new laws would mean fewer people under age 21 are smoking.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We really do want to save lives,\" she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Effective today, the legal age to buy tobacco products-- including e-cigarettes -- in California is now 21 years old.\u003c/p>\n\u003cp>For 144 years the legal age to buy tobacco in California was 18. But a package of anti-tobacco bills moved through the legislature and Gov. Jerry Brown\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/gov-brown-signs-major-tobacco-bills-raises-legal-age-to-21/\" target=\"_blank\"> signed five of them\u003c/a> last month.\u003c/p>\n\u003cp>The intent of the higher age is to get tobacco products out of the hands of teenagers. Many 18-year-olds are in high school and can share their lawfully-purchased cigarettes with those too young to buy.\u003c/p>\n\u003cp>Moving the tobacco age to 21 moves legal purchasers out of the orbit of teens. An Institute of Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Activities/PublicHealth/TobaccoMinimumAge.aspx\" target=\"_blank\">analysis \u003c/a>last year concluded that raising the tobacco age to 21 nationwide would result in a 12 percent drop in the number of teen and young adult smokers.\u003c/p>\n\u003cp>An estimated 240,000 18- to 20-year-olds use tobacco products.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a press conference Thursday morning, the California Department of Public Health announced an education program targeted at vape shops and tobacco retailers.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"Our goal is to help retailers comply with these important new laws governing the sale of tobacco products,\" said Dr. Karen Smith, director of the health department.\u003c/p>\n\u003cp>Smith also pointed out that 70 percent of tobacco retailers also sell alcohol, and now the age of sale for tobacco matches that of alcohol products.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/Pages/FDB.aspx\" target=\"_blank\">food and drug branch\u003c/a> of the health department oversees enforcement of tobacco control. The Stop Tobacco Access to Kids Enforcement Act, commonly known as the Stake Act, has netted a significant drop in illegal sales of tobacco to minors.\u003c/p>\n\u003cp>Smith said that in 1995 one in three California stores illegally sold tobacco products to minors under age 18. \"In 2015, it was just one in 13 stores violating the law,\" Smith said.\u003c/p>\n\u003cp>Active members of the United States military are exempt from the new law and can still purchase tobacco at 18 with military-issued ID.\u003c/p>\n\u003cp>Also effective today -- e-cigarettes are subject to the same smoke-free laws traditional cigarettes are. So, wherever cigarettes can't be smoked, e-cigarettes can't be used either. This includes hookah products as well.\u003c/p>\n\u003cp>The only indoor places where smoking is allowed are \"tobacco-only retailers.\" These are businesses that sell only tobacco. Use of tobacco products would not be permitted, for example, in a business that sells tobacco along with food and drinks.\u003c/p>\n\u003cp>Smith said that success in the implementation of the new laws would mean fewer people under age 21 are smoking.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We really do want to save lives,\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Day Camp for Transgender Youth Allows Kids to be Themselves",
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"content": "\u003cp>Two years ago, a six-year-old girl named Scarlett went to her first girl’s empowerment summer camp. But on the first day Scarlett’s best friend got mad at her after being left out of a game. In a moment of anger, she shared something private about Scarlett.\u003c/p>\n\u003cp>\"(The friend) told everyone at camp that Scarlett was a biological boy,\" remembers Sandra Collins, Scarlett's mother.\u003c/p>\n\u003cp>Her daughter had gone to camp in stealth mode. Scarlett didn’t tell anyone that she was born a boy, that her parents had named her Ezra.\u003c/p>\n\u003cp>After being outed, \"Scarlett came home really sad, crying because she said, 'I don’t know how I’m going to go back because everybody knows I was born a biological boy even though I know I’m a girl,'\" Sandra Collins says.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268543838\" 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>Scarlett first started expressing her female gender when she was two, going off to preschool in boy clothes, then changing into spare clothes at school and coming home dressed as a girl. She transitioned fully to Scarlett at six -- going by that name all the time, using female pronouns in reference to herself and wearing girl's clothes. So when her friend told everyone at camp Scarlett was a boy, she was devastated, but only initially.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Scarlett, being the amazing, empathetic soul that she is,\" says Collins, \"was able to go to camp the next day and go for the remainder of that week and the following week.\"\u003c/p>\n\u003cp>Scarlett still plays with that friend today.\u003c/p>\n\u003cfigure id=\"attachment_196100\" class=\"wp-caption aligncenter\" style=\"max-width: 1154px\">\u003cimg class=\"wp-image-196100 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19739_Scarlett_SC-.jpg\" alt=\"Scarlett Collins' (right) experiences influenced her mother, Sandra Collins (L), to found a day camp for transgender kids and teens. \" width=\"1154\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC-.jpg 1154w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--400x333.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--800x666.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--768x639.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--960x799.jpg 960w\" sizes=\"(max-width: 1154px) 100vw, 1154px\">\u003cfigcaption class=\"wp-caption-text\">Sandra Collins (L), said her young daughter's experiences informed her decision to found a day camp for transgender kids and teens. \u003ccite>(Courtesy Sandra Collins)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This experience stayed with Sandra. She realized it’s a lot to ask kids to keep big secrets about identity. That's why last summer she started two day camps for transgender and gender fluid kids and teenagers where they can be themselves. No sneaking around; no fear of bullying.\u003c/p>\n\u003cp>The camps -- \u003ca href=\"http://rainbowdaycamp.org/\">Bay Area Rainbow Day Camp\u003c/a> for kids and \u003ca href=\"http://www.campkickinit.com/\">Camp Kickin' It\u003c/a> for teens -- offer two week-long sessions in El Cerrito, outside San Francisco. While there are a handful of overnight camps for transgender youth and their allies, Collins' camps seem to be the only day camps in the country.\u003c/p>\n\u003cp>Scarlett, now eight, loves it. \"It’s a place where gender creative and gender fluid people can have fun together,\" she says.\u003c/p>\n\u003cp>That's the big picture. Actual day-to-day camp activities sound like pretty much any other camp. \"We have snack in the morning. And then we also get to play on the play structure,\" Scarlett says.\u003c/p>\n\u003cp>That very normal-sounding response is what camp director AK Kramer is going for. \"It’s a very traditional camp. We throw water balloons at each other. We make art projects. I got pied in the face,\" Kramer says. \"But because of our poetry unit or because of storytelling where all the stories we read are about gender creative kids, things really come up.\"\u003c/p>\n\u003cp>When they do, the camp has therapists on staff who are ready to talk. Another benefit of camp is its positive role models. Camp director Kramer and many counselors are transgender, making it easier for campers to imagine what life would be like as a teen or a grown up.\u003c/p>\n\u003cp>Kramer says even one week can have a big impact on kids' confidence.\u003c/p>\n\u003cp>\"They come day one and the kids are a little bit more reserved, and they’re not sure what to expect. By day four or five everyone’s in princess wigs, and they just are presenting much more how they see themselves,\" he says. \"The parents are so moved by that and also I think really scared for their kids.\"\u003c/p>\n\u003cp>That fear comes from a world that isn’t as kind as Rainbow Day Camp. Research shows transgender people have higher rates of depression, suicide, and homelessness among other things.\u003c/p>\n\u003cp>There’s controversy about whether parents should let their kids transition to another gender, especially at a young age. But these parents have decided this is the best choice for their children.\u003c/p>\n\u003cp>\"There’s a quiet revolution going on here in the Bay Area in terms of allowing our children to transition so young,\" says Collins. \"And we’re doing it very thoughtfully and mindfully.\"\u003c/p>\n\u003cfigure id=\"attachment_196101\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196101\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19741_teen-oma-qut.jpg\" alt=\"Teens in Camp Kickin' It, a day camp for transgender teens, go on an excursion to the Oakland Museum.\" width=\"1920\" height=\"2560\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-960x1280.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Teens in Camp Kickin' It, a day camp for transgender teens, go on an excursion to the Oakland Museum. \u003ccite>(Courtesy Sandra Collins)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>She points to a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/02/25/transgender-children-living-openly-are-doing-well-study-shows/\" target=\"_blank\">study released in the journal \u003cem>Pediatrics\u003c/em>\u003c/a> earlier this year. It says trans children who live as their preferred gender and are supported by their parents have the same mental health outcomes as other kids their age.\u003c/p>\n\u003cp>In the past year, Collins has grown the camps into a larger nonprofit called enGender. The organization's goals are to support both trans children and children who do not identify as either gender, as well as their families.\u003c/p>\n\u003cp>Part of enGender's work is running a monthly playgroup. Kids meet in a school library in El Cerrito where they jump around on large blue foam blocks or work on art pieces. While the kids play, parents meet separately in a formal support group. Topics range from navigating school systems to self-care.\u003c/p>\n\u003cp>This network has really helped parent Nancy Brunn. \"There is a time you have to get past the fear for them to be able to really appreciate the incredible gift that it is to have a child that’s gender expansive.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"xxrZBycpzDZUhsSdtdgzzIyKmJj8TyKK\"]\u003cbr>\nBrunn and her kids never miss playgroups, even though they live a 45-minute drive away. Brunn's eight-year-old twins also went to Bay Area Rainbow Day Camp last summer. While one of her twins is transgender, the other isn’t, but embraces her role as an advocate.\u003c/p>\n\u003cp>\"For Pride weekend she made a sign that said, 'I love trans,'\" says Brunn. \"She had just completed kindergarten so just beginning writing, and that was what she wanted to write.\"\u003c/p>\n\u003cp>Today, eight-year-old Scarlett is speaking up for transgender issues, too. Last year when her teacher talked about transgender awareness, she felt shy and left the classroom.\u003c/p>\n\u003cp>\"But this year she raised her hand and (said), 'I’m transgender and my job is to educate people on how to have empathy,'\" her mother says, while growing emotional. \"That’s when I realized she had pride, right?\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Sandra Collins' camp starts at the end of June. Eventually, she hopes Bay Area Rainbow Day Camp won't be so unique. She wants this model to grow so transgender kids across the country experience camp the way most of us do: as a safe, fun, and sometimes crazy place.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two years ago, a six-year-old girl named Scarlett went to her first girl’s empowerment summer camp. But on the first day Scarlett’s best friend got mad at her after being left out of a game. In a moment of anger, she shared something private about Scarlett.\u003c/p>\n\u003cp>\"(The friend) told everyone at camp that Scarlett was a biological boy,\" remembers Sandra Collins, Scarlett's mother.\u003c/p>\n\u003cp>Her daughter had gone to camp in stealth mode. Scarlett didn’t tell anyone that she was born a boy, that her parents had named her Ezra.\u003c/p>\n\u003cp>After being outed, \"Scarlett came home really sad, crying because she said, 'I don’t know how I’m going to go back because everybody knows I was born a biological boy even though I know I’m a girl,'\" Sandra Collins says.\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/268543838&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/268543838'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Scarlett first started expressing her female gender when she was two, going off to preschool in boy clothes, then changing into spare clothes at school and coming home dressed as a girl. She transitioned fully to Scarlett at six -- going by that name all the time, using female pronouns in reference to herself and wearing girl's clothes. So when her friend told everyone at camp Scarlett was a boy, she was devastated, but only initially.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Scarlett, being the amazing, empathetic soul that she is,\" says Collins, \"was able to go to camp the next day and go for the remainder of that week and the following week.\"\u003c/p>\n\u003cp>Scarlett still plays with that friend today.\u003c/p>\n\u003cfigure id=\"attachment_196100\" class=\"wp-caption aligncenter\" style=\"max-width: 1154px\">\u003cimg class=\"wp-image-196100 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19739_Scarlett_SC-.jpg\" alt=\"Scarlett Collins' (right) experiences influenced her mother, Sandra Collins (L), to found a day camp for transgender kids and teens. \" width=\"1154\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC-.jpg 1154w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--400x333.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--800x666.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--768x639.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19739_Scarlett_SC--960x799.jpg 960w\" sizes=\"(max-width: 1154px) 100vw, 1154px\">\u003cfigcaption class=\"wp-caption-text\">Sandra Collins (L), said her young daughter's experiences informed her decision to found a day camp for transgender kids and teens. \u003ccite>(Courtesy Sandra Collins)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This experience stayed with Sandra. She realized it’s a lot to ask kids to keep big secrets about identity. That's why last summer she started two day camps for transgender and gender fluid kids and teenagers where they can be themselves. No sneaking around; no fear of bullying.\u003c/p>\n\u003cp>The camps -- \u003ca href=\"http://rainbowdaycamp.org/\">Bay Area Rainbow Day Camp\u003c/a> for kids and \u003ca href=\"http://www.campkickinit.com/\">Camp Kickin' It\u003c/a> for teens -- offer two week-long sessions in El Cerrito, outside San Francisco. While there are a handful of overnight camps for transgender youth and their allies, Collins' camps seem to be the only day camps in the country.\u003c/p>\n\u003cp>Scarlett, now eight, loves it. \"It’s a place where gender creative and gender fluid people can have fun together,\" she says.\u003c/p>\n\u003cp>That's the big picture. Actual day-to-day camp activities sound like pretty much any other camp. \"We have snack in the morning. And then we also get to play on the play structure,\" Scarlett says.\u003c/p>\n\u003cp>That very normal-sounding response is what camp director AK Kramer is going for. \"It’s a very traditional camp. We throw water balloons at each other. We make art projects. I got pied in the face,\" Kramer says. \"But because of our poetry unit or because of storytelling where all the stories we read are about gender creative kids, things really come up.\"\u003c/p>\n\u003cp>When they do, the camp has therapists on staff who are ready to talk. Another benefit of camp is its positive role models. Camp director Kramer and many counselors are transgender, making it easier for campers to imagine what life would be like as a teen or a grown up.\u003c/p>\n\u003cp>Kramer says even one week can have a big impact on kids' confidence.\u003c/p>\n\u003cp>\"They come day one and the kids are a little bit more reserved, and they’re not sure what to expect. By day four or five everyone’s in princess wigs, and they just are presenting much more how they see themselves,\" he says. \"The parents are so moved by that and also I think really scared for their kids.\"\u003c/p>\n\u003cp>That fear comes from a world that isn’t as kind as Rainbow Day Camp. Research shows transgender people have higher rates of depression, suicide, and homelessness among other things.\u003c/p>\n\u003cp>There’s controversy about whether parents should let their kids transition to another gender, especially at a young age. But these parents have decided this is the best choice for their children.\u003c/p>\n\u003cp>\"There’s a quiet revolution going on here in the Bay Area in terms of allowing our children to transition so young,\" says Collins. \"And we’re doing it very thoughtfully and mindfully.\"\u003c/p>\n\u003cfigure id=\"attachment_196101\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-196101\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/RS19741_teen-oma-qut.jpg\" alt=\"Teens in Camp Kickin' It, a day camp for transgender teens, go on an excursion to the Oakland Museum.\" width=\"1920\" height=\"2560\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-1440x1920.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/RS19741_teen-oma-qut-960x1280.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Teens in Camp Kickin' It, a day camp for transgender teens, go on an excursion to the Oakland Museum. \u003ccite>(Courtesy Sandra Collins)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>She points to a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/02/25/transgender-children-living-openly-are-doing-well-study-shows/\" target=\"_blank\">study released in the journal \u003cem>Pediatrics\u003c/em>\u003c/a> earlier this year. It says trans children who live as their preferred gender and are supported by their parents have the same mental health outcomes as other kids their age.\u003c/p>\n\u003cp>In the past year, Collins has grown the camps into a larger nonprofit called enGender. The organization's goals are to support both trans children and children who do not identify as either gender, as well as their families.\u003c/p>\n\u003cp>Part of enGender's work is running a monthly playgroup. Kids meet in a school library in El Cerrito where they jump around on large blue foam blocks or work on art pieces. While the kids play, parents meet separately in a formal support group. Topics range from navigating school systems to self-care.\u003c/p>\n\u003cp>This network has really helped parent Nancy Brunn. \"There is a time you have to get past the fear for them to be able to really appreciate the incredible gift that it is to have a child that’s gender expansive.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003cbr>\nBrunn and her kids never miss playgroups, even though they live a 45-minute drive away. Brunn's eight-year-old twins also went to Bay Area Rainbow Day Camp last summer. While one of her twins is transgender, the other isn’t, but embraces her role as an advocate.\u003c/p>\n\u003cp>\"For Pride weekend she made a sign that said, 'I love trans,'\" says Brunn. \"She had just completed kindergarten so just beginning writing, and that was what she wanted to write.\"\u003c/p>\n\u003cp>Today, eight-year-old Scarlett is speaking up for transgender issues, too. Last year when her teacher talked about transgender awareness, she felt shy and left the classroom.\u003c/p>\n\u003cp>\"But this year she raised her hand and (said), 'I’m transgender and my job is to educate people on how to have empathy,'\" her mother says, while growing emotional. \"That’s when I realized she had pride, right?\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sandra Collins' camp starts at the end of June. Eventually, she hopes Bay Area Rainbow Day Camp won't be so unique. She wants this model to grow so transgender kids across the country experience camp the way most of us do: as a safe, fun, and sometimes crazy place.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California’s Aid-in-Dying Law Takes Effect Today -- Here's What You Need to Know",
"title": "California’s Aid-in-Dying Law Takes Effect Today -- Here's What You Need to Know",
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"content": "\u003cp>Starting Thursday, June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.\u003c/p>\n\u003cp>If that sounds simple, it won’t be.\u003c/p>\n\u003caside class=\"pullquote alignright\">The patient has to jump through a lot of hoops -- that's to make sure the decision is made voluntarily.\u003c/aside>\n\u003cp>California’s \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_0001-0050/abx2_15_bill_20151005_chaptered.htm\" target=\"_blank\">End of Life Option Act\u003c/a> creates a long list of administrative hurdles that both patients and their doctors must clear.\u003c/p>\n\u003cp>For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).\u003c/p>\n\u003cp>Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And more.\u003c/p>\n\u003cp>“This will not be an on-demand service,” says Sarah Hooper, executive director of the \u003ca href=\"http://www.ucconsortium.org/\" target=\"_blank\">UCSF/UC Hastings Consortium on Law, Science and Health Policy\u003c/a>.\u003c/p>\n\u003cp>“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.\"\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268313233\" 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://ww2.kqed.org/lowdown/2015/10/06/california-becomes-fifth-state-to-legalize-physician-assisted-suicide-interactive-map/\" target=\"_blank\">California will be the fifth state \u003c/a>to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\">Compassion & Choices\u003c/a>.\u003c/p>\n\u003cp>Rather than list every requirement, I’m going to describe a few potential challenges you might face if you or a loved one is considering asking for these medications — ranging from doctors who are unwilling to write prescriptions to the cost of the medications themselves.\u003c/p>\n\u003cp>This law is voluntary “every step of the way,” says state Sen. Bill Monning, D-Carmel, co-author of the law.\u003c/p>\n\u003cp>That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.\u003c/p>\n\u003cp>Nothing requires patients to take the drugs once they have obtained a prescription.\u003c/p>\n\u003cp>[contextly_sidebar id=\"oappkhqYOxY2odvQWXkqxRUPDLXRQOaq\"]Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf\" target=\"_blank\">data compiled by the Oregon Public Health Division\u003c/a>.\u003c/p>\n\u003cp>“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’ ” Monning says.\u003c/p>\n\u003cp>But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.\u003c/p>\n\u003cp>“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.\u003c/p>\n\u003cp>For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.\u003c/p>\n\u003cp>If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.\u003c/p>\n\u003cp>But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.\u003c/p>\n\u003cp>Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the \u003ca href=\"http://www.thealliance.net/\" target=\"_blank\">Alliance of Catholic Health Care\u003c/a>.\u003c/p>\n\u003cp>Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”\u003c/p>\n\u003cp>If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.\u003c/p>\n\u003cp>[contextly_sidebar id=\"eEwOCzZsqwP8UpYpMkLX1qXElE4Krqd6\"]Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.\u003c/p>\n\u003cp>In Oregon, Washington and Montana — states where aid-in-dying is legal — some health plans cover the cost and some don’t, he says. He expects the same to occur here.\u003c/p>\n\u003cp>Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>.\u003c/p>\n\u003cp>If you have questions about coverage, she suggests you contact your insurer directly.\u003c/p>\n\u003cp>Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.\u003c/p>\n\u003cp>If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>If you need more step-by-step guidance about the law, tap into these resources:\u003c/p>\n\u003cul>\n\u003cli>Compassion & Choices has online guides for consumers and doctors at \u003ca href=\"http://www.endoflifeoption.org/\" target=\"_blank\">www.EndOfLifeOption.org\u003c/a>. You can also call the group’s help line at 800-893-4548.\u003c/li>\n\u003cli>The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a \u003ca href=\"http://www.ucconsortium.org/wp-content/uploads/2015/12/FACT-SHEET-End-of-Life-Option-Act-Updated-01.15.16.pdf\" target=\"_blank\">helpful fact sheet\u003c/a> at \u003ca href=\"http://bit.ly/248Z2l6\" target=\"_blank\">http://bit.ly/248Z2l6\u003c/a>.\u003c/li>\n\u003cli>The California Medical Association, which represents doctors, has a detailed, \u003ca href=\"http://www.cmanet.org/resource-library/detail/?item=the-california-end-of-life-option-act&r_search=Document%203459&r_page=1&return_to=list\" target=\"_blank\">14-page document\u003c/a> at \u003ca href=\"http://www.cmanet.org/endoflife\" target=\"_blank\">www.cmanet.org/endoflife\u003c/a>. You’ll need to register on the site to read the document.\u003c/li>\n\u003cli>Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: \u003ca href=\"http://www.mbc.ca.gov/\" target=\"_blank\">www.mbc.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\n",
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"excerpt": "The law takes effect Thursday and gives certain terminally ill patients the right to end their lives at a time of their choosing. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Starting Thursday, June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.\u003c/p>\n\u003cp>If that sounds simple, it won’t be.\u003c/p>\n\u003caside class=\"pullquote alignright\">The patient has to jump through a lot of hoops -- that's to make sure the decision is made voluntarily.\u003c/aside>\n\u003cp>California’s \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_0001-0050/abx2_15_bill_20151005_chaptered.htm\" target=\"_blank\">End of Life Option Act\u003c/a> creates a long list of administrative hurdles that both patients and their doctors must clear.\u003c/p>\n\u003cp>For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).\u003c/p>\n\u003cp>Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And more.\u003c/p>\n\u003cp>“This will not be an on-demand service,” says Sarah Hooper, executive director of the \u003ca href=\"http://www.ucconsortium.org/\" target=\"_blank\">UCSF/UC Hastings Consortium on Law, Science and Health Policy\u003c/a>.\u003c/p>\n\u003cp>“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.\"\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/268313233&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/268313233'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/lowdown/2015/10/06/california-becomes-fifth-state-to-legalize-physician-assisted-suicide-interactive-map/\" target=\"_blank\">California will be the fifth state \u003c/a>to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\">Compassion & Choices\u003c/a>.\u003c/p>\n\u003cp>Rather than list every requirement, I’m going to describe a few potential challenges you might face if you or a loved one is considering asking for these medications — ranging from doctors who are unwilling to write prescriptions to the cost of the medications themselves.\u003c/p>\n\u003cp>This law is voluntary “every step of the way,” says state Sen. Bill Monning, D-Carmel, co-author of the law.\u003c/p>\n\u003cp>That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.\u003c/p>\n\u003cp>Nothing requires patients to take the drugs once they have obtained a prescription.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf\" target=\"_blank\">data compiled by the Oregon Public Health Division\u003c/a>.\u003c/p>\n\u003cp>“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’ ” Monning says.\u003c/p>\n\u003cp>But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.\u003c/p>\n\u003cp>“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.\u003c/p>\n\u003cp>For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.\u003c/p>\n\u003cp>If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.\u003c/p>\n\u003cp>But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.\u003c/p>\n\u003cp>Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the \u003ca href=\"http://www.thealliance.net/\" target=\"_blank\">Alliance of Catholic Health Care\u003c/a>.\u003c/p>\n\u003cp>Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”\u003c/p>\n\u003cp>If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.\u003c/p>\n\u003cp>In Oregon, Washington and Montana — states where aid-in-dying is legal — some health plans cover the cost and some don’t, he says. He expects the same to occur here.\u003c/p>\n\u003cp>Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>.\u003c/p>\n\u003cp>If you have questions about coverage, she suggests you contact your insurer directly.\u003c/p>\n\u003cp>Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.\u003c/p>\n\u003cp>If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If you need more step-by-step guidance about the law, tap into these resources:\u003c/p>\n\u003cul>\n\u003cli>Compassion & Choices has online guides for consumers and doctors at \u003ca href=\"http://www.endoflifeoption.org/\" target=\"_blank\">www.EndOfLifeOption.org\u003c/a>. You can also call the group’s help line at 800-893-4548.\u003c/li>\n\u003cli>The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a \u003ca href=\"http://www.ucconsortium.org/wp-content/uploads/2015/12/FACT-SHEET-End-of-Life-Option-Act-Updated-01.15.16.pdf\" target=\"_blank\">helpful fact sheet\u003c/a> at \u003ca href=\"http://bit.ly/248Z2l6\" target=\"_blank\">http://bit.ly/248Z2l6\u003c/a>.\u003c/li>\n\u003cli>The California Medical Association, which represents doctors, has a detailed, \u003ca href=\"http://www.cmanet.org/resource-library/detail/?item=the-california-end-of-life-option-act&r_search=Document%203459&r_page=1&return_to=list\" target=\"_blank\">14-page document\u003c/a> at \u003ca href=\"http://www.cmanet.org/endoflife\" target=\"_blank\">www.cmanet.org/endoflife\u003c/a>. You’ll need to register on the site to read the document.\u003c/li>\n\u003cli>Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: \u003ca href=\"http://www.mbc.ca.gov/\" target=\"_blank\">www.mbc.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Senate Kills Bill Requiring Doctors on Probation to Let You Know",
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"content": "\u003cp>The state Senate this week rejected legislation that would have required doctors and other medical to notify their patients if they were on probation for serious infractions.\u003c/p>\n\u003caside class=\"pullquote alignright\">The bill was aimed at a tiny fraction of doctors -- those disciplined for serious offenses including sexual misconduct\u003c/aside>\n\u003cp>The bill would have applied to a tiny pool of practitioners – those disciplined for serious offenses such as gross negligence, sexual misconduct, substance abuse or a felony conviction related to patient care. It would have required such physicians, chiropractors, podiatrists and acupuncturists to notify their patients in a one-page, “easy to read” notice that explained why they had been put on probation.\u003c/p>\n\u003cp>The bill’s supporters said consumers were ill-served by the Senate’s decision.\u003c/p>\n\u003cp>“Today’s vote means that most Californians will remain in the dark when their doctor is on probation for offenses that could jeopardize their health,” said Lisa McGiffert, manager of the Safe Patient Project at Consumers Union.\u003c/p>\n\u003cp>Opponents of the bill, including the California Medical Association, had argued that, as written, it would undermine physicians’ rights to due process and amount to a de facto suspension by severely restricting their ability to practice. They also noted that information about doctors’ offenses is already available on the internet.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"rb8PrSswaxF1kGnSGu3CLNCZF9vs5kpb\"]Some senators who opposed the measure said the language in the bill suggested that doctors and other providers could be forced to tell their patients about unproven allegations against them.\u003c/p>\n\u003cp>Sen. Richard Pan, D-Sacramento, a pediatrician, said he voted against it for that reason. “This is a significant concern, because I do believe that everyone has a right to due process in this country. It’s an issue of principle,” Pan said.\u003c/p>\n\u003cp>McGiffert said the due process argument was based on a misunderstanding. Before an accusation is made, there has to be clear and convincing evidence, and every case then gets full due process before doctors are put on probation, she said.\u003c/p>\n\u003cp>Under current law, clinicians are required to notify hospitals and malpractice insurers when they’re placed on probation. They don’t have to tell patients, but the information is available on the California Medical Board’s \u003ca href=\"https://www.breeze.ca.gov/datamart/loginCADCA.do;jsessionid=1AACA3B0BA91391B2472BEF33B8D086E.vo19\">BreEZe website\u003c/a>.\u003c/p>\n\u003cp>Some supporters of the bill have argued that the medical board website is too difficult for the average person to navigate and creates a barrier for those without internet access.\u003c/p>\n\u003cp>McGiffert said she hopes the bill's sponsor, \u003ca href=\"http://californiahealthline.org/news/is-your-doctor-hiding-something-from-you/\" target=\"_blank\">Sen. Jerry Hill, D – San Mateo,\u003c/a>, will present the bill again. If so, she and other advocates are prepared to speak with Senate members because, “we believe they have been misled in some ways,” she said. “I guarantee you that every single person who voted against [the bill] would want to know if their doctor was on probation.”\u003c/p>\n\u003cp>The Senate Wednesday voted 15-13 for the bill, short of the 21 votes needed to pass it. The Senate then unanimously approved a motion allowing the proposal to be amended and brought up for another vote this week. Hill had planned to seek a new vote on Thursday, but he later decided against it after realizing it still would not garner sufficient support.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hill could reintroduce the measure in the next legislative session, which begins in early December. But a spokeswoman in his office said she didn’t know if he would.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The state Senate this week rejected legislation that would have required doctors and other medical to notify their patients if they were on probation for serious infractions.\u003c/p>\n\u003caside class=\"pullquote alignright\">The bill was aimed at a tiny fraction of doctors -- those disciplined for serious offenses including sexual misconduct\u003c/aside>\n\u003cp>The bill would have applied to a tiny pool of practitioners – those disciplined for serious offenses such as gross negligence, sexual misconduct, substance abuse or a felony conviction related to patient care. It would have required such physicians, chiropractors, podiatrists and acupuncturists to notify their patients in a one-page, “easy to read” notice that explained why they had been put on probation.\u003c/p>\n\u003cp>The bill’s supporters said consumers were ill-served by the Senate’s decision.\u003c/p>\n\u003cp>“Today’s vote means that most Californians will remain in the dark when their doctor is on probation for offenses that could jeopardize their health,” said Lisa McGiffert, manager of the Safe Patient Project at Consumers Union.\u003c/p>\n\u003cp>Opponents of the bill, including the California Medical Association, had argued that, as written, it would undermine physicians’ rights to due process and amount to a de facto suspension by severely restricting their ability to practice. They also noted that information about doctors’ offenses is already available on the internet.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Some senators who opposed the measure said the language in the bill suggested that doctors and other providers could be forced to tell their patients about unproven allegations against them.\u003c/p>\n\u003cp>Sen. Richard Pan, D-Sacramento, a pediatrician, said he voted against it for that reason. “This is a significant concern, because I do believe that everyone has a right to due process in this country. It’s an issue of principle,” Pan said.\u003c/p>\n\u003cp>McGiffert said the due process argument was based on a misunderstanding. Before an accusation is made, there has to be clear and convincing evidence, and every case then gets full due process before doctors are put on probation, she said.\u003c/p>\n\u003cp>Under current law, clinicians are required to notify hospitals and malpractice insurers when they’re placed on probation. They don’t have to tell patients, but the information is available on the California Medical Board’s \u003ca href=\"https://www.breeze.ca.gov/datamart/loginCADCA.do;jsessionid=1AACA3B0BA91391B2472BEF33B8D086E.vo19\">BreEZe website\u003c/a>.\u003c/p>\n\u003cp>Some supporters of the bill have argued that the medical board website is too difficult for the average person to navigate and creates a barrier for those without internet access.\u003c/p>\n\u003cp>McGiffert said she hopes the bill's sponsor, \u003ca href=\"http://californiahealthline.org/news/is-your-doctor-hiding-something-from-you/\" target=\"_blank\">Sen. Jerry Hill, D – San Mateo,\u003c/a>, will present the bill again. If so, she and other advocates are prepared to speak with Senate members because, “we believe they have been misled in some ways,” she said. “I guarantee you that every single person who voted against [the bill] would want to know if their doctor was on probation.”\u003c/p>\n\u003cp>The Senate Wednesday voted 15-13 for the bill, short of the 21 votes needed to pass it. The Senate then unanimously approved a motion allowing the proposal to be amended and brought up for another vote this week. Hill had planned to seek a new vote on Thursday, but he later decided against it after realizing it still would not garner sufficient support.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hill could reintroduce the measure in the next legislative session, which begins in early December. But a spokeswoman in his office said she didn’t know if he would.\u003c/p>\n\n\u003c/div>\u003c/p>",
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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": "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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"tagline": "Art is where you find it",
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"soldout": {
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"tagline": "A new future for housing",
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"info": "",
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"tech-nation": {
"id": "tech-nation",
"title": "Tech Nation Radio Podcast",
"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
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"ted-radio-hour": {
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"title": "TED Radio Hour",
"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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