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"content": "\u003cp>Opioids like Vicodin and Percocet are commonly prescribed to dull pain after medical procedures and to treat chronic pain. They also commonly languish in medicine cabinets, sometimes for years, making easy pickings for someone with an addiction.\u003c/p>\n\u003cp>The consequences can be deadly: More than 165,000 people died in the U.S. from overdoses related to prescription opioids between 1999 and 2014, says the \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">Centers for Disease Control and Prevention.\u003c/a>\u003c/p>\n\u003cp>I’m guilty of keeping them too long myself. I had a bottle of opioids left over from a dental procedure three years ago and kept it in a freezer bag full of unwanted and expired medications. In April, I turned them all in on the twice-a-year \u003ca href=\"http://www.dea.gov/divisions/hq/2016/hq050616.shtml\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>.\u003c/p>\n\u003cp>What are consumers to do the rest of the year if they want a safe alternative to flushing unwanted drugs down the toilet or tossing them into the garbage? Drugs that are flushed can taint our rivers, lakes and water supplies. Drugs in the trash \u003ca href=\"http://www.epa.illinois.gov/topics/waste-management/waste-disposal/medication-disposal/faqs/index\" target=\"_blank\">also may harm the environment\u003c/a>, and can be found by children, pets — and even adults looking for a high.\u003c/p>\n\u003cp>There are a growing number of year-round disposal sites in California, but your options depend largely on where you live and what kind of drugs you’re trying to unload.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For instance, it might be difficult to find a place that will accept \u003ca href=\"http://www.dea.gov/druginfo/ds.shtml\" target=\"_blank\">“controlled” drugs\u003c/a>, which include legal drugs that are closely regulated by the government, such as addictive opiates.\u003c/p>\n\u003cp>In reality, it might be hard for you to find a convenient place at all.\u003c/p>\n\u003cp>“It’s very time-consuming and you may get the runaround,” warns Heidi Sanborn, executive director of the \u003ca href=\"http://calpsc.org/\" target=\"_blank\">California Product Stewardship Council\u003c/a>, a nonprofit that created the website \u003ca href=\"http://dontrushtoflush.org/\" target=\"_blank\">DontRushToFlush.org\u003c/a>. (The group also calls on pharmaceutical companies to share in the cost of drug disposal.)\u003c/p>\n\u003cp>The safest and most environmentally responsible option is to take unwanted medications to a drug take-back site.\u003c/p>\n\u003cp>But there’s no consistent, statewide collection system because there’s no consistent source of funding, Sanborn says. “It’s whoever can afford to offer it and whoever wants to do it,” she says.\u003c/p>\n\u003cp>Some communities, mostly in Northern California, have adopted ordinances to operate drug collection programs funded by drug makers. They include \u003ca href=\"http://www.acgov.org/aceh/safedisposal/\" target=\"_blank\">Alameda\u003c/a>, \u003ca href=\"http://www.marincounty.org/depts/cd/divisions/environmental-health-services/safe-drug-disposal-ordinance\" target=\"_blank\">Marin\u003c/a> and \u003ca href=\"http://www.codepublishing.com/CA/SantaCruzCounty/html/SantaCruzCounty07/SantaCruzCounty0795.html\" target=\"_blank\">Santa Cruz\u003c/a> Counties. One is also pending before the Los Angeles County Board of Supervisors.\u003c/p>\n\u003cp>But most of these programs are not yet up and running, Sanborn says.\u003c/p>\n\u003cp>So, to find sites near you, start with \u003ca href=\"http://dontrushtoflush.org/dontrush2flush/map/\" target=\"_blank\">Don’t Rush To Flush\u003c/a>, where you can search by California zip code.\u003c/p>\n\u003cp>Pay attention to the search results, which explain whether controlled drugs are accepted. (Some other medications — such as chemotherapy drugs — also come with specific disposal instructions and locations. Same with sharps, such as hypodermic needles.)\u003c/p>\n\u003cp>For more options, try the state’s CalRecycle website at \u003ca href=\"http://www.calrecycle.ca.gov/\" target=\"_blank\">www.calrecycle.ca.gov\u003c/a>. Click on the “Consumers” tab and then on the “Medication Waste” link, where you’ll be directed to \u003ca href=\"http://www.calrecycle.ca.gov/FacIT/Facility/Search.aspx?Activity=Medication\" target=\"_blank\">a not-very-user-friendly search page\u003c/a>.\u003c/p>\n\u003cp>When I asked CalRecycle for more information, I was advised to contact the state Department of Public Health, which I was told supplies the data for the search function. I did on May 17 and several times thereafter, but as of May 26, the department had not answered my questions, opting only to \u003ca href=\"http://www.cdph.ca.gov/certlic/medicalwaste/Documents/MedicalWaste/2013/HomeGenShConsolPtjune09.pdf\" target=\"_blank\">send me a link to a spreadsheet on its website\u003c/a>, which is even less user-friendly than the CalRecycle search function.\u003c/p>\n\u003cp>To find take-back sites that definitely accept controlled drugs, check the federal Drug Enforcement Administration’s website at \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/\" target=\"_blank\">www.deadiversion.usdoj.gov/drug_disposal/\u003c/a> or call 800-882-9539.\u003c/p>\n\u003cp>It turns out the most convenient option may be a new one. The drugstore chain Walgreens \u003ca href=\"http://news.walgreens.com/press-releases/general-news/walgreens-leads-fight-against-prescription-drug-abuse-in-california-with-new-program-to-help-curb-misuse-of-medications-and-the-rise-in-overdose-deaths.htm\" target=\"_blank\">announced plans\u003c/a> to install medication disposal bins at 500 stores nationwide.\u003c/p>\n\u003cp>The effort began last month in California with 50 stores, says Walgreens spokesman Phil Caruso.\u003c/p>\n\u003cp>The bins are available during pharmacy hours — usually 24-hours — and accept prescription medications, including controlled drugs, and over-the-counter medications. They don’t accept sharps.\u003c/p>\n\u003cp>“Our goal is to get at the misuse of medications as well as to help curb the rise in overdose deaths,” Caruso says.\u003c/p>\n\u003cp>Don’t Rush To Flush has integrated participating Walgreens stores into its search results, or find a list of stores here: \u003ca href=\"http://bit.ly/246LNQ4\" target=\"_blank\">http://bit.ly/246LNQ4\u003c/a>.\u003c/p>\n\u003cp>If your search is still coming up short, try checking with your garbage hauler, local household hazardous waste program, pharmacy or hospital, or local law-enforcement agency.\u003c/p>\n\u003cp>Finally, if you can’t find a convenient disposal site, most government agencies — including the \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm\" target=\"_blank\">U.S. Food and Drug Administration\u003c/a> and the U.S. Environmental Protection Agency — suggest you throw unwanted drugs into the trash following these rules:\u003c/p>\n\u003cul>\n\u003cli>Remove the drugs from their containers and mix them with dirt, kitty litter or used coffee grounds to make them unappealing to kids and pets, and to dissuade anyone who might be hunting for drugs.\u003c/li>\n\u003cli>Before tossing in the trash, place the mixture in a sealable plastic bag or other container to prevent it from leaking.\u003c/li>\n\u003cli>Scratch out any personal information on prescription labels to protect your privacy before disposing of medicine containers.\u003c/li>\n\u003c/ul>\n\u003cp>And though Sanborn and some others disagree, the FDA says some drugs should be flushed if you can’t find a take-back site because they “may be especially harmful and, in some cases, fatal with just one dose,” says spokesman Christopher Kelly. The list of drugs, which you can find at \u003ca href=\"http://1.usa.gov/1YWB4q7\" target=\"_blank\">http://1.usa.gov/1YWB4q7\u003c/a>, includes Fentanyl, Oxycodone and other opioids.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We believe that this risk far outweighs any potential risk to human health or the environment that may come from disposal by flushing,” \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafel\" target=\"_blank\">the FDA says\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Opioids like Vicodin and Percocet are commonly prescribed to dull pain after medical procedures and to treat chronic pain. They also commonly languish in medicine cabinets, sometimes for years, making easy pickings for someone with an addiction.\u003c/p>\n\u003cp>The consequences can be deadly: More than 165,000 people died in the U.S. from overdoses related to prescription opioids between 1999 and 2014, says the \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">Centers for Disease Control and Prevention.\u003c/a>\u003c/p>\n\u003cp>I’m guilty of keeping them too long myself. I had a bottle of opioids left over from a dental procedure three years ago and kept it in a freezer bag full of unwanted and expired medications. In April, I turned them all in on the twice-a-year \u003ca href=\"http://www.dea.gov/divisions/hq/2016/hq050616.shtml\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>.\u003c/p>\n\u003cp>What are consumers to do the rest of the year if they want a safe alternative to flushing unwanted drugs down the toilet or tossing them into the garbage? Drugs that are flushed can taint our rivers, lakes and water supplies. Drugs in the trash \u003ca href=\"http://www.epa.illinois.gov/topics/waste-management/waste-disposal/medication-disposal/faqs/index\" target=\"_blank\">also may harm the environment\u003c/a>, and can be found by children, pets — and even adults looking for a high.\u003c/p>\n\u003cp>There are a growing number of year-round disposal sites in California, but your options depend largely on where you live and what kind of drugs you’re trying to unload.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For instance, it might be difficult to find a place that will accept \u003ca href=\"http://www.dea.gov/druginfo/ds.shtml\" target=\"_blank\">“controlled” drugs\u003c/a>, which include legal drugs that are closely regulated by the government, such as addictive opiates.\u003c/p>\n\u003cp>In reality, it might be hard for you to find a convenient place at all.\u003c/p>\n\u003cp>“It’s very time-consuming and you may get the runaround,” warns Heidi Sanborn, executive director of the \u003ca href=\"http://calpsc.org/\" target=\"_blank\">California Product Stewardship Council\u003c/a>, a nonprofit that created the website \u003ca href=\"http://dontrushtoflush.org/\" target=\"_blank\">DontRushToFlush.org\u003c/a>. (The group also calls on pharmaceutical companies to share in the cost of drug disposal.)\u003c/p>\n\u003cp>The safest and most environmentally responsible option is to take unwanted medications to a drug take-back site.\u003c/p>\n\u003cp>But there’s no consistent, statewide collection system because there’s no consistent source of funding, Sanborn says. “It’s whoever can afford to offer it and whoever wants to do it,” she says.\u003c/p>\n\u003cp>Some communities, mostly in Northern California, have adopted ordinances to operate drug collection programs funded by drug makers. They include \u003ca href=\"http://www.acgov.org/aceh/safedisposal/\" target=\"_blank\">Alameda\u003c/a>, \u003ca href=\"http://www.marincounty.org/depts/cd/divisions/environmental-health-services/safe-drug-disposal-ordinance\" target=\"_blank\">Marin\u003c/a> and \u003ca href=\"http://www.codepublishing.com/CA/SantaCruzCounty/html/SantaCruzCounty07/SantaCruzCounty0795.html\" target=\"_blank\">Santa Cruz\u003c/a> Counties. One is also pending before the Los Angeles County Board of Supervisors.\u003c/p>\n\u003cp>But most of these programs are not yet up and running, Sanborn says.\u003c/p>\n\u003cp>So, to find sites near you, start with \u003ca href=\"http://dontrushtoflush.org/dontrush2flush/map/\" target=\"_blank\">Don’t Rush To Flush\u003c/a>, where you can search by California zip code.\u003c/p>\n\u003cp>Pay attention to the search results, which explain whether controlled drugs are accepted. (Some other medications — such as chemotherapy drugs — also come with specific disposal instructions and locations. Same with sharps, such as hypodermic needles.)\u003c/p>\n\u003cp>For more options, try the state’s CalRecycle website at \u003ca href=\"http://www.calrecycle.ca.gov/\" target=\"_blank\">www.calrecycle.ca.gov\u003c/a>. Click on the “Consumers” tab and then on the “Medication Waste” link, where you’ll be directed to \u003ca href=\"http://www.calrecycle.ca.gov/FacIT/Facility/Search.aspx?Activity=Medication\" target=\"_blank\">a not-very-user-friendly search page\u003c/a>.\u003c/p>\n\u003cp>When I asked CalRecycle for more information, I was advised to contact the state Department of Public Health, which I was told supplies the data for the search function. I did on May 17 and several times thereafter, but as of May 26, the department had not answered my questions, opting only to \u003ca href=\"http://www.cdph.ca.gov/certlic/medicalwaste/Documents/MedicalWaste/2013/HomeGenShConsolPtjune09.pdf\" target=\"_blank\">send me a link to a spreadsheet on its website\u003c/a>, which is even less user-friendly than the CalRecycle search function.\u003c/p>\n\u003cp>To find take-back sites that definitely accept controlled drugs, check the federal Drug Enforcement Administration’s website at \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/\" target=\"_blank\">www.deadiversion.usdoj.gov/drug_disposal/\u003c/a> or call 800-882-9539.\u003c/p>\n\u003cp>It turns out the most convenient option may be a new one. The drugstore chain Walgreens \u003ca href=\"http://news.walgreens.com/press-releases/general-news/walgreens-leads-fight-against-prescription-drug-abuse-in-california-with-new-program-to-help-curb-misuse-of-medications-and-the-rise-in-overdose-deaths.htm\" target=\"_blank\">announced plans\u003c/a> to install medication disposal bins at 500 stores nationwide.\u003c/p>\n\u003cp>The effort began last month in California with 50 stores, says Walgreens spokesman Phil Caruso.\u003c/p>\n\u003cp>The bins are available during pharmacy hours — usually 24-hours — and accept prescription medications, including controlled drugs, and over-the-counter medications. They don’t accept sharps.\u003c/p>\n\u003cp>“Our goal is to get at the misuse of medications as well as to help curb the rise in overdose deaths,” Caruso says.\u003c/p>\n\u003cp>Don’t Rush To Flush has integrated participating Walgreens stores into its search results, or find a list of stores here: \u003ca href=\"http://bit.ly/246LNQ4\" target=\"_blank\">http://bit.ly/246LNQ4\u003c/a>.\u003c/p>\n\u003cp>If your search is still coming up short, try checking with your garbage hauler, local household hazardous waste program, pharmacy or hospital, or local law-enforcement agency.\u003c/p>\n\u003cp>Finally, if you can’t find a convenient disposal site, most government agencies — including the \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm\" target=\"_blank\">U.S. Food and Drug Administration\u003c/a> and the U.S. Environmental Protection Agency — suggest you throw unwanted drugs into the trash following these rules:\u003c/p>\n\u003cul>\n\u003cli>Remove the drugs from their containers and mix them with dirt, kitty litter or used coffee grounds to make them unappealing to kids and pets, and to dissuade anyone who might be hunting for drugs.\u003c/li>\n\u003cli>Before tossing in the trash, place the mixture in a sealable plastic bag or other container to prevent it from leaking.\u003c/li>\n\u003cli>Scratch out any personal information on prescription labels to protect your privacy before disposing of medicine containers.\u003c/li>\n\u003c/ul>\n\u003cp>And though Sanborn and some others disagree, the FDA says some drugs should be flushed if you can’t find a take-back site because they “may be especially harmful and, in some cases, fatal with just one dose,” says spokesman Christopher Kelly. The list of drugs, which you can find at \u003ca href=\"http://1.usa.gov/1YWB4q7\" target=\"_blank\">http://1.usa.gov/1YWB4q7\u003c/a>, includes Fentanyl, Oxycodone and other opioids.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We believe that this risk far outweighs any potential risk to human health or the environment that may come from disposal by flushing,” \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafel\" target=\"_blank\">the FDA says\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Few people have the unusual set of professional experiences that Lonny Shavelson does. He worked as an emergency room physician in Berkeley for years -- while also working as a journalist. He has written several books and takes hauntingly beautiful photographs.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This can only work when you're sure that the patients have been given the best end-of-life care, which to me is most guaranteed by being a part of hospice or at least having a good palliative care physician.' \u003ccite>Dr. Lonny Shavelson \u003c/cite>\u003c/aside>\n\u003cp>Now he'll add another specialty. Just as California's \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act\u003c/a>, a law legalizing physician aid-in-dying for people who are terminally ill, is set to take effect next week, Shavelson has become a consultant aimed at answering questions from physicians and patients about the practice -- even becoming a physician to terminally ill patients seeking to end their lives.\u003c/p>\n\u003cp>I first met Shavelson in 1996 as I was covering the reaction to Oregon voters' approval of \u003ca href=\"https://ballotpedia.org/Oregon_%22Death_with_Dignity%22,_Measure_16_(1994)\" target=\"_blank\">Measure 16, the state's Death with Dignity Act\u003c/a>.\u003c/p>\n\u003cp>Oregon was the first state to approve the practice, and in 1996 the law was held up in court. I turned to Shavelson as he had published \"\u003ca href=\"http://www.photowords.com/index.php?page=books\" target=\"_blank\">A Chosen Death\u003c/a>,\" a moving book following five terminally ill people over two years as they determined whether to amass drugs on their own and end their lives at a time of their choosing. He was present at the death of all of them.\u003c/p>\n\u003cp>He followed the issue of assisted suicide closely for several years more, but ultimately moved on to other major projects -- among them \u003ca href=\"http://www.photowords.com/index.php?page=books\" target=\"_blank\">a book about addiction\u003c/a> and a \u003ca href=\"http://www.threetoinfinity.com\" target=\"_blank\">documentary\u003c/a> about people who identify as neither male nor female.\u003c/p>\n\u003cfigure id=\"attachment_192314\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-192314\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/lonnybooks-e1464884484238.jpg\" alt=\"The wall of Lonny Shavelson's office, lined with covers of the books he has written. \" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">The wall of Lonny Shavelson's office, lined with covers of the books he has written. \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Then last fall came the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\">surprising passage of California's End of Life Option Act,\u003c/a> giving terminally ill adults with six months to live the right to request lethal medication to end their lives. The law takes effect June 9.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Shavelson decided he had to act, although he feels \"quite guilty\" about having been away from the issue while others pushed it forward.\u003c/p>\n\u003cp>\"Can I just sit back and watch?\" Shavelson told me from his cottage office in his backyard in Berkeley. \"This is really an amazing opportunity to be part of establishing policy and initiating something in medicine. This is a major change ... [that] very, very few people know anything about and how to do it.\"\u003c/p>\n\u003cp>His website, \u003ca href=\"https://bayareaendoflifeoptions.com\" target=\"_blank\">Bay Area End of Life Options,\u003c/a> went up in April, and he's outlined the law at \"grand rounds\" at several Bay Area hospitals this spring. His practice will be focused on consulting not only with physicians whose patients request aid-in-dying, but also with patients themselves, including offering care to patients who choose him as their \"attending End-of-Life physician,\" as he indicates on his site.\u003c/p>\n\u003cp>Shavelson is adamant that this is \"something that has to be done right.\" To him, that means starting every patient encounter with a one-word question: \"Why?\"\u003c/p>\n\u003cp>\"In fact, it's the only initial approach that I think is acceptable. If somebody calls me and says, 'I want to take the medication,' my first question is, why? Let me talk to you about all the various alternatives and all the ways that we can think about this,\" he predicts he will say.\u003c/p>\n\u003cp>Shavelson worries that patients may seek aid-in-dying because they are in pain, so first, he would like all his patients to be enrolled in hospice care.\u003c/p>\n\u003cp>\"This can only work when you're sure that the patients have been given the best end-of-life care, which to me is most guaranteed by being a part of hospice or at least having a good palliative care physician. Then this is a rational decision. If you're doing it otherwise, it's because of lack of good care.\"\u003c/p>\n\u003cp>California is the fifth state to legalize aid-in-dying, joining Oregon, Washington, Vermont and Montana. The option is very rarely used. For example, in \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">2014 in Oregon\u003c/a>, 155 lethal prescriptions were written under the state's law, and 105 people ultimately took the medicine and died, a death rate under this method of less than 0.5 percent.\u003c/p>\n\u003cp>Under the law, two doctors must agree that a mentally competent patient has six months or less to live. One of the patient-doctor meetings must be private, between only the patient and the physician, to ensure the patient is acting independently. Patients must be able to swallow the medication themselves and must state, in writing, within 48 hours before taking the medication, that they will do so.\u003c/p>\n\u003cp>Shavelson says he has been surprised by the lack of understanding he hears from some health care providers about the law. One person insisted the law was not taking effect this year; another asked how the law would benefit his patients with Alzheimer's disease. To be clear, the law takes effect next week, and patients with dementia cannot access the law because they are not mentally competent.\u003c/p>\n\u003cfigure id=\"attachment_192674\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-192674 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Renee-1-copy-400x598.jpg\" alt='Renee Sahm, one of five terminally ill people followed by Lonny Shavelson in his 1994 book \"A Chosen Death.\"' width=\"400\" height=\"598\">\u003cfigcaption class=\"wp-caption-text\">Renee Sahm, one of five terminally ill people followed by Lonny Shavelson in his 1995 book \"A Chosen Death.\" \u003ccite>(Courtesy: Lonny Shavelson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The law does not mandate participation by any health care providers. Many physicians are \"queasy\" with the new law, Shavelson says he's hearing, and are unwilling to prescribe to patients who request the lethal medication -- even though they tell him they think the law is the right thing to do.\u003c/p>\n\u003cp>\"My response to that is as health care providers, you might have been uncomfortable the first time you drew blood. You might have been uncomfortable the first time you took out somebody's gall bladder,\" he says. \"If it's a medical procedure you believe in and you believe it's the patient's right, then it's your obligation to learn how to do it -- and do it correctly.\"\u003c/p>\n\u003cp>Shavelson said he predicts that many physicians who are initially reluctant to provide this option to their patients may become more comfortable after the law goes into effect and they see how it works.\u003c/p>\n\u003cp>Burt Presberg, an East Bay psychiatrist who works specifically with cancer patients and their families, said a talk he attended by Shavelson sparked a conversation at his practice. Yet, in my own talk with him, he peppered his statements with \"on the other hand,\" as he clearly wrestled with his own comfort level of handling patient requests.\u003c/p>\n\u003cp>Presberg spoke of his concern that patients suffer from clinical depression at the end of life, sometimes feeling they are a burden to family members who could \"really push for the end of life to happen a little sooner than the patient themselves.\" He spoke from his experience of successfully treating terminally ill patients with clinical depression.\u003c/p>\n\u003cp>\"Depression is something that's really undertreated,\" Presberg said. \"I often talk to people about the difference between normal sadness and normal grieving at the end of life.\"\u003c/p>\n\u003cp>He said he believes Shavelson will be aware of treating depression, \"but I do have concerns about other physicians,\" he said. \"On the other hand, I think it's really good that this is an option.\"\u003c/p>\n\u003cp>Shavelson says he's already received a handful of calls from patients, but he's mostly spent this time before the law takes effect talking to other physicians. He needs a consulting physician and a pharmacist that will accept prescriptions for the lethal dose of medicine.\u003c/p>\n\u003cp>Then he returns to the patient. \"It's important ... that we're moving forward,\" he says. \"It's crucial that we do that because this is part of the rights of patient care to have a certain level of autonomy in how they die.\"\u003c/p>\n\u003cp>To many of the doctors who feel \"queasy\" about moving to end a patient's life, this type of care \"isn't so tangibly different to me,\" Shavelson says, than other kinds of questions doctors address.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I'm just one of those docs who sees dying as a process, and method of death is less important than making sure it's a good death.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Few people have the unusual set of professional experiences that Lonny Shavelson does. He worked as an emergency room physician in Berkeley for years -- while also working as a journalist. He has written several books and takes hauntingly beautiful photographs.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This can only work when you're sure that the patients have been given the best end-of-life care, which to me is most guaranteed by being a part of hospice or at least having a good palliative care physician.' \u003ccite>Dr. Lonny Shavelson \u003c/cite>\u003c/aside>\n\u003cp>Now he'll add another specialty. Just as California's \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act\u003c/a>, a law legalizing physician aid-in-dying for people who are terminally ill, is set to take effect next week, Shavelson has become a consultant aimed at answering questions from physicians and patients about the practice -- even becoming a physician to terminally ill patients seeking to end their lives.\u003c/p>\n\u003cp>I first met Shavelson in 1996 as I was covering the reaction to Oregon voters' approval of \u003ca href=\"https://ballotpedia.org/Oregon_%22Death_with_Dignity%22,_Measure_16_(1994)\" target=\"_blank\">Measure 16, the state's Death with Dignity Act\u003c/a>.\u003c/p>\n\u003cp>Oregon was the first state to approve the practice, and in 1996 the law was held up in court. I turned to Shavelson as he had published \"\u003ca href=\"http://www.photowords.com/index.php?page=books\" target=\"_blank\">A Chosen Death\u003c/a>,\" a moving book following five terminally ill people over two years as they determined whether to amass drugs on their own and end their lives at a time of their choosing. He was present at the death of all of them.\u003c/p>\n\u003cp>He followed the issue of assisted suicide closely for several years more, but ultimately moved on to other major projects -- among them \u003ca href=\"http://www.photowords.com/index.php?page=books\" target=\"_blank\">a book about addiction\u003c/a> and a \u003ca href=\"http://www.threetoinfinity.com\" target=\"_blank\">documentary\u003c/a> about people who identify as neither male nor female.\u003c/p>\n\u003cfigure id=\"attachment_192314\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-192314\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/lonnybooks-e1464884484238.jpg\" alt=\"The wall of Lonny Shavelson's office, lined with covers of the books he has written. \" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">The wall of Lonny Shavelson's office, lined with covers of the books he has written. \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Then last fall came the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\">surprising passage of California's End of Life Option Act,\u003c/a> giving terminally ill adults with six months to live the right to request lethal medication to end their lives. The law takes effect June 9.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Shavelson decided he had to act, although he feels \"quite guilty\" about having been away from the issue while others pushed it forward.\u003c/p>\n\u003cp>\"Can I just sit back and watch?\" Shavelson told me from his cottage office in his backyard in Berkeley. \"This is really an amazing opportunity to be part of establishing policy and initiating something in medicine. This is a major change ... [that] very, very few people know anything about and how to do it.\"\u003c/p>\n\u003cp>His website, \u003ca href=\"https://bayareaendoflifeoptions.com\" target=\"_blank\">Bay Area End of Life Options,\u003c/a> went up in April, and he's outlined the law at \"grand rounds\" at several Bay Area hospitals this spring. His practice will be focused on consulting not only with physicians whose patients request aid-in-dying, but also with patients themselves, including offering care to patients who choose him as their \"attending End-of-Life physician,\" as he indicates on his site.\u003c/p>\n\u003cp>Shavelson is adamant that this is \"something that has to be done right.\" To him, that means starting every patient encounter with a one-word question: \"Why?\"\u003c/p>\n\u003cp>\"In fact, it's the only initial approach that I think is acceptable. If somebody calls me and says, 'I want to take the medication,' my first question is, why? Let me talk to you about all the various alternatives and all the ways that we can think about this,\" he predicts he will say.\u003c/p>\n\u003cp>Shavelson worries that patients may seek aid-in-dying because they are in pain, so first, he would like all his patients to be enrolled in hospice care.\u003c/p>\n\u003cp>\"This can only work when you're sure that the patients have been given the best end-of-life care, which to me is most guaranteed by being a part of hospice or at least having a good palliative care physician. Then this is a rational decision. If you're doing it otherwise, it's because of lack of good care.\"\u003c/p>\n\u003cp>California is the fifth state to legalize aid-in-dying, joining Oregon, Washington, Vermont and Montana. The option is very rarely used. For example, in \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">2014 in Oregon\u003c/a>, 155 lethal prescriptions were written under the state's law, and 105 people ultimately took the medicine and died, a death rate under this method of less than 0.5 percent.\u003c/p>\n\u003cp>Under the law, two doctors must agree that a mentally competent patient has six months or less to live. One of the patient-doctor meetings must be private, between only the patient and the physician, to ensure the patient is acting independently. Patients must be able to swallow the medication themselves and must state, in writing, within 48 hours before taking the medication, that they will do so.\u003c/p>\n\u003cp>Shavelson says he has been surprised by the lack of understanding he hears from some health care providers about the law. One person insisted the law was not taking effect this year; another asked how the law would benefit his patients with Alzheimer's disease. To be clear, the law takes effect next week, and patients with dementia cannot access the law because they are not mentally competent.\u003c/p>\n\u003cfigure id=\"attachment_192674\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-192674 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Renee-1-copy-400x598.jpg\" alt='Renee Sahm, one of five terminally ill people followed by Lonny Shavelson in his 1994 book \"A Chosen Death.\"' width=\"400\" height=\"598\">\u003cfigcaption class=\"wp-caption-text\">Renee Sahm, one of five terminally ill people followed by Lonny Shavelson in his 1995 book \"A Chosen Death.\" \u003ccite>(Courtesy: Lonny Shavelson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The law does not mandate participation by any health care providers. Many physicians are \"queasy\" with the new law, Shavelson says he's hearing, and are unwilling to prescribe to patients who request the lethal medication -- even though they tell him they think the law is the right thing to do.\u003c/p>\n\u003cp>\"My response to that is as health care providers, you might have been uncomfortable the first time you drew blood. You might have been uncomfortable the first time you took out somebody's gall bladder,\" he says. \"If it's a medical procedure you believe in and you believe it's the patient's right, then it's your obligation to learn how to do it -- and do it correctly.\"\u003c/p>\n\u003cp>Shavelson said he predicts that many physicians who are initially reluctant to provide this option to their patients may become more comfortable after the law goes into effect and they see how it works.\u003c/p>\n\u003cp>Burt Presberg, an East Bay psychiatrist who works specifically with cancer patients and their families, said a talk he attended by Shavelson sparked a conversation at his practice. Yet, in my own talk with him, he peppered his statements with \"on the other hand,\" as he clearly wrestled with his own comfort level of handling patient requests.\u003c/p>\n\u003cp>Presberg spoke of his concern that patients suffer from clinical depression at the end of life, sometimes feeling they are a burden to family members who could \"really push for the end of life to happen a little sooner than the patient themselves.\" He spoke from his experience of successfully treating terminally ill patients with clinical depression.\u003c/p>\n\u003cp>\"Depression is something that's really undertreated,\" Presberg said. \"I often talk to people about the difference between normal sadness and normal grieving at the end of life.\"\u003c/p>\n\u003cp>He said he believes Shavelson will be aware of treating depression, \"but I do have concerns about other physicians,\" he said. \"On the other hand, I think it's really good that this is an option.\"\u003c/p>\n\u003cp>Shavelson says he's already received a handful of calls from patients, but he's mostly spent this time before the law takes effect talking to other physicians. He needs a consulting physician and a pharmacist that will accept prescriptions for the lethal dose of medicine.\u003c/p>\n\u003cp>Then he returns to the patient. \"It's important ... that we're moving forward,\" he says. \"It's crucial that we do that because this is part of the rights of patient care to have a certain level of autonomy in how they die.\"\u003c/p>\n\u003cp>To many of the doctors who feel \"queasy\" about moving to end a patient's life, this type of care \"isn't so tangibly different to me,\" Shavelson says, than other kinds of questions doctors address.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I'm just one of those docs who sees dying as a process, and method of death is less important than making sure it's a good death.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Depressed Teen's Struggle to Find Mental Health Care in Rural California",
"title": "Depressed Teen's Struggle to Find Mental Health Care in Rural California",
"headTitle": "State of Mind | State of Health | KQED News",
"content": "\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/266972349\" 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>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"X2OS9UvvrWrgYd3y51AcrwAvhclm8opt\"]Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Have a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\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/266972349&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/266972349'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The California Assembly approved a bill on Tuesday that would permit undocumented immigrants access to Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>Under federal law undocumented immigrants are barred from any of the benefits of the Affordable Care Act.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">Senate Bill 10\u003c/a> would direct California to ask the federal government for a waiver that would permit undocumented immigrants the option to buy insurance on Covered California -- with their own money. It passed by a vote of 54-19.\u003c/p>\n\u003cp>California would be the first state to make such a request.\u003c/p>\n\u003cp>“This waiver will allow an estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal to purchase healthcare through the exchange under the Affordable Care Act,\" said Sen. Ricardo Lara, D-Bell Gardens, author of the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Undocumented immigrants would not be eligible for subsidies. If such a waiver were ultimately approved, families with mixed status -- where some family members are undocumented and some are lawfully present -- could all be on the same health insurance plan, potentially simplifying access to finding care.\u003c/p>\n\u003cp>Robin Hvidston, executive director of the Claremont-based group We the People Rising, a group which advocates for strict enforcement of immigration laws, criticized the measure last month in \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-undocumented-immigrant-health-insurance-20160414-story.html\" target=\"_blank\">an interview with the Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>“We oppose that [bill] because that encourages illegal immigration,” Hvidston said. “It sends a message to the world that if you come to our country you will be rewarded.”\u003c/p>\n\u003cp>A law permitting Medi-Cal coverage for undocumented children \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/13/undocumented-kids-soon-eligible-for-medi-cal/\" target=\"_blank\">went into effect earlier this month\u003c/a>. An estimated 170,000 children are expected to benefit at a cost to the state of $40 million this year and $132 million annually after that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill goes back to the Senate this week for final approval before it can head to the governor's desk.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The California Assembly approved a bill on Tuesday that would permit undocumented immigrants access to Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>Under federal law undocumented immigrants are barred from any of the benefits of the Affordable Care Act.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">Senate Bill 10\u003c/a> would direct California to ask the federal government for a waiver that would permit undocumented immigrants the option to buy insurance on Covered California -- with their own money. It passed by a vote of 54-19.\u003c/p>\n\u003cp>California would be the first state to make such a request.\u003c/p>\n\u003cp>“This waiver will allow an estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal to purchase healthcare through the exchange under the Affordable Care Act,\" said Sen. Ricardo Lara, D-Bell Gardens, author of the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Undocumented immigrants would not be eligible for subsidies. If such a waiver were ultimately approved, families with mixed status -- where some family members are undocumented and some are lawfully present -- could all be on the same health insurance plan, potentially simplifying access to finding care.\u003c/p>\n\u003cp>Robin Hvidston, executive director of the Claremont-based group We the People Rising, a group which advocates for strict enforcement of immigration laws, criticized the measure last month in \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-undocumented-immigrant-health-insurance-20160414-story.html\" target=\"_blank\">an interview with the Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>“We oppose that [bill] because that encourages illegal immigration,” Hvidston said. “It sends a message to the world that if you come to our country you will be rewarded.”\u003c/p>\n\u003cp>A law permitting Medi-Cal coverage for undocumented children \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/13/undocumented-kids-soon-eligible-for-medi-cal/\" target=\"_blank\">went into effect earlier this month\u003c/a>. An estimated 170,000 children are expected to benefit at a cost to the state of $40 million this year and $132 million annually after that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill goes back to the Senate this week for final approval before it can head to the governor's desk.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Regulators Examining Whether Health Net Is Stiffing Drug Treatment Providers",
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"content": "\u003cp>California insurance officials are looking into whether Health Net Inc. has improperly withheld payments to addiction treatment centers for months while the company investigates concerns about fraudulent claims.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Health Net has stopped payment for services already provided and it’s unconscionable.'\u003ccite>Stampp Corbin, Addiction Treatment Advocacy Coalition \u003c/cite>\u003c/aside>\n\u003cp>The California Department of Insurance began an inquiry after receiving numerous complaints from substance-abuse treatment facilities statewide that Health Net had not paid them since at least January, according to providers questioned by the agency. Health Net is California’s fourth-largest health insurer, acquired in March for $6 billion by Centene Corp., a St. Louis-based insurer.\u003c/p>\n\u003cp>Officials at the California Department of Managed Health Care, the state’s other insurance regulator, said they are reviewing a May 20 complaint about Health Net’s actions signed by executives and owners of 118 for-profit treatment centers.\u003c/p>\n\u003cp>The treatment providers say they can’t afford to accept Health Net patients without reimbursement, and that the insurer is harming its policyholders by limiting their access to treatment. Drug and alcohol treatment centers in Arizona have filed similar complaints about Health Net with insurance officials there.\u003c/p>\n\u003cp>A Health Net spokesman said “our policy is to not comment on these kinds of inquiries.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>All this comes as the country grapples with an opioid epidemic and more people need help getting sober.\u003c/p>\n\u003cp>“Health Net has stopped payment for services already provided and it’s unconscionable,” said Stampp Corbin, president of the Addiction Treatment Advocacy Coalition, a nonprofit group in Los Angeles that represents California’s for-profit treatment centers. “The net effect is some small facilities may go out of business if they had a high concentration of Health Net clients.”\u003c/p>\n\u003cp>Janice Rocco, the insurance department’s deputy commissioner, said she can’t comment specifically on complaints that are still under investigation.\u003c/p>\n\u003cp>“If we receive complaints from a number of providers about the same insurer not paying in a timely fashion, we would take that very seriously,” Rocco said. “We do communicate with insurers immediately when we receive these types of complaints.”\u003c/p>\n\u003cp>After confirming the complaints, a spokeswoman for the Department of Managed Health Care said “ensuring consumers have access to mental health services which they are entitled to under the law is a priority for the DMHC.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Health Net is examining whether treatment providers paid kickbacks to brokers, labs or doctors who might give referrals.\u003c/aside>\n\u003cp>The current dispute began in January when Health Net’s director of special investigations, Matthew Ciganek, sent a letter to numerous treatment facilities in California outlining a “number of potential concerns” about “false and/or fraudulent claims.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.files.wordpress.com/2016/05/health-net-january-letter.pdf\" target=\"_blank\">In his Jan. 8 letter to providers\u003c/a>, Ciganek cited concerns that people who came for treatment from out of state were obtaining benefits for which they were not eligible because they didn’t “continually reside in our defined California service area.”\u003c/p>\n\u003cp>The letter also said Health Net was looking into allegations that providers had waived deductibles or copayments to attract patients or had paid kickbacks to brokers, testing labs, physicians or other providers who might give referrals.\u003c/p>\n\u003cp>The company followed up with similar letters to rehab facilities in March and, in addition, contacted patients for information about their treatment.\u003c/p>\n\u003cp>The letters to patients asked them to show evidence they had paid their deductibles, copays or coinsurance and to furnish a copy of the state license for the treatment facility they visited.\u003c/p>\n\u003cp>“This is to notify you there will be a delay in finalization of this claim until the requested information has been received,” Health Net said in its March letters to patients.\u003c/p>\n\u003cp>[contextly_sidebar id=\"PkgqpVSxuWYsUdCJN0h4IQQof6nk2jyE\"]In the meantime, some Health Net members say finding a treatment center has become more difficult.\u003c/p>\n\u003cp>Gary Millman of Santa Rosa said his adult son sought help in April for his heroin addiction, and two facilities refused to take him because they had concerns about his Health Net coverage.\u003c/p>\n\u003cp>“When they found out he had Health Net, they wouldn’t touch him,” Millman said. “The facilities don’t know if Health Net will come through on paying for treatment, yet the insurance company takes your money easy enough.”\u003c/p>\n\u003cp>Millman’s son eventually located a rehab center with the help of a family friend.\u003c/p>\n\u003cp>Health Net’s action comes after years of criticism and \u003ca href=\"http://www.cnn.com/2013/07/29/health/rehab-racket-siu-cir-part-one/\" target=\"_blank\">media coverage faulting health insurers and the state’s Medi-Cal program\u003c/a> for lax oversight of drug rehab facilities. Some have billed for services never provided or sought to boost revenues by enrolling patients in health plans without their knowledge.\u003c/p>\n\u003cp>Industry representatives acknowledge that the rehab business has a history of fraud and abuse that warrants close scrutiny, but they say Health Net’s audit goes too far.\u003c/p>\n\u003cp>“There are bad players in every industry, but this dragnet is too broad,” said Joan Borsten, a co-founder of the Malibu Beach Recovery Center and vice president of the Addiction Treatment Advocacy Coalition.\u003c/p>\n\u003cp>She said some treatment centers in the coalition report being owed $1 million or more by Health Net for residential or outpatient care. The total amount billed and left unpaid is unclear, she said.\u003c/p>\n\u003cp>Treatment providers in Arizona express similar frustrations.\u003c/p>\n\u003cp>In a recent letter to the Arizona Department of Insurance, the Northern Arizona Recovery Association said Health Net’s “sweeping and indiscriminate audit … has caused significant and undue hardship for quality providers, and more importantly, for the individuals who have paid their premiums and are seeking medically necessary services.”\u003c/p>\n\u003cp>A spokesman for the Arizona agency said it doesn’t comment on matters that might be under investigation.\u003c/p>\n\u003cp>Even before the present standstill over payments, Health Net fell short in ensuring its patients received timely treatment for drug and alcohol problems, data in California show.\u003c/p>\n\u003cp>Only 25 percent of Health Net’s HMO members started treatment within 14 days of being diagnosed with a drug or alcohol addiction, according to 2014 data from the California Office of the Patient Advocate. That was second-to-last among 10 health plans rated. The score for top health plans nationally was 44 percent.\u003c/p>\n\u003cp>Health Net did only slightly better on its PPO plans. Thirty-one percent received treatment within 14 days of diagnosis, placing Health Net fourth among six insurers that were rated. Nationally, top-performing PPO plans posted a treatment rate of 43 percent.\u003c/p>\n\u003cp>Health Net had similar below-average results for providing timely follow-up treatment for addicts.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>California Insurance Commissioner Dave Jones approved Centene’s acquisition of Health Net in March with a number of conditions. One of them is that the new company make efforts to improve Health Net’s ratings on the Patient Advocate’s report card.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California insurance officials are looking into whether Health Net Inc. has improperly withheld payments to addiction treatment centers for months while the company investigates concerns about fraudulent claims.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Health Net has stopped payment for services already provided and it’s unconscionable.'\u003ccite>Stampp Corbin, Addiction Treatment Advocacy Coalition \u003c/cite>\u003c/aside>\n\u003cp>The California Department of Insurance began an inquiry after receiving numerous complaints from substance-abuse treatment facilities statewide that Health Net had not paid them since at least January, according to providers questioned by the agency. Health Net is California’s fourth-largest health insurer, acquired in March for $6 billion by Centene Corp., a St. Louis-based insurer.\u003c/p>\n\u003cp>Officials at the California Department of Managed Health Care, the state’s other insurance regulator, said they are reviewing a May 20 complaint about Health Net’s actions signed by executives and owners of 118 for-profit treatment centers.\u003c/p>\n\u003cp>The treatment providers say they can’t afford to accept Health Net patients without reimbursement, and that the insurer is harming its policyholders by limiting their access to treatment. Drug and alcohol treatment centers in Arizona have filed similar complaints about Health Net with insurance officials there.\u003c/p>\n\u003cp>A Health Net spokesman said “our policy is to not comment on these kinds of inquiries.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>All this comes as the country grapples with an opioid epidemic and more people need help getting sober.\u003c/p>\n\u003cp>“Health Net has stopped payment for services already provided and it’s unconscionable,” said Stampp Corbin, president of the Addiction Treatment Advocacy Coalition, a nonprofit group in Los Angeles that represents California’s for-profit treatment centers. “The net effect is some small facilities may go out of business if they had a high concentration of Health Net clients.”\u003c/p>\n\u003cp>Janice Rocco, the insurance department’s deputy commissioner, said she can’t comment specifically on complaints that are still under investigation.\u003c/p>\n\u003cp>“If we receive complaints from a number of providers about the same insurer not paying in a timely fashion, we would take that very seriously,” Rocco said. “We do communicate with insurers immediately when we receive these types of complaints.”\u003c/p>\n\u003cp>After confirming the complaints, a spokeswoman for the Department of Managed Health Care said “ensuring consumers have access to mental health services which they are entitled to under the law is a priority for the DMHC.”\u003c/p>\n\u003caside class=\"pullquote alignright\">Health Net is examining whether treatment providers paid kickbacks to brokers, labs or doctors who might give referrals.\u003c/aside>\n\u003cp>The current dispute began in January when Health Net’s director of special investigations, Matthew Ciganek, sent a letter to numerous treatment facilities in California outlining a “number of potential concerns” about “false and/or fraudulent claims.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.files.wordpress.com/2016/05/health-net-january-letter.pdf\" target=\"_blank\">In his Jan. 8 letter to providers\u003c/a>, Ciganek cited concerns that people who came for treatment from out of state were obtaining benefits for which they were not eligible because they didn’t “continually reside in our defined California service area.”\u003c/p>\n\u003cp>The letter also said Health Net was looking into allegations that providers had waived deductibles or copayments to attract patients or had paid kickbacks to brokers, testing labs, physicians or other providers who might give referrals.\u003c/p>\n\u003cp>The company followed up with similar letters to rehab facilities in March and, in addition, contacted patients for information about their treatment.\u003c/p>\n\u003cp>The letters to patients asked them to show evidence they had paid their deductibles, copays or coinsurance and to furnish a copy of the state license for the treatment facility they visited.\u003c/p>\n\u003cp>“This is to notify you there will be a delay in finalization of this claim until the requested information has been received,” Health Net said in its March letters to patients.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In the meantime, some Health Net members say finding a treatment center has become more difficult.\u003c/p>\n\u003cp>Gary Millman of Santa Rosa said his adult son sought help in April for his heroin addiction, and two facilities refused to take him because they had concerns about his Health Net coverage.\u003c/p>\n\u003cp>“When they found out he had Health Net, they wouldn’t touch him,” Millman said. “The facilities don’t know if Health Net will come through on paying for treatment, yet the insurance company takes your money easy enough.”\u003c/p>\n\u003cp>Millman’s son eventually located a rehab center with the help of a family friend.\u003c/p>\n\u003cp>Health Net’s action comes after years of criticism and \u003ca href=\"http://www.cnn.com/2013/07/29/health/rehab-racket-siu-cir-part-one/\" target=\"_blank\">media coverage faulting health insurers and the state’s Medi-Cal program\u003c/a> for lax oversight of drug rehab facilities. Some have billed for services never provided or sought to boost revenues by enrolling patients in health plans without their knowledge.\u003c/p>\n\u003cp>Industry representatives acknowledge that the rehab business has a history of fraud and abuse that warrants close scrutiny, but they say Health Net’s audit goes too far.\u003c/p>\n\u003cp>“There are bad players in every industry, but this dragnet is too broad,” said Joan Borsten, a co-founder of the Malibu Beach Recovery Center and vice president of the Addiction Treatment Advocacy Coalition.\u003c/p>\n\u003cp>She said some treatment centers in the coalition report being owed $1 million or more by Health Net for residential or outpatient care. The total amount billed and left unpaid is unclear, she said.\u003c/p>\n\u003cp>Treatment providers in Arizona express similar frustrations.\u003c/p>\n\u003cp>In a recent letter to the Arizona Department of Insurance, the Northern Arizona Recovery Association said Health Net’s “sweeping and indiscriminate audit … has caused significant and undue hardship for quality providers, and more importantly, for the individuals who have paid their premiums and are seeking medically necessary services.”\u003c/p>\n\u003cp>A spokesman for the Arizona agency said it doesn’t comment on matters that might be under investigation.\u003c/p>\n\u003cp>Even before the present standstill over payments, Health Net fell short in ensuring its patients received timely treatment for drug and alcohol problems, data in California show.\u003c/p>\n\u003cp>Only 25 percent of Health Net’s HMO members started treatment within 14 days of being diagnosed with a drug or alcohol addiction, according to 2014 data from the California Office of the Patient Advocate. That was second-to-last among 10 health plans rated. The score for top health plans nationally was 44 percent.\u003c/p>\n\u003cp>Health Net did only slightly better on its PPO plans. Thirty-one percent received treatment within 14 days of diagnosis, placing Health Net fourth among six insurers that were rated. Nationally, top-performing PPO plans posted a treatment rate of 43 percent.\u003c/p>\n\u003cp>Health Net had similar below-average results for providing timely follow-up treatment for addicts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California Insurance Commissioner Dave Jones approved Centene’s acquisition of Health Net in March with a number of conditions. One of them is that the new company make efforts to improve Health Net’s ratings on the Patient Advocate’s report card.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Maria Spivey was driving the #1 bus in San Diego one spring day two years ago, when her cellphone started ringing and ringing. She figured it was her 17-year-old daughter Chloe.\u003c/p>\n\u003cp>\"There was no way I could stop and answer the phone,\" she remembers. So she kept going.\u003c/p>\n\u003cp>\"When I get to the end of the line,\" she told herself, \"I'll take a break. I'll call Chloe.\"\u003c/p>\n\u003cp>When she got to the terminal, the calls became more insistent. Now it was her partner, Charles.\u003c/p>\n\u003cp>“‘You need to get home,’” Spivey remembers him telling her. “’Get home now.’”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She rushed home to find police cars parked in every direction outside her house. Charles opened her car door.\u003c/p>\n\u003cp>\"Chloe's gone,\" he told her.\u003c/p>\n\u003cp>Chloe had killed herself.\u003c/p>\n\u003cp>“I think I almost fell to my knees,” Spivey says, holding back tears. “But I didn’t want to lose complete control. My kids were watching me.”\u003c/p>\n\u003cfigure id=\"attachment_189450\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-189450\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS19311_IMG_1779-e1464305449405.jpg\" alt=\"Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \" width=\"1920\" height=\"1920\">\u003cfigcaption class=\"wp-caption-text\">Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At first Spivey blamed herself.\u003cstrong> \u003c/strong>But later, she blamed Kaiser Permanente. Spivey says the HMO failed to take care of her daughter. When Chloe started having trouble with depression and anxiety in middle school, Kaiser told her she couldn’t get weekly individual therapy.\u003c/p>\n\u003cp>“There's no one-on-one,” Spivey remembers being told.\u003c/p>\n\u003cp>Chloe had attempted suicide once before, when she was 16. Even then, Kaiser did not schedule her into individual therapy. Instead she was put into a weekly group for teens with drug abuse problems.\u003c/p>\n\u003cp>“They didn't discuss depression, anxiety, PTSD,\" Spivey says. No one asked if she was feeling suicidal. “Chloe told me more often than not, ‘Mom, this is not what I need.'\"\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/266777047\" 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>\u003cstrong>History of Complaints\u003c/strong>\u003c/p>\n\u003cp>Complaints like these had been building up at Kaiser for years. Mental health clinicians at Kaiser who were members of the National Union of Healthcare Workers started to organize across the state. They sent thousands of pages of internal Kaiser documents to state regulators.\u003c/p>\n\u003cp>The clinicians said Kaiser was understaffing its psychiatric department. They said patients were being shuttled into groups or forced to wait four to six weeks for individual therapy appointments.\u003c/p>\n\u003cp>The Department of Managed Health Care, the main regulator of health insurers in the state, found merit in these claims and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">fined Kaiser\u003c/a> $4 million, which Kaiser initially contested, then agreed to pay in 2014.\u003c/p>\n\u003cp>But the union was still not satisfied. It said patients were still waiting too long for appointments, and in 2015, they went \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/12/kaiser-mental-health-workers-launch-7-day-strike/\" target=\"_blank\">on strike\u003c/a>.\u003c/p>\n\u003cp>Kaiser eventually reached a contract agreement with the union, building more time into therapists’ schedules for patient care, and offering “competitive” salaries and benefits, said Yener Balan, Kaiser’s executive director of behavioral health quality, in a statement. It also hired hundreds of new therapists last year and is \"aggressively\" recruiting more.\u003c/p>\n\u003cp>“Kaiser Permanente is actively working to meet the challenges that everyone in the mental health treatment community is facing,” Balan said. “As one of the largest mental health providers in California, we recognize that we are in a position to lead, and that is what we are committed to do.\"\u003c/p>\n\u003cp>While the union is pleased with the changes, union president Sal Roselli says there’s still more work to do.\u003c/p>\n\u003cp>“We want to make Kaiser the poster child to take to other [insurance] providers, in terms of how to do it right,” he says.\u003c/p>\n\u003cp>\u003cstrong>Kaiser May Be 'Victim of Their Own Data' \u003c/strong>\u003c/p>\n\u003cp>Kaiser is the only insurance company that’s been fined in California for forcing patients to wait excessively long for mental health visits. But is it really the only one with problems?\u003c/p>\n\u003cp>Last year in Sacramento, Shelley Rouillard, the head the state's Department of Managed Health Care, testified before a senate committee on mental health that Kaiser's integrated system -- where the insurer and medical provider are one entity -- made it something of an easy target.\u003c/p>\n\u003cp>“Kaiser probably has much better data than anyone else,” she told state lawmakers. \"And so to some extent they may be a victim of their own data.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"Pj1zuPmPSNXAFV3QoGyu3PznrAQcrKbd\"]Other insurers don’t have a centralized call center that tracks appointment wait times, like Kaiser. They have fragmented networks of self-employed therapists. There’s no way to count how many calls a patient makes before they find one who’s available. Or how many patients simply give up.\u003c/p>\n\u003cp>Right now in California, insurance companies monitor themselves to make sure they have enough clinicians. Insurers are responsible for surveying therapists in their directories to make sure they are accepting new patients. But these surveys do not simulate the typical patient experience -– as therapists’ answers about whether they are taking new patients can vary dramatically if the person calling is a patient or the insurance company who pays them.\u003c/p>\n\u003cp>For example, a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey of 100 psychologists \u003c/a>in the Blue Shield network in San Francisco found that only 28 were actually taking new patients, a rate Rouillard said was “not acceptable.”\u003c/p>\n\u003cp>Mental health clinicians and advocates criticize the Department of Managed Health Care for going easy on insurance companies.\u003c/p>\n\u003cp>The fines are too low and too infrequent, says Meiram Bendat, a plaintiffs’ lawyer in Los Angeles. “They’re a slow bureaucracy that takes way too long to respond to consumer complaints.”\u003c/p>\n\u003cp>\u003cstrong>Difficulty of Enforcement \u003c/strong>\u003c/p>\n\u003cp>Rouillard says the mental health parity laws her agency is tasked with enforcing are extremely complicated, so it makes more sense to work with the companies to correct problems.\u003c/p>\n\u003cp>“We want the plans to do the right thing from the beginning,\" Rouillard says. \"It's worth it to spend the time to help them understand what the law is and what their responsibilities are and for us to work with them to get it right.”\u003c/p>\n\u003cp>Right now, the agency is reviewing health insurance plans’ mental health benefits. Where there are violations of the law -- say a plan charges a higher copay for mental health services compared to other medical services -- the agency tells the insurer to fix the plan so the copays are the same. Of 25 insurance companies reviewed this year, 24 had a violation like this, according to the department. Later this year, department officials will visit insurance companies on site to audit patient files.\u003c/p>\n\u003cp>“It's been a good process,” Rouillard says. “It’s been a little long and dragged out, but we’re getting there and we’ll see on the back end how well it really works.”\u003c/p>\n\u003cp>Other states are taking a much more aggressive approach.\u003c/p>\n\u003cp>In New York, the state attorney general has been suing insurers, using subpoena power to demand data from companies about what kind of care patients are actually getting, not just what the companies say they’re giving.\u003c/p>\n\u003cp>“It doesn’t seem like there’s any lack of winnable cases available,” says Keith Humphreys, a psychiatrist at Stanford who served as a policy advisor to the Obama administration. “The reason we see that in New York is not that New York is an unusual place -- but that you had a public official who was engaged enough and talented enough to expose it.”\u003c/p>\n\u003cp>He calls the New York attorney general a hero.\u003c/p>\n\u003cp>The investigations pursued in New York and by California's Department of Managed Health Care have depended largely on consumers submitting complaints about their health plans. This can be a tall order for people suffering from a mental illness, who may be too distraught, or even cognitively impaired by their condition to navigate the web of agencies, and the web of forms. Advocates believe the number of complaints submitted to regulators represent only a fraction of potential violations of mental health laws.\u003c/p>\n\u003cp>Maria Spivey says when her daughter Chloe was struggling, she didn’t have the energy to file a complaint with state regulators. She didn’t know how -- or even that it was an option.\u003c/p>\n\u003cp>“I didn’t have time to waste on Kaiser and what they weren’t doing for Chloe,\" she says. \"I was trying to save Chloe and find people that would help me.”\u003c/p>\n\u003cp>Spivey is now one of several plaintiffs in a lawsuit against Kaiser. She wants to see Kaiser make a more meaningful overhaul to its mental health system -- to provide one-on-one therapy to all patients who need it, as soon as they need it.\u003c/p>\n\u003cp>\u003cem>Consumers who feel they have been unfairly denied mental health coverage can file a complaint with the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V0dHwFeOuUg\" target=\"_blank\">Department of Managed Health Care\u003c/a> or the \u003ca href=\"http://www.insurance.ca.gov/01-consumers/101-help/\" target=\"_blank\">Department of Insurance\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Got a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Maria Spivey was driving the #1 bus in San Diego one spring day two years ago, when her cellphone started ringing and ringing. She figured it was her 17-year-old daughter Chloe.\u003c/p>\n\u003cp>\"There was no way I could stop and answer the phone,\" she remembers. So she kept going.\u003c/p>\n\u003cp>\"When I get to the end of the line,\" she told herself, \"I'll take a break. I'll call Chloe.\"\u003c/p>\n\u003cp>When she got to the terminal, the calls became more insistent. Now it was her partner, Charles.\u003c/p>\n\u003cp>“‘You need to get home,’” Spivey remembers him telling her. “’Get home now.’”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She rushed home to find police cars parked in every direction outside her house. Charles opened her car door.\u003c/p>\n\u003cp>\"Chloe's gone,\" he told her.\u003c/p>\n\u003cp>Chloe had killed herself.\u003c/p>\n\u003cp>“I think I almost fell to my knees,” Spivey says, holding back tears. “But I didn’t want to lose complete control. My kids were watching me.”\u003c/p>\n\u003cfigure id=\"attachment_189450\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-189450\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS19311_IMG_1779-e1464305449405.jpg\" alt=\"Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \" width=\"1920\" height=\"1920\">\u003cfigcaption class=\"wp-caption-text\">Maria Spivey, riding a bus in San Diego. She's on leave from her job as a driver. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At first Spivey blamed herself.\u003cstrong> \u003c/strong>But later, she blamed Kaiser Permanente. Spivey says the HMO failed to take care of her daughter. When Chloe started having trouble with depression and anxiety in middle school, Kaiser told her she couldn’t get weekly individual therapy.\u003c/p>\n\u003cp>“There's no one-on-one,” Spivey remembers being told.\u003c/p>\n\u003cp>Chloe had attempted suicide once before, when she was 16. Even then, Kaiser did not schedule her into individual therapy. Instead she was put into a weekly group for teens with drug abuse problems.\u003c/p>\n\u003cp>“They didn't discuss depression, anxiety, PTSD,\" Spivey says. No one asked if she was feeling suicidal. “Chloe told me more often than not, ‘Mom, this is not what I need.'\"\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/266777047&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/266777047'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>History of Complaints\u003c/strong>\u003c/p>\n\u003cp>Complaints like these had been building up at Kaiser for years. Mental health clinicians at Kaiser who were members of the National Union of Healthcare Workers started to organize across the state. They sent thousands of pages of internal Kaiser documents to state regulators.\u003c/p>\n\u003cp>The clinicians said Kaiser was understaffing its psychiatric department. They said patients were being shuttled into groups or forced to wait four to six weeks for individual therapy appointments.\u003c/p>\n\u003cp>The Department of Managed Health Care, the main regulator of health insurers in the state, found merit in these claims and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">fined Kaiser\u003c/a> $4 million, which Kaiser initially contested, then agreed to pay in 2014.\u003c/p>\n\u003cp>But the union was still not satisfied. It said patients were still waiting too long for appointments, and in 2015, they went \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/12/kaiser-mental-health-workers-launch-7-day-strike/\" target=\"_blank\">on strike\u003c/a>.\u003c/p>\n\u003cp>Kaiser eventually reached a contract agreement with the union, building more time into therapists’ schedules for patient care, and offering “competitive” salaries and benefits, said Yener Balan, Kaiser’s executive director of behavioral health quality, in a statement. It also hired hundreds of new therapists last year and is \"aggressively\" recruiting more.\u003c/p>\n\u003cp>“Kaiser Permanente is actively working to meet the challenges that everyone in the mental health treatment community is facing,” Balan said. “As one of the largest mental health providers in California, we recognize that we are in a position to lead, and that is what we are committed to do.\"\u003c/p>\n\u003cp>While the union is pleased with the changes, union president Sal Roselli says there’s still more work to do.\u003c/p>\n\u003cp>“We want to make Kaiser the poster child to take to other [insurance] providers, in terms of how to do it right,” he says.\u003c/p>\n\u003cp>\u003cstrong>Kaiser May Be 'Victim of Their Own Data' \u003c/strong>\u003c/p>\n\u003cp>Kaiser is the only insurance company that’s been fined in California for forcing patients to wait excessively long for mental health visits. But is it really the only one with problems?\u003c/p>\n\u003cp>Last year in Sacramento, Shelley Rouillard, the head the state's Department of Managed Health Care, testified before a senate committee on mental health that Kaiser's integrated system -- where the insurer and medical provider are one entity -- made it something of an easy target.\u003c/p>\n\u003cp>“Kaiser probably has much better data than anyone else,” she told state lawmakers. \"And so to some extent they may be a victim of their own data.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Other insurers don’t have a centralized call center that tracks appointment wait times, like Kaiser. They have fragmented networks of self-employed therapists. There’s no way to count how many calls a patient makes before they find one who’s available. Or how many patients simply give up.\u003c/p>\n\u003cp>Right now in California, insurance companies monitor themselves to make sure they have enough clinicians. Insurers are responsible for surveying therapists in their directories to make sure they are accepting new patients. But these surveys do not simulate the typical patient experience -– as therapists’ answers about whether they are taking new patients can vary dramatically if the person calling is a patient or the insurance company who pays them.\u003c/p>\n\u003cp>For example, a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey of 100 psychologists \u003c/a>in the Blue Shield network in San Francisco found that only 28 were actually taking new patients, a rate Rouillard said was “not acceptable.”\u003c/p>\n\u003cp>Mental health clinicians and advocates criticize the Department of Managed Health Care for going easy on insurance companies.\u003c/p>\n\u003cp>The fines are too low and too infrequent, says Meiram Bendat, a plaintiffs’ lawyer in Los Angeles. “They’re a slow bureaucracy that takes way too long to respond to consumer complaints.”\u003c/p>\n\u003cp>\u003cstrong>Difficulty of Enforcement \u003c/strong>\u003c/p>\n\u003cp>Rouillard says the mental health parity laws her agency is tasked with enforcing are extremely complicated, so it makes more sense to work with the companies to correct problems.\u003c/p>\n\u003cp>“We want the plans to do the right thing from the beginning,\" Rouillard says. \"It's worth it to spend the time to help them understand what the law is and what their responsibilities are and for us to work with them to get it right.”\u003c/p>\n\u003cp>Right now, the agency is reviewing health insurance plans’ mental health benefits. Where there are violations of the law -- say a plan charges a higher copay for mental health services compared to other medical services -- the agency tells the insurer to fix the plan so the copays are the same. Of 25 insurance companies reviewed this year, 24 had a violation like this, according to the department. Later this year, department officials will visit insurance companies on site to audit patient files.\u003c/p>\n\u003cp>“It's been a good process,” Rouillard says. “It’s been a little long and dragged out, but we’re getting there and we’ll see on the back end how well it really works.”\u003c/p>\n\u003cp>Other states are taking a much more aggressive approach.\u003c/p>\n\u003cp>In New York, the state attorney general has been suing insurers, using subpoena power to demand data from companies about what kind of care patients are actually getting, not just what the companies say they’re giving.\u003c/p>\n\u003cp>“It doesn’t seem like there’s any lack of winnable cases available,” says Keith Humphreys, a psychiatrist at Stanford who served as a policy advisor to the Obama administration. “The reason we see that in New York is not that New York is an unusual place -- but that you had a public official who was engaged enough and talented enough to expose it.”\u003c/p>\n\u003cp>He calls the New York attorney general a hero.\u003c/p>\n\u003cp>The investigations pursued in New York and by California's Department of Managed Health Care have depended largely on consumers submitting complaints about their health plans. This can be a tall order for people suffering from a mental illness, who may be too distraught, or even cognitively impaired by their condition to navigate the web of agencies, and the web of forms. Advocates believe the number of complaints submitted to regulators represent only a fraction of potential violations of mental health laws.\u003c/p>\n\u003cp>Maria Spivey says when her daughter Chloe was struggling, she didn’t have the energy to file a complaint with state regulators. She didn’t know how -- or even that it was an option.\u003c/p>\n\u003cp>“I didn’t have time to waste on Kaiser and what they weren’t doing for Chloe,\" she says. \"I was trying to save Chloe and find people that would help me.”\u003c/p>\n\u003cp>Spivey is now one of several plaintiffs in a lawsuit against Kaiser. She wants to see Kaiser make a more meaningful overhaul to its mental health system -- to provide one-on-one therapy to all patients who need it, as soon as they need it.\u003c/p>\n\u003cp>\u003cem>Consumers who feel they have been unfairly denied mental health coverage can file a complaint with the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V0dHwFeOuUg\" target=\"_blank\">Department of Managed Health Care\u003c/a> or the \u003ca href=\"http://www.insurance.ca.gov/01-consumers/101-help/\" target=\"_blank\">Department of Insurance\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Got a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fresno Teen Reliable Sex Ed Resource for Fellow Students",
"title": "Fresno Teen Reliable Sex Ed Resource for Fellow Students",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cp>Maryjane Davis, a 17-year-old with long brown hair, pulls out a thick, white binder from her backpack in the bedroom she shares with her two younger sisters. The binder is filled with information -- about different kinds of contraceptives, how to prevent sexually transmitted infections, and emotionally healthy relationships versus abusive ones.\u003c/p>\n\u003cp>Maryjane carries it almost daily to her high school in Fresno. It’s a handy tool she turns to when other students approach her during lunch breaks with questions about sexual health or how to select the right contraceptive.\u003c/p>\n\u003cp>“I just keep it on my person. That way in case someone needs something, I can just pull it out,\" she says. “It makes me feel like a superhero. And it's kind of like a superpower to know about sex ed and healthy relationships.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/266812920\" 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>Maryjane trained to become a peer health ambassador at \u003ca href=\"http://www.fresnobarriosunidos.org/\" target=\"_blank\">Fresno Barrios Unidos\u003c/a>, a local education and advocacy group.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Three years ago, Maryjane wasn’t as informed. She thought kissing equaled sex. She had all kinds of questions, but asking her parents or searching online wasn’t yielding answers. Many of her friends were in the same boat, she says. Some were getting pregnant and dropping out of school.\u003c/p>\n\u003cp>It worried her that some teen moms she knew “weren't sure how they got pregnant or when they even started to get pregnant,” she says. When Maryjane sought to learn more about sex, she says her middle school teacher handed her an “abstinence card” to sign. It stated that the person signing it would avoid sex until marriage.\u003c/p>\n\u003cp>“I didn’t even know what the word abstinence meant,” she says. “It was just one card and that was going to be my sex ed class.\"\u003c/p>\n\u003cfigure id=\"attachment_189989\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-189989 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut.jpg\" alt=\"Maryjane Davis in her bedroom with sister Ricci, 12, friend Mary Jane Rodriguez, 11, and sister Lily, 8. Maryjane trained to become a peer health ambassador with a local non-profit to help friends at school learn about how to prevent STDs and unplanned pregnancies.\" width=\"1920\" height=\"1261\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-400x263.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-800x525.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-768x504.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-1440x946.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-1180x775.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-960x631.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Maryjane Davis in her bedroom with sister Ricci, 12, friend Mary Jane Rodriguez, 11, and sister Lily, 8. Maryjane often carries the binder she's holding to help educate kids at school on sexual health. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>New State Law Requires Comprehensive Sex Ed\u003c/strong>\u003c/p>\n\u003cp>Until last year, public schools in California were not required to teach sex education, although information on HIV/AIDS prevention has been mandatory. At Fresno Unified, the fourth largest school district in the state, students learned about HIV/AIDS prevention and some sex ed. But youth health advocates say the quality and accuracy of that education varied greatly from school to school, leaving many kids without the necessary tools to make informed decisions about their health.\u003c/p>\n\u003cp>Fresno County has the state’s second highest rates of the sexually transmitted infections chlamydia and gonorrhea, according to the California Department of Public Health. The county also has one of the highest rates of teen pregnancy.\u003c/p>\n\u003cp>Barrios Unidos has been filling the gap in education. For years, it has offered teen pregnancy prevention and other sex ed through after school programs. Maryjane signed up for one course and felt empowered by the new information.\u003c/p>\n\u003cp>Maryjane and other students lobbied Fresno Unified to improve its sex ed, and last October, the school board approved a comprehensive program.\u003c/p>\n\u003cp>The Fresno Unified school board’s vote came just two months before a California law requiring all districts to provide comprehensive sexual education and HIV prevention went into effect. The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB329\" target=\"_blank\">California Healthy Youth Act\u003c/a> mandates that curriculum on “human development and sexuality, including education on pregnancy, contraception and sexually transmitted infections” be provided to students at least once in junior high or middle school and once in high school. Parents can refuse the classes on behalf of their children.\u003c/p>\n\u003cp>\u003cstrong>'Full Imprementation' in Fresno Schools\u003c/strong>\u003c/p>\n\u003cp>Science and biology classes at Fresno Unified now teach 7th and 9th graders the Positive Prevention Plus curriculum, the highest-rated sexual health education program approved by the California Department of Education, says Rosario Sanchez, associate superintendent of curriculum and instruction at Fresno Unified.\u003c/p>\n\u003cp>“We are in full implementation,” says Sanchez. “Giving (our students) access to this information is critical, so we can reduce the county stats that are stark.”\u003c/p>\n\u003cp>Fresno Unified, with 73,000 students, now also contracts with Barrios Unidos to provide half of the sex ed courses to high school students.\u003c/p>\n\u003cp>“The education they are getting is very comprehensive and medically accurate,\" says Socorro Santillan, executive director at Barrios Unidos. Students \"will be able to make good decisions for themselves not based on scare tactics, but knowledge.”\u003c/p>\n\u003cp>Fourteen other area school districts are working with the Fresno County Office of Education to provide the classes, says Kayla Wilson, a consultant with FCOE.\u003c/p>\n\u003cp>Over the last two months, Wilson and five nurses have been teaching a similar curriculum to 7th and 9th graders in the Fresno County school districts of Fowler, Mendota and Firebaugh-Las Deltas.\u003c/p>\n\u003cp>Wilson said a lot of her outreach work focuses on speaking with parents and school boards about the curriculum, and addressing parents' and administrators' fears about what the students will be learning. She said no students have opted out so far.\u003c/p>\n\u003cfigure id=\"attachment_189987\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-189987\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut.jpg\" alt=\"Maryjane Davis, 17, holds the binder with sexual health information that she uses to answer the questions of peers at school in Fresno. She says some teen moms didn't know how they got pregnant.\" width=\"1920\" height=\"1952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-400x407.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-800x813.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-768x781.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-1440x1464.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-1180x1200.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-960x976.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-64x64.jpg 64w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Maryjane Davis, 17, holds the binder with sexual health information that she uses to answer the questions of peers at school in Fresno. She says some teen moms didn't know how they got pregnant. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At Maryjane Davis’ home, sex ed has changed the family dynamics. Maryjane's mother, Sara Angulo, was so inspired by her daughter's greater confidence and desire to help other teens after taking the sex ed course at Barrios Unidos that she took her 8- and 12-year-old daughters to age-appropriate sex ed classes at Barrios as well.\u003c/p>\n\u003cp>“I think it's very important that everyone learns,” says Angulo, 38. “There are questions that they won't ask me. But they'll ask someone else, and so it's awesome.”\u003c/p>\n\u003cp>Angulo, who has nine children, says when she was growing up, there was no talk about sex in her family.\u003c/p>\n\u003cp>“It was never, never talked about. I had my first (baby) at a very young age,\" she says. \"It was almost expected to be a teenage mother in my family,” says Angulo.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“These girls know enough to (say), ‘I can wait.’”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Maryjane Davis, a 17-year-old with long brown hair, pulls out a thick, white binder from her backpack in the bedroom she shares with her two younger sisters. The binder is filled with information -- about different kinds of contraceptives, how to prevent sexually transmitted infections, and emotionally healthy relationships versus abusive ones.\u003c/p>\n\u003cp>Maryjane carries it almost daily to her high school in Fresno. It’s a handy tool she turns to when other students approach her during lunch breaks with questions about sexual health or how to select the right contraceptive.\u003c/p>\n\u003cp>“I just keep it on my person. That way in case someone needs something, I can just pull it out,\" she says. “It makes me feel like a superhero. And it's kind of like a superpower to know about sex ed and healthy relationships.”\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/266812920&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/266812920'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Maryjane trained to become a peer health ambassador at \u003ca href=\"http://www.fresnobarriosunidos.org/\" target=\"_blank\">Fresno Barrios Unidos\u003c/a>, a local education and advocacy group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Three years ago, Maryjane wasn’t as informed. She thought kissing equaled sex. She had all kinds of questions, but asking her parents or searching online wasn’t yielding answers. Many of her friends were in the same boat, she says. Some were getting pregnant and dropping out of school.\u003c/p>\n\u003cp>It worried her that some teen moms she knew “weren't sure how they got pregnant or when they even started to get pregnant,” she says. When Maryjane sought to learn more about sex, she says her middle school teacher handed her an “abstinence card” to sign. It stated that the person signing it would avoid sex until marriage.\u003c/p>\n\u003cp>“I didn’t even know what the word abstinence meant,” she says. “It was just one card and that was going to be my sex ed class.\"\u003c/p>\n\u003cfigure id=\"attachment_189989\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-189989 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut.jpg\" alt=\"Maryjane Davis in her bedroom with sister Ricci, 12, friend Mary Jane Rodriguez, 11, and sister Lily, 8. Maryjane trained to become a peer health ambassador with a local non-profit to help friends at school learn about how to prevent STDs and unplanned pregnancies.\" width=\"1920\" height=\"1261\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-400x263.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-800x525.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-768x504.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-1440x946.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-1180x775.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19634_WithSiblingsBedroom-qut-960x631.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Maryjane Davis in her bedroom with sister Ricci, 12, friend Mary Jane Rodriguez, 11, and sister Lily, 8. Maryjane often carries the binder she's holding to help educate kids at school on sexual health. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>New State Law Requires Comprehensive Sex Ed\u003c/strong>\u003c/p>\n\u003cp>Until last year, public schools in California were not required to teach sex education, although information on HIV/AIDS prevention has been mandatory. At Fresno Unified, the fourth largest school district in the state, students learned about HIV/AIDS prevention and some sex ed. But youth health advocates say the quality and accuracy of that education varied greatly from school to school, leaving many kids without the necessary tools to make informed decisions about their health.\u003c/p>\n\u003cp>Fresno County has the state’s second highest rates of the sexually transmitted infections chlamydia and gonorrhea, according to the California Department of Public Health. The county also has one of the highest rates of teen pregnancy.\u003c/p>\n\u003cp>Barrios Unidos has been filling the gap in education. For years, it has offered teen pregnancy prevention and other sex ed through after school programs. Maryjane signed up for one course and felt empowered by the new information.\u003c/p>\n\u003cp>Maryjane and other students lobbied Fresno Unified to improve its sex ed, and last October, the school board approved a comprehensive program.\u003c/p>\n\u003cp>The Fresno Unified school board’s vote came just two months before a California law requiring all districts to provide comprehensive sexual education and HIV prevention went into effect. The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB329\" target=\"_blank\">California Healthy Youth Act\u003c/a> mandates that curriculum on “human development and sexuality, including education on pregnancy, contraception and sexually transmitted infections” be provided to students at least once in junior high or middle school and once in high school. Parents can refuse the classes on behalf of their children.\u003c/p>\n\u003cp>\u003cstrong>'Full Imprementation' in Fresno Schools\u003c/strong>\u003c/p>\n\u003cp>Science and biology classes at Fresno Unified now teach 7th and 9th graders the Positive Prevention Plus curriculum, the highest-rated sexual health education program approved by the California Department of Education, says Rosario Sanchez, associate superintendent of curriculum and instruction at Fresno Unified.\u003c/p>\n\u003cp>“We are in full implementation,” says Sanchez. “Giving (our students) access to this information is critical, so we can reduce the county stats that are stark.”\u003c/p>\n\u003cp>Fresno Unified, with 73,000 students, now also contracts with Barrios Unidos to provide half of the sex ed courses to high school students.\u003c/p>\n\u003cp>“The education they are getting is very comprehensive and medically accurate,\" says Socorro Santillan, executive director at Barrios Unidos. Students \"will be able to make good decisions for themselves not based on scare tactics, but knowledge.”\u003c/p>\n\u003cp>Fourteen other area school districts are working with the Fresno County Office of Education to provide the classes, says Kayla Wilson, a consultant with FCOE.\u003c/p>\n\u003cp>Over the last two months, Wilson and five nurses have been teaching a similar curriculum to 7th and 9th graders in the Fresno County school districts of Fowler, Mendota and Firebaugh-Las Deltas.\u003c/p>\n\u003cp>Wilson said a lot of her outreach work focuses on speaking with parents and school boards about the curriculum, and addressing parents' and administrators' fears about what the students will be learning. She said no students have opted out so far.\u003c/p>\n\u003cfigure id=\"attachment_189987\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-189987\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut.jpg\" alt=\"Maryjane Davis, 17, holds the binder with sexual health information that she uses to answer the questions of peers at school in Fresno. She says some teen moms didn't know how they got pregnant.\" width=\"1920\" height=\"1952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-400x407.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-800x813.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-768x781.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-1440x1464.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-1180x1200.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-960x976.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19632_HoldingBinder-qut-64x64.jpg 64w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Maryjane Davis, 17, holds the binder with sexual health information that she uses to answer the questions of peers at school in Fresno. She says some teen moms didn't know how they got pregnant. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At Maryjane Davis’ home, sex ed has changed the family dynamics. Maryjane's mother, Sara Angulo, was so inspired by her daughter's greater confidence and desire to help other teens after taking the sex ed course at Barrios Unidos that she took her 8- and 12-year-old daughters to age-appropriate sex ed classes at Barrios as well.\u003c/p>\n\u003cp>“I think it's very important that everyone learns,” says Angulo, 38. “There are questions that they won't ask me. But they'll ask someone else, and so it's awesome.”\u003c/p>\n\u003cp>Angulo, who has nine children, says when she was growing up, there was no talk about sex in her family.\u003c/p>\n\u003cp>“It was never, never talked about. I had my first (baby) at a very young age,\" she says. \"It was almost expected to be a teenage mother in my family,” says Angulo.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“These girls know enough to (say), ‘I can wait.’”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Burned by negative reviews, some health providers are casting their patients’ privacy aside and sharing intimate details online as they try to rebut criticism.\u003c/p>\n\u003caside class=\"pullquote alignright\">One California dentist scolded a patient who accused him of misdiagnosing her. 'You can live in a world of denial and simply believe what you want to hear from your other dentist or make an educated and informed decision.'\u003c/aside>\n\u003cp>In the course of these arguments — which have spilled out publicly on ratings sites like \u003ca href=\"https://www.yelp.com/\" target=\"_blank\">Yelp\u003c/a> — doctors, dentists, chiropractors and massage therapists, among others, have divulged details of patients’ diagnoses, treatments and idiosyncrasies.\u003c/p>\n\u003cp>One Washington state dentist turned the tables on a patient who blamed him for the loss of a molar: “Due to your clenching and grinding habit, this is not the first molar tooth you have lost due to a fractured root,” he wrote. “This tooth is no different.”\u003c/p>\n\u003cp>In California, a chiropractor pushed back against a mother’s claims that he misdiagnosed her daughter with scoliosis. “You brought your daughter in for the exam in early March 2014,” he wrote. “The exam identified one or more of the signs I mentioned above for scoliosis. I absolutely recommended an x-ray to determine if this condition existed; this x-ray was at no additional cost to you.”\u003c/p>\n\u003cp>And a California dentist scolded a patient who accused him of misdiagnosing her. “I looked very closely at your radiographs and it was obvious that you have cavities and gum disease that your other dentist has overlooked. … You can live in a world of denial and simply believe what you want to hear from your other dentist or make an educated and informed decision.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Health professionals are adapting to a harsh reality in which consumers rate them on sites like Yelp, Vitals and RateMDs much as they do restaurants, hotels and spas. The vast majority of reviews are positive. But in trying to respond to negative ones, some providers appear to be violating the Health Insurance Portability and Accountability Act, the federal patient privacy law known as \u003ca href=\"http://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html\" target=\"_blank\">HIPAA\u003c/a>. The law forbids them from disclosing any patient health information without permission.\u003c/p>\n\u003cp>[contextly_sidebar id=\"d6pxF3w1yvSQqhLKwa6WBniDhTQV1yf5\"]Yelp has given ProPublica \u003ca href=\"https://www.propublica.org/article/stay-far-far-away-and-other-things-gleaned-from-yelp-health-reviews\" target=\"_blank\">unprecedented access\u003c/a> to its trove of public reviews — more than 1.7 million in all — allowing us to search them by keyword. Using \u003ca href=\"http://enrico.bertini.io/revex\" target=\"_blank\">a tool developed\u003c/a> by the Department of Computer Science and Engineering at the NYU Tandon School of Engineering, we identified more than 3,500 one-star reviews (the lowest) in which patients mention privacy or HIPAA. In dozens of instances, responses to complaints about medical care turned into disputes over patient privacy.\u003c/p>\n\u003cp>The patients affected say they’ve been doubly injured — first by poor service or care and then by the disclosure of information they considered private.\u003c/p>\n\u003cp>The shock of exposure can be effective, prompting patients to back off.\u003c/p>\n\u003cp>“I posted a negative review” on Yelp, a client of a California dentist wrote in 2013. “After that, she posted a response with details that included my personal dental information. … I removed my review to protect my medical privacy.”\u003c/p>\n\u003cp>The consumer complained to the Office for Civil Rights within the U.S. Department of Health and Human Services, which enforces HIPAA. The office warned the dentist about posting personal information in response to Yelp reviews. It is currently investigating a New York dentist for divulging personal information about a patient who complained about her care, according to a letter reviewed by ProPublica.\u003c/p>\n\u003cp>The office couldn’t say how many complaints it has received in this area because it doesn’t track complaints this way. ProPublica has \u003ca href=\"https://www.propublica.org/article/few-consequences-for-health-privacy-law-repeat-offenders\" target=\"_blank\">previously reported\u003c/a> about the agency’s historic inability to analyze its complaints and identify repeat HIPAA violators.\u003c/p>\n\u003cp>Deven McGraw, the office’s deputy director of health information privacy, said health professionals responding to online reviews can speak generally about the way they treat patients but must have permission to discuss individual cases. Just because patients have rated their health provider publicly doesn’t give their health provider permission to rate them in return.\u003c/p>\n\u003cp>“If the complaint is about poor patient care, they can come back and say, ‘I provide all of my patients with good patient care’ and ‘I’ve been reviewed in other contexts and have good reviews,’ ” McGraw said. But they can’t “take those accusations on individually by the patient.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"6uBq1ebppHdyoTZuJufJQP8Oyv5kL0C8\"]McGraw pointed to a 2013 \u003ca href=\"http://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/SRMC/press-release/index.html\" target=\"_blank\">case in California\u003c/a> in which a hospital was fined $275,000 for disclosing information about a patient to the media without permission, allegedly in retaliation for the patient complaining to the media about the hospital.\u003c/p>\n\u003cp>Yelp’s senior director of litigation, Aaron Schur, said most reviews of doctors and dentists aren’t about the actual health care delivered but rather their office wait, the front office staff, billing procedures or bedside manner. Many health providers are careful and appropriate in responding to online reviews, encouraging patients to contact them offline or apologizing for any perceived slights. Some don’t respond at all.\u003c/p>\n\u003cp>“There’s certainly ways to respond to reviews that don’t implicate HIPAA,” Schur said.\u003c/p>\n\u003cp>In 2012, University of Utah Health Care in Salt Lake City was the \u003ca href=\"http://healthcare.utah.edu/publicaffairs/news/archive/2012/12-10-2012_physician_reviews%20.php\" target=\"_blank\">first hospital system in the country\u003c/a> to post patient reviews and comments online. The system, which had to overcome doctors’ resistance to being rated, found positive comments far outnumbered negative ones.\u003c/p>\n\u003cp>“If you whitewash comments, if you only put those that are highly positive, the public is very savvy and will consider that to be only advertising,” said Thomas Miller, chief medical officer for the University of Utah Hospitals and Clinics.\u003c/p>\n\u003cp>Unlike Yelp, the University of Utah does not allow comments about a doctor’s medical competency and it does not allow physicians to respond to comments.\u003c/p>\n\u003cp>In discussing their battles over online reviews, patients said they’d turned to ratings sites for closure and in the hope that their experiences would help others seeking care. Their providers’ responses, however, left them with a lingering sense of lost trust.\u003c/p>\n\u003cp>Angela Grijalva brought her then-12-year-old daughter to Maximize Chiropractic in Sacramento a couple years ago for an exam. In a one-star \u003ca href=\"https://www.yelp.com/biz/maximize-chiropractic-west-sacramento-3\" target=\"_blank\">review on Yelp\u003c/a>, Grijalva alleged that chiropractor Tim Nicholl led her daughter to “believe she had scoliosis and urgently needed x-rays, which could be performed at her next appointment. … My daughter cried all night and had a tough time concentrating at school.”\u003c/p>\n\u003cp>But it turned out her daughter did not have scoliosis, Grijalva wrote. She encouraged parents to stay away from the office.\u003c/p>\n\u003cp>Nicholl replied on Yelp, acknowledging that Grijalva’s daughter was a patient (a disclosure that is not allowed under HIPAA) and discussing the procedures he performed on her and her condition, though he said he could not disclose specifics of the diagnosis “due to privacy and patient confidentiality.”\u003c/p>\n\u003cp>“The next day you brought your daughter back in for a verbal review of the x-rays and I informed you that the x-rays had identified some issues, but the good news was that your daughter did not have scoliosis, great news!” he recounted. “I proceeded to adjust your daughter and the adjustment went very well, as did the entire appointment; you made no mention of a ‘misdiagnosis’ or any other concern.”\u003c/p>\n\u003cp>In an interview, Grijalva said Nicholl’s response “violated my daughter and her privacy.”\u003c/p>\n\u003cp>“I wouldn’t want another parent, another child to go through what my daughter went through: the panic, the stress, the fear,” she added.\u003c/p>\n\u003cp>Nicholl declined a request for comment. “It just doesn’t seem like this is worth my time,” he said. His practice has mixed reviews on Yelp, but more positive than negative.\u003c/p>\n\u003cp>A few years ago, Marisa Speed posted a review of \u003ca href=\"https://www.yelp.com/biz/north-valley-plastic-surgery-phoenix\" target=\"_blank\">North Valley Plastic Surgery\u003c/a> in Phoenix after her then–3-year-old son received stitches there for a gash on his chin. “Half-way through the procedure, the doctor seemed flustered with my crying child. …,” she wrote. “At this point the doctor was more upset and he ended up throwing the instruments to the floor. I understand that dealing with kids requires extra effort, but if you don’t like to do it, don’t even welcome them.”\u003c/p>\n\u003cp>An employee named Chase replied on the business’s behalf: “This patient presented in an agitated and uncontrollable state. Despite our best efforts, this patient was screaming, crying, inconsolable, and a danger to both himself and to our staff. As any parent that has raised a young boy knows, they have the strength to cause harm.”\u003c/p>\n\u003cp>Speed and her husband complained to the Office for Civil Rights. “You may wish to remove any specific information about current or former patients from your Web-blog,” the Office for Civil Rights wrote in an \u003ca href=\"https://www.propublica.org/documents/item/2843212-North-Valley-Plastic-Surgery.html\" target=\"_blank\">October 2013 letter to the surgery center.\u003c/a>\u003c/p>\n\u003cp>In an email, a representative of the surgery center declined to comment. “Everyone that was directly involved in the incident no longer works here. The nurse on this case left a year ago, the surgeon in the case retired last month, and the administrator left a few years ago,” he wrote.\u003c/p>\n\u003cp>Reviews of North Valley Plastic Surgery are mixed on Yelp.\u003c/p>\n\u003cp>Health providers have tried a host of ways to try to combat negative reviews. Some have sued their patients, attracting a torrent of attention but scoring few, if any, legal successes. Others have begged patients to remove their complaints.\u003c/p>\n\u003cp>Jeffrey Segal, a onetime critic of review sites, now says doctors need to embrace them. Beginning in 2007, Segal’s company, Medical Justice, crafted contracts that health providers could give to patients asking them to sign over the copyright to any reviews, which allowed providers to demand that negative ones be removed. But \u003ca href=\"http://www.citizen.org/pressroom/pressroomredirect.cfm?ID=3464\" target=\"_blank\">after a lawsuit\u003c/a>, Medical Justice stopped recommending the contracts in 2011.\u003c/p>\n\u003cp>Segal said he has come to believe reviews are valuable and that providers should encourage patients who are satisfied to post positive reviews and should respond — carefully — to negative ones.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“For doctors who get bent out of shape to get rid of negative reviews, it’s a denominator problem,” he said. “If they only have three reviews and two are negative, the denominator is the problem. … If you can figure out a way to cultivate reviews from hundreds of patients rather than a few patients, the problem is solved.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Burned by negative reviews, some health providers are casting their patients’ privacy aside and sharing intimate details online as they try to rebut criticism.\u003c/p>\n\u003caside class=\"pullquote alignright\">One California dentist scolded a patient who accused him of misdiagnosing her. 'You can live in a world of denial and simply believe what you want to hear from your other dentist or make an educated and informed decision.'\u003c/aside>\n\u003cp>In the course of these arguments — which have spilled out publicly on ratings sites like \u003ca href=\"https://www.yelp.com/\" target=\"_blank\">Yelp\u003c/a> — doctors, dentists, chiropractors and massage therapists, among others, have divulged details of patients’ diagnoses, treatments and idiosyncrasies.\u003c/p>\n\u003cp>One Washington state dentist turned the tables on a patient who blamed him for the loss of a molar: “Due to your clenching and grinding habit, this is not the first molar tooth you have lost due to a fractured root,” he wrote. “This tooth is no different.”\u003c/p>\n\u003cp>In California, a chiropractor pushed back against a mother’s claims that he misdiagnosed her daughter with scoliosis. “You brought your daughter in for the exam in early March 2014,” he wrote. “The exam identified one or more of the signs I mentioned above for scoliosis. I absolutely recommended an x-ray to determine if this condition existed; this x-ray was at no additional cost to you.”\u003c/p>\n\u003cp>And a California dentist scolded a patient who accused him of misdiagnosing her. “I looked very closely at your radiographs and it was obvious that you have cavities and gum disease that your other dentist has overlooked. … You can live in a world of denial and simply believe what you want to hear from your other dentist or make an educated and informed decision.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Health professionals are adapting to a harsh reality in which consumers rate them on sites like Yelp, Vitals and RateMDs much as they do restaurants, hotels and spas. The vast majority of reviews are positive. But in trying to respond to negative ones, some providers appear to be violating the Health Insurance Portability and Accountability Act, the federal patient privacy law known as \u003ca href=\"http://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html\" target=\"_blank\">HIPAA\u003c/a>. The law forbids them from disclosing any patient health information without permission.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Yelp has given ProPublica \u003ca href=\"https://www.propublica.org/article/stay-far-far-away-and-other-things-gleaned-from-yelp-health-reviews\" target=\"_blank\">unprecedented access\u003c/a> to its trove of public reviews — more than 1.7 million in all — allowing us to search them by keyword. Using \u003ca href=\"http://enrico.bertini.io/revex\" target=\"_blank\">a tool developed\u003c/a> by the Department of Computer Science and Engineering at the NYU Tandon School of Engineering, we identified more than 3,500 one-star reviews (the lowest) in which patients mention privacy or HIPAA. In dozens of instances, responses to complaints about medical care turned into disputes over patient privacy.\u003c/p>\n\u003cp>The patients affected say they’ve been doubly injured — first by poor service or care and then by the disclosure of information they considered private.\u003c/p>\n\u003cp>The shock of exposure can be effective, prompting patients to back off.\u003c/p>\n\u003cp>“I posted a negative review” on Yelp, a client of a California dentist wrote in 2013. “After that, she posted a response with details that included my personal dental information. … I removed my review to protect my medical privacy.”\u003c/p>\n\u003cp>The consumer complained to the Office for Civil Rights within the U.S. Department of Health and Human Services, which enforces HIPAA. The office warned the dentist about posting personal information in response to Yelp reviews. It is currently investigating a New York dentist for divulging personal information about a patient who complained about her care, according to a letter reviewed by ProPublica.\u003c/p>\n\u003cp>The office couldn’t say how many complaints it has received in this area because it doesn’t track complaints this way. ProPublica has \u003ca href=\"https://www.propublica.org/article/few-consequences-for-health-privacy-law-repeat-offenders\" target=\"_blank\">previously reported\u003c/a> about the agency’s historic inability to analyze its complaints and identify repeat HIPAA violators.\u003c/p>\n\u003cp>Deven McGraw, the office’s deputy director of health information privacy, said health professionals responding to online reviews can speak generally about the way they treat patients but must have permission to discuss individual cases. Just because patients have rated their health provider publicly doesn’t give their health provider permission to rate them in return.\u003c/p>\n\u003cp>“If the complaint is about poor patient care, they can come back and say, ‘I provide all of my patients with good patient care’ and ‘I’ve been reviewed in other contexts and have good reviews,’ ” McGraw said. But they can’t “take those accusations on individually by the patient.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>McGraw pointed to a 2013 \u003ca href=\"http://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/SRMC/press-release/index.html\" target=\"_blank\">case in California\u003c/a> in which a hospital was fined $275,000 for disclosing information about a patient to the media without permission, allegedly in retaliation for the patient complaining to the media about the hospital.\u003c/p>\n\u003cp>Yelp’s senior director of litigation, Aaron Schur, said most reviews of doctors and dentists aren’t about the actual health care delivered but rather their office wait, the front office staff, billing procedures or bedside manner. Many health providers are careful and appropriate in responding to online reviews, encouraging patients to contact them offline or apologizing for any perceived slights. Some don’t respond at all.\u003c/p>\n\u003cp>“There’s certainly ways to respond to reviews that don’t implicate HIPAA,” Schur said.\u003c/p>\n\u003cp>In 2012, University of Utah Health Care in Salt Lake City was the \u003ca href=\"http://healthcare.utah.edu/publicaffairs/news/archive/2012/12-10-2012_physician_reviews%20.php\" target=\"_blank\">first hospital system in the country\u003c/a> to post patient reviews and comments online. The system, which had to overcome doctors’ resistance to being rated, found positive comments far outnumbered negative ones.\u003c/p>\n\u003cp>“If you whitewash comments, if you only put those that are highly positive, the public is very savvy and will consider that to be only advertising,” said Thomas Miller, chief medical officer for the University of Utah Hospitals and Clinics.\u003c/p>\n\u003cp>Unlike Yelp, the University of Utah does not allow comments about a doctor’s medical competency and it does not allow physicians to respond to comments.\u003c/p>\n\u003cp>In discussing their battles over online reviews, patients said they’d turned to ratings sites for closure and in the hope that their experiences would help others seeking care. Their providers’ responses, however, left them with a lingering sense of lost trust.\u003c/p>\n\u003cp>Angela Grijalva brought her then-12-year-old daughter to Maximize Chiropractic in Sacramento a couple years ago for an exam. In a one-star \u003ca href=\"https://www.yelp.com/biz/maximize-chiropractic-west-sacramento-3\" target=\"_blank\">review on Yelp\u003c/a>, Grijalva alleged that chiropractor Tim Nicholl led her daughter to “believe she had scoliosis and urgently needed x-rays, which could be performed at her next appointment. … My daughter cried all night and had a tough time concentrating at school.”\u003c/p>\n\u003cp>But it turned out her daughter did not have scoliosis, Grijalva wrote. She encouraged parents to stay away from the office.\u003c/p>\n\u003cp>Nicholl replied on Yelp, acknowledging that Grijalva’s daughter was a patient (a disclosure that is not allowed under HIPAA) and discussing the procedures he performed on her and her condition, though he said he could not disclose specifics of the diagnosis “due to privacy and patient confidentiality.”\u003c/p>\n\u003cp>“The next day you brought your daughter back in for a verbal review of the x-rays and I informed you that the x-rays had identified some issues, but the good news was that your daughter did not have scoliosis, great news!” he recounted. “I proceeded to adjust your daughter and the adjustment went very well, as did the entire appointment; you made no mention of a ‘misdiagnosis’ or any other concern.”\u003c/p>\n\u003cp>In an interview, Grijalva said Nicholl’s response “violated my daughter and her privacy.”\u003c/p>\n\u003cp>“I wouldn’t want another parent, another child to go through what my daughter went through: the panic, the stress, the fear,” she added.\u003c/p>\n\u003cp>Nicholl declined a request for comment. “It just doesn’t seem like this is worth my time,” he said. His practice has mixed reviews on Yelp, but more positive than negative.\u003c/p>\n\u003cp>A few years ago, Marisa Speed posted a review of \u003ca href=\"https://www.yelp.com/biz/north-valley-plastic-surgery-phoenix\" target=\"_blank\">North Valley Plastic Surgery\u003c/a> in Phoenix after her then–3-year-old son received stitches there for a gash on his chin. “Half-way through the procedure, the doctor seemed flustered with my crying child. …,” she wrote. “At this point the doctor was more upset and he ended up throwing the instruments to the floor. I understand that dealing with kids requires extra effort, but if you don’t like to do it, don’t even welcome them.”\u003c/p>\n\u003cp>An employee named Chase replied on the business’s behalf: “This patient presented in an agitated and uncontrollable state. Despite our best efforts, this patient was screaming, crying, inconsolable, and a danger to both himself and to our staff. As any parent that has raised a young boy knows, they have the strength to cause harm.”\u003c/p>\n\u003cp>Speed and her husband complained to the Office for Civil Rights. “You may wish to remove any specific information about current or former patients from your Web-blog,” the Office for Civil Rights wrote in an \u003ca href=\"https://www.propublica.org/documents/item/2843212-North-Valley-Plastic-Surgery.html\" target=\"_blank\">October 2013 letter to the surgery center.\u003c/a>\u003c/p>\n\u003cp>In an email, a representative of the surgery center declined to comment. “Everyone that was directly involved in the incident no longer works here. The nurse on this case left a year ago, the surgeon in the case retired last month, and the administrator left a few years ago,” he wrote.\u003c/p>\n\u003cp>Reviews of North Valley Plastic Surgery are mixed on Yelp.\u003c/p>\n\u003cp>Health providers have tried a host of ways to try to combat negative reviews. Some have sued their patients, attracting a torrent of attention but scoring few, if any, legal successes. Others have begged patients to remove their complaints.\u003c/p>\n\u003cp>Jeffrey Segal, a onetime critic of review sites, now says doctors need to embrace them. Beginning in 2007, Segal’s company, Medical Justice, crafted contracts that health providers could give to patients asking them to sign over the copyright to any reviews, which allowed providers to demand that negative ones be removed. But \u003ca href=\"http://www.citizen.org/pressroom/pressroomredirect.cfm?ID=3464\" target=\"_blank\">after a lawsuit\u003c/a>, Medical Justice stopped recommending the contracts in 2011.\u003c/p>\n\u003cp>Segal said he has come to believe reviews are valuable and that providers should encourage patients who are satisfied to post positive reviews and should respond — carefully — to negative ones.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“For doctors who get bent out of shape to get rid of negative reviews, it’s a denominator problem,” he said. “If they only have three reviews and two are negative, the denominator is the problem. … If you can figure out a way to cultivate reviews from hundreds of patients rather than a few patients, the problem is solved.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California falls significantly short of a new recommendation by an influential group of pediatricians calling for every school in the United States to have at least one nurse on site.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Districts are stretched for money, and school nurses aren’t required, so they don’t see the need.\"\u003ccite>Linda Davis-Alldritt, former president, National Association of School Nurses \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>Fifty-seven percent of California’s public school districts, with 1.2 million students, do not employ nurses, according to research from Sacramento State University’s School of Nursing.\u003c/p>\n\u003cp>The call for a nurse in every school appeared this week in a policy statement by the \u003ca href=\"https://www.aap.org/\" target=\"_blank\">American Academy of Pediatrics\u003c/a>. The group’s \u003ca href=\"http://pediatrics.aappublications.org/content/early/2016/05/19/peds.2016-0852\" target=\"_blank\">new guideline\u003c/a> replaces its previous one, which recommended that school districts have one nurse for every 750 healthy students, and one for every 225 students who need daily assistance.\u003c/p>\n\u003cp>The academy said the use of a numerical ratio was “inadequate to fill the increasingly complex health needs of students.”\u003c/p>\n\u003cp>Even when measured against that old yardstick, California’s schools are woefully deficient. Statewide, there is one nurse for every 2,784 students, according to 2014 numbers from \u003ca href=\"http://www.kidsdata.org/\" target=\"_blank\">KidsData\u003c/a>, a program of the Lucile Packard Foundation for Children’s Health. That’s nearly four times more students per nurse than the academy had recommended.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And in some regions it is far worse than that. In Santa Cruz County, for example, there were 13,432 students for every nurse in 2014.\u003c/p>\n\u003cp>California’s school nursing shortage is troublesome, experts say, because nurses provide much more than basic health services to students. They help manage chronic diseases, assist with obesity prevention, and participate in emergency preparedness and behavioral assessment, among other things.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/417Hs/3/\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"570\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>“School nursing is one of the most effective ways to keep children healthy and in school and to prevent chronic absenteeism,” said Breena Welch Holmes, lead author of the academy’s policy statement.\u003c/p>\n\u003cp>Kathy Ryan, president of the \u003ca href=\"http://www.csno.org/\" target=\"_blank\">California School Nurses Organization\u003c/a>, said the academy’s new guideline, which also calls for access to a physician in every school district, underscores the vital need to upgrade health services in the state’s schools.\u003c/p>\n\u003cp>She noted that the new recommendation is stronger than the previous ratio-based guideline for whole school districts. Having a nurse across town, even if it means a school district is meeting a numerical target, is not as effective as having a full-time nurse on site every day, she explained.\u003c/p>\n\u003cp>Ryan noted that when children are absent, schools loses money. So when school nurses help reduce absenteeism, they could eventually pay for themselves, she said.\u003c/p>\n\u003cp>California’s school nurse deficiency is due in large part to the fact that schools are not legally obliged to hire nurses, and employing them competes with other priorities for scarce funding, said Linda Davis-Alldritt, ex-president of the \u003ca href=\"https://www.nasn.org/\" target=\"_blank\">National Association of School Nurses\u003c/a> and a former nursing consultant to the state’s Department of Education.\u003c/p>\n\u003cp>“Districts are stretched for money, and school nurses aren’t required, so they don’t see the need,” she said.\u003c/p>\n\u003cp>For California to attain the academy’s goal of a nurse in every school, the state legislature would need to make it a requirement, Davis-Alldritt said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara Feder-Ostrov contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California falls significantly short of a new recommendation by an influential group of pediatricians calling for every school in the United States to have at least one nurse on site.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Districts are stretched for money, and school nurses aren’t required, so they don’t see the need.\"\u003ccite>Linda Davis-Alldritt, former president, National Association of School Nurses \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>Fifty-seven percent of California’s public school districts, with 1.2 million students, do not employ nurses, according to research from Sacramento State University’s School of Nursing.\u003c/p>\n\u003cp>The call for a nurse in every school appeared this week in a policy statement by the \u003ca href=\"https://www.aap.org/\" target=\"_blank\">American Academy of Pediatrics\u003c/a>. The group’s \u003ca href=\"http://pediatrics.aappublications.org/content/early/2016/05/19/peds.2016-0852\" target=\"_blank\">new guideline\u003c/a> replaces its previous one, which recommended that school districts have one nurse for every 750 healthy students, and one for every 225 students who need daily assistance.\u003c/p>\n\u003cp>The academy said the use of a numerical ratio was “inadequate to fill the increasingly complex health needs of students.”\u003c/p>\n\u003cp>Even when measured against that old yardstick, California’s schools are woefully deficient. Statewide, there is one nurse for every 2,784 students, according to 2014 numbers from \u003ca href=\"http://www.kidsdata.org/\" target=\"_blank\">KidsData\u003c/a>, a program of the Lucile Packard Foundation for Children’s Health. That’s nearly four times more students per nurse than the academy had recommended.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And in some regions it is far worse than that. In Santa Cruz County, for example, there were 13,432 students for every nurse in 2014.\u003c/p>\n\u003cp>California’s school nursing shortage is troublesome, experts say, because nurses provide much more than basic health services to students. They help manage chronic diseases, assist with obesity prevention, and participate in emergency preparedness and behavioral assessment, among other things.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/417Hs/3/\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"570\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>“School nursing is one of the most effective ways to keep children healthy and in school and to prevent chronic absenteeism,” said Breena Welch Holmes, lead author of the academy’s policy statement.\u003c/p>\n\u003cp>Kathy Ryan, president of the \u003ca href=\"http://www.csno.org/\" target=\"_blank\">California School Nurses Organization\u003c/a>, said the academy’s new guideline, which also calls for access to a physician in every school district, underscores the vital need to upgrade health services in the state’s schools.\u003c/p>\n\u003cp>She noted that the new recommendation is stronger than the previous ratio-based guideline for whole school districts. Having a nurse across town, even if it means a school district is meeting a numerical target, is not as effective as having a full-time nurse on site every day, she explained.\u003c/p>\n\u003cp>Ryan noted that when children are absent, schools loses money. So when school nurses help reduce absenteeism, they could eventually pay for themselves, she said.\u003c/p>\n\u003cp>California’s school nurse deficiency is due in large part to the fact that schools are not legally obliged to hire nurses, and employing them competes with other priorities for scarce funding, said Linda Davis-Alldritt, ex-president of the \u003ca href=\"https://www.nasn.org/\" target=\"_blank\">National Association of School Nurses\u003c/a> and a former nursing consultant to the state’s Department of Education.\u003c/p>\n\u003cp>“Districts are stretched for money, and school nurses aren’t required, so they don’t see the need,” she said.\u003c/p>\n\u003cp>For California to attain the academy’s goal of a nurse in every school, the state legislature would need to make it a requirement, Davis-Alldritt said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Barbara Feder-Ostrov contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Therapy Became A Hobby of the Wealthy – Rather Than A Necessity for the Mentally Ill",
"title": "How Therapy Became A Hobby of the Wealthy – Rather Than A Necessity for the Mentally Ill",
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"content": "\u003cp>There’s something that really bothers Stanford psychiatry professor Keith Humphreys. When he thinks of all the years he spends training the next generation of psychiatrists, the enormous investment in medical school and residency, he wants them to devote that education to taking care of people with serious mental illness.\u003c/p>\n\u003cp>But many of them instead set up a private practice, where they can charge $400 an hour in cash to help people who Humphreys calls “the worried well” –- people who enjoy the self-exploration of therapy but do not necessarily have a mental health problem.\u003c/p>\n\u003cp>\"A minute I spend training that person is a minute of my life wasted,” Humphreys says. “That very well-trained person should be taking care of very, very troubled people. When they don’t, everyone who needs that care loses out.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.'\u003ccite>Keith Humphreys, Stanford Psychiatry Professor \u003c/cite>\u003c/aside>\n\u003cp>Humphreys says this trend of mental health clinicians shunning the health insurance industry and decamping to the cash market dates back 70 years, to the end of World War II.\u003c/p>\n\u003cp>In 1946, the majority of veterans cared for by what was then called the Veterans Administration were mental health patients, Humphreys says. But there weren’t enough mental health providers to take care of them. So the VA partnered with several medical schools, including Stanford where Humphreys teaches, to train mental health professionals.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Those schools started turning out hundreds and hundreds of psychologists a year. The expansion dovetailed with soaring American affluence -- and soaring American interest in self-exploration.\u003c/p>\n\u003cp>Having a psychoanalyst became \"a sort of status symbol,\" Humphreys says.\u003c/p>\n\u003cp>A lot of psychologists who were trained to work in the public sector saw a better financial opportunity and jumped ship. They hung shingles and started their own private practices where they could charge wealthy people much higher rates.\u003c/p>\n\u003cp>“When you put in a free market in a society where people were very interested in self-exploration, a lot of them went out and did their own thing,” Humphreys says.\u003c/p>\n\u003cfigure id=\"attachment_187932\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-187932\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/keithatDavos-400x225.jpg\" alt=\"Stanford psychiatry professor Keith Humphreys\" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Stanford psychiatry professor Keith Humphreys \u003ccite>(Courtesy: Keith Humphreys)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The reason this was possible is because of how the overall U.S. health care system was established, Humphreys says. Most people got their health insurance through work. Employers competed with each other for the best employees by offering better benefits.\u003c/p>\n\u003cp>So the standards for coverage developed over time in a piecemeal, haphazard way.\u003c/p>\n\u003cp>As health policy evolved, mental health benefits continuously lagged, Humphreys says. Coverage for mental health treatments or hospitalizations was meager or nonexistent.\u003c/p>\n\u003cp>“We don’t seem to have this problem with cardiology or oncology,” Humphreys says. “You don’t see people lining up to pay cash for those services because the benefits are so low.\"\u003c/p>\n\u003cp>This wouldn’t happen in places that have single-payer health systems, like Canada, Humphreys says, because all the health care payments are controlled by the government. Mental health care was baked into that system earlier on.\u003c/p>\n\u003cp>As a result, people in Canada with more severe mental illness are more likely to get services, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199702203360806\" target=\"_blank\">a study\u003c/a> published in the New England Journal of Medicine.\u003c/p>\n\u003cp>That’s not the case in the U.S. People with less serious mental health conditions get more services here. Humphreys says it's mainly wealthy people who fall into the worried well category, who are consuming psychotherapy.\u003c/p>\n\u003cp>“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” he says.\u003c/p>\n\u003cp>The growing workforce of psychiatrists, psychologists, marriage and family therapists, and licensed social workers has responded to that market demand.\u003c/p>\n\u003cp>And not just because it’s better money. Treating high-functioning professionals in a private office is a lot less stressful than doing rounds on a psychiatric ward of a public hospital.\u003c/p>\n\u003cp>“It’s understandable why someone would say this is really demanding,” Humphreys says. “For my own well-being or professional satisfaction, I’m going to stop doing this and move into doing outpatient psychotherapy with executives from Google who have angst. My salary goes up dramatically and my work is much, much easier.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"tU61AbaxNL1XAbjFbyvdGvgJyPnAKYCV\"]Especially in affluent places like the Bay Area, this creates a divide, a culture of mental health haves and have-nots. Mental health clinicians don’t need to participate in the health care system or take insurance to keep their schedules full -- making it harder and harder for people of lower income to find a therapist.\u003c/p>\n\u003cp>“That’s why you can have a lot of mental health professionals in an area, but still have a shortage of care for people in need,” Humphreys adds. “The person who’s hurt is the person who’s suicidal, maybe they’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.”\u003c/p>\n\u003cp>Mental health advocates have worked to shift this balance, passing the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010. Together, those laws require health plans to offer mental health coverage on par with other medical coverage.\u003c/p>\n\u003cp>But so far, it hasn’t put a dent in the cash market for mental health. Humphreys says given the nature of mental health care and the American obsession with self-improvement, the cash market will be here to stay.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Accessing mental health care is often pleasurable and enjoyable, and accessing a lot of other health care isn’t,” Humphreys says. “I mean, who goes to the dentist for fun?”\u003c/p>\n\n",
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"headline": "How Therapy Became A Hobby of the Wealthy – Rather Than A Necessity for the Mentally Ill",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There’s something that really bothers Stanford psychiatry professor Keith Humphreys. When he thinks of all the years he spends training the next generation of psychiatrists, the enormous investment in medical school and residency, he wants them to devote that education to taking care of people with serious mental illness.\u003c/p>\n\u003cp>But many of them instead set up a private practice, where they can charge $400 an hour in cash to help people who Humphreys calls “the worried well” –- people who enjoy the self-exploration of therapy but do not necessarily have a mental health problem.\u003c/p>\n\u003cp>\"A minute I spend training that person is a minute of my life wasted,” Humphreys says. “That very well-trained person should be taking care of very, very troubled people. When they don’t, everyone who needs that care loses out.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.'\u003ccite>Keith Humphreys, Stanford Psychiatry Professor \u003c/cite>\u003c/aside>\n\u003cp>Humphreys says this trend of mental health clinicians shunning the health insurance industry and decamping to the cash market dates back 70 years, to the end of World War II.\u003c/p>\n\u003cp>In 1946, the majority of veterans cared for by what was then called the Veterans Administration were mental health patients, Humphreys says. But there weren’t enough mental health providers to take care of them. So the VA partnered with several medical schools, including Stanford where Humphreys teaches, to train mental health professionals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Those schools started turning out hundreds and hundreds of psychologists a year. The expansion dovetailed with soaring American affluence -- and soaring American interest in self-exploration.\u003c/p>\n\u003cp>Having a psychoanalyst became \"a sort of status symbol,\" Humphreys says.\u003c/p>\n\u003cp>A lot of psychologists who were trained to work in the public sector saw a better financial opportunity and jumped ship. They hung shingles and started their own private practices where they could charge wealthy people much higher rates.\u003c/p>\n\u003cp>“When you put in a free market in a society where people were very interested in self-exploration, a lot of them went out and did their own thing,” Humphreys says.\u003c/p>\n\u003cfigure id=\"attachment_187932\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-187932\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/keithatDavos-400x225.jpg\" alt=\"Stanford psychiatry professor Keith Humphreys\" width=\"400\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/keithatDavos-960x540.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Stanford psychiatry professor Keith Humphreys \u003ccite>(Courtesy: Keith Humphreys)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The reason this was possible is because of how the overall U.S. health care system was established, Humphreys says. Most people got their health insurance through work. Employers competed with each other for the best employees by offering better benefits.\u003c/p>\n\u003cp>So the standards for coverage developed over time in a piecemeal, haphazard way.\u003c/p>\n\u003cp>As health policy evolved, mental health benefits continuously lagged, Humphreys says. Coverage for mental health treatments or hospitalizations was meager or nonexistent.\u003c/p>\n\u003cp>“We don’t seem to have this problem with cardiology or oncology,” Humphreys says. “You don’t see people lining up to pay cash for those services because the benefits are so low.\"\u003c/p>\n\u003cp>This wouldn’t happen in places that have single-payer health systems, like Canada, Humphreys says, because all the health care payments are controlled by the government. Mental health care was baked into that system earlier on.\u003c/p>\n\u003cp>As a result, people in Canada with more severe mental illness are more likely to get services, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199702203360806\" target=\"_blank\">a study\u003c/a> published in the New England Journal of Medicine.\u003c/p>\n\u003cp>That’s not the case in the U.S. People with less serious mental health conditions get more services here. Humphreys says it's mainly wealthy people who fall into the worried well category, who are consuming psychotherapy.\u003c/p>\n\u003cp>“If it’s a market where you pretty much have to pay for yourself, the rich are always going to win,” he says.\u003c/p>\n\u003cp>The growing workforce of psychiatrists, psychologists, marriage and family therapists, and licensed social workers has responded to that market demand.\u003c/p>\n\u003cp>And not just because it’s better money. Treating high-functioning professionals in a private office is a lot less stressful than doing rounds on a psychiatric ward of a public hospital.\u003c/p>\n\u003cp>“It’s understandable why someone would say this is really demanding,” Humphreys says. “For my own well-being or professional satisfaction, I’m going to stop doing this and move into doing outpatient psychotherapy with executives from Google who have angst. My salary goes up dramatically and my work is much, much easier.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Especially in affluent places like the Bay Area, this creates a divide, a culture of mental health haves and have-nots. Mental health clinicians don’t need to participate in the health care system or take insurance to keep their schedules full -- making it harder and harder for people of lower income to find a therapist.\u003c/p>\n\u003cp>“That’s why you can have a lot of mental health professionals in an area, but still have a shortage of care for people in need,” Humphreys adds. “The person who’s hurt is the person who’s suicidal, maybe they’re horribly addicted to OxyContin or their child is showing signs of bipolar disorder, and they can’t find somebody to take their insurance. It’s unjust.”\u003c/p>\n\u003cp>Mental health advocates have worked to shift this balance, passing the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010. Together, those laws require health plans to offer mental health coverage on par with other medical coverage.\u003c/p>\n\u003cp>But so far, it hasn’t put a dent in the cash market for mental health. Humphreys says given the nature of mental health care and the American obsession with self-improvement, the cash market will be here to stay.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Accessing mental health care is often pleasurable and enjoyable, and accessing a lot of other health care isn’t,” Humphreys says. “I mean, who goes to the dentist for fun?”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Frustrated You Can't Find a Therapist? They're Frustrated, Too",
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"content": "\u003cp>When San Francisco resident Natalie Dunnege needed a therapist, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">she couldn’t find one\u003c/a> who took her insurance.\u003c/p>\n\u003cp>“When I would call them they wouldn’t return my phone calls or they wouldn’t be accepting patients,” she says.\u003c/p>\n\u003cp>Insurance companies say there’s a shortage of therapists.\u003c/p>\n\u003cp>But it’s not that simple. Especially in urban areas, there are lots of therapists. They just don’t want to work with the insurance companies.\u003c/p>\n\u003cp>Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“With the right kind of support, they blossom,” he says.\u003c/p>\n\u003cp>Klein doesn’t accept insurance -- and he’s far from alone. Nearly half of therapists in California don’t take insurance, according to a \u003ca href=\"http://www.camft.org/ias/images/PDFs/articles/mariam/2015_demographic_survey.pdf\" target=\"_blank\">recent survey\u003c/a> from the California Association of Marriage and Family Therapists. The same is true of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967759/\">psychiatrists\u003c/a>. There are two reasons why, Klein says.\u003c/p>\n\u003caside class=\"pullquote alignright\">Insurance companies say there's a shortage of therapists, but therapists struggle to be accepted into a network.\u003c/aside>\n\u003cp>“One, because the reimbursement rates don’t provide a living wage,” Klein says. “You can’t own a home and drive a car and survive on what in-network providers pay you.”\u003c/p>\n\u003cp>Most insurance companies pay therapists in their networks between $60 and $80 per session. In the Bay Area and Los Angeles, therapists say the market rate for therapy is more like $150 or $200 a session.\u003c/p>\n\u003cp>“The second thing is the paperwork. For an hour of psychotherapy you spend a half hour of paperwork. So, I got into this field because I don’t like paper work,” Klein says with a laugh.\u003c/p>\n\u003cp>On that first point -- money -- insurance companies acknowledge that they may have to raise their rates to attract more therapists, particularly in rural areas. But they also say it’s on therapists to compromise.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/265685067\" 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>“I think it’s unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid,” says Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry.\u003c/p>\n\u003cp>“That's not sustainable,” he continues. “So you're either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn't exist. That's your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income.\"\u003c/p>\n\u003cp>That’s exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance. But he’s hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.\u003c/p>\n\u003cp>“I might knock on Cigna’s door and say, 'Hey are you guys accepting any new therapists in 94105?'” he says. “And they might say, 'No we’re not doing that. We’re totally full.'”\u003c/p>\n\u003cp>[contextly_sidebar id=\"eS6QVmoo2kjciQQ0tu4JO43ybZNtSzAw\"]\u003c/p>\n\u003cp>Six different companies told Horowitz their networks were full.\u003c/p>\n\u003cp>So even though a patient like Natalie Dunnege might call seven therapists in her insurance network and not be able to get an appointment, insurance companies are telling new and willing therapists that there’s no demand for them.\u003c/p>\n\u003cp>“I definitely think it’s to control costs,” Horowitz says. “That’s very clear.”\u003c/p>\n\u003cp>He tried for a year, and one company finally said yes. Sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.\u003c/p>\n\u003cp>“It was just like, 'Oh wait, it looks like we’re suddenly getting a couple referrals from them. I wonder if we’re in their directory,'” he explains.\u003c/p>\n\u003cp>They were. Sort of. The clinic was listed in the directory. But the therapists who work at the clinic weren’t approved yet, meaning there was no one who was allowed to see the clients calling the clinic.\u003c/p>\n\u003cp>So Horowitz tried to call the insurance company to clear things up. He tried many, many times. Here’s what happened during his latest attempt to navigate the automated phone system:\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company automated attendant:\u003c/strong> First I’ll need your provider identification number. If you need a moment, say, hold on.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Hold on.\u003c/em>\u003c/p>\n\u003cp>Sound familiar? Turns out therapists get the automated run around as much as patients do. Horowitz persevered.\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Okay, please say or enter your pin.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> My pin? Is this my pin? (He enters a few numbers).\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> I’m sorry I couldn’t find an account using the info you gave me. Do you already belong to the network?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> I think so?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry, yes or no.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Um, I don’t know ... yes?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Alright. And have you already requested a credentialing application?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Yes.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry could you repeat that.\u003c/em>\u003c/p>\n\u003cp>These experiences did not bode well from Horowitz' perspective.\u003c/p>\n\u003cp>“Honestly, I got a really bad feeling about it,” he says.\u003c/p>\n\u003cp>He figured, if this is what it’s like just finding out if he’s in the network, how’s it going to be when he has a problem with a claim and can’t get paid?\u003c/p>\n\u003cp>“I could just see that getting out of hand really quickly,” he says. “So at that point we just said, do we really even want to do this?”\u003c/p>\n\u003cp>Not just that. The reimbursement rate was even lower than he expected, and the billing was so complicated that he was going to have to hire someone to do it. He says he couldn’t afford that.\u003c/p>\n\u003cp>“We made the decision that we’re just going to cancel the contract and continue to go with cash,” he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Easier said than done. Horowitz hasn’t been able to get through to anyone on the phone to cancel the contract. In the meantime, prospective patients are finding his name on the directory and are calling for appointments. Horowitz says he just has to say no.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When San Francisco resident Natalie Dunnege needed a therapist, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">she couldn’t find one\u003c/a> who took her insurance.\u003c/p>\n\u003cp>“When I would call them they wouldn’t return my phone calls or they wouldn’t be accepting patients,” she says.\u003c/p>\n\u003cp>Insurance companies say there’s a shortage of therapists.\u003c/p>\n\u003cp>But it’s not that simple. Especially in urban areas, there are lots of therapists. They just don’t want to work with the insurance companies.\u003c/p>\n\u003cp>Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“With the right kind of support, they blossom,” he says.\u003c/p>\n\u003cp>Klein doesn’t accept insurance -- and he’s far from alone. Nearly half of therapists in California don’t take insurance, according to a \u003ca href=\"http://www.camft.org/ias/images/PDFs/articles/mariam/2015_demographic_survey.pdf\" target=\"_blank\">recent survey\u003c/a> from the California Association of Marriage and Family Therapists. The same is true of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967759/\">psychiatrists\u003c/a>. There are two reasons why, Klein says.\u003c/p>\n\u003caside class=\"pullquote alignright\">Insurance companies say there's a shortage of therapists, but therapists struggle to be accepted into a network.\u003c/aside>\n\u003cp>“One, because the reimbursement rates don’t provide a living wage,” Klein says. “You can’t own a home and drive a car and survive on what in-network providers pay you.”\u003c/p>\n\u003cp>Most insurance companies pay therapists in their networks between $60 and $80 per session. In the Bay Area and Los Angeles, therapists say the market rate for therapy is more like $150 or $200 a session.\u003c/p>\n\u003cp>“The second thing is the paperwork. For an hour of psychotherapy you spend a half hour of paperwork. So, I got into this field because I don’t like paper work,” Klein says with a laugh.\u003c/p>\n\u003cp>On that first point -- money -- insurance companies acknowledge that they may have to raise their rates to attract more therapists, particularly in rural areas. But they also say it’s on therapists to compromise.\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/265685067&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/265685067'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I think it’s unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid,” says Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry.\u003c/p>\n\u003cp>“That's not sustainable,” he continues. “So you're either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn't exist. That's your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income.\"\u003c/p>\n\u003cp>That’s exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance. But he’s hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.\u003c/p>\n\u003cp>“I might knock on Cigna’s door and say, 'Hey are you guys accepting any new therapists in 94105?'” he says. “And they might say, 'No we’re not doing that. We’re totally full.'”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Six different companies told Horowitz their networks were full.\u003c/p>\n\u003cp>So even though a patient like Natalie Dunnege might call seven therapists in her insurance network and not be able to get an appointment, insurance companies are telling new and willing therapists that there’s no demand for them.\u003c/p>\n\u003cp>“I definitely think it’s to control costs,” Horowitz says. “That’s very clear.”\u003c/p>\n\u003cp>He tried for a year, and one company finally said yes. Sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.\u003c/p>\n\u003cp>“It was just like, 'Oh wait, it looks like we’re suddenly getting a couple referrals from them. I wonder if we’re in their directory,'” he explains.\u003c/p>\n\u003cp>They were. Sort of. The clinic was listed in the directory. But the therapists who work at the clinic weren’t approved yet, meaning there was no one who was allowed to see the clients calling the clinic.\u003c/p>\n\u003cp>So Horowitz tried to call the insurance company to clear things up. He tried many, many times. Here’s what happened during his latest attempt to navigate the automated phone system:\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company automated attendant:\u003c/strong> First I’ll need your provider identification number. If you need a moment, say, hold on.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Hold on.\u003c/em>\u003c/p>\n\u003cp>Sound familiar? Turns out therapists get the automated run around as much as patients do. Horowitz persevered.\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Okay, please say or enter your pin.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> My pin? Is this my pin? (He enters a few numbers).\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> I’m sorry I couldn’t find an account using the info you gave me. Do you already belong to the network?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> I think so?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry, yes or no.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Um, I don’t know ... yes?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Alright. And have you already requested a credentialing application?\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Horowitz:\u003c/strong> Yes.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Insurance company:\u003c/strong> Sorry could you repeat that.\u003c/em>\u003c/p>\n\u003cp>These experiences did not bode well from Horowitz' perspective.\u003c/p>\n\u003cp>“Honestly, I got a really bad feeling about it,” he says.\u003c/p>\n\u003cp>He figured, if this is what it’s like just finding out if he’s in the network, how’s it going to be when he has a problem with a claim and can’t get paid?\u003c/p>\n\u003cp>“I could just see that getting out of hand really quickly,” he says. “So at that point we just said, do we really even want to do this?”\u003c/p>\n\u003cp>Not just that. The reimbursement rate was even lower than he expected, and the billing was so complicated that he was going to have to hire someone to do it. He says he couldn’t afford that.\u003c/p>\n\u003cp>“We made the decision that we’re just going to cancel the contract and continue to go with cash,” he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Easier said than done. Horowitz hasn’t been able to get through to anyone on the phone to cancel the contract. In the meantime, prospective patients are finding his name on the directory and are calling for appointments. Horowitz says he just has to say no.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It's been more than 18 months since California's governor signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">a law\u003c/a> allowing pharmacists to distribute birth control without a prescription.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They're being cautious. They don't know what demand is going to be, and they're a little hesitant to ramp up.'\u003ccite>Virginia Herold, California Board of Pharmacy. \u003c/cite>\u003c/aside>\n\u003cp>Now, legally, women can simply walk into their local pharmacy and pick up contraceptive pills, the patch or the ring -- much like getting a flu shot or buying over-the-counter medication.\u003c/p>\n\u003cp>But good luck finding a pharmacy that will actually do it.\u003c/p>\n\u003cp>Calls to eight pharmacies around the Bay Area, including both large corporate locations and smaller independent stores, yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.\u003c/p>\n\u003cp>There's confusion, too. One person told me that the law hadn’t yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control without a prescription.\u003c/p>\n\u003cp>Jim Graham, a spokesman for Walgreens, which operates 629 pharmacies in California, said the company is “currently assessing” the law’s requirements. \"We plan to test the service in a small number of pharmacies,\" he said.\u003c/p>\n\u003cp>CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.\u003c/p>\n\u003cp>It’s hard to pin down exactly how many -- or few -- pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute birth control without a prescription.\u003c/p>\n\u003cp>\u003ca href=\"https://birthcontrolpharmacist.com/about/\" target=\"_blank\">Sally Rafie\u003c/a>, a professor at the UC San Diego School of Pharmacy, specializes in birth control training and access. She estimates that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing non-prescription birth control to customers.\u003c/p>\n\u003cp>Rafie has been involved in training pharmacists to comply with the new law. Under protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and select the appropriate birth control option, as well as identify potential health red flags. Online courses are also available. Students in pharmacy programs in California since the law passed receive this training in their classes.\u003c/p>\n\u003cp>At the California Pharmacists Association's annual meeting two weeks ago, Rafie says, 150 people took the birth control training workshop. There are 29,000 registered pharmacists in the state.\u003c/p>\n\u003cp>Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who has been involved in the implementation of the law.\u003c/p>\n\u003cp>\"There's just a lot of hoops that a large corporation has to implement,\" she said. She speaks from experience. The Walgreens where \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/04/california-women-can-soon-skip-the-doctor-to-get-their-birth-control/\" target=\"_blank\">Kroon oversees pharmacy students\u003c/a> on the UCSF campus has yet to implement the law.\u003c/p>\n\u003cp>Kroon says she is \"really pushing\" Walgreens to move the process along.\u003c/p>\n\u003cp>Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, or where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.\u003c/p>\n\u003cp>All of this takes time, but there are other factors in play.\u003c/p>\n\u003cp class=\"p1\">Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.\u003c/p>\n\u003cp>\"I think that they're being cautious,\" said Virginia Herold, head of the state Board of Pharmacy. \"They don't know what demand is going to be, and they're a little hesitant to ramp up.\"\u003c/p>\n\u003cp>Complying with the law is optional, not mandatory, and there’s no reason for pharmacies to opt in if there isn’t an incentive for them to do so. And right now, there’s actually a financial incentive for them \u003cem>not\u003c/em> to.\u003c/p>\n\u003cp>\"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services,\" said Kroon.\u003c/p>\n\u003cp>If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers would either have to pay out of their own pocket or the pharmacist has to work for free. In Oregon, the state's Medicaid pays $35 for the service. Kroon says there are efforts toward a similar law in California.\u003c/p>\n\u003cp>The bill to allow non-prescription birth control was put forward by Sen. Ed Hernandez, D-West Covina, and sponsored by \u003ca href=\"http://www.cpha.com/\" target=\"_blank\">the California Pharmacists Association\u003c/a> as part of a larger effort to put more primary care in the hands of pharmacists and other non-physician providers.\u003c/p>\n\u003cp>\"Pharmacists are accessible, and they're underutilized,\" said Herold.\u003c/p>\n\u003cp>Concerns have been raised, though, that by allowing women to bypass a visit to their doctor, they're less likely to get screened for cervical cancer or STDs.\u003c/p>\n\u003cp>Studies of women living near the border of Texas and Mexico found that women who obtained their birth control over the counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\" target=\"_blank\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who got contraception at clinics. But women who had to go to the clinic were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\" target=\"_blank\">more likely to stop using birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>The potential for controversy may be part of what has slowed adoption at some pharmacies. And, certainly, said Rafie, it will require different marketing than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all believe that pharmacies will eventually get on board.\u003c/p>\n\u003cp>\"By the end of the year, this will be very commonplace in California,\" said Herold.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's been more than 18 months since California's governor signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">a law\u003c/a> allowing pharmacists to distribute birth control without a prescription.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They're being cautious. They don't know what demand is going to be, and they're a little hesitant to ramp up.'\u003ccite>Virginia Herold, California Board of Pharmacy. \u003c/cite>\u003c/aside>\n\u003cp>Now, legally, women can simply walk into their local pharmacy and pick up contraceptive pills, the patch or the ring -- much like getting a flu shot or buying over-the-counter medication.\u003c/p>\n\u003cp>But good luck finding a pharmacy that will actually do it.\u003c/p>\n\u003cp>Calls to eight pharmacies around the Bay Area, including both large corporate locations and smaller independent stores, yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.\u003c/p>\n\u003cp>There's confusion, too. One person told me that the law hadn’t yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control without a prescription.\u003c/p>\n\u003cp>Jim Graham, a spokesman for Walgreens, which operates 629 pharmacies in California, said the company is “currently assessing” the law’s requirements. \"We plan to test the service in a small number of pharmacies,\" he said.\u003c/p>\n\u003cp>CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.\u003c/p>\n\u003cp>It’s hard to pin down exactly how many -- or few -- pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute birth control without a prescription.\u003c/p>\n\u003cp>\u003ca href=\"https://birthcontrolpharmacist.com/about/\" target=\"_blank\">Sally Rafie\u003c/a>, a professor at the UC San Diego School of Pharmacy, specializes in birth control training and access. She estimates that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing non-prescription birth control to customers.\u003c/p>\n\u003cp>Rafie has been involved in training pharmacists to comply with the new law. Under protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and select the appropriate birth control option, as well as identify potential health red flags. Online courses are also available. Students in pharmacy programs in California since the law passed receive this training in their classes.\u003c/p>\n\u003cp>At the California Pharmacists Association's annual meeting two weeks ago, Rafie says, 150 people took the birth control training workshop. There are 29,000 registered pharmacists in the state.\u003c/p>\n\u003cp>Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who has been involved in the implementation of the law.\u003c/p>\n\u003cp>\"There's just a lot of hoops that a large corporation has to implement,\" she said. She speaks from experience. The Walgreens where \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/04/california-women-can-soon-skip-the-doctor-to-get-their-birth-control/\" target=\"_blank\">Kroon oversees pharmacy students\u003c/a> on the UCSF campus has yet to implement the law.\u003c/p>\n\u003cp>Kroon says she is \"really pushing\" Walgreens to move the process along.\u003c/p>\n\u003cp>Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, or where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.\u003c/p>\n\u003cp>All of this takes time, but there are other factors in play.\u003c/p>\n\u003cp class=\"p1\">Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.\u003c/p>\n\u003cp>\"I think that they're being cautious,\" said Virginia Herold, head of the state Board of Pharmacy. \"They don't know what demand is going to be, and they're a little hesitant to ramp up.\"\u003c/p>\n\u003cp>Complying with the law is optional, not mandatory, and there’s no reason for pharmacies to opt in if there isn’t an incentive for them to do so. And right now, there’s actually a financial incentive for them \u003cem>not\u003c/em> to.\u003c/p>\n\u003cp>\"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services,\" said Kroon.\u003c/p>\n\u003cp>If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers would either have to pay out of their own pocket or the pharmacist has to work for free. In Oregon, the state's Medicaid pays $35 for the service. Kroon says there are efforts toward a similar law in California.\u003c/p>\n\u003cp>The bill to allow non-prescription birth control was put forward by Sen. Ed Hernandez, D-West Covina, and sponsored by \u003ca href=\"http://www.cpha.com/\" target=\"_blank\">the California Pharmacists Association\u003c/a> as part of a larger effort to put more primary care in the hands of pharmacists and other non-physician providers.\u003c/p>\n\u003cp>\"Pharmacists are accessible, and they're underutilized,\" said Herold.\u003c/p>\n\u003cp>Concerns have been raised, though, that by allowing women to bypass a visit to their doctor, they're less likely to get screened for cervical cancer or STDs.\u003c/p>\n\u003cp>Studies of women living near the border of Texas and Mexico found that women who obtained their birth control over the counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\" target=\"_blank\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who got contraception at clinics. But women who had to go to the clinic were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\" target=\"_blank\">more likely to stop using birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>The potential for controversy may be part of what has slowed adoption at some pharmacies. And, certainly, said Rafie, it will require different marketing than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all believe that pharmacies will eventually get on board.\u003c/p>\n\u003cp>\"By the end of the year, this will be very commonplace in California,\" said Herold.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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},
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"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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},
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"order": 8
},
"link": "/californiareport",
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},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
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"order": 10
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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},
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"order": 1
},
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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},
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"id": "fresh-air",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"source": "NPR"
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"how-i-built-this": {
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
"id": "hyphenacion",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
},
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"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.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
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