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"content": "\u003cp>With drug manufacturers charging $1,000 a pill for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/21/covered-california-considers-capping-patients-drug-costs/\" target=\"_blank\">hepatitis C treatments\u003c/a> and raising the price of a longstanding \u003ca href=\"http://www.huffingtonpost.com/james-peron/why-one-hiv-drug-costs-5000-percent-more-overnight_b_8174724.html\" target=\"_blank\">HIV medication 5,000 percent\u003c/a>, state lawmakers hope to revive a bill that would demystify prescription drug costs.\u003c/p>\n\u003caside class=\"pullquote align right\">\"Sunlight on costs will help control costs.\"\u003ccite>Assemblyman David Chiu, D-San Francisco\u003c/cite>\u003c/aside>\n\u003cp>\u003ca href=\"https://legiscan.com/CA/sponsors/AB463/2015\" target=\"_blank\">Assembly Bill 463\u003c/a> would require pharmaceutical companies to report production and marketing costs associated with any drug treatment priced at $10,000 or more. The bill, called the Pharmaceutical Cost Transparency Act, was initially\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB463\" target=\"_blank\"> introduced last February\u003c/a>, but floundered in the Legislature. Now the authors are hoping the growing outcry in the last six months over drug prices will help garner new supporters.\u003c/p>\n\u003cp>“Discontent with drug prices has reached a real breaking point,” said Assemblyman David Chiu, D-San Francisco, author of the bill. “Skyrocketing drug prices are gouging consumers, are costing government billions of dollars, are hitting at the bottom lines of businesses. And this is significantly impacting our health care costs.”\u003c/p>\n\u003cp>Specifically, the bill would require drug makers to report:\u003c/p>\n\u003cul>\n\u003cli>Profits attributed to the drug\u003c/li>\n\u003cli>Costs associated with clinical drug trials, research and development, and manufacturing\u003c/li>\n\u003cli>Government grants that supported research\u003c/li>\n\u003cli>Marketing and advertising\u003c/li>\n\u003c/ul>\n\u003cp>“I think sunlight on costs will help control costs,” Chiu says. “The data that we do know of, suggests that many of these companies are spending billions of dollars marketing and advertising their drugs, and not as much as they suggest on research and development.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Drug makers oppose the bill. They say the time and money spent on the new reporting requirements would be better spent on developing new life saving drugs.\u003c/p>\n\u003cp>“It’s unclear how the bill will actually help patients in the long run,” says Priscilla VanderVeer, spokesperson for the Pharmaceutical Research and Manufacturers of America, a trade group for the industry. “Does it actually lead to lower prices? Once all this information is compiled, then what?”\u003c/p>\n\u003cp>Drug companies are also concerned that some of the information they would have to report is proprietary.\u003c/p>\n\u003cp>“For competitive purposes, the company doesn't want extreme specifics to fall into the hands of their competitors,” VanderVeer says.\u003c/p>\n\u003cp>For example, if companies disclose how much they are spending on a clinical trial, it could signal to a competitor their level of investment in a certain drug or disease, and the competitor might adjust their own practices.\u003c/p>\n\u003cp>Health insurance companies say they have to disclose proprietary information to regulators to justify hikes in premium rates, and they argue the protections for that information are adequate.\u003c/p>\n\u003cp>Health plans have been particularly interested in seeing AB 463 pass. Even though they can negotiate what they pay pharmaceutical companies for drugs to some extent, they're limited in how much of the cost they can pass on directly to consumers. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339\" target=\"_blank\">A new law\u003c/a> in California limits how much plans can charge patients out of pocket for specialty drugs to $250 per month, per prescription.\u003c/p>\n\u003cp>\"At the end of the day, we have to buy these drugs,\" says Charles Bacchi, president and CEO of the California Association of Health Plans.\u003c/p>\n\u003cp>Health insurers will have no choice but to raise premium rates for everybody in order to balance the costs, he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When it comes to high priced specialty drugs, the elephant in the room is how much those drugs cost America,\" Bacchi says. \"The pharmaceutical companies want to try to sweep that under the rug, but you can't sweep an elephant under the rug.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With drug manufacturers charging $1,000 a pill for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/21/covered-california-considers-capping-patients-drug-costs/\" target=\"_blank\">hepatitis C treatments\u003c/a> and raising the price of a longstanding \u003ca href=\"http://www.huffingtonpost.com/james-peron/why-one-hiv-drug-costs-5000-percent-more-overnight_b_8174724.html\" target=\"_blank\">HIV medication 5,000 percent\u003c/a>, state lawmakers hope to revive a bill that would demystify prescription drug costs.\u003c/p>\n\u003caside class=\"pullquote align right\">\"Sunlight on costs will help control costs.\"\u003ccite>Assemblyman David Chiu, D-San Francisco\u003c/cite>\u003c/aside>\n\u003cp>\u003ca href=\"https://legiscan.com/CA/sponsors/AB463/2015\" target=\"_blank\">Assembly Bill 463\u003c/a> would require pharmaceutical companies to report production and marketing costs associated with any drug treatment priced at $10,000 or more. The bill, called the Pharmaceutical Cost Transparency Act, was initially\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB463\" target=\"_blank\"> introduced last February\u003c/a>, but floundered in the Legislature. Now the authors are hoping the growing outcry in the last six months over drug prices will help garner new supporters.\u003c/p>\n\u003cp>“Discontent with drug prices has reached a real breaking point,” said Assemblyman David Chiu, D-San Francisco, author of the bill. “Skyrocketing drug prices are gouging consumers, are costing government billions of dollars, are hitting at the bottom lines of businesses. And this is significantly impacting our health care costs.”\u003c/p>\n\u003cp>Specifically, the bill would require drug makers to report:\u003c/p>\n\u003cul>\n\u003cli>Profits attributed to the drug\u003c/li>\n\u003cli>Costs associated with clinical drug trials, research and development, and manufacturing\u003c/li>\n\u003cli>Government grants that supported research\u003c/li>\n\u003cli>Marketing and advertising\u003c/li>\n\u003c/ul>\n\u003cp>“I think sunlight on costs will help control costs,” Chiu says. “The data that we do know of, suggests that many of these companies are spending billions of dollars marketing and advertising their drugs, and not as much as they suggest on research and development.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Drug makers oppose the bill. They say the time and money spent on the new reporting requirements would be better spent on developing new life saving drugs.\u003c/p>\n\u003cp>“It’s unclear how the bill will actually help patients in the long run,” says Priscilla VanderVeer, spokesperson for the Pharmaceutical Research and Manufacturers of America, a trade group for the industry. “Does it actually lead to lower prices? Once all this information is compiled, then what?”\u003c/p>\n\u003cp>Drug companies are also concerned that some of the information they would have to report is proprietary.\u003c/p>\n\u003cp>“For competitive purposes, the company doesn't want extreme specifics to fall into the hands of their competitors,” VanderVeer says.\u003c/p>\n\u003cp>For example, if companies disclose how much they are spending on a clinical trial, it could signal to a competitor their level of investment in a certain drug or disease, and the competitor might adjust their own practices.\u003c/p>\n\u003cp>Health insurance companies say they have to disclose proprietary information to regulators to justify hikes in premium rates, and they argue the protections for that information are adequate.\u003c/p>\n\u003cp>Health plans have been particularly interested in seeing AB 463 pass. Even though they can negotiate what they pay pharmaceutical companies for drugs to some extent, they're limited in how much of the cost they can pass on directly to consumers. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339\" target=\"_blank\">A new law\u003c/a> in California limits how much plans can charge patients out of pocket for specialty drugs to $250 per month, per prescription.\u003c/p>\n\u003cp>\"At the end of the day, we have to buy these drugs,\" says Charles Bacchi, president and CEO of the California Association of Health Plans.\u003c/p>\n\u003cp>Health insurers will have no choice but to raise premium rates for everybody in order to balance the costs, he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When it comes to high priced specialty drugs, the elephant in the room is how much those drugs cost America,\" Bacchi says. \"The pharmaceutical companies want to try to sweep that under the rug, but you can't sweep an elephant under the rug.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Legislature reconvenes its extraordinary session on health care Monday and officially embarks on the long public debate over the governor's proposed budget.\u003c/p>\n\u003cp>Almost every budget proposal is greeted with opinions about what's missing in it. The big question is, among the cacophony of requests for more funding, which big-ticket health care proposal is likely to be advanced by legislative leaders?\u003c/p>\n\u003cp>The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">front-burner issue is replacing the $1.1 billion \"MCO\" \u003c/a>(managed care organization) tax, and both the state Senate and Assembly are convening their special sessions on health today to address it.\u003c/p>\n\u003cp>Some of the higher-profile pieces of health legislation this session will be on the agenda Monday because the special session on health didn't adjourn when the regular session did last year. A slate of anti-tobacco bills introduced in special session also will be raised in the Assembly today.\u003c/p>\n\u003cp>Health coverage for undocumented adults promises to be pushed hard in the Legislature this year after that effort ended in a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\">compromise last year to cover undocumented children\u003c/a> in California.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB10\u003c/a> by Sen. Ricardo Lara, D-Bell Gardens, picks up where last year's compromise bill left off.\u003c/p>\n\u003cp>\"The budget proposal misses important opportunities to invest in the health of California’s new majority, communities of color,\" said Sarah de Guia, executive director of the California Pan-Ethnic Health Network.\u003c/p>\n\u003cp>Coverage for undocumented children is expected to begin May 1.\u003c/p>\n\u003cp>A number of bills will be heard today in special session, including proposal to impose a $2-a-pack tax on cigarettes and a bill to apply the same regulations to e-cigarettes that are followed by traditional cigarettes.\u003c/p>\n\u003cp>More funding for seniors and the disabled will likely be on the Legislature's agenda this year. That population got a boost from an extension of the Coordinated Care Initiative and a bump in Supplemental Security Income and restoration of a 7 percent cut in In-Home Supportive Services hours -- but that's not enough, according to advocacy organization Justice in Aging, particularly since the IHSS restoration was a court-brokered agreement. \"More action and bolder policies will be needed to lift seniors and people with disabilities out of poverty,\" the group said in a written statement.\u003c/p>\n\u003cp>And according to Doug Moore, president of UDW/AFSCME Local 3930, those bolder policies must go beyond tying help for the developmentally disabled to the MCO tax. \"… People with disabilities, seniors, and caregivers are tired of being held hostage as Sacramento bickers about passing renewed taxes,\" Moore said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We do need additional, long-term revenues, but using vulnerable Californians' health and welfare as a bargaining chip is simply not acceptable.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Legislature reconvenes its extraordinary session on health care Monday and officially embarks on the long public debate over the governor's proposed budget.\u003c/p>\n\u003cp>Almost every budget proposal is greeted with opinions about what's missing in it. The big question is, among the cacophony of requests for more funding, which big-ticket health care proposal is likely to be advanced by legislative leaders?\u003c/p>\n\u003cp>The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">front-burner issue is replacing the $1.1 billion \"MCO\" \u003c/a>(managed care organization) tax, and both the state Senate and Assembly are convening their special sessions on health today to address it.\u003c/p>\n\u003cp>Some of the higher-profile pieces of health legislation this session will be on the agenda Monday because the special session on health didn't adjourn when the regular session did last year. A slate of anti-tobacco bills introduced in special session also will be raised in the Assembly today.\u003c/p>\n\u003cp>Health coverage for undocumented adults promises to be pushed hard in the Legislature this year after that effort ended in a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\">compromise last year to cover undocumented children\u003c/a> in California.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB10\u003c/a> by Sen. Ricardo Lara, D-Bell Gardens, picks up where last year's compromise bill left off.\u003c/p>\n\u003cp>\"The budget proposal misses important opportunities to invest in the health of California’s new majority, communities of color,\" said Sarah de Guia, executive director of the California Pan-Ethnic Health Network.\u003c/p>\n\u003cp>Coverage for undocumented children is expected to begin May 1.\u003c/p>\n\u003cp>A number of bills will be heard today in special session, including proposal to impose a $2-a-pack tax on cigarettes and a bill to apply the same regulations to e-cigarettes that are followed by traditional cigarettes.\u003c/p>\n\u003cp>More funding for seniors and the disabled will likely be on the Legislature's agenda this year. That population got a boost from an extension of the Coordinated Care Initiative and a bump in Supplemental Security Income and restoration of a 7 percent cut in In-Home Supportive Services hours -- but that's not enough, according to advocacy organization Justice in Aging, particularly since the IHSS restoration was a court-brokered agreement. \"More action and bolder policies will be needed to lift seniors and people with disabilities out of poverty,\" the group said in a written statement.\u003c/p>\n\u003cp>And according to Doug Moore, president of UDW/AFSCME Local 3930, those bolder policies must go beyond tying help for the developmentally disabled to the MCO tax. \"… People with disabilities, seniors, and caregivers are tired of being held hostage as Sacramento bickers about passing renewed taxes,\" Moore said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We do need additional, long-term revenues, but using vulnerable Californians' health and welfare as a bargaining chip is simply not acceptable.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Anne and Omar Shamiyeh first learned something was wrong with one of their twins during an ultrasound, when Anne was 18 weeks pregnant.\u003c/p>\n\u003cp>\"The technician was, like, 'Well, there's no visualization of his stomach,'\" says Anne. \"And I was like, 'How does our baby have no stomach?' \"\u003c/p>\n\u003cp>It turned out that the baby's esophagus was not connected to his stomach. He also had a heart defect. At the very least, he was likely to face surgeries and a long stay in intensive care. He might have lifelong disabilities.\u003c/p>\n\u003cp>This was only the start of an eight-month ordeal for the Shamiyeh family.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/241060950\" 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>Decisions about how much care to offer very sick family members are always challenging. But they can be particularly wrenching for parents like the Shamiyehs, who face harrowing choices during what is supposed to be a wonderful time — the start of a life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As doctors and families consider how far to push medical care, a chasm can open between the parents' hopes and what providers consider realistic.\u003c/p>\n\u003cp>For the Shamiyehs, the first major decision was whether to \"selectively reduce,\" the clinical term for aborting one fetus in a multiple pregnancy. \"Omar and I were very uncomfortable with that,\" Anne says. \"We really wanted to see what he was going to be like, and what life had to offer.\"\u003c/p>\n\u003cp>That decision meant the twins, a boy and a girl, would likely be born prematurely. As it turned out, they were delivered by cesarean section at 30 weeks — about two months early — at UCSF Benioff Children's Hospital, in San Francisco.\u003c/p>\n\u003cp>The boy was named Kai, the girl Malia. Each weighed about 3 pounds. They were rushed immediately to the neonatal intensive care unit. That night Kai had his first surgery.\u003c/p>\n\u003cp>Malia went home after about five weeks. But Kai was far from ready. He was on a ventilator, had to be fed through a tube directly into his stomach and was still struggling to survive. Eventually, he was diagnosed with \u003ca href=\"http://www.chargesyndrome.org/about-charge.asp\" target=\"_blank\">CHARGE syndrome\u003c/a> — a rare genetic condition that can result in severe cognitive and physical disabilities.\u003c/p>\n\u003cfigure id=\"attachment_136337\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136337 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg\" alt=\"Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>About the time Malia went home, the doctors and nurses sat down with the Shamiyehs to discuss Kai's treatment. They needed to know whether the family wanted a tracheostomy — surgeons would insert a breathing tube directly into Kai's neck to ease passage of air into his lungs.\u003c/p>\n\u003cp>\"It seemed awful,\" Anne recalls. \"We were both really unhappy with that, but we understood it wasn't a choice. It was something we had to do.\"\u003c/p>\n\u003cp>But \u003ca href=\"https://www.ucsfbenioffchildrens.org/elizabeth.rogers\" target=\"_blank\">Dr. Liz Rogers\u003c/a>, a UCSF neonatologist who cared for Kai, saw it as a significant decision.\u003c/p>\n\u003cp>\"To be very honest,\" Rogers says, \"for many, many of our families, the point of decision around a tracheostomy is a major, major time when families say, 'This has gone on for too long, and it's not what I want for him.' \"\u003c/p>\n\u003cp>Anne had real hope for Kai's future, despite the pessimism of some doctors.\u003c/p>\n\u003cp>\"I kept thinking, maybe that doctor's view of quality of life is different from mine. And maybe, for me, loving my child and having him feel love is enough,\" Anne says. \"And it's OK if he can't talk. Maybe he'll wear a diaper until he's 5, and maybe he'll be in a wheelchair, but that's OK. Because he'll be alive, and he'll be my child.\"\u003c/p>\n\u003cp>Studies \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10359387\">suggest\u003c/a> that health care providers do tend to have a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24112219\">different view\u003c/a> of quality of life than parents do. In Kai's case, many of his day-to-day caregivers — the nurses — felt Kai was suffering unnecessarily.\u003c/p>\n\u003cfigure id=\"attachment_136368\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-136368 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/kai-13-400x267.jpg\" alt=\"Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13.jpg 770w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Deidre Miller, a registered nurse in the NICU, says she was one of just a handful of nurses willing to be part of his primary care team. It was clear to all of them, she says, that Kai wasn't going to make it. Miller says she felt comfortable caring for Kai, but faced pressure from other nurses.\u003c/p>\n\u003cp>\"A lot of people thought, 'OK, well, let's just offer the Shamiyehs the opportunity to withdraw care today.' And, as a primary nurse, you knew that the Shamiyehs were never going to agree to that, and you knew that he had joy in his life,\" she recalls. \"But you go into the break room, and everybody wants to talk about it, and everyone wants \u003cem>you\u003c/em> to be the person to tell the Shamiyehs.\"\u003c/p>\n\u003cp>There's often a lag between when health care providers and parents sense a child isn't going to make it. In \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=193278\" target=\"_blank\">one study\u003c/a>, for instance, oncologists realized that their young patients would not recover months before the parents recognized it.\u003c/p>\n\u003cp>\"As easy as it is to \u003cem>say\u003c/em> we knew Kai was going to die, and we knew he was going to have a difficult life — gosh, what if we had been wrong?\" Miller says.\u003c/p>\n\u003cp>From Anne's and Omar's perspective, Kai had many happy moments. They visited every day, always with Malia in tow. He smiled, cooed and connected with them. But he wasn't getting better.\u003c/p>\n\u003cp>In May 2013, five months into Kai's stay in the NICU, the Shamiyehs and their doctors sat down to talk about whether they wanted to go forward with the heart surgery that had been on the calendar since his birth. It would have to be done if Kai was ever to leave the hospital.\u003c/p>\n\u003cp>The surgery wouldn't help, doctors explained, and Kai might die during the procedure. This time, Anne and Omar decided not to go forward.\u003c/p>\n\u003cp>\"So that was the day we found out we wouldn't ever be bringing Kai home,\" Anne says.\u003c/p>\n\u003cp>Two weeks later, Kai developed an infection the doctors couldn't treat. On June 5, 2013, he died in his mother's arms.\u003c/p>\n\u003cp>There were real costs to Kai's long stay in the NICU. Based on billing statements, the Shamiyehs calculate that the charges for Kai's care added up to more than $11 million, though their insurer very likely negotiated a lower rate.\u003c/p>\n\u003cp>There were also consequences for Kai's twin sister, Malia, whose parents were mostly focused on her brother during her first six months of life. Born two months prematurely herself, she had physical and speech delays; although at age 3, she's already caught up.\u003c/p>\n\u003cfigure id=\"attachment_136339\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136339 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg\" alt=\"Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Looking back, Omar says he wonders if they went too far. \"It's really hard to think — for five months he was going through all this pain and all this stress,\" Omar says. \"You wonder if you made the right decision in keeping it going, you know?\"\u003c/p>\n\u003cp>But Anne, who is now studying to become a nurse in the NICU, says she does not regret giving their son the best possible chance at life.\u003c/p>\n\u003cp>She's at peace with both their decisions — to try to save Kai, and to let him go.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jenny Gold is a reporter with \u003c/em>\u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003cem> and completed this story while participating in the \u003c/em>\u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars\" target=\"_blank\">California Health Journalism Fellowship\u003c/a>,\u003cem> a program of USC's Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"excerpt": "As families consider how far to push an infant's medical care, a chasm can open between the parents' hopes and what doctors and nurses consider realistic. How do you measure a baby's quality of life?",
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"description": "As families consider how far to push an infant's medical care, a chasm can open between the parents' hopes and what doctors and nurses consider realistic. How do you measure a baby's quality of life?",
"title": "A Sick Newborn, A Loving Family and A Litany of Wrenching Choices | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anne and Omar Shamiyeh first learned something was wrong with one of their twins during an ultrasound, when Anne was 18 weeks pregnant.\u003c/p>\n\u003cp>\"The technician was, like, 'Well, there's no visualization of his stomach,'\" says Anne. \"And I was like, 'How does our baby have no stomach?' \"\u003c/p>\n\u003cp>It turned out that the baby's esophagus was not connected to his stomach. He also had a heart defect. At the very least, he was likely to face surgeries and a long stay in intensive care. He might have lifelong disabilities.\u003c/p>\n\u003cp>This was only the start of an eight-month ordeal for the Shamiyeh family.\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/241060950&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/241060950'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Decisions about how much care to offer very sick family members are always challenging. But they can be particularly wrenching for parents like the Shamiyehs, who face harrowing choices during what is supposed to be a wonderful time — the start of a life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As doctors and families consider how far to push medical care, a chasm can open between the parents' hopes and what providers consider realistic.\u003c/p>\n\u003cp>For the Shamiyehs, the first major decision was whether to \"selectively reduce,\" the clinical term for aborting one fetus in a multiple pregnancy. \"Omar and I were very uncomfortable with that,\" Anne says. \"We really wanted to see what he was going to be like, and what life had to offer.\"\u003c/p>\n\u003cp>That decision meant the twins, a boy and a girl, would likely be born prematurely. As it turned out, they were delivered by cesarean section at 30 weeks — about two months early — at UCSF Benioff Children's Hospital, in San Francisco.\u003c/p>\n\u003cp>The boy was named Kai, the girl Malia. Each weighed about 3 pounds. They were rushed immediately to the neonatal intensive care unit. That night Kai had his first surgery.\u003c/p>\n\u003cp>Malia went home after about five weeks. But Kai was far from ready. He was on a ventilator, had to be fed through a tube directly into his stomach and was still struggling to survive. Eventually, he was diagnosed with \u003ca href=\"http://www.chargesyndrome.org/about-charge.asp\" target=\"_blank\">CHARGE syndrome\u003c/a> — a rare genetic condition that can result in severe cognitive and physical disabilities.\u003c/p>\n\u003cfigure id=\"attachment_136337\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136337 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg\" alt=\"Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-12small-2f176b34a82e823212962a085679b964c0079eb8-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>About the time Malia went home, the doctors and nurses sat down with the Shamiyehs to discuss Kai's treatment. They needed to know whether the family wanted a tracheostomy — surgeons would insert a breathing tube directly into Kai's neck to ease passage of air into his lungs.\u003c/p>\n\u003cp>\"It seemed awful,\" Anne recalls. \"We were both really unhappy with that, but we understood it wasn't a choice. It was something we had to do.\"\u003c/p>\n\u003cp>But \u003ca href=\"https://www.ucsfbenioffchildrens.org/elizabeth.rogers\" target=\"_blank\">Dr. Liz Rogers\u003c/a>, a UCSF neonatologist who cared for Kai, saw it as a significant decision.\u003c/p>\n\u003cp>\"To be very honest,\" Rogers says, \"for many, many of our families, the point of decision around a tracheostomy is a major, major time when families say, 'This has gone on for too long, and it's not what I want for him.' \"\u003c/p>\n\u003cp>Anne had real hope for Kai's future, despite the pessimism of some doctors.\u003c/p>\n\u003cp>\"I kept thinking, maybe that doctor's view of quality of life is different from mine. And maybe, for me, loving my child and having him feel love is enough,\" Anne says. \"And it's OK if he can't talk. Maybe he'll wear a diaper until he's 5, and maybe he'll be in a wheelchair, but that's OK. Because he'll be alive, and he'll be my child.\"\u003c/p>\n\u003cp>Studies \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10359387\">suggest\u003c/a> that health care providers do tend to have a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24112219\">different view\u003c/a> of quality of life than parents do. In Kai's case, many of his day-to-day caregivers — the nurses — felt Kai was suffering unnecessarily.\u003c/p>\n\u003cfigure id=\"attachment_136368\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-136368 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/kai-13-400x267.jpg\" alt=\"Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/kai-13.jpg 770w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Kai Shamiyeh’s memorial card is posted on the refrigerator. “Kai is part of our everyday life,” said Annie Shamiyeh. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Deidre Miller, a registered nurse in the NICU, says she was one of just a handful of nurses willing to be part of his primary care team. It was clear to all of them, she says, that Kai wasn't going to make it. Miller says she felt comfortable caring for Kai, but faced pressure from other nurses.\u003c/p>\n\u003cp>\"A lot of people thought, 'OK, well, let's just offer the Shamiyehs the opportunity to withdraw care today.' And, as a primary nurse, you knew that the Shamiyehs were never going to agree to that, and you knew that he had joy in his life,\" she recalls. \"But you go into the break room, and everybody wants to talk about it, and everyone wants \u003cem>you\u003c/em> to be the person to tell the Shamiyehs.\"\u003c/p>\n\u003cp>There's often a lag between when health care providers and parents sense a child isn't going to make it. In \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=193278\" target=\"_blank\">one study\u003c/a>, for instance, oncologists realized that their young patients would not recover months before the parents recognized it.\u003c/p>\n\u003cp>\"As easy as it is to \u003cem>say\u003c/em> we knew Kai was going to die, and we knew he was going to have a difficult life — gosh, what if we had been wrong?\" Miller says.\u003c/p>\n\u003cp>From Anne's and Omar's perspective, Kai had many happy moments. They visited every day, always with Malia in tow. He smiled, cooed and connected with them. But he wasn't getting better.\u003c/p>\n\u003cp>In May 2013, five months into Kai's stay in the NICU, the Shamiyehs and their doctors sat down to talk about whether they wanted to go forward with the heart surgery that had been on the calendar since his birth. It would have to be done if Kai was ever to leave the hospital.\u003c/p>\n\u003cp>The surgery wouldn't help, doctors explained, and Kai might die during the procedure. This time, Anne and Omar decided not to go forward.\u003c/p>\n\u003cp>\"So that was the day we found out we wouldn't ever be bringing Kai home,\" Anne says.\u003c/p>\n\u003cp>Two weeks later, Kai developed an infection the doctors couldn't treat. On June 5, 2013, he died in his mother's arms.\u003c/p>\n\u003cp>There were real costs to Kai's long stay in the NICU. Based on billing statements, the Shamiyehs calculate that the charges for Kai's care added up to more than $11 million, though their insurer very likely negotiated a lower rate.\u003c/p>\n\u003cp>There were also consequences for Kai's twin sister, Malia, whose parents were mostly focused on her brother during her first six months of life. Born two months prematurely herself, she had physical and speech delays; although at age 3, she's already caught up.\u003c/p>\n\u003cfigure id=\"attachment_136339\" class=\"wp-caption aligncenter\" style=\"max-width: 1780px\">\u003cimg class=\"wp-image-136339 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg\" alt=\"Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU.\" width=\"1780\" height=\"1335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56.jpg 1780w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/shamiyeh-9small-b979741189722172d683aa11277945b4996fec56-960x720.jpg 960w\" sizes=\"(max-width: 1780px) 100vw, 1780px\">\u003cfigcaption class=\"wp-caption-text\">Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Looking back, Omar says he wonders if they went too far. \"It's really hard to think — for five months he was going through all this pain and all this stress,\" Omar says. \"You wonder if you made the right decision in keeping it going, you know?\"\u003c/p>\n\u003cp>But Anne, who is now studying to become a nurse in the NICU, says she does not regret giving their son the best possible chance at life.\u003c/p>\n\u003cp>She's at peace with both their decisions — to try to save Kai, and to let him go.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The Los Angeles-area chapter of the Alzheimer’s Association is splitting from the national organization, the latest in a string of departures that could impact the national group’s bottom line.\u003c/p>\n\u003cp>The chapter, which covers Los Angeles, Riverside and San Bernardino counties, announced its decision Thursday to separate and form its own organization. Chapters in San Diego and Orange County, California announced similar plans late last year, as did chapters in New York City and New Jersey.\u003c/p>\n\u003cp>The departures come after the Alzheimer’s Association voted last fall to consolidate into one national organization that will centrally manage the funds and programs for people living with the disease throughout the United States.\u003c/p>\n\u003cp>Currently, local chapters are affiliated with the umbrella national group and help fund its operations and research. But they are independent nonprofits that keep about 60 percent of the money they raise and largely set their own priorities on how to spend it. Under the new structure, the Chicago-based national headquarters will be the only legal entity of the Alzheimer’s Association.\u003c/p>\n\u003cp>The Los Angeles-area chapter decided to go out on its own because of concerns that the consolidation would take away local flexibility and make it harder to provide services tailored to the diverse population of Southern California, said Susan Galeas, president and CEO of the new organization, known as Alzheimer’s Greater Los Angeles.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Galeas said she and the local board also feared the national organization wouldn’t place as much of a priority on funding direct care for people with Alzheimer’s and their families as the local chapter does.\u003c/p>\n\u003cp>“There was a legitimate concern that would diminish over time,” she said. “It was in the best interest of the communities that we serve – and the growing number of people who are going to be affected by this disease — to make a change.”\u003c/p>\n\u003cp>The national board of the Alzheimer’s Association voted in October to combine its operations and gave its 54 chapters until Jan. 15 to decide whether to join. The chapters are expected to merge with the national entity by summer, said Stewart Putnam, chair of the national board of directors.\u003c/p>\n\u003cp>Putnam said combining forces will help the organization be even more efficient in tackling a disease that impacts 5 million people and is expected to affect far more in the future. There is no cure for the brain disease, which weakens people’s memory and cognition.\u003c/p>\n\u003cp>“We need to be taking care of more people, we need to be raising more money for research and we need to increase awareness and concern about the disease,” Putnam said. “By working together as one organization, we believe we can be more effective at that.”\u003c/p>\n\u003cp>Other similar nonprofits such as the American Cancer Society and the American Heart Association have already consolidated. The model is a better way to raise an organization’s profile, have significant national impact and reduce redundancies, said John Graham, CEO and president of the American Society of Association Executives.\u003c/p>\n\u003cp>“Imagine if you were trying to fight a war and every platoon could make its own decisions,” said Graham, who oversaw a consolidation as head of the American Diabetes Association.\u003c/p>\n\u003cp>But the process of consolidation is not always smooth, Graham said. Local chapters don’t want to give up control, especially over money. “It is a bumpy ride,” he said.\u003c/p>\n\u003cp>Putnam said there would still be Alzheimer’s Association chapters throughout the country, including in the areas that have decided to disaffiliate from the national organization.\u003c/p>\n\u003cp>Los Angeles and the four other chapters that have split from the association will no longer be able to use the well-known name. They will, however, be able to retain 100 percent of the money that they raise locally.\u003c/p>\n\u003cp>Galeas said the new Los Angeles-area organization is already up and running and she is confident that it will be able to continue attracting donors and providing support, education and other services. The group also plans to form new partnerships with local research organizations and to expand its programs across the region, she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We are really looking to grow,” she said. “In order to grow, we have to be nimble and we have to be creative.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Los Angeles-area chapter of the Alzheimer’s Association is splitting from the national organization, the latest in a string of departures that could impact the national group’s bottom line.\u003c/p>\n\u003cp>The chapter, which covers Los Angeles, Riverside and San Bernardino counties, announced its decision Thursday to separate and form its own organization. Chapters in San Diego and Orange County, California announced similar plans late last year, as did chapters in New York City and New Jersey.\u003c/p>\n\u003cp>The departures come after the Alzheimer’s Association voted last fall to consolidate into one national organization that will centrally manage the funds and programs for people living with the disease throughout the United States.\u003c/p>\n\u003cp>Currently, local chapters are affiliated with the umbrella national group and help fund its operations and research. But they are independent nonprofits that keep about 60 percent of the money they raise and largely set their own priorities on how to spend it. Under the new structure, the Chicago-based national headquarters will be the only legal entity of the Alzheimer’s Association.\u003c/p>\n\u003cp>The Los Angeles-area chapter decided to go out on its own because of concerns that the consolidation would take away local flexibility and make it harder to provide services tailored to the diverse population of Southern California, said Susan Galeas, president and CEO of the new organization, known as Alzheimer’s Greater Los Angeles.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Galeas said she and the local board also feared the national organization wouldn’t place as much of a priority on funding direct care for people with Alzheimer’s and their families as the local chapter does.\u003c/p>\n\u003cp>“There was a legitimate concern that would diminish over time,” she said. “It was in the best interest of the communities that we serve – and the growing number of people who are going to be affected by this disease — to make a change.”\u003c/p>\n\u003cp>The national board of the Alzheimer’s Association voted in October to combine its operations and gave its 54 chapters until Jan. 15 to decide whether to join. The chapters are expected to merge with the national entity by summer, said Stewart Putnam, chair of the national board of directors.\u003c/p>\n\u003cp>Putnam said combining forces will help the organization be even more efficient in tackling a disease that impacts 5 million people and is expected to affect far more in the future. There is no cure for the brain disease, which weakens people’s memory and cognition.\u003c/p>\n\u003cp>“We need to be taking care of more people, we need to be raising more money for research and we need to increase awareness and concern about the disease,” Putnam said. “By working together as one organization, we believe we can be more effective at that.”\u003c/p>\n\u003cp>Other similar nonprofits such as the American Cancer Society and the American Heart Association have already consolidated. The model is a better way to raise an organization’s profile, have significant national impact and reduce redundancies, said John Graham, CEO and president of the American Society of Association Executives.\u003c/p>\n\u003cp>“Imagine if you were trying to fight a war and every platoon could make its own decisions,” said Graham, who oversaw a consolidation as head of the American Diabetes Association.\u003c/p>\n\u003cp>But the process of consolidation is not always smooth, Graham said. Local chapters don’t want to give up control, especially over money. “It is a bumpy ride,” he said.\u003c/p>\n\u003cp>Putnam said there would still be Alzheimer’s Association chapters throughout the country, including in the areas that have decided to disaffiliate from the national organization.\u003c/p>\n\u003cp>Los Angeles and the four other chapters that have split from the association will no longer be able to use the well-known name. They will, however, be able to retain 100 percent of the money that they raise locally.\u003c/p>\n\u003cp>Galeas said the new Los Angeles-area organization is already up and running and she is confident that it will be able to continue attracting donors and providing support, education and other services. The group also plans to form new partnerships with local research organizations and to expand its programs across the region, she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We are really looking to grow,” she said. “In order to grow, we have to be nimble and we have to be creative.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Gov. Jerry Brown introduced his \u003ca href=\"http://ww2.kqed.org/news/2016/01/07/browns-budget-mantra-caution\" target=\"_blank\">$122.6 billion general fund budget\u003c/a> in Sacramento on Thursday, including a new approach to replacing a soon-to-expire tax on managed care organizations.\u003c/p>\n\u003cp>The present MCO tax will end on June 30 if legislators cannot agree on a replacement. California faces the loss of $1.1 billion in revenue, including federal match funds. A plan launched last year during a special legislative session on health did not advance.\u003c/p>\n\u003cp>Brown is now proposing an overall reform package on taxes insurers pay that he says will ultimately save them money.\u003c/p>\n\u003cp>\"It's lowering the corporate tax, lowering the premiums tax,\" Brown said, \"and you blend all that together. Because of the way the federal government works, money can flow to us, and it will be net for California.\"\u003c/p>\n\u003cp>Brown said he hoped to get the issue resolved \"in a month,\" but stressed there was no deal as yet with the health plans.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"http://www.ebudget.ca.gov/FullBudgetSummary.pdf\" target=\"_blank\">Brown's proposal\u003c/a> includes where that money might be spent:\u003c/p>\n\u003cblockquote>\u003cp>The Budget also assumes that revenues from the tax be placed in a special fund and be used to restore the 7‐percent reduction to the In‐Home Supportive Services ($236 million annually). Finally, the Budget assumes the tax is in place for three years starting in 2016‐17.\u003c/p>\u003c/blockquote>\n\u003cp>Charles Bacchi, California Association of Health Plans CEO, said he appreciated new options on an MCO tax. \"I think they've been working very hard, and certainly credit is due to them. At this time, we're still looking at it. We're still trying to confirm it. There will be more discussions this week with the administration.\"\u003c/p>\n\u003cp>Some are already critical of the proposed plan, which earmarks some of the MCO revenue to the Department of Developmental Services.\u003c/p>\n\u003cp>Tim Hornbecker, director of business development for The Arc of Alameda County, believes tying developmental disabilities funding to the MCO tax is the governor’s way of garnering Republican support for the tax -- he needs a two-thirds vote from the Legislature for the tax to pass.\u003c/p>\n\u003cp>“The governor is using people with developmental disabilities as pawns in the system, until he can get his votes from Republicans,” Hornbecker said.\u003c/p>\n\u003cp>Assemblyman Tom Lackey, R-Palmdale, did not approve of the approach.\u003c/p>\n\u003cp>“These folks deserve to be a top consideration in the general funding arena,\" he said. \"And they’ve been an ‘oh, by the way’ consideration, which is deplorable.”\u003c/p>\n\u003cp>\u003cstrong>SSI Increase\u003c/strong>\u003c/p>\n\u003cp>The budget includes a 2.8 percent increase in benefits for people who receive Supplemental Security Income/State Supplementary Payment (SSI/SSP). An estimated 1.3 million people are expected to receive monthly benefits in 2016-17, and their maximum grants will be $889 per month for individuals and $1,496 per month for couples, an increase of $17 and $31 respectively.\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal Enrollment\u003c/strong>\u003c/p>\n\u003cp>The state's Medi-Cal enrollment is expected to reach a new high in the next fiscal year -- 13.5 million people, or more than a third of all Californians.\u003c/p>\n\u003cp>California expanded Medi-Cal as part of the Affordable Care Act. The federal government has been paying 100 percent of the cost of those in the expansion population, but in 2017, California will be responsible for 5 percent of that cost, or $740.2 million in general fund money.\u003c/p>\n\u003cp>The state is responsible for half the cost of those who were always eligible for Medi-Cal but did not sign up until the Affordable Care Act went into effect. Next year, that's expected to be $1.9 billion from the general fund.\u003c/p>\n\u003cp>\u003cstrong>Undocumented Immigrant Health Care\u003c/strong>\u003c/p>\n\u003cp>On May 1, 170,000 \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\">undocumented children will become eligible \u003c/a>for full Medi-Cal benefits. California is the first state in the country to cover undocumented children. The governor earmarked $145 million in general fund money to cover the new costs.\u003c/p>\n\u003cp>While advocates noted there were no new cuts to programs, they were disappointed that the governor did not go further in restoring funding that was deeply cut in the wake of the 2008 recession.\u003c/p>\n\u003cp>\"This budget proposal largely continues the recession-era cuts to health and human services,\" Anthony Wright, executive director, of Health Access, an advocacy group, said in a statement. \"The [budget] surplus was created in part from $15 billion in HHS cuts; it's high time to restore cuts to Medi-Cal benefits and rates and other public health programs.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>An earlier version of this story incorrectly quoted Gov. Brown who said his revised MCO plan would be \"net for California\" not \"net positive.\" KQED regrets the error.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Jerry Brown introduced his \u003ca href=\"http://ww2.kqed.org/news/2016/01/07/browns-budget-mantra-caution\" target=\"_blank\">$122.6 billion general fund budget\u003c/a> in Sacramento on Thursday, including a new approach to replacing a soon-to-expire tax on managed care organizations.\u003c/p>\n\u003cp>The present MCO tax will end on June 30 if legislators cannot agree on a replacement. California faces the loss of $1.1 billion in revenue, including federal match funds. A plan launched last year during a special legislative session on health did not advance.\u003c/p>\n\u003cp>Brown is now proposing an overall reform package on taxes insurers pay that he says will ultimately save them money.\u003c/p>\n\u003cp>\"It's lowering the corporate tax, lowering the premiums tax,\" Brown said, \"and you blend all that together. Because of the way the federal government works, money can flow to us, and it will be net for California.\"\u003c/p>\n\u003cp>Brown said he hoped to get the issue resolved \"in a month,\" but stressed there was no deal as yet with the health plans.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.ebudget.ca.gov/FullBudgetSummary.pdf\" target=\"_blank\">Brown's proposal\u003c/a> includes where that money might be spent:\u003c/p>\n\u003cblockquote>\u003cp>The Budget also assumes that revenues from the tax be placed in a special fund and be used to restore the 7‐percent reduction to the In‐Home Supportive Services ($236 million annually). Finally, the Budget assumes the tax is in place for three years starting in 2016‐17.\u003c/p>\u003c/blockquote>\n\u003cp>Charles Bacchi, California Association of Health Plans CEO, said he appreciated new options on an MCO tax. \"I think they've been working very hard, and certainly credit is due to them. At this time, we're still looking at it. We're still trying to confirm it. There will be more discussions this week with the administration.\"\u003c/p>\n\u003cp>Some are already critical of the proposed plan, which earmarks some of the MCO revenue to the Department of Developmental Services.\u003c/p>\n\u003cp>Tim Hornbecker, director of business development for The Arc of Alameda County, believes tying developmental disabilities funding to the MCO tax is the governor’s way of garnering Republican support for the tax -- he needs a two-thirds vote from the Legislature for the tax to pass.\u003c/p>\n\u003cp>“The governor is using people with developmental disabilities as pawns in the system, until he can get his votes from Republicans,” Hornbecker said.\u003c/p>\n\u003cp>Assemblyman Tom Lackey, R-Palmdale, did not approve of the approach.\u003c/p>\n\u003cp>“These folks deserve to be a top consideration in the general funding arena,\" he said. \"And they’ve been an ‘oh, by the way’ consideration, which is deplorable.”\u003c/p>\n\u003cp>\u003cstrong>SSI Increase\u003c/strong>\u003c/p>\n\u003cp>The budget includes a 2.8 percent increase in benefits for people who receive Supplemental Security Income/State Supplementary Payment (SSI/SSP). An estimated 1.3 million people are expected to receive monthly benefits in 2016-17, and their maximum grants will be $889 per month for individuals and $1,496 per month for couples, an increase of $17 and $31 respectively.\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal Enrollment\u003c/strong>\u003c/p>\n\u003cp>The state's Medi-Cal enrollment is expected to reach a new high in the next fiscal year -- 13.5 million people, or more than a third of all Californians.\u003c/p>\n\u003cp>California expanded Medi-Cal as part of the Affordable Care Act. The federal government has been paying 100 percent of the cost of those in the expansion population, but in 2017, California will be responsible for 5 percent of that cost, or $740.2 million in general fund money.\u003c/p>\n\u003cp>The state is responsible for half the cost of those who were always eligible for Medi-Cal but did not sign up until the Affordable Care Act went into effect. Next year, that's expected to be $1.9 billion from the general fund.\u003c/p>\n\u003cp>\u003cstrong>Undocumented Immigrant Health Care\u003c/strong>\u003c/p>\n\u003cp>On May 1, 170,000 \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\">undocumented children will become eligible \u003c/a>for full Medi-Cal benefits. California is the first state in the country to cover undocumented children. The governor earmarked $145 million in general fund money to cover the new costs.\u003c/p>\n\u003cp>While advocates noted there were no new cuts to programs, they were disappointed that the governor did not go further in restoring funding that was deeply cut in the wake of the 2008 recession.\u003c/p>\n\u003cp>\"This budget proposal largely continues the recession-era cuts to health and human services,\" Anthony Wright, executive director, of Health Access, an advocacy group, said in a statement. \"The [budget] surplus was created in part from $15 billion in HHS cuts; it's high time to restore cuts to Medi-Cal benefits and rates and other public health programs.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>An earlier version of this story incorrectly quoted Gov. Brown who said his revised MCO plan would be \"net for California\" not \"net positive.\" KQED regrets the error.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California now has one of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">strictest vaccination laws\u003c/a> in the country, but ambiguity in its wording has left school districts deciding on their own whether to grant special education students a de facto exemption.\u003c/p>\n\u003caside class=\"pullquote alignright\">'School districts are grappling with how they want to approach this right now.'\u003cbr>\n\u003ccite>Jonathan Read, attorney\u003c/cite>\u003c/aside>\n\u003cp>The California Department of Public Health and the California Department of Education have not yet issued guidance on how to apply \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">the vaccination law \u003c/a>to special education students. Under the federal \u003ca href=\"http://idea.ed.gov/\" target=\"_blank\">Individuals with Disabilities Education Act\u003c/a>, students who qualify for special education services, such as speech therapy or small-group instruction, must receive those services. Failure to comply leaves districts vulnerable to lawsuits from parents.\u003c/p>\n\u003cp>At the same time, beginning July 1, the state law will require all kindergarten, transitional kindergarten and seventh-grade students to be vaccinated against 10 communicable diseases before they are allowed to attend school, unless they have a medical condition that makes them unable to do so. Under the new law, parents can no longer refuse to vaccinate their children in public or private schools and child-care centers based on their personal beliefs.\u003c/p>\n\u003cp>With kindergarten enrollment beginning this month in the Sacramento City Unified School District and continuing through the spring in districts around the state, school lawyers are parsing the law on their own.\u003c/p>\n\u003cp>The intent of the new law is “to increase community immunity,” said Shannan Martinez, a spokeswoman for state Sen. Richard Pan, D-Sacramento, who co-authored the legislation, Senate Bill 277. Pan said he acted to address rising numbers of unvaccinated children and a corresponding increase in outbreaks of diseases once considered obliterated in the U.S., including the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">measles outbreak tied to Disneyland last year\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the law appears to have unwittingly created a loophole that could be used to exempt the 10 percent of students who are enrolled in special education, a number far greater than the 2.5 percent of kindergarten students who opted out of vaccinations during the 2014-2015 school year through personal belief exemptions.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are not holding anyone to vaccination requirements that would interfere with access to special education programs.'\u003cbr>\n\u003ccite>Dr. Kimberly Uyeda, L.A. Unified School District\u003c/cite>\u003c/aside>\n\u003cp>The Los Angeles Unified School District, which serves more than 640,000 K-12 students and is the largest district in the state, has decided not to require students in special education to comply with required immunizations if that requirement would prevent them from getting services, including instruction in general education classrooms, to which they are legally entitled, said Dr. Kimberly Uyeda, director of student medical services for the district.\u003c/p>\n\u003cp>“We are not holding anyone to vaccination requirements that would interfere with access to special education programs,” Uyeda said. The decision was based on advice from district legal counsel, she said. The district serves about 73,000 special education students, but only “a very small number” are not fully vaccinated, she said.\u003c/p>\n\u003cp>“The broadest way the law can be interpreted is that special education students get access to everything, regardless of immunization status,” said Jennifer Nix, an attorney with School and College Legal Services of California. In terms of the risk of lawsuits from special education parents, “it is the safest route, but I don’t know if it’s the right route,” Nix said.\u003c/p>\n\u003cp>While the immunization law specifically exempts students who are home-schooled or who are enrolled in independent study with no classroom attendance, it does not use the word “exempt” to describe the status of students in special education. Instead, the law states that it does not “prohibit” special education students from access to services. Special education students wouldn’t necessarily be attending school, Martinez said.\u003c/p>\n\u003cp>Unlike students who are home-schooled or studying independently outside of classrooms, students who receive special education services -– they number one in 10 students in California, according to \u003ca href=\"http://www.lao.ca.gov/handouts/education/2015/Overview-of-Special-Education-in-California050715.pdf\" target=\"_blank\">a 2015 report from the Legislative Analyst’s Office\u003c/a> -– are in school buildings and almost always spend time in general education classrooms, physical education classes or cafeterias.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IJg8DasAtRTB1SNDndbXhRlaoqNX6euf\"]Jonathan Read, who specializes in special education law at the San Diego firm Fagen Friedman & Fulfrost, said that in the absence of guidance from the state, the immunization law is being interpreted in two ways. The first is that special education students are required by federal law to be educated in the least restrictive environment, which often means spending time in general education classrooms, and that right cannot be limited by a state law requiring them to be vaccinated to obtain access.\u003c/p>\n\u003cp>The second interpretation is that immunizations are a health and safety concern. While districts are obligated to make inclusive special education environments available, according to this line of reasoning, Read said, it is up to parents to decide whether they want their child to have access to those environments by having their child vaccinated.\u003c/p>\n\u003cp>“School districts are grappling with how they want to approach this right now,” Read said.\u003c/p>\n\u003cp>“There are going to be some conflicts,” said Maggie Roberts, associate managing attorney at Disability Rights California, the state’s watchdog group. “School districts will feel they have the right to keep out kids” who are not immunized, she said, while parents will press schools to fulfill their obligation to provide special education services, even if their children are not vaccinated.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/24/orange-county-says-special-ed-students-must-also-comply-with-vaccination-law/\" target=\"_blank\">Orange County has made the strongest public statement\u003c/a>, insisting that special education students be vaccinated along with all other students on campus, except those with medical exemptions. “If you exempt all special education kids, you’re going to decrease the vaccination rate by 11 or 12 percent,” said Ronald Wenkart, general counsel for the Orange County Office of Education. “I don’t see how you can interpret the law that way.”\u003c/p>\n\u003cp>Wenkart has advised school districts in the county that special education students must be vaccinated.\u003c/p>\n\u003cp>Other districts are planning for scenarios that could include providing special education services at home for unvaccinated students or meeting with the students in separate facilities at or near school grounds.\u003c/p>\n\u003cp>In the Sacramento City Unified School District, Terri Fox, lead district nurse, said one plan could be to refuse to admit an unvaccinated special education student who requires only an hour or two a week of speech therapy, for instance, and instead provide services to the student offsite. The student would be home-schooled for the remainder of his or her instruction.\u003c/p>\n\u003cp>But unvaccinated students who require extensive academic, behavioral and therapeutic assistance all day in a special education classroom “will probably have to be admitted,” Fox said.\u003c/p>\n\u003cp>In the Long Beach Unified School District, Joyce Cox, program specialist for student health services, said a formal policy has not been adopted. But one idea might be to offer temporary home instruction for students in special education, she said. “That is a way you could still deliver services to the child, and still comply with the state law -- but that decision has not been made,” she said.\u003c/p>\n\u003cp>Gail Williams, director of health services at Fresno Unified, said she will meet with parents of special education students to encourage them to vaccinate their children. If that fails, the path is not clear, she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Our numbers are small,” she said. “We will handle it on a case-by-case basis.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California now has one of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">strictest vaccination laws\u003c/a> in the country, but ambiguity in its wording has left school districts deciding on their own whether to grant special education students a de facto exemption.\u003c/p>\n\u003caside class=\"pullquote alignright\">'School districts are grappling with how they want to approach this right now.'\u003cbr>\n\u003ccite>Jonathan Read, attorney\u003c/cite>\u003c/aside>\n\u003cp>The California Department of Public Health and the California Department of Education have not yet issued guidance on how to apply \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">the vaccination law \u003c/a>to special education students. Under the federal \u003ca href=\"http://idea.ed.gov/\" target=\"_blank\">Individuals with Disabilities Education Act\u003c/a>, students who qualify for special education services, such as speech therapy or small-group instruction, must receive those services. Failure to comply leaves districts vulnerable to lawsuits from parents.\u003c/p>\n\u003cp>At the same time, beginning July 1, the state law will require all kindergarten, transitional kindergarten and seventh-grade students to be vaccinated against 10 communicable diseases before they are allowed to attend school, unless they have a medical condition that makes them unable to do so. Under the new law, parents can no longer refuse to vaccinate their children in public or private schools and child-care centers based on their personal beliefs.\u003c/p>\n\u003cp>With kindergarten enrollment beginning this month in the Sacramento City Unified School District and continuing through the spring in districts around the state, school lawyers are parsing the law on their own.\u003c/p>\n\u003cp>The intent of the new law is “to increase community immunity,” said Shannan Martinez, a spokeswoman for state Sen. Richard Pan, D-Sacramento, who co-authored the legislation, Senate Bill 277. Pan said he acted to address rising numbers of unvaccinated children and a corresponding increase in outbreaks of diseases once considered obliterated in the U.S., including the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">measles outbreak tied to Disneyland last year\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the law appears to have unwittingly created a loophole that could be used to exempt the 10 percent of students who are enrolled in special education, a number far greater than the 2.5 percent of kindergarten students who opted out of vaccinations during the 2014-2015 school year through personal belief exemptions.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are not holding anyone to vaccination requirements that would interfere with access to special education programs.'\u003cbr>\n\u003ccite>Dr. Kimberly Uyeda, L.A. Unified School District\u003c/cite>\u003c/aside>\n\u003cp>The Los Angeles Unified School District, which serves more than 640,000 K-12 students and is the largest district in the state, has decided not to require students in special education to comply with required immunizations if that requirement would prevent them from getting services, including instruction in general education classrooms, to which they are legally entitled, said Dr. Kimberly Uyeda, director of student medical services for the district.\u003c/p>\n\u003cp>“We are not holding anyone to vaccination requirements that would interfere with access to special education programs,” Uyeda said. The decision was based on advice from district legal counsel, she said. The district serves about 73,000 special education students, but only “a very small number” are not fully vaccinated, she said.\u003c/p>\n\u003cp>“The broadest way the law can be interpreted is that special education students get access to everything, regardless of immunization status,” said Jennifer Nix, an attorney with School and College Legal Services of California. In terms of the risk of lawsuits from special education parents, “it is the safest route, but I don’t know if it’s the right route,” Nix said.\u003c/p>\n\u003cp>While the immunization law specifically exempts students who are home-schooled or who are enrolled in independent study with no classroom attendance, it does not use the word “exempt” to describe the status of students in special education. Instead, the law states that it does not “prohibit” special education students from access to services. Special education students wouldn’t necessarily be attending school, Martinez said.\u003c/p>\n\u003cp>Unlike students who are home-schooled or studying independently outside of classrooms, students who receive special education services -– they number one in 10 students in California, according to \u003ca href=\"http://www.lao.ca.gov/handouts/education/2015/Overview-of-Special-Education-in-California050715.pdf\" target=\"_blank\">a 2015 report from the Legislative Analyst’s Office\u003c/a> -– are in school buildings and almost always spend time in general education classrooms, physical education classes or cafeterias.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Jonathan Read, who specializes in special education law at the San Diego firm Fagen Friedman & Fulfrost, said that in the absence of guidance from the state, the immunization law is being interpreted in two ways. The first is that special education students are required by federal law to be educated in the least restrictive environment, which often means spending time in general education classrooms, and that right cannot be limited by a state law requiring them to be vaccinated to obtain access.\u003c/p>\n\u003cp>The second interpretation is that immunizations are a health and safety concern. While districts are obligated to make inclusive special education environments available, according to this line of reasoning, Read said, it is up to parents to decide whether they want their child to have access to those environments by having their child vaccinated.\u003c/p>\n\u003cp>“School districts are grappling with how they want to approach this right now,” Read said.\u003c/p>\n\u003cp>“There are going to be some conflicts,” said Maggie Roberts, associate managing attorney at Disability Rights California, the state’s watchdog group. “School districts will feel they have the right to keep out kids” who are not immunized, she said, while parents will press schools to fulfill their obligation to provide special education services, even if their children are not vaccinated.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/24/orange-county-says-special-ed-students-must-also-comply-with-vaccination-law/\" target=\"_blank\">Orange County has made the strongest public statement\u003c/a>, insisting that special education students be vaccinated along with all other students on campus, except those with medical exemptions. “If you exempt all special education kids, you’re going to decrease the vaccination rate by 11 or 12 percent,” said Ronald Wenkart, general counsel for the Orange County Office of Education. “I don’t see how you can interpret the law that way.”\u003c/p>\n\u003cp>Wenkart has advised school districts in the county that special education students must be vaccinated.\u003c/p>\n\u003cp>Other districts are planning for scenarios that could include providing special education services at home for unvaccinated students or meeting with the students in separate facilities at or near school grounds.\u003c/p>\n\u003cp>In the Sacramento City Unified School District, Terri Fox, lead district nurse, said one plan could be to refuse to admit an unvaccinated special education student who requires only an hour or two a week of speech therapy, for instance, and instead provide services to the student offsite. The student would be home-schooled for the remainder of his or her instruction.\u003c/p>\n\u003cp>But unvaccinated students who require extensive academic, behavioral and therapeutic assistance all day in a special education classroom “will probably have to be admitted,” Fox said.\u003c/p>\n\u003cp>In the Long Beach Unified School District, Joyce Cox, program specialist for student health services, said a formal policy has not been adopted. But one idea might be to offer temporary home instruction for students in special education, she said. “That is a way you could still deliver services to the child, and still comply with the state law -- but that decision has not been made,” she said.\u003c/p>\n\u003cp>Gail Williams, director of health services at Fresno Unified, said she will meet with parents of special education students to encourage them to vaccinate their children. If that fails, the path is not clear, she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Opponents of a \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\" rel=\"noopener\">new California law\u003c/a> that will allow terminally ill patients to legally end their own lives say they did not collect enough signatures to ask voters to repeal the law.\u003c/p>\n\u003cp>The group Seniors Against Suicide had hoped to take the right-to-die question to California voters in November. Proponents needed to submit nearly 366,000 signatures by Monday to qualify for the ballot.\u003c/p>\n\u003cp>But backer Mark Hoffman says in an email to supporters that the group does not have enough signatures to qualify.\u003c/p>\n\u003cp>[contextly_sidebar id=”Lsbqe97gfMpXGFZFjLqQ37PGHO1BEBOl”]Right-to-die was among the most hotly contested issues last year. The legislative debate followed the case of Brittany Maynard, a terminally ill 29-year-old who moved to Oregon from California to take her own life. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/03/25/posthumous-brittany-maynard-video-supports-calif-death-with-dignity-bill/\" target=\"_blank\" rel=\"noopener\">In a video aired posthumously\u003c/a>, Maynard called for California lawmakers to legalize the option.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\" rel=\"noopener\">Under the law\u003c/a>, two doctors must determine that a patient has six months or less to live. The patient must request the life-ending medications and be physically able to swallow the drugs. Patients must be mentally competent to make the decision and reaffirm the decision in writing within 48 hours of taking the medication.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is the fifth state to legalize “aid in dying,” along with Oregon, Washington, Montana and Vermont. The law cannot take effect until California’s special session on health care ends.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Opponents of a \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\" rel=\"noopener\">new California law\u003c/a> that will allow terminally ill patients to legally end their own lives say they did not collect enough signatures to ask voters to repeal the law.\u003c/p>\n\u003cp>The group Seniors Against Suicide had hoped to take the right-to-die question to California voters in November. Proponents needed to submit nearly 366,000 signatures by Monday to qualify for the ballot.\u003c/p>\n\u003cp>But backer Mark Hoffman says in an email to supporters that the group does not have enough signatures to qualify.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Right-to-die was among the most hotly contested issues last year. The legislative debate followed the case of Brittany Maynard, a terminally ill 29-year-old who moved to Oregon from California to take her own life. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/03/25/posthumous-brittany-maynard-video-supports-calif-death-with-dignity-bill/\" target=\"_blank\" rel=\"noopener\">In a video aired posthumously\u003c/a>, Maynard called for California lawmakers to legalize the option.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\" rel=\"noopener\">Under the law\u003c/a>, two doctors must determine that a patient has six months or less to live. The patient must request the life-ending medications and be physically able to swallow the drugs. Patients must be mentally competent to make the decision and reaffirm the decision in writing within 48 hours of taking the medication.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>California is preparing to launch an ambitious plan to reduce C-sections rates. If successful, that reduction will save taxpayer money and keep both mothers and babies healthier.\u003c/p>\n\u003cp>Kicking off in early 2016, \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20ReducingCSectionsFlier.pdf\" target=\"_blank\">the plan\u003c/a> funded by the Oakland-based California HealthCare Foundation is meant to financially reward hospitals for vaginal births and reduce the pressure on doctors and laboring mothers to deliver quickly.\u003c/p>\n\u003cp>Last year, amid increasing attention to maternal care by health advocates, CHCF released \u003ca href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">an alarming report\u003c/a>. A healthy pregnant woman's chances of giving birth by C-section are uncomfortably dependent upon where she delivers her baby.\u003c/p>\n\u003cp>Overall, just over 27 percent of healthy women in California deliver their babies by C-section. But that's an average. At hospitals across the state, the C-section rate ranges from 10 to a whopping 70 percent.\u003c/p>\n\u003cp>That’s a problem because C-sections are \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/cmqcc-publications/white-paper-cesarean-deliveries\" target=\"_blank\">major surgeries that carry risks\u003c/a> of infection, uncontrolled bleeding, blood transfusions, blood clots, and postpartum depression. They’re also correlated with a lower breastfeeding rate, which is detrimental both to mother and baby.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It doesn't have to be this way. Other developed countries have far lower C-section rates. Only about one in five —or 20 percent—of Finnish, French and Swedish babies are born this way.\u003c/p>\n\u003cp>Earlier this year the World Health Organization \u003ca href=\"http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/\" target=\"_blank\">released a statement\u003c/a> saying the \"ideal rate\" for C-sections is between 10 and 15 percent, about half the average rate in California. While C-sections can save lives both for mothers and babies, that's only true up to a point. The WHO says globally the number of maternal and newborn deaths go down as C-section rates rise towards 10 percent. After that, there is no improvement.\u003c/p>\n\u003cp>Beyond being risky, C-sections — the \u003ca href=\"http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm\" target=\"_blank\">most commonly performed \u003c/a>surgery in the U.S. — are expensive, about $15,000-$20,000 per birth. Both nationally and in California, Medicaid pays for roughly half of all births.\u003c/p>\n\u003cp>Policymakers see lowering the C-section rates as wins both for patient health and state coffers. The U.S. government has set a national target of 23.9 percent as part of its \u003ca href=\"http://www.healthypeople.gov/2020/topics-objectives/objective/mich-71\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. To meet that benchmark, 60 percent of California hospitals need to reduce their C-section rates.\u003c/p>\n\u003cp>\u003cstrong>One route: Using Nurse Midwives \u003c/strong>\u003c/p>\n\u003cp>If any woman has tried hard to have a vaginal birth, it has been Edwina Brown. Brown moved to California from the U.K. with her husband last year. The couple was expecting their first child, who was born last September.\u003c/p>\n\u003cp>For several months she saw an obstetrician. She chose to switch to nurse midwives. The preference was partially cultural, she says. In her native England midwives attend 80 percent of all births. In the U.S. they are present for just 8 percent.\u003c/p>\n\u003cp>\"At the obstetrician's I felt that there was less room for questions and discussion about the testing they were doing, and how the birth would be,\" says Brown from her home in Petaluma, cradling Lily in her arms.\u003c/p>\n\u003cp>\"With the midwives, I felt it was much more supportive. They wanted to listen and understand what you wanted and---while keeping baby and mum safe---find a way to respect your wishes.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"WPmIYP70LrUKZEjJkcHPyr8TEsXjYxw6\"]Brown delivered at Marin General Hospital, where, several years ago, the hospital changed staffing protocols in an effort to reduce C-sections. (The change was independent of any direction from CHCF.)\u003c/p>\n\u003cp>Years of data had shown two populations of women within in the hospital consistently maintained significantly different C-section rates. Privately insured women averaged 32 percent, while publicly insured women averaged only 16. A similar discrepancy is seen in many other hospitals.\u003c/p>\n\u003cp>Nurse midwives provided most of the care for publicly-insured women. A 24-hour laborist -- a doctor who specializes in delivering babies -- was always on hand to operate or give assistance if needed. Privately insured women followed the more traditional U.S model. Their private physicians would leave busy practices and lives to deliver at the hospital when the baby was expected.\u003c/p>\n\u003cp>In 2011 the hospital revamped its staffing so that all expecting mothers would have access to 24-hour midwives and a 24-hour laborist. The change caught the attention of Melissa Rosenstein with UC, San Francisco's Center for Reproductive Science.\u003c/p>\n\u003cp>\"Laborists are becoming more popular, but there isn’t a ton of data on what the outcomes are,\" she says. \"And it's the same with midwives. There is plenty of data about how safe and effective midwifery is, but not as much as research on what the effect is on cesarean delivery rates, so we thought this would be an excellent natural experiment since this practice change was going to happen.\"\u003c/p>\n\u003cp>In a study published last September in \u003ca href=\"http://journals.lww.com/greenjournal/Fulltext/2015/10000/The_Association_of_Expanded_Access_to_a.5.aspx\" target=\"_blank\">Obstetrics & Gynecology\u003c/a>, Rosenstein and her colleagues reported a significant drop in privately insured women's C-section rates -- from 31.7 to 25 percent -- between 2011 and 2014.\u003c/p>\n\u003cp>\"It was our working hypothesis that we would see a decrease,\" she says, \"but it was more dramatic than we expected.\"\u003c/p>\n\u003cp>Though every C-section seems necessary in the moment, Rosenstein says, \"the truth is there are very few indications that a woman really needs one, there is usually a little wiggle room.\" If physicians work on labor and delivery exclusively, then they can be \"a little bit more patient,\" she added, and wait for a vaginal delivery.\u003c/p>\n\u003cp>Sherri Matteo, one of the certified nurse midwives at Marin General Hospital, says women and doctors don't always know what women are capable of.\u003c/p>\n\u003cp>\"Even when they think, 'Oh! You’re going to have a 12-pound baby? You can’t possibly have this baby vaginally.' I can tell you from experience that some women can. Until you allow a trial of labor, and allow a woman’s body to do what it’s supposed to do, we don’t know for sure.\"\u003c/p>\n\u003cp>There are clear exceptions. When a baby is in a breech position -- when the bottom or feet, rather than the head, will be the first to come out -- is not supported for vaginal delivery by most U.S. doctors and hospitals.\u003c/p>\n\u003cp>That's what happened to Brown's baby and she was desperate for the baby to turn head down.\u003c/p>\n\u003cp>\"I didn’t want a cesarean but I knew it was a possibility from week 32,\" she says. Brown had bad dreams about waking up on an operating table, but says her relationship with hospital staff helped allay her anxiety. In the end she did have a C-section -- efforts to manually turn Lily in the hospital prior to delivery weren't successful -- but she feels the birth was a better experience than it would have been if led by a physician.\u003c/p>\n\u003cp>\"I felt so supported the entire time,\" Brown says.\u003c/p>\n\u003cp>\u003cstrong>Carrots and Sticks\u003c/strong>\u003c/p>\n\u003cp>Hospitals don't have to embrace the nurse midwife model to reduce their C-section rates, however. In fact, with so few midwives and midwife training programs in California, there would not be enough to meet the needs of the state, says Stephanie Teleki, who is overseeing the CHCF effort to reduce c-sections.\u003c/p>\n\u003cp>\"You need to pull a lot of different levers to make these changes,\" she says. \"Nurse midwives could be part of the long-term solution, but in the short-term we'll need to be creative about how to get this done.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"Y9SYFgtQLgVTVLaiPzqUNatniraxX0gv\"]Hoag Memorial Hospital Presbyterian in Orange County, under pressure from large employers and groups like the Pacific Business Group on Health, \u003ca href=\"http://pbgh.org/storage/documents/TMC_Case_Study_Oct_2015.pdf\" target=\"_blank\">reduced C-section rates by 20 percent \u003c/a>over 15 months through a suite of measures, some carrots, some sticks. Administrators shared the C-section rates of individual doctors. Large insurance buyers like Disney and Blue Shield altered payments so that hospitals didn't earn more from elective C-sections than from vaginal births. And nurses received end-of-the-year bonuses if they helped the hospital reach its goals. Hoag became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/10/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry/\" target=\"_blank\"> a test case for measures\u003c/a> that will be taken around the state, under the CHCF's initiative.\u003c/p>\n\u003cp>One key aspect of the CHCF's plan is to fund a \"\u003ca href=\"https://www.cmqcc.org/projects/support-vaginal-birth-and-reduce-primary-cesarean-delivery)\" target=\"_blank\">toolkit\u003c/a>,\" prepared by the California Maternal Quality Care Collaborative, a nonprofit group comprised of several dozen public and private agencies and funded by CHCF and the Centers for Disease Control, among others. It's due out in March 2016. The California HealthCare Foundation is also funding medical professionals to assist about 60 hospitals in implementing the guidelines.\u003c/p>\n\u003cp>Teleki says they're particularly interested in reaching hospitals in Los Angeles, San Diego and Orange counties. \"(T)hat is where the birth rate is the highest and C-section rates are also very high,\" she says. \"If we double down in some of those markets it's a real opportunity to not only impact those areas but to move the needle statewide.\"\u003c/p>\n\u003cp>In what will perhaps be the most impactful step, the foundation plans to work with groups of health care purchasers to make C-sections less profitable.\u003c/p>\n\u003cp>This could mean the wider use of \"bundled payments,\" where hospitals are paid a per-birth rate, instead of being paid a higher rate for C-sections, as they are now. At a flat rate, hospitals should preferentially slant toward vaginal births.\u003c/p>\n\u003cp>Ultimately, says Teleki, it will be critical to financially reward providers for promoting vaginal birth.\u003c/p>\n\u003cp>\"There might be some do-gooders right now,\" she says. \"But if hospitals earn more money to do C-sections, it's hard to then say, 'Now please lower your c-sections.'\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>\u003cem>This post was updated to clarify the range of C-section rates at California hospitals. The rates at individual hospitals range from 10 to 70 percent.\u003c/em>\u003c/strong>\u003c/p>\n\n",
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"excerpt": "California's C-section rate is twice as high as recommended. A statewide effort to reduce it could improve health of mothers and babies.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California is preparing to launch an ambitious plan to reduce C-sections rates. If successful, that reduction will save taxpayer money and keep both mothers and babies healthier.\u003c/p>\n\u003cp>Kicking off in early 2016, \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20ReducingCSectionsFlier.pdf\" target=\"_blank\">the plan\u003c/a> funded by the Oakland-based California HealthCare Foundation is meant to financially reward hospitals for vaginal births and reduce the pressure on doctors and laboring mothers to deliver quickly.\u003c/p>\n\u003cp>Last year, amid increasing attention to maternal care by health advocates, CHCF released \u003ca href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">an alarming report\u003c/a>. A healthy pregnant woman's chances of giving birth by C-section are uncomfortably dependent upon where she delivers her baby.\u003c/p>\n\u003cp>Overall, just over 27 percent of healthy women in California deliver their babies by C-section. But that's an average. At hospitals across the state, the C-section rate ranges from 10 to a whopping 70 percent.\u003c/p>\n\u003cp>That’s a problem because C-sections are \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/cmqcc-publications/white-paper-cesarean-deliveries\" target=\"_blank\">major surgeries that carry risks\u003c/a> of infection, uncontrolled bleeding, blood transfusions, blood clots, and postpartum depression. They’re also correlated with a lower breastfeeding rate, which is detrimental both to mother and baby.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It doesn't have to be this way. Other developed countries have far lower C-section rates. Only about one in five —or 20 percent—of Finnish, French and Swedish babies are born this way.\u003c/p>\n\u003cp>Earlier this year the World Health Organization \u003ca href=\"http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/\" target=\"_blank\">released a statement\u003c/a> saying the \"ideal rate\" for C-sections is between 10 and 15 percent, about half the average rate in California. While C-sections can save lives both for mothers and babies, that's only true up to a point. The WHO says globally the number of maternal and newborn deaths go down as C-section rates rise towards 10 percent. After that, there is no improvement.\u003c/p>\n\u003cp>Beyond being risky, C-sections — the \u003ca href=\"http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm\" target=\"_blank\">most commonly performed \u003c/a>surgery in the U.S. — are expensive, about $15,000-$20,000 per birth. Both nationally and in California, Medicaid pays for roughly half of all births.\u003c/p>\n\u003cp>Policymakers see lowering the C-section rates as wins both for patient health and state coffers. The U.S. government has set a national target of 23.9 percent as part of its \u003ca href=\"http://www.healthypeople.gov/2020/topics-objectives/objective/mich-71\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. To meet that benchmark, 60 percent of California hospitals need to reduce their C-section rates.\u003c/p>\n\u003cp>\u003cstrong>One route: Using Nurse Midwives \u003c/strong>\u003c/p>\n\u003cp>If any woman has tried hard to have a vaginal birth, it has been Edwina Brown. Brown moved to California from the U.K. with her husband last year. The couple was expecting their first child, who was born last September.\u003c/p>\n\u003cp>For several months she saw an obstetrician. She chose to switch to nurse midwives. The preference was partially cultural, she says. In her native England midwives attend 80 percent of all births. In the U.S. they are present for just 8 percent.\u003c/p>\n\u003cp>\"At the obstetrician's I felt that there was less room for questions and discussion about the testing they were doing, and how the birth would be,\" says Brown from her home in Petaluma, cradling Lily in her arms.\u003c/p>\n\u003cp>\"With the midwives, I felt it was much more supportive. They wanted to listen and understand what you wanted and---while keeping baby and mum safe---find a way to respect your wishes.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Brown delivered at Marin General Hospital, where, several years ago, the hospital changed staffing protocols in an effort to reduce C-sections. (The change was independent of any direction from CHCF.)\u003c/p>\n\u003cp>Years of data had shown two populations of women within in the hospital consistently maintained significantly different C-section rates. Privately insured women averaged 32 percent, while publicly insured women averaged only 16. A similar discrepancy is seen in many other hospitals.\u003c/p>\n\u003cp>Nurse midwives provided most of the care for publicly-insured women. A 24-hour laborist -- a doctor who specializes in delivering babies -- was always on hand to operate or give assistance if needed. Privately insured women followed the more traditional U.S model. Their private physicians would leave busy practices and lives to deliver at the hospital when the baby was expected.\u003c/p>\n\u003cp>In 2011 the hospital revamped its staffing so that all expecting mothers would have access to 24-hour midwives and a 24-hour laborist. The change caught the attention of Melissa Rosenstein with UC, San Francisco's Center for Reproductive Science.\u003c/p>\n\u003cp>\"Laborists are becoming more popular, but there isn’t a ton of data on what the outcomes are,\" she says. \"And it's the same with midwives. There is plenty of data about how safe and effective midwifery is, but not as much as research on what the effect is on cesarean delivery rates, so we thought this would be an excellent natural experiment since this practice change was going to happen.\"\u003c/p>\n\u003cp>In a study published last September in \u003ca href=\"http://journals.lww.com/greenjournal/Fulltext/2015/10000/The_Association_of_Expanded_Access_to_a.5.aspx\" target=\"_blank\">Obstetrics & Gynecology\u003c/a>, Rosenstein and her colleagues reported a significant drop in privately insured women's C-section rates -- from 31.7 to 25 percent -- between 2011 and 2014.\u003c/p>\n\u003cp>\"It was our working hypothesis that we would see a decrease,\" she says, \"but it was more dramatic than we expected.\"\u003c/p>\n\u003cp>Though every C-section seems necessary in the moment, Rosenstein says, \"the truth is there are very few indications that a woman really needs one, there is usually a little wiggle room.\" If physicians work on labor and delivery exclusively, then they can be \"a little bit more patient,\" she added, and wait for a vaginal delivery.\u003c/p>\n\u003cp>Sherri Matteo, one of the certified nurse midwives at Marin General Hospital, says women and doctors don't always know what women are capable of.\u003c/p>\n\u003cp>\"Even when they think, 'Oh! You’re going to have a 12-pound baby? You can’t possibly have this baby vaginally.' I can tell you from experience that some women can. Until you allow a trial of labor, and allow a woman’s body to do what it’s supposed to do, we don’t know for sure.\"\u003c/p>\n\u003cp>There are clear exceptions. When a baby is in a breech position -- when the bottom or feet, rather than the head, will be the first to come out -- is not supported for vaginal delivery by most U.S. doctors and hospitals.\u003c/p>\n\u003cp>That's what happened to Brown's baby and she was desperate for the baby to turn head down.\u003c/p>\n\u003cp>\"I didn’t want a cesarean but I knew it was a possibility from week 32,\" she says. Brown had bad dreams about waking up on an operating table, but says her relationship with hospital staff helped allay her anxiety. In the end she did have a C-section -- efforts to manually turn Lily in the hospital prior to delivery weren't successful -- but she feels the birth was a better experience than it would have been if led by a physician.\u003c/p>\n\u003cp>\"I felt so supported the entire time,\" Brown says.\u003c/p>\n\u003cp>\u003cstrong>Carrots and Sticks\u003c/strong>\u003c/p>\n\u003cp>Hospitals don't have to embrace the nurse midwife model to reduce their C-section rates, however. In fact, with so few midwives and midwife training programs in California, there would not be enough to meet the needs of the state, says Stephanie Teleki, who is overseeing the CHCF effort to reduce c-sections.\u003c/p>\n\u003cp>\"You need to pull a lot of different levers to make these changes,\" she says. \"Nurse midwives could be part of the long-term solution, but in the short-term we'll need to be creative about how to get this done.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Hoag Memorial Hospital Presbyterian in Orange County, under pressure from large employers and groups like the Pacific Business Group on Health, \u003ca href=\"http://pbgh.org/storage/documents/TMC_Case_Study_Oct_2015.pdf\" target=\"_blank\">reduced C-section rates by 20 percent \u003c/a>over 15 months through a suite of measures, some carrots, some sticks. Administrators shared the C-section rates of individual doctors. Large insurance buyers like Disney and Blue Shield altered payments so that hospitals didn't earn more from elective C-sections than from vaginal births. And nurses received end-of-the-year bonuses if they helped the hospital reach its goals. Hoag became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/10/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry/\" target=\"_blank\"> a test case for measures\u003c/a> that will be taken around the state, under the CHCF's initiative.\u003c/p>\n\u003cp>One key aspect of the CHCF's plan is to fund a \"\u003ca href=\"https://www.cmqcc.org/projects/support-vaginal-birth-and-reduce-primary-cesarean-delivery)\" target=\"_blank\">toolkit\u003c/a>,\" prepared by the California Maternal Quality Care Collaborative, a nonprofit group comprised of several dozen public and private agencies and funded by CHCF and the Centers for Disease Control, among others. It's due out in March 2016. The California HealthCare Foundation is also funding medical professionals to assist about 60 hospitals in implementing the guidelines.\u003c/p>\n\u003cp>Teleki says they're particularly interested in reaching hospitals in Los Angeles, San Diego and Orange counties. \"(T)hat is where the birth rate is the highest and C-section rates are also very high,\" she says. \"If we double down in some of those markets it's a real opportunity to not only impact those areas but to move the needle statewide.\"\u003c/p>\n\u003cp>In what will perhaps be the most impactful step, the foundation plans to work with groups of health care purchasers to make C-sections less profitable.\u003c/p>\n\u003cp>This could mean the wider use of \"bundled payments,\" where hospitals are paid a per-birth rate, instead of being paid a higher rate for C-sections, as they are now. At a flat rate, hospitals should preferentially slant toward vaginal births.\u003c/p>\n\u003cp>Ultimately, says Teleki, it will be critical to financially reward providers for promoting vaginal birth.\u003c/p>\n\u003cp>\"There might be some do-gooders right now,\" she says. \"But if hospitals earn more money to do C-sections, it's hard to then say, 'Now please lower your c-sections.'\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003cem>This post was updated to clarify the range of C-section rates at California hospitals. The rates at individual hospitals range from 10 to 70 percent.\u003c/em>\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hospitals Now Required to Keep Caregivers Informed",
"title": "Hospitals Now Required to Keep Caregivers Informed",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Diana Matsushima cares for both her husband and sister-in-law full-time, giving them their medications and driving them to their doctor appointments.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new state law ensures caregivers have the information they need to take care of a patient at home.\u003c/aside>\n\u003cp>But when either ends up hospitalized, Matsushima said her role as their primary caregiver is often overlooked. She isn’t always included in the discussions at the hospital, and she sometimes leaves confused about how to best care for them when she gets home. When they are discharged, she said the nurses hand her a stack of papers without much -- if any -- explanation.\u003c/p>\n\u003cp>“They print out these cryptic notes,” said Matsushima. “My background is health education and I don’t know what these things mean to me and my family.”\u003c/p>\n\u003cp>Beginning Jan. 1, family caregivers like Matsushima could have a much different experience. A new California law, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">SB 675\u003c/a>, requires hospital staffers to involve a family caregiver during the hospitalization and discharge process, which supporters say will improve patients’ overall health and reduce their chances of readmission.\u003c/p>\n\u003cp>The law, sponsored by state Sen. Carol Liu, D-La Cañada Flintridge, mandates that hospitals give patients an opportunity to identify a caregiver, notify that caregiver when the patient is to be discharged and provide information and instruction on patient’s needs and medications following the hospitalization. Hospitals still must follow privacy laws and aren’t required to release information if the patient doesn’t give consent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California is among 18 states to pass such laws over the past two years, including Arkansas, New Hampshire, Oregon and Virginia. It’s part of a growing awareness among policymakers and legislators that family caregivers play an important role during and after a relative’s hospitalization.\u003c/p>\n\u003cp>How hospitals communicate with caregivers is expected to become more important as the population ages and the number of unpaid family caregivers continues to increase. An estimated 40 million Americans have cared for a relative in the past year, according to a 2015 study by the National Alliance for Caregiving and AARP.\u003c/p>\n\u003cp>The changes are largely being driven by AARP, which is leading a campaign to reduce barriers for family caregivers. The impetus comes from the organization’s 2012 survey, which found that 46 percent of caregivers perform medical tasks, such as giving injections, most without any training or guidance from medical professionals. AARP crafted model legislation known as the Caregiver Advise, Record, Enable, or CARE Act, and is promoting it around the nation.\u003c/p>\n\u003cfigure id=\"attachment_132363\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-132363 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/Matsushima-3-400x267.jpg\" alt=\"Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister who has had two major operations in the last few years.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister-in-law who has had two major operations in the last year. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Elaine Ryan, AARP’s vice president of state advocacy and strategy, said the legislation is designed to improve caregivers’ competency and give them peace of mind.\u003c/p>\n\u003cp>“A piece of paper can’t really educate people how to fill a syringe or clean a PICC line,” Ryan said, referring to a catheter inserted into a vein in a patient’s arm. The laws “make sure that family caregivers have all the information they need to safely care for their loved one at home.”\u003c/p>\n\u003cp>Matsushima said she has struggled to get that sort of information since 2009, when her husband had a stroke and she became a caregiver. During one hospital visit, she had to demand that nurses instruct her how to remove her husband’s catheter.\u003c/p>\n\u003cp>Over the past year, she has also helped her sister-in-law through two surgeries and two lengthy hospital stays. The first time her sister-in-law was discharged, Matsushima said she got very little notice or guidance. Two days later, her sister-in-law fell while getting out of bed and ended up back in the hospital.\u003c/p>\n\u003cp>Matsushima said she feels “fed up with hospitals” and hopes the new law will make things better for her and other caregivers.\u003c/p>\n\u003cp>Around the country, however, some hospital associations say their members already include caregivers in the discharge planning process and that adding specific requirements only adds more work. At the same time, hospitals face increased pressure from the Centers for Medicare & Medicaid Services to keep patients from being readmitted, and some recognize that improving communication with family caregivers can’t hurt.\u003c/p>\n\u003cp>In New Jersey, where a similar law passed last year, the state’s hospital association had some reservations but made a political decision to work with AARP to tailor their model legislation to the state, said Neil Eicher, vice president of government relations for the association. That meant making changes, including stripping out time requirements for notifying caregivers of discharge.\u003c/p>\n\u003cp>“We understand the importance of having good discharge planning,” he said. “We just didn’t want our hands tied to those time frames.”\u003c/p>\n\u003cp>Oklahoma also passed a caregiver law last year, and Sandra Harrison of the state’s hospital association said some members find it challenging to implement.\u003c/p>\n\u003cp>“You’ve now got a requirement to educate the caregiver,” she said. “But not everybody has a caregiver … And not all caregivers want to learn or carry out the instructions.”\u003c/p>\n\u003cp>Currently, hospital staff members often make incorrect assumptions about who the caregivers are or how much they know, said Donna Benton, associate research professor of gerontology at University of Southern California. They send people home without knowing whether food is in the house or someone to get patients’ medication or bring them to a follow-up appointment.\u003c/p>\n\u003cp>“This is a very important bill,” said Benton, co-director of the Los Angeles Caregiver Resource Center. “This really puts the pressure on the hospital to actually identify the caregiver and try to meet with them according to their schedule.”\u003c/p>\n\u003cp>Pamela Bingham, an engineer who lives in Virginia, said she quickly felt overwhelmed by everything she had to learn to care for her parents. Her father, who died earlier this year, had kidney disease, diabetes and high blood pressure. She still takes care of her mother, who is blind and has dementia and diabetes.\u003c/p>\n\u003cp>“It was like I was a nurse,” she said. “And it takes nurses years to learn this stuff.”\u003c/p>\n\u003cp>Bingham said she was relieved to see a law pass in Virginia earlier this year so caregivers can get more guidance. She said doctors and nurses are focused on treating patients while they are at the hospital – not on what happens after they and their caregivers leave.\u003c/p>\n\u003cp>“Bills like this are important,” she said. “They force the hospitals to really focus on the discharge process.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was reported while participating in a fellowship supported by New America Media, the Gerontological Society of America and The Commonwealth Fund.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Diana Matsushima cares for both her husband and sister-in-law full-time, giving them their medications and driving them to their doctor appointments.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new state law ensures caregivers have the information they need to take care of a patient at home.\u003c/aside>\n\u003cp>But when either ends up hospitalized, Matsushima said her role as their primary caregiver is often overlooked. She isn’t always included in the discussions at the hospital, and she sometimes leaves confused about how to best care for them when she gets home. When they are discharged, she said the nurses hand her a stack of papers without much -- if any -- explanation.\u003c/p>\n\u003cp>“They print out these cryptic notes,” said Matsushima. “My background is health education and I don’t know what these things mean to me and my family.”\u003c/p>\n\u003cp>Beginning Jan. 1, family caregivers like Matsushima could have a much different experience. A new California law, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">SB 675\u003c/a>, requires hospital staffers to involve a family caregiver during the hospitalization and discharge process, which supporters say will improve patients’ overall health and reduce their chances of readmission.\u003c/p>\n\u003cp>The law, sponsored by state Sen. Carol Liu, D-La Cañada Flintridge, mandates that hospitals give patients an opportunity to identify a caregiver, notify that caregiver when the patient is to be discharged and provide information and instruction on patient’s needs and medications following the hospitalization. Hospitals still must follow privacy laws and aren’t required to release information if the patient doesn’t give consent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California is among 18 states to pass such laws over the past two years, including Arkansas, New Hampshire, Oregon and Virginia. It’s part of a growing awareness among policymakers and legislators that family caregivers play an important role during and after a relative’s hospitalization.\u003c/p>\n\u003cp>How hospitals communicate with caregivers is expected to become more important as the population ages and the number of unpaid family caregivers continues to increase. An estimated 40 million Americans have cared for a relative in the past year, according to a 2015 study by the National Alliance for Caregiving and AARP.\u003c/p>\n\u003cp>The changes are largely being driven by AARP, which is leading a campaign to reduce barriers for family caregivers. The impetus comes from the organization’s 2012 survey, which found that 46 percent of caregivers perform medical tasks, such as giving injections, most without any training or guidance from medical professionals. AARP crafted model legislation known as the Caregiver Advise, Record, Enable, or CARE Act, and is promoting it around the nation.\u003c/p>\n\u003cfigure id=\"attachment_132363\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-132363 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/Matsushima-3-400x267.jpg\" alt=\"Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister who has had two major operations in the last few years.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Diana and Yoshi Matsushima at their home in Glendale. Diane is also a caregiver for her sister-in-law who has had two major operations in the last year. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Elaine Ryan, AARP’s vice president of state advocacy and strategy, said the legislation is designed to improve caregivers’ competency and give them peace of mind.\u003c/p>\n\u003cp>“A piece of paper can’t really educate people how to fill a syringe or clean a PICC line,” Ryan said, referring to a catheter inserted into a vein in a patient’s arm. The laws “make sure that family caregivers have all the information they need to safely care for their loved one at home.”\u003c/p>\n\u003cp>Matsushima said she has struggled to get that sort of information since 2009, when her husband had a stroke and she became a caregiver. During one hospital visit, she had to demand that nurses instruct her how to remove her husband’s catheter.\u003c/p>\n\u003cp>Over the past year, she has also helped her sister-in-law through two surgeries and two lengthy hospital stays. The first time her sister-in-law was discharged, Matsushima said she got very little notice or guidance. Two days later, her sister-in-law fell while getting out of bed and ended up back in the hospital.\u003c/p>\n\u003cp>Matsushima said she feels “fed up with hospitals” and hopes the new law will make things better for her and other caregivers.\u003c/p>\n\u003cp>Around the country, however, some hospital associations say their members already include caregivers in the discharge planning process and that adding specific requirements only adds more work. At the same time, hospitals face increased pressure from the Centers for Medicare & Medicaid Services to keep patients from being readmitted, and some recognize that improving communication with family caregivers can’t hurt.\u003c/p>\n\u003cp>In New Jersey, where a similar law passed last year, the state’s hospital association had some reservations but made a political decision to work with AARP to tailor their model legislation to the state, said Neil Eicher, vice president of government relations for the association. That meant making changes, including stripping out time requirements for notifying caregivers of discharge.\u003c/p>\n\u003cp>“We understand the importance of having good discharge planning,” he said. “We just didn’t want our hands tied to those time frames.”\u003c/p>\n\u003cp>Oklahoma also passed a caregiver law last year, and Sandra Harrison of the state’s hospital association said some members find it challenging to implement.\u003c/p>\n\u003cp>“You’ve now got a requirement to educate the caregiver,” she said. “But not everybody has a caregiver … And not all caregivers want to learn or carry out the instructions.”\u003c/p>\n\u003cp>Currently, hospital staff members often make incorrect assumptions about who the caregivers are or how much they know, said Donna Benton, associate research professor of gerontology at University of Southern California. They send people home without knowing whether food is in the house or someone to get patients’ medication or bring them to a follow-up appointment.\u003c/p>\n\u003cp>“This is a very important bill,” said Benton, co-director of the Los Angeles Caregiver Resource Center. “This really puts the pressure on the hospital to actually identify the caregiver and try to meet with them according to their schedule.”\u003c/p>\n\u003cp>Pamela Bingham, an engineer who lives in Virginia, said she quickly felt overwhelmed by everything she had to learn to care for her parents. Her father, who died earlier this year, had kidney disease, diabetes and high blood pressure. She still takes care of her mother, who is blind and has dementia and diabetes.\u003c/p>\n\u003cp>“It was like I was a nurse,” she said. “And it takes nurses years to learn this stuff.”\u003c/p>\n\u003cp>Bingham said she was relieved to see a law pass in Virginia earlier this year so caregivers can get more guidance. She said doctors and nurses are focused on treating patients while they are at the hospital – not on what happens after they and their caregivers leave.\u003c/p>\n\u003cp>“Bills like this are important,” she said. “They force the hospitals to really focus on the discharge process.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "New California Database to Help Doctors Spot Prescription Drug Abuse",
"title": "New California Database to Help Doctors Spot Prescription Drug Abuse",
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"content": "\u003cp>Long plagued by technical problems, the state’s prescription drug database has finally been overhauled. State officials will fully launch the new system Friday, Jan. 8, when all doctors will be automatically upgraded to the new system.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We had a single patient go to 116 prescribers over four years, and got 45,000 dosage units of controlled substances worth at least $850,000 on the street.'\u003ccite> Virginia Herold, state Board of Pharmacy \u003c/cite>\u003c/aside>\n\u003cp>Health officials now refer to prescription drug addiction as an epidemic. More Americans die from \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">prescription opioid overdose \u003c/a>than in \u003ca href=\"http://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html\" target=\"_blank\">drunken-driving car crashes,\u003c/a> according to data from the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>California regulators have been preoccupied for years with doctor shoppers.\u003c/p>\n\u003cp>“We had a single patient go to 116 prescribers over four years, and went to 58 pharmacies and got 45,000 dosage units of controlled substances worth at least $850,000 on the street,” said Virginia Herold, executive officer of the state Board of Pharmacy.\u003c/p>\n\u003cp>Pharmacists are required to report all drugs they dispense in the state’s prescription drug database, known as the Controlled Substance Utilization Review and Evaluation System, or CURES.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But neither pharmacists nor doctors are required to check the database before dispensing or writing new prescriptions.\u003c/p>\n\u003cp>\"If any of those 58 pharmacies or 116 practitioners would have checked, they would have seen that the patient in front of them, that may have only been in there once every 30 days, was actually going to other places and to multiple prescribers to get the medication,\" Herold said.\u003c/p>\n\u003cp>Pharmacists and doctors have complained for years that the reason they don’t use the system is because of a long history of technical glitches. In the past, for example, doctors had to submit paper registration materials to the Department of Justice just to get a login and password, a process that took as long as six months for some doctors.\u003c/p>\n\u003cp>“There’s been a huge backlog at the DOJ,” said Molly Weedn, spokeswoman for the California Medical Association. “People want it to be a usable system, but in the past few years, it’s been severely understaffed and underfunded.”\u003c/p>\n\u003cp>Funding for the database was slashed in 2009 when the economic recession hit, leaving the technical problems to linger. \u003ca href=\"http://audio.californiareport.org/archive/R201202140850/a\" target=\"_blank\">More cuts followed in 2012\u003c/a>.\u003c/p>\n\u003cp>In 2013, the state Legislature passed SB809, which charged doctors a $6 annual fee when renewing their medical license to provide funds for database improvements. The state slowly began rolling out CURES 2.0 this past summer, and after fixing a Web browser compatibility problem, will do so universally in the new year.\u003c/p>\n\u003cp>“The new system is more user-friendly,” said Deputy Attorney General Robert Sumner, who oversees IT projects for the Department of Justice. “It’s faster, it’s more responsive, it’s more intuitive.”\u003c/p>\n\u003cp>It also allows doctors to delegate searches to nurses, so a nurse can cue up a patient’s prescription drug record for the doctor prior to a consultation, and includes a number of patient alerts.\u003c/p>\n\u003cp>\"Physicians will automatically be told if, based on their prescription history, the algorithm has picked up that the patient might be at risk for doctor shopping,” Sumner said. “Whether or not you’ve gone to a number of different prescribers, whether or not you’ve been given a number of different prescriptions in volumes, and also the frequency at which you’ve been receiving prescriptions.”\u003c/p>\n\u003cp>Despite the improvements, safety advocate Bob Pack is still not satisfied. He says the only way the database will really work is if doctors are required to use it.\u003c/p>\n\u003cp>“I’ve been disappointed all along,” he said. “I’ve always believed it needed to be a mandatory requirement.”\u003c/p>\n\u003cp>In 2003, Pack’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/30/prop-46-was-inspired-by-tragic-accident-pits-doctors-against-lawyers/\" target=\"_blank\">two children were killed by a driver \u003c/a>who was high on prescription drugs, which she had obtained from multiple doctors. Ever since, Pack has pushed for redevelopment of the database, convincing his local representatives to write various bills, including SB809, which provided the funding to update the database, and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/13/should-california-doctors-be-required-to-use-drug-monitoring-database/\" target=\"_blank\">a pending bill\u003c/a>, SB482, which would require doctors to consult a patient’s medical history before prescribing narcotics for the first time.\u003c/p>\n\u003cp>“I wanted this thing to be mandatory for the last nine years,” Pack said. “But the medical lobby keeps fighting this.”\u003c/p>\n\u003cp>The California Medical Association says it will wait to see how well the new system works before agreeing to any requirements.\u003c/p>\n\u003cp>“Before we make the system mandatory, let’s make sure it’s functional,” said Weedn.\u003c/p>\n\u003cp>While 49 states have a prescription drug database in one form or another, only about 10 states require doctors and pharmacists to check it before writing new prescriptions, including Kentucky and New York. Some studies show that the number of narcotic prescriptions written in those states went down after the mandate, and enrollment in addiction treatment went up, though it is unclear if some drug abusers may have turned to street drugs instead.\u003c/p>\n\u003cp>Congressman Mark DeSaulnier, D-California, who authored SB809 when he was a state assemblyman representing Walnut Creek, says he wants to bring some of these reforms to the national level, starting with incentivizing states to upgrade their systems.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>These can be wonderful drugs,” he said, “but they're disastrous if not used right.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Long plagued by technical problems, the state’s prescription drug database has finally been overhauled. State officials will fully launch the new system Friday, Jan. 8, when all doctors will be automatically upgraded to the new system.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We had a single patient go to 116 prescribers over four years, and got 45,000 dosage units of controlled substances worth at least $850,000 on the street.'\u003ccite> Virginia Herold, state Board of Pharmacy \u003c/cite>\u003c/aside>\n\u003cp>Health officials now refer to prescription drug addiction as an epidemic. More Americans die from \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">prescription opioid overdose \u003c/a>than in \u003ca href=\"http://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html\" target=\"_blank\">drunken-driving car crashes,\u003c/a> according to data from the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>California regulators have been preoccupied for years with doctor shoppers.\u003c/p>\n\u003cp>“We had a single patient go to 116 prescribers over four years, and went to 58 pharmacies and got 45,000 dosage units of controlled substances worth at least $850,000 on the street,” said Virginia Herold, executive officer of the state Board of Pharmacy.\u003c/p>\n\u003cp>Pharmacists are required to report all drugs they dispense in the state’s prescription drug database, known as the Controlled Substance Utilization Review and Evaluation System, or CURES.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But neither pharmacists nor doctors are required to check the database before dispensing or writing new prescriptions.\u003c/p>\n\u003cp>\"If any of those 58 pharmacies or 116 practitioners would have checked, they would have seen that the patient in front of them, that may have only been in there once every 30 days, was actually going to other places and to multiple prescribers to get the medication,\" Herold said.\u003c/p>\n\u003cp>Pharmacists and doctors have complained for years that the reason they don’t use the system is because of a long history of technical glitches. In the past, for example, doctors had to submit paper registration materials to the Department of Justice just to get a login and password, a process that took as long as six months for some doctors.\u003c/p>\n\u003cp>“There’s been a huge backlog at the DOJ,” said Molly Weedn, spokeswoman for the California Medical Association. “People want it to be a usable system, but in the past few years, it’s been severely understaffed and underfunded.”\u003c/p>\n\u003cp>Funding for the database was slashed in 2009 when the economic recession hit, leaving the technical problems to linger. \u003ca href=\"http://audio.californiareport.org/archive/R201202140850/a\" target=\"_blank\">More cuts followed in 2012\u003c/a>.\u003c/p>\n\u003cp>In 2013, the state Legislature passed SB809, which charged doctors a $6 annual fee when renewing their medical license to provide funds for database improvements. The state slowly began rolling out CURES 2.0 this past summer, and after fixing a Web browser compatibility problem, will do so universally in the new year.\u003c/p>\n\u003cp>“The new system is more user-friendly,” said Deputy Attorney General Robert Sumner, who oversees IT projects for the Department of Justice. “It’s faster, it’s more responsive, it’s more intuitive.”\u003c/p>\n\u003cp>It also allows doctors to delegate searches to nurses, so a nurse can cue up a patient’s prescription drug record for the doctor prior to a consultation, and includes a number of patient alerts.\u003c/p>\n\u003cp>\"Physicians will automatically be told if, based on their prescription history, the algorithm has picked up that the patient might be at risk for doctor shopping,” Sumner said. “Whether or not you’ve gone to a number of different prescribers, whether or not you’ve been given a number of different prescriptions in volumes, and also the frequency at which you’ve been receiving prescriptions.”\u003c/p>\n\u003cp>Despite the improvements, safety advocate Bob Pack is still not satisfied. He says the only way the database will really work is if doctors are required to use it.\u003c/p>\n\u003cp>“I’ve been disappointed all along,” he said. “I’ve always believed it needed to be a mandatory requirement.”\u003c/p>\n\u003cp>In 2003, Pack’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/09/30/prop-46-was-inspired-by-tragic-accident-pits-doctors-against-lawyers/\" target=\"_blank\">two children were killed by a driver \u003c/a>who was high on prescription drugs, which she had obtained from multiple doctors. Ever since, Pack has pushed for redevelopment of the database, convincing his local representatives to write various bills, including SB809, which provided the funding to update the database, and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/13/should-california-doctors-be-required-to-use-drug-monitoring-database/\" target=\"_blank\">a pending bill\u003c/a>, SB482, which would require doctors to consult a patient’s medical history before prescribing narcotics for the first time.\u003c/p>\n\u003cp>“I wanted this thing to be mandatory for the last nine years,” Pack said. “But the medical lobby keeps fighting this.”\u003c/p>\n\u003cp>The California Medical Association says it will wait to see how well the new system works before agreeing to any requirements.\u003c/p>\n\u003cp>“Before we make the system mandatory, let’s make sure it’s functional,” said Weedn.\u003c/p>\n\u003cp>While 49 states have a prescription drug database in one form or another, only about 10 states require doctors and pharmacists to check it before writing new prescriptions, including Kentucky and New York. Some studies show that the number of narcotic prescriptions written in those states went down after the mandate, and enrollment in addiction treatment went up, though it is unclear if some drug abusers may have turned to street drugs instead.\u003c/p>\n\u003cp>Congressman Mark DeSaulnier, D-California, who authored SB809 when he was a state assemblyman representing Walnut Creek, says he wants to bring some of these reforms to the national level, starting with incentivizing states to upgrade their systems.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>These can be wonderful drugs,” he said, “but they're disastrous if not used right.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The new year arrives Friday, and with it a host of new state laws.\u003c/p>\n\u003cp>Here's our roundup of new ones coming in health. Most take effect on Friday, except where noted:\u003c/p>\n\u003cp>\u003cstrong>Vaccines: \u003c/strong>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a> was perhaps the most vehemently debated bill in Sacramento in a long time. Sen. Richard Pan (D-Sacramento) introduced the bill just weeks after a measles outbreak tied to Disneyland. The law requires that all children be fully vaccinated to attend school -- both public and private -- unless they have a medical exemption. The law takes effect July 1, in advance of the 2016-2017 school year.\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB792\" target=\"_blank\"> A second law\u003c/a> related to vaccines requires all child-care workers to be vaccinated against measles, pertussis and influenza.\u003c/p>\n\u003cp>\u003cstrong>Physician-Assisted Suicide\u003c/strong>: Gov. Jerry Brown signed the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act \u003c/a>into law with\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\"> an unusually personal comment.\u003c/a> The law permits physicians to prescribe lethal medication to terminally ill patients who request it. There is no firm date for the law to go into effect because it was passed as part of an ongoing special legislative session that was called by the governor to address health care financing. It won't take effect until 90 days after the session ends. California became the fifth state to allow the practice, along with Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal for Undocumented Children\u003c/strong>: California became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\"> the first state in the country\u003c/a> to extend state-subsidized health coverage to children who are living in the United States illegally. An estimated 170,000 children under age 19 will become eligible for Medi-Cal, the state's health insurance problem for people who are low income, when \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB4\" target=\"_blank\">the law\u003c/a> goes into effect on May 1. (Legislators are expected to consider \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB10,\u003c/a> which would extend Medi-Cal to adults, in 2016 as well.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Reproductive Services Notification\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB775\" target=\"_blank\">The new law\u003c/a> covers required notifications at two types of facilities. Unlicensed facilities now will be required to notify clients that they are not licensed as medical facilities by the state. Meanwhile, licensed medical facilities are required to notify clients that California has public programs that provide free or low-cost access to contraceptives, prenatal care and abortion services. The law was\u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\"> challenged by centers \u003c/a>that do not provide abortions. Just before Christmas, \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article51197235.html\" target=\"_blank\">a federal judge upheld the law\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Translation of Prescription Drug Information\u003c/strong>: Pharmacists are now required, upon request, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/10/calif-legislature-approves-bill-requiring-prescription-labels-in-5-foreign-languages/\" target=\"_blank\">to provide labels or medication information \u003c/a>in the five most common languages in California, after English: Spanish, Tagalog, Chinese, Vietnamese or Korean.\u003c/p>\n\u003cp>\u003cstrong>Hospitals and Caregivers\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">AB675\u003c/a> requires hospitals to include family caregivers in the hospitalization and discharge process. \u003ca href=\"http://newamericamedia.org/2015/12/california-latest-state-requiring-hospitals-to-keep-caregivers-in-the-loop.php\" target=\"_blank\">The goal \u003c/a>is to improve a patient's care and reduce the chance of readmission. California is one of 18 states to pass this type of law in the last two years.\u003c/p>\n\u003cp>\u003cstrong>CONSUMER PROTECTIONS:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Caps on Drug Copays\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339\" target=\"_blank\">This law\u003c/a> limits patient's cost-sharing on specialty drugs to $250 a month and prohibits placing most or all drugs used to treat a certain condition on the highest cost tier in drug formularies.\u003c/li>\n\u003cli>\u003cstrong>Accurate Provider Directories\u003c/strong>: Insurers now must maintain an accurate database of providers on a website -- and they must update that directory every week, under \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\">this new law. \u003c/a>The directories will include languages spoken by providers other than English.\u003c/li>\n\u003cli>\u003cstrong>Cost-sharing Limits in Family Plans\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1305\" target=\"_blank\">This law\u003c/a> brings California into line with federal regulations, that an individual patient faces the out-of-pocket maximum set by the Affordable Care Act (now $6,600) for an individual, even if they are in a family plan (which has a max of $13,200 at present).\u003c/li>\n\u003cli>\u003cstrong>Insurance offered by Large Employers\u003c/strong>: Large employers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB248\" target=\"_blank\">must now follow consumer protections \u003c/a>that ensure they do not offer so-called junk insurance that does not offer minimum value, as defined.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>LGBT HEALTH CARE:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Sperm Donation:\u003c/strong> \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB960\" target=\"_blank\">AB960 \u003c/a>was inspired by lesbian couples who want to have children. Many receive sperm donations from friends or relatives. This law says that the donor will not be viewed as the \"natural parent\" unless otherwise agreed to in writing prior to conception of the child.\u003c/li>\n\u003cli>\u003cstrong>Demographic Data Collection\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB959\" target=\"_blank\">This law requires\u003c/a> state departments overseeing health programs to collect voluntary information about sexual orientation and gender identity just as they collect race and ethnicity data.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>FOSTER CHILDREN\u003c/strong>:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Placements for Trans Children\u003c/strong>: Foster children \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB731\" target=\"_blank\">now have the right \u003c/a>to placements consistent with their gender identity.\u003c/li>\n\u003cli>\u003cstrong>Psychotropic Medications\u003c/strong>: Child welfare social workers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB238\" target=\"_blank\">will be better able \u003c/a>to oversee mental health treatments, including use of psychotropic medications, by foster children.\u003c/li>\n\u003cli>\u003cstrong>Foster Children Who Are Parents\u003c/strong>: This law \u003ca href=\"http://www.calyouthconn.org/assets/files/AB%20260%20Fact%20Sheet%20(4.1.15).pdf\" target=\"_blank\">provides support and protections\u003c/a> for foster children who are parents themselves.\u003c/li>\n\u003c/ul>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The new year arrives Friday, and with it a host of new state laws.\u003c/p>\n\u003cp>Here's our roundup of new ones coming in health. Most take effect on Friday, except where noted:\u003c/p>\n\u003cp>\u003cstrong>Vaccines: \u003c/strong>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a> was perhaps the most vehemently debated bill in Sacramento in a long time. Sen. Richard Pan (D-Sacramento) introduced the bill just weeks after a measles outbreak tied to Disneyland. The law requires that all children be fully vaccinated to attend school -- both public and private -- unless they have a medical exemption. The law takes effect July 1, in advance of the 2016-2017 school year.\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB792\" target=\"_blank\"> A second law\u003c/a> related to vaccines requires all child-care workers to be vaccinated against measles, pertussis and influenza.\u003c/p>\n\u003cp>\u003cstrong>Physician-Assisted Suicide\u003c/strong>: Gov. Jerry Brown signed the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act \u003c/a>into law with\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\"> an unusually personal comment.\u003c/a> The law permits physicians to prescribe lethal medication to terminally ill patients who request it. There is no firm date for the law to go into effect because it was passed as part of an ongoing special legislative session that was called by the governor to address health care financing. It won't take effect until 90 days after the session ends. California became the fifth state to allow the practice, along with Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal for Undocumented Children\u003c/strong>: California became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\"> the first state in the country\u003c/a> to extend state-subsidized health coverage to children who are living in the United States illegally. An estimated 170,000 children under age 19 will become eligible for Medi-Cal, the state's health insurance problem for people who are low income, when \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB4\" target=\"_blank\">the law\u003c/a> goes into effect on May 1. (Legislators are expected to consider \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB10,\u003c/a> which would extend Medi-Cal to adults, in 2016 as well.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Reproductive Services Notification\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB775\" target=\"_blank\">The new law\u003c/a> covers required notifications at two types of facilities. Unlicensed facilities now will be required to notify clients that they are not licensed as medical facilities by the state. Meanwhile, licensed medical facilities are required to notify clients that California has public programs that provide free or low-cost access to contraceptives, prenatal care and abortion services. The law was\u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\"> challenged by centers \u003c/a>that do not provide abortions. Just before Christmas, \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article51197235.html\" target=\"_blank\">a federal judge upheld the law\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Translation of Prescription Drug Information\u003c/strong>: Pharmacists are now required, upon request, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/10/calif-legislature-approves-bill-requiring-prescription-labels-in-5-foreign-languages/\" target=\"_blank\">to provide labels or medication information \u003c/a>in the five most common languages in California, after English: Spanish, Tagalog, Chinese, Vietnamese or Korean.\u003c/p>\n\u003cp>\u003cstrong>Hospitals and Caregivers\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">AB675\u003c/a> requires hospitals to include family caregivers in the hospitalization and discharge process. \u003ca href=\"http://newamericamedia.org/2015/12/california-latest-state-requiring-hospitals-to-keep-caregivers-in-the-loop.php\" target=\"_blank\">The goal \u003c/a>is to improve a patient's care and reduce the chance of readmission. California is one of 18 states to pass this type of law in the last two years.\u003c/p>\n\u003cp>\u003cstrong>CONSUMER PROTECTIONS:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Caps on Drug Copays\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339\" target=\"_blank\">This law\u003c/a> limits patient's cost-sharing on specialty drugs to $250 a month and prohibits placing most or all drugs used to treat a certain condition on the highest cost tier in drug formularies.\u003c/li>\n\u003cli>\u003cstrong>Accurate Provider Directories\u003c/strong>: Insurers now must maintain an accurate database of providers on a website -- and they must update that directory every week, under \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\">this new law. \u003c/a>The directories will include languages spoken by providers other than English.\u003c/li>\n\u003cli>\u003cstrong>Cost-sharing Limits in Family Plans\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1305\" target=\"_blank\">This law\u003c/a> brings California into line with federal regulations, that an individual patient faces the out-of-pocket maximum set by the Affordable Care Act (now $6,600) for an individual, even if they are in a family plan (which has a max of $13,200 at present).\u003c/li>\n\u003cli>\u003cstrong>Insurance offered by Large Employers\u003c/strong>: Large employers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB248\" target=\"_blank\">must now follow consumer protections \u003c/a>that ensure they do not offer so-called junk insurance that does not offer minimum value, as defined.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>LGBT HEALTH CARE:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Sperm Donation:\u003c/strong> \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB960\" target=\"_blank\">AB960 \u003c/a>was inspired by lesbian couples who want to have children. Many receive sperm donations from friends or relatives. This law says that the donor will not be viewed as the \"natural parent\" unless otherwise agreed to in writing prior to conception of the child.\u003c/li>\n\u003cli>\u003cstrong>Demographic Data Collection\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB959\" target=\"_blank\">This law requires\u003c/a> state departments overseeing health programs to collect voluntary information about sexual orientation and gender identity just as they collect race and ethnicity data.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>FOSTER CHILDREN\u003c/strong>:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Placements for Trans Children\u003c/strong>: Foster children \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB731\" target=\"_blank\">now have the right \u003c/a>to placements consistent with their gender identity.\u003c/li>\n\u003cli>\u003cstrong>Psychotropic Medications\u003c/strong>: Child welfare social workers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB238\" target=\"_blank\">will be better able \u003c/a>to oversee mental health treatments, including use of psychotropic medications, by foster children.\u003c/li>\n\u003cli>\u003cstrong>Foster Children Who Are Parents\u003c/strong>: This law \u003ca href=\"http://www.calyouthconn.org/assets/files/AB%20260%20Fact%20Sheet%20(4.1.15).pdf\" target=\"_blank\">provides support and protections\u003c/a> for foster children who are parents themselves.\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman’s contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical — part of Dignity Health — does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. “We shouldn’t allow religion or any hospital to decide what is best for a patient and her family,” said Dr. Pratima Gupta, a fellow with the organization. “It really should be in consultation with her doctor.”\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/240534476″ 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>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\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/240534476″&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/240534476″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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},
"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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