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"content": "\u003cp>The state plans to \u003ca href=\"http://www.scpr.org/news/2015/08/14/53799/lead-based-pollution-from-exide-smelter-may-have-r/\" target=\"_blank\">significantly expand the scope of the cleanup \u003c/a>of lead-tainted soil from properties around the former Exide plant in Vernon, but its efforts to date have been incomplete, as many homeowners have passed up the opportunity to have professionals also clean the interiors of their homes.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237690993\" 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>Of the 174 property owners in Boyle Heights and Maywood who have had soil removed from their yards, only 44 have requested the accompanying interior cleanup, according to the Department of Toxic Substances Control, which is overseeing the effort. The operation began after the agency found elevated levels of lead in the soil of homes around Exide's now shuttered battery recycling facility.\u003c/p>\n\u003cp>Interviews with residents whose yards were the subjects of remediation, along with a review of the letter offering an interior cleaning, suggest that at least one of the reasons so few have taken that step is miscommunication.\u003c/p>\n\u003cp>\"The agency is not doing a good enough job in conveying that we are cleaning up poison from homes and not just dust,\" says Mark Lopez, executive director of East Yard Communities for Environmental Justice.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Because dirt contaminated with lead can easily make its way from a yard to a living room, the state's remediation operation includes a free cleaning of the affected homes with a HEPA vacuum. HEPA stands for High Efficiency Particulate Air; the vaccum is an industrial strength machine outfitted with special filters that can trap tiny particles.\u003c/p>\n\u003cp>\u003cstrong>A 'Voucher for a Maid Service'\u003c/strong>\u003c/p>\n\u003cp>Maldonado Raul of Boyle Heights had his yard cleaned, but he says he did not follow up on the offer for the interior work because he already has a woman who cleans his house.\u003c/p>\n\u003cp>\"No no, I don’t want [another] lady who comes and cleans inside the house,\" says Raul, noting that he also passed on the offer to clean the interiors of the two rental units he owns on his street.\u003c/p>\n\u003cp>Reiser Torres of Maywood says his mom, who owns their house, had a similar reaction.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/10/28/55299/exide-cleanup-efforts-are-incomplete-in-most-cases/\" target=\"_blank\">Read the rest of this story at KPCC.org.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The state plans to \u003ca href=\"http://www.scpr.org/news/2015/08/14/53799/lead-based-pollution-from-exide-smelter-may-have-r/\" target=\"_blank\">significantly expand the scope of the cleanup \u003c/a>of lead-tainted soil from properties around the former Exide plant in Vernon, but its efforts to date have been incomplete, as many homeowners have passed up the opportunity to have professionals also clean the interiors of their homes.\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/237690993&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/237690993'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Of the 174 property owners in Boyle Heights and Maywood who have had soil removed from their yards, only 44 have requested the accompanying interior cleanup, according to the Department of Toxic Substances Control, which is overseeing the effort. The operation began after the agency found elevated levels of lead in the soil of homes around Exide's now shuttered battery recycling facility.\u003c/p>\n\u003cp>Interviews with residents whose yards were the subjects of remediation, along with a review of the letter offering an interior cleaning, suggest that at least one of the reasons so few have taken that step is miscommunication.\u003c/p>\n\u003cp>\"The agency is not doing a good enough job in conveying that we are cleaning up poison from homes and not just dust,\" says Mark Lopez, executive director of East Yard Communities for Environmental Justice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Because dirt contaminated with lead can easily make its way from a yard to a living room, the state's remediation operation includes a free cleaning of the affected homes with a HEPA vacuum. HEPA stands for High Efficiency Particulate Air; the vaccum is an industrial strength machine outfitted with special filters that can trap tiny particles.\u003c/p>\n\u003cp>\u003cstrong>A 'Voucher for a Maid Service'\u003c/strong>\u003c/p>\n\u003cp>Maldonado Raul of Boyle Heights had his yard cleaned, but he says he did not follow up on the offer for the interior work because he already has a woman who cleans his house.\u003c/p>\n\u003cp>\"No no, I don’t want [another] lady who comes and cleans inside the house,\" says Raul, noting that he also passed on the offer to clean the interiors of the two rental units he owns on his street.\u003c/p>\n\u003cp>Reiser Torres of Maywood says his mom, who owns their house, had a similar reaction.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/10/28/55299/exide-cleanup-efforts-are-incomplete-in-most-cases/\" target=\"_blank\">Read the rest of this story at KPCC.org.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Sacramento, Calls for Tougher Gun Laws Debated at Federal Hearing",
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"content": "\u003cp>Everyone from gun violence prevention advocates to law enforcement officers to gun dealers gathered in Sacramento Monday for a forum on reducing gun violence.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence.'\u003cbr>\n\u003ccite>Rep. Mike Thompson, D-Napa\u003c/cite>\u003c/aside>\n\u003cp>U.S. Congressman Mike Thompson, D-Napa, called the meeting, held three years to the day when 20 school children and six teachers were fatally shot at Sandy Hook Elementary School in Connecticut, and less then two weeks after 14 people were killed in San Bernardino.\u003c/p>\n\u003cp>Thompson is a self-described \"gun guy,\" and remembers he was duck hunting when he got the call about the Sandy Hook shooting.\u003c/p>\n\u003cp>\"As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence, or at least put a dent in gun violence,\" said Thompson, now chair of the House Gun Violence Prevention Task Force.\u003c/p>\n\u003cp>California has some of the strongest gun control laws in the country, including strict background checks, even on second-hand sales, and, starting in January, the ability to remove guns from potentially dangerous people. But Thompson says those restrictions don't stop people from buying firearms in Nevada or Arizona and bringing them back across state lines. He says stronger federal laws are needed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237698878\" 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>Thompson has proposed universal federal background checks on people who want to buy guns, including firearms sold at gun shows and online. He also wants to prohibit people on the \"no-fly\" list from buying guns.\u003c/p>\n\u003cp>Gun dealers were among those who spoke in favor of stronger rules.\u003c/p>\n\u003cp>\"With our constitutional right to bear arms comes a responsibility to protect our loved ones, our neighbors, and anybody else from the devastating effects of gun violence,\" said Joe Deaser, owner of Capital Gun Club, a gun shop and shooting range in Roseville, outside Sacramento.\u003c/p>\n\u003cp>He said he does a background check on everybody who comes to his shop, even in instances when he's not required to by law.\u003c/p>\n\u003cp>\"This really isn’t about gun control. It’s about keeping bad people from doing dumb things,\" Deaser said.\u003c/p>\n\u003cp>Most background checks take 90 seconds. But some take longer. And there's a loophole in the national law, that allows dealers to sell a gun if they don’t get a response in three days, said Chris Kitaeff, a gun show dealer from Phoenix, Arizona.\u003c/p>\n\u003cp>\"What we've done, and what we urge other gun dealers to do, is to adopt the common sense code of 'no completed background check, no sale,'\" he said. \"Walmart, one of our nation's largest retailers of firearms, has implemented this exact policy since 2002.\"\u003c/p>\n\u003cp>But several gun advocates at the forum said they opposed measures that would make it harder for law-abiding citizens to buy guns to protect themselves. One was Chase Buchanan from a group called the Pink Pistols.\u003c/p>\n\u003cp>\"It's a group for lesbian, gay, bisexual people who have made the decision to use firearms for self-defense against people who want to murder us. Against gay bashers, I suppose,\" Buchanan said.\u003c/p>\n\u003cp>He said discussions about gun control need to include the LGBT community.\u003c/p>\n\u003cp>\"We're here. We're queer. We're armed. Get used to it,\" he said.\u003c/p>\n\u003cp>Sam Paredes told a story about a home intruder who went into his daughter’s bedroom. Paredes got his gun and says that frightened the intruder away.\u003c/p>\n\u003cp>\"If I didn't have a gun, I could have lost a family member,\" he said.\u003c/p>\n\u003cp>A third gun rights advocate argued that California already has the strictest gun laws in the country, but they didn't stop the mass shooting in San Bernardino.\u003c/p>\n\u003cp>\"Criminals, terrorists don't care about the laws,\" said Craig DeLuz, legislative advocate for the California Association of Federal Firearms Licensees. \"Bad guys get guns no matter how strict the laws are. All these laws do is disarm law-abiding citizens.\"\u003c/p>\n\u003cp>But those who favor tougher gun laws say they're not aimed at eliminating gun violence. They're meant to reduce rates of violence, said Amanda Wilcox, legislative chair with the Brady Campaign to Prevent Gun Violence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When someone runs a stop sign and causes a car crash, we don't say, 'See, stop signs don't work, let's get rid of all stop signs,'\" she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Everyone from gun violence prevention advocates to law enforcement officers to gun dealers gathered in Sacramento Monday for a forum on reducing gun violence.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence.'\u003cbr>\n\u003ccite>Rep. Mike Thompson, D-Napa\u003c/cite>\u003c/aside>\n\u003cp>U.S. Congressman Mike Thompson, D-Napa, called the meeting, held three years to the day when 20 school children and six teachers were fatally shot at Sandy Hook Elementary School in Connecticut, and less then two weeks after 14 people were killed in San Bernardino.\u003c/p>\n\u003cp>Thompson is a self-described \"gun guy,\" and remembers he was duck hunting when he got the call about the Sandy Hook shooting.\u003c/p>\n\u003cp>\"As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence, or at least put a dent in gun violence,\" said Thompson, now chair of the House Gun Violence Prevention Task Force.\u003c/p>\n\u003cp>California has some of the strongest gun control laws in the country, including strict background checks, even on second-hand sales, and, starting in January, the ability to remove guns from potentially dangerous people. But Thompson says those restrictions don't stop people from buying firearms in Nevada or Arizona and bringing them back across state lines. He says stronger federal laws are needed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\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/237698878&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/237698878'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Thompson has proposed universal federal background checks on people who want to buy guns, including firearms sold at gun shows and online. He also wants to prohibit people on the \"no-fly\" list from buying guns.\u003c/p>\n\u003cp>Gun dealers were among those who spoke in favor of stronger rules.\u003c/p>\n\u003cp>\"With our constitutional right to bear arms comes a responsibility to protect our loved ones, our neighbors, and anybody else from the devastating effects of gun violence,\" said Joe Deaser, owner of Capital Gun Club, a gun shop and shooting range in Roseville, outside Sacramento.\u003c/p>\n\u003cp>He said he does a background check on everybody who comes to his shop, even in instances when he's not required to by law.\u003c/p>\n\u003cp>\"This really isn’t about gun control. It’s about keeping bad people from doing dumb things,\" Deaser said.\u003c/p>\n\u003cp>Most background checks take 90 seconds. But some take longer. And there's a loophole in the national law, that allows dealers to sell a gun if they don’t get a response in three days, said Chris Kitaeff, a gun show dealer from Phoenix, Arizona.\u003c/p>\n\u003cp>\"What we've done, and what we urge other gun dealers to do, is to adopt the common sense code of 'no completed background check, no sale,'\" he said. \"Walmart, one of our nation's largest retailers of firearms, has implemented this exact policy since 2002.\"\u003c/p>\n\u003cp>But several gun advocates at the forum said they opposed measures that would make it harder for law-abiding citizens to buy guns to protect themselves. One was Chase Buchanan from a group called the Pink Pistols.\u003c/p>\n\u003cp>\"It's a group for lesbian, gay, bisexual people who have made the decision to use firearms for self-defense against people who want to murder us. Against gay bashers, I suppose,\" Buchanan said.\u003c/p>\n\u003cp>He said discussions about gun control need to include the LGBT community.\u003c/p>\n\u003cp>\"We're here. We're queer. We're armed. Get used to it,\" he said.\u003c/p>\n\u003cp>Sam Paredes told a story about a home intruder who went into his daughter’s bedroom. Paredes got his gun and says that frightened the intruder away.\u003c/p>\n\u003cp>\"If I didn't have a gun, I could have lost a family member,\" he said.\u003c/p>\n\u003cp>A third gun rights advocate argued that California already has the strictest gun laws in the country, but they didn't stop the mass shooting in San Bernardino.\u003c/p>\n\u003cp>\"Criminals, terrorists don't care about the laws,\" said Craig DeLuz, legislative advocate for the California Association of Federal Firearms Licensees. \"Bad guys get guns no matter how strict the laws are. All these laws do is disarm law-abiding citizens.\"\u003c/p>\n\u003cp>But those who favor tougher gun laws say they're not aimed at eliminating gun violence. They're meant to reduce rates of violence, said Amanda Wilcox, legislative chair with the Brady Campaign to Prevent Gun Violence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When someone runs a stop sign and causes a car crash, we don't say, 'See, stop signs don't work, let's get rid of all stop signs,'\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors Call for End to 20-Year Ban on Gun Violence Research",
"title": "Doctors Call for End to 20-Year Ban on Gun Violence Research",
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"content": "\u003cp>Harrison Alter is an emergency room doctor at Highland Hospital in Oakland. He sees about one to two gun injuries every shift he works.\u003c/p>\n\u003caside class=\"pullquote alignright\">'To have starved our society of research in this matter for 20 years is really difficult to justify.'\u003cbr>\n\u003ccite>Harrison Alter, Highland Hospital ER doctor\u003c/cite>\u003c/aside>\n\u003cp>“These are young people,” he says. “And there’s an enormous amount of human potential that’s lost to a lifetime of colostomy bags and pressure sores and wheelchair ramps. And there’s real fear in their eyes.”\u003c/p>\n\u003cp>Alter says there’s a serious lack of research that could help prevent gun injuries. In 1996, gun lobbyists accused the Centers for Disease Control and Prevention of promoting gun control, and Congress threatened to cut the agency’s funding. A rider attached to an appropriations bill banned the use of federal money on studies that promote gun control.\u003c/p>\n\u003cp>But the effect was more broad: Out of fear of losing its funding, the CDC stopped conducting or supporting studies into the public health effects of gun violence.\u003c/p>\n\u003cp>“So that sort of wiped out a generation of firearm injury researchers,” Alter says. “To have starved our society of research in this matter for 20 years is really difficult to justify.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237531561\" 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>Today he says there are fewer than 20 medical researchers dedicated to studying gun violence. One of them is Garen Wintemute, an ER doctor at UC Davis Medical Center.\u003c/p>\n\u003cp>“Let me draw a contrast between firearms and motor vehicles,” he says.\u003c/p>\n\u003cp>In the 1960s, death rates from car accidents were going up every year. It was a true epidemic on the highway, Wintemute says.\u003c/p>\n\u003cp>“So we mobilized. We recognized the problem, we put smart people in charge, and we gave them money to do research,” he said. “Policymakers asked for recommendations, and turned them into new policy and regulation.”\u003c/p>\n\u003cp>Advocates pushed car manufacturers to install airbags; cars were re-engineered to make them safer. Since then, Wintemute says motor vehicle death rates plummeted 60 percent, even though Americans are driving more.\u003c/p>\n\u003cp>“With firearm violence, we've done exactly the opposite,” he says. “We have repeatedly, consciously, deliberately turned our back on the problem.”\u003c/p>\n\u003cp>Wintemute thinks the reason is race politics. Gun violence is seen as a problem that mainly affects young African-American men killed on city streets.\u003c/p>\n\u003cp>“They’re people not like policymakers,” he says. “There’s a difference in age and ethnicity. And so it’s easy not to take action.”\u003c/p>\n\u003cp>In fact, gun suicides far outnumber gun homicides. More middle-aged white men die from self-inflicted gunshot wounds than men of color who die in gun homicides. Wintemute points this out when he meets with lawmakers.\u003c/p>\n\u003cp>“These people look just like you, Senator,” he says he tells them.\u003c/p>\n\u003cp>[contextly_sidebar id=\"9IZgBXDFKjE2dZU0vJQ8GaWeOfVjkl67\"]Wintemute says more research is needed to understand what the risk factors and patterns of gun violence are and what kinds of interventions work.\u003c/p>\n\u003cp>Recently,\u003ca href=\"http://www.drsforamerica.org/press-releases/over-2000-physicians-urge-congress-to-end-the-ban-on-cdc-and-nih-gun-violence-research\" target=\"_blank\"> 2,000 doctors\u003c/a> signed a petition asking Congress to remove barriers to doing research like this. Some Democrats are trying. House Minority Leader Nancy Pelosi, D-San Francisco, said she would push to end the ban in the year-end funding bill.\u003c/p>\n\u003cp>Rep. Mike Thompson, D-Napa, hosted a forum for the House Gun Violence Prevention Task Force last week.\u003c/p>\n\u003cp>“I’m a gun guy. I’m a hunter. I support the Second Amendment,” he says. “I believe law-abiding people have a right to own and use firearms.”\u003c/p>\n\u003cp>But he says those rights can be protected at the same time experts conduct research.\u003c/p>\n\u003cp>“I don’t believe the debate that we’re having, the issue of gun safety or gun violence prevention, is in conflict with the Second Amendment,” he says. “It’s not an either-or.”\u003c/p>\n\u003cp>But Republicans and the National Rifle Association have resisted.\u003c/p>\n\u003cp>“If efforts were made to do a stringent, unbiased, all-inclusive evaluation on which laws actually work when it comes to reducing gun violence, that would be a different story,” says Amy Hunter, NRA spokeswoman.\u003c/p>\n\u003cp>She says past CDC studies were “biased” and questioned whether the agency could be trusted to do unbiased research now.\u003c/p>\n\u003cp>“We're just not going to support efforts that do nothing but attempt to convince Americans that lawfully owned firearms are a public health menace,” she says.\u003c/p>\n\u003cp>Back in Oakland, where hundreds of people have been killed or assaulted with a gun this year, Dr. Harrison Alter says research would play an important role for the community.\u003c/p>\n\u003cp>“I think one thing research can do is restore hope,” he says.\u003c/p>\n\u003cp>Take cancer research that has led to more effective treatments. Or the car accident research that has led to safer child seats and cars. Alter believes they can do the same with guns.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“So a situation that seemed hopeless, to thousands of families every year, now, there’s hope,” he says. “And that’s research.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Harrison Alter is an emergency room doctor at Highland Hospital in Oakland. He sees about one to two gun injuries every shift he works.\u003c/p>\n\u003caside class=\"pullquote alignright\">'To have starved our society of research in this matter for 20 years is really difficult to justify.'\u003cbr>\n\u003ccite>Harrison Alter, Highland Hospital ER doctor\u003c/cite>\u003c/aside>\n\u003cp>“These are young people,” he says. “And there’s an enormous amount of human potential that’s lost to a lifetime of colostomy bags and pressure sores and wheelchair ramps. And there’s real fear in their eyes.”\u003c/p>\n\u003cp>Alter says there’s a serious lack of research that could help prevent gun injuries. In 1996, gun lobbyists accused the Centers for Disease Control and Prevention of promoting gun control, and Congress threatened to cut the agency’s funding. A rider attached to an appropriations bill banned the use of federal money on studies that promote gun control.\u003c/p>\n\u003cp>But the effect was more broad: Out of fear of losing its funding, the CDC stopped conducting or supporting studies into the public health effects of gun violence.\u003c/p>\n\u003cp>“So that sort of wiped out a generation of firearm injury researchers,” Alter says. “To have starved our society of research in this matter for 20 years is really difficult to justify.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\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/237531561&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/237531561'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Today he says there are fewer than 20 medical researchers dedicated to studying gun violence. One of them is Garen Wintemute, an ER doctor at UC Davis Medical Center.\u003c/p>\n\u003cp>“Let me draw a contrast between firearms and motor vehicles,” he says.\u003c/p>\n\u003cp>In the 1960s, death rates from car accidents were going up every year. It was a true epidemic on the highway, Wintemute says.\u003c/p>\n\u003cp>“So we mobilized. We recognized the problem, we put smart people in charge, and we gave them money to do research,” he said. “Policymakers asked for recommendations, and turned them into new policy and regulation.”\u003c/p>\n\u003cp>Advocates pushed car manufacturers to install airbags; cars were re-engineered to make them safer. Since then, Wintemute says motor vehicle death rates plummeted 60 percent, even though Americans are driving more.\u003c/p>\n\u003cp>“With firearm violence, we've done exactly the opposite,” he says. “We have repeatedly, consciously, deliberately turned our back on the problem.”\u003c/p>\n\u003cp>Wintemute thinks the reason is race politics. Gun violence is seen as a problem that mainly affects young African-American men killed on city streets.\u003c/p>\n\u003cp>“They’re people not like policymakers,” he says. “There’s a difference in age and ethnicity. And so it’s easy not to take action.”\u003c/p>\n\u003cp>In fact, gun suicides far outnumber gun homicides. More middle-aged white men die from self-inflicted gunshot wounds than men of color who die in gun homicides. Wintemute points this out when he meets with lawmakers.\u003c/p>\n\u003cp>“These people look just like you, Senator,” he says he tells them.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Wintemute says more research is needed to understand what the risk factors and patterns of gun violence are and what kinds of interventions work.\u003c/p>\n\u003cp>Recently,\u003ca href=\"http://www.drsforamerica.org/press-releases/over-2000-physicians-urge-congress-to-end-the-ban-on-cdc-and-nih-gun-violence-research\" target=\"_blank\"> 2,000 doctors\u003c/a> signed a petition asking Congress to remove barriers to doing research like this. Some Democrats are trying. House Minority Leader Nancy Pelosi, D-San Francisco, said she would push to end the ban in the year-end funding bill.\u003c/p>\n\u003cp>Rep. Mike Thompson, D-Napa, hosted a forum for the House Gun Violence Prevention Task Force last week.\u003c/p>\n\u003cp>“I’m a gun guy. I’m a hunter. I support the Second Amendment,” he says. “I believe law-abiding people have a right to own and use firearms.”\u003c/p>\n\u003cp>But he says those rights can be protected at the same time experts conduct research.\u003c/p>\n\u003cp>“I don’t believe the debate that we’re having, the issue of gun safety or gun violence prevention, is in conflict with the Second Amendment,” he says. “It’s not an either-or.”\u003c/p>\n\u003cp>But Republicans and the National Rifle Association have resisted.\u003c/p>\n\u003cp>“If efforts were made to do a stringent, unbiased, all-inclusive evaluation on which laws actually work when it comes to reducing gun violence, that would be a different story,” says Amy Hunter, NRA spokeswoman.\u003c/p>\n\u003cp>She says past CDC studies were “biased” and questioned whether the agency could be trusted to do unbiased research now.\u003c/p>\n\u003cp>“We're just not going to support efforts that do nothing but attempt to convince Americans that lawfully owned firearms are a public health menace,” she says.\u003c/p>\n\u003cp>Back in Oakland, where hundreds of people have been killed or assaulted with a gun this year, Dr. Harrison Alter says research would play an important role for the community.\u003c/p>\n\u003cp>“I think one thing research can do is restore hope,” he says.\u003c/p>\n\u003cp>Take cancer research that has led to more effective treatments. Or the car accident research that has led to safer child seats and cars. Alter believes they can do the same with guns.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“So a situation that seemed hopeless, to thousands of families every year, now, there’s hope,” he says. “And that’s research.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Hundreds of people with developmental disabilities marched in seven cities throughout California Thursday, carrying signs reading “Save Our Programs” and “Keep Your Promise.” They say their services are on the brink of collapse and are asking state lawmakers to increase funding by 10 percent.\u003c/p>\n\u003cp>Workers who care for people with disabilities including autism, down syndrome, and cerebral palsy say they earn less than employees at Burger King and McDonalds.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237134552\" 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>“That’s for flipping burgers,” says Tim Hornbecker, business director at The Arc of Alameda County, a service provider. “We have people who literally turn people over. They transfer people from their wheelchair to bed at night. And they get minimum wage of $9.50.”\u003c/p>\n\u003cp>Protestors say provider rates haven’t budged for a decade, at the same time the costs of providing supportive care and job training programs have gone up. Multiple pleas to the governor to increase funding have not resulted in any rate increases in the state budget.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So people took to the streets in San Diego, Bakersfield, Redding, and other cities.\u003c/p>\n\u003cp>Andrew Silliman marched in Berkeley to rally support for a job training program he attends at ToolWorks for people with developmental disabilities.\u003c/p>\n\u003cp>[contextly_sidebar id=\"LgcAvzzlwD7rLJgSAez4hLiWdrnS5GVP\"]\u003c/p>\n\u003cp>“I want to work at Applebee’s,” he says. “I want to do dessert, cook eggs, do your dishes. Everything. It’s cool.”\u003c/p>\n\u003cp>But advocates are worried that if the state doesn’t increase funding for the program for programs like Silliman's job training program, they might close. Several day programs and job-training sites have been shuttered already in recent years, Hornbecker says, adding that his agency loses $200,000 a year.\u003c/p>\n\u003cp>“We’re running on reserves. We’re liquidating property,” he says. “That’s no way to run a business. And, we can’t pay people a living wage.”\u003c/p>\n\u003cp>While the state has passed laws to increase the minimum wage and offer paid sick leave, adding to agencies' labor costs, Hornbecker says they haven't gotten any extra funds to comply with these mandates. Many agencies have simply cut hours, and that’s forced a lot of workers to move on.\u003c/p>\n\u003cp>\"The turnover rate is so high, by the time folks get trained they leave for a better job,\" says Paul King, whose son receives supportive services so he can live independently. \"The turnover rate is destroying these wonderful programs.\"\u003c/p>\n\u003cp>Jerry Brown called for a special legislative session on health care financing this summer, in part, to come up with new revenue streams to support services for people who are developmentally disabled. Lawmakers have proposed taxes on alcoholic beverages and health plans to raise money for the services, but so far, those proposals are floundering.\u003c/p>\n\u003cp>“Democrats and Republicans agree that these are good services,” says Assemblymember Tony Thurmond, D-Richmond. “Not everyone agrees we need to create taxes to support it.”\u003c/p>\n\u003cp>He says he will continue proposing solutions when meetings of the special session resume in January. Thurmond says even these taxes will be cheaper than the alternative.\u003c/p>\n\u003cp>“I would hate to see people going into institutional care, which is more restrictive and more expensive,” he says.\u003c/p>\n\u003cp>California is seen as a leader in providing community-based services that allow people with developmental disabilities to live on their own or with their families. These services were established in 1969, under the Lanterman Act, and are paid for by the state. There are no income thresholds for families.\u003c/p>\n\u003cp>Shira Leeder wants to make sure those rights are preserved. She has cerebral palsy and was at the Berkeley protest in her wheelchair. Without the funding increase, she says, she could end up living in an institution.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“That’s not what we want. We want to be here,” she says. “And we want to have a life, like everybody else.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Hundreds of people with developmental disabilities marched in seven cities throughout California Thursday, carrying signs reading “Save Our Programs” and “Keep Your Promise.” They say their services are on the brink of collapse and are asking state lawmakers to increase funding by 10 percent.\u003c/p>\n\u003cp>Workers who care for people with disabilities including autism, down syndrome, and cerebral palsy say they earn less than employees at Burger King and McDonalds.\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/237134552&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/237134552'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“That’s for flipping burgers,” says Tim Hornbecker, business director at The Arc of Alameda County, a service provider. “We have people who literally turn people over. They transfer people from their wheelchair to bed at night. And they get minimum wage of $9.50.”\u003c/p>\n\u003cp>Protestors say provider rates haven’t budged for a decade, at the same time the costs of providing supportive care and job training programs have gone up. Multiple pleas to the governor to increase funding have not resulted in any rate increases in the state budget.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So people took to the streets in San Diego, Bakersfield, Redding, and other cities.\u003c/p>\n\u003cp>Andrew Silliman marched in Berkeley to rally support for a job training program he attends at ToolWorks for people with developmental disabilities.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I want to work at Applebee’s,” he says. “I want to do dessert, cook eggs, do your dishes. Everything. It’s cool.”\u003c/p>\n\u003cp>But advocates are worried that if the state doesn’t increase funding for the program for programs like Silliman's job training program, they might close. Several day programs and job-training sites have been shuttered already in recent years, Hornbecker says, adding that his agency loses $200,000 a year.\u003c/p>\n\u003cp>“We’re running on reserves. We’re liquidating property,” he says. “That’s no way to run a business. And, we can’t pay people a living wage.”\u003c/p>\n\u003cp>While the state has passed laws to increase the minimum wage and offer paid sick leave, adding to agencies' labor costs, Hornbecker says they haven't gotten any extra funds to comply with these mandates. Many agencies have simply cut hours, and that’s forced a lot of workers to move on.\u003c/p>\n\u003cp>\"The turnover rate is so high, by the time folks get trained they leave for a better job,\" says Paul King, whose son receives supportive services so he can live independently. \"The turnover rate is destroying these wonderful programs.\"\u003c/p>\n\u003cp>Jerry Brown called for a special legislative session on health care financing this summer, in part, to come up with new revenue streams to support services for people who are developmentally disabled. Lawmakers have proposed taxes on alcoholic beverages and health plans to raise money for the services, but so far, those proposals are floundering.\u003c/p>\n\u003cp>“Democrats and Republicans agree that these are good services,” says Assemblymember Tony Thurmond, D-Richmond. “Not everyone agrees we need to create taxes to support it.”\u003c/p>\n\u003cp>He says he will continue proposing solutions when meetings of the special session resume in January. Thurmond says even these taxes will be cheaper than the alternative.\u003c/p>\n\u003cp>“I would hate to see people going into institutional care, which is more restrictive and more expensive,” he says.\u003c/p>\n\u003cp>California is seen as a leader in providing community-based services that allow people with developmental disabilities to live on their own or with their families. These services were established in 1969, under the Lanterman Act, and are paid for by the state. There are no income thresholds for families.\u003c/p>\n\u003cp>Shira Leeder wants to make sure those rights are preserved. She has cerebral palsy and was at the Berkeley protest in her wheelchair. Without the funding increase, she says, she could end up living in an institution.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“That’s not what we want. We want to be here,” she says. “And we want to have a life, like everybody else.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California To Revamp Addiction Treatment For Medicaid Recipients",
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"content": "\u003cp>California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This was a long time coming. It’s a win/win for people with substance use issues and their families.'\u003cbr>\n\u003ccite>Keith Lewis, executive director of Horizon Services\u003c/cite>\u003c/aside>\n\u003cp>The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what’s known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-System.aspx\" target=\"_blank\">waiver\u003c/a>, the state plans to expand treatment services, including inpatient care, case management, recovery services and added medication. Beginning next year, drug treatment centers will be able to get reimbursed for providing this much wider range of options to people on Medi-Cal.\u003c/p>\n\u003cp>Only a small fraction of low-income Californians with substance abuse disorders receive treatment, largely because of restrictions on what Medicaid will pay for.\u003c/p>\n\u003cp>“This was a long time coming,” said Keith Lewis, executive director of Horizon Services, which provides treatment in San Mateo, Santa Clara and Alameda counties. “It’s a win/win for people with substance use issues and their families … and for the people providing those services.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The changes will be phased in next year, beginning first in Bay Area counties before going to Los Angeles and Orange counties.\u003c/p>\n\u003cp>The changes stem in part from the Affordable Care Act, which required that substance abuse treatment be covered for people newly insured through Medicaid or insurance exchanges. The health law allowed states to expand Medicaid to cover millions more people.\u003c/p>\n\u003cp>Drug rehabilitation providers say the changes will give addicts a better chance at getting -- and staying -- clean. But they fear the state won’t raise traditionally low Medi-Cal reimbursement rates for treatment, making it harder to provide the new services and produce the outcomes California is hoping for.\u003c/p>\n\u003cp>Lewis, of Horizon Services, said that under the waiver, he expects drug treatment services to be higher quality and the workforce better trained. But he said that “Medi-Cal rates, which have always been too low, have to go up.\"\u003c/p>\n\u003cp>California’s Medi-Cal drug treatment program currently costs about $180 million annually, paid through a combination of state and federal funds. There aren’t any estimates for costs under the new approach, set to begin next year. But the idea is that the changes will lower overall health care expenses by enabling more people to get sober and healthier so they stop rotating through treatment centers, jails and hospitals.\u003c/p>\n\u003cp>\u003cstrong>New Access to Residential Treatment\u003c/strong>\u003c/p>\n\u003cp>Nearly 14 percent of Medicaid recipients are believed to have a substance abuse disorder, according to the National Survey on Drug Use and Health.\u003c/p>\n\u003cp>The five-year pilot project was approved by the federal Centers for Medicare & Medicaid Services in August. Under the waiver, California counties will approve treatment for Medi-Cal patients based on medical necessity and criteria established by the \u003ca href=\"http://www.asam.org/\" target=\"_blank\">American Society of Addiction Medicine\u003c/a>.\u003c/p>\n\u003cp>Currently, federal rules limit drug treatment centers' ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and post-partum women. That restriction will be dropped for California under the waiver.\u003c/p>\n\u003cp>Now, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year (with a possibility of one 30-day extension) if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays.\u003c/p>\n\u003cp>John Connolly, deputy director of substance abuse prevention and control for the Los Angeles County Department of Public Health, said the waiver is also designed to provide better coordination between physical, mental health and substance abuse services. That, along with more access, could result in fewer emergency room visits and hospitalizations, he said.\u003c/p>\n\u003cp>\u003cstrong>Treating Substance Abuse as Disease, Not Short-Term Illness\u003c/strong>\u003c/p>\n\u003cp>That’s potentially good news for patients like Caitlin Knoles, who says she gets turned down for treatment of her methamphetamine addiction every time she tells residential centers she’s on Medi-Cal. More than once, she has ended up in the hospital because of her addiction.\u003c/p>\n\u003cp>“It’s hard,” she said. “I can’t get help.”\u003c/p>\n\u003cp>The only way she can reliably get clean now is in jail, she says.\u003c/p>\n\u003cp>“It’d be nice to have a job and have my family back and just be normal,” said Knoles, 24, as she sat outside a liquor store in Laguna Hills.\u003c/p>\n\u003cp>For the first time, substance abuse disorders will be treated like a disease rather than a short-term illness, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services.\u003c/p>\n\u003cp>“Even though we know it’s a chronic condition, we have treated it acutely,” she said. “If they relapse, they have come right through the front door again.”\u003c/p>\n\u003cp>“We are really paving the way in California with this waiver,” she added.\u003c/p>\n\u003cp>Much depends, however, on reimbursement rates, which are still being negotiated. Clinic officials say they need higher rates to expand services and handle the influx of clients, many of whom will be seeking rehab for the first time.\u003c/p>\n\u003cfigure id=\"attachment_120372\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-e1449601995985.jpg\">\u003cimg class=\"wp-image-120372 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-400x300.jpg\" alt=\"Tarzan Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Los Angeles County-based Tarzana Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is a cost to raising the bar on treatment,” said Albert Senella, president of the California Association of Alcohol and Drug Program Executives. “If the rates aren’t adequate … we are not going to be able to effectively meet the [new requirements] and the needs of the population.”\u003c/p>\n\u003cp>Senella, who is also CEO of Tarzana Treatment Centers, said many clinics across the state don’t have money upfront to prepare for the overhaul, which will require improving technology and adding and training staff. For now, no plans are in place to provide counties or clinics with startup funds.\u003c/p>\n\u003cp>Eli Veitzer, interim CEO of Prototypes, which provides treatment services in Los Angeles, Orange and Ventura counties, said the waiver provides an “incredible opportunity” to transform care.\u003c/p>\n\u003cp>But in addition to fears about rates, Veitzer said he is also worried that 90 days -- the limit for residential treatment -- won’t be long enough. Someone may be able to stem their addiction in three months but will still need more time in a treatment facility to prepare for life outside.\u003c/p>\n\u003cp>“If their ability to function independently in the community is not addressed, they are likely to relapse,” he said.\u003c/p>\n\u003cp>Danny Montgomery, a 33-year-old patient at Tarzana Treatment Centers, said he needed more than a few months to get clean after nearly a decade on heroin. The addiction, which he estimated cost him up to $100 a day, caused him to lose his job and nearly lose his family.\u003c/p>\n\u003cp>“The whole thing is a process,” said Montgomery, who lives in the San Fernando Valley. “You get the substance removed from your body but you have to retrain your mind.” Montgomery said he tried to get a bed in a residential treatment center but couldn’t find one that would take Medi-Cal.\u003c/p>\n\u003cp>He tried to get clean on his own but it never lasted. Months after beginning his search, Montgomery was finally able to get a spot at Tarzana. He said Los Angeles County is paying for his stay, which began in May.\u003c/p>\n\u003cp>As worried as they are about reimbursements, clinic operators said a big advantage of the new approach to drug treatment is that it could help stabilize their funding. Providers now depend largely on counties to pay for residential treatment for low-income residents.\u003c/p>\n\u003cp>“You always suffered the vagaries of the budget cycle,” said Vitka Eisen, CEO of HealthRIGHT 360, which provides drug treatment in the Bay Area.\u003c/p>\n\u003cp>The waiver means increased oversight of treatment centers. Last year, a state audit found widespread fraud and questionable billing among Medi-Cal drug treatment providers. The audit followed reports by the \u003ca href=\"http://cironline.org/rehabracket\" target=\"_blank\">Center for Investigative Reporting\u003c/a> that clinics were billing for fake clients.\u003c/p>\n\u003cp>Perez, of the state Department of Health Care Services, said the new system builds in more levels of accountability, including more stringent requirements for clinics and more local control over contracting.\u003c/p>\n\u003cp>Knoles, the methamphetamine addict from Orange County, said she hopes that more people like her will be able to get treatment.\u003c/p>\n\u003cp>“I’ve had a lot of friends die from addiction,” she said. “Imagine if they’d gotten the help they wanted and needed. Things would have been different.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Anna Gorman is a reporter with \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The state is the first to overhaul substance abuse treatment as part of a federally approved experiment intended to improve outcomes and reduce costs.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This was a long time coming. It’s a win/win for people with substance use issues and their families.'\u003cbr>\n\u003ccite>Keith Lewis, executive director of Horizon Services\u003c/cite>\u003c/aside>\n\u003cp>The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what’s known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-System.aspx\" target=\"_blank\">waiver\u003c/a>, the state plans to expand treatment services, including inpatient care, case management, recovery services and added medication. Beginning next year, drug treatment centers will be able to get reimbursed for providing this much wider range of options to people on Medi-Cal.\u003c/p>\n\u003cp>Only a small fraction of low-income Californians with substance abuse disorders receive treatment, largely because of restrictions on what Medicaid will pay for.\u003c/p>\n\u003cp>“This was a long time coming,” said Keith Lewis, executive director of Horizon Services, which provides treatment in San Mateo, Santa Clara and Alameda counties. “It’s a win/win for people with substance use issues and their families … and for the people providing those services.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The changes will be phased in next year, beginning first in Bay Area counties before going to Los Angeles and Orange counties.\u003c/p>\n\u003cp>The changes stem in part from the Affordable Care Act, which required that substance abuse treatment be covered for people newly insured through Medicaid or insurance exchanges. The health law allowed states to expand Medicaid to cover millions more people.\u003c/p>\n\u003cp>Drug rehabilitation providers say the changes will give addicts a better chance at getting -- and staying -- clean. But they fear the state won’t raise traditionally low Medi-Cal reimbursement rates for treatment, making it harder to provide the new services and produce the outcomes California is hoping for.\u003c/p>\n\u003cp>Lewis, of Horizon Services, said that under the waiver, he expects drug treatment services to be higher quality and the workforce better trained. But he said that “Medi-Cal rates, which have always been too low, have to go up.\"\u003c/p>\n\u003cp>California’s Medi-Cal drug treatment program currently costs about $180 million annually, paid through a combination of state and federal funds. There aren’t any estimates for costs under the new approach, set to begin next year. But the idea is that the changes will lower overall health care expenses by enabling more people to get sober and healthier so they stop rotating through treatment centers, jails and hospitals.\u003c/p>\n\u003cp>\u003cstrong>New Access to Residential Treatment\u003c/strong>\u003c/p>\n\u003cp>Nearly 14 percent of Medicaid recipients are believed to have a substance abuse disorder, according to the National Survey on Drug Use and Health.\u003c/p>\n\u003cp>The five-year pilot project was approved by the federal Centers for Medicare & Medicaid Services in August. Under the waiver, California counties will approve treatment for Medi-Cal patients based on medical necessity and criteria established by the \u003ca href=\"http://www.asam.org/\" target=\"_blank\">American Society of Addiction Medicine\u003c/a>.\u003c/p>\n\u003cp>Currently, federal rules limit drug treatment centers' ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and post-partum women. That restriction will be dropped for California under the waiver.\u003c/p>\n\u003cp>Now, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year (with a possibility of one 30-day extension) if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays.\u003c/p>\n\u003cp>John Connolly, deputy director of substance abuse prevention and control for the Los Angeles County Department of Public Health, said the waiver is also designed to provide better coordination between physical, mental health and substance abuse services. That, along with more access, could result in fewer emergency room visits and hospitalizations, he said.\u003c/p>\n\u003cp>\u003cstrong>Treating Substance Abuse as Disease, Not Short-Term Illness\u003c/strong>\u003c/p>\n\u003cp>That’s potentially good news for patients like Caitlin Knoles, who says she gets turned down for treatment of her methamphetamine addiction every time she tells residential centers she’s on Medi-Cal. More than once, she has ended up in the hospital because of her addiction.\u003c/p>\n\u003cp>“It’s hard,” she said. “I can’t get help.”\u003c/p>\n\u003cp>The only way she can reliably get clean now is in jail, she says.\u003c/p>\n\u003cp>“It’d be nice to have a job and have my family back and just be normal,” said Knoles, 24, as she sat outside a liquor store in Laguna Hills.\u003c/p>\n\u003cp>For the first time, substance abuse disorders will be treated like a disease rather than a short-term illness, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services.\u003c/p>\n\u003cp>“Even though we know it’s a chronic condition, we have treated it acutely,” she said. “If they relapse, they have come right through the front door again.”\u003c/p>\n\u003cp>“We are really paving the way in California with this waiver,” she added.\u003c/p>\n\u003cp>Much depends, however, on reimbursement rates, which are still being negotiated. Clinic officials say they need higher rates to expand services and handle the influx of clients, many of whom will be seeking rehab for the first time.\u003c/p>\n\u003cfigure id=\"attachment_120372\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-e1449601995985.jpg\">\u003cimg class=\"wp-image-120372 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-400x300.jpg\" alt=\"Tarzan Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Los Angeles County-based Tarzana Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is a cost to raising the bar on treatment,” said Albert Senella, president of the California Association of Alcohol and Drug Program Executives. “If the rates aren’t adequate … we are not going to be able to effectively meet the [new requirements] and the needs of the population.”\u003c/p>\n\u003cp>Senella, who is also CEO of Tarzana Treatment Centers, said many clinics across the state don’t have money upfront to prepare for the overhaul, which will require improving technology and adding and training staff. For now, no plans are in place to provide counties or clinics with startup funds.\u003c/p>\n\u003cp>Eli Veitzer, interim CEO of Prototypes, which provides treatment services in Los Angeles, Orange and Ventura counties, said the waiver provides an “incredible opportunity” to transform care.\u003c/p>\n\u003cp>But in addition to fears about rates, Veitzer said he is also worried that 90 days -- the limit for residential treatment -- won’t be long enough. Someone may be able to stem their addiction in three months but will still need more time in a treatment facility to prepare for life outside.\u003c/p>\n\u003cp>“If their ability to function independently in the community is not addressed, they are likely to relapse,” he said.\u003c/p>\n\u003cp>Danny Montgomery, a 33-year-old patient at Tarzana Treatment Centers, said he needed more than a few months to get clean after nearly a decade on heroin. The addiction, which he estimated cost him up to $100 a day, caused him to lose his job and nearly lose his family.\u003c/p>\n\u003cp>“The whole thing is a process,” said Montgomery, who lives in the San Fernando Valley. “You get the substance removed from your body but you have to retrain your mind.” Montgomery said he tried to get a bed in a residential treatment center but couldn’t find one that would take Medi-Cal.\u003c/p>\n\u003cp>He tried to get clean on his own but it never lasted. Months after beginning his search, Montgomery was finally able to get a spot at Tarzana. He said Los Angeles County is paying for his stay, which began in May.\u003c/p>\n\u003cp>As worried as they are about reimbursements, clinic operators said a big advantage of the new approach to drug treatment is that it could help stabilize their funding. Providers now depend largely on counties to pay for residential treatment for low-income residents.\u003c/p>\n\u003cp>“You always suffered the vagaries of the budget cycle,” said Vitka Eisen, CEO of HealthRIGHT 360, which provides drug treatment in the Bay Area.\u003c/p>\n\u003cp>The waiver means increased oversight of treatment centers. Last year, a state audit found widespread fraud and questionable billing among Medi-Cal drug treatment providers. The audit followed reports by the \u003ca href=\"http://cironline.org/rehabracket\" target=\"_blank\">Center for Investigative Reporting\u003c/a> that clinics were billing for fake clients.\u003c/p>\n\u003cp>Perez, of the state Department of Health Care Services, said the new system builds in more levels of accountability, including more stringent requirements for clinics and more local control over contracting.\u003c/p>\n\u003cp>Knoles, the methamphetamine addict from Orange County, said she hopes that more people like her will be able to get treatment.\u003c/p>\n\u003cp>“I’ve had a lot of friends die from addiction,” she said. “Imagine if they’d gotten the help they wanted and needed. Things would have been different.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Anna Gorman is a reporter with \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hayward 'Promotoras' Make House Calls, Connect Neighbors to Health Care",
"title": "Hayward 'Promotoras' Make House Calls, Connect Neighbors to Health Care",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cp>Carolina Arroyo-Solveson and Guadalupe Perez are community health workers, but the bulk of their work is done outside a clinic or hospital setting. Instead, they share health information right in people's homes.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237124405\" 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 two women are \u003cem>\u003ca href=\"http://www.cdc.gov/minorityhealth/promotores.html\" target=\"_blank\">promotoras de \u003c/a>\u003cspan style=\"color: #24890d\">salud\u003c/span>, \u003c/em>Spanish-speaking lay health educators. Promotoras have a long history in California, and Arroyo-Solveson and Perez are working today in Hayward as part of \u003ca href=\"http://www.haywardpromise.org/\" target=\"_blank\">Hayward Promise Neighborhood\u003c/a>, a federally-funded initiative that is honing in on the Jackson Triangle neighborhood, a lower-income, ethnically diverse area of the city.\u003c/p>\n\u003cp>The women go door to door, connecting residents to community clinics and other health services.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They know that we are part of the community. We have our kids in the same schools. We go to the same stores.'\u003cbr>\n\u003ccite>Guadalupe Perez, a promotora in Hayward\u003c/cite>\u003c/aside>\n\u003cp>Arroyo-Solveson says there is nothing like face-to-face interaction to reach parents and others who may feel isolated or distrustful of government programs for which they would qualify.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Often when you have cultural barriers, language barriers, economic barriers, it’s very hard to feel empowered,\" Arroyo-Solveson says. \"We are trying to bridge these services for them so they can get empowered and engaged with the community.\"\u003c/p>\n\u003cp>Arroyo-Solveson is originally from Chile and says her own immigrant experience helps her relate to the families she works with.\u003c/p>\n\u003cp>Today, Arroyo-Solveson and Perez will meet with Liliana Salas, a stay-at-home mother with two children. Salas has invited the promotoras to her home, which is a welcome change from days past.\u003c/p>\n\u003cp>“When we started this work, nobody would tell us, 'Can you please come to our home?' They would slam the door or take a long time to answer,\" Arroyo-Solveson says with a chuckle. \"Now people hear about us and invite us to their home, which is wonderful.\"\u003c/p>\n\u003cp>Perez says that part of the success of promotoras in reaching residents is their familiarity with the neighborhood.\u003c/p>\n\u003cp>\"They know that we are part of the community. We have our kids in the same schools. We go to the same stores,\" says Perez.\u003c/p>\n\u003cp>After everyone is settled in Salas' living room, Arroyo-Solveson and Perez try to assess the family's needs. Do they have health insurance? They do. Has Salas heard of CalFresh, the state's food stamps program? She hasn’t, but wants to know more.\u003c/p>\n\u003cfigure id=\"attachment_117943\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\">\u003cimg class=\"wp-image-117943 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Liliana Salas (R), a stay-at-home mom, listens to Perez explain CalFresh, the state's Supplemental Nutrition Assistance Program, formerly known as food stamps. Perez and Arroyo-Solveson visited Salas at her home as part of the Hayward Promise Neighborhood initiative. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Salas listens attentively and asks questions as the promotoras explain how to apply for CalFresh. They also describe neighborhood events nearby -- the local library is offering kids help with their homework, and a community center is soon holding a drum circle.\u003c/p>\n\u003cp>“It’s a great event that helps to relieve stress,” explains Perez in Spanish. “And you can bring your kids to participate.\"\u003c/p>\n\u003cp>As the women close their visit, Salas promises to review the information, including a subsidized training course to become a medical assistant.\u003c/p>\n\u003cp>“I’ll try to find the programs that are the most relevant to me and my family,” says Salas, holding a stack of papers and phone numbers for local resources.\u003c/p>\n\u003cfigure id=\"attachment_117947\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut.jpg\">\u003cimg class=\"wp-image-117947 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carolina Arroyo-Solveson (L) and Guadalupe Perez prepare to visit immigrant families in Hayward's Jackson Triangle neighborhood. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says it's interactions like these that give her role meaning. And she is committed. She volunteers as a promotora; her work is generally unpaid. During her four years as a promotora for the \u003ca href=\"http://www.tvhc.org/\" target=\"_blank\">Tiburcio Vasquez Health Center\u003c/a>, Perez says she has witnessed positive changes in people’s mindsets -– and consequently, their lives.\u003c/p>\n\u003cp>One example she cites is clients who are initially resigned to getting chronic diseases like diabetes if their relatives also suffer from it.\u003c/p>\n\u003cp>“We'll tell them, ‘No. Don’t think like this! You can break the pattern.’ How? By exercising, changing your diet and being more relaxed,” says Perez, adding that many of the parents she meets with work more than one job and face high levels of stress.\u003c/p>\n\u003cp>Nationwide, Latinos are \u003ca href=\"http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=63\" target=\"_blank\">40 percent\u003c/a> more likely to die from diabetes than non-Hispanic whites, according to federal statistics.\u003c/p>\n\u003cp>Perez, a mother of three who cleans homes for a living, says that her own family has benefited from the knowledge she’s gained as a promotora. Her kids are more aware of nutritional labels as they browse aisles at the supermarket –- and appreciate the dangers of too much sugar and salt in their diets. Her husband reduced his daily soda intake from three or more cans daily to just one.\u003c/p>\n\u003cfigure id=\"attachment_117944\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut.jpg\">\u003cimg class=\"wp-image-117944 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Perez shares information about a support group for parents to a resident she visited at her home. Most of the immigrant families Perez works with in Hayward's Jackson Triangle are low income. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says being a promotora has also boosted her confidence and sense of purpose.\u003c/p>\n\u003cp>\"The training of promotora completely changed my life,\" says Perez, who is originally from Mexico.\u003c/p>\n\u003cp>She’s lost weight by adding vegetables to her diet and exercising more. It’s an approach she preaches to her clients: make the time for small beneficial changes that you can keep.\u003c/p>\n\u003cp>“I don’t have the time to go to the gym and also I don’t have money to go to the gym, so I do my exercise at home,” she said. “I have some zumba videos, so I'll play them and dance at home with my kids.\"\u003c/p>\n\u003cp>Another benefit she says, is how much more connected she feels with her community. Before, she would try to ignore problems -- like drug users at the park or gang-related violence. Now, she's taking an active role in improving her neighborhood.\u003c/p>\n\u003cp>\"Health is about everything -- good schools, access to good foods, and feeling safe in your neighborhood,\" says Perez, who earlier this year received a volunteer award from the city of Hayward.\u003c/p>\n\u003cp>Arroyo-Solveson says promotoras are an agent of change with tangible impacts.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"When I see that children get vaccinated because we have provided [parents with] resources on where to do that, they get health insurance because the promotoras came with all the information. It’s just a wonderful thing to see the transformation,\" says Arroyo-Solvenson. \"We are transforming a community with information, with care, because we care for them.\"\u003c/p>\n\n",
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"excerpt": "Spanish-speaking lay health workers go door to door in the Jackson Triangle neighborhood, a low-income area of Hayward.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Carolina Arroyo-Solveson and Guadalupe Perez are community health workers, but the bulk of their work is done outside a clinic or hospital setting. Instead, they share health information right in people's homes.\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/237124405&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/237124405'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The two women are \u003cem>\u003ca href=\"http://www.cdc.gov/minorityhealth/promotores.html\" target=\"_blank\">promotoras de \u003c/a>\u003cspan style=\"color: #24890d\">salud\u003c/span>, \u003c/em>Spanish-speaking lay health educators. Promotoras have a long history in California, and Arroyo-Solveson and Perez are working today in Hayward as part of \u003ca href=\"http://www.haywardpromise.org/\" target=\"_blank\">Hayward Promise Neighborhood\u003c/a>, a federally-funded initiative that is honing in on the Jackson Triangle neighborhood, a lower-income, ethnically diverse area of the city.\u003c/p>\n\u003cp>The women go door to door, connecting residents to community clinics and other health services.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They know that we are part of the community. We have our kids in the same schools. We go to the same stores.'\u003cbr>\n\u003ccite>Guadalupe Perez, a promotora in Hayward\u003c/cite>\u003c/aside>\n\u003cp>Arroyo-Solveson says there is nothing like face-to-face interaction to reach parents and others who may feel isolated or distrustful of government programs for which they would qualify.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Often when you have cultural barriers, language barriers, economic barriers, it’s very hard to feel empowered,\" Arroyo-Solveson says. \"We are trying to bridge these services for them so they can get empowered and engaged with the community.\"\u003c/p>\n\u003cp>Arroyo-Solveson is originally from Chile and says her own immigrant experience helps her relate to the families she works with.\u003c/p>\n\u003cp>Today, Arroyo-Solveson and Perez will meet with Liliana Salas, a stay-at-home mother with two children. Salas has invited the promotoras to her home, which is a welcome change from days past.\u003c/p>\n\u003cp>“When we started this work, nobody would tell us, 'Can you please come to our home?' They would slam the door or take a long time to answer,\" Arroyo-Solveson says with a chuckle. \"Now people hear about us and invite us to their home, which is wonderful.\"\u003c/p>\n\u003cp>Perez says that part of the success of promotoras in reaching residents is their familiarity with the neighborhood.\u003c/p>\n\u003cp>\"They know that we are part of the community. We have our kids in the same schools. We go to the same stores,\" says Perez.\u003c/p>\n\u003cp>After everyone is settled in Salas' living room, Arroyo-Solveson and Perez try to assess the family's needs. Do they have health insurance? They do. Has Salas heard of CalFresh, the state's food stamps program? She hasn’t, but wants to know more.\u003c/p>\n\u003cfigure id=\"attachment_117943\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\">\u003cimg class=\"wp-image-117943 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Liliana Salas (R), a stay-at-home mom, listens to Perez explain CalFresh, the state's Supplemental Nutrition Assistance Program, formerly known as food stamps. Perez and Arroyo-Solveson visited Salas at her home as part of the Hayward Promise Neighborhood initiative. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Salas listens attentively and asks questions as the promotoras explain how to apply for CalFresh. They also describe neighborhood events nearby -- the local library is offering kids help with their homework, and a community center is soon holding a drum circle.\u003c/p>\n\u003cp>“It’s a great event that helps to relieve stress,” explains Perez in Spanish. “And you can bring your kids to participate.\"\u003c/p>\n\u003cp>As the women close their visit, Salas promises to review the information, including a subsidized training course to become a medical assistant.\u003c/p>\n\u003cp>“I’ll try to find the programs that are the most relevant to me and my family,” says Salas, holding a stack of papers and phone numbers for local resources.\u003c/p>\n\u003cfigure id=\"attachment_117947\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut.jpg\">\u003cimg class=\"wp-image-117947 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carolina Arroyo-Solveson (L) and Guadalupe Perez prepare to visit immigrant families in Hayward's Jackson Triangle neighborhood. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says it's interactions like these that give her role meaning. And she is committed. She volunteers as a promotora; her work is generally unpaid. During her four years as a promotora for the \u003ca href=\"http://www.tvhc.org/\" target=\"_blank\">Tiburcio Vasquez Health Center\u003c/a>, Perez says she has witnessed positive changes in people’s mindsets -– and consequently, their lives.\u003c/p>\n\u003cp>One example she cites is clients who are initially resigned to getting chronic diseases like diabetes if their relatives also suffer from it.\u003c/p>\n\u003cp>“We'll tell them, ‘No. Don’t think like this! You can break the pattern.’ How? By exercising, changing your diet and being more relaxed,” says Perez, adding that many of the parents she meets with work more than one job and face high levels of stress.\u003c/p>\n\u003cp>Nationwide, Latinos are \u003ca href=\"http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=63\" target=\"_blank\">40 percent\u003c/a> more likely to die from diabetes than non-Hispanic whites, according to federal statistics.\u003c/p>\n\u003cp>Perez, a mother of three who cleans homes for a living, says that her own family has benefited from the knowledge she’s gained as a promotora. Her kids are more aware of nutritional labels as they browse aisles at the supermarket –- and appreciate the dangers of too much sugar and salt in their diets. Her husband reduced his daily soda intake from three or more cans daily to just one.\u003c/p>\n\u003cfigure id=\"attachment_117944\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut.jpg\">\u003cimg class=\"wp-image-117944 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Perez shares information about a support group for parents to a resident she visited at her home. Most of the immigrant families Perez works with in Hayward's Jackson Triangle are low income. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says being a promotora has also boosted her confidence and sense of purpose.\u003c/p>\n\u003cp>\"The training of promotora completely changed my life,\" says Perez, who is originally from Mexico.\u003c/p>\n\u003cp>She’s lost weight by adding vegetables to her diet and exercising more. It’s an approach she preaches to her clients: make the time for small beneficial changes that you can keep.\u003c/p>\n\u003cp>“I don’t have the time to go to the gym and also I don’t have money to go to the gym, so I do my exercise at home,” she said. “I have some zumba videos, so I'll play them and dance at home with my kids.\"\u003c/p>\n\u003cp>Another benefit she says, is how much more connected she feels with her community. Before, she would try to ignore problems -- like drug users at the park or gang-related violence. Now, she's taking an active role in improving her neighborhood.\u003c/p>\n\u003cp>\"Health is about everything -- good schools, access to good foods, and feeling safe in your neighborhood,\" says Perez, who earlier this year received a volunteer award from the city of Hayward.\u003c/p>\n\u003cp>Arroyo-Solveson says promotoras are an agent of change with tangible impacts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"When I see that children get vaccinated because we have provided [parents with] resources on where to do that, they get health insurance because the promotoras came with all the information. It’s just a wonderful thing to see the transformation,\" says Arroyo-Solvenson. \"We are transforming a community with information, with care, because we care for them.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In a trailer park tucked among the irrigated orchards outside Fresno that help make California's San Joaquin Valley the richest farm region in the world, 16-year-old Giselle Alvarez, one of the few English speakers in this community of farmworkers, puzzles over the notices posted on front doors: There's a danger in their drinking water.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This has been a decades-long process that has occurred. It’s going to take many decades to reverse.”\u003cbr>\n\u003ccite>Bryant Jurgens, U.S. Geological Survey hydrologist\u003c/cite>\u003c/aside>\n\u003cp>Tests for uranium, the notices warn, show a level considered unsafe by federal and state standards. The trailer park's owners are legally required to post the warnings. But the notices are awkwardly worded and in English, a language few of the park's dozens of Spanish-speaking families can read.\u003c/p>\n\u003cp>\"It says you can drink the water -- but if you drink the water over a period of time, you can get cancer,\" said Alvarez, whose working-class family has no choice but to keep drinking and cooking with the tainted tap water daily, as they have since Alvarez was just learning to walk. \"They really don't explain.\"\u003c/p>\n\u003cp>Uranium, the stuff of nuclear fuel for power plants and atom bombs, \u003ca href=\"http://pubs.usgs.gov/circ/1358/\" target=\"_blank\">increasingly is showing up in drinking water systems \u003c/a>in major farming regions of the U.S. West — a naturally occurring but unexpected byproduct of irrigation, of drought, and of the overpumping of natural underground water reserves.\u003c/p>\n\u003cp>An Associated Press investigation in Central California — along with the U.S. Central Plains, among the areas most affected — found authorities are doing little to inform the public at large of the growing risk.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At particular risk are the San Joaquin Valley families who rely on private wells; as many as one out of every four of them are unknowingly drinking dangerous amounts of uranium, researchers determined this year and last. Government authorities say long-term exposure to uranium can damage kidneys and raise cancer risks, and scientists say it can have other harmful effects.\u003c/p>\n\u003cp>In this swath of farmland, roughly 250 miles long and encompassing major cities, including Fresno, Bakersfield, and Modesto, the pre-treated water of up to one in 10 public systems has uranium levels that exceed federal and state safety standards, the \u003ca href=\"http://pubs.usgs.gov/circ/1358/\" target=\"_blank\">U.S. Geological Survey has found\u003c/a>.\u003c/p>\n\u003cp>More broadly, nearly 2 million people in California's Central Valley and in the U.S. Midwest live within a half-mile of groundwater containing uranium over the safety standards, University of Nebraska researchers said in a study published in September.\u003c/p>\n\u003cp>Everything from state agencies to tiny rural schools are scrambling to deal with hundreds of tainted public wells — more regulated than private wells under safe-drinking-water laws.\u003c/p>\n\u003cp>That includes water wells at Westport Elementary School, where 450 children from rural families study outside the Central California farm hub of Modesto.\u003c/p>\n\u003cp>At Westport's playground, schoolchildren take a break from tetherball to sip from fountains marked with Spanish and English placards: \"SAFE TO DRINK.\"\u003c/p>\n\u003cp>The school, which draws on its own wells for its drinking fountains, sinks and cafeteria, is one of about 10 water systems in the farm region that have installed uranium removal facilities in recent years. Prices range from $65,000 for the smallest system to millions of dollars.\u003c/p>\n\u003cp>[contextly_sidebar id=\"rPJv8j1Ci8bZ6nTksYCUVlSr51iN6Pw7\"]Just off Westport's playground, a school maintenance chief jangles the keys to the school's treatment operation, locked in a shed the size of a garage. Inside, a system of tubes, dials and canisters resembling large scuba tanks removes up to a pound a year of uranium from the school's wells.\u003c/p>\n\u003cp>The uranium gleaned from the school's well water and other Central California water systems is handled like the nuclear material it is — taken away by workers in masks, gloves and other protective garments, said Ron Dollar, a vice president at Water Remediation Technology, a Colorado-based firm.\u003c/p>\n\u003cp>It is then processed into nuclear fuel for power plants, Dollar said.\u003c/p>\n\u003cp>Before treatment, Westport's water tested up to four times state and federal limits. After treatment, it's safe for the children, teachers and staff to drink.\u003c/p>\n\u003cp>Other Central California farm schools opt to buy bottled water in place of drinking fountains, which are off limits because of uranium and other contaminants.\u003c/p>\n\u003cp>\"We don't have a choice,\" said Terri Lancaster, principal of the 260 students at Waukena Elementary School in rural Tulare County. \"You do what you have to do.\"\u003c/p>\n\u003cp>Until winning a state grant to pay for trucked-in drinking water, her school was spending $10,000 a year from its general fund on bottled water.\u003c/p>\n\u003cp>Meanwhile, the city of Modesto, with a half-million residents, recently spent more than $500,000 to start blending water from one contaminated well to dilute the uranium to safe levels. The city has retired a half-dozen other wells with excess levels of uranium.\u003c/p>\n\u003cp>State officials don't track spending on uranium-contaminated wells. But the state's Water Resources Control Board identified at least $16.7 million the state has spent since 2010 helping public water systems deal with high levels of uranium.\u003c/p>\n\u003cp>In coming years, more public water systems likely will be compelled to invest in such costly fixes, said Miranda Fram, a researcher with the U.S. Geological Survey in Sacramento.\u003c/p>\n\u003cp>Fram and colleagues at USGS have taken the lead over the past decade in identifying the problem in farm centers, including Central California, which produces a quarter of the country's agriculture.\u003c/p>\n\u003cp>Geologists and water experts are still piecing together the ways in which levels of uranium exceeding federal and state health standards are seeping into more public water systems and household wells in major farm areas.\u003c/p>\n\u003cp>Fram and her colleagues believe the amount of uranium increased in Central Valley drinking water supplies over the last 150 years with the spread of farming.\u003c/p>\n\u003cp>In California, as in the Rockies, mountain snowmelt washes uranium-laden sediment to the flatlands, where groundwater is used to irrigate crops.\u003c/p>\n\u003cp>Irrigation allows year-round farming, and the irrigated plants naturally create a weak acid that is leeching more and more uranium from sediment, said Fram and Bryant Jurgens, another USGS researcher.\u003c/p>\n\u003cp>\u003cstrong>Ongoing Drought is a Factor\u003c/strong>\u003c/p>\n\u003cp>Groundwater pumping pulls the contaminated water down into the earth, where it is tapped by wells that supply drinking water.\u003c/p>\n\u003cp>California is now experiencing its driest four-year span on record, and farmers and other users are pumping groundwater at the highest rates ever, helping to pull yet more uranium into areas of aquifers tapped by water wells.\u003c/p>\n\u003cp>\"This has been a decades-long process that has occurred,\" Jurgens said.\u003c/p>\n\u003cp>And even if authorities were to intervene to somehow curb uranium contamination — and no such effort is under way — \"we expect that it's going to take many decades to reverse this,\" Jurgens said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We should not have any doubts as to whether drinking water with uranium in it is a problem or not. It is.' \u003ccite>Doug Brugge, professor of public health, Tufts University School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>The USGS calculates that the average level of uranium in public-supply wells of the eastern San Joaquin Valley increased 17 percent from 1990 to the mid-2000s. The number of public-supply wells with unsafe levels of uranium, meantime, climbed from 7 percent to 10 percent over the same period there.\u003c/p>\n\u003cp>But the problem remains so unpublicized that even Fresno County farmer Mark Sorensen — who grows grapes and blueberries in one of the most impacted parts of the country, and deals with water issues routinely as a leader of the local farm bureau — admits to not knowing about it.\u003c/p>\n\u003cp>\"To be honest, I have never spoken to anybody about uranium,\" said Sorensen, a fifth-generation farmer. \"I've never even heard of it in drinking water.\"\u003c/p>\n\u003cp>Scientists have long known that uranium can damage kidneys and increase the risks of cancer when consumed over a year or more, which is why authorities have set maximum levels for drinking water.\u003c/p>\n\u003cp>Drinking water tainted by uranium is the chief concern — but uranium also sticks to potatoes, radishes and other root vegetables if they're not properly washed. (While studies have confirmed livestock and people can ingest high levels of uranium by eating contaminated vegetation, scientists have yet to fully research the dangers involved.)\u003c/p>\n\u003cp>Though people think mainly about uranium's radioactivity, the danger in water mainly comes from the toxic chemical effects of the metal.\u003c/p>\n\u003cp>Old public health models for uranium date back to the U.S. uranium boom of the 1940s and 1950s, when the U.S. Atomic Energy Commission set off a nuclear-age mining boom in the Central Valley and other points West as the country sought to build uranium stockpiles. Countless miners succumbed to cancer from breathing radioactive gas.\u003c/p>\n\u003cp>But those models now need revising to deal with the larger population exposed through sources like drinking water, academics say.\u003c/p>\n\u003cp>\"We should not have any doubts as to whether drinking water with uranium in it is a problem or not. It is,\" said Doug Brugge, professor of public health and community medicine at Tufts University School of Medicine in Boston. \"The larger the population that's drinking this water, the more people that are going to be affected.\"\u003c/p>\n\u003cp>Because \"there has not been an appreciation of the number of people exposed, it has received a lot less attention\" than it should, said researcher Johnnye Lewis at the University of New Mexico, which along with Brugge's team is studying the health impacts of uranium on communities.\u003c/p>\n\u003cp>Research teams at Tufts and the University of New Mexico also link long-term exposure to signs of reproductive and genetic damage, among other problems.\u003c/p>\n\u003cp>In California, changes in water standards since the late 2000s have mandated testing for uranium in public water systems, and the state frequently helps public water systems deal with wells testing at high levels.\u003c/p>\n\u003cp>\u003cstrong>'I'm Sure A Lot of People Are Unaware'\u003c/strong>\u003c/p>\n\u003cp>For private well owners and small water systems, however, officials were unable to point to any public health campaigns in the most affected areas or any help with testing or dealing with wells that do test for high levels.\u003c/p>\n\u003cp>USGS researchers recently sampled 170 domestic water wells in the San Joaquin Valley, and found 20 to 25 percent bore uranium at levels that broke federal and state limits.\u003c/p>\n\u003cp>State and federal regulators say the U.S. Congress, outlining drinking water standards, has limited its enforcement authority to public water systems. \"Your home's your castle. If you've got a well at home, that's your business,\" said Bruce Macler, a San Francisco-based water program toxicologist for the U.S. Environmental Protection Agency.\u003c/p>\n\u003cp>Uranium is on the radar of California water officials, but the officials are\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/13/nitrates-in-california-drinking-water-new-attention-from-state-water-board/?_ga=1.249130563.514739197.1438904388\" target=\"_blank\"> paying more attention to other farming-related contaminants\u003c/a>, including nitrates, as well as simply having enough water in the fourth year of the state's drought, said John Borkovich, head of water quality at the state Water Resources Control Board.\u003c/p>\n\u003cp>\"When it comes to private domestic wells, we do what we can to get the word out,\" Borkovich said. \"It's safe to say that there's always more that can be done.\"\u003c/p>\n\u003cp>The Associated Press commissioned sampling of wells at five homes in the countryside outside Modesto, to look more closely at whether unregulated private wells that families depend on were as vulnerable as contaminated public water systems nearby.\u003c/p>\n\u003cp>The results: Water from two of the five wells contained dangerous levels of uranium.\u003c/p>\n\u003cp>None of the five families, however, had ever heard that uranium could be a problem in groundwater — let alone that it was a problem in their area.\u003c/p>\n\u003cp>\"That's something I'm sure a lot of people are unaware of,\" said Reyna Rico, whose rural home overlooking farm fields had a well that tested three times the federal and state health limits.\u003c/p>\n\u003cp>\"It would be nice to be informed, so we can make an informed decision, and those wells can be tested,\" said a resident nearby, Michelle Norleen, who was relieved to know that her own water — unlike those of two of her neighbors — tested below the limits in the AP sampling.\u003c/p>\n\u003cp>Even for bigger water systems for which government help is available, accessing safe water doesn't always come quickly. That's true at the Double L Mobile Ranch outside Fresno, where Giselle Alvarez lives in a one-room trailer with her mother and father.\u003c/p>\n\u003cp>Authorities have recorded years of tests showing dangerous levels of uranium in the water provided to the Double L's low-income residents.\u003c/p>\n\u003cp>The park's owner, Carl Hunt, minimized the health risks to the families who live there.\u003c/p>\n\u003cp>\"Not afraid of that water at all,\" Hunt told the AP.\u003c/p>\n\u003cp>An independent water test commissioned by the AP found water at Hunt's trailer park remained over the limits for uranium.\u003c/p>\n\u003cp>Officials trying to set up delivery of safe water for the Double L's families have arranged with a local farm town, Kerman, to run its own water lines out to the trailer park — but Kerman is awaiting funding to deal with its own, uranium-contaminated well first. State officials expect it will take another three years to get safe water to the trailer park.\u003c/p>\n\u003cp>For now, families in the rural trailer park mostly throw away the regular water notices, unable to comprehend their meaning. Suspicious in general of the park's tap water, families at the Double L who can afford it buy bottled water.\u003c/p>\n\u003cp>That doesn't include Alvarez's family.\u003c/p>\n\u003cp>\"We can't really do anything about it,\" she says on the wooden steps of her mobile home. \"As you can see, we're not rich.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Manuel Valdes and Serdar Tumgoren contributed to this report.\u003c/em>\u003c/p>\n\n",
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"excerpt": "As many as one in four San Joaquin Valley families with private wells are unknowingly drinking dangerous amounts of uranium.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a trailer park tucked among the irrigated orchards outside Fresno that help make California's San Joaquin Valley the richest farm region in the world, 16-year-old Giselle Alvarez, one of the few English speakers in this community of farmworkers, puzzles over the notices posted on front doors: There's a danger in their drinking water.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This has been a decades-long process that has occurred. It’s going to take many decades to reverse.”\u003cbr>\n\u003ccite>Bryant Jurgens, U.S. Geological Survey hydrologist\u003c/cite>\u003c/aside>\n\u003cp>Tests for uranium, the notices warn, show a level considered unsafe by federal and state standards. The trailer park's owners are legally required to post the warnings. But the notices are awkwardly worded and in English, a language few of the park's dozens of Spanish-speaking families can read.\u003c/p>\n\u003cp>\"It says you can drink the water -- but if you drink the water over a period of time, you can get cancer,\" said Alvarez, whose working-class family has no choice but to keep drinking and cooking with the tainted tap water daily, as they have since Alvarez was just learning to walk. \"They really don't explain.\"\u003c/p>\n\u003cp>Uranium, the stuff of nuclear fuel for power plants and atom bombs, \u003ca href=\"http://pubs.usgs.gov/circ/1358/\" target=\"_blank\">increasingly is showing up in drinking water systems \u003c/a>in major farming regions of the U.S. West — a naturally occurring but unexpected byproduct of irrigation, of drought, and of the overpumping of natural underground water reserves.\u003c/p>\n\u003cp>An Associated Press investigation in Central California — along with the U.S. Central Plains, among the areas most affected — found authorities are doing little to inform the public at large of the growing risk.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At particular risk are the San Joaquin Valley families who rely on private wells; as many as one out of every four of them are unknowingly drinking dangerous amounts of uranium, researchers determined this year and last. Government authorities say long-term exposure to uranium can damage kidneys and raise cancer risks, and scientists say it can have other harmful effects.\u003c/p>\n\u003cp>In this swath of farmland, roughly 250 miles long and encompassing major cities, including Fresno, Bakersfield, and Modesto, the pre-treated water of up to one in 10 public systems has uranium levels that exceed federal and state safety standards, the \u003ca href=\"http://pubs.usgs.gov/circ/1358/\" target=\"_blank\">U.S. Geological Survey has found\u003c/a>.\u003c/p>\n\u003cp>More broadly, nearly 2 million people in California's Central Valley and in the U.S. Midwest live within a half-mile of groundwater containing uranium over the safety standards, University of Nebraska researchers said in a study published in September.\u003c/p>\n\u003cp>Everything from state agencies to tiny rural schools are scrambling to deal with hundreds of tainted public wells — more regulated than private wells under safe-drinking-water laws.\u003c/p>\n\u003cp>That includes water wells at Westport Elementary School, where 450 children from rural families study outside the Central California farm hub of Modesto.\u003c/p>\n\u003cp>At Westport's playground, schoolchildren take a break from tetherball to sip from fountains marked with Spanish and English placards: \"SAFE TO DRINK.\"\u003c/p>\n\u003cp>The school, which draws on its own wells for its drinking fountains, sinks and cafeteria, is one of about 10 water systems in the farm region that have installed uranium removal facilities in recent years. Prices range from $65,000 for the smallest system to millions of dollars.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Just off Westport's playground, a school maintenance chief jangles the keys to the school's treatment operation, locked in a shed the size of a garage. Inside, a system of tubes, dials and canisters resembling large scuba tanks removes up to a pound a year of uranium from the school's wells.\u003c/p>\n\u003cp>The uranium gleaned from the school's well water and other Central California water systems is handled like the nuclear material it is — taken away by workers in masks, gloves and other protective garments, said Ron Dollar, a vice president at Water Remediation Technology, a Colorado-based firm.\u003c/p>\n\u003cp>It is then processed into nuclear fuel for power plants, Dollar said.\u003c/p>\n\u003cp>Before treatment, Westport's water tested up to four times state and federal limits. After treatment, it's safe for the children, teachers and staff to drink.\u003c/p>\n\u003cp>Other Central California farm schools opt to buy bottled water in place of drinking fountains, which are off limits because of uranium and other contaminants.\u003c/p>\n\u003cp>\"We don't have a choice,\" said Terri Lancaster, principal of the 260 students at Waukena Elementary School in rural Tulare County. \"You do what you have to do.\"\u003c/p>\n\u003cp>Until winning a state grant to pay for trucked-in drinking water, her school was spending $10,000 a year from its general fund on bottled water.\u003c/p>\n\u003cp>Meanwhile, the city of Modesto, with a half-million residents, recently spent more than $500,000 to start blending water from one contaminated well to dilute the uranium to safe levels. The city has retired a half-dozen other wells with excess levels of uranium.\u003c/p>\n\u003cp>State officials don't track spending on uranium-contaminated wells. But the state's Water Resources Control Board identified at least $16.7 million the state has spent since 2010 helping public water systems deal with high levels of uranium.\u003c/p>\n\u003cp>In coming years, more public water systems likely will be compelled to invest in such costly fixes, said Miranda Fram, a researcher with the U.S. Geological Survey in Sacramento.\u003c/p>\n\u003cp>Fram and colleagues at USGS have taken the lead over the past decade in identifying the problem in farm centers, including Central California, which produces a quarter of the country's agriculture.\u003c/p>\n\u003cp>Geologists and water experts are still piecing together the ways in which levels of uranium exceeding federal and state health standards are seeping into more public water systems and household wells in major farm areas.\u003c/p>\n\u003cp>Fram and her colleagues believe the amount of uranium increased in Central Valley drinking water supplies over the last 150 years with the spread of farming.\u003c/p>\n\u003cp>In California, as in the Rockies, mountain snowmelt washes uranium-laden sediment to the flatlands, where groundwater is used to irrigate crops.\u003c/p>\n\u003cp>Irrigation allows year-round farming, and the irrigated plants naturally create a weak acid that is leeching more and more uranium from sediment, said Fram and Bryant Jurgens, another USGS researcher.\u003c/p>\n\u003cp>\u003cstrong>Ongoing Drought is a Factor\u003c/strong>\u003c/p>\n\u003cp>Groundwater pumping pulls the contaminated water down into the earth, where it is tapped by wells that supply drinking water.\u003c/p>\n\u003cp>California is now experiencing its driest four-year span on record, and farmers and other users are pumping groundwater at the highest rates ever, helping to pull yet more uranium into areas of aquifers tapped by water wells.\u003c/p>\n\u003cp>\"This has been a decades-long process that has occurred,\" Jurgens said.\u003c/p>\n\u003cp>And even if authorities were to intervene to somehow curb uranium contamination — and no such effort is under way — \"we expect that it's going to take many decades to reverse this,\" Jurgens said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We should not have any doubts as to whether drinking water with uranium in it is a problem or not. It is.' \u003ccite>Doug Brugge, professor of public health, Tufts University School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>The USGS calculates that the average level of uranium in public-supply wells of the eastern San Joaquin Valley increased 17 percent from 1990 to the mid-2000s. The number of public-supply wells with unsafe levels of uranium, meantime, climbed from 7 percent to 10 percent over the same period there.\u003c/p>\n\u003cp>But the problem remains so unpublicized that even Fresno County farmer Mark Sorensen — who grows grapes and blueberries in one of the most impacted parts of the country, and deals with water issues routinely as a leader of the local farm bureau — admits to not knowing about it.\u003c/p>\n\u003cp>\"To be honest, I have never spoken to anybody about uranium,\" said Sorensen, a fifth-generation farmer. \"I've never even heard of it in drinking water.\"\u003c/p>\n\u003cp>Scientists have long known that uranium can damage kidneys and increase the risks of cancer when consumed over a year or more, which is why authorities have set maximum levels for drinking water.\u003c/p>\n\u003cp>Drinking water tainted by uranium is the chief concern — but uranium also sticks to potatoes, radishes and other root vegetables if they're not properly washed. (While studies have confirmed livestock and people can ingest high levels of uranium by eating contaminated vegetation, scientists have yet to fully research the dangers involved.)\u003c/p>\n\u003cp>Though people think mainly about uranium's radioactivity, the danger in water mainly comes from the toxic chemical effects of the metal.\u003c/p>\n\u003cp>Old public health models for uranium date back to the U.S. uranium boom of the 1940s and 1950s, when the U.S. Atomic Energy Commission set off a nuclear-age mining boom in the Central Valley and other points West as the country sought to build uranium stockpiles. Countless miners succumbed to cancer from breathing radioactive gas.\u003c/p>\n\u003cp>But those models now need revising to deal with the larger population exposed through sources like drinking water, academics say.\u003c/p>\n\u003cp>\"We should not have any doubts as to whether drinking water with uranium in it is a problem or not. It is,\" said Doug Brugge, professor of public health and community medicine at Tufts University School of Medicine in Boston. \"The larger the population that's drinking this water, the more people that are going to be affected.\"\u003c/p>\n\u003cp>Because \"there has not been an appreciation of the number of people exposed, it has received a lot less attention\" than it should, said researcher Johnnye Lewis at the University of New Mexico, which along with Brugge's team is studying the health impacts of uranium on communities.\u003c/p>\n\u003cp>Research teams at Tufts and the University of New Mexico also link long-term exposure to signs of reproductive and genetic damage, among other problems.\u003c/p>\n\u003cp>In California, changes in water standards since the late 2000s have mandated testing for uranium in public water systems, and the state frequently helps public water systems deal with wells testing at high levels.\u003c/p>\n\u003cp>\u003cstrong>'I'm Sure A Lot of People Are Unaware'\u003c/strong>\u003c/p>\n\u003cp>For private well owners and small water systems, however, officials were unable to point to any public health campaigns in the most affected areas or any help with testing or dealing with wells that do test for high levels.\u003c/p>\n\u003cp>USGS researchers recently sampled 170 domestic water wells in the San Joaquin Valley, and found 20 to 25 percent bore uranium at levels that broke federal and state limits.\u003c/p>\n\u003cp>State and federal regulators say the U.S. Congress, outlining drinking water standards, has limited its enforcement authority to public water systems. \"Your home's your castle. If you've got a well at home, that's your business,\" said Bruce Macler, a San Francisco-based water program toxicologist for the U.S. Environmental Protection Agency.\u003c/p>\n\u003cp>Uranium is on the radar of California water officials, but the officials are\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/13/nitrates-in-california-drinking-water-new-attention-from-state-water-board/?_ga=1.249130563.514739197.1438904388\" target=\"_blank\"> paying more attention to other farming-related contaminants\u003c/a>, including nitrates, as well as simply having enough water in the fourth year of the state's drought, said John Borkovich, head of water quality at the state Water Resources Control Board.\u003c/p>\n\u003cp>\"When it comes to private domestic wells, we do what we can to get the word out,\" Borkovich said. \"It's safe to say that there's always more that can be done.\"\u003c/p>\n\u003cp>The Associated Press commissioned sampling of wells at five homes in the countryside outside Modesto, to look more closely at whether unregulated private wells that families depend on were as vulnerable as contaminated public water systems nearby.\u003c/p>\n\u003cp>The results: Water from two of the five wells contained dangerous levels of uranium.\u003c/p>\n\u003cp>None of the five families, however, had ever heard that uranium could be a problem in groundwater — let alone that it was a problem in their area.\u003c/p>\n\u003cp>\"That's something I'm sure a lot of people are unaware of,\" said Reyna Rico, whose rural home overlooking farm fields had a well that tested three times the federal and state health limits.\u003c/p>\n\u003cp>\"It would be nice to be informed, so we can make an informed decision, and those wells can be tested,\" said a resident nearby, Michelle Norleen, who was relieved to know that her own water — unlike those of two of her neighbors — tested below the limits in the AP sampling.\u003c/p>\n\u003cp>Even for bigger water systems for which government help is available, accessing safe water doesn't always come quickly. That's true at the Double L Mobile Ranch outside Fresno, where Giselle Alvarez lives in a one-room trailer with her mother and father.\u003c/p>\n\u003cp>Authorities have recorded years of tests showing dangerous levels of uranium in the water provided to the Double L's low-income residents.\u003c/p>\n\u003cp>The park's owner, Carl Hunt, minimized the health risks to the families who live there.\u003c/p>\n\u003cp>\"Not afraid of that water at all,\" Hunt told the AP.\u003c/p>\n\u003cp>An independent water test commissioned by the AP found water at Hunt's trailer park remained over the limits for uranium.\u003c/p>\n\u003cp>Officials trying to set up delivery of safe water for the Double L's families have arranged with a local farm town, Kerman, to run its own water lines out to the trailer park — but Kerman is awaiting funding to deal with its own, uranium-contaminated well first. State officials expect it will take another three years to get safe water to the trailer park.\u003c/p>\n\u003cp>For now, families in the rural trailer park mostly throw away the regular water notices, unable to comprehend their meaning. Suspicious in general of the park's tap water, families at the Double L who can afford it buy bottled water.\u003c/p>\n\u003cp>That doesn't include Alvarez's family.\u003c/p>\n\u003cp>\"We can't really do anything about it,\" she says on the wooden steps of her mobile home. \"As you can see, we're not rich.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Catholic Hospital in Redding Denies Two Women Tubal Ligation",
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"content": "\u003cp>Redding's Mercy Medical Center has refused -- for the second time in four months -- to allow doctors to perform sterilization on two pregnant women. The women requested the procedure be done immediately after they give birth next year. The hospital cited religious reasons.\u003c/p>\n\u003cp>The American Civil Liberties Union and Physicians for Reproductive Health have sent a letter to Dignity Health, which owns Mercy Medical, saying they will go to court if the issue is not resolved by Wednesday evening.\u003c/p>\n\u003cp>In August, another woman, Rachel Miller, was initially refused her request for tubal ligation -- commonly known as having \"tubes tied\" -- but the \u003ca href=\"http://www.sfgate.com/health/article/Catholic-hospital-backs-down-on-tubal-ligation-6463205.php\" target=\"_blank\">hospital relented and approved the procedure\u003c/a>, after the ACLU threatened legal action.\u003c/p>\n\u003cp>Dignity Health says its general policy is not to provide sterilization unless necessary for the \"cure or alleviation of a present and serious pathology.\"\u003c/p>\n\u003cp>Since Miller's case was resolved, these two additional women have requested, in consultation with their obstetrician, tubal ligation to be performed immediately after they give birth.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of them, 30-year-old Lynsie Brushett, is scheduled to deliver a second child in March. As the \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article47890585.html\" target=\"_blank\">Sacramento Bee reports\u003c/a>, her first pregnancy was difficult.\u003c/p>\n\u003cblockquote>\u003cp>Her son was born 12 weeks prematurely, and she developed severe pre-eclampsia. She said having a second child is all she can safely afford.\u003c/p>\n\u003cp>“It was worth the risk, but I know my body can’t handle any more pregnancies.” she said. “We decided a tubal ligation was the best option to prevent any future unintended pregnancies, for my health and my family.”\u003c/p>\u003c/blockquote>\n\u003cp>She said Mercy Medical, about 200 miles north of San Francisco, is the only place within 70 miles of her home that delivers babies.\u003c/p>\n\u003cp>In its \"Ethical and Religious Directives for Catholic Healthcare Services,\" 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\">U.S. Conference of Catholic Bishops specifically prohibits sterilization\u003c/a>, even labelling it \"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 is California's largest private health care system and owns 32 hospitals in the state. More than half are affiliated with the Catholic Church.\u003c/p>\n\u003cp>California law allows Catholic hospitals to refuse to perform abortions but does not allow them to deny sterilizations. The American College of Obstetricians and Gynecologists says the procedure is safe and used by about 600,000 women in the United States a year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Redding's Mercy Medical Center has refused -- for the second time in four months -- to allow doctors to perform sterilization on two pregnant women. The women requested the procedure be done immediately after they give birth next year. The hospital cited religious reasons.\u003c/p>\n\u003cp>The American Civil Liberties Union and Physicians for Reproductive Health have sent a letter to Dignity Health, which owns Mercy Medical, saying they will go to court if the issue is not resolved by Wednesday evening.\u003c/p>\n\u003cp>In August, another woman, Rachel Miller, was initially refused her request for tubal ligation -- commonly known as having \"tubes tied\" -- but the \u003ca href=\"http://www.sfgate.com/health/article/Catholic-hospital-backs-down-on-tubal-ligation-6463205.php\" target=\"_blank\">hospital relented and approved the procedure\u003c/a>, after the ACLU threatened legal action.\u003c/p>\n\u003cp>Dignity Health says its general policy is not to provide sterilization unless necessary for the \"cure or alleviation of a present and serious pathology.\"\u003c/p>\n\u003cp>Since Miller's case was resolved, these two additional women have requested, in consultation with their obstetrician, tubal ligation to be performed immediately after they give birth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of them, 30-year-old Lynsie Brushett, is scheduled to deliver a second child in March. As the \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article47890585.html\" target=\"_blank\">Sacramento Bee reports\u003c/a>, her first pregnancy was difficult.\u003c/p>\n\u003cblockquote>\u003cp>Her son was born 12 weeks prematurely, and she developed severe pre-eclampsia. She said having a second child is all she can safely afford.\u003c/p>\n\u003cp>“It was worth the risk, but I know my body can’t handle any more pregnancies.” she said. “We decided a tubal ligation was the best option to prevent any future unintended pregnancies, for my health and my family.”\u003c/p>\u003c/blockquote>\n\u003cp>She said Mercy Medical, about 200 miles north of San Francisco, is the only place within 70 miles of her home that delivers babies.\u003c/p>\n\u003cp>In its \"Ethical and Religious Directives for Catholic Healthcare Services,\" 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\">U.S. Conference of Catholic Bishops specifically prohibits sterilization\u003c/a>, even labelling it \"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 is California's largest private health care system and owns 32 hospitals in the state. More than half are affiliated with the Catholic Church.\u003c/p>\n\u003cp>California law allows Catholic hospitals to refuse to perform abortions but does not allow them to deny sterilizations. The American College of Obstetricians and Gynecologists says the procedure is safe and used by about 600,000 women in the United States a year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Oakland Minister Inspires Churchgoers to Address Mental Health",
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"content": "\u003cp>For Rev. Donna Allen’s congregation in West Oakland, the New Revelation Community Church is a place to share with other African-Americans and to find support when facing life’s small and big crises. And for Allen, one of the most important messages is that their community has too often ignored the scourge of mental illness.\u003c/p>\n\u003cp>“They’ll describe being very depressed, like ‘I don’t want to go on. I don’t want to get out of bed, I don’t want to live anymore,’ ” said Allen. “They’re really describing things that are mental health issues.”\u003c/p>\n\u003cp>She is trying to strengthen the community response to the needs of others and make sure church members understand that it’s not just faith that they can lean on when facing mental health problems. It’s an effort promoted by Alameda County, which has invested more than $1 million to help faith communities and other groups to bring mental health services to underserved communities.\u003c/p>\n\u003cp>Allen’s church has secured nearly $5,000 of that money to train congregants about how to help their peers with mental illness.\u003c/p>\n\u003cp>“When you talk to people and say who is the leader in your community, typically they say the ‘faith leaders,’ ” said Gigi Crowder, the ethnic services manager at Alameda County Behavioral Health Care Services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So the county has focused specifically on churches, inviting religious leaders to roundtable discussions about mental health and funding workshops to help congregants reach out to one another.\u003c/p>\n\u003cp>Churches can be particularly helpful in African-American communities where the need for mental health services is great but access often is limited. In general, African-Americans are \u003ca href=\"http://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24\" target=\"_blank\">20 percent more likely\u003c/a> to experience serious mental health problems than non-Hispanic whites, yet only 7.6 percent of black people sought treatment for mental health concerns, according to the \u003ca href=\"http://archive.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2K11MHFR/NSDUHmhfr2011.htm\" target=\"_blank\">Department of Health and Human Services\u003c/a>. That contrasts with 13.6 percent of the general population that has received treatment.\u003c/p>\n\u003cp>Just a year ago, the American Psychological Association published a \u003ca href=\"http://www.apa.org/pubs/journals/releases/ser-a0038122.pdf\" target=\"_blank\">study \u003c/a>that found “significant barriers to mental health services” remain for minority populations, even though the problem has been studied for more than a decade. Dr. David Satcher, while surgeon general, issued a \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK44243/\" target=\"_blank\">landmark report\u003c/a> in 2001 that found minority groups generally had poorer quality mental health care than whites.\u003c/p>\n\u003cp>Allen said she is hoping that by talking about mental health issues and helping to get members of her congregation trained, people “will be less likely to ignore, less likely to walk away, to minimize.”\u003c/p>\n\u003cp>Allen knows firsthand how debilitating that can be. “I’m up front with them that I see a therapist,” she said. “I share with them that I’ve had periods of depression — not saying that I’m going through what you’re going through, but I at least can identify.”\u003c/p>\n\u003cp>She hugs her congregants, she visits their houses, she offers her support. She gives them an opportunity to open up about very personal things that affect mental health, something she says the black church has not always embraced.\u003c/p>\n\u003cp>“I think it helps, especially if I don’t have the stigmas and I don’t have issues with someone having a mental health condition,” she says. “The next step is connecting them with resources and following up with them, encouraging them” to get treatment.\u003c/p>\n\u003cp>So far, her church has held two training sessions for interested congregants on how to handle a mental health crisis.\u003c/p>\n\u003cp>During the day-long sessions, church members learn how to recognize and assist someone who needs help.\u003c/p>\n\u003cp>“Mental disorders can cause disability across a person’s life span and this is why it’s important to detect problems early and ensure the person is properly treated,” says Naki-Ta Thomas, a church member and co-facilitator for the workshop.\u003c/p>\n\u003cp>At their latest training session last summer, the group divided into groups of three for an exercise designed to show what experiencing a schizophrenic episode could be like. One of the participants asked another a constant barrage of basic questions, such as what is your name, where do you work. At the same time, another participant said distracting things through a funnel positioned in the ear of the person trying to answer the questions. “Don’t trust him!” the woman with the funnel said. “He’s looking at you, why is he looking at you? Why would he want to talk to you? He’s looking at you!”\u003c/p>\n\u003cp>Later in the session, Allen points out to the participants that the first instinct when dealing with a person affected by a mental health crisis might be to call the police. Unless there is an immediate threat, that may not be the best choice, she said, because it could “escalate the situation.” That can be especially dangerous in minority communities where distrust and fear on both sides can lead to violence.\u003c/p>\n\u003cp>“It leads people of color to some dire consequences, in terms of being killed, injured or incarcerated as opposed to them getting the treatment that they need for the mental disorder,” Allen said.\u003c/p>\n\u003cp>As an alternative, she suggested to people being trained that they should consider a 24-hour crisis prevention telephone hotline or a suicide hotline phone number.\u003c/p>\n\u003cp>Yvette Frazier, one of Allen’s congregants in the training, put those numbers on her cellphone.\u003c/p>\n\u003cp>“I think that it’s important to recognize,” she said, “that when someone is having some difficulties in church we don’t get scared and run away, regardless of whatever their disorders may be.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For Rev. Donna Allen’s congregation in West Oakland, the New Revelation Community Church is a place to share with other African-Americans and to find support when facing life’s small and big crises. And for Allen, one of the most important messages is that their community has too often ignored the scourge of mental illness.\u003c/p>\n\u003cp>“They’ll describe being very depressed, like ‘I don’t want to go on. I don’t want to get out of bed, I don’t want to live anymore,’ ” said Allen. “They’re really describing things that are mental health issues.”\u003c/p>\n\u003cp>She is trying to strengthen the community response to the needs of others and make sure church members understand that it’s not just faith that they can lean on when facing mental health problems. It’s an effort promoted by Alameda County, which has invested more than $1 million to help faith communities and other groups to bring mental health services to underserved communities.\u003c/p>\n\u003cp>Allen’s church has secured nearly $5,000 of that money to train congregants about how to help their peers with mental illness.\u003c/p>\n\u003cp>“When you talk to people and say who is the leader in your community, typically they say the ‘faith leaders,’ ” said Gigi Crowder, the ethnic services manager at Alameda County Behavioral Health Care Services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So the county has focused specifically on churches, inviting religious leaders to roundtable discussions about mental health and funding workshops to help congregants reach out to one another.\u003c/p>\n\u003cp>Churches can be particularly helpful in African-American communities where the need for mental health services is great but access often is limited. In general, African-Americans are \u003ca href=\"http://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24\" target=\"_blank\">20 percent more likely\u003c/a> to experience serious mental health problems than non-Hispanic whites, yet only 7.6 percent of black people sought treatment for mental health concerns, according to the \u003ca href=\"http://archive.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2K11MHFR/NSDUHmhfr2011.htm\" target=\"_blank\">Department of Health and Human Services\u003c/a>. That contrasts with 13.6 percent of the general population that has received treatment.\u003c/p>\n\u003cp>Just a year ago, the American Psychological Association published a \u003ca href=\"http://www.apa.org/pubs/journals/releases/ser-a0038122.pdf\" target=\"_blank\">study \u003c/a>that found “significant barriers to mental health services” remain for minority populations, even though the problem has been studied for more than a decade. Dr. David Satcher, while surgeon general, issued a \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK44243/\" target=\"_blank\">landmark report\u003c/a> in 2001 that found minority groups generally had poorer quality mental health care than whites.\u003c/p>\n\u003cp>Allen said she is hoping that by talking about mental health issues and helping to get members of her congregation trained, people “will be less likely to ignore, less likely to walk away, to minimize.”\u003c/p>\n\u003cp>Allen knows firsthand how debilitating that can be. “I’m up front with them that I see a therapist,” she said. “I share with them that I’ve had periods of depression — not saying that I’m going through what you’re going through, but I at least can identify.”\u003c/p>\n\u003cp>She hugs her congregants, she visits their houses, she offers her support. She gives them an opportunity to open up about very personal things that affect mental health, something she says the black church has not always embraced.\u003c/p>\n\u003cp>“I think it helps, especially if I don’t have the stigmas and I don’t have issues with someone having a mental health condition,” she says. “The next step is connecting them with resources and following up with them, encouraging them” to get treatment.\u003c/p>\n\u003cp>So far, her church has held two training sessions for interested congregants on how to handle a mental health crisis.\u003c/p>\n\u003cp>During the day-long sessions, church members learn how to recognize and assist someone who needs help.\u003c/p>\n\u003cp>“Mental disorders can cause disability across a person’s life span and this is why it’s important to detect problems early and ensure the person is properly treated,” says Naki-Ta Thomas, a church member and co-facilitator for the workshop.\u003c/p>\n\u003cp>At their latest training session last summer, the group divided into groups of three for an exercise designed to show what experiencing a schizophrenic episode could be like. One of the participants asked another a constant barrage of basic questions, such as what is your name, where do you work. At the same time, another participant said distracting things through a funnel positioned in the ear of the person trying to answer the questions. “Don’t trust him!” the woman with the funnel said. “He’s looking at you, why is he looking at you? Why would he want to talk to you? He’s looking at you!”\u003c/p>\n\u003cp>Later in the session, Allen points out to the participants that the first instinct when dealing with a person affected by a mental health crisis might be to call the police. Unless there is an immediate threat, that may not be the best choice, she said, because it could “escalate the situation.” That can be especially dangerous in minority communities where distrust and fear on both sides can lead to violence.\u003c/p>\n\u003cp>“It leads people of color to some dire consequences, in terms of being killed, injured or incarcerated as opposed to them getting the treatment that they need for the mental disorder,” Allen said.\u003c/p>\n\u003cp>As an alternative, she suggested to people being trained that they should consider a 24-hour crisis prevention telephone hotline or a suicide hotline phone number.\u003c/p>\n\u003cp>Yvette Frazier, one of Allen’s congregants in the training, put those numbers on her cellphone.\u003c/p>\n\u003cp>“I think that it’s important to recognize,” she said, “that when someone is having some difficulties in church we don’t get scared and run away, regardless of whatever their disorders may be.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Assisted-Death Laws Accentuate Need for Palliative Care, Doctors Say",
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"content": "\u003cp>More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming.\u003c/p>\n\u003cp>If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. “I would want an escape hatch,” she said.\u003c/p>\n\u003cp>In October, California became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it. The law takes effect in 2016.\u003c/p>\n\u003cp>Yet van Zyl can’t see herself as one of those doctors.\u003c/p>\n\u003cp>“This is my life’s work, to relieve suffering,” said van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center. To her, that does not mean cutting short a life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I can’t imagine pulling the trigger,” she said.\u003c/p>\n\u003cp>Weeks after California 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, palliative care physicians like van Zyl are trying to come to terms with what it means for them and their terminally ill patients.\u003c/p>\n\u003cfigure id=\"attachment_118447\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\">\u003cimg class=\"size-full wp-image-118447\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\" alt=\"Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer.\" width=\"1919\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not just a question of whether they support aid-in-dying or personally would ever help end a life. Palliative care doctors say the law underscores the need to raise awareness among doctors and patients about what they do and to expand access to high-quality programs.\u003c/p>\n\u003cp>Contrary to some patients’ fears, they say, palliative care doctors are not there to hasten death. Their job is to help seriously ill people get relief from symptoms and stress, and to improve quality of life for them and their families, regardless of how long the patients have to live.\u003c/p>\n\u003cp>The California law should be a “wake-up” call because it shows “how terrified patients are of what they will experience at the end of life,” said Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York.\u003c/p>\n\u003cp>Morrison said that once patients who want to hasten their death get their symptoms controlled and their spiritual needs addressed, the overwhelming majority want to keep living.\u003c/p>\n\u003cp>“Their choice shouldn’t be an assisted death or living with intractable suffering,” Morrison said. “That’s what laws allowing assisted suicide, in the absence of palliative care, present as a choice to patients.”\u003c/p>\n\u003cp>Palliative care has become more widespread in recent years, and more doctors, nurses and social workers are being trained in how to provide it. In addition, \u003ca href=\"http://Dr.%20Carin%20van%20Zyl%20talks%20to%20patient%20Jose%20Garcia%20Flores%20about%20his%20treatment%20options%20for%20his%20advanced%20stage%20colon%20cancer.\" target=\"_blank\">recent legislation in California\u003c/a> requires that Medi-Cal managed care plans ensure access to programs.\u003c/p>\n\u003cfigure id=\"attachment_118446\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\">\u003cimg class=\"size-full wp-image-118446\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\" alt=\"Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But gaps remain. A \u003ca href=\"http://www.chcf.org/publications/2015/02/palliative-care-data\" target=\"_blank\">recent report by\u003c/a> the California HealthCare Foundation showed that residents in 22 of 58 California counties don’t have access to community-based palliative care, and those in 19 counties don’t have access to in-patient programs. Foundation researchers also found recently that specialists are in short supply and that there is no reliable way to pay for such care.\u003c/p>\n\u003cp>Dr. Ira Byock, a palliative care expert who opposed the California law, said its passage makes it more important than ever that all doctors receive more education on how to treat symptoms in seriously ill patients and talk with patients about what they want in their final months.\u003c/p>\n\u003cp>“As hard as illness and dying are … people still have the capacity to experience the sense of well-being,” said Byock, who heads the Providence Institute for Human Caring in Torrance, Calif.\u003c/p>\n\u003cp>Without palliative care programs, Byock and others say those conversations don’t always take place. Only about 17 percent of patients have had end-of-life discussions with their doctors, though nearly 90 percent believe doctors should be doing so, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-september-2015/\" target=\"_blank\">recent poll by the Kaiser Family Foundation\u003c/a>. In addition, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25488909\" target=\"_blank\">research out of the Mayo Clinic\u003c/a> found that only 12 percent of doctors had yearly end-of-life discussions with heart failure patients, and about 30 percent of the physicians had “little confidence” doing so.\u003c/p>\n\u003cp>Dr. Tony Back, who is co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, said that after a similar aid-in-dying law passed in his state, more doctors realized that they “couldn’t just push it off on somebody else.”\u003c/p>\n\u003cp>As van Zyl struggles with her own reactions to the new law, she continues to have those tough conversations with one patient after another, every day.\u003c/p>\n\u003cfigure id=\"attachment_118445\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-e1449270397355.jpg\">\u003cimg class=\"size-thumbnail wp-image-118445\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-400x599.jpg\" alt=\"Jose Garcia Flores’ wife stands quietly at her husband’s bedside.\" width=\"400\" height=\"599\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores’ wife stands quietly at her husband’s bedside. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent day, more than two dozen names were listed on a white board in her hospital offices — all of them patients referred to her team for care. A 33-year-old woman with metastatic breast cancer. A 50-year-old with pancreatic cancer that had spread to her lungs. A 20-year-old man with a fast-growing brain tumor.\u003c/p>\n\u003cp>One patient van Zyl visited that day was Jose Garcia Flores, a gaunt, 60-year-old with advanced stage colon cancer. The former electrician had been diagnosed in the spring and was back in the hospital because of pain and nausea.\u003c/p>\n\u003cp>Van Zyl told him that there was a possibility that doctors would no longer be able to continue chemotherapy because of a complication. Van Zyl asked what he valued more — living longer, no matter what that looked like, or not living as long but being able to spend quality time with family at home.\u003c/p>\n\u003cp>“There is no right answer,” she said, promising to do everything she could to ease his pain and control his symptoms, regardless of whether he wanted to continue treatment for his cancer.\u003c/p>\n\u003cp>Garcia Flores paused and looked over at his wife standing next to the hospital bed. “I would prefer… to enjoy time with my family,” he said in Spanish.\u003c/p>\n\u003cp>“This isn’t fair — any of this,” she told him. “You are very brave.”\u003c/p>\n\u003cp>Van Zyl said that none of her patients have asked yet about the aid-in-dying law, which takes effect next year. She wonders if many of them even know about it.\u003c/p>\n\u003cp>A native of South Africa who used to work in emergency medicine, van Zyl said she recognizes that her views on the new law are hypocritical. “I don’t have a logical answer why I would want it for myself but not want to offer it to my patients,” she said. “I don’t know why I am still sitting on this fence that is increasingly pointy and uncomfortable.”\u003c/p>\n\u003cp>Part of it, she believes, is simple: “I’m deeply afraid of dying.”\u003c/p>\n\u003cfigure id=\"attachment_118448\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\">\u003cimg class=\"size-full wp-image-118448\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\" alt=\"Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center.\" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she knows, as a doctor, that death doesn’t have to be scary. Some problems, she says, have medical solutions — there are effective medications for pain and anxiety, for instance, so people can die peacefully. Van Zyl says her patients have always stopped asking to have their lives shortened once their symptoms were controlled.\u003c/p>\n\u003cp>Van Zyl believes medical providers, regardless of specialty, can be taught how to provide palliative care. That’s part of her job. And on this day, she stood before half a dozen medical residents, reviewing the best treatments for nausea, pain and shortness of breath. But suffering isn’t always physical, she said. Patients and families also need help coping with emotional suffering, she said.\u003c/p>\n\u003cp>“It is possible to screw up a family for life with a bad conversation,” she said. Van Zyl urged the residents not to run away from direct and honest — though hard — discussions. “Don’t do what so many doctors do, which is crumble.”\u003c/p>\n\u003cp>Then van Zyl brought up the aid-in-dying law. “What will you do when your patients says, ‘Can you kill me?’” she asked the group. “Somebody, at some point, is going to ask you to do that.”\u003c/p>\n\u003cp>One resident said that for her, prescribing lethal medication would be on a case-by-case basis. She would want to make sure the patient’s symptoms and pain were under control first. Another said she worried about how her own family would view her decision to help patients end their lives.\u003c/p>\n\u003cp>A third, Roshel Graham, said that no matter what, she hoped the law will help raise awareness about the benefits of palliative care. “I don’t think a lot of people even know palliative care exists,” she said.\u003c/p>\n\u003cp>As time goes on and doctors in California begin prescribing medicine to help people hasten their deaths, van Zyl said, perhaps her own views will become less conflicted.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Maybe my position will evolve,” she said. “I could imagine one bad death tipping me over.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming.\u003c/p>\n\u003cp>If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. “I would want an escape hatch,” she said.\u003c/p>\n\u003cp>In October, California became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it. The law takes effect in 2016.\u003c/p>\n\u003cp>Yet van Zyl can’t see herself as one of those doctors.\u003c/p>\n\u003cp>“This is my life’s work, to relieve suffering,” said van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center. To her, that does not mean cutting short a life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I can’t imagine pulling the trigger,” she said.\u003c/p>\n\u003cp>Weeks after California 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, palliative care physicians like van Zyl are trying to come to terms with what it means for them and their terminally ill patients.\u003c/p>\n\u003cfigure id=\"attachment_118447\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\">\u003cimg class=\"size-full wp-image-118447\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\" alt=\"Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer.\" width=\"1919\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not just a question of whether they support aid-in-dying or personally would ever help end a life. Palliative care doctors say the law underscores the need to raise awareness among doctors and patients about what they do and to expand access to high-quality programs.\u003c/p>\n\u003cp>Contrary to some patients’ fears, they say, palliative care doctors are not there to hasten death. Their job is to help seriously ill people get relief from symptoms and stress, and to improve quality of life for them and their families, regardless of how long the patients have to live.\u003c/p>\n\u003cp>The California law should be a “wake-up” call because it shows “how terrified patients are of what they will experience at the end of life,” said Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York.\u003c/p>\n\u003cp>Morrison said that once patients who want to hasten their death get their symptoms controlled and their spiritual needs addressed, the overwhelming majority want to keep living.\u003c/p>\n\u003cp>“Their choice shouldn’t be an assisted death or living with intractable suffering,” Morrison said. “That’s what laws allowing assisted suicide, in the absence of palliative care, present as a choice to patients.”\u003c/p>\n\u003cp>Palliative care has become more widespread in recent years, and more doctors, nurses and social workers are being trained in how to provide it. In addition, \u003ca href=\"http://Dr.%20Carin%20van%20Zyl%20talks%20to%20patient%20Jose%20Garcia%20Flores%20about%20his%20treatment%20options%20for%20his%20advanced%20stage%20colon%20cancer.\" target=\"_blank\">recent legislation in California\u003c/a> requires that Medi-Cal managed care plans ensure access to programs.\u003c/p>\n\u003cfigure id=\"attachment_118446\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\">\u003cimg class=\"size-full wp-image-118446\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\" alt=\"Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But gaps remain. A \u003ca href=\"http://www.chcf.org/publications/2015/02/palliative-care-data\" target=\"_blank\">recent report by\u003c/a> the California HealthCare Foundation showed that residents in 22 of 58 California counties don’t have access to community-based palliative care, and those in 19 counties don’t have access to in-patient programs. Foundation researchers also found recently that specialists are in short supply and that there is no reliable way to pay for such care.\u003c/p>\n\u003cp>Dr. Ira Byock, a palliative care expert who opposed the California law, said its passage makes it more important than ever that all doctors receive more education on how to treat symptoms in seriously ill patients and talk with patients about what they want in their final months.\u003c/p>\n\u003cp>“As hard as illness and dying are … people still have the capacity to experience the sense of well-being,” said Byock, who heads the Providence Institute for Human Caring in Torrance, Calif.\u003c/p>\n\u003cp>Without palliative care programs, Byock and others say those conversations don’t always take place. Only about 17 percent of patients have had end-of-life discussions with their doctors, though nearly 90 percent believe doctors should be doing so, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-september-2015/\" target=\"_blank\">recent poll by the Kaiser Family Foundation\u003c/a>. In addition, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25488909\" target=\"_blank\">research out of the Mayo Clinic\u003c/a> found that only 12 percent of doctors had yearly end-of-life discussions with heart failure patients, and about 30 percent of the physicians had “little confidence” doing so.\u003c/p>\n\u003cp>Dr. Tony Back, who is co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, said that after a similar aid-in-dying law passed in his state, more doctors realized that they “couldn’t just push it off on somebody else.”\u003c/p>\n\u003cp>As van Zyl struggles with her own reactions to the new law, she continues to have those tough conversations with one patient after another, every day.\u003c/p>\n\u003cfigure id=\"attachment_118445\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-e1449270397355.jpg\">\u003cimg class=\"size-thumbnail wp-image-118445\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-400x599.jpg\" alt=\"Jose Garcia Flores’ wife stands quietly at her husband’s bedside.\" width=\"400\" height=\"599\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores’ wife stands quietly at her husband’s bedside. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent day, more than two dozen names were listed on a white board in her hospital offices — all of them patients referred to her team for care. A 33-year-old woman with metastatic breast cancer. A 50-year-old with pancreatic cancer that had spread to her lungs. A 20-year-old man with a fast-growing brain tumor.\u003c/p>\n\u003cp>One patient van Zyl visited that day was Jose Garcia Flores, a gaunt, 60-year-old with advanced stage colon cancer. The former electrician had been diagnosed in the spring and was back in the hospital because of pain and nausea.\u003c/p>\n\u003cp>Van Zyl told him that there was a possibility that doctors would no longer be able to continue chemotherapy because of a complication. Van Zyl asked what he valued more — living longer, no matter what that looked like, or not living as long but being able to spend quality time with family at home.\u003c/p>\n\u003cp>“There is no right answer,” she said, promising to do everything she could to ease his pain and control his symptoms, regardless of whether he wanted to continue treatment for his cancer.\u003c/p>\n\u003cp>Garcia Flores paused and looked over at his wife standing next to the hospital bed. “I would prefer… to enjoy time with my family,” he said in Spanish.\u003c/p>\n\u003cp>“This isn’t fair — any of this,” she told him. “You are very brave.”\u003c/p>\n\u003cp>Van Zyl said that none of her patients have asked yet about the aid-in-dying law, which takes effect next year. She wonders if many of them even know about it.\u003c/p>\n\u003cp>A native of South Africa who used to work in emergency medicine, van Zyl said she recognizes that her views on the new law are hypocritical. “I don’t have a logical answer why I would want it for myself but not want to offer it to my patients,” she said. “I don’t know why I am still sitting on this fence that is increasingly pointy and uncomfortable.”\u003c/p>\n\u003cp>Part of it, she believes, is simple: “I’m deeply afraid of dying.”\u003c/p>\n\u003cfigure id=\"attachment_118448\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\">\u003cimg class=\"size-full wp-image-118448\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\" alt=\"Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center.\" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she knows, as a doctor, that death doesn’t have to be scary. Some problems, she says, have medical solutions — there are effective medications for pain and anxiety, for instance, so people can die peacefully. Van Zyl says her patients have always stopped asking to have their lives shortened once their symptoms were controlled.\u003c/p>\n\u003cp>Van Zyl believes medical providers, regardless of specialty, can be taught how to provide palliative care. That’s part of her job. And on this day, she stood before half a dozen medical residents, reviewing the best treatments for nausea, pain and shortness of breath. But suffering isn’t always physical, she said. Patients and families also need help coping with emotional suffering, she said.\u003c/p>\n\u003cp>“It is possible to screw up a family for life with a bad conversation,” she said. Van Zyl urged the residents not to run away from direct and honest — though hard — discussions. “Don’t do what so many doctors do, which is crumble.”\u003c/p>\n\u003cp>Then van Zyl brought up the aid-in-dying law. “What will you do when your patients says, ‘Can you kill me?’” she asked the group. “Somebody, at some point, is going to ask you to do that.”\u003c/p>\n\u003cp>One resident said that for her, prescribing lethal medication would be on a case-by-case basis. She would want to make sure the patient’s symptoms and pain were under control first. Another said she worried about how her own family would view her decision to help patients end their lives.\u003c/p>\n\u003cp>A third, Roshel Graham, said that no matter what, she hoped the law will help raise awareness about the benefits of palliative care. “I don’t think a lot of people even know palliative care exists,” she said.\u003c/p>\n\u003cp>As time goes on and doctors in California begin prescribing medicine to help people hasten their deaths, van Zyl said, perhaps her own views will become less conflicted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Maybe my position will evolve,” she said. “I could imagine one bad death tipping me over.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Kaiser Permanente, the California-based health care and insurance provider, says it will acquire another major insurer in Washington state, Group Health Cooperative.\u003c/p>\n\u003cp>The proposed deal announced Friday would add about 590,000 members to Kaiser, which already serves more than 10 million people in eight states and Washington, D.C., 7.8 million of them in California. Both insurers are nonprofits which feature integrated systems of health care where they provide insurance and health care providers in one system.\u003c/p>\n\u003cp>In a joint statement, the companies said the proceeds of the deal, about $1.8 billion, will fund a new, nonprofit foundation, \"with the goal of improving community health.\"\u003c/p>\n\u003cp>Officials said no immediate changes are planned in coverage and care for current Group Health members. The transaction is subject to approval by Group Health's voting membership and by regulators.\u003c/p>\n\u003cp>\"This agreement is a natural extension of our long, successful working relationship with Group Health and it provides us with the opportunity to expand access to high-quality, affordable care and coverage,\" Bernard J. Tyson, CEO of Kaiser Foundation Health Plan and Hospitals, said in a statement, and called the two organizations \"a natural fit.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"http://www.wsj.com/articles/kaiser-permanente-to-buy-major-insurer-in-washington-state-1449241200\" target=\"_blank\">Wall Street Journal \u003c/a>cited analysts who said the deal makes sense:\u003c/p>\n\u003cblockquote>\u003cp>“They are certainly aligned philosophically,” said Raj Bal, an insurance-industry consultant, who added that Kaiser could bring technology and other resources to the smaller insurer, while the combined operation will have significant scale in its region. ...\u003c/p>\n\u003cp>The Group Health acquisition will draw attention “as a potential bellwether for other deals like it” that Kaiser could make in the future, said Dave Osterndorf, a partner at Health Exchange Resources Inc., a consultancy.\u003c/p>\u003c/blockquote>\n\u003cp>Scott Armstrong, Group Health's president and CEO said that the deal was a \"unique opportunity to accelerate our growth and potential.\" Kaiser said it will invest in Group Health's facilities and technology.\u003c/p>\n\u003cp>The two plans have allowed the other's members to receive care if visiting the other plan's service area for almost two decades.\u003c/p>\n\u003cp>Kaiser Permanente is based in Oakland and had $56.4 billion in revenue last year. In addition to its California membership, the plan operates in Oregon, Hawaii, parts of southwest Washington, Colorado, Georgia, Virginia, Maryland and Washington, D.C.\u003c/p>\n\u003cp>Group Health is based in Seattle and had $3.7 billion in revenue last year. It operates mostly in Washington but also serves two counties in northern Idaho.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kaiser Permanente, the California-based health care and insurance provider, says it will acquire another major insurer in Washington state, Group Health Cooperative.\u003c/p>\n\u003cp>The proposed deal announced Friday would add about 590,000 members to Kaiser, which already serves more than 10 million people in eight states and Washington, D.C., 7.8 million of them in California. Both insurers are nonprofits which feature integrated systems of health care where they provide insurance and health care providers in one system.\u003c/p>\n\u003cp>In a joint statement, the companies said the proceeds of the deal, about $1.8 billion, will fund a new, nonprofit foundation, \"with the goal of improving community health.\"\u003c/p>\n\u003cp>Officials said no immediate changes are planned in coverage and care for current Group Health members. The transaction is subject to approval by Group Health's voting membership and by regulators.\u003c/p>\n\u003cp>\"This agreement is a natural extension of our long, successful working relationship with Group Health and it provides us with the opportunity to expand access to high-quality, affordable care and coverage,\" Bernard J. Tyson, CEO of Kaiser Foundation Health Plan and Hospitals, said in a statement, and called the two organizations \"a natural fit.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"http://www.wsj.com/articles/kaiser-permanente-to-buy-major-insurer-in-washington-state-1449241200\" target=\"_blank\">Wall Street Journal \u003c/a>cited analysts who said the deal makes sense:\u003c/p>\n\u003cblockquote>\u003cp>“They are certainly aligned philosophically,” said Raj Bal, an insurance-industry consultant, who added that Kaiser could bring technology and other resources to the smaller insurer, while the combined operation will have significant scale in its region. ...\u003c/p>\n\u003cp>The Group Health acquisition will draw attention “as a potential bellwether for other deals like it” that Kaiser could make in the future, said Dave Osterndorf, a partner at Health Exchange Resources Inc., a consultancy.\u003c/p>\u003c/blockquote>\n\u003cp>Scott Armstrong, Group Health's president and CEO said that the deal was a \"unique opportunity to accelerate our growth and potential.\" Kaiser said it will invest in Group Health's facilities and technology.\u003c/p>\n\u003cp>The two plans have allowed the other's members to receive care if visiting the other plan's service area for almost two decades.\u003c/p>\n\u003cp>Kaiser Permanente is based in Oakland and had $56.4 billion in revenue last year. In addition to its California membership, the plan operates in Oregon, Hawaii, parts of southwest Washington, Colorado, Georgia, Virginia, Maryland and Washington, D.C.\u003c/p>\n\u003cp>Group Health is based in Seattle and had $3.7 billion in revenue last year. It operates mostly in Washington but also serves two counties in northern Idaho.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "inland-regional-center-san-bernardino-mass-shooting",
"title": "The Story Behind the Inland Regional Center, Site of San Bernardino Massacre",
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"headTitle": "The Story Behind the Inland Regional Center, Site of San Bernardino Massacre | KQED",
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"content": "\u003cp>As you’ve certainly heard by now,\u003ca href=\"https://www.kqed.org/news/10779221/many-casualties-in-mass-shooting-in-san-bernardino\" target=\"_blank\"> a mass shooting\u003c/a> in San Bernardino on Wednesday morning has left at least 14 people dead and at least 17 wounded.\u003c/p>\n\u003cp>Two suspects in the attack, which occurred on the grounds of a social service facility called the Inland Regional Center, died in a gunbattle with police.\u003c/p>\n\u003cp>What exactly is the Inland Regional Center and its mission?\u003c/p>\n\u003cp>It was created by the state as part of a network of regional centers, and it serves adults and children in San Bernardino and Riverside counties who have developmental disabilities.\u003c/p>\n\u003cp>Such disabilities include those resulting from Down syndrome, epilepsy, autism and cerebral palsy.\u003c/p>\n\u003cp>If you have a loved one with a developmental disability, your first stop in California is the regional center in your area. There are \u003ca href=\"https://www.dds.ca.gov/rc/listings/\" target=\"_blank\">21 regional centers\u003c/a> statewide. As State of Health \u003ca href=\"https://www.kqed.org/stateofhealth/113928/developmentally-disabled-people-face-losing-access-to-services-as-closures-hit\" target=\"_blank\">reported last week\u003c/a>, regional centers were created after the \u003ca href=\"https://www.dds.ca.gov/newsletter/the-lanterman-act-entitlement-a-promise-that-sets-california-apart/\" target=\"_blank\">1969 Lanterman Act\u003c/a> ended the mass institutionalization of people with developmental disabilities and created the network of the nonprofit centers.\u003c/p>\n\u003cp>“The majority of work that regional centers do,” said Eileen Richey, executive director of the \u003ca href=\"http://arcanet.org\" target=\"_blank\">Association of Regional Center Agencies\u003c/a>, “is providing case management services to people with developmental disabilities as well as their families.”\u003c/p>\n\u003cfigure id=\"attachment_117454\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-117454\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-800x533.jpg\" alt=\"Employees and other people are evacuated by bus from the site of a mass shooting at the Inland Regional Center in San Bernardino.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-960x640.jpg 960w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" />\u003cfigcaption class=\"wp-caption-text\">Employees and other people are evacuated by bus from the site of a mass shooting at the Inland Regional Center in San Bernardino. \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While most of the direct services or treatments happen at providers’ offices in the community, clients and families are frequently found in the regional centers.\u003c/p>\n\u003cp>“They could be there for a development plan,” Richey said in an interview, “and they could be at a regional center for an evaluation or an assessment for services.”\u003c/p>\n\u003cp>Almost certainly, people with developmental disabilities and family members were in the Inland Regional Center when the shooting started. The Inland center is the state’s largest, with more than 600 staff members and 30,000 clients. It’s hard to gauge how widespread the impact of today’s events will be on the center’s clients.\u003c/p>\n\u003cp>Helping a loved one with a developmental disability cope with the tragedy will depend on the person, says Karla McLaren, the Santa Rosa author of “The Art of Empathy.”\u003c/p>\n\u003cp>“Everyone will experience it differently,” she said. “And it’s important to listen to the person’s own fears or own concerns … and to talk about that frankly.”\u003c/p>\n\u003cp>Olivia Balcao, a social worker and senior program analyst with the Association of Regional Center Agencies, said it’s important to be aware of the person’s disability and their own ability to take in the information.\u003c/p>\n\u003cp>“You share an amount and try to see how much they’re grasping, how much they’re processing, if they have any questions, and give them the lead.”\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As you’ve certainly heard by now,\u003ca href=\"https://www.kqed.org/news/10779221/many-casualties-in-mass-shooting-in-san-bernardino\" target=\"_blank\"> a mass shooting\u003c/a> in San Bernardino on Wednesday morning has left at least 14 people dead and at least 17 wounded.\u003c/p>\n\u003cp>Two suspects in the attack, which occurred on the grounds of a social service facility called the Inland Regional Center, died in a gunbattle with police.\u003c/p>\n\u003cp>What exactly is the Inland Regional Center and its mission?\u003c/p>\n\u003cp>It was created by the state as part of a network of regional centers, and it serves adults and children in San Bernardino and Riverside counties who have developmental disabilities.\u003c/p>\n\u003cp>Such disabilities include those resulting from Down syndrome, epilepsy, autism and cerebral palsy.\u003c/p>\n\u003cp>If you have a loved one with a developmental disability, your first stop in California is the regional center in your area. There are \u003ca href=\"https://www.dds.ca.gov/rc/listings/\" target=\"_blank\">21 regional centers\u003c/a> statewide. As State of Health \u003ca href=\"https://www.kqed.org/stateofhealth/113928/developmentally-disabled-people-face-losing-access-to-services-as-closures-hit\" target=\"_blank\">reported last week\u003c/a>, regional centers were created after the \u003ca href=\"https://www.dds.ca.gov/newsletter/the-lanterman-act-entitlement-a-promise-that-sets-california-apart/\" target=\"_blank\">1969 Lanterman Act\u003c/a> ended the mass institutionalization of people with developmental disabilities and created the network of the nonprofit centers.\u003c/p>\n\u003cp>“The majority of work that regional centers do,” said Eileen Richey, executive director of the \u003ca href=\"http://arcanet.org\" target=\"_blank\">Association of Regional Center Agencies\u003c/a>, “is providing case management services to people with developmental disabilities as well as their families.”\u003c/p>\n\u003cfigure id=\"attachment_117454\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-117454\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-800x533.jpg\" alt=\"Employees and other people are evacuated by bus from the site of a mass shooting at the Inland Regional Center in San Bernardino.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2015/12/RS17552_GettyImages-499638876-qut-960x640.jpg 960w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" />\u003cfigcaption class=\"wp-caption-text\">Employees and other people are evacuated by bus from the site of a mass shooting at the Inland Regional Center in San Bernardino. \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While most of the direct services or treatments happen at providers’ offices in the community, clients and families are frequently found in the regional centers.\u003c/p>\n\u003cp>“They could be there for a development plan,” Richey said in an interview, “and they could be at a regional center for an evaluation or an assessment for services.”\u003c/p>\n\u003cp>Almost certainly, people with developmental disabilities and family members were in the Inland Regional Center when the shooting started. The Inland center is the state’s largest, with more than 600 staff members and 30,000 clients. It’s hard to gauge how widespread the impact of today’s events will be on the center’s clients.\u003c/p>\n\u003cp>Helping a loved one with a developmental disability cope with the tragedy will depend on the person, says Karla McLaren, the Santa Rosa author of “The Art of Empathy.”\u003c/p>\n\u003cp>“Everyone will experience it differently,” she said. “And it’s important to listen to the person’s own fears or own concerns … and to talk about that frankly.”\u003c/p>\n\u003cp>Olivia Balcao, a social worker and senior program analyst with the Association of Regional Center Agencies, said it’s important to be aware of the person’s disability and their own ability to take in the information.\u003c/p>\n\u003cp>“You share an amount and try to see how much they’re grasping, how much they’re processing, if they have any questions, and give them the lead.”\u003c/p>\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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