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Jerry Brown signed the End of Life Option Act on Monday.\u003c/p>\n\u003cp>But the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\">law\u003c/a> still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>And there might be no good way around this.\u003c/p>\n\u003cp>These restrictions might be necessary at this point in the history of aid in dying in this country, according to Judith Schwarz of the advocacy group \u003ca href=\"http://endoflifechoicesny.org/\" target=\"_blank\">End of Life Choices New York\u003c/a>. \"Opponents have many fears that such laws will be misapplied to the disenfranchised,\" she wrote in an email, and it's important to guarantee that for these groups — the poor, the elderly, the isolated — the \"right to die\" doesn't somehow morph into the duty to die \"for the sake of others.\"\u003c/p>\n\u003cp>Still, there's a problem with limiting the death-with-dignity option only to those with a prognosis of fewer than six months. For one thing, prognosis is difficult, and studies show that doctors are actually overoptimistic in their assessment of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/384011538/cancer-patients-and-doctors-struggle-to-predict-survival\" target=\"_blank\">how long their patients have to live\u003c/a>. \"Some doctors may wish to be more compassionate and not be as specific,\" Janis Landis, president of the Final Exit Network, wrote in an email, \"and ironically thus deny the patient the certification that is required.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And then there are the conditions that are completely unpredictable, not only in terms of life expectancy but in terms of how, when and in what order functions will be lost. This includes progressive neurological diseases like multiple sclerosis and ALS, where those who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to swallow a pill might disappear without warning.\u003c/p>\n\u003cp>\"Fear of this actually drives some individuals to act early, while they can still procure the equipment they need,\" Landis wrote. To her, it seems especially harsh \"to force such a cruel choice on an individual already suffering so greatly.\"\u003c/p>\n\u003cp>As fraught as it is, though, the requirement that a person be able to swallow lethal medication on his own is an important safeguard, according to Mickey MacIntyre, the chief strategic officer of Compassion & Choices. \"This self-administration requirement is a critical distinction between medical aid in dying and euthanasia,\" he wrote in an email.\u003c/p>\n\u003cp>\"Unlike medical aid in dying, euthanasia requires a healthcare professional or someone else, not the individual, to administer the medication,\" he added, \"So the individual loses control of the decision.\"\u003c/p>\n\u003cp>MacIntyre pointed out that people often change their minds at the last minute, and have every right to do so. In Oregon, he noted, about one-third of the people who obtained lethal drugs through the state's death-with-dignity program since 1998 ultimately \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">decided not to take them\u003c/a>.\u003c/p>\n\u003cp>This seems to be a distinctly American quandary, though. In other countries, such as Belgium and the Netherlands, there are also safeguards written into their right-to-die laws, but they are broader and more inclusive.\u003c/p>\n\u003cp>\"The European safeguard is 'intolerable suffering,' \" said Margaret Pabst Battin, a bioethicist at the University of Utah. \"It's not defined in terms of the time until death, and it does include people with ALS or other conditions that wouldn't fall under our laws, which don't say anything about suffering.\"\u003c/p>\n\u003cp>Battin experienced the complexities of deciding when suffering becomes unbearable in caring for her husband, Brooke Hopkins, who was paralyzed from the shoulders down in a 2008 bicycle crash and lived for five more years, until he finally \u003ca href=\"http://6thfloor.blogs.nytimes.com/2013/08/21/choosing-to-die-after-a-struggle-with-life/\">decided\u003c/a> in 2013 to withdraw the machinery keeping him alive.\u003c/p>\n\u003cp>Earlier this year, the Supreme Court of Canada used European-style language \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/02/06/384292996/canadians-have-a-right-to-assisted-suicide-high-court-says\">upholding\u003c/a> the right to die for anyone with \"a grievous and irremediable medical condition ... that causes enduring suffering that is intolerable.\"\u003c/p>\n\u003cp>A death-with-dignity bill introduced in Battin's own state tried to broaden the safeguards to include people with a wider range of illnesses. On the phone with me, Battin read aloud from the \u003ca href=\"http://le.utah.gov/~2015/bills/static/HB0391.html\">Utah Death with Dignity Act\u003c/a>, introduced by Rep. Rebecca Chavez-Houk, which could apply to someone with an \"intractable and unbearable illness,\" defined as \"bodily disorder that cannot be cured or successfully palliated, and that causes such severe suffering that a patient prefers death.\" She said such broad language would no doubt be changed if the bill works its way through the state Legislature, as has happened elsewhere.\u003c/p>\n\u003cp>But people with Alzheimer's disease and other forms of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">dementia\u003c/a> are beyond the scope of almost all these laws.\u003c/p>\n\u003cp>Schwarz said that maybe, very far in the future, there might be some way to cover dementia, but it's \"so complicated\" that she doesn't see it happening anytime soon. How, for instance, do you write legislation to deal with the question of personhood, which alters as the disease progresses? Is the demented individual — perhaps someone relatively content in her diminishment — \"the same as the individual who so FIRMLY REQUESTED/DEMANDED lethal meds at a certain point in their future demented state?\" Schwarz wondered. \"And who are you going to get to administer lethal meds under such circumstances?\"\u003c/p>\n\u003cp>Schwarz spends a lot of time these days with Alzheimer's patients who want to choose the timing of their deaths. She said all she can offer them is guidance about \u003ca href=\"http://journals.lww.com/ajnonline/Abstract/2009/09000/Stopping_Eating_and_Drinking.28.aspx\">stopping eating and drinking\u003c/a> as a way to hasten the end.\u003c/p>\n\u003cp>\"It's a very, very hard choice to make when life still has pleasure & purpose,\" she wrote. But \"the window can close\" on a person with dementia, affecting the ability to refuse food and water once that person can no longer feed herself and caregivers enter into the decision.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This means that \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">a self-directed death for someone with dementia\u003c/a> might always have to mean saying farewell to life a bit sooner than she might have otherwise chosen.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Despite+Sweeping+Death-With-Dignity+Law%2C+Few+Will+Have+That+Option&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The death-with-dignity movement took a giant step forward this week, with 38 million people coming under its umbrella in a single swoop when California Gov. Jerry Brown signed the End of Life Option Act on Monday.\u003c/p>\n\u003cp>But the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\">law\u003c/a> still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>And there might be no good way around this.\u003c/p>\n\u003cp>These restrictions might be necessary at this point in the history of aid in dying in this country, according to Judith Schwarz of the advocacy group \u003ca href=\"http://endoflifechoicesny.org/\" target=\"_blank\">End of Life Choices New York\u003c/a>. \"Opponents have many fears that such laws will be misapplied to the disenfranchised,\" she wrote in an email, and it's important to guarantee that for these groups — the poor, the elderly, the isolated — the \"right to die\" doesn't somehow morph into the duty to die \"for the sake of others.\"\u003c/p>\n\u003cp>Still, there's a problem with limiting the death-with-dignity option only to those with a prognosis of fewer than six months. For one thing, prognosis is difficult, and studies show that doctors are actually overoptimistic in their assessment of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/384011538/cancer-patients-and-doctors-struggle-to-predict-survival\" target=\"_blank\">how long their patients have to live\u003c/a>. \"Some doctors may wish to be more compassionate and not be as specific,\" Janis Landis, president of the Final Exit Network, wrote in an email, \"and ironically thus deny the patient the certification that is required.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And then there are the conditions that are completely unpredictable, not only in terms of life expectancy but in terms of how, when and in what order functions will be lost. This includes progressive neurological diseases like multiple sclerosis and ALS, where those who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to swallow a pill might disappear without warning.\u003c/p>\n\u003cp>\"Fear of this actually drives some individuals to act early, while they can still procure the equipment they need,\" Landis wrote. To her, it seems especially harsh \"to force such a cruel choice on an individual already suffering so greatly.\"\u003c/p>\n\u003cp>As fraught as it is, though, the requirement that a person be able to swallow lethal medication on his own is an important safeguard, according to Mickey MacIntyre, the chief strategic officer of Compassion & Choices. \"This self-administration requirement is a critical distinction between medical aid in dying and euthanasia,\" he wrote in an email.\u003c/p>\n\u003cp>\"Unlike medical aid in dying, euthanasia requires a healthcare professional or someone else, not the individual, to administer the medication,\" he added, \"So the individual loses control of the decision.\"\u003c/p>\n\u003cp>MacIntyre pointed out that people often change their minds at the last minute, and have every right to do so. In Oregon, he noted, about one-third of the people who obtained lethal drugs through the state's death-with-dignity program since 1998 ultimately \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">decided not to take them\u003c/a>.\u003c/p>\n\u003cp>This seems to be a distinctly American quandary, though. In other countries, such as Belgium and the Netherlands, there are also safeguards written into their right-to-die laws, but they are broader and more inclusive.\u003c/p>\n\u003cp>\"The European safeguard is 'intolerable suffering,' \" said Margaret Pabst Battin, a bioethicist at the University of Utah. \"It's not defined in terms of the time until death, and it does include people with ALS or other conditions that wouldn't fall under our laws, which don't say anything about suffering.\"\u003c/p>\n\u003cp>Battin experienced the complexities of deciding when suffering becomes unbearable in caring for her husband, Brooke Hopkins, who was paralyzed from the shoulders down in a 2008 bicycle crash and lived for five more years, until he finally \u003ca href=\"http://6thfloor.blogs.nytimes.com/2013/08/21/choosing-to-die-after-a-struggle-with-life/\">decided\u003c/a> in 2013 to withdraw the machinery keeping him alive.\u003c/p>\n\u003cp>Earlier this year, the Supreme Court of Canada used European-style language \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/02/06/384292996/canadians-have-a-right-to-assisted-suicide-high-court-says\">upholding\u003c/a> the right to die for anyone with \"a grievous and irremediable medical condition ... that causes enduring suffering that is intolerable.\"\u003c/p>\n\u003cp>A death-with-dignity bill introduced in Battin's own state tried to broaden the safeguards to include people with a wider range of illnesses. On the phone with me, Battin read aloud from the \u003ca href=\"http://le.utah.gov/~2015/bills/static/HB0391.html\">Utah Death with Dignity Act\u003c/a>, introduced by Rep. Rebecca Chavez-Houk, which could apply to someone with an \"intractable and unbearable illness,\" defined as \"bodily disorder that cannot be cured or successfully palliated, and that causes such severe suffering that a patient prefers death.\" She said such broad language would no doubt be changed if the bill works its way through the state Legislature, as has happened elsewhere.\u003c/p>\n\u003cp>But people with Alzheimer's disease and other forms of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">dementia\u003c/a> are beyond the scope of almost all these laws.\u003c/p>\n\u003cp>Schwarz said that maybe, very far in the future, there might be some way to cover dementia, but it's \"so complicated\" that she doesn't see it happening anytime soon. How, for instance, do you write legislation to deal with the question of personhood, which alters as the disease progresses? Is the demented individual — perhaps someone relatively content in her diminishment — \"the same as the individual who so FIRMLY REQUESTED/DEMANDED lethal meds at a certain point in their future demented state?\" Schwarz wondered. \"And who are you going to get to administer lethal meds under such circumstances?\"\u003c/p>\n\u003cp>Schwarz spends a lot of time these days with Alzheimer's patients who want to choose the timing of their deaths. She said all she can offer them is guidance about \u003ca href=\"http://journals.lww.com/ajnonline/Abstract/2009/09000/Stopping_Eating_and_Drinking.28.aspx\">stopping eating and drinking\u003c/a> as a way to hasten the end.\u003c/p>\n\u003cp>\"It's a very, very hard choice to make when life still has pleasure & purpose,\" she wrote. But \"the window can close\" on a person with dementia, affecting the ability to refuse food and water once that person can no longer feed herself and caregivers enter into the decision.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This means that \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">a self-directed death for someone with dementia\u003c/a> might always have to mean saying farewell to life a bit sooner than she might have otherwise chosen.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Despite+Sweeping+Death-With-Dignity+Law%2C+Few+Will+Have+That+Option&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Berkeley Soda Tax Means Higher Prices on Some Sugary Drinks",
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"content": "\u003cp>In order for Berkeley’s penny-an-ounce soda tax to work, advocates say, retailers have to pass it through to customers. That way, the shoppers will see the higher price on the shelf, and some will choose lower priced (i.e. non-sugary) drinks.\u003c/p>\n\u003cp>In an analysis, UC Berkeley researchers say many retailers are doing just that. They sampled prices in Berkeley, Oakland and San Francisco, just before last November’s election when \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\" rel=\"noopener\">Berkeley voters overwhelmingly passed\u003c/a> the first-in-the-country soda tax.\u003c/p>\n\u003cp>Then they sampled prices again last summer, after the tax had gone into effect March 1. They found that retailers were passing through 69 percent of the tax on sodas and 47 percent of the tax on average for all sugar-sweetened beverages.\u003c/p>\n\u003cp>For a 20-ounce soda that had cost $1.75 now would cost $1.89, a 14-cent increase.\u003c/p>\n\u003cp>Lead author Jennifer Falbe, a post-doctoral researcher in the UC Berkeley School of Public Health, said she was encouraged by these findings.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s promising that so early after implementation, we’re already seeing prices increase,” she said. “However, because it is so early, it’s worth it to continue to monitor how the prices change to see where prices ultimately end up.”\u003c/p>\n\u003cp>\u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302881\" target=\"_blank\" rel=\"noopener\">The analysis\u003c/a> is published in the American Journal of Public Health.\u003c/p>\n\u003cp>In August, \u003ca href=\"http://www.news.cornell.edu/stories/2015/08/study-berkeley-soda-tax-falls-flat\" target=\"_blank\" rel=\"noopener\">another study\u003c/a> found a similar result — less than half of the tax was passed through. Oddly, researchers found that the pass through for Coke and Pepsi was only 22 percent.\u003c/p>\n\u003cp>Falbe said some store owners had told the research team that they planned to raise prices. “Some store owners said they hadn’t had a chance to go through their invoices to find out how much they should be rising prices on all their beverages,” Falbe said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The study did not address if the higher price means people are buying fewer sugary drinks. Falbe said her team is in the process of looking at that data.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In order for Berkeley’s penny-an-ounce soda tax to work, advocates say, retailers have to pass it through to customers. That way, the shoppers will see the higher price on the shelf, and some will choose lower priced (i.e. non-sugary) drinks.\u003c/p>\n\u003cp>In an analysis, UC Berkeley researchers say many retailers are doing just that. They sampled prices in Berkeley, Oakland and San Francisco, just before last November’s election when \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\" rel=\"noopener\">Berkeley voters overwhelmingly passed\u003c/a> the first-in-the-country soda tax.\u003c/p>\n\u003cp>Then they sampled prices again last summer, after the tax had gone into effect March 1. They found that retailers were passing through 69 percent of the tax on sodas and 47 percent of the tax on average for all sugar-sweetened beverages.\u003c/p>\n\u003cp>For a 20-ounce soda that had cost $1.75 now would cost $1.89, a 14-cent increase.\u003c/p>\n\u003cp>Lead author Jennifer Falbe, a post-doctoral researcher in the UC Berkeley School of Public Health, said she was encouraged by these findings.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s promising that so early after implementation, we’re already seeing prices increase,” she said. “However, because it is so early, it’s worth it to continue to monitor how the prices change to see where prices ultimately end up.”\u003c/p>\n\u003cp>\u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302881\" target=\"_blank\" rel=\"noopener\">The analysis\u003c/a> is published in the American Journal of Public Health.\u003c/p>\n\u003cp>In August, \u003ca href=\"http://www.news.cornell.edu/stories/2015/08/study-berkeley-soda-tax-falls-flat\" target=\"_blank\" rel=\"noopener\">another study\u003c/a> found a similar result — less than half of the tax was passed through. Oddly, researchers found that the pass through for Coke and Pepsi was only 22 percent.\u003c/p>\n\u003cp>Falbe said some store owners had told the research team that they planned to raise prices. “Some store owners said they hadn’t had a chance to go through their invoices to find out how much they should be rising prices on all their beverages,” Falbe said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The study did not address if the higher price means people are buying fewer sugary drinks. Falbe said her team is in the process of looking at that data.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The breast cancer rate in Marin County -- once called the highest in the world -- is now at the lowest level since tracking started in 1988 and matches the statewide average, according to a \u003ca href=\"http://www.cpic.org/files/PDF/Cancer_Registry/Cancer_Data_and_Statistics/CPIC_Breast_Cancer_Marin_Update_2015-09-21.pdf\" target=\"_blank\">new analysis. \u003c/a>\u003c/p>\n\u003cp>The question, of course, is why.\u003c/p>\n\u003cp>\"A whole lot of people are scratching their heads over this one,\" said Tina Clarke, an epidemiologist with the Cancer Prevention Institute of California and the study's lead author.\u003c/p>\n\u003cp>To be fair, Clarke can explain part of the decline. But before we get into more detail on that, a bit of history.\u003c/p>\n\u003cp>In 1994, \u003ca href=\"http://www.zerobreastcancer.org/breast-cancer-in-marin\" target=\"_blank\">a report from CPIC \u003c/a>(then called Northern California Cancer Center) identified the high rate of breast cancer in Marin County, compared it to that of countries around the world and concluded that the Marin County rate was the highest.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Women in Marin, an affluent county, have \"a whole cluster of established risk factors for breast cancer,\" Clarke said. These risk factors tend to go along with being more affluent: later age of childbearing, if at all, and higher alcohol consumption. White women are at slightly higher risk of developing breast cancer than are women of other races or ethnicities.\u003c/p>\n\u003cp>Through the 1990s, breast cancer rates for non-Hispanic white women in Marin \u003ca href=\"http://www.marincounty.org/~/media/files/departments/bs/district-4/docs/faq_breast_cancer_in_marin.pdf?la=en\" target=\"_blank\">climbed 60 percent,\u003c/a> compared to 5 percent in other parts of the Bay Area. It reached its peak in 2001.\u003c/p>\n\u003cp>The rate started to fall after a \u003ca href=\"https://www.nhlbi.nih.gov/news/press-releases/2002/nhlbi-stops-trial-of-estrogen-plus-progestin-due-to-increased-breast-cancer-risk-lack-of-overall-benefit\" target=\"_blank\">major study was halted in 2002\u003c/a>, when researchers identified a link between use of hormone replacement therapy and breast cancer. Affluent women were also more likely to use hormone therapy.\u003c/p>\n\u003cp>Women abandoned the hormones in droves, and the breast cancer rate started to fall, in Marin and nationwide.\u003c/p>\n\u003cp>But Marin county's breast cancer rate still exceeded the statewide average until a second drop started in 2007. That's what researchers can't quite account for.\u003c/p>\n\u003cp>Clarke said it's likely due to a host of reasons -- perhaps women are exercising more or losing weight, two other factors that reduce risk of breast cancer. It's also possible women are consuming less alcohol, she said.\u003c/p>\n\u003cp>One factor they know is not responsible: the change in mammography screening guidelines. In 2009, a major government panel, the U.S. Preventive Services Task Force, \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening\" target=\"_blank\">recommended women have fewer mammograms\u003c/a>. Researchers found no evidence that this recommendation has led to less breast cancer being found, in part because the incidence of ductal carcinoma in situ -- or DCIS -- is increasing.\u003c/p>\n\u003cp>\"The increased incidence of \u003cem>in situ \u003c/em>cancer suggests a decline in mammography screening likely is not a key factor contributing to the decline in invasive breast cancer in Marin County,\" Dr. Karly Kerlikowske, a UCSF epidemiologist said in a release.\u003c/p>\n\u003cp>Whatever the reason, \"We're really happy to see things trending in the right direction,\" Clarke said. \"We're obviously delighted to tell women in Marin County that the rates are similar to the rest of the state.\"\u003c/p>\n\u003cp>Since 2001, the breast cancer rate in Marin has dropped 31 percent. Mortality has also sharply declined. Since record-keeping began in 1988, the death rate from breast cancer has dropped 65 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>An interesting footnote: Clarke said that monitoring incidence rates is based on county-level census data. It's highly likely, she said, that similarly affluent areas in California, like Palo Alto or West LA, might have had the same pattern of a higher rate -- fueled at least in part by hormone therapy -- and the decline that Marin has seen.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The breast cancer rate in Marin County -- once called the highest in the world -- is now at the lowest level since tracking started in 1988 and matches the statewide average, according to a \u003ca href=\"http://www.cpic.org/files/PDF/Cancer_Registry/Cancer_Data_and_Statistics/CPIC_Breast_Cancer_Marin_Update_2015-09-21.pdf\" target=\"_blank\">new analysis. \u003c/a>\u003c/p>\n\u003cp>The question, of course, is why.\u003c/p>\n\u003cp>\"A whole lot of people are scratching their heads over this one,\" said Tina Clarke, an epidemiologist with the Cancer Prevention Institute of California and the study's lead author.\u003c/p>\n\u003cp>To be fair, Clarke can explain part of the decline. But before we get into more detail on that, a bit of history.\u003c/p>\n\u003cp>In 1994, \u003ca href=\"http://www.zerobreastcancer.org/breast-cancer-in-marin\" target=\"_blank\">a report from CPIC \u003c/a>(then called Northern California Cancer Center) identified the high rate of breast cancer in Marin County, compared it to that of countries around the world and concluded that the Marin County rate was the highest.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Women in Marin, an affluent county, have \"a whole cluster of established risk factors for breast cancer,\" Clarke said. These risk factors tend to go along with being more affluent: later age of childbearing, if at all, and higher alcohol consumption. White women are at slightly higher risk of developing breast cancer than are women of other races or ethnicities.\u003c/p>\n\u003cp>Through the 1990s, breast cancer rates for non-Hispanic white women in Marin \u003ca href=\"http://www.marincounty.org/~/media/files/departments/bs/district-4/docs/faq_breast_cancer_in_marin.pdf?la=en\" target=\"_blank\">climbed 60 percent,\u003c/a> compared to 5 percent in other parts of the Bay Area. It reached its peak in 2001.\u003c/p>\n\u003cp>The rate started to fall after a \u003ca href=\"https://www.nhlbi.nih.gov/news/press-releases/2002/nhlbi-stops-trial-of-estrogen-plus-progestin-due-to-increased-breast-cancer-risk-lack-of-overall-benefit\" target=\"_blank\">major study was halted in 2002\u003c/a>, when researchers identified a link between use of hormone replacement therapy and breast cancer. Affluent women were also more likely to use hormone therapy.\u003c/p>\n\u003cp>Women abandoned the hormones in droves, and the breast cancer rate started to fall, in Marin and nationwide.\u003c/p>\n\u003cp>But Marin county's breast cancer rate still exceeded the statewide average until a second drop started in 2007. That's what researchers can't quite account for.\u003c/p>\n\u003cp>Clarke said it's likely due to a host of reasons -- perhaps women are exercising more or losing weight, two other factors that reduce risk of breast cancer. It's also possible women are consuming less alcohol, she said.\u003c/p>\n\u003cp>One factor they know is not responsible: the change in mammography screening guidelines. In 2009, a major government panel, the U.S. Preventive Services Task Force, \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening\" target=\"_blank\">recommended women have fewer mammograms\u003c/a>. Researchers found no evidence that this recommendation has led to less breast cancer being found, in part because the incidence of ductal carcinoma in situ -- or DCIS -- is increasing.\u003c/p>\n\u003cp>\"The increased incidence of \u003cem>in situ \u003c/em>cancer suggests a decline in mammography screening likely is not a key factor contributing to the decline in invasive breast cancer in Marin County,\" Dr. Karly Kerlikowske, a UCSF epidemiologist said in a release.\u003c/p>\n\u003cp>Whatever the reason, \"We're really happy to see things trending in the right direction,\" Clarke said. \"We're obviously delighted to tell women in Marin County that the rates are similar to the rest of the state.\"\u003c/p>\n\u003cp>Since 2001, the breast cancer rate in Marin has dropped 31 percent. Mortality has also sharply declined. Since record-keeping began in 1988, the death rate from breast cancer has dropped 65 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>An interesting footnote: Clarke said that monitoring incidence rates is based on county-level census data. It's highly likely, she said, that similarly affluent areas in California, like Palo Alto or West LA, might have had the same pattern of a higher rate -- fueled at least in part by hormone therapy -- and the decline that Marin has seen.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How U.S. Supreme Court Just Made It Tougher to Challenge California Vaccine Law",
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"content": "\u003cp>The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated, unless they have a religious exemption, before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution.\u003c/p>\n\u003cp>While the particulars of the New York vaccine mandate is somewhat different than in California, this decision still matters here. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\"> new law\u003c/a> passed in June requires virtually all California schoolchildren to be vaccinated against a range of diseases in order to attend school.\u003c/p>\n\u003cp>The high court's move means that potential challenges to the California law are \"not likely to succeed,\" Prof. Dorit Reiss, a vaccine law expert at UC Hastings College of the Law in San Francisco, told KQED.\u003c/p>\n\u003cp>During the rancorous debate over the bill, SB277, one of the arguments I heard from those opposing it was that the Supreme Court's major cases on childhood vaccination were decades old -- or more -- and that the world had changed dramatically since the last major rulings.\u003c/p>\n\u003cp>Yes, this is the health blog, but bear with me while we take a look at two key cases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>First, in 1905, the Supreme Court in \u003ca href=\"http://caselaw.findlaw.com/us-supreme-court/197/11.html\" target=\"_blank\">Jacobson v. Commonwealth of Massachusetts\u003c/a> essentially ruled that the states could enforce mandatory vaccination laws.\u003c/p>\n\u003cp>Reiss noted that Jacobson found \"states have extensive leeway to require vaccination.\"\u003c/p>\n\u003cp>California never had a religious exemption written into the law. Instead the state had only a \"personal belief exemption,\" now abolished by SB277. Only those children with a medical exemption may attend school without being vaccinated.\u003c/p>\n\u003cp>And that brings us to the second key case.\u003c/p>\n\u003cp>[contextly_sidebar id=\"XCNlz9GH0RZ29XkqsHVBKv8dlxU9i4f5\"]In 1944, the U.S. Supreme Court heard arguments in \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/321/158\" target=\"_blank\">Prince v. Massachusetts\u003c/a>. The case was not explicitly about vaccines -- a Jehovah's Witness was charged with violating child labor law by having her child sell religious material. Rather, the case is seen as one that spells out limits on parental rights. Parents do not have absolute authority over their children, and that can include decisions about vaccination. From the decision:\u003c/p>\n\u003cblockquote>\u003cp> \"The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.\"\u003c/p>\u003c/blockquote>\n\u003cp>\"You don't get out of a general law because you have a religious exemption,\" Reiss told me. She used taxes as an example. You may have a religious objection, but you still must pay. Because SB277 is \"not aimed at a particular religion,\" one cannot apply a religious exemption.\u003c/p>\n\u003cp>Returning to the challenge to the New York law, Reiss said that by declining an opportunity to consider it, the Supreme Court is not reaffirming these older decisions. But it is also declining an opportunity to reconsider those rulings.\u003c/p>\n\u003cp>It may be that the petition was denied \"because there are not four justices on the Supreme Court who think Jacobson is such bad law that it should be overturned,\" Reiss wrote on\u003ca href=\"http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-and-religious-exemptions-recent-legal-decision/\" target=\"_blank\"> Skeptical Raptor\u003c/a>.\u003c/p>\n\u003cp>Here in California the new vaccine law appears to raise a different constitutional question -- all California children have a \u003ca href=\"https://oag.ca.gov/publications/CRhandbook/ch6\" target=\"_blank\">constitutional right to an education\u003c/a>. Under SB277, children who are not vaccinated cannot attend school.\u003c/p>\n\u003cp>Is the constitutional right to an education violated by SB277?\u003c/p>\n\u003cp>Reiss said she believes a constitutional challenge on these grounds would be \"incorrect.\" She pointed to a series of famous cases in California, \u003ca href=\"http://scocal.stanford.edu/opinion/serrano-v-priest-27628\" target=\"_blank\">Serrano v. Priest\u003c/a>, which found inequity in school financing. Schools were found to be \"discriminating on wealth,\" Reiss said.\u003c/p>\n\u003cp>But requiring schoolchildren to be vaccinated is not a violation under Serrano v. Priest, Reiss said, because choosing not to vaccinate is a behavior and not a fact of one's existence, such as wealth or race. \"It is perfectly legitimate for the state to regulate behavior, which is what SB277 does,\" Reiss said.\u003c/p>\n\u003cp>The new law goes into effect next July 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Oct. 8, 2015: this post has been updated to clarify that New York state permits a religious exemption from its vaccine mandate.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated, unless they have a religious exemption, before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution.\u003c/p>\n\u003cp>While the particulars of the New York vaccine mandate is somewhat different than in California, this decision still matters here. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\"> new law\u003c/a> passed in June requires virtually all California schoolchildren to be vaccinated against a range of diseases in order to attend school.\u003c/p>\n\u003cp>The high court's move means that potential challenges to the California law are \"not likely to succeed,\" Prof. Dorit Reiss, a vaccine law expert at UC Hastings College of the Law in San Francisco, told KQED.\u003c/p>\n\u003cp>During the rancorous debate over the bill, SB277, one of the arguments I heard from those opposing it was that the Supreme Court's major cases on childhood vaccination were decades old -- or more -- and that the world had changed dramatically since the last major rulings.\u003c/p>\n\u003cp>Yes, this is the health blog, but bear with me while we take a look at two key cases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>First, in 1905, the Supreme Court in \u003ca href=\"http://caselaw.findlaw.com/us-supreme-court/197/11.html\" target=\"_blank\">Jacobson v. Commonwealth of Massachusetts\u003c/a> essentially ruled that the states could enforce mandatory vaccination laws.\u003c/p>\n\u003cp>Reiss noted that Jacobson found \"states have extensive leeway to require vaccination.\"\u003c/p>\n\u003cp>California never had a religious exemption written into the law. Instead the state had only a \"personal belief exemption,\" now abolished by SB277. Only those children with a medical exemption may attend school without being vaccinated.\u003c/p>\n\u003cp>And that brings us to the second key case.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In 1944, the U.S. Supreme Court heard arguments in \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/321/158\" target=\"_blank\">Prince v. Massachusetts\u003c/a>. The case was not explicitly about vaccines -- a Jehovah's Witness was charged with violating child labor law by having her child sell religious material. Rather, the case is seen as one that spells out limits on parental rights. Parents do not have absolute authority over their children, and that can include decisions about vaccination. From the decision:\u003c/p>\n\u003cblockquote>\u003cp> \"The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.\"\u003c/p>\u003c/blockquote>\n\u003cp>\"You don't get out of a general law because you have a religious exemption,\" Reiss told me. She used taxes as an example. You may have a religious objection, but you still must pay. Because SB277 is \"not aimed at a particular religion,\" one cannot apply a religious exemption.\u003c/p>\n\u003cp>Returning to the challenge to the New York law, Reiss said that by declining an opportunity to consider it, the Supreme Court is not reaffirming these older decisions. But it is also declining an opportunity to reconsider those rulings.\u003c/p>\n\u003cp>It may be that the petition was denied \"because there are not four justices on the Supreme Court who think Jacobson is such bad law that it should be overturned,\" Reiss wrote on\u003ca href=\"http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-and-religious-exemptions-recent-legal-decision/\" target=\"_blank\"> Skeptical Raptor\u003c/a>.\u003c/p>\n\u003cp>Here in California the new vaccine law appears to raise a different constitutional question -- all California children have a \u003ca href=\"https://oag.ca.gov/publications/CRhandbook/ch6\" target=\"_blank\">constitutional right to an education\u003c/a>. Under SB277, children who are not vaccinated cannot attend school.\u003c/p>\n\u003cp>Is the constitutional right to an education violated by SB277?\u003c/p>\n\u003cp>Reiss said she believes a constitutional challenge on these grounds would be \"incorrect.\" She pointed to a series of famous cases in California, \u003ca href=\"http://scocal.stanford.edu/opinion/serrano-v-priest-27628\" target=\"_blank\">Serrano v. Priest\u003c/a>, which found inequity in school financing. Schools were found to be \"discriminating on wealth,\" Reiss said.\u003c/p>\n\u003cp>But requiring schoolchildren to be vaccinated is not a violation under Serrano v. Priest, Reiss said, because choosing not to vaccinate is a behavior and not a fact of one's existence, such as wealth or race. \"It is perfectly legitimate for the state to regulate behavior, which is what SB277 does,\" Reiss said.\u003c/p>\n\u003cp>The new law goes into effect next July 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Oct. 8, 2015: this post has been updated to clarify that New York state permits a religious exemption from its vaccine mandate.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Governor Signs Physician-Assisted Suicide Bill Into Law",
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"content": "\u003cp>California Gov. Jerry Brown signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">landmark legislation\u003c/a> today allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.\u003c/p>\n\u003cp>In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.\u003c/p>\n\u003cp>\"I do not know what I would do if I were dying in prolonged and excruciating pain,\" he wrote. \"I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others.\"\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Listen to a special presentation from The California Report:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227092538\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>One of the key co-authors of the legislation, Sen. Bill Monning, D-Carmel, said the signing “marks a historic day in California” and called the governor’s thoughts “a powerful statement.”\u003c/p>\n\u003cp>Brown’s signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iTOdYPi32BS7nDkgWWeO1fNHFQH9Ia8E\"]\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227091620\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Gov. Jerry Brown signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">landmark legislation\u003c/a> today allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.\u003c/p>\n\u003cp>In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.\u003c/p>\n\u003cp>\"I do not know what I would do if I were dying in prolonged and excruciating pain,\" he wrote. \"I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others.\"\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Listen to a special presentation from The California Report:\u003c/h3>\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/227092538&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/227092538'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>One of the key co-authors of the legislation, Sen. Bill Monning, D-Carmel, said the signing “marks a historic day in California” and called the governor’s thoughts “a powerful statement.”\u003c/p>\n\u003cp>Brown’s signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\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/227091620&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/227091620'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "'Senior Villages' Struggle with Call to Diversify",
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"content": "\u003cp>You couldn’t pay any of the 80-year-olds in this Pacific Heights living room to go to a senior center. About a dozen sit in a circle in armchairs, or shoulder to shoulder on the sofa, a thick book of plays in their laps.\u003c/p>\n\u003cp>\"One, two, cha cha cha!\" one woman reads, \"Very good, cha cha cha!\"\u003c/p>\n\u003cp>The group gathers once a month, rotating among each other's houses, to read plays together. Today, it’s Neil Simon’s “Come Blow Your Horn,” a comedy about a young man, bored living with his parents, who moves in with his older brother to find excitement.\u003c/p>\n\u003cp>\"Answer phone, cha cha cha,\" the actor reads. \"Hello? Snow? Don’t you know you could get arrested for having such a sexy voice?\"\u003c/p>\n\u003cp>Everyone here is a member of the \u003ca href=\"http://www.sfvillage.org\" target=\"_blank\">San Francisco Village\u003c/a> -- a grass-roots group of local seniors from across the city, who banded together to support each other so they could stay home as they age.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/226663948\" 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>Members help each other with things like grocery shopping, changing lightbulbs, giving rides to doctors’ appointments. A corps of volunteers is on hand to help with gardening, computer support and other chores. And a roster of local vendors offers a range of discounted services, like plumbing. But at the heart of the movement are the social activities.\u003c/p>\n\u003cp>\"You know what I hear they played at 3 in the morning?\" another actor reads from the script. \"Strip Scrabble.\"\u003c/p>\n\u003cp>Throughout the year, there are holiday dinners, museum outings, yoga classes, hiking groups. Sarah Goldman started this play-reading group five years ago. For her, joining the village was really about meeting new people after she left her job.\u003c/p>\n\u003cp>\"So the village came along at a time when I was looking to expand a friendship circle,\" she says.\u003c/p>\n\u003cp>It’s more than that, of course. Goldman is 87. The stairs in her apartment building seem to be getting steeper every year. She knows she can't stay forever.\u003c/p>\n\u003cp>\u003ci>\"\u003c/i>I do not want to move to a continuing care community,\" she says. \"Nor would I have the funds to do so if I did.\"\u003c/p>\n\u003cp>Like many elderly people, Goldman isn't interested in living with her kids.\u003c/p>\n\u003cp>\"My family is estranged from me, my biological family,\" she says. \"I have difficult relationships. They’re across the country.\"\u003c/p>\n\u003cp>Goldman had hoped people in the village could help her identify somewhere else to live on her own. But in mid-September, she moved into a retirement community in San Francisco, one that can provide assisted living if she ever needs it. She says she's still part of the village and plans to continue with the play-reading group and other activities.\u003c/p>\n\u003cp>\"I appreciate being able to have people that I can talk to,\" she says.\u003c/p>\n\u003cp>\u003cstrong>100 Villages and Growing\u003c/strong>\u003c/p>\n\u003cp>There are now more than 100 senior villages across the country, and another hundred in the works. But as the movement grows, it is starting to confront some growing pains, particularly around financial sustainability and diversity.\u003c/p>\n\u003cp>Ninety percent of village members are white and middle class. These demographics date back to the founders of the village movement: They didn't have the money to pay for full-time care to stay at home, but they had too much money to qualify for many government services. Most in-home programs are strictly for low-income folks.\u003c/p>\n\u003cp>\"But there aren’t really services for seniors who are near poor, or who are middle income,\" says Carrie Graham, a medical sociologist at UC Berkeley who studies villages.\u003cem> \"\u003c/em>And a lot of services that are available to middle-income seniors are unaffordable.\"\u003c/p>\n\u003cp>Joining a village costs about $50 a month. Those membership fees fund the staff that administers the services and organizes volunteers who give rides and help with chores. But those fees may not be enough anymore. As members grow older, Graham says, village finances are getting strained.\u003c/p>\n\u003cp>\"We hear villages saying older members might use more services, they might need more volunteers,\" she says.\u003c/p>\n\u003cp>\u003cstrong>New Funds Come with Strings Attached\u003c/strong>\u003c/p>\n\u003cp>So they’re looking for more money. In San Francisco, the village started hunting for grants from the city and foundations. But this money comes with strings attached. Funders want the white, middle-class movement to expand to more low-income and minority elders. This might be harder than it sounds.\u003c/p>\n\u003cp>At a recent happy hour for members of the Ashby Village in Berkeley, everyone was white. Executive Director Andy Gaines says the Berkeley group was started by former professors from the university. Diversifying beyond that circle has been really difficult.\u003c/p>\n\u003cp>News about Ashby Village \"is very much passing word of mouth,\" Gaines says. \"So it’s people who know people, and so the tendency is for it to stay within a smaller community.\"\u003c/p>\n\u003cp>Ashby Village tried to recruit more African-Americans from local churches. But they weren’t interested. Some organizers have observed that communities of color have a stronger emphasis on families caring for elders.\u003c/p>\n\u003cp>\"There tends to be a stereotype of ethnic groups or immigrant groups being much more accepting of relying on their children. And in fact, expect to rely on their children in old age,\" says Graham. \"It would make sense that they may not find a model of independent aging as attractive.\"\u003c/p>\n\u003cp>In general, Graham and Gaines have noticed a tendency toward racial and religious isolation in aging services.\u003c/p>\n\u003cfigure id=\"attachment_83261\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg\">\u003cimg class=\"size-thumbnail wp-image-83261\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg\" alt=\"Janey Norman is a member of San Francisco Village. \" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg 959w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Janey Norman is a member of San Francisco Village. \u003ccite>(Courtesy: San Francisco Village)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"Especially as people are growing older, there is more kind of desire to stay like with like,\" Gaines says. \"And less active movement towards reaching out to meet other populations.\"\u003c/p>\n\u003cp>Back at San Francisco Village, member Janey Norman thinks the focus on race is misplaced. She’s African-American. She says, for her, joining the village was never about meeting other people of color.\u003c/p>\n\u003cp>\"Belonging to a village, it’s about human beings and\u003cem> \u003c/em>sharing interests, and caring for each other and being there for each other,\" she says.\u003c/p>\n\u003cp>Norman is all for subsidizing membership fees so that low-income people can join the village. But the idea of funders pushing the movement to diversify racially offends her.\u003c/p>\n\u003cp>\"It becomes a money thing. 'If we get more black people in here, if we get more Asians, we can get more money here,' \" she says. \"What is all of this? Why? Why?\"\u003c/p>\n\u003cp>What Norman wants is friends to share a bottle of Louis Martini cabernet with. People to talk to about art and music. Folks who will look out for her if there’s an earthquake.\u003c/p>\n\u003cp>\"It goes beyond color, OK,\" she says. \"To me it’s not about color. It’s about connection with human beings.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>New America Media and the Gerontological Society of America provided support for this story. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You couldn’t pay any of the 80-year-olds in this Pacific Heights living room to go to a senior center. About a dozen sit in a circle in armchairs, or shoulder to shoulder on the sofa, a thick book of plays in their laps.\u003c/p>\n\u003cp>\"One, two, cha cha cha!\" one woman reads, \"Very good, cha cha cha!\"\u003c/p>\n\u003cp>The group gathers once a month, rotating among each other's houses, to read plays together. Today, it’s Neil Simon’s “Come Blow Your Horn,” a comedy about a young man, bored living with his parents, who moves in with his older brother to find excitement.\u003c/p>\n\u003cp>\"Answer phone, cha cha cha,\" the actor reads. \"Hello? Snow? Don’t you know you could get arrested for having such a sexy voice?\"\u003c/p>\n\u003cp>Everyone here is a member of the \u003ca href=\"http://www.sfvillage.org\" target=\"_blank\">San Francisco Village\u003c/a> -- a grass-roots group of local seniors from across the city, who banded together to support each other so they could stay home as they age.\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/226663948&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/226663948'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Members help each other with things like grocery shopping, changing lightbulbs, giving rides to doctors’ appointments. A corps of volunteers is on hand to help with gardening, computer support and other chores. And a roster of local vendors offers a range of discounted services, like plumbing. But at the heart of the movement are the social activities.\u003c/p>\n\u003cp>\"You know what I hear they played at 3 in the morning?\" another actor reads from the script. \"Strip Scrabble.\"\u003c/p>\n\u003cp>Throughout the year, there are holiday dinners, museum outings, yoga classes, hiking groups. Sarah Goldman started this play-reading group five years ago. For her, joining the village was really about meeting new people after she left her job.\u003c/p>\n\u003cp>\"So the village came along at a time when I was looking to expand a friendship circle,\" she says.\u003c/p>\n\u003cp>It’s more than that, of course. Goldman is 87. The stairs in her apartment building seem to be getting steeper every year. She knows she can't stay forever.\u003c/p>\n\u003cp>\u003ci>\"\u003c/i>I do not want to move to a continuing care community,\" she says. \"Nor would I have the funds to do so if I did.\"\u003c/p>\n\u003cp>Like many elderly people, Goldman isn't interested in living with her kids.\u003c/p>\n\u003cp>\"My family is estranged from me, my biological family,\" she says. \"I have difficult relationships. They’re across the country.\"\u003c/p>\n\u003cp>Goldman had hoped people in the village could help her identify somewhere else to live on her own. But in mid-September, she moved into a retirement community in San Francisco, one that can provide assisted living if she ever needs it. She says she's still part of the village and plans to continue with the play-reading group and other activities.\u003c/p>\n\u003cp>\"I appreciate being able to have people that I can talk to,\" she says.\u003c/p>\n\u003cp>\u003cstrong>100 Villages and Growing\u003c/strong>\u003c/p>\n\u003cp>There are now more than 100 senior villages across the country, and another hundred in the works. But as the movement grows, it is starting to confront some growing pains, particularly around financial sustainability and diversity.\u003c/p>\n\u003cp>Ninety percent of village members are white and middle class. These demographics date back to the founders of the village movement: They didn't have the money to pay for full-time care to stay at home, but they had too much money to qualify for many government services. Most in-home programs are strictly for low-income folks.\u003c/p>\n\u003cp>\"But there aren’t really services for seniors who are near poor, or who are middle income,\" says Carrie Graham, a medical sociologist at UC Berkeley who studies villages.\u003cem> \"\u003c/em>And a lot of services that are available to middle-income seniors are unaffordable.\"\u003c/p>\n\u003cp>Joining a village costs about $50 a month. Those membership fees fund the staff that administers the services and organizes volunteers who give rides and help with chores. But those fees may not be enough anymore. As members grow older, Graham says, village finances are getting strained.\u003c/p>\n\u003cp>\"We hear villages saying older members might use more services, they might need more volunteers,\" she says.\u003c/p>\n\u003cp>\u003cstrong>New Funds Come with Strings Attached\u003c/strong>\u003c/p>\n\u003cp>So they’re looking for more money. In San Francisco, the village started hunting for grants from the city and foundations. But this money comes with strings attached. Funders want the white, middle-class movement to expand to more low-income and minority elders. This might be harder than it sounds.\u003c/p>\n\u003cp>At a recent happy hour for members of the Ashby Village in Berkeley, everyone was white. Executive Director Andy Gaines says the Berkeley group was started by former professors from the university. Diversifying beyond that circle has been really difficult.\u003c/p>\n\u003cp>News about Ashby Village \"is very much passing word of mouth,\" Gaines says. \"So it’s people who know people, and so the tendency is for it to stay within a smaller community.\"\u003c/p>\n\u003cp>Ashby Village tried to recruit more African-Americans from local churches. But they weren’t interested. Some organizers have observed that communities of color have a stronger emphasis on families caring for elders.\u003c/p>\n\u003cp>\"There tends to be a stereotype of ethnic groups or immigrant groups being much more accepting of relying on their children. And in fact, expect to rely on their children in old age,\" says Graham. \"It would make sense that they may not find a model of independent aging as attractive.\"\u003c/p>\n\u003cp>In general, Graham and Gaines have noticed a tendency toward racial and religious isolation in aging services.\u003c/p>\n\u003cfigure id=\"attachment_83261\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg\">\u003cimg class=\"size-thumbnail wp-image-83261\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg\" alt=\"Janey Norman is a member of San Francisco Village. \" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg 959w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Janey Norman is a member of San Francisco Village. \u003ccite>(Courtesy: San Francisco Village)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"Especially as people are growing older, there is more kind of desire to stay like with like,\" Gaines says. \"And less active movement towards reaching out to meet other populations.\"\u003c/p>\n\u003cp>Back at San Francisco Village, member Janey Norman thinks the focus on race is misplaced. She’s African-American. She says, for her, joining the village was never about meeting other people of color.\u003c/p>\n\u003cp>\"Belonging to a village, it’s about human beings and\u003cem> \u003c/em>sharing interests, and caring for each other and being there for each other,\" she says.\u003c/p>\n\u003cp>Norman is all for subsidizing membership fees so that low-income people can join the village. But the idea of funders pushing the movement to diversify racially offends her.\u003c/p>\n\u003cp>\"It becomes a money thing. 'If we get more black people in here, if we get more Asians, we can get more money here,' \" she says. \"What is all of this? Why? Why?\"\u003c/p>\n\u003cp>What Norman wants is friends to share a bottle of Louis Martini cabernet with. People to talk to about art and music. Folks who will look out for her if there’s an earthquake.\u003c/p>\n\u003cp>\"It goes beyond color, OK,\" she says. \"To me it’s not about color. It’s about connection with human beings.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>New America Media and the Gerontological Society of America provided support for this story. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>SACRAMENTO — Dirty cooling towers were to blame for an \u003ca href=\"http://ww2.kqed.org/news/2015/08/28/san-quentin-responds-to-possible-legionnaires-outbreak\" target=\"_blank\">outbreak of Legionnaires' disease\u003c/a> that has sickened dozens of inmates and at least three employees at San Quentin State Prison since late August, according to a report Thursday.\u003c/p>\n\u003cp>Tests showed two of the towers on the roof of the prison's Central Health Services Building had high concentrations of the bacterium that causes the disease, according to the federal receiver who controls inmate medical care. The report says people walking near the towers evidently inhaled contaminated mist, because no drinking water was affected.\u003c/p>\n\u003cp>Receiver J. Clark Kelso blamed a buildup of sludge in the cooling tower water pans, as well as a heat wave in the San Francisco Bay Area, for the Legionnaires' disease outbreak that sickened 81 inmates and sent 13 of them to outside hospitals. Twelve employees are still being tested.\u003c/p>\n\u003cp>The towers have since been cleaned and the 163-year-old prison north of San Francisco is back to normal.\u003c/p>\n\u003cp>In an interview with KQED, Donald Specter with the Prison Law Office, an advocacy group, says the administration handled the situation well.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"They were quite transparent about the whole process. We were allowed to go into the prison and interview scores of prisoners and talk to prison officials. And they brought in the appropriate specialists to help them solve the problem.”\u003c/p>\n\u003cp>For a time, the outbreak caused the state's oldest prison to cancel visits, hot meals and showers, and haul in water and portable toilets for the more than 3,300 inmates and 1,200 employees.\u003c/p>\n\u003cp>Legionnaires' disease is considered a severe type of pneumonia that can bring high fever, chills and a cough. It occurs when contaminated water is inhaled in the form of steam, mist or moisture. A recent outbreak that sickened 128 people and killed 12 in New York City was similarly traced to a Bronx hotel's rooftop air conditioning unit.\u003c/p>\n\u003cp>The Department of Corrections and Rehabilitation said it is working with employees at prisons statewide to make sure they carefully clean danger areas.\u003c/p>\n\u003cp>Separately, Kelso reported that 88 percent of 5,420 inmates housed in Avenal and Pleasant Valley state prisons, the epicenter of California's Valley Fever outbreak, recently refused to be tested for exposure to the soil-borne fungus that causes the disease.\u003c/p>\n\u003cp>Those who were tested at the two Central Valley prisons were four times as likely to have been exposed to the fungus as inmates at other state prisons. However, the high rate of refusals raises questions about the effectiveness of the testing, which cost taxpayers $5.4 million this year, Kelso said.\u003c/p>\n\u003cp>The prison system is using the tests to decide which inmates can more safely be housed at the prisons near Fresno. An early round of tests this year forced more than 2,100 inmates to be moved from the two prisons, while more than 3,000 inmates could be moved in to take their place because they are less likely to get the disease.\u003c/p>\n\u003cp>Liz Gransee, a spokeswoman for the receiver, said the office is sending a team to talk to inmate representatives at the two prisons to find out why so many refused, and it plans an education campaign based on the results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Andrew Stelzer contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SACRAMENTO — Dirty cooling towers were to blame for an \u003ca href=\"http://ww2.kqed.org/news/2015/08/28/san-quentin-responds-to-possible-legionnaires-outbreak\" target=\"_blank\">outbreak of Legionnaires' disease\u003c/a> that has sickened dozens of inmates and at least three employees at San Quentin State Prison since late August, according to a report Thursday.\u003c/p>\n\u003cp>Tests showed two of the towers on the roof of the prison's Central Health Services Building had high concentrations of the bacterium that causes the disease, according to the federal receiver who controls inmate medical care. The report says people walking near the towers evidently inhaled contaminated mist, because no drinking water was affected.\u003c/p>\n\u003cp>Receiver J. Clark Kelso blamed a buildup of sludge in the cooling tower water pans, as well as a heat wave in the San Francisco Bay Area, for the Legionnaires' disease outbreak that sickened 81 inmates and sent 13 of them to outside hospitals. Twelve employees are still being tested.\u003c/p>\n\u003cp>The towers have since been cleaned and the 163-year-old prison north of San Francisco is back to normal.\u003c/p>\n\u003cp>In an interview with KQED, Donald Specter with the Prison Law Office, an advocacy group, says the administration handled the situation well.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"They were quite transparent about the whole process. We were allowed to go into the prison and interview scores of prisoners and talk to prison officials. And they brought in the appropriate specialists to help them solve the problem.”\u003c/p>\n\u003cp>For a time, the outbreak caused the state's oldest prison to cancel visits, hot meals and showers, and haul in water and portable toilets for the more than 3,300 inmates and 1,200 employees.\u003c/p>\n\u003cp>Legionnaires' disease is considered a severe type of pneumonia that can bring high fever, chills and a cough. It occurs when contaminated water is inhaled in the form of steam, mist or moisture. A recent outbreak that sickened 128 people and killed 12 in New York City was similarly traced to a Bronx hotel's rooftop air conditioning unit.\u003c/p>\n\u003cp>The Department of Corrections and Rehabilitation said it is working with employees at prisons statewide to make sure they carefully clean danger areas.\u003c/p>\n\u003cp>Separately, Kelso reported that 88 percent of 5,420 inmates housed in Avenal and Pleasant Valley state prisons, the epicenter of California's Valley Fever outbreak, recently refused to be tested for exposure to the soil-borne fungus that causes the disease.\u003c/p>\n\u003cp>Those who were tested at the two Central Valley prisons were four times as likely to have been exposed to the fungus as inmates at other state prisons. However, the high rate of refusals raises questions about the effectiveness of the testing, which cost taxpayers $5.4 million this year, Kelso said.\u003c/p>\n\u003cp>The prison system is using the tests to decide which inmates can more safely be housed at the prisons near Fresno. An early round of tests this year forced more than 2,100 inmates to be moved from the two prisons, while more than 3,000 inmates could be moved in to take their place because they are less likely to get the disease.\u003c/p>\n\u003cp>Liz Gransee, a spokeswoman for the receiver, said the office is sending a team to talk to inmate representatives at the two prisons to find out why so many refused, and it plans an education campaign based on the results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Andrew Stelzer contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "African-Americans Face Higher Colon Cancer Risk, Less Likely to be Screened",
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"content": "\u003cp>Every year, 140,000 Americans are diagnosed with colon cancer, and more than 50,000 die from it. It's the third leading cause of cancer-related deaths. But among those tens of thousands who are suffering, African-Americans are especially vulnerable.\u003c/p>\n\u003cp>“African-Americans are more likely to get colon cancer, they’re more likely to have an advanced stage of disease when they’re diagnosed with colon cancer,\" says Dr. Fola May, a gastroenterologist at UCLA. \"They’re more likely to die from colon cancer.”\u003c/p>\n\u003caside class=\"pullquote alignright\">\n“It’s a message that we need to get out, especially to the African-American community, that by going and having a colonoscopy, you lessen the chances of being diagnosed with this.\"\u003cbr>\n\u003ccite>Erin Stennis, widow of colon cancer patient\u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>May is co-author of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25737445\" target=\"_blank\">recent study\u003c/a> that looked at the records of Californians between 40 and 80 years old who have a parent, sibling, or child that’s had colon cancer. That population is at higher risk of developing colon cancer themselves. But of that group, only three out of five had been screened for colon cancer themselves.\u003c/p>\n\u003cp>Dr. Brennan Spiegel, senior author of the study and director of health services at Cedars Sinai in Los Angeles, said this finding revealed \"a big problem.\" The findings grew more sobering from there.\u003c/p>\n\u003cp>\"(W)hen we drilled down into that group and looked at racial and ethnic disparities, we found that African-Americans were 71 percent less likely to get screened than white Californians,\" he said. \"So, this is an even bigger indictment.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Colon cancer screening is especially beneficial, because benign lesions can be found and removed, preventing cancer from having a chance to develop.\u003c/p>\n\u003cp>You might think that close relatives of colon cancer patients would want to be screened. But take the case of the family of Cordell Harper, a 67-year-old African-American man. Fourteen years ago he was diagnosed with colon cancer. He underwent surgery and chemotherapy.\u003c/p>\n\u003cp>Harper has three brothers. They all refuse to get colonoscopies.\u003c/p>\n\u003cp>“So, if having a brother get colon cancer doesn’t make you want to get a colonoscopy, what will?” he asks, with a laugh. \"Having issues, you know, and it may be too late then.”\u003c/p>\n\u003cp>Harper’s brothers are all over 50. That’s the age many\u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\"> national organizations\u003c/a> recommend people begin colon cancer screening. But those with a family history \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations\" target=\"_blank\">should start sooner\u003c/a>. Part of the reason Harper’s brothers won’t get screened has to do with the stigma of having a colonoscopy, which involves threading a flexible tube, called a colonoscope, through the rectum and into the colon. Dr. Fola May says that’s a common concern.\u003c/p>\n\u003cp>“Men in our \u003ca href=\"http://www.researchgate.net/publication/276209726_Addressing_Low_Colorectal_Cancer_Screening_in_African_Americans_Using_Focus_Groups_to_Inform_the_Development_of_Effective_Interventions\" target=\"_blank\">focus group study \u003c/a>and men in other studies have said, ‘I do not want any sort of procedure where I have to have any sort of instrument that’s placed into my behind,' \" May said. \"That was a persistent theme throughout our ... studies.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/226272254\" 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 was the case with Michael Stennis, who died of colon cancer in 2003. I met his wife, Erin Stennis, at a “Relay for Life” cancer event in Los Angeles this summer. After he found blood in his stool, a gastroenterologist told him to get a colonoscopy.\u003c/p>\n\u003cp>“When he found out what a colonoscopy was, he said no one was going to do that to him,\" Erin Stennis told me. \"So he literally sucked up the pain for about six years, and it got to the point where I found him one day hunched over in a closet in our home.”\u003c/p>\n\u003cp>Her husband was soon diagnosed with stage four colon cancer. He lived just two more years. During that time, the couple talked to everyone they could, going to churches and other groups, to try to raise awareness of colon cancer among African Americans.\u003c/p>\n\u003cp>“I think it’s a message that we need to get out, especially to the African-American community,\" Erin Stennis said, \"that by going and having a colonoscopy, you lessen the chances of being diagnosed with this. It’s getting over the stigma attached to colonoscopy and what the procedure entails.\"\u003c/p>\n\u003cp>But the low screening rates are due to more than stigma. In another \u003ca href=\"http://www.gastrojournal.org/article/S0016-5085(15)32000-X/abstract\" target=\"_blank\">study\u003c/a>, Spiegel and his colleagues, found that part of the responsibility may rest with doctors.\u003c/p>\n\u003cp>“We found that African-Americans were more likely to say that their doctor never recommended a colonoscopy or any kind of colon cancer screening than any other racial and ethnic groups,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel says that’s a big failure at the provider level. A nudge from the doctor could make a big difference.\u003c/p>\n\u003cp>“We found that when doctors do recommend screening, it increases the chances of getting screened by nearly twofold,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel’s team is planning a follow-up study to see if the Affordable Care Act, which fully covers preventive tests like colonoscopies, will make any dent in the racial disparity of colon cancer outcomes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Avishay Artsy reported this story as a 2015 California Health Journalism Fellow at the USC Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every year, 140,000 Americans are diagnosed with colon cancer, and more than 50,000 die from it. It's the third leading cause of cancer-related deaths. But among those tens of thousands who are suffering, African-Americans are especially vulnerable.\u003c/p>\n\u003cp>“African-Americans are more likely to get colon cancer, they’re more likely to have an advanced stage of disease when they’re diagnosed with colon cancer,\" says Dr. Fola May, a gastroenterologist at UCLA. \"They’re more likely to die from colon cancer.”\u003c/p>\n\u003caside class=\"pullquote alignright\">\n“It’s a message that we need to get out, especially to the African-American community, that by going and having a colonoscopy, you lessen the chances of being diagnosed with this.\"\u003cbr>\n\u003ccite>Erin Stennis, widow of colon cancer patient\u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>May is co-author of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25737445\" target=\"_blank\">recent study\u003c/a> that looked at the records of Californians between 40 and 80 years old who have a parent, sibling, or child that’s had colon cancer. That population is at higher risk of developing colon cancer themselves. But of that group, only three out of five had been screened for colon cancer themselves.\u003c/p>\n\u003cp>Dr. Brennan Spiegel, senior author of the study and director of health services at Cedars Sinai in Los Angeles, said this finding revealed \"a big problem.\" The findings grew more sobering from there.\u003c/p>\n\u003cp>\"(W)hen we drilled down into that group and looked at racial and ethnic disparities, we found that African-Americans were 71 percent less likely to get screened than white Californians,\" he said. \"So, this is an even bigger indictment.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Colon cancer screening is especially beneficial, because benign lesions can be found and removed, preventing cancer from having a chance to develop.\u003c/p>\n\u003cp>You might think that close relatives of colon cancer patients would want to be screened. But take the case of the family of Cordell Harper, a 67-year-old African-American man. Fourteen years ago he was diagnosed with colon cancer. He underwent surgery and chemotherapy.\u003c/p>\n\u003cp>Harper has three brothers. They all refuse to get colonoscopies.\u003c/p>\n\u003cp>“So, if having a brother get colon cancer doesn’t make you want to get a colonoscopy, what will?” he asks, with a laugh. \"Having issues, you know, and it may be too late then.”\u003c/p>\n\u003cp>Harper’s brothers are all over 50. That’s the age many\u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\"> national organizations\u003c/a> recommend people begin colon cancer screening. But those with a family history \u003ca href=\"http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations\" target=\"_blank\">should start sooner\u003c/a>. Part of the reason Harper’s brothers won’t get screened has to do with the stigma of having a colonoscopy, which involves threading a flexible tube, called a colonoscope, through the rectum and into the colon. Dr. Fola May says that’s a common concern.\u003c/p>\n\u003cp>“Men in our \u003ca href=\"http://www.researchgate.net/publication/276209726_Addressing_Low_Colorectal_Cancer_Screening_in_African_Americans_Using_Focus_Groups_to_Inform_the_Development_of_Effective_Interventions\" target=\"_blank\">focus group study \u003c/a>and men in other studies have said, ‘I do not want any sort of procedure where I have to have any sort of instrument that’s placed into my behind,' \" May said. \"That was a persistent theme throughout our ... studies.”\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/226272254&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/226272254'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That was the case with Michael Stennis, who died of colon cancer in 2003. I met his wife, Erin Stennis, at a “Relay for Life” cancer event in Los Angeles this summer. After he found blood in his stool, a gastroenterologist told him to get a colonoscopy.\u003c/p>\n\u003cp>“When he found out what a colonoscopy was, he said no one was going to do that to him,\" Erin Stennis told me. \"So he literally sucked up the pain for about six years, and it got to the point where I found him one day hunched over in a closet in our home.”\u003c/p>\n\u003cp>Her husband was soon diagnosed with stage four colon cancer. He lived just two more years. During that time, the couple talked to everyone they could, going to churches and other groups, to try to raise awareness of colon cancer among African Americans.\u003c/p>\n\u003cp>“I think it’s a message that we need to get out, especially to the African-American community,\" Erin Stennis said, \"that by going and having a colonoscopy, you lessen the chances of being diagnosed with this. It’s getting over the stigma attached to colonoscopy and what the procedure entails.\"\u003c/p>\n\u003cp>But the low screening rates are due to more than stigma. In another \u003ca href=\"http://www.gastrojournal.org/article/S0016-5085(15)32000-X/abstract\" target=\"_blank\">study\u003c/a>, Spiegel and his colleagues, found that part of the responsibility may rest with doctors.\u003c/p>\n\u003cp>“We found that African-Americans were more likely to say that their doctor never recommended a colonoscopy or any kind of colon cancer screening than any other racial and ethnic groups,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel says that’s a big failure at the provider level. A nudge from the doctor could make a big difference.\u003c/p>\n\u003cp>“We found that when doctors do recommend screening, it increases the chances of getting screened by nearly twofold,” Dr. Spiegel said.\u003c/p>\n\u003cp>Dr. Spiegel’s team is planning a follow-up study to see if the Affordable Care Act, which fully covers preventive tests like colonoscopies, will make any dent in the racial disparity of colon cancer outcomes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Avishay Artsy reported this story as a 2015 California Health Journalism Fellow at the USC Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Vaccine Law Opponents File Petitions for Repeal",
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"content": "\u003cp>SACRAMENTO, Calif. (AP) — Supporters of an effort to repeal California's new law requiring mandatory vaccines for schoolchildren faced a Monday deadline to turn in enough signatures to qualify a ballot initiative asking voters to repeal the law.\u003c/p>\n\u003cp>The group had until the end of the day to submit the needed 366,000 signatures to county clerks to ask California voters to repeal SB277, which struck down the state's personal belief exemption for immunizations, a move that requires nearly all public schoolchildren to be vaccinated.\u003c/p>\n\u003cp>Gov. Jerry Brown signed SB277 into law earlier this year amid fierce opposition from some parents rights groups who argue the state should not force their children to be vaccinated. He said the science is clear that vaccines \"dramatically protect children against a number of infectious and dangerous diseases.\"\u003c/p>\n\u003cp>It's unclear whether supporters have enough signatures to make it to the ballot and it might not be known until next week, when clerks face a deadline to report how many signatures they received. The leading proponent of the effort, former Republican Assemblyman Tim Donnelly, said in an email Monday that volunteers were coerced and threatened while collecting signatures.\u003c/p>\n\u003cp>Donnelly did not return repeated messages inquiring about the effort's chances, but said in his email that he was proud of the volunteers who worked on the campaign \"whatever the outcome is.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The SB277 Referendum was sabotaged from without and within by powerful forces from its very inception, but we never gave up and we never gave in,\" he wrote.\u003c/p>\n\u003cp>The bill's author, Sen. Richard Pan, D-Sacramento, told reporters Monday that he's confident voters support the vaccination requirement, whether the initiative makes the ballot or not.\u003c/p>\n\u003cp>\"I'm sure the voters of California are not interested in letting a privileged few take away the rights of all Californians to be safe from preventable disease,\" Pan said. \"If they don't have the signatures, I think it would be a direct reflection of the fact that Californians wanted to see their communities safe.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California will join Mississippi and West Virginia as the only states with such strict requirements, if the law takes effect as planned next year.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SACRAMENTO, Calif. (AP) — Supporters of an effort to repeal California's new law requiring mandatory vaccines for schoolchildren faced a Monday deadline to turn in enough signatures to qualify a ballot initiative asking voters to repeal the law.\u003c/p>\n\u003cp>The group had until the end of the day to submit the needed 366,000 signatures to county clerks to ask California voters to repeal SB277, which struck down the state's personal belief exemption for immunizations, a move that requires nearly all public schoolchildren to be vaccinated.\u003c/p>\n\u003cp>Gov. Jerry Brown signed SB277 into law earlier this year amid fierce opposition from some parents rights groups who argue the state should not force their children to be vaccinated. He said the science is clear that vaccines \"dramatically protect children against a number of infectious and dangerous diseases.\"\u003c/p>\n\u003cp>It's unclear whether supporters have enough signatures to make it to the ballot and it might not be known until next week, when clerks face a deadline to report how many signatures they received. The leading proponent of the effort, former Republican Assemblyman Tim Donnelly, said in an email Monday that volunteers were coerced and threatened while collecting signatures.\u003c/p>\n\u003cp>Donnelly did not return repeated messages inquiring about the effort's chances, but said in his email that he was proud of the volunteers who worked on the campaign \"whatever the outcome is.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The SB277 Referendum was sabotaged from without and within by powerful forces from its very inception, but we never gave up and we never gave in,\" he wrote.\u003c/p>\n\u003cp>The bill's author, Sen. Richard Pan, D-Sacramento, told reporters Monday that he's confident voters support the vaccination requirement, whether the initiative makes the ballot or not.\u003c/p>\n\u003cp>\"I'm sure the voters of California are not interested in letting a privileged few take away the rights of all Californians to be safe from preventable disease,\" Pan said. \"If they don't have the signatures, I think it would be a direct reflection of the fact that Californians wanted to see their communities safe.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California will join Mississippi and West Virginia as the only states with such strict requirements, if the law takes effect as planned next year.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mexican Indigenous Immigrants' Dire Need for Medical Interpreters",
"title": "Mexican Indigenous Immigrants' Dire Need for Medical Interpreters",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\n\u003cp>https://vimeo.com/140479930\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>[contextly_sidebar id=\"2KQd30QKKYZZL3bwvUkl6icTu31wfvST\"]\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/225965640\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\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/225965640&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/225965640'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Roughly 350 drop-off sites in California will take consumers' unwanted or unused medications on Saturday and properly dispose of them.\u003c/p>\n\u003cp>It's part of an annual nationwide event Saturday called the 10th annual \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/takeback/\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>, organized by the federal Drug Enforcement Administration and involving hundreds of police stations across California as well as a large number of Kaiser Permanente medical offices. (\u003ca href=\"https://www.deadiversion.usdoj.gov/NTBI/NTBI-PUB.pub?_flowExecutionKey=_c7A27A4CE-B30B-D21F-E593-91FD10C1A30E_kEF810816-0A7D-6A83-7B91-2A6CA227C291\" target=\"_blank\">Look up a collection site near you.\u003c/a>)\u003c/p>\n\u003cp>It's one of several efforts statewide to control misuse and abuse of prescription medication.\u003c/p>\n\u003cp>\"When left laying around, too often unused medications get into the hands of seniors, children and others, and usually those medications are expired or no longer being taken,\" said Steve Gray, a Kaiser Permanente pharmacist and KP's pharmacy professional affairs leader for California.\u003c/p>\n\u003cp>\"The most important part of this [effort] is public safety,\" Gray said, \"so people don't hurt themselves or hurt others.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Seniors sometimes self-prescribe with leftover medications, he said, or they give them to other seniors. Children can take them by accident, or drug abusers can steal them.\u003c/p>\n\u003cp>As part of his job, Gray travels around the state to counties that are considering ordinances to require drug manufacturers to take back unused and unwanted prescription medications.\u003c/p>\n\u003cp>So far, at least four counties have adopted these rules and another seven to 10 counties are considering legislation, Gray said. He said he's meeting with Los Angeles County officials on Monday to help shape their take-back policy.\u003c/p>\n\u003cp>\"There is nothing at the state or federal level to deal with this so the counties are trying to do what they can through their ordinances. It gets difficult if each of the 58 counties have a different program. So I try to help identify best practices so [the ordinances] are the same,\" Gray said.\u003c/p>\n\u003cp>There are a couple of other ways to keep prescription medications from piling up, he said:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Small initial quantity.\u003c/strong> Instead of prescribing a drug for the first time for a full course of a month or even three months, Gray said there's an effort underway to start with a smaller amount. \"The provider doesn't know what will be tolerated by you, and doesn’t know whether it's going to work,\" Gray said, \"so let's start out with a small quantity that would be a good test of whether it might work or not first.\"\u003c/li>\n\u003cli>\u003cstrong>Mail-back envelopes.\u003c/strong> Many retail drug stores now sell pre-paid unused-medication envelopes, to more easily dispose of unwanted prescription drugs. \"The envelopes are approved by the federal government,\" Gray said. \"That is probably the most convenient at this point.\"\u003c/li>\n\u003c/ul>\n\u003cp>Opioids are the most-misused and dangerous medication, he said, but they're not the only ones that can be deadly.\u003c/p>\n\u003cp>\"That's just one category,\" he said. \"You can really hurt yourself with opioids, but many times people think, 'I have diabetes, too,' and they can kill themselves by taking someone else's diabetes medication.\"\u003c/p>\n\u003cp>Gray said his own parents lived through the Great Depression, \"and they don't like to see anything thrown away,\" he said. \"They think, 'Maybe someday I'll need that.' This is a real problem with seniors.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">\u003cem>California Healthline. \u003c/em>\u003c/a>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Roughly 350 drop-off sites in California will take consumers' unwanted or unused medications on Saturday and properly dispose of them.\u003c/p>\n\u003cp>It's part of an annual nationwide event Saturday called the 10th annual \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/takeback/\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>, organized by the federal Drug Enforcement Administration and involving hundreds of police stations across California as well as a large number of Kaiser Permanente medical offices. (\u003ca href=\"https://www.deadiversion.usdoj.gov/NTBI/NTBI-PUB.pub?_flowExecutionKey=_c7A27A4CE-B30B-D21F-E593-91FD10C1A30E_kEF810816-0A7D-6A83-7B91-2A6CA227C291\" target=\"_blank\">Look up a collection site near you.\u003c/a>)\u003c/p>\n\u003cp>It's one of several efforts statewide to control misuse and abuse of prescription medication.\u003c/p>\n\u003cp>\"When left laying around, too often unused medications get into the hands of seniors, children and others, and usually those medications are expired or no longer being taken,\" said Steve Gray, a Kaiser Permanente pharmacist and KP's pharmacy professional affairs leader for California.\u003c/p>\n\u003cp>\"The most important part of this [effort] is public safety,\" Gray said, \"so people don't hurt themselves or hurt others.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Seniors sometimes self-prescribe with leftover medications, he said, or they give them to other seniors. Children can take them by accident, or drug abusers can steal them.\u003c/p>\n\u003cp>As part of his job, Gray travels around the state to counties that are considering ordinances to require drug manufacturers to take back unused and unwanted prescription medications.\u003c/p>\n\u003cp>So far, at least four counties have adopted these rules and another seven to 10 counties are considering legislation, Gray said. He said he's meeting with Los Angeles County officials on Monday to help shape their take-back policy.\u003c/p>\n\u003cp>\"There is nothing at the state or federal level to deal with this so the counties are trying to do what they can through their ordinances. It gets difficult if each of the 58 counties have a different program. So I try to help identify best practices so [the ordinances] are the same,\" Gray said.\u003c/p>\n\u003cp>There are a couple of other ways to keep prescription medications from piling up, he said:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Small initial quantity.\u003c/strong> Instead of prescribing a drug for the first time for a full course of a month or even three months, Gray said there's an effort underway to start with a smaller amount. \"The provider doesn't know what will be tolerated by you, and doesn’t know whether it's going to work,\" Gray said, \"so let's start out with a small quantity that would be a good test of whether it might work or not first.\"\u003c/li>\n\u003cli>\u003cstrong>Mail-back envelopes.\u003c/strong> Many retail drug stores now sell pre-paid unused-medication envelopes, to more easily dispose of unwanted prescription drugs. \"The envelopes are approved by the federal government,\" Gray said. \"That is probably the most convenient at this point.\"\u003c/li>\n\u003c/ul>\n\u003cp>Opioids are the most-misused and dangerous medication, he said, but they're not the only ones that can be deadly.\u003c/p>\n\u003cp>\"That's just one category,\" he said. \"You can really hurt yourself with opioids, but many times people think, 'I have diabetes, too,' and they can kill themselves by taking someone else's diabetes medication.\"\u003c/p>\n\u003cp>Gray said his own parents lived through the Great Depression, \"and they don't like to see anything thrown away,\" he said. \"They think, 'Maybe someday I'll need that.' This is a real problem with seniors.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">\u003cem>California Healthline. \u003c/em>\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Valley Fire Triggers Memories of Vietnam Trauma for Evacuated Veteran",
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"content": "\u003cp>\u003cem>Editor's note: For Lake County veterans who fought in Vietnam, the sights and sounds of the Valley Fire two weeks ago immediately stirred images of burning napalm and exploding grenades. As part of our \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Vital Signs\u003c/a> series, reporter April Dembosky interviewed Vietnam veteran Jack Reece. He shares his story, starting with his view of the fire -- just before he fled his home in Hidden Valley. The interview has been edited for length and clarity.\u003c/em>\u003c/p>\n\u003cp>I was up there on that hillside watching that fire come off of Cobb [in Lake County] and then down and into the valley.\u003c/p>\n\u003cp>It was like a unit moving forward with tanks and everything, and those canisters, those propane canisters going off, they make a \"whooooo... boom!\"\u003c/p>\n\u003cp>I tried to stay there as long as I could, and then I had to drive out through a firestorm. All those houses were on fire and I had to drive through it, about 150 yards. It tripped me, the flashes.\u003c/p>\n\u003cp>It all flashed back.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>I mean, watching people get hit with napalm. Taking a hill and having little children dropping grenades down these things. You run up to them and kill them all -- and find out they’re children. It's horrible. You don’t want to know. I was a squad leader and a hit man.\u003c/p>\n\u003cp>My whole f***ing leg got blown apart. All the way up to here. And then I got a concussion. I was in a coma for three days.\u003c/p>\n\u003cp>Ninety-six of us went over in our unit, and only 14 of us came back.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/225536921\" 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>As soon as you go through an experience like that again, you start hearing people screaming and yelling. I don’t need that in my life and so, I self medicated. Night before last -- I like gin and tonic, and I can just, run 'em through. It was okay, for just that night, because I couldn’t get any meds -- because my meds were up the house.\u003c/p>\n\u003cp>Monday morning, I knew I had to, I knew it. I got my ass over there and got to see the psychiatrist, and she took care of me.\u003c/p>\n\u003cp>Because with vets, we’re never going to get over it, honey. Never. But, we can learn to manage it. When we realize we’re at those points where we go and we need help and we ask for it. Most guys don’t know that. They freak out on it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Anyway. I’m so fortunate. I think the guys upstairs, whoever’s watching over, they have to do double time with me.\u003c/p>\n\n",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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"info": "",
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"tech-nation": {
"id": "tech-nation",
"title": "Tech Nation Radio Podcast",
"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
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"ted-radio-hour": {
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"title": "TED Radio Hour",
"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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