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"content": "\u003cp>By \u003ca href=\"http://kvpr.org/people/rebecca-plevin\" target=\"_blank\">Rebecca Plevin\u003c/a>, \u003ca href=\"http://kvpr.org/post/reedley-farmer-goes-farm-school-strawberries\" target=\"_blank\">Valley Public Radio\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11889\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/03/small-farmer-in-central-valley-takes-his-strawberries-farm-to-school/paesaephan_rebeccaplevin_kvpr/\" rel=\"attachment wp-att-11889\">\u003cimg class=\"size-large wp-image-11889\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/PaeSaephan_RebeccaPlevin_KVPR-620x465.jpg\" alt=\"Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\" width=\"620\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\u003c/figcaption>\u003c/figure>\n\u003cp>Pao Saephan crouches down in his sun-drenched field. He cups a red jewel in his hand. In a few more days, his strawberries will be fully ripe. He’ll pick them once they are rosy red from stem to tip.\u003c/p>\n\u003cp>“We want all the strawberries, to be full ripe, full flavor, with 100 percent sugar in them,” says Saephan.\u003c/p>\n\u003cp>In the past, he would sell the fresh berries at his roadside stand, in the small town of Reedley, southeast of Fresno.\u003c/p>\n\u003caside class=\"pullquote alignright\">The goal is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/aside>\n\u003cp>But this year, he will sell the bulk of his berries directly to the Fresno Unified School District. He says he is thrilled to share the fruits of his labor with Central Valley students.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have farmed a long time, but this is my passion, to be farming something that feeds local,” says Saephan.\u003c/p>\n\u003cp>Saephan is the first small farmer to sell his produce directly to Fresno Unified. He could pave the way for other small farmers to begin selling their produce directly with the school district.\u003c/p>\n\u003cp>Jose Alvarado, food services director for Fresno Unified notes that the district is located in the \"produce and vegetable capital\" of the world. “We have been taking advantage of that,\" he says, \"but now it’s taking it to another level, from the farmer, when the occasion is right, and it meets our needs. Strawberries were just a natural for us.\"\u003c!--more-->\u003c/p>\n\u003cp>Alvarado hopes every Fresno Unified student can taste Saephan’s strawberries at their peak. His goal, he said, is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/p>\n\u003cp>Still, he acknowledged that there are several barriers to linking small farms and large school districts. For logistical reasons, it’s often easier for school districts to buy produce from large distributors.\u003c/p>\n\u003cp>“Some school districts like to work with one company: you go to the grocery store, not the cucumber stand, the broccoli stand, the strawberry stand,” Alvarado said.\u003c/p>\n\u003cp>He said another challenge is that some small farmers are not trained in food safety.\u003c/p>\n\u003cp>“Pao is our first step to truly go to the farm – we have worked with other farmers, this is one where the farmer was lacking all the food safety certifications,\" Alvarado said. \"We’re breaking new ground with Pao, and learning what it takes for him to be certified.\"\u003c/p>\n\u003cp>Despite those barriers, Alvarado said there are many benefits to buying produce, and especially strawberries, from local farmers. Among those is the cost.\u003c/p>\n\u003cp>The district serves about 85,000 meals a day. Alvarado’s goal is for each of those meals to include three or four of Saephan’s beauties.\u003c/p>\n\u003cp>“A locally grown strawberry that we buy from the farmer more than likely will be more cost effective for the district,\" Alvarado said. \"But that’s not the driver.\"\u003c/p>\n\u003cp>Beyond dollars, strawberries are one of those fruits that just taste better when they’re picked fully ripe.\u003c/p>\n\u003cp>“The driver is, fresh products that taste good are more likely to be eaten than products that don’t,\" Alvarado said. \"If they don’t eat it, we’re wasting money.\" Plus fruits and vegetables in school lunches that end up in the trash aren't helping children's overall nutrition either.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fresno Unified students should start seeing Saephan’s berries on the menu in May.\u003c/p>\n\n",
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"excerpt": "Pao Saephan crouches down in his sun-drenched field. He cups a red jewel in his hand. In a few more days, his strawberries will be fully ripe. He’ll pick them once they are rosy red from stem to tip.\r\n\r\n“We want all the strawberries, to be full ripe, full flavor, with 100 percent sugar in them,” says Saephan.\r\n\r\nIn the past, he would sell the fresh berries at his roadside stand, in the small town of Reedley, southeast of Fresno. But this year, he will sell the bulk of his berries directly to the Fresno Unified School District. He says he is thrilled to share the fruits of his labor with Central Valley students.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://kvpr.org/people/rebecca-plevin\" target=\"_blank\">Rebecca Plevin\u003c/a>, \u003ca href=\"http://kvpr.org/post/reedley-farmer-goes-farm-school-strawberries\" target=\"_blank\">Valley Public Radio\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11889\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/03/small-farmer-in-central-valley-takes-his-strawberries-farm-to-school/paesaephan_rebeccaplevin_kvpr/\" rel=\"attachment wp-att-11889\">\u003cimg class=\"size-large wp-image-11889\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/PaeSaephan_RebeccaPlevin_KVPR-620x465.jpg\" alt=\"Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\" width=\"620\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pao Saephan's strawberries are just days away from being fully ripe. (Rebecca Plevin/Valley Public Radio)\u003c/figcaption>\u003c/figure>\n\u003cp>Pao Saephan crouches down in his sun-drenched field. He cups a red jewel in his hand. In a few more days, his strawberries will be fully ripe. He’ll pick them once they are rosy red from stem to tip.\u003c/p>\n\u003cp>“We want all the strawberries, to be full ripe, full flavor, with 100 percent sugar in them,” says Saephan.\u003c/p>\n\u003cp>In the past, he would sell the fresh berries at his roadside stand, in the small town of Reedley, southeast of Fresno.\u003c/p>\n\u003caside class=\"pullquote alignright\">The goal is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/aside>\n\u003cp>But this year, he will sell the bulk of his berries directly to the Fresno Unified School District. He says he is thrilled to share the fruits of his labor with Central Valley students.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have farmed a long time, but this is my passion, to be farming something that feeds local,” says Saephan.\u003c/p>\n\u003cp>Saephan is the first small farmer to sell his produce directly to Fresno Unified. He could pave the way for other small farmers to begin selling their produce directly with the school district.\u003c/p>\n\u003cp>Jose Alvarado, food services director for Fresno Unified notes that the district is located in the \"produce and vegetable capital\" of the world. “We have been taking advantage of that,\" he says, \"but now it’s taking it to another level, from the farmer, when the occasion is right, and it meets our needs. Strawberries were just a natural for us.\"\u003c!--more-->\u003c/p>\n\u003cp>Alvarado hopes every Fresno Unified student can taste Saephan’s strawberries at their peak. His goal, he said, is for children to “experience fresh produce and make healthy eating choices over a lifetime.”\u003c/p>\n\u003cp>Still, he acknowledged that there are several barriers to linking small farms and large school districts. For logistical reasons, it’s often easier for school districts to buy produce from large distributors.\u003c/p>\n\u003cp>“Some school districts like to work with one company: you go to the grocery store, not the cucumber stand, the broccoli stand, the strawberry stand,” Alvarado said.\u003c/p>\n\u003cp>He said another challenge is that some small farmers are not trained in food safety.\u003c/p>\n\u003cp>“Pao is our first step to truly go to the farm – we have worked with other farmers, this is one where the farmer was lacking all the food safety certifications,\" Alvarado said. \"We’re breaking new ground with Pao, and learning what it takes for him to be certified.\"\u003c/p>\n\u003cp>Despite those barriers, Alvarado said there are many benefits to buying produce, and especially strawberries, from local farmers. Among those is the cost.\u003c/p>\n\u003cp>The district serves about 85,000 meals a day. Alvarado’s goal is for each of those meals to include three or four of Saephan’s beauties.\u003c/p>\n\u003cp>“A locally grown strawberry that we buy from the farmer more than likely will be more cost effective for the district,\" Alvarado said. \"But that’s not the driver.\"\u003c/p>\n\u003cp>Beyond dollars, strawberries are one of those fruits that just taste better when they’re picked fully ripe.\u003c/p>\n\u003cp>“The driver is, fresh products that taste good are more likely to be eaten than products that don’t,\" Alvarado said. \"If they don’t eat it, we’re wasting money.\" Plus fruits and vegetables in school lunches that end up in the trash aren't helping children's overall nutrition either.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fresno Unified students should start seeing Saephan’s berries on the menu in May.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California's Breast Density Notification Law Goes Into Effect",
"title": "California's Breast Density Notification Law Goes Into Effect",
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"content": "\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/05/01/new-research-for-women-in-their-40s-on-mammograms/080922-n-2688m-004/\" rel=\"attachment wp-att-5549\">\u003cimg class=\"size-medium wp-image-5549\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\u003c/p>\n\u003cp>Starting Monday, \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/sen/sb_1501-1550/sb_1538_bill_20120922_chaptered.html\" target=\"_blank\">a new California law\u003c/a> will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>Former state Sen. Joe Simitian (D-Palo Alto) introduced the law last year. It grew out of his concern that while doctors were aware of a patient's breast density, the patient herself was not, preventing women from talking with their doctors about how they might want to address their potential increased risk. He wanted to change that.\u003c/p>\n\u003cp>\"The fundamental premise of the legislation,\" he said in a recent call with reporters, \"is that absent this information, these conversations weren't going to take place.\"\u003c/p>\n\u003cp>Some background: breast tissue is graded from 1 (not dense) to 4 (extremely dense). The law requires that women graded either a 3 or a 4 be notified.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Here's the specific notification required by the law:\u003c/p>\n\u003cblockquote>\u003cp>Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the \u003c!--more-->results of your mammogram and may also be associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.\u003c/p>\u003c/blockquote>\n\u003cp>But here's where the law and medical data collide: while there's fairly solid scientific evidence about the increased breast cancer risk for women with a \"4\" rating, there's not for women with a \"3\" rating. Yet, women with a \"3\" rating will be notified.\u003c/p>\n\u003cp>To put the increased risk in perspective, a woman in her 40s with \"extremely dense breasts\" has roughly the same risk of breast cancer as an average-risk woman in her 50s, according to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/mammograms-which-women-how-often/\" target=\"_blank\">a study of nearly 1 million women\u003c/a> published earlier this month by researchers from UCSF. About 12 to 15 percent of women in their 40s have \"extremely dense breasts.\"\u003c/p>\n\u003cp>So, what's a woman who receives the notification to do? The law simply suggests women decide on a course of action with their doctors.\u003c/p>\n\u003cp>The UCSF study looked specifically at the issue of breast density and found that women in their 40s with \"extremely dense breasts\" should have a mammogram every year. Major guidelines conflict as to the frequency of mammograms for women in their 40s. \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">One says annually\u003c/a>; \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">another says \u003c/a>it's a woman's individual choice.\u003c/p>\n\u003cp>But this most recent study from UCSF suggests that women in their 40s with extremely dense breasts will reduce their risk of being diagnosed with advanced disease if they have a digital mammogram every year. For women in their 50s, the researchers found no increased risk of late- stage disease if a woman had a mammogram every two years -- no matter how dense the breast tissue is.\u003c/p>\n\u003cp>So, that's some of the most up-to-date research on mammography.\u003c/p>\n\u003cp>But the new law also mentions deciding \"which screening options are right for you.\" The press call with Simitian included a radiologist and a nurse. Both discussed ultrasound screening for breast cancer. But Karla Kerlikowske, biostatistician and lead researcher of the UCSF study, said that while she supports women having information, in this case, the law may be ahead of the science \"because we don't know that women need additional imaging tests beyond digital mammography if they fall into one of those (breast density) categories.\"\u003c/p>\n\u003cp>In a subsequent email, Kerlikowske said that there are no studies of what's known as \"whole breast ultrasound\" to determine cancer detection and whether detection makes a difference in cancer staging.\u003c/p>\n\u003cp>Women with higher breast density are also at higher risk of false positives and might need to go through additional imaging and unnecessary biopsies. As Otis Brawley, chief medical officer of the American Cancer Society, noted, \"The thing that increases risk also makes screening more difficult to do. God is not fair here.\"\u003c/p>\n\u003cp>Perhaps that is what's most worth remembering: that life is not fair. At a time when people in general -- not just women -- want certainty in the face of a possible disease, medical science cannot yet provide it.\u003c/p>\n\u003cp>Again, what should you do if you get a notification of high breast density? Talk to your doctor.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003cbr>\n\u003ca href=\"http://www.kqed.org/news/story/2013/04/01/118772/breast_density_notification_law_goes_into_effect?category=bay+area\" target=\"_blank\">Listen to the story.\u003c/a>\u003c/p>\n\n",
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"excerpt": "As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\r\n\r\nStarting Monday, a new California law will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.",
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"description": "As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\r\n\r\nStarting Monday, a new California law will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/05/01/new-research-for-women-in-their-40s-on-mammograms/080922-n-2688m-004/\" rel=\"attachment wp-att-5549\">\u003cimg class=\"size-medium wp-image-5549\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>As women are well aware, the purpose of a mammogram is to screen for cancer. What many women don't know is that as part of the screening, radiologists also assess the level of density in a woman's breast tissue.\u003c/p>\n\u003cp>Starting Monday, \u003ca href=\"http://leginfo.ca.gov/pub/11-12/bill/sen/sb_1501-1550/sb_1538_bill_20120922_chaptered.html\" target=\"_blank\">a new California law\u003c/a> will require that doctors notify women if their breast tissue is dense. Dense breast tissue makes it harder to read mammograms and is associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>Former state Sen. Joe Simitian (D-Palo Alto) introduced the law last year. It grew out of his concern that while doctors were aware of a patient's breast density, the patient herself was not, preventing women from talking with their doctors about how they might want to address their potential increased risk. He wanted to change that.\u003c/p>\n\u003cp>\"The fundamental premise of the legislation,\" he said in a recent call with reporters, \"is that absent this information, these conversations weren't going to take place.\"\u003c/p>\n\u003cp>Some background: breast tissue is graded from 1 (not dense) to 4 (extremely dense). The law requires that women graded either a 3 or a 4 be notified.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Here's the specific notification required by the law:\u003c/p>\n\u003cblockquote>\u003cp>Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the \u003c!--more-->results of your mammogram and may also be associated with an increased risk of breast cancer.\u003c/p>\n\u003cp>This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. A report of your results was sent to your physician.\u003c/p>\u003c/blockquote>\n\u003cp>But here's where the law and medical data collide: while there's fairly solid scientific evidence about the increased breast cancer risk for women with a \"4\" rating, there's not for women with a \"3\" rating. Yet, women with a \"3\" rating will be notified.\u003c/p>\n\u003cp>To put the increased risk in perspective, a woman in her 40s with \"extremely dense breasts\" has roughly the same risk of breast cancer as an average-risk woman in her 50s, according to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/mammograms-which-women-how-often/\" target=\"_blank\">a study of nearly 1 million women\u003c/a> published earlier this month by researchers from UCSF. About 12 to 15 percent of women in their 40s have \"extremely dense breasts.\"\u003c/p>\n\u003cp>So, what's a woman who receives the notification to do? The law simply suggests women decide on a course of action with their doctors.\u003c/p>\n\u003cp>The UCSF study looked specifically at the issue of breast density and found that women in their 40s with \"extremely dense breasts\" should have a mammogram every year. Major guidelines conflict as to the frequency of mammograms for women in their 40s. \u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\">One says annually\u003c/a>; \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">another says \u003c/a>it's a woman's individual choice.\u003c/p>\n\u003cp>But this most recent study from UCSF suggests that women in their 40s with extremely dense breasts will reduce their risk of being diagnosed with advanced disease if they have a digital mammogram every year. For women in their 50s, the researchers found no increased risk of late- stage disease if a woman had a mammogram every two years -- no matter how dense the breast tissue is.\u003c/p>\n\u003cp>So, that's some of the most up-to-date research on mammography.\u003c/p>\n\u003cp>But the new law also mentions deciding \"which screening options are right for you.\" The press call with Simitian included a radiologist and a nurse. Both discussed ultrasound screening for breast cancer. But Karla Kerlikowske, biostatistician and lead researcher of the UCSF study, said that while she supports women having information, in this case, the law may be ahead of the science \"because we don't know that women need additional imaging tests beyond digital mammography if they fall into one of those (breast density) categories.\"\u003c/p>\n\u003cp>In a subsequent email, Kerlikowske said that there are no studies of what's known as \"whole breast ultrasound\" to determine cancer detection and whether detection makes a difference in cancer staging.\u003c/p>\n\u003cp>Women with higher breast density are also at higher risk of false positives and might need to go through additional imaging and unnecessary biopsies. As Otis Brawley, chief medical officer of the American Cancer Society, noted, \"The thing that increases risk also makes screening more difficult to do. God is not fair here.\"\u003c/p>\n\u003cp>Perhaps that is what's most worth remembering: that life is not fair. At a time when people in general -- not just women -- want certainty in the face of a possible disease, medical science cannot yet provide it.\u003c/p>\n\u003cp>Again, what should you do if you get a notification of high breast density? Talk to your doctor.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003cbr>\n\u003ca href=\"http://www.kqed.org/news/story/2013/04/01/118772/breast_density_notification_law_goes_into_effect?category=bay+area\" target=\"_blank\">Listen to the story.\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Put That Baby Spoon Down: Doctors Say Infants Fed Solid Food Too Soon",
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"content": "\u003cfigure id=\"attachment_11670\" class=\"wp-caption alignleft\" style=\"max-width: 283px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/25/put-that-baby-spoon-down-infants-fed-solid-food-too-soon/baby2_andypeters_flickr-copy/\" rel=\"attachment wp-att-11670\">\u003cimg class=\"size-medium wp-image-11670\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/baby2_AndyPeters_Flickr-copy-300x317.jpg\" alt=\"Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\" width=\"283\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A new survey from the Centers for Disease Control finds that mothers (the CDC surveyed only mothers) are giving their babies solid food too early, despite guidelines from the American Academy of Pediatrics.\u003c/p>\n\u003cp>In \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2012-2265\" target=\"_blank\">the survey\u003c/a>, or more than 1,334 women, just over 40 percent of mothers gave their babies solid food before they were four months old.\u003c/p>\n\u003cp>For years, the AAP had recommended that babies be at least four months old before being given solid food. But last year, it recommended that babies be \u003ca href=\"http://www.healthychildren.org/English/news/Pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx\" target=\"_blank\">breastfed -- exclusively -- for six months\u003c/a>, before \"complementary\" foods are given. Now we see that many mothers are not even waiting the full four months.\u003c/p>\n\u003cp>From \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/03/25/infants-feeding-solids-formula/2006725/\" target=\"_blank\">USA Today\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Understanding parents' motivations is important, because a number of health problems are associated with the early introduction of solid foods, says study co-author Kelley Scanlon, an epidemiologist with the Centers for Disease Control and Prevention. These findings \"don't offer a full understanding why, but they give us some insight,\" she says.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The moms cited reasons such as, \"My baby was old enough,\" and, \"It would help my baby sleep longer at night.\"\u003c/p>\n\u003cp>According to the American Academy of Pediatrics, the head and neck control and overall coordination that infants need to safely eat solids does not develop until around 4 months. In addition, the early introduction of solids may increase the risk of some chronic diseases, such as diabetes, obesity, eczema and celiac disease, the study notes.\u003c/p>\n\u003cp>Giving solids too soon also ends exclusive breast-feeding, which the AAP recommends for about the first 6 months because of numerous health benefits for infants, including reduced risk of respiratory and ear infections, diarrhea, diabetes, obesity and sudden infant death syndrome.\u003c/p>\n\u003cp>A bit of cereal added to a bottle of formula is sometimes recommended by physicians for babies with reflux, says Lana Gagin, a pediatrician at the Helen DeVos Children's Hospital in Grand Rapids, Mich. She was not involved in the study. From a medical standpoint, however, \"There is no good, solid evidence that it helps a baby sleep,\" she says. ...\u003c/p>\n\u003cp>\"We didn't expect to see so many (give solids) before 4 months,\" says Scanlon. She says the finding in this study that 40.4% do so is higher than previous findings that range from 19% to 29%. Unlike most past studies, which surveyed mothers two or three years after they first introduced solids, the new study asked moms to recall what was fed during the previous seven days.\u003c/p>\n\u003cp> \u003c/p>\u003c/blockquote>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "A new survey from the Centers for Disease Control finds that mothers (the CDC surveyed only mothers) are giving their babies solid food too early, despite guidelines from the American Academy of Pediatrics. \r\n\r\nIn the survey, or more than 1,334 women, just over 40 percent of mothers gave their babies solid food before they were four months old.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11670\" class=\"wp-caption alignleft\" style=\"max-width: 283px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/25/put-that-baby-spoon-down-infants-fed-solid-food-too-soon/baby2_andypeters_flickr-copy/\" rel=\"attachment wp-att-11670\">\u003cimg class=\"size-medium wp-image-11670\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/baby2_AndyPeters_Flickr-copy-300x317.jpg\" alt=\"Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\" width=\"283\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Forty percent of mothers surveyed reported giving their baby solid food before the baby was four months old. (Andy Peters/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A new survey from the Centers for Disease Control finds that mothers (the CDC surveyed only mothers) are giving their babies solid food too early, despite guidelines from the American Academy of Pediatrics.\u003c/p>\n\u003cp>In \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2012-2265\" target=\"_blank\">the survey\u003c/a>, or more than 1,334 women, just over 40 percent of mothers gave their babies solid food before they were four months old.\u003c/p>\n\u003cp>For years, the AAP had recommended that babies be at least four months old before being given solid food. But last year, it recommended that babies be \u003ca href=\"http://www.healthychildren.org/English/news/Pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx\" target=\"_blank\">breastfed -- exclusively -- for six months\u003c/a>, before \"complementary\" foods are given. Now we see that many mothers are not even waiting the full four months.\u003c/p>\n\u003cp>From \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/03/25/infants-feeding-solids-formula/2006725/\" target=\"_blank\">USA Today\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Understanding parents' motivations is important, because a number of health problems are associated with the early introduction of solid foods, says study co-author Kelley Scanlon, an epidemiologist with the Centers for Disease Control and Prevention. These findings \"don't offer a full understanding why, but they give us some insight,\" she says.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The moms cited reasons such as, \"My baby was old enough,\" and, \"It would help my baby sleep longer at night.\"\u003c/p>\n\u003cp>According to the American Academy of Pediatrics, the head and neck control and overall coordination that infants need to safely eat solids does not develop until around 4 months. In addition, the early introduction of solids may increase the risk of some chronic diseases, such as diabetes, obesity, eczema and celiac disease, the study notes.\u003c/p>\n\u003cp>Giving solids too soon also ends exclusive breast-feeding, which the AAP recommends for about the first 6 months because of numerous health benefits for infants, including reduced risk of respiratory and ear infections, diarrhea, diabetes, obesity and sudden infant death syndrome.\u003c/p>\n\u003cp>A bit of cereal added to a bottle of formula is sometimes recommended by physicians for babies with reflux, says Lana Gagin, a pediatrician at the Helen DeVos Children's Hospital in Grand Rapids, Mich. She was not involved in the study. From a medical standpoint, however, \"There is no good, solid evidence that it helps a baby sleep,\" she says. ...\u003c/p>\n\u003cp>\"We didn't expect to see so many (give solids) before 4 months,\" says Scanlon. She says the finding in this study that 40.4% do so is higher than previous findings that range from 19% to 29%. Unlike most past studies, which surveyed mothers two or three years after they first introduced solids, the new study asked moms to recall what was fed during the previous seven days.\u003c/p>\n\u003cp> \u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "E.R. Docs and Gun Violence: Emotional Stories of Fatalities 'Hard to Forget'",
"title": "E.R. Docs and Gun Violence: Emotional Stories of Fatalities 'Hard to Forget'",
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"content": "\u003cp>By Eric Whitney for Colorado Public Radio and \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/21/colorado-doctors-and-guns.aspx\" target=\"_blank\">Kaiser Health News \u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11618\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/22/e-r-doctors-and-gun-violence-emotional-stories-of-fatalities-hard-to-forget/chris-colwell/\" rel=\"attachment wp-att-11618\">\u003cimg class=\"size-full wp-image-11618\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/ChrisColwell_KHN03222013.jpg\" alt=\"Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>In Colorado, where more people \u003ca href=\"http://www.suicidepreventioncolorado.org/uploads/8/7/8/4/8784346/firearms_deaths_in_co_2004_2011.pdf\" target=\"_blank\">die from gunshots than car crashes\u003c/a>, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.\u003c/p>\n\u003cp>Dr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.\u003c/p>\n\u003cp>\"These are the injuries that the [patients] will come in, and they'll look at me, and they'll talk to me, and then they'll die,\" says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"These are the injuries that the (patients) will come in, and they'll look at me, and they'll talk to me, and then they'll die.\"\u003c/aside>\n\u003cp>Colwell also treated casualties from two of the deadliest mass shootings in American history. He responded to the scene during the 1999 massacre at Columbine High School where 15 people died. He also treated victims of last July's movie theater shooting in\u003ca href=\"http://www.acep.org/sa/videos/\" target=\"_blank\"> Aurora\u003c/a>, where a dozen were killed and 58 wounded.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Often, Colwell will treat a shooting victim, and then treat the shooter after he or she has been caught by police. Colwell describes a case from a few months ago in which he treated a woman who later died -- and then her husband, who fired the gun.\u003c!--more-->\u003c/p>\n\u003cp>\"They had had a fight. He had caught her in what he felt was cheating, and he had lost his temper,\" he says. \"He went and grabbed the pistol that he had for home defense at his bedside, and he made a snap decision.\" Now, he adds, \"his life will never be the same, and hers was gone.\"\u003c/p>\n\u003cp>Colwell says it's remarkable how often people who pull the trigger are surprised at the consequences of their actions. And he's deeply disturbed by how easy guns are to get.\u003c/p>\n\u003cp>\"I see patients every day that are right on the edge of being unstable. … They describe problems with access to medications; problems with access to psychiatric care or substance abuse care; problems with access to homes or to shelter,\" says Colwell. \"But they don't describe problems with access to guns.\"\u003c/p>\n\u003cp>Dr. Katie Bakes, who has worked with Colwell in the emergency department for 10 years, also says it's the gunshot victims that she can't shake.\u003c/p>\n\u003cp>A few weeks ago she treated a three-year-old who'd been shot in the head. Her mother had shot each of her three children and then committed suicide. \"Our patient was the only one who was \u003ca href=\"http://www.denverpost.com/breakingnews/ci_22646862/doctors-say-condition-denver-girl-shot-by-mother?IADID=Search-www.denverpost.com-www.denverpost.com\" target=\"_blank\">a survivor\u003c/a>,\" Bakes says.\u003c/p>\n\u003cp>Such experiences have made Bakes unequivocal in her opposition to guns.\u003c/p>\n\u003cp>\"I hate guns. If I could snap my finger and get rid of all the guns I would. I think they're evil,\" Bakes says, \"I don't really care what the other side of the argument is. I just don't want to see another 3-year-old come in and be shot in the head.\"\u003c/p>\n\u003cp>Bakes and Colwell say gun injuries feel much more deliberate than any other kind of trauma they see.\u003c/p>\n\u003cp>\"It's so senseless,\" Bakes says. \"You know, it's not an accident, somebody intentionally pulled the trigger for whatever reason.\"\u003c/p>\n\u003cp>But not all physicians share this perspective.\u003c/p>\n\u003cp>Dr. Jack Cletcher, a retired orthopedic surgeon, has treated his share of gunshot victims, too, from the streets of Chicago, and, decades ago, he took care of wounded soldiers just off the plane from Vietnam. He can sympathize with Bakes and Colwell, but he doesn't agree that laws need to change.\u003c/p>\n\u003cp>\"This is the kind of emotional reaction that occurs with these horrible catastrophes that happen,\" Cletcher says. \"The gun is only the instrument. It's not something that happens because the gun does it. There has to be somebody holding the gun to do it.\"\u003c/p>\n\u003cp>Cletcher is opposed to most of the new gun restrictions lawmakers are talking about in Denver and Washington.\u003c/p>\n\u003cp>\"I don't think we need new laws, we just need to make the ones we have work better,\" says Cletcher, who would rather see lawmakers focus on better treatment for the mentally ill, and keeping guns out of their hands.\u003c/p>\n\u003cp>Recently, leaders of the Colorado Medical Society went to Washington to \u003ca href=\"http://www.denvermedsociety.org/newsletters/DENVER%20MEDICAL%20BULLETIN%202013%2003.pdf\">lobby\u003c/a> for measures to help prevent gun violence. Strengthening mental health care was on their agenda, and they support President Barack Obama's executive action for increased research into gun violence.\u003c/p>\n\u003cp>Dr. John Bender, the organization's president-elect, showed Rep. Ed Perlmutter, D- Colo., the results of a recent survey of the medical society's members in which about two-thirds want to see gun regulations strengthened and about a third don't.\u003c/p>\n\u003cp>No similar survey exists for doctors nationwide, but a majority of AMA delegates have \u003ca href=\"https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/ama1/pub/upload/mm/PolicyFinder/policyfiles/HnE/H-145.985.HTM\" target=\"_blank\">endorsed\u003c/a> tighter restrictions on guns. \u003ca href=\"http://www.drgo.us/?tag=doctors-for-responsible-gun-ownership\">Not all doctors agree\u003c/a>, but among those calling for stricter gun control laws are the \u003ca href=\"http://www.ama-assn.org/resources/doc/washington/2013-01-29-feinstein-assault-weapons-ban.pdf\">AMA\u003c/a> and several groups of specialists, including the \u003ca href=\"http://www.acep.org/Physician-Resources/Policies/Policy-statements/Firearm-Injury-Prevention/\" target=\"_blank\">American College of Emergency Physicians\u003c/a>, the \u003ca href=\"http://blogs.aafp.org/cfr/leadervoices/entry/time_for_a_national_conversation\" target=\"_blank\">American Academy of Family Physicians\u003c/a> and the \u003ca href=\"http://pediatrics.aappublications.org/content/130/5/e1416.full?sid=0fd76a3f-2ca9-4069-9960-8c889def313a\" target=\"_blank\">American Academy of Pediatrics\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Kaiser Health News, \u003ca href=\"http://www.cpr.org/#load_category_page%7Cnews\" target=\"_blank\">Colorado Public Radio\u003c/a>, and \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">\u003cem>NPR\u003c/em>\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "In Colorado, where more people die from gunshots than car crashes, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.\r\n\r\nDr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.\r\n\r\n\"These are the injuries that the [patients] will come in, and they'll look at me, and they'll talk to me, and then they'll die,\" says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.",
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"description": "In Colorado, where more people die from gunshots than car crashes, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.\r\n\r\nDr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.\r\n\r\n"These are the injuries that the will come in, and they'll look at me, and they'll talk to me, and then they'll die," says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.",
"title": "E.R. Docs and Gun Violence: Emotional Stories of Fatalities 'Hard to Forget' | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Eric Whitney for Colorado Public Radio and \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/21/colorado-doctors-and-guns.aspx\" target=\"_blank\">Kaiser Health News \u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11618\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/22/e-r-doctors-and-gun-violence-emotional-stories-of-fatalities-hard-to-forget/chris-colwell/\" rel=\"attachment wp-att-11618\">\u003cimg class=\"size-full wp-image-11618\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/ChrisColwell_KHN03222013.jpg\" alt=\"Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Denver emergency room physician Chris Colwell (Barry Gutierrez/For KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>In Colorado, where more people \u003ca href=\"http://www.suicidepreventioncolorado.org/uploads/8/7/8/4/8784346/firearms_deaths_in_co_2004_2011.pdf\" target=\"_blank\">die from gunshots than car crashes\u003c/a>, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.\u003c/p>\n\u003cp>Dr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.\u003c/p>\n\u003cp>\"These are the injuries that the [patients] will come in, and they'll look at me, and they'll talk to me, and then they'll die,\" says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"These are the injuries that the (patients) will come in, and they'll look at me, and they'll talk to me, and then they'll die.\"\u003c/aside>\n\u003cp>Colwell also treated casualties from two of the deadliest mass shootings in American history. He responded to the scene during the 1999 massacre at Columbine High School where 15 people died. He also treated victims of last July's movie theater shooting in\u003ca href=\"http://www.acep.org/sa/videos/\" target=\"_blank\"> Aurora\u003c/a>, where a dozen were killed and 58 wounded.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Often, Colwell will treat a shooting victim, and then treat the shooter after he or she has been caught by police. Colwell describes a case from a few months ago in which he treated a woman who later died -- and then her husband, who fired the gun.\u003c!--more-->\u003c/p>\n\u003cp>\"They had had a fight. He had caught her in what he felt was cheating, and he had lost his temper,\" he says. \"He went and grabbed the pistol that he had for home defense at his bedside, and he made a snap decision.\" Now, he adds, \"his life will never be the same, and hers was gone.\"\u003c/p>\n\u003cp>Colwell says it's remarkable how often people who pull the trigger are surprised at the consequences of their actions. And he's deeply disturbed by how easy guns are to get.\u003c/p>\n\u003cp>\"I see patients every day that are right on the edge of being unstable. … They describe problems with access to medications; problems with access to psychiatric care or substance abuse care; problems with access to homes or to shelter,\" says Colwell. \"But they don't describe problems with access to guns.\"\u003c/p>\n\u003cp>Dr. Katie Bakes, who has worked with Colwell in the emergency department for 10 years, also says it's the gunshot victims that she can't shake.\u003c/p>\n\u003cp>A few weeks ago she treated a three-year-old who'd been shot in the head. Her mother had shot each of her three children and then committed suicide. \"Our patient was the only one who was \u003ca href=\"http://www.denverpost.com/breakingnews/ci_22646862/doctors-say-condition-denver-girl-shot-by-mother?IADID=Search-www.denverpost.com-www.denverpost.com\" target=\"_blank\">a survivor\u003c/a>,\" Bakes says.\u003c/p>\n\u003cp>Such experiences have made Bakes unequivocal in her opposition to guns.\u003c/p>\n\u003cp>\"I hate guns. If I could snap my finger and get rid of all the guns I would. I think they're evil,\" Bakes says, \"I don't really care what the other side of the argument is. I just don't want to see another 3-year-old come in and be shot in the head.\"\u003c/p>\n\u003cp>Bakes and Colwell say gun injuries feel much more deliberate than any other kind of trauma they see.\u003c/p>\n\u003cp>\"It's so senseless,\" Bakes says. \"You know, it's not an accident, somebody intentionally pulled the trigger for whatever reason.\"\u003c/p>\n\u003cp>But not all physicians share this perspective.\u003c/p>\n\u003cp>Dr. Jack Cletcher, a retired orthopedic surgeon, has treated his share of gunshot victims, too, from the streets of Chicago, and, decades ago, he took care of wounded soldiers just off the plane from Vietnam. He can sympathize with Bakes and Colwell, but he doesn't agree that laws need to change.\u003c/p>\n\u003cp>\"This is the kind of emotional reaction that occurs with these horrible catastrophes that happen,\" Cletcher says. \"The gun is only the instrument. It's not something that happens because the gun does it. There has to be somebody holding the gun to do it.\"\u003c/p>\n\u003cp>Cletcher is opposed to most of the new gun restrictions lawmakers are talking about in Denver and Washington.\u003c/p>\n\u003cp>\"I don't think we need new laws, we just need to make the ones we have work better,\" says Cletcher, who would rather see lawmakers focus on better treatment for the mentally ill, and keeping guns out of their hands.\u003c/p>\n\u003cp>Recently, leaders of the Colorado Medical Society went to Washington to \u003ca href=\"http://www.denvermedsociety.org/newsletters/DENVER%20MEDICAL%20BULLETIN%202013%2003.pdf\">lobby\u003c/a> for measures to help prevent gun violence. Strengthening mental health care was on their agenda, and they support President Barack Obama's executive action for increased research into gun violence.\u003c/p>\n\u003cp>Dr. John Bender, the organization's president-elect, showed Rep. Ed Perlmutter, D- Colo., the results of a recent survey of the medical society's members in which about two-thirds want to see gun regulations strengthened and about a third don't.\u003c/p>\n\u003cp>No similar survey exists for doctors nationwide, but a majority of AMA delegates have \u003ca href=\"https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/ama1/pub/upload/mm/PolicyFinder/policyfiles/HnE/H-145.985.HTM\" target=\"_blank\">endorsed\u003c/a> tighter restrictions on guns. \u003ca href=\"http://www.drgo.us/?tag=doctors-for-responsible-gun-ownership\">Not all doctors agree\u003c/a>, but among those calling for stricter gun control laws are the \u003ca href=\"http://www.ama-assn.org/resources/doc/washington/2013-01-29-feinstein-assault-weapons-ban.pdf\">AMA\u003c/a> and several groups of specialists, including the \u003ca href=\"http://www.acep.org/Physician-Resources/Policies/Policy-statements/Firearm-Injury-Prevention/\" target=\"_blank\">American College of Emergency Physicians\u003c/a>, the \u003ca href=\"http://blogs.aafp.org/cfr/leadervoices/entry/time_for_a_national_conversation\" target=\"_blank\">American Academy of Family Physicians\u003c/a> and the \u003ca href=\"http://pediatrics.aappublications.org/content/130/5/e1416.full?sid=0fd76a3f-2ca9-4069-9960-8c889def313a\" target=\"_blank\">American Academy of Pediatrics\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Kaiser Health News, \u003ca href=\"http://www.cpr.org/#load_category_page%7Cnews\" target=\"_blank\">Colorado Public Radio\u003c/a>, and \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">\u003cem>NPR\u003c/em>\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What's Up With the California Health Care Overhaul Bills?",
"title": "What's Up With the California Health Care Overhaul Bills?",
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"content": "\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/sacramento_capital_seliaymiwell_flickr/\" rel=\"attachment wp-att-9250\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>While President Obama's health care overhaul turns three on Saturday, many states are scrambling to get everything ready for the full rollout on January 1. California was the \u003ca href=\"http://www.californiareport.org/archive/R201008270850/b\" target=\"_blank\">first state to pass legislation\u003c/a> to set up a marketplace, and the Legislature has done a lot of work since. But there's still a lot left to do -- and fast.\u003c/p>\n\u003cp>To bring you up to date, three major sets of bills are before the Legislature in its Affordable Care Act special session. (Six bills total; Assembly and Senate have their own versions of three proposals).\u003c/p>\n\u003cp>Of those, two issues are key:\u003c/p>\n\u003cul>\n\u003cli>Reforming the individual market\u003c/li>\n\u003cli>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/07/how-to-expand-medi-cal-assembly-weighs-gov-browns-two-proposals/\" target=\"_blank\">Medi-Cal expansion\u003c/a> (the state's health insurance program for the poor.\u003c/li>\n\u003c/ul>\n\u003cp>As David Gorn of the CaliforniaHealthline reports, the California Legislature went on spring recess yesterday. These ACA bills are outstanding, much to the frustration of advocates. These special session bills take effect in 90 days, once they are passed. ACA proponents had hoped passage would have happened already.\u003c!--more-->\u003c/p>\n\u003cp>As far as the individual market reform goes, those bills were hung up over technical language which appears to have been resolved (tie-back to the federal law's individual mandate, for you wonks out there). Gorn reports that Sen. Ed Hernandez (D-West Covina) is confident the bill will be on Gov. Brown's desk soon after the Legislature is back in session.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That's the good news. More from \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/3/special-session-bills-still-pending-in-recess.aspx\" target=\"_blank\">CaliforniaHealthline\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The Medi-Cal expansion legislation, though, is a different story.\u003c/p>\n\u003cp>\"The one we're going to have trouble with is the Medicaid expansion bill,\" Hernandez said. \"We're miles apart on that one.\"\u003c/p>\n\u003cp>Assembly member Pan, who chairs the Assembly Committee on Health, said the hang-up on passage of the special session bills has to do, in part, with the debate over distribution of federal money. Counties are likely getting a large financial reprieve from optional Medi-Cal expansion and the state would like to get a piece of that.\u003c/p>\n\u003cp>\"The governor is looking for sources of funding for the Medi-Cal expansion,\" Pan said. \"The expansion itself, though, is more of a policy issue than a budget issue. Those are big issues, so let's not hold up the policy over other concerns.\"\u003c/p>\n\u003cp>Hernandez the Medi-Cal expansion portion of the special session could be bumped into regular session.\u003c/p>\n\u003cp>\"My sense is the administration wants to run this in the regular session,\" he said. \"That one's going to be bottled up for a long time, and I can't tell you how long.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The Legislature is back in session on Monday, April 1.\u003c/p>\n\n",
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"excerpt": "While President Obama's health care overhaul turns three on Saturday, many states are scrambling to get everything ready for the full rollout of the Affordable Care Act on January 1. California may have been the first state of pass legislation to set up a marketplace, and the legislature has done a lot of work since. But there's still a lot left to do -- and fast.\r\n\r\nTo bring you up to date, three major sets of bills are before the legislature in its ACA special session. (Six bills total; Assembly and Senate have their own versions of three proposals).",
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"description": "While President Obama's health care overhaul turns three on Saturday, many states are scrambling to get everything ready for the full rollout of the Affordable Care Act on January 1. California may have been the first state of pass legislation to set up a marketplace, and the legislature has done a lot of work since. But there's still a lot left to do -- and fast.\r\n\r\nTo bring you up to date, three major sets of bills are before the legislature in its ACA special session. (Six bills total; Assembly and Senate have their own versions of three proposals).",
"title": "What's Up With the California Health Care Overhaul Bills? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/sacramento_capital_seliaymiwell_flickr/\" rel=\"attachment wp-att-9250\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>While President Obama's health care overhaul turns three on Saturday, many states are scrambling to get everything ready for the full rollout on January 1. California was the \u003ca href=\"http://www.californiareport.org/archive/R201008270850/b\" target=\"_blank\">first state to pass legislation\u003c/a> to set up a marketplace, and the Legislature has done a lot of work since. But there's still a lot left to do -- and fast.\u003c/p>\n\u003cp>To bring you up to date, three major sets of bills are before the Legislature in its Affordable Care Act special session. (Six bills total; Assembly and Senate have their own versions of three proposals).\u003c/p>\n\u003cp>Of those, two issues are key:\u003c/p>\n\u003cul>\n\u003cli>Reforming the individual market\u003c/li>\n\u003cli>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/07/how-to-expand-medi-cal-assembly-weighs-gov-browns-two-proposals/\" target=\"_blank\">Medi-Cal expansion\u003c/a> (the state's health insurance program for the poor.\u003c/li>\n\u003c/ul>\n\u003cp>As David Gorn of the CaliforniaHealthline reports, the California Legislature went on spring recess yesterday. These ACA bills are outstanding, much to the frustration of advocates. These special session bills take effect in 90 days, once they are passed. ACA proponents had hoped passage would have happened already.\u003c!--more-->\u003c/p>\n\u003cp>As far as the individual market reform goes, those bills were hung up over technical language which appears to have been resolved (tie-back to the federal law's individual mandate, for you wonks out there). Gorn reports that Sen. Ed Hernandez (D-West Covina) is confident the bill will be on Gov. Brown's desk soon after the Legislature is back in session.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's the good news. More from \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/3/special-session-bills-still-pending-in-recess.aspx\" target=\"_blank\">CaliforniaHealthline\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The Medi-Cal expansion legislation, though, is a different story.\u003c/p>\n\u003cp>\"The one we're going to have trouble with is the Medicaid expansion bill,\" Hernandez said. \"We're miles apart on that one.\"\u003c/p>\n\u003cp>Assembly member Pan, who chairs the Assembly Committee on Health, said the hang-up on passage of the special session bills has to do, in part, with the debate over distribution of federal money. Counties are likely getting a large financial reprieve from optional Medi-Cal expansion and the state would like to get a piece of that.\u003c/p>\n\u003cp>\"The governor is looking for sources of funding for the Medi-Cal expansion,\" Pan said. \"The expansion itself, though, is more of a policy issue than a budget issue. Those are big issues, so let's not hold up the policy over other concerns.\"\u003c/p>\n\u003cp>Hernandez the Medi-Cal expansion portion of the special session could be bumped into regular session.\u003c/p>\n\u003cp>\"My sense is the administration wants to run this in the regular session,\" he said. \"That one's going to be bottled up for a long time, and I can't tell you how long.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The Legislature is back in session on Monday, April 1.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sometimes Three Isn't A Crowd: Group Appointments with Doctors",
"title": "Sometimes Three Isn't A Crowd: Group Appointments with Doctors",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>You've heard of group therapy for mental health issues, how about physical conditions?\u003c/strong>\u003c/p>\n\u003cp>By Michelle Andrews, \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/031913-Michelle-Andrews-on-group-patient-appointments.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11535\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/21/sometimes-three-isnt-a-crowd-group-appointments-with-doctors/paper-people-khn/\" rel=\"attachment wp-att-11535\">\u003cimg class=\"size-full wp-image-11535\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/paper-people-KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>When visiting the doctor, there may be strength in numbers.\u003c/p>\n\u003cp>A growing number of doctors have begun holding group appointments -- seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.\u003c/p>\n\u003cp>Some of the most successful shared appointments bring together patients with the same chronic condition, such as diabetes or heart disease. For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We tell people, 'You don't have to say anything,' But give them 10 minutes, and they're talking about their sex lives.\"\u003c/aside>\n\u003cp>Insurance typically covers a group appointment just as it would an individual appointment -- no change in the co-pay amount. Insurers generally focus on the level of care provided rather than where it's provided or how many people are in the room, says Edward Noffsinger, who consults about group visits. (His website is even called \u003ca href=\"http://www.groupvisits.com\" target=\"_blank\">groupvisits.com\u003c/a>.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some patients say there are advantages to the group setting. \"Patients like the diversity of issues discussed,\" Noffsinger says. \"And they like getting 2 hours with their doctor.\"\u003c!--more-->\u003c/p>\n\u003cp>Patients sign an agreement promising not to disclose what they discuss at the meeting. Although some patients are initially hesitant about the approach, doctors say their shyness generally evaporates quickly.\u003c/p>\n\u003cp>\"We tell people, 'You don't have to say anything,' \" says Edward Shahady, with the Florida Academy of Family Physicians Foundation in Jacksonville. \"But give them 10 minutes, and they're talking about their sex lives.\" Shahady trains medical residents and doctors to conduct group visits with diabetes patients.\u003c/p>\n\u003cp>Though group appointments may allow doctors to increase the number of patients they see and thereby boost their income, many doctors are uncomfortable with the concept, experts say, because they're used to taking a more authoritative approach with patients rather than facilitating a discussion with them.\u003c/p>\n\u003cp>According to the American Academy of Family Physicians, 12.7 percent of family physicians conducted group visits in 2010, up from 5.7 percent in 2005.\u003c/p>\n\u003cp>Doctors say patients may learn more from each other than they do from physicians. \"Patients really want to hear what others patients are experiencing, \" Shahady says.\u003c/p>\n\u003cp>Jake Padilla of Westminster, Colo., participated in his first group visit more than a decade ago, shortly after he had heart bypass surgery.\u003c/p>\n\u003cp>Padilla, now 67, continued to attend group appointments geared to primary-care patients' concerns for years after that at the Kaiser Permanente outpatient clinic near his home. He usually went once a month or so, and the members of the group constantly changed.\u003c/p>\n\u003cp>One woman who attended the group was 102 years old, he remembers. Fellow patients wanted to know how she managed to live that long. One of her secrets, she said, was deep breathing. Padilla has since used that advice when his blood pressure gets out of control.\u003c/p>\n\u003cp>But group visits aren't for everyone. Padilla's wife, Tedi, went to one meeting with him and never went back.\u003c/p>\n\u003cp>\"She said she didn't have time to sit there and listen to all those patients,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "When visiting the doctor, there may be strength in numbers.\r\n\r\nA growing number of doctors have begun holding group appointments -- seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>You've heard of group therapy for mental health issues, how about physical conditions?\u003c/strong>\u003c/p>\n\u003cp>By Michelle Andrews, \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/031913-Michelle-Andrews-on-group-patient-appointments.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11535\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/21/sometimes-three-isnt-a-crowd-group-appointments-with-doctors/paper-people-khn/\" rel=\"attachment wp-att-11535\">\u003cimg class=\"size-full wp-image-11535\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/paper-people-KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>When visiting the doctor, there may be strength in numbers.\u003c/p>\n\u003cp>A growing number of doctors have begun holding group appointments -- seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.\u003c/p>\n\u003cp>Some of the most successful shared appointments bring together patients with the same chronic condition, such as diabetes or heart disease. For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We tell people, 'You don't have to say anything,' But give them 10 minutes, and they're talking about their sex lives.\"\u003c/aside>\n\u003cp>Insurance typically covers a group appointment just as it would an individual appointment -- no change in the co-pay amount. Insurers generally focus on the level of care provided rather than where it's provided or how many people are in the room, says Edward Noffsinger, who consults about group visits. (His website is even called \u003ca href=\"http://www.groupvisits.com\" target=\"_blank\">groupvisits.com\u003c/a>.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some patients say there are advantages to the group setting. \"Patients like the diversity of issues discussed,\" Noffsinger says. \"And they like getting 2 hours with their doctor.\"\u003c!--more-->\u003c/p>\n\u003cp>Patients sign an agreement promising not to disclose what they discuss at the meeting. Although some patients are initially hesitant about the approach, doctors say their shyness generally evaporates quickly.\u003c/p>\n\u003cp>\"We tell people, 'You don't have to say anything,' \" says Edward Shahady, with the Florida Academy of Family Physicians Foundation in Jacksonville. \"But give them 10 minutes, and they're talking about their sex lives.\" Shahady trains medical residents and doctors to conduct group visits with diabetes patients.\u003c/p>\n\u003cp>Though group appointments may allow doctors to increase the number of patients they see and thereby boost their income, many doctors are uncomfortable with the concept, experts say, because they're used to taking a more authoritative approach with patients rather than facilitating a discussion with them.\u003c/p>\n\u003cp>According to the American Academy of Family Physicians, 12.7 percent of family physicians conducted group visits in 2010, up from 5.7 percent in 2005.\u003c/p>\n\u003cp>Doctors say patients may learn more from each other than they do from physicians. \"Patients really want to hear what others patients are experiencing, \" Shahady says.\u003c/p>\n\u003cp>Jake Padilla of Westminster, Colo., participated in his first group visit more than a decade ago, shortly after he had heart bypass surgery.\u003c/p>\n\u003cp>Padilla, now 67, continued to attend group appointments geared to primary-care patients' concerns for years after that at the Kaiser Permanente outpatient clinic near his home. He usually went once a month or so, and the members of the group constantly changed.\u003c/p>\n\u003cp>One woman who attended the group was 102 years old, he remembers. Fellow patients wanted to know how she managed to live that long. One of her secrets, she said, was deep breathing. Padilla has since used that advice when his blood pressure gets out of control.\u003c/p>\n\u003cp>But group visits aren't for everyone. Padilla's wife, Tedi, went to one meeting with him and never went back.\u003c/p>\n\u003cp>\"She said she didn't have time to sit there and listen to all those patients,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Investigation Reprimands Kaiser Over Mental Health Services",
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"content": "\u003cp>By \u003ca href=\"http://www.kqed.org/radio/about/staff/mina-kim.jsp\" target=\"_blank\">Mina Kim\u003c/a>, KQED\u003c/p>\n\u003cfigure id=\"attachment_21359\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-e1410283672646.jpg\">\u003cimg class=\"size-medium wp-image-21359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-300x183.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"183\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a \u003ca href=\"http://nuhw.squarespace.com/storage/docs/kaiser-docs/DMHC-FinalReportKaiserMentalHlthSvces3-18-13.pdf\" target=\"_blank\">recent report\u003c/a> by the Department of Managed Health Care.\u003c/p>\n\u003cp>The report says Kaiser's mental health services are deficient in key areas.\u003c/p>\n\u003cp>State regulators found insufficient staffing at some clinics across the state -- with patients waiting longer than the legal limit of 10 days for appointments. The report also says some patients were being misled due to inaccurate information about Kaiser's mental health services. Regulators also found that at Northern California facilities staff members were not accurately tracking and reporting how long patients had to wait to get initial appointments or follow ups.\u003c!--more-->\u003c/p>\n\u003cp>Shelly Rouillard, chief deputy director at the department, says the agency will be taking the unusual step of conducting a follow-up survey in six months rather than the normal 18 months.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"These are significant deficiencies, and we're concerned that consumers aren't getting the care that they need when they need it,\" she said \"and particularly when they are in distress.\"\u003c/p>\n\u003cp>Kaiser employees affiliated with the National Union of Healthcare Workers are calling the report a vindication of concerns they laid out in 2011. Clement Papazian is a social worker with Kaiser Oakland and a chapter officer for the union that represents more than 2000 clinicians and psychologists. Papazian says delays have been hard on patients.\u003c/p>\n\u003cp>\"Some of them will drop out of care,\" he described. \"Some of them will seek medication only -- or the services that are available to them: group services.\"\u003c/p>\n\u003cp>But Kaiser Permanente officials say the problems occurred at a limited number of sites and did not effect the quality of mental health care. Mason Turner is assistant director of regional mental health for Kaiser Permanente Northern California. He says the agency has been working hard to correct problems since it received a draft of the report last August.\u003c/p>\n\u003cp>\"We have hired more staff,\" he said. \"We have provided more appointments for our patients, and we're very committed to correcting these issues and providing the highest quality of care that we possibly can.\"\u003c/p>\n\u003cp>Kaiser also issued a \u003ca href=\"http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bhplanresponse031813.pdf\" target=\"_blank\">complete response\u003c/a> to all its members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Department of Managed Health Care's enforcement office is now evaluating options for penalties, including fines.\u003c/p>\n\n",
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"excerpt": "Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a recent report by the Department of Managed Health Care.\r\n\r\nThe report says Kaiser's mental health services are deficient in key areas.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.kqed.org/radio/about/staff/mina-kim.jsp\" target=\"_blank\">Mina Kim\u003c/a>, KQED\u003c/p>\n\u003cfigure id=\"attachment_21359\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-e1410283672646.jpg\">\u003cimg class=\"size-medium wp-image-21359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-300x183.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"183\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a \u003ca href=\"http://nuhw.squarespace.com/storage/docs/kaiser-docs/DMHC-FinalReportKaiserMentalHlthSvces3-18-13.pdf\" target=\"_blank\">recent report\u003c/a> by the Department of Managed Health Care.\u003c/p>\n\u003cp>The report says Kaiser's mental health services are deficient in key areas.\u003c/p>\n\u003cp>State regulators found insufficient staffing at some clinics across the state -- with patients waiting longer than the legal limit of 10 days for appointments. The report also says some patients were being misled due to inaccurate information about Kaiser's mental health services. Regulators also found that at Northern California facilities staff members were not accurately tracking and reporting how long patients had to wait to get initial appointments or follow ups.\u003c!--more-->\u003c/p>\n\u003cp>Shelly Rouillard, chief deputy director at the department, says the agency will be taking the unusual step of conducting a follow-up survey in six months rather than the normal 18 months.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"These are significant deficiencies, and we're concerned that consumers aren't getting the care that they need when they need it,\" she said \"and particularly when they are in distress.\"\u003c/p>\n\u003cp>Kaiser employees affiliated with the National Union of Healthcare Workers are calling the report a vindication of concerns they laid out in 2011. Clement Papazian is a social worker with Kaiser Oakland and a chapter officer for the union that represents more than 2000 clinicians and psychologists. Papazian says delays have been hard on patients.\u003c/p>\n\u003cp>\"Some of them will drop out of care,\" he described. \"Some of them will seek medication only -- or the services that are available to them: group services.\"\u003c/p>\n\u003cp>But Kaiser Permanente officials say the problems occurred at a limited number of sites and did not effect the quality of mental health care. Mason Turner is assistant director of regional mental health for Kaiser Permanente Northern California. He says the agency has been working hard to correct problems since it received a draft of the report last August.\u003c/p>\n\u003cp>\"We have hired more staff,\" he said. \"We have provided more appointments for our patients, and we're very committed to correcting these issues and providing the highest quality of care that we possibly can.\"\u003c/p>\n\u003cp>Kaiser also issued a \u003ca href=\"http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bhplanresponse031813.pdf\" target=\"_blank\">complete response\u003c/a> to all its members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Department of Managed Health Care's enforcement office is now evaluating options for penalties, including fines.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hospital Ratings Are In The Eye Of The Beholder",
"title": "Hospital Ratings Are In The Eye Of The Beholder",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/18/expanding-number-of-groups-offer-hospital-ratings.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11485\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/hospital-ratings-are-in-the-eye-of-the-beholder/ratings-300_khn/\" rel=\"attachment wp-att-11485\">\u003cimg class=\"size-full wp-image-11485\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Ratings-300_KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\u003c/p>\n\u003cp>The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\u003c/p>\n\u003cp>But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/21/medicare-hospitals-value-based-purchasing.aspx\" target=\"_blank\">rewarding hospitals\u003c/a> for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\u003c/p>\n\u003cp>Is your head spinning yet?\u003c/p>\n\u003caside class=\"pullquote alignleft\">As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals won at least one distinction from a major rating group or company.\u003c/aside>\n\u003cp>Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as \"\u003ca href=\"http://health.usnews.com/best-hospitals\" target=\"_blank\">Best Hospitals Honor Roll\u003c/a>,\" \"\u003ca href=\"http://www.healthgrades.com/quality/top-hospitals-2013\" target=\"_blank\">America's Best Hospitals\u003c/a>\" and \"\u003ca href=\"http://www.100tophospitals.com/\" target=\"_blank\">100 Top Hospitals\u003c/a>.\" Some states have created their own report cards. In California there are more than a dozen organizations offering assessments on hospital quality.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers.\u003c!--more-->\u003c/p>\n\u003cp>\"We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,\" said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.\u003c/p>\n\u003cp>And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Pages/APCountySanFrancisco.aspx\" target=\"_blank\">California public health officials\u003c/a> have fined it $425,000 repeatedly for endangering patients.\u003c/p>\n\u003cp>As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals — more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.\u003c/p>\n\u003cp>\"I worry a lot about these ratings,\" said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. \"They're all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.\"\u003c/p>\n\u003cp>\u003cstrong>Not A 'Complete Picture Of The Care'\u003c/strong>\u003c/p>\n\u003cp>There are so many report cards on hospitals that the Informed Patient Institute \u003ca href=\"http://www.informedpatientinstitute.org/index.html\" target=\"_blank\">runs a website\u003c/a> that grades the raters. Carol Cronin, its executive director, said most report cards are not easy for consumers to use. \"A lot of them don’t help users quickly understand which hospital is better than another,\" she said.\u003c/p>\n\u003cp>But many hospitals are eager to trump these distinctions in their marketing. Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. \"A hospital cannot buy an award, they must achieve it,\" Healthgrades said in a statement.\u003c/p>\n\u003cp>Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. \"Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don't do that,\" he said. \"U.S. News is in the $50,000 range. Leapfrog is $12,500.\"\u003c/p>\n\u003cp>Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. (Others generally provide free access to ratings on their sites.) The Joint Commission does not charge hospitals that make its top quality list.\u003c/p>\n\u003cp>The calculations that go into these ratings are complex. Most hospital assessments synthesize dozens of pieces of data Medicare publishes on its \u003ca href=\"http://www.medicare.gov/hospitalcompare/\" target=\"_blank\">Hospital Compare website\u003c/a>, including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.\u003c/p>\n\u003cp>Here's a snapshot of what different ratings measure:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.jointcommission.org/accreditation/top_performers.aspx\" target=\"_blank\">The Joint Commission\u003c/a> looks at how frequently patients received recommended treatments, such as flu shots for those with pneumonia.\u003c/li>\n\u003cli>Consumer Reports examines the numbers of patients who die or are readmitted, infection rates and Medicare patient surveys of their experiences.\u003c/li>\n\u003cli>Leapfrog looks at data from its surveys of hospitals, the consistency with which hospitals followed safe surgical practices and frequencies of infections and some types of patient harm.\u003c/li>\n\u003cli>Healthgrades analyzes detailed Medicare records to find death and complication rates for 27 procedures and conditions.\u003c/li>\n\u003cli>Truven considers profitability along with quality in its assessments.\u003c/li>\n\u003cli>U.S. News surveys physicians about which places they think are the best, and those reputation ratings account for a third of most of its assessments. U.S. News ranks hospitals by geography and singles out hospitals that do well in 16 specialties, including cancer, neurology and orthopedics.\u003c/li>\n\u003c/ul>\n\u003cp>\"Ratings and ranking programs certainly offer people information they can use to make their hospital selections, but we don’t recommend relying on any one of them completely,\" Jennifer Kennedy, a spokeswoman for St. Mary Mercy, said in an e-mail. \"None are able to tell the whole story or paint a complete picture of the care that is delivered.\"\u003c/p>\n\u003cp>Patient safety rankings are based on how frequently correct procedures or errors occur, so hospitals can get good grades even if they have made some egregious errors. \u003ca href=\"http://leapfrog-hss.web01.atlasworks.com/hospital-details?location_id=298\" target=\"_blank\">Leapfrog gave\u003c/a> a \"B\" to UCSF Medical Center in San Francisco even though California regulators have penalized UCSF eight times for infractions since 2008, most recently for \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-V65C11-SanFran.pdf\" target=\"_blank\">leaving a sponge\u003c/a> in one patient and a \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-CW9Y11-SanFran.pdf\" target=\"_blank\">plastic clip in the skull\u003c/a> of another. Those errors cost UCSF $200,000 in fines.\u003c/p>\n\u003cp>Dr. Josh Adler, the chief medical officer at UCSF, said penalties were partly a result of the hospital's policy to make sure that all errors are reported to authorities. \"The key is that we constantly strive to deliver the highest quality, safest, and most satisfying care, and that we are a learning organization,\" he said in an e-mail.\u003c/p>\n\u003cp>The ratings groups believe the public benefits from the multitude of ratings. Dr. John Santa, who directs Consumer Reports' health ratings, said consumers benefit from different vantages just as they do for cars or electronic devices, and the competition spurs each rating group to get better. \"We think that’s consistent with good science,\" Santa said.\u003c/p>\n\u003cp>\u003cstrong>Constant Turnover\u003c/strong>\u003c/p>\n\u003cp>Much of the quality data is rudimentary, as the science of evaluating hospitals is still in its adolescence. Adding to the confusion is that hospitals can rise and fall from year to year as groups tweak their methods of assessment and as hospital performance shifts, even slightly.\u003c/p>\n\u003cp>In some cases, hospitals that have won awards are being penalized financially by Medicare for falling short on the government's quality assessment. Saint Francis Hospital in Tulsa, Okla., which is losing 0.54 percent of its Medicare payments this year under the government's quality program, is a Healthgrades Distinguished Hospital for Clinical Excellence and was ranked the second best hospital in Oklahoma by U.S. News.\u003c/p>\n\u003cp>Some of the hospitals that do the best in the rankings have limited respect for them. Advocate Christ Medical Center in Oak Lawn, Ill., last year received praise from Leapfrog, U.S. News, the Joint Commission, Truven and Healthgrades. But Dr. William Adair, vice president for clinical transformation, says the hospital doesn't license any of the distinctions. \"We're all made a little bit uneasy, to be frank about it,\" Adair says. \"Some of these organizations are looking for revenue. It blurs the effectiveness of the ratings processes.\"\u003c/p>\n\u003cp>Still, many hospitals are happy to use the praise. Dr. Brotman from NYU said: \"Even though there's not a hospital executive who won't tell you that they have a great deal of skepticism about a lot of the methodology, there’s not one who will tell you they don't want to be on the lists.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\r\n\r\nThe Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\r\n\r\nBut the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\r\n\r\nIs your head spinning yet?",
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"description": "How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\r\n\r\nThe Leapfrog Group, a respected nonprofit that promotes patient safety, gave an "A" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\r\n\r\nBut the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\r\n\r\nIs your head spinning yet?",
"title": "Hospital Ratings Are In The Eye Of The Beholder | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/18/expanding-number-of-groups-offer-hospital-ratings.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11485\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/hospital-ratings-are-in-the-eye-of-the-beholder/ratings-300_khn/\" rel=\"attachment wp-att-11485\">\u003cimg class=\"size-full wp-image-11485\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Ratings-300_KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\u003c/p>\n\u003cp>The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\u003c/p>\n\u003cp>But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/21/medicare-hospitals-value-based-purchasing.aspx\" target=\"_blank\">rewarding hospitals\u003c/a> for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\u003c/p>\n\u003cp>Is your head spinning yet?\u003c/p>\n\u003caside class=\"pullquote alignleft\">As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals won at least one distinction from a major rating group or company.\u003c/aside>\n\u003cp>Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as \"\u003ca href=\"http://health.usnews.com/best-hospitals\" target=\"_blank\">Best Hospitals Honor Roll\u003c/a>,\" \"\u003ca href=\"http://www.healthgrades.com/quality/top-hospitals-2013\" target=\"_blank\">America's Best Hospitals\u003c/a>\" and \"\u003ca href=\"http://www.100tophospitals.com/\" target=\"_blank\">100 Top Hospitals\u003c/a>.\" Some states have created their own report cards. In California there are more than a dozen organizations offering assessments on hospital quality.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers.\u003c!--more-->\u003c/p>\n\u003cp>\"We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,\" said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.\u003c/p>\n\u003cp>And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Pages/APCountySanFrancisco.aspx\" target=\"_blank\">California public health officials\u003c/a> have fined it $425,000 repeatedly for endangering patients.\u003c/p>\n\u003cp>As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals — more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.\u003c/p>\n\u003cp>\"I worry a lot about these ratings,\" said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. \"They're all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.\"\u003c/p>\n\u003cp>\u003cstrong>Not A 'Complete Picture Of The Care'\u003c/strong>\u003c/p>\n\u003cp>There are so many report cards on hospitals that the Informed Patient Institute \u003ca href=\"http://www.informedpatientinstitute.org/index.html\" target=\"_blank\">runs a website\u003c/a> that grades the raters. Carol Cronin, its executive director, said most report cards are not easy for consumers to use. \"A lot of them don’t help users quickly understand which hospital is better than another,\" she said.\u003c/p>\n\u003cp>But many hospitals are eager to trump these distinctions in their marketing. Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. \"A hospital cannot buy an award, they must achieve it,\" Healthgrades said in a statement.\u003c/p>\n\u003cp>Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. \"Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don't do that,\" he said. \"U.S. News is in the $50,000 range. Leapfrog is $12,500.\"\u003c/p>\n\u003cp>Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. (Others generally provide free access to ratings on their sites.) The Joint Commission does not charge hospitals that make its top quality list.\u003c/p>\n\u003cp>The calculations that go into these ratings are complex. Most hospital assessments synthesize dozens of pieces of data Medicare publishes on its \u003ca href=\"http://www.medicare.gov/hospitalcompare/\" target=\"_blank\">Hospital Compare website\u003c/a>, including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.\u003c/p>\n\u003cp>Here's a snapshot of what different ratings measure:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.jointcommission.org/accreditation/top_performers.aspx\" target=\"_blank\">The Joint Commission\u003c/a> looks at how frequently patients received recommended treatments, such as flu shots for those with pneumonia.\u003c/li>\n\u003cli>Consumer Reports examines the numbers of patients who die or are readmitted, infection rates and Medicare patient surveys of their experiences.\u003c/li>\n\u003cli>Leapfrog looks at data from its surveys of hospitals, the consistency with which hospitals followed safe surgical practices and frequencies of infections and some types of patient harm.\u003c/li>\n\u003cli>Healthgrades analyzes detailed Medicare records to find death and complication rates for 27 procedures and conditions.\u003c/li>\n\u003cli>Truven considers profitability along with quality in its assessments.\u003c/li>\n\u003cli>U.S. News surveys physicians about which places they think are the best, and those reputation ratings account for a third of most of its assessments. U.S. News ranks hospitals by geography and singles out hospitals that do well in 16 specialties, including cancer, neurology and orthopedics.\u003c/li>\n\u003c/ul>\n\u003cp>\"Ratings and ranking programs certainly offer people information they can use to make their hospital selections, but we don’t recommend relying on any one of them completely,\" Jennifer Kennedy, a spokeswoman for St. Mary Mercy, said in an e-mail. \"None are able to tell the whole story or paint a complete picture of the care that is delivered.\"\u003c/p>\n\u003cp>Patient safety rankings are based on how frequently correct procedures or errors occur, so hospitals can get good grades even if they have made some egregious errors. \u003ca href=\"http://leapfrog-hss.web01.atlasworks.com/hospital-details?location_id=298\" target=\"_blank\">Leapfrog gave\u003c/a> a \"B\" to UCSF Medical Center in San Francisco even though California regulators have penalized UCSF eight times for infractions since 2008, most recently for \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-V65C11-SanFran.pdf\" target=\"_blank\">leaving a sponge\u003c/a> in one patient and a \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-CW9Y11-SanFran.pdf\" target=\"_blank\">plastic clip in the skull\u003c/a> of another. Those errors cost UCSF $200,000 in fines.\u003c/p>\n\u003cp>Dr. Josh Adler, the chief medical officer at UCSF, said penalties were partly a result of the hospital's policy to make sure that all errors are reported to authorities. \"The key is that we constantly strive to deliver the highest quality, safest, and most satisfying care, and that we are a learning organization,\" he said in an e-mail.\u003c/p>\n\u003cp>The ratings groups believe the public benefits from the multitude of ratings. Dr. John Santa, who directs Consumer Reports' health ratings, said consumers benefit from different vantages just as they do for cars or electronic devices, and the competition spurs each rating group to get better. \"We think that’s consistent with good science,\" Santa said.\u003c/p>\n\u003cp>\u003cstrong>Constant Turnover\u003c/strong>\u003c/p>\n\u003cp>Much of the quality data is rudimentary, as the science of evaluating hospitals is still in its adolescence. Adding to the confusion is that hospitals can rise and fall from year to year as groups tweak their methods of assessment and as hospital performance shifts, even slightly.\u003c/p>\n\u003cp>In some cases, hospitals that have won awards are being penalized financially by Medicare for falling short on the government's quality assessment. Saint Francis Hospital in Tulsa, Okla., which is losing 0.54 percent of its Medicare payments this year under the government's quality program, is a Healthgrades Distinguished Hospital for Clinical Excellence and was ranked the second best hospital in Oklahoma by U.S. News.\u003c/p>\n\u003cp>Some of the hospitals that do the best in the rankings have limited respect for them. Advocate Christ Medical Center in Oak Lawn, Ill., last year received praise from Leapfrog, U.S. News, the Joint Commission, Truven and Healthgrades. But Dr. William Adair, vice president for clinical transformation, says the hospital doesn't license any of the distinctions. \"We're all made a little bit uneasy, to be frank about it,\" Adair says. \"Some of these organizations are looking for revenue. It blurs the effectiveness of the ratings processes.\"\u003c/p>\n\u003cp>Still, many hospitals are happy to use the praise. Dr. Brotman from NYU said: \"Even though there's not a hospital executive who won't tell you that they have a great deal of skepticism about a lot of the methodology, there’s not one who will tell you they don't want to be on the lists.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mammograms: Which Women? How Often?",
"title": "Mammograms: Which Women? How Often?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/05/01/new-research-for-women-in-their-40s-on-mammograms/080922-n-2688m-004/\" rel=\"attachment wp-att-5549\">\u003cimg class=\"size-medium wp-image-5549\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>As everybody knows by now, how frequently a woman should have a mammogram is a topic of hot debate in the U.S. In particular, women in their 40s have been troubled by recommendations almost four years ago from the U.S. Preventive Services Task Force that mammograms are \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">not routinely recommended\u003c/a> for them. Instead, the decision is an \"individual one\" that a woman can make, presumably in conversation with her doctor.\u003c/p>\n\u003cp>Now, \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1669103\" target=\"_blank\">a new study\u003c/a> has a tailored recommendation. For women in their 40s with \"extremely dense breasts,\" annual screening will reduce their risk of being diagnosed with advanced stage breast cancer.\u003c/p>\n\u003cp>\"There is this sub-group that is higher risk and has more aggressive tumors,\" said lead researcher Karla Kerlikowske, an epidemiologist and biostatistician at UCSF. \"Annual mammography is probably better for that group.\"\u003c/p>\n\u003cp>To date, most recommendations have relied on one risk factor: age. A woman's risk of breast cancer increases as she gets older. But there are other risk factors, too, like breast density. About 12 to 15 percent of women in their 40s have \"extremely dense breasts.\" Radiologists categorize breast density on a scale of 1 to 4, and a score of 4 is \"extremely dense.\"\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But women with dense breasts are also at higher risk of false positives and may need to go through additional imaging and unnecessary biopsies. How much? The researchers report that women with extremely dense breasts have a 65.5 percent likelihood of a false positive over a ten year period. Still, \"annual screening has added benefit to detect breast cancer at an earlier stage\" than screening every other year, the researchers write.\u003c/p>\n\u003cp>(As an aside: if you're a woman in your 40s with doctor-diagnosed \"extremely dense breasts,\" then your risk of breast cancer matches that of an average-risk woman in her 50s, according to the analysis.)\u003c/p>\n\u003cp>In the study, published in this week's JAMA Internal Medicine, researchers looked at nearly one million women -- more than 11,000 women with breast cancer and more than 900,000 without breast cancer, all of whom had mammograms.\u003c/p>\n\u003cp>Researchers also looked at women who used hormone therapy after menopause. Hormone therapy has been shown to increase a woman's risk of breast cancer. For women ages 50-74, even for women with dense breasts or hormone therapy use, annual screening made no difference.\u003c/p>\n\u003cp>\"They could be screened every two years and have the same benefit as being screened every year and fewer harms from mammography,\" Kerlikowske said.\u003c/p>\n\u003cp>Those harms can be common. If you're a woman in the 50-74 group, with less dense breasts (a \"2\" scored by a radiologist), and do not take hormone therapy, your risk of a false positive after ten years of annual mammography is 49.8 percent. The likelihood of a false positive falls to 30.7 percent if a woman is having a mammogram every other year.\u003c/p>\n\u003cp>In a \u003ca href=\"http://annfammed.org/content/11/2/106.full\" target=\"_blank\">separate study\u003c/a> this week, researchers found that these false positives lead to \"long-term psychosocial harm\" for many women.\u003c/p>\n\u003cp>It's unlikely that recommendations will be changed based on this study. The American Cancer Society offers\u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\"> different recommendations\u003c/a> than the U.S. Preventive Services Task Force. The ACS continues to recommend an annual mammogram for women beginning at age 40. The group's chief medical officer, Dr. Otis Brawley says he doesn't \"see us changing right now.\"\u003c/p>\n\u003cp>But he also said he could foresee a time of targeted recommendations for women-- not just for having mammograms more frequently, but less frequently, too.\u003c/p>\n\u003cp>\"I think we are moving toward a period of time,\" Brawley said, \"where we will identify through a bunch of questions that involve family history, age, density of breast tissue ... whether one is menopausal or not menopausal, and we're going to have a group of women who will be in their 50s, and we will tell them you ought to have a mammogram every three years.\"\u003c/p>\n\u003cp>He added there could be a group that needs mammograms annually and a very targeted group that might need to be screened even more frequently.\u003c/p>\n\u003cp>\u003cstrong>New law takes effect April 1st\u003c/strong>\u003c/p>\n\u003cp>The study comes just as\u003ca href=\"http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_1501-1550/sb_1538_bill_20120922_chaptered.pdf\" target=\"_blank\"> a new law\u003c/a> is scheduled to take effect in California. Starting April 1st, radiologists will be required to notify women if they have heterogeneously dense or extremely dense breast tissue (category 3 or 4). Radiologists already send women a report after their mammogram; they would add this information to that letter.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The law passed with overwhelming support in the California legislature, but Brawley says aside from extremely dense breasts, that breast density is a subjective measure. UCSF's Kerlikowske says she thinks the \"law is ahead of the science,\" because there's no data showing that other kinds of screening tests, such as ultrasound or MRI, have any benefit for these women.\u003c/p>\n\n",
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"excerpt": "As everybody knows by now, how frequently a woman should have a mammogram is a topic of hot debate in the U.S. In particular, women in their 40s have been troubled by recommendations four years ago from the US Preventive Services Task Force that mammograms are not routinely recommended for them. Instead, the decision is an \"individual one\" that a woman can make, presumably in conversation with her doctor.\r\n\r\nTo date, most recommendations have relied on one risk factor: age. A woman's risk of breast cancer increases as she gets older. But there are other risk factors, too. In particular, women with dense breasts are at higher risk for cancer. Now a new study, led by researchers at UCSF have looked specifically at breast density and how what doctors call the \"screening interval\" of mammograms might affect their risk of being diagnosed with advanced breast cancer.",
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"description": "As everybody knows by now, how frequently a woman should have a mammogram is a topic of hot debate in the U.S. In particular, women in their 40s have been troubled by recommendations four years ago from the US Preventive Services Task Force that mammograms are not routinely recommended for them. Instead, the decision is an "individual one" that a woman can make, presumably in conversation with her doctor.\r\n\r\nTo date, most recommendations have relied on one risk factor: age. A woman's risk of breast cancer increases as she gets older. But there are other risk factors, too. In particular, women with dense breasts are at higher risk for cancer. Now a new study, led by researchers at UCSF have looked specifically at breast density and how what doctors call the "screening interval" of mammograms might affect their risk of being diagnosed with advanced breast cancer.",
"title": "Mammograms: Which Women? How Often? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_5549\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/05/01/new-research-for-women-in-their-40s-on-mammograms/080922-n-2688m-004/\" rel=\"attachment wp-att-5549\">\u003cimg class=\"size-medium wp-image-5549\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/WomanGetsMammogram_WikimediaCommons-300x203.jpg\" alt=\"(Photo: U.S. Navy)\" width=\"300\" height=\"203\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: U.S. Navy)\u003c/figcaption>\u003c/figure>\n\u003cp>As everybody knows by now, how frequently a woman should have a mammogram is a topic of hot debate in the U.S. In particular, women in their 40s have been troubled by recommendations almost four years ago from the U.S. Preventive Services Task Force that mammograms are \u003ca href=\"http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm\" target=\"_blank\">not routinely recommended\u003c/a> for them. Instead, the decision is an \"individual one\" that a woman can make, presumably in conversation with her doctor.\u003c/p>\n\u003cp>Now, \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1669103\" target=\"_blank\">a new study\u003c/a> has a tailored recommendation. For women in their 40s with \"extremely dense breasts,\" annual screening will reduce their risk of being diagnosed with advanced stage breast cancer.\u003c/p>\n\u003cp>\"There is this sub-group that is higher risk and has more aggressive tumors,\" said lead researcher Karla Kerlikowske, an epidemiologist and biostatistician at UCSF. \"Annual mammography is probably better for that group.\"\u003c/p>\n\u003cp>To date, most recommendations have relied on one risk factor: age. A woman's risk of breast cancer increases as she gets older. But there are other risk factors, too, like breast density. About 12 to 15 percent of women in their 40s have \"extremely dense breasts.\" Radiologists categorize breast density on a scale of 1 to 4, and a score of 4 is \"extremely dense.\"\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But women with dense breasts are also at higher risk of false positives and may need to go through additional imaging and unnecessary biopsies. How much? The researchers report that women with extremely dense breasts have a 65.5 percent likelihood of a false positive over a ten year period. Still, \"annual screening has added benefit to detect breast cancer at an earlier stage\" than screening every other year, the researchers write.\u003c/p>\n\u003cp>(As an aside: if you're a woman in your 40s with doctor-diagnosed \"extremely dense breasts,\" then your risk of breast cancer matches that of an average-risk woman in her 50s, according to the analysis.)\u003c/p>\n\u003cp>In the study, published in this week's JAMA Internal Medicine, researchers looked at nearly one million women -- more than 11,000 women with breast cancer and more than 900,000 without breast cancer, all of whom had mammograms.\u003c/p>\n\u003cp>Researchers also looked at women who used hormone therapy after menopause. Hormone therapy has been shown to increase a woman's risk of breast cancer. For women ages 50-74, even for women with dense breasts or hormone therapy use, annual screening made no difference.\u003c/p>\n\u003cp>\"They could be screened every two years and have the same benefit as being screened every year and fewer harms from mammography,\" Kerlikowske said.\u003c/p>\n\u003cp>Those harms can be common. If you're a woman in the 50-74 group, with less dense breasts (a \"2\" scored by a radiologist), and do not take hormone therapy, your risk of a false positive after ten years of annual mammography is 49.8 percent. The likelihood of a false positive falls to 30.7 percent if a woman is having a mammogram every other year.\u003c/p>\n\u003cp>In a \u003ca href=\"http://annfammed.org/content/11/2/106.full\" target=\"_blank\">separate study\u003c/a> this week, researchers found that these false positives lead to \"long-term psychosocial harm\" for many women.\u003c/p>\n\u003cp>It's unlikely that recommendations will be changed based on this study. The American Cancer Society offers\u003ca href=\"http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer\" target=\"_blank\"> different recommendations\u003c/a> than the U.S. Preventive Services Task Force. The ACS continues to recommend an annual mammogram for women beginning at age 40. The group's chief medical officer, Dr. Otis Brawley says he doesn't \"see us changing right now.\"\u003c/p>\n\u003cp>But he also said he could foresee a time of targeted recommendations for women-- not just for having mammograms more frequently, but less frequently, too.\u003c/p>\n\u003cp>\"I think we are moving toward a period of time,\" Brawley said, \"where we will identify through a bunch of questions that involve family history, age, density of breast tissue ... whether one is menopausal or not menopausal, and we're going to have a group of women who will be in their 50s, and we will tell them you ought to have a mammogram every three years.\"\u003c/p>\n\u003cp>He added there could be a group that needs mammograms annually and a very targeted group that might need to be screened even more frequently.\u003c/p>\n\u003cp>\u003cstrong>New law takes effect April 1st\u003c/strong>\u003c/p>\n\u003cp>The study comes just as\u003ca href=\"http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_1501-1550/sb_1538_bill_20120922_chaptered.pdf\" target=\"_blank\"> a new law\u003c/a> is scheduled to take effect in California. Starting April 1st, radiologists will be required to notify women if they have heterogeneously dense or extremely dense breast tissue (category 3 or 4). Radiologists already send women a report after their mammogram; they would add this information to that letter.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The law passed with overwhelming support in the California legislature, but Brawley says aside from extremely dense breasts, that breast density is a subjective measure. UCSF's Kerlikowske says she thinks the \"law is ahead of the science,\" because there's no data showing that other kinds of screening tests, such as ultrasound or MRI, have any benefit for these women.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Diego Emergency Departments Consider New Guidelines to Crack Down on Painkiller Abuse",
"title": "San Diego Emergency Departments Consider New Guidelines to Crack Down on Painkiller Abuse",
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"content": "\u003cp>By Kenny Goldberg, \u003ca href=\"http://www.kpbs.org/news/2013/mar/05/san-diego-emergency-departments-crack-down-painkil/\" target=\"_blank\">KPBS\u003c/a>\u003c/p>\n\u003cp>More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to \u003ca href=\"http://wiki.answers.com/Q/List_of_prescription_pain_killers_by_trade_names\">prescription painkillers\u003c/a> like Oxycontin and Percocet.\u003c/p>\n\u003cp>Hospital emergency departments in San Diego are now reevaluating their role in dispensing these medications.\u003c/p>\n\u003cp>Bobby Stevens, not his real name, first started popping Oxycontin when he was in high school in northern San Diego county. His classmates used to hand it out at parties.\u003c/p>\n\u003cp>Stevens soon became hooked. At the height of his addiction, he was taking up to 20 Oxycontin pills a day, plus the anti-anxiety drug Xanax and the amphetamine Adderall. He was spending $1500 a week on his habit.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Stevens used to get his a lot of his drugs from hospital emergency rooms. He had a few standard lies he would tell the doctors.\u003c/p>\n\u003cp>\"That I either had lower back pain, or I did something to my knee, running,\" Stevens recalls. \"It pretty much was the same story every time. I would go to different doctors, I wouldn’t go to the same ER. So I could pretty much use the same story.\"\u003c/p>\n\u003cp>Most of the time, ER doctors would give Stevens a prescription for at least a month’s worth of pills. He said he didn't have to do much acting.\u003c/p>\n\u003cp>\"I would just explain the pain I had. But they were so busy, it seemed that they took you for your word, and wrote you the prescription,\" Stevens said. \"I mean I didn’t have to do x-rays, I didn’t have to do an MRI, or any of that type of stuff. They just asked what I was there for, and they wrote me the scrip.\"\u003c/p>\n\u003cp>Sales of prescriptions opiates have skyrocketed in recent years. So have \u003ca href=\"http://www.kpbs.org/news/2011/dec/15/prescription-drugs-san-diegos-leading-cause-accide/\">drug-related deaths\u003c/a>.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/homeandrecreationalsafety/rxbrief/\">Centers for Disease Control\u003c/a> says hospital emergency departments are the biggest source of these drugs.\u003c/p>\n\u003cp>Dr. Kevin Kelly, director of the ED at La Mesa’s Alvarado Hospital, said many patients are asking for them.\u003c/p>\n\u003cp>\"I think all the emergency departments are experiencing an incredible influx of opiate requests, and opiate-related emergencies,\" he explained.\u003c/p>\n\u003cp>Dr. Kelly said physicians can’t always tell when someone is really in pain -- or just faking it.\u003c/p>\n\u003cp>\"Our goal, first of all, is we want to help,\" Kelly explained. \"So, each case we look at and we say, 'How can I help this person?' and then second, we really want to do no harm. And that’s where a lot of narcotic issues come up; there’s a lot of harm related to the use and misuse of these medications.\"\u003c/p>\n\u003cp>The emergency department at \u003ca href=\"http://www.scripps.org/locations/hospitals__scripps-mercy-hospital\">Scripps Mercy Hospital\u003c/a> in Hillcrest is one of San Diego’s busiest. More than 57,000 patients were treated there last year.\u003c/p>\n\u003cp>Scripps' \u003ca href=\"http://www.scripps.org/physicians/4598-roneet-lev-md\">Dr. Roneet Lev\u003c/a> said these days, about one out of five patients in her ED are taking narcotics.\u003c/p>\n\u003cp>\"When you talk about cocaine or heroin, you talk about the drug lords in Columbia,\" Dr. Lev said. \"But prescription drug abuse and deaths usually are given by well-intentioned, well-meaning physicians, and we need to kind of change the way we practice and get a hold of this epidemic.\"\u003c/p>\n\u003cp>To that end, Dr. Lev is leading an effort to change the way local emergency departments dispense painkillers. With the help of some other ED doctors in San Diego, Lev has come up with a set of guidelines.\u003c/p>\n\u003cp>Under the new rules, people who come to the ED for chronic pain will be directed to visit their primary care doctor.\u003c/p>\n\u003cp>\"Someone who has pain for more than three months, or needs any long-acting pain medications that last in the body for a long time, those are the people who need to get all there prescriptions coordinated by one prescriber and one pharmacy,\" Dr. Lev explained.\u003c/p>\n\u003cp>These changes will not affect people with acute or sudden pain, from say a broken arm or a kidney stone. The new guidelines will only apply to those complaining of chronic pain.\u003c/p>\n\u003cp>\"That’s the population at risk, who die unintentionally,\" Dr. Lev said. \"They don’t know that they’re taking all these medicines from different providers, different prescribers. They got something from the ER, something from the psychiatrist, something from the primary care doctor. And people die from that. That’s what we want to get a grasp on and prevent.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthgrades.com/physician/dr-michele-lamantia-2q2cd\">Dr. Michele Lamantia\u003c/a> directs the chronic pain program at the \u003ca href=\"http://www.syhc.org/\">San Ysidro Health Center\u003c/a>, a network of community clinics in southern San Diego County.\u003c/p>\n\u003cp>She said there are some non-narcotic prescription drugs that are quite effective for chronic pain. Lamantia thinks doctors who prescribe narcotic painkillers need to be more careful.\u003c/p>\n\u003cp>“I think sometimes we feel it’s only a percent of people who might have a problem with the drugs and that we as physicians are going to easily be able to pick them up. But that’s really not the case,\" she said.\u003c/p>\n\u003cp>All hospitals in San Diego and Imperial County have tentatively agreed to the new narcotic guidelines. They could be rolled out sometime this spring.\u003c/p>\n\u003cp>After eight years of abusing narcotics, Bobby Stevens has finally quit. He’s been in recovery now for four months.\u003c/p>\n\u003cp>Stevens says he wishes those emergency room guidelines had been in place back when he got hooked on painkillers.\u003c/p>\n\u003cp>\"I don’t personally feel like I would be where I’m at today, if they weren’t so easily available,\" Stevens lamented.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In 2010, more than 16,000 Americans died from an \u003ca href=\"http://abcnews.go.com/Health/Drugs/drug-deaths-exceed-traffic-deaths/story?id=14554903\">overdose of prescription narcotics\u003c/a>.\u003c/p>\n\n",
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"excerpt": "More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to prescription painkillers like Oxycontin and Percocet.\r\n\r\nHospital emergency departments in San Diego are now reevaluating their role in dispensing these medications.\r\n\r\nBobby Stevens, not his real name, first started popping Oxycontin when he was in high school in northern San Diego county. His classmates used to hand it out at parties.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Kenny Goldberg, \u003ca href=\"http://www.kpbs.org/news/2013/mar/05/san-diego-emergency-departments-crack-down-painkil/\" target=\"_blank\">KPBS\u003c/a>\u003c/p>\n\u003cp>More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to \u003ca href=\"http://wiki.answers.com/Q/List_of_prescription_pain_killers_by_trade_names\">prescription painkillers\u003c/a> like Oxycontin and Percocet.\u003c/p>\n\u003cp>Hospital emergency departments in San Diego are now reevaluating their role in dispensing these medications.\u003c/p>\n\u003cp>Bobby Stevens, not his real name, first started popping Oxycontin when he was in high school in northern San Diego county. His classmates used to hand it out at parties.\u003c/p>\n\u003cp>Stevens soon became hooked. At the height of his addiction, he was taking up to 20 Oxycontin pills a day, plus the anti-anxiety drug Xanax and the amphetamine Adderall. He was spending $1500 a week on his habit.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Stevens used to get his a lot of his drugs from hospital emergency rooms. He had a few standard lies he would tell the doctors.\u003c/p>\n\u003cp>\"That I either had lower back pain, or I did something to my knee, running,\" Stevens recalls. \"It pretty much was the same story every time. I would go to different doctors, I wouldn’t go to the same ER. So I could pretty much use the same story.\"\u003c/p>\n\u003cp>Most of the time, ER doctors would give Stevens a prescription for at least a month’s worth of pills. He said he didn't have to do much acting.\u003c/p>\n\u003cp>\"I would just explain the pain I had. But they were so busy, it seemed that they took you for your word, and wrote you the prescription,\" Stevens said. \"I mean I didn’t have to do x-rays, I didn’t have to do an MRI, or any of that type of stuff. They just asked what I was there for, and they wrote me the scrip.\"\u003c/p>\n\u003cp>Sales of prescriptions opiates have skyrocketed in recent years. So have \u003ca href=\"http://www.kpbs.org/news/2011/dec/15/prescription-drugs-san-diegos-leading-cause-accide/\">drug-related deaths\u003c/a>.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/homeandrecreationalsafety/rxbrief/\">Centers for Disease Control\u003c/a> says hospital emergency departments are the biggest source of these drugs.\u003c/p>\n\u003cp>Dr. Kevin Kelly, director of the ED at La Mesa’s Alvarado Hospital, said many patients are asking for them.\u003c/p>\n\u003cp>\"I think all the emergency departments are experiencing an incredible influx of opiate requests, and opiate-related emergencies,\" he explained.\u003c/p>\n\u003cp>Dr. Kelly said physicians can’t always tell when someone is really in pain -- or just faking it.\u003c/p>\n\u003cp>\"Our goal, first of all, is we want to help,\" Kelly explained. \"So, each case we look at and we say, 'How can I help this person?' and then second, we really want to do no harm. And that’s where a lot of narcotic issues come up; there’s a lot of harm related to the use and misuse of these medications.\"\u003c/p>\n\u003cp>The emergency department at \u003ca href=\"http://www.scripps.org/locations/hospitals__scripps-mercy-hospital\">Scripps Mercy Hospital\u003c/a> in Hillcrest is one of San Diego’s busiest. More than 57,000 patients were treated there last year.\u003c/p>\n\u003cp>Scripps' \u003ca href=\"http://www.scripps.org/physicians/4598-roneet-lev-md\">Dr. Roneet Lev\u003c/a> said these days, about one out of five patients in her ED are taking narcotics.\u003c/p>\n\u003cp>\"When you talk about cocaine or heroin, you talk about the drug lords in Columbia,\" Dr. Lev said. \"But prescription drug abuse and deaths usually are given by well-intentioned, well-meaning physicians, and we need to kind of change the way we practice and get a hold of this epidemic.\"\u003c/p>\n\u003cp>To that end, Dr. Lev is leading an effort to change the way local emergency departments dispense painkillers. With the help of some other ED doctors in San Diego, Lev has come up with a set of guidelines.\u003c/p>\n\u003cp>Under the new rules, people who come to the ED for chronic pain will be directed to visit their primary care doctor.\u003c/p>\n\u003cp>\"Someone who has pain for more than three months, or needs any long-acting pain medications that last in the body for a long time, those are the people who need to get all there prescriptions coordinated by one prescriber and one pharmacy,\" Dr. Lev explained.\u003c/p>\n\u003cp>These changes will not affect people with acute or sudden pain, from say a broken arm or a kidney stone. The new guidelines will only apply to those complaining of chronic pain.\u003c/p>\n\u003cp>\"That’s the population at risk, who die unintentionally,\" Dr. Lev said. \"They don’t know that they’re taking all these medicines from different providers, different prescribers. They got something from the ER, something from the psychiatrist, something from the primary care doctor. And people die from that. That’s what we want to get a grasp on and prevent.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.healthgrades.com/physician/dr-michele-lamantia-2q2cd\">Dr. Michele Lamantia\u003c/a> directs the chronic pain program at the \u003ca href=\"http://www.syhc.org/\">San Ysidro Health Center\u003c/a>, a network of community clinics in southern San Diego County.\u003c/p>\n\u003cp>She said there are some non-narcotic prescription drugs that are quite effective for chronic pain. Lamantia thinks doctors who prescribe narcotic painkillers need to be more careful.\u003c/p>\n\u003cp>“I think sometimes we feel it’s only a percent of people who might have a problem with the drugs and that we as physicians are going to easily be able to pick them up. But that’s really not the case,\" she said.\u003c/p>\n\u003cp>All hospitals in San Diego and Imperial County have tentatively agreed to the new narcotic guidelines. They could be rolled out sometime this spring.\u003c/p>\n\u003cp>After eight years of abusing narcotics, Bobby Stevens has finally quit. He’s been in recovery now for four months.\u003c/p>\n\u003cp>Stevens says he wishes those emergency room guidelines had been in place back when he got hooked on painkillers.\u003c/p>\n\u003cp>\"I don’t personally feel like I would be where I’m at today, if they weren’t so easily available,\" Stevens lamented.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In 2010, more than 16,000 Americans died from an \u003ca href=\"http://abcnews.go.com/Health/Drugs/drug-deaths-exceed-traffic-deaths/story?id=14554903\">overdose of prescription narcotics\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones announced the approval of \u003ca href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2013/upload/nr027AutismReg.pdf\" target=\"_blank\">emergency rules\u003c/a> this week, which take effect immediately.\u003c/p>\n\u003cp>“Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities,\" Jones wrote in a statement.\u003c/p>\n\u003cp>Insurers have already been required to comply with medically necessary treatment by the state's Mental Health Parity Law and SB 946, which reinforced the mandate for private insurers to provide behavioral treatment for autism.\u003c/p>\n\u003cp>However Karen Fessel, executive director of the Northern California-based \u003ca href=\"http://www.autismhealthinsurance.org/\" target=\"_blank\">Autism Health Insurance Project\u003c/a>, says these emergency regulations were needed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is an example how even with the right laws in place you still need vigilant regulators who will help interpret the law in ways that they were intended,\" says Fessel \"Because the health plans often twist things around so much people don’t get the care they need even with the laws.\"\u003c!--more-->\u003c/p>\n\u003cp>Fessel says even with the laws her organization heard from many people getting frivolous denials.\u003c/p>\n\u003cp>\"They were denied by insurers saying your child is too low functioning to benefit from the therapy,\" says Fessel. \"And if they were high functioning they’d say 'your child doesn’t need the treatment,'\" even though the child was having behavioral issues in the community.\u003c/p>\n\u003cp>One specific change is banning visit limits or cost limits on coverage unless limits apply equally to all benefits under the policy. Fessel says until now the limits were way too low.\u003c/p>\n\u003cp>\"On average a lot of these policies were limited to 30 sessions a year for speech and occupational therapy,\" Fessel says. \"Whereas what is needed is 2 a week of speech and one a week of occupational therapy.\"\u003c/p>\n\u003cp>One of the other issues addressed by the emergency regulations were consumer complaints about undue delays. Bryna Siegel, retired Professor and Director of the UCSF Autism Clinic, says the new rules are sensitive to the fact that many insurers are requiring patients to get IQ tests before they can get treatment.\u003c/p>\n\u003cp>“I have been getting a large number of calls from parents saying they need intelligence testing to go forward with insurance companies,” says Siegel. Siegel says the insurance companies may be using the results as a way to set expectations for treatment. But she says in this case, “I think it is being thrown up as a barrier, you have to wait to get it done, submitted, looked at.”\u003c/p>\n\u003cp>The president of the Association of California Life and Health Insurance Companies (ACLHIC), Brad Wenger, said in a statement that the organization had been interested in getting clarification on these topics but hoped for a public comment period.\u003c/p>\n\u003cp>\"'Emergency' regulations shortcut the public comment process and deny stakeholders an opportunity to contribute their expertise and viewpoints,\" said Wenger.\u003c/p>\n\u003cp>Wenger added, \"A patient who is denied coverage on the basis of medical necessity, whether it is related to a mental health condition or a medical condition, can appeal that decision to an independent medical review board comprised of independent medical experts whose decisions are binding on insurers.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There is a financial element to the rules as well. This emergency regulation is expected to save California taxpayers approximately $138.8 million to $197.8 million over the next year by shifting some of the costs for the therapy from the state to private insurers.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California regulators have issued emergency regulations aimed at keeping insurance companies from delaying or denying coverage for autism treatment.\u003c/p>\n\u003cp>Insurance Commissioner Dave Jones announced the approval of \u003ca href=\"http://www.insurance.ca.gov/0400-news/0100-press-releases/2013/upload/nr027AutismReg.pdf\" target=\"_blank\">emergency rules\u003c/a> this week, which take effect immediately.\u003c/p>\n\u003cp>“Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities,\" Jones wrote in a statement.\u003c/p>\n\u003cp>Insurers have already been required to comply with medically necessary treatment by the state's Mental Health Parity Law and SB 946, which reinforced the mandate for private insurers to provide behavioral treatment for autism.\u003c/p>\n\u003cp>However Karen Fessel, executive director of the Northern California-based \u003ca href=\"http://www.autismhealthinsurance.org/\" target=\"_blank\">Autism Health Insurance Project\u003c/a>, says these emergency regulations were needed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is an example how even with the right laws in place you still need vigilant regulators who will help interpret the law in ways that they were intended,\" says Fessel \"Because the health plans often twist things around so much people don’t get the care they need even with the laws.\"\u003c!--more-->\u003c/p>\n\u003cp>Fessel says even with the laws her organization heard from many people getting frivolous denials.\u003c/p>\n\u003cp>\"They were denied by insurers saying your child is too low functioning to benefit from the therapy,\" says Fessel. \"And if they were high functioning they’d say 'your child doesn’t need the treatment,'\" even though the child was having behavioral issues in the community.\u003c/p>\n\u003cp>One specific change is banning visit limits or cost limits on coverage unless limits apply equally to all benefits under the policy. Fessel says until now the limits were way too low.\u003c/p>\n\u003cp>\"On average a lot of these policies were limited to 30 sessions a year for speech and occupational therapy,\" Fessel says. \"Whereas what is needed is 2 a week of speech and one a week of occupational therapy.\"\u003c/p>\n\u003cp>One of the other issues addressed by the emergency regulations were consumer complaints about undue delays. Bryna Siegel, retired Professor and Director of the UCSF Autism Clinic, says the new rules are sensitive to the fact that many insurers are requiring patients to get IQ tests before they can get treatment.\u003c/p>\n\u003cp>“I have been getting a large number of calls from parents saying they need intelligence testing to go forward with insurance companies,” says Siegel. Siegel says the insurance companies may be using the results as a way to set expectations for treatment. But she says in this case, “I think it is being thrown up as a barrier, you have to wait to get it done, submitted, looked at.”\u003c/p>\n\u003cp>The president of the Association of California Life and Health Insurance Companies (ACLHIC), Brad Wenger, said in a statement that the organization had been interested in getting clarification on these topics but hoped for a public comment period.\u003c/p>\n\u003cp>\"'Emergency' regulations shortcut the public comment process and deny stakeholders an opportunity to contribute their expertise and viewpoints,\" said Wenger.\u003c/p>\n\u003cp>Wenger added, \"A patient who is denied coverage on the basis of medical necessity, whether it is related to a mental health condition or a medical condition, can appeal that decision to an independent medical review board comprised of independent medical experts whose decisions are binding on insurers.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There is a financial element to the rules as well. This emergency regulation is expected to save California taxpayers approximately $138.8 million to $197.8 million over the next year by shifting some of the costs for the therapy from the state to private insurers.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Judge Strikes Down NYC Ban on Large Sugary Drinks",
"title": "Judge Strikes Down NYC Ban on Large Sugary Drinks",
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"content": "\u003cp>\u003cstrong>Law was set to take effect Tuesday\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_11293\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/11/judge-strikes-down-nyc-ban-on-large-sugary-drinks/soda_flickr_kjm-427/\" rel=\"attachment wp-att-11293\">\u003cimg class=\"size-medium wp-image-11293\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Soda_Flickr_KJM-427-300x199.jpg\" alt=\"(KJM-427/Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(KJM-427/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A judge struck down New York City's ban on sugary beverages larger than 16 ounces on Monday, less than 24 hours before the law was scheduled to go into effect. In \u003ca href=\"http://s3.documentcloud.org/documents/613095/new-york-state-supreme-court-decision-on-sugary.pdf\" target=\"_blank\">a decision\u003c/a> [PDF] from the state's Supreme Court in New York County, Judge Milton Tingling found that the Board of Health's rule was \"arbitrary and capricious.\"\u003c/p>\n\u003cp>New York City's Board of Health had \u003ca href=\"http://www.nyc.gov/html/doh/downloads/pdf/notice/2012/notice-adoption-amend-article81.pdf\" target=\"_blank\">approved the rule\u003c/a> [PDF] last September, a significant public health effort from Mayor Michael Bloomberg. In his ruling Tingling also said the rule violated the separation of powers, that this type of action should be determined by the city council, not the New York City's Board of Health. \"The Rule would not only violate the separation of powers doctrine, it would eviscerate it,\" Tingling wrote. \"Such an evisceration has the potential to be more troubling than sugar sweetened beverages.\"\u003c/p>\n\u003cp>A lawsuit \u003ca href=\"http://ww2.kqed.org/stateofhealth/jp/quick-read-fight-over-bloombergs-soda-ban-reaches-courtroom/\" target=\"_blank\">challenging the rule\u003c/a> was brought by a coalition of groups including a statewide coalition of Hispanic chambers of commerce, New York's Korean-American Grocers Association, several unions and the American Beverage Association.\u003c!--more-->\u003c/p>\n\u003cp>City officials immediately stated they would appeal the ruling. (Note that the Supreme Court which issued this decision is a trial-level court in New York.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Harold Goldstein is executive director of the California Center for Public Health Advocacy. He said he wasn't terribly surprised by today's ruling and acknowledged the public education value of Mayor Bloomberg's efforts.\u003c/p>\n\u003cp>\"New York City's proposal did as much as anything in the country to raise awareness that soda is the biggest source of sugar in the diet and the largest contributor to obesity and diabetes,\" Goldstein said.\u003c/p>\n\u003cp>He believes that portion size restriction on sodas by local and state governments are coming. \"The tide has turned across the country against sugary drinks. People now know about the harmful effects of sugary drinks,\" he said \"It's because of initiatives like Mayor Bloomberg's that are informing people about these products.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In a 36-page decision Tingling detailed the history of New York's City Charter going back to 1686, as well as the history of the powers of the Board of Health. Tingling acknowledged the authority of the board to \"prevent and protect against communicable, infectious, and pestilent diseases.\" But he questioned the board's authority to \"limit or ban a legal item under the guise of 'controlling chronic disease.'\"\u003c/p>\n\n",
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"excerpt": "A judge struck down New York City's ban on sugary beverages larger than 16 ounces, less than 24 hours before the law was scheduled to go into effect. In a decision [PDF] from the state's Supreme Court in New York County, Judge Milton Tingling found that the Board of Health's rule was \"arbitrary and capricious.\"\r\n\r\nNew York City's Board of Health had approved the rule [PDF] last September, a significant public health effort from Mayor Michael Bloomberg. In his ruling Tingling also said the rule violated the separation of powers, that this type of action should be determined by the city council, not the New York City's board of health. \"The Rule would not only violate the separation of powers doctrine, it would eviscerate it,\" Tingling wrote. \"Such an evisceration has the potential to be more troubling than sugar sweetened beverages.\"",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Law was set to take effect Tuesday\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_11293\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/11/judge-strikes-down-nyc-ban-on-large-sugary-drinks/soda_flickr_kjm-427/\" rel=\"attachment wp-att-11293\">\u003cimg class=\"size-medium wp-image-11293\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Soda_Flickr_KJM-427-300x199.jpg\" alt=\"(KJM-427/Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(KJM-427/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>A judge struck down New York City's ban on sugary beverages larger than 16 ounces on Monday, less than 24 hours before the law was scheduled to go into effect. In \u003ca href=\"http://s3.documentcloud.org/documents/613095/new-york-state-supreme-court-decision-on-sugary.pdf\" target=\"_blank\">a decision\u003c/a> [PDF] from the state's Supreme Court in New York County, Judge Milton Tingling found that the Board of Health's rule was \"arbitrary and capricious.\"\u003c/p>\n\u003cp>New York City's Board of Health had \u003ca href=\"http://www.nyc.gov/html/doh/downloads/pdf/notice/2012/notice-adoption-amend-article81.pdf\" target=\"_blank\">approved the rule\u003c/a> [PDF] last September, a significant public health effort from Mayor Michael Bloomberg. In his ruling Tingling also said the rule violated the separation of powers, that this type of action should be determined by the city council, not the New York City's Board of Health. \"The Rule would not only violate the separation of powers doctrine, it would eviscerate it,\" Tingling wrote. \"Such an evisceration has the potential to be more troubling than sugar sweetened beverages.\"\u003c/p>\n\u003cp>A lawsuit \u003ca href=\"http://ww2.kqed.org/stateofhealth/jp/quick-read-fight-over-bloombergs-soda-ban-reaches-courtroom/\" target=\"_blank\">challenging the rule\u003c/a> was brought by a coalition of groups including a statewide coalition of Hispanic chambers of commerce, New York's Korean-American Grocers Association, several unions and the American Beverage Association.\u003c!--more-->\u003c/p>\n\u003cp>City officials immediately stated they would appeal the ruling. (Note that the Supreme Court which issued this decision is a trial-level court in New York.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Harold Goldstein is executive director of the California Center for Public Health Advocacy. He said he wasn't terribly surprised by today's ruling and acknowledged the public education value of Mayor Bloomberg's efforts.\u003c/p>\n\u003cp>\"New York City's proposal did as much as anything in the country to raise awareness that soda is the biggest source of sugar in the diet and the largest contributor to obesity and diabetes,\" Goldstein said.\u003c/p>\n\u003cp>He believes that portion size restriction on sodas by local and state governments are coming. \"The tide has turned across the country against sugary drinks. People now know about the harmful effects of sugary drinks,\" he said \"It's because of initiatives like Mayor Bloomberg's that are informing people about these products.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In a 36-page decision Tingling detailed the history of New York's City Charter going back to 1686, as well as the history of the powers of the Board of Health. Tingling acknowledged the authority of the board to \"prevent and protect against communicable, infectious, and pestilent diseases.\" But he questioned the board's authority to \"limit or ban a legal item under the guise of 'controlling chronic disease.'\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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