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She is a certified teacher of Soul Motion®, a conscious dance practice, and can sometimes be found in the Mojave desert or the Eastern Sierra.","avatar":"https://secure.gravatar.com/avatar/fa6bf8a74a2692973a5484e64ebd2b52?s=600&d=blank&r=g","twitter":"cosmologicalkat","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["contributor"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["editor"]},{"site":"science","roles":["editor"]}],"headData":{"title":"Katrin Snow | KQED","description":"Senior Editor","ogImgSrc":"https://secure.gravatar.com/avatar/fa6bf8a74a2692973a5484e64ebd2b52?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/fa6bf8a74a2692973a5484e64ebd2b52?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/katsnow"},"adembosky":{"type":"authors","id":"3205","meta":{"index":"authors_1591205172","id":"3205","found":true},"name":"April Dembosky","firstName":"April","lastName":"Dembosky","slug":"adembosky","email":"adembosky@kqed.org","display_author_email":false,"staff_mastheads":["news","science"],"title":"KQED Health Correspondent","bio":"April Dembosky is the health correspondent for KQED News and a regular contributor to NPR. She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"},"lesleymcclurg":{"type":"authors","id":"11229","meta":{"index":"authors_1591205172","id":"11229","found":true},"name":"Lesley McClurg","firstName":"Lesley","lastName":"McClurg","slug":"lesleymcclurg","email":"lmcclurg@KQED.org","display_author_email":false,"staff_mastheads":["news","science"],"title":"KQED Health Correspondent","bio":"\u003cspan style=\"font-weight: 400;\">Lesley McClurg is a health correspondent and fill-in host. \u003c/span>\u003cspan style=\"font-weight: 400;\">Her work is regularly rebroadcast on numerous NPR and PBS shows. She has won several regional Emmy awards, a regional and a national Edward R. Murrow award. The Association for Health Journalists awarded Lesley best beat coverage. The Society of Professional Journalists has recognized her reporting several times. The Society of Environmental Journalists spotlighted her ongoing coverage of California's historic drought. \u003c/span>\u003cspan style=\"font-weight: 400;\">Before joining KQED in 2016, she covered food and sustainability for Capital Public Radio, the environment for Colorado Public Radio, and reported for both KUOW and KCTS9 in Seattle. \u003c/span>\u003cspan style=\"font-weight: 400;\">When not hunched over her laptop Lesley enjoys skiing with her toddler, surfing with her husband or scheming their next globetrotting adventure. Before motherhood she relished dancing tango till sunrise. When on deadline she fuels herself almost exclusively on chocolate chips.\u003c/span>\r\n\r\n\u003cspan style=\"font-weight: 400;\"> \u003c/span>","avatar":"https://secure.gravatar.com/avatar/3fb78e873af3312f34d0bc1d60a07c7f?s=600&d=blank&r=g","twitter":"lesleywmcclurg","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["editor"]},{"site":"stateofhealth","roles":["author"]},{"site":"science","roles":["editor"]}],"headData":{"title":"Lesley McClurg | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/3fb78e873af3312f34d0bc1d60a07c7f?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/3fb78e873af3312f34d0bc1d60a07c7f?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lesleymcclurg"},"aheidt":{"type":"authors","id":"11520","meta":{"index":"authors_1591205172","id":"11520","found":true},"name":"Amanda Heidt","firstName":"Amanda","lastName":"Heidt","slug":"aheidt","email":"aheidt@kqed.org","display_author_email":false,"staff_mastheads":[],"title":"KQED Contributor","bio":"Amanda Heidt was the 2018 Dr. Allen Fuhs KQED-CSUMB Fellow at KQED Science. Amanda came to KQED from Moss Landing Marine Laboratories, where her masters research uses molecular techniques to describe communities of meiofauna, small invertebrates living between grains of sand. She has a background in education, outreach, and science communication, fostered by a recent position with the Stanford Center for Ocean Solutions. She has a BS in Marine Science and a minor in Chemistry from the University of California, Santa Cruz. Her interests include climbing, diving, camping, baking, and reading. Find her on Twitter and Instagram @Scatter_Cushion.","avatar":"https://secure.gravatar.com/avatar/e646090632bd7fef75fff4616269ff8c?s=600&d=blank&r=g","twitter":"Scatter_Cushion","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"science","roles":["author"]}],"headData":{"title":"Amanda Heidt | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/e646090632bd7fef75fff4616269ff8c?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/e646090632bd7fef75fff4616269ff8c?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/aheidt"},"kevinstark":{"type":"authors","id":"11608","meta":{"index":"authors_1591205172","id":"11608","found":true},"name":"Kevin Stark","firstName":"Kevin","lastName":"Stark","slug":"kevinstark","email":"kstark@kqed.org","display_author_email":true,"staff_mastheads":["science"],"title":"Senior Editor","bio":"Kevin is a senior editor for KQED Science, managing the station's health and climate desks. His journalism career began in the Pacific Northwest, and he later became a lead reporter for the San Francisco Public Press. His work has appeared in Pacific Standard magazine, the Energy News Network, the Center for Investigative Reporting's Reveal and WBEZ in Chicago. Kevin joined KQED in 2019, and has covered issues related to energy, wildfire, climate change and the environment.","avatar":"https://secure.gravatar.com/avatar/1f646bf546a63d638e04ff23b52b0e79?s=600&d=blank&r=g","twitter":"starkkev","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"","roles":["editor"]},{"site":"news","roles":["editor"]},{"site":"science","roles":["administrator"]}],"headData":{"title":"Kevin Stark | KQED","description":"Senior Editor","ogImgSrc":"https://secure.gravatar.com/avatar/1f646bf546a63d638e04ff23b52b0e79?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/1f646bf546a63d638e04ff23b52b0e79?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/kevinstark"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"news","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"science_1991871":{"type":"posts","id":"science_1991871","meta":{"index":"posts_1591205157","site":"science","id":"1991871","score":null,"sort":[1710945038000]},"guestAuthors":[],"slug":"systemic-neglect-how-staffing-shortages-in-nursing-homes-leave-patients-trapped-in-hospitals","title":"Systemic Neglect: How Staffing Shortages In Nursing Homes Leave Patients Trapped in Hospitals","publishDate":1710945038,"format":"standard","headTitle":"Systemic Neglect: How Staffing Shortages In Nursing Homes Leave Patients Trapped in Hospitals | KQED","labelTerm":{"site":"science"},"content":"\u003cp>On a warm September morning in 2020, David Alter was cleaning up his kitchen in Berkeley. He saw his wife, Lisa, move towards him out of the corner of his eye. He turned to dry his hands on a towel, and then he heard a loud noise.\u003c/p>\n\u003cp>“I’ll never forget that sound,” he said. “It was like the sound of a baseball getting hit. She did nothing to brace her fall. Her head smacked directly on the linoleum floor.”\u003c/p>\n\u003cp>His wife lay still as blood pooled around her body, and Alter sprinted to the bathroom to scavenge for bandages. He wrapped Lisa’s head in gauze and then carried her to the car before speeding to the emergency department at Kaiser Permanente’s Richmond Medical Center, where he said a doctor diagnosed Lisa with a brain bleed.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Kristof Stremikis, director of market analysis and insight, California Health Care Foundation\"]‘We definitely know that across California more patients are spending longer times in the hospital.’[/pullquote]Lisa has Huntington’s disease, a genetic disorder that causes nerve cells to break down over time, ravaging the brain and body. The condition is marked by involuntary jerking and writhing movements. It impairs one’s gait, posture and balance. Eventually, Lisa could not walk, talk or think.\u003c/p>\n\u003cp>Alter had failed for an entire year to find a nursing home for his wife, as she was no longer safe at home.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It got to the point that we were going to the ER weekly,” Alter said. “If the fall was late at night, we wouldn’t go right away because we were too exhausted. I would patch her up. I would use suture strips or even sometimes Krazy Glue to close cuts.”\u003c/p>\n\u003cfigure id=\"attachment_1991935\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1991935 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\" alt=\"A man wearing glasses and a dark shirt sits next to a woman lying down in a bed.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter sits next to his wife, Lisa Alter, in Walnut Creek on Feb. 9, 2024. \u003ccite>(Kathryn Styer Martínez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He had called hundreds of skilled nursing facilities across California. He penned personal letters to facility directors illustrated with color photos of their family, describing his wife as “a vibrant woman, wife, elementary school teacher and mother.”\u003c/p>\n\u003cp>He received denial after denial. There was not a single facility that would accept a complex patient who would likely need many years of specialized, very expensive care. Lisa received her Huntington’s disease diagnosis when she was 45 years old. From the onset of symptoms, people with the condition have a life expectancy of 10 to 25 years. Lisa’s needs will likely increase over time.\u003c/p>\n\u003cp>Alter turned to social workers with the Huntington’s Disease Society for help. They advised him to leave his wife in the hospital the next time she landed in the emergency department. “That’s the last resort if the caregiver isn’t safe to take their loved one home,” said Jessica Marsolek, the society’s associate director of community services.\u003c/p>\n\u003cfigure id=\"attachment_1991923\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991923\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\" alt=\"A hallway of a medical center with people walking through.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals are much more equipped to connect and successfully transfer patients to nursing homes. “I don’t know anybody that’s gotten into a nursing home any other way,” said Maura Gibney, executive director for California Advocates for Nursing Home Reform. She regularly advises families to leave their loved ones in the hospital. “That’s the only way.”\u003c/p>\n\u003cp>Four days after Lisa’s fall, she was ready for discharge from Kaiser’s emergency department in Richmond, but Alter made the decision not to pick her up. She wouldn’t leave the hospital for several months.\u003c/p>\n\u003ch2>Part of a growing trend\u003c/h2>\n\u003cp>Patients spend more and more time in the hospital, even people who — like Lisa Alter — are medically stable and ready for a lower level of care at a facility like a nursing home or a psychiatric treatment center. Increasingly, they languish for weeks, months and even years, which delays their recovery, and that, in turn, delays care for patients who need urgent care.\u003c/p>\n\u003cp>“We can’t accept some patients trying to transfer in from smaller hospitals,” said Dr. Valerie Norton, emergency medicine physician at Scripps Mercy Hospital in San Diego. “Because we don’t have room for them. Or there might be somebody down in the emergency department that’s waiting to be admitted into the hospital. And we have to wait until somebody else gets discharged before we can move them upstairs. If you’re lying in a bed in the emergency department, that’s just a hard gurney with a broken hip, and you’re waiting 16 hours for a bed to open up somewhere, that’s pretty tough.”\u003c/p>\n\u003cfigure id=\"attachment_1991924\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991924\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\" alt='The side of a building that says \"Kaiser Permanente.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2022, the average length of stay inside hospitals across the country \u003ca href=\"https://www.aha.org/issue-brief/2022-12-05-patients-and-providers-faced-increasing-delays-timely-discharges\">increased by 19.2%\u003c/a> compared to the year before, according to an issue brief prepared by the American Hospital Association. In California, 4,500 patients are stranded inside hospitals every day, according to a \u003ca href=\"https://calhospital.org/wp-content/uploads/2024/01/Impact-of-Inadequate-Networks-CHA-Analysis-FINAL.pdf\">report from the California Hospital Association, \u003c/a>which attributes the problem of discharge delays to insurance companies openly disregarding “the clinical guidance of doctors and nurses” and “delaying or denying the care” that patients need.\u003c/p>\n\u003cp>“We definitely know that across California, more patients are spending longer times in the hospital,” said Kristof Stremikis, who directs the California Health Care Foundation’s market analysis and insight team.\u003c/p>\n\u003cp>“It’s both very complicated and incredibly simple,” Stremikis said. “It’s rising demand with problems in the supply. There’s more patients that need to be discharged. They tend to be sicker. They tend to have more complex conditions. And then on the supply side, there’s just fewer and fewer places to send them.”\u003c/p>\n\u003cp>[aside postID=\"science_1991739,news_11976372,news_11968579\" label=\"Related Stories\"]As the country’s demographics trend older, more and more patients require care at nursing homes, but those facilities are plagued by dire staffing shortages, according to the \u003ca href=\"https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Historic-Staffing-Shortages-Continue-To-Force-Nursing-Homes-To-Limit-New-Admissions,-Creating-Bottlenecks-at-Hospitals-and-.aspx\">American Health Care Association\u003c/a>. A lack of workers downstream means patients like Lisa Alter get stuck upstream inside the hospital’s emergency department.\u003c/p>\n\u003cp>“We don’t have anywhere safe to send them,” Norton said. “They would qualify to be at a lower level of care like a skilled nursing facility or an assisted living facility. But because of their multiple medical problems or their psychiatric condition, there’s not a place that’s willing to take them.”\u003c/p>\n\u003cp>The number of days patients are stuck at Scripps has tripled in recent years, she said, and costs the health care system $56 million a year.\u003c/p>\n\u003cp>“It’s just insane how long these patients stay in the hospital,” Norton said. “And we’re not getting paid for that. We’re just eating that cost. And they should be in a nursing home somewhere.”\u003c/p>\n\u003cp>The problem was exacerbated by the pandemic, which accelerated feelings of anguish and other persistent mental health issues in health care workers.\u003c/p>\n\u003cp>Nearly half of health care workers across the U.S. reported often feeling burned out in 2022, according to a \u003ca href=\"https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html\">federal survey from the Centers for Disease Control\u003c/a>. About the same amount said they intended to look for a new job.\u003c/p>\n\u003cp>“We’ve had a long, long, long-term problem,” said Craig Cornett, CEO of the California Association of Health Facilities. “Every other part of the health care sector has recovered its staff to its pre-COVID days. We are the only part of the health care continuum that is still below where we were before COVID.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"David Alter, software engineer\"]‘You shouldn’t have to leave someone in the hospital and force them to take care of it.’[/pullquote]California is spending $26 million to \u003ca href=\"https://yourcnastory.org/\">recruit\u003c/a> more health care workers to help fill this gap, with the hope of attracting 5,500 certified nursing assistants by 2027. State lawmakers are considering \u003ca href=\"https://legiscan.com/CA/text/SB895/id/2868455\">SB 895\u003c/a>, a new bill that would allow select community college districts to offer nursing degrees, lowering the bar for entry and making it easier for workers to enter the health care industry.\u003c/p>\n\u003cp>But, Cornett said, the workforce challenge is huge, and it is not going away.\u003c/p>\n\u003ch2>The breaking point\u003c/h2>\n\u003cp>Alter always thought he’d grow old alongside his wife. But he could no longer parent his two children, hold a full-time job as a software engineer, and care for Lisa around the clock.\u003c/p>\n\u003cfigure id=\"attachment_1991920\" class=\"wp-caption aligncenter\" style=\"max-width: 1330px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991920\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\" alt=\"A man, woman, and two children wearing tie die t shirts stands outside a home.\" width=\"1330\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg 1330w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-800x1203.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1020x1534.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-160x241.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-768x1155.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1021x1536.jpg 1021w\" sizes=\"(max-width: 1330px) 100vw, 1330px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A family photo of Lisa (left) and David Alter and their children Zachary and Maya in front of their home in Berkeley in 2010, the year before Lisa was diagnosed with Huntington’s disease. \u003ccite>(Courtesy of David Alter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When he learned that his wife was ready to be discharged from the emergency department at Kaiser Richmond, he steadied himself.\u003c/p>\n\u003cp>“I remember talking to them, and I said: ‘I’m not gonna pick her up. I’m not going to take her home.’”\u003c/p>\n\u003cp>Alter said the hospital’s discharge team struggled to find a nursing home for Lisa, too. His wife Lisa would spend over four months at Kaiser, a time period that Alter described as “excruciating” for him. He was so worried that the hospital would force him to take his wife home that he held off from visiting her in the hospital initially.\u003c/p>\n\u003cp>“It’s incredibly emotional to walk away,” Alter said. “And Kaiser’s calling you. And they’re like, ‘Why aren’t you picking her up?’ It’s really, really stressful. And it gets worse every day she’s there.”\u003c/p>\n\u003cp>Kaiser Permanente declined an interview for this story. In an emailed statement, the organization said it strives to find the right care for patients as quickly as possible. “While the vast majority of placements occur in a timely fashion, there are some circumstances, including the need for highly specialized care and patient or family preferences, that can present challenges,” the statement said.\u003c/p>\n\u003cp>\u003cb>Patient discrimination\u003c/b>\u003c/p>\n\u003cp>On top of staffing issues, facilities have a financial incentive to choose patients who can pay the highest price. “It’s unfortunate, but it is true,” Stremikis said. “Medi-Cal rates are way lower than private payers. It’s just another example of the inequalities within our system.”\u003c/p>\n\u003cp>Medi-Cal is the state’s insurance program, which covers Alter’s wife. It’s supposed to pay for her to receive specialized care at a round-the-clock facility, but that has not been his experience. “There’s nowhere I can place her,” Alter said.\u003c/p>\n\u003cfigure id=\"attachment_1991922\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991922\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\" alt=\"A person holds an image of a man, woman and young child.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter holds a photo of himself, his wife Lisa, and their son Zachary at his home in Berkeley on March 18, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Eventually, after more than four months, Kaiser Permanente did find housing for Lisa in Walnut Creek. The home provides food and supervision but not specialized nurses or regular doctor visits. Alter said she’s not at the right facility, but he doesn’t know what to do. He hired consultants and lawyers and wrote his legislators, all to no avail.\u003c/p>\n\u003cp>Three years after Alter left his wife in the hospital as a hail mary play to get her the care she needs, that’s still not happening. “You’re just defeated,” he said.\u003c/p>\n\u003cp>Meanwhile, his wife declines. “She’s 70 or 80 pounds,” Alter said. “She’s so tiny. She’s skin and bones.”\u003c/p>\n\u003cp>He also worries she could injure herself again, land back in the hospital, and then get stuck in the cycle all over again.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“You shouldn’t have to leave someone in the hospital and force them to take care of it,” Alter said. “That’s not the right solution. As a society, we’re not set up in a way to care for people properly.”\u003c/p>\n\n","blocks":[],"excerpt":"One woman with Huntington's disease was left in limbo at Kaiser’s emergency department in Richmond for more than 4 months as she waited for space in a nursing home. ","status":"publish","parent":0,"modified":1710956564,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":41,"wordCount":2084},"headData":{"title":"Systemic Neglect: How Staffing Shortages In Nursing Homes Leave Patients Trapped in Hospitals | KQED","description":"One woman with Huntington's disease was left in limbo at Kaiser’s emergency department in Richmond for more than 4 months as she waited for space in a nursing home. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Systemic Neglect: How Staffing Shortages In Nursing Homes Leave Patients Trapped in Hospitals","datePublished":"2024-03-20T14:30:38.000Z","dateModified":"2024-03-20T17:42:44.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-4[…]f-aaef00f5a073/2b50ce24-d6da-4ae1-8623-b131010710cc/audio.mp3","sticky":false,"WpOldSlug":"california-patients-stranded-in-hospitals-due-to-lack-of-specialized-care-facilities","excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1991871/systemic-neglect-how-staffing-shortages-in-nursing-homes-leave-patients-trapped-in-hospitals","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>On a warm September morning in 2020, David Alter was cleaning up his kitchen in Berkeley. He saw his wife, Lisa, move towards him out of the corner of his eye. He turned to dry his hands on a towel, and then he heard a loud noise.\u003c/p>\n\u003cp>“I’ll never forget that sound,” he said. “It was like the sound of a baseball getting hit. She did nothing to brace her fall. Her head smacked directly on the linoleum floor.”\u003c/p>\n\u003cp>His wife lay still as blood pooled around her body, and Alter sprinted to the bathroom to scavenge for bandages. He wrapped Lisa’s head in gauze and then carried her to the car before speeding to the emergency department at Kaiser Permanente’s Richmond Medical Center, where he said a doctor diagnosed Lisa with a brain bleed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘We definitely know that across California more patients are spending longer times in the hospital.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Kristof Stremikis, director of market analysis and insight, California Health Care Foundation","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Lisa has Huntington’s disease, a genetic disorder that causes nerve cells to break down over time, ravaging the brain and body. The condition is marked by involuntary jerking and writhing movements. It impairs one’s gait, posture and balance. Eventually, Lisa could not walk, talk or think.\u003c/p>\n\u003cp>Alter had failed for an entire year to find a nursing home for his wife, as she was no longer safe at home.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It got to the point that we were going to the ER weekly,” Alter said. “If the fall was late at night, we wouldn’t go right away because we were too exhausted. I would patch her up. I would use suture strips or even sometimes Krazy Glue to close cuts.”\u003c/p>\n\u003cfigure id=\"attachment_1991935\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1991935 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\" alt=\"A man wearing glasses and a dark shirt sits next to a woman lying down in a bed.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter sits next to his wife, Lisa Alter, in Walnut Creek on Feb. 9, 2024. \u003ccite>(Kathryn Styer Martínez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He had called hundreds of skilled nursing facilities across California. He penned personal letters to facility directors illustrated with color photos of their family, describing his wife as “a vibrant woman, wife, elementary school teacher and mother.”\u003c/p>\n\u003cp>He received denial after denial. There was not a single facility that would accept a complex patient who would likely need many years of specialized, very expensive care. Lisa received her Huntington’s disease diagnosis when she was 45 years old. From the onset of symptoms, people with the condition have a life expectancy of 10 to 25 years. Lisa’s needs will likely increase over time.\u003c/p>\n\u003cp>Alter turned to social workers with the Huntington’s Disease Society for help. They advised him to leave his wife in the hospital the next time she landed in the emergency department. “That’s the last resort if the caregiver isn’t safe to take their loved one home,” said Jessica Marsolek, the society’s associate director of community services.\u003c/p>\n\u003cfigure id=\"attachment_1991923\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991923\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\" alt=\"A hallway of a medical center with people walking through.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals are much more equipped to connect and successfully transfer patients to nursing homes. “I don’t know anybody that’s gotten into a nursing home any other way,” said Maura Gibney, executive director for California Advocates for Nursing Home Reform. She regularly advises families to leave their loved ones in the hospital. “That’s the only way.”\u003c/p>\n\u003cp>Four days after Lisa’s fall, she was ready for discharge from Kaiser’s emergency department in Richmond, but Alter made the decision not to pick her up. She wouldn’t leave the hospital for several months.\u003c/p>\n\u003ch2>Part of a growing trend\u003c/h2>\n\u003cp>Patients spend more and more time in the hospital, even people who — like Lisa Alter — are medically stable and ready for a lower level of care at a facility like a nursing home or a psychiatric treatment center. Increasingly, they languish for weeks, months and even years, which delays their recovery, and that, in turn, delays care for patients who need urgent care.\u003c/p>\n\u003cp>“We can’t accept some patients trying to transfer in from smaller hospitals,” said Dr. Valerie Norton, emergency medicine physician at Scripps Mercy Hospital in San Diego. “Because we don’t have room for them. Or there might be somebody down in the emergency department that’s waiting to be admitted into the hospital. And we have to wait until somebody else gets discharged before we can move them upstairs. If you’re lying in a bed in the emergency department, that’s just a hard gurney with a broken hip, and you’re waiting 16 hours for a bed to open up somewhere, that’s pretty tough.”\u003c/p>\n\u003cfigure id=\"attachment_1991924\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991924\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\" alt='The side of a building that says \"Kaiser Permanente.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2022, the average length of stay inside hospitals across the country \u003ca href=\"https://www.aha.org/issue-brief/2022-12-05-patients-and-providers-faced-increasing-delays-timely-discharges\">increased by 19.2%\u003c/a> compared to the year before, according to an issue brief prepared by the American Hospital Association. In California, 4,500 patients are stranded inside hospitals every day, according to a \u003ca href=\"https://calhospital.org/wp-content/uploads/2024/01/Impact-of-Inadequate-Networks-CHA-Analysis-FINAL.pdf\">report from the California Hospital Association, \u003c/a>which attributes the problem of discharge delays to insurance companies openly disregarding “the clinical guidance of doctors and nurses” and “delaying or denying the care” that patients need.\u003c/p>\n\u003cp>“We definitely know that across California, more patients are spending longer times in the hospital,” said Kristof Stremikis, who directs the California Health Care Foundation’s market analysis and insight team.\u003c/p>\n\u003cp>“It’s both very complicated and incredibly simple,” Stremikis said. “It’s rising demand with problems in the supply. There’s more patients that need to be discharged. They tend to be sicker. They tend to have more complex conditions. And then on the supply side, there’s just fewer and fewer places to send them.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"science_1991739,news_11976372,news_11968579","label":"Related Stories "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>As the country’s demographics trend older, more and more patients require care at nursing homes, but those facilities are plagued by dire staffing shortages, according to the \u003ca href=\"https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Historic-Staffing-Shortages-Continue-To-Force-Nursing-Homes-To-Limit-New-Admissions,-Creating-Bottlenecks-at-Hospitals-and-.aspx\">American Health Care Association\u003c/a>. A lack of workers downstream means patients like Lisa Alter get stuck upstream inside the hospital’s emergency department.\u003c/p>\n\u003cp>“We don’t have anywhere safe to send them,” Norton said. “They would qualify to be at a lower level of care like a skilled nursing facility or an assisted living facility. But because of their multiple medical problems or their psychiatric condition, there’s not a place that’s willing to take them.”\u003c/p>\n\u003cp>The number of days patients are stuck at Scripps has tripled in recent years, she said, and costs the health care system $56 million a year.\u003c/p>\n\u003cp>“It’s just insane how long these patients stay in the hospital,” Norton said. “And we’re not getting paid for that. We’re just eating that cost. And they should be in a nursing home somewhere.”\u003c/p>\n\u003cp>The problem was exacerbated by the pandemic, which accelerated feelings of anguish and other persistent mental health issues in health care workers.\u003c/p>\n\u003cp>Nearly half of health care workers across the U.S. reported often feeling burned out in 2022, according to a \u003ca href=\"https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html\">federal survey from the Centers for Disease Control\u003c/a>. About the same amount said they intended to look for a new job.\u003c/p>\n\u003cp>“We’ve had a long, long, long-term problem,” said Craig Cornett, CEO of the California Association of Health Facilities. “Every other part of the health care sector has recovered its staff to its pre-COVID days. We are the only part of the health care continuum that is still below where we were before COVID.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘You shouldn’t have to leave someone in the hospital and force them to take care of it.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"David Alter, software engineer","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>California is spending $26 million to \u003ca href=\"https://yourcnastory.org/\">recruit\u003c/a> more health care workers to help fill this gap, with the hope of attracting 5,500 certified nursing assistants by 2027. State lawmakers are considering \u003ca href=\"https://legiscan.com/CA/text/SB895/id/2868455\">SB 895\u003c/a>, a new bill that would allow select community college districts to offer nursing degrees, lowering the bar for entry and making it easier for workers to enter the health care industry.\u003c/p>\n\u003cp>But, Cornett said, the workforce challenge is huge, and it is not going away.\u003c/p>\n\u003ch2>The breaking point\u003c/h2>\n\u003cp>Alter always thought he’d grow old alongside his wife. But he could no longer parent his two children, hold a full-time job as a software engineer, and care for Lisa around the clock.\u003c/p>\n\u003cfigure id=\"attachment_1991920\" class=\"wp-caption aligncenter\" style=\"max-width: 1330px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991920\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\" alt=\"A man, woman, and two children wearing tie die t shirts stands outside a home.\" width=\"1330\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg 1330w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-800x1203.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1020x1534.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-160x241.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-768x1155.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1021x1536.jpg 1021w\" sizes=\"(max-width: 1330px) 100vw, 1330px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A family photo of Lisa (left) and David Alter and their children Zachary and Maya in front of their home in Berkeley in 2010, the year before Lisa was diagnosed with Huntington’s disease. \u003ccite>(Courtesy of David Alter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When he learned that his wife was ready to be discharged from the emergency department at Kaiser Richmond, he steadied himself.\u003c/p>\n\u003cp>“I remember talking to them, and I said: ‘I’m not gonna pick her up. I’m not going to take her home.’”\u003c/p>\n\u003cp>Alter said the hospital’s discharge team struggled to find a nursing home for Lisa, too. His wife Lisa would spend over four months at Kaiser, a time period that Alter described as “excruciating” for him. He was so worried that the hospital would force him to take his wife home that he held off from visiting her in the hospital initially.\u003c/p>\n\u003cp>“It’s incredibly emotional to walk away,” Alter said. “And Kaiser’s calling you. And they’re like, ‘Why aren’t you picking her up?’ It’s really, really stressful. And it gets worse every day she’s there.”\u003c/p>\n\u003cp>Kaiser Permanente declined an interview for this story. In an emailed statement, the organization said it strives to find the right care for patients as quickly as possible. “While the vast majority of placements occur in a timely fashion, there are some circumstances, including the need for highly specialized care and patient or family preferences, that can present challenges,” the statement said.\u003c/p>\n\u003cp>\u003cb>Patient discrimination\u003c/b>\u003c/p>\n\u003cp>On top of staffing issues, facilities have a financial incentive to choose patients who can pay the highest price. “It’s unfortunate, but it is true,” Stremikis said. “Medi-Cal rates are way lower than private payers. It’s just another example of the inequalities within our system.”\u003c/p>\n\u003cp>Medi-Cal is the state’s insurance program, which covers Alter’s wife. It’s supposed to pay for her to receive specialized care at a round-the-clock facility, but that has not been his experience. “There’s nowhere I can place her,” Alter said.\u003c/p>\n\u003cfigure id=\"attachment_1991922\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991922\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\" alt=\"A person holds an image of a man, woman and young child.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter holds a photo of himself, his wife Lisa, and their son Zachary at his home in Berkeley on March 18, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Eventually, after more than four months, Kaiser Permanente did find housing for Lisa in Walnut Creek. The home provides food and supervision but not specialized nurses or regular doctor visits. Alter said she’s not at the right facility, but he doesn’t know what to do. He hired consultants and lawyers and wrote his legislators, all to no avail.\u003c/p>\n\u003cp>Three years after Alter left his wife in the hospital as a hail mary play to get her the care she needs, that’s still not happening. “You’re just defeated,” he said.\u003c/p>\n\u003cp>Meanwhile, his wife declines. “She’s 70 or 80 pounds,” Alter said. “She’s so tiny. She’s skin and bones.”\u003c/p>\n\u003cp>He also worries she could injure herself again, land back in the hospital, and then get stuck in the cycle all over again.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“You shouldn’t have to leave someone in the hospital and force them to take care of it,” Alter said. “That’s not the right solution. As a society, we’re not set up in a way to care for people properly.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1991871/systemic-neglect-how-staffing-shortages-in-nursing-homes-leave-patients-trapped-in-hospitals","authors":["11229"],"categories":["science_39","science_40","science_4450"],"tags":["science_4414","science_1648","science_5259","science_2918"],"featImg":"science_1991934","label":"science"},"science_1991739":{"type":"posts","id":"science_1991739","meta":{"index":"posts_1591205157","site":"science","id":"1991739","score":null,"sort":[1709812832000]},"guestAuthors":[],"slug":"bay-area-medical-psychiatry-pushes-for-hospital-safety-after-violent-attack","title":"Bay Area Psychiatry Resident Pushes for Hospital Safety After Violent Attack","publishDate":1709812832,"format":"standard","headTitle":"Bay Area Psychiatry Resident Pushes for Hospital Safety After Violent Attack | KQED","labelTerm":{"site":"science"},"content":"\u003cp>When Dani Golomb started her shift on Sept. 5, 2020, she had no idea that she’d be beaten, dragged and knocked unconscious.\u003c/p>\n\u003cp>Like usual, the psychiatry resident reported to an inpatient unit at California Pacific Medical Center at 8 a.m. The hospital was extending one patient’s legal hold, and it fell on Golomb to deliver the news.\u003c/p>\n\u003cp>“Most of the patients we’re seeing are San Francisco’s sickest,” Golomb said, referring to what health care workers call “5150s,” a California legal code that allows people experiencing a mental health crisis to be involuntarily committed for 72 hours if they are a danger to others or themselves.\u003c/p>\n\u003cp>The patient had been violent before and had a temper.\u003c/p>\n\u003cp>“‘I know this isn’t what you wanted to hear, and I know you want to go home. I want to inform you that we are keeping you longer,’” Golomb, who was 33 at the time, recalled saying to the patient. “‘You will have the opportunity to meet with a judge on Monday.’”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The patient called her a thief and a liar, Golomb told KQED in a recent interview.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Chris Van Gorder, CEO, Scripps Health\"]‘Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far.’[/pullquote]Golomb said she placed paperwork and the phone number for a patient advocacy line on the foot of the bed before slowly walking out of the room, closing the door behind her. She was seeing other patients when she heard someone yell “thief” and “liar.”\u003c/p>\n\u003cp>Suddenly, from behind, came a forceful shove and Golomb was on the ground being “punched in the head, neck and shoulders,” she said. The patient grabbed her metal clipboard, “smashing it repeatedly on my head, dragging me by my hair.”\u003c/p>\n\u003cp>Golomb suffered a concussion and a traumatic brain injury, but she wouldn’t find out about that until later.\u003c/p>\n\u003cp>“I came to, and there was one of our wonderful nurses kneeling before me,” she said. “I don’t know if he broke up what was happening or if another patient pulled [them off]. But I immediately ran off to go upstairs to collect myself and just cry.”\u003c/p>\n\u003cp>Health care workers suffer the highest rates of injury caused by violence on the job. They are five times as likely than workers overall to experience a violent injury, according to \u003ca href=\"https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm\">federal statistics\u003c/a>. California hospitals tallied roughly \u003ca href=\"https://www.dir.ca.gov/dosh/WPVIH_Annual_Reports.html\">10,000 incidents annually in recent years\u003c/a>.\u003c/p>\n\u003cp>In February, San Mateo County prosecutors charged an unhoused man with attempted murder after he \u003ca href=\"https://www.beckershospitalreview.com/legal-regulatory-issues/sutter-hospital-employee-stabbed-man-charged.html\">allegedly stabbed a health worker nine times with a pocket knife\u003c/a> at Sutter Health’s Mills-Peninsula Medical Center in Burlingame.\u003c/p>\n\u003cp>[aside postID=\"news_11955211,news_11944448\" label=\"Related Stories\"]Nurses in the Santa Clara County health system have authorized a strike over what they describe as violent work conditions. James Mount, who works in the intensive care unit at the St. Louise Regional Hospital in Gilroy, said the vast majority of his colleagues don’t feel safe.\u003c/p>\n\u003cp>“They have witnessed the escalation of violence within hospitals since COVID,” he said. “It’s disheartening. Our challenge is to try and feel secure in our job and take care of our patients. That’s why we are there. What we are asking for is for someone to protect those frontline workers who are treating the patients.”\u003c/p>\n\u003cfigure id=\"attachment_1991425\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991425\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt='The outside of a building and sign that reads \"Sutter Health.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Sutter Health CPMC Davies Campus in San Francisco on Feb. 8, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Staff inside the Sutter Health inpatient psych unit in San Francisco where Golomb was attacked said they are regularly threatened and assaulted, including being pushed, punched and pulled to the ground, according to interviews with Golomb and more than a half dozen of her resident colleagues and nurses and a KQED review of internal documents.\u003c/p>\n\u003cp>In a survey conducted by the psych residents, three-quarters of those who responded and work on that unit said they are in “an unsafe situation on a daily or weekly basis.” They all report they have experienced violence or harassment from a patient.\u003c/p>\n\u003cp>“Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far,” said Chris Van Gorder, the CEO of Scripps Health in San Diego. He attributes the uptick in violence to a surge in homelessness, a drug crisis and a lack of available care for behavioral health patients.\u003c/p>\n\u003cp>“The hospital is the end of the food chain,” he said. “Nobody else knows what to do with you. They bring you to the hospital emergency room and assume that we’re going to somehow be able to take care of you.”\u003c/p>\n\u003cp>Golomb and her colleagues said the hospital is not doing enough to ensure their safety, as 91% of the residents responded to the survey saying the security presence was “not at all adequate.”\u003c/p>\n\u003cfigure id=\"attachment_1991428\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991428\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\" alt=\"A person's hand holds up a cellphone with an image of people holding signs.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, holds a photo of herself and fellow psych unit staff holding signs asking for more safety measures at their hospital at her home in San Francisco on Feb. 9, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s one of the reasons that Golomb and about 15 of her resident colleagues \u003ca href=\"https://sfstandard.com/2023/01/17/san-francisco-hospital-cpmc-residents-unionize/\">announced in January their plans to unionize\u003c/a> and join the Committee of Interns and Residents, which represents 30,000 resident and fellow physicians and is a local of the powerful Service Employees International Union.\u003c/p>\n\u003cp>As part of their bargaining with Sutter Health, residents demand round-the-clock security presence in the inpatient psych unit. At the time of Golomb’s attack, the unit was located in the Pacific Heights neighborhood across the street from the larger medical campus. Staff would call security, and they “would come running from a full city block away,” Golomb said.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dani Golomb, psychiatry resident, California Pacific Medical Center\"]‘They see their doctor get pummeled, dragged and beat up. What must that feel like as a patient?’[/pullquote]In 2022, Sutter moved the inpatient psych unit to its California Pacific Medical Center Davies campus near the Duboce Triangle in San Francisco and, in a statement to KQED, Sutter said it had spent nearly $40 million to “enhance safety at the facility,” on things like cameras, panic buttons, duress alarms and secured doors. Staff can reach security by phone and a voice-operated device.\u003c/p>\n\u003cp>“Inpatient psychiatric units, in particular, are among the more challenging work environments to fully secure while providing therapeutic and compassionate care to the patients being served by them,” Sutter’s statement said.\u003c/p>\n\u003cp>But Golomb and other hospital staff said security officers at the new facility are often stationed on the lower floors of the hospital, on the other side of the building, which means they would have to run across the building and then ride an elevator up to the third-floor psych unit before badging through two sets of doors.\u003c/p>\n\u003cfigure id=\"attachment_1991429\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991429\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt=\"A man wearing glasses and a jacket over scrubs sits outside on a bench.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, poses for a portrait at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The security issue is particularly salient for us residents because we’re actively asking for [Sutter] to help us, and we’ve not been receiving that help,” said Eric Kalis, a second-year psychiatry resident with California Pacific Medical Center.\u003c/p>\n\u003cp>Sutter’s statement said the hospital had planned to staff the inpatient psych unit with a “dedicated in-unit security officer” from 11 a.m. to 7 p.m. when it moved into the Davies facility in 2022. However, that “proved challenging” and didn’t initially happen.\u003c/p>\n\u003cp>“Since late last year, this position has been consistently staffed,” the statement said.\u003c/p>\n\u003cp>The hospital said it recently extended the hours, beginning at 9 a.m.\u003c/p>\n\u003ch2>Fallout from the assault\u003c/h2>\n\u003cp>For days following her assault, Golomb “felt very surreal and odd and strange.” She had trouble with her vision, hearing, balance and sense of spatial relations. She had trouble multitasking and making decisions, and her mood was volatile.\u003c/p>\n\u003cp>A series of brain scans revealed that an abnormal cluster of blood vessels in her brain had bled either during or after the attack.\u003c/p>\n\u003cp>“And while all that was going on, I was desperately trying to find out what to do,” Golomb said. “What does a resident do when they are assaulted? And I couldn’t get any answers.”\u003c/p>\n\u003cp>After a week, Golomb returned to work and “white-knuckled it” for a while, powering through what she described as “excruciating headaches.” She felt embarrassed, having been “torn apart in front of my colleagues,” and worried about the attack’s impact on her patients.\u003c/p>\n\u003cp>“They see their doctor get pummeled, dragged and beat up,” she said. “What must that feel like as a patient?”\u003c/p>\n\u003ch2>California passes controversial plans to expand involuntary holds\u003c/h2>\n\u003cp>State lawmakers have passed a flurry of laws in recent years targeted at workplace violence in health care, including requiring \u003ca href=\"https://www.nationalnursesunited.org/press/california-senate-approves-rn-sponsored-bill-reduce-workplace-violence-hospitals\">hospitals to have a violence prevention plan\u003c/a> and \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1251-1300/sb_1299_cfa_20140609_152624_asm_comm.html\">report violent incidents to the state\u003c/a>. This year, an association of hospitals — including Sutter and Scripps — are pushing \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB977\">AB 977\u003c/a>, which would increase penalties on people who are violent toward patients or hospital staff.\u003c/p>\n\u003cp>Lawmakers have also thrown billions of dollars at trying to address the mental health issues at the root cause of some of that violence.\u003c/p>\n\u003cfigure id=\"attachment_1991430\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991430\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\" alt='A purple button that says \"Doctors Uniting for Patient Care.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, wears a pin that says, ‘Doctors Uniting for Patient Care’ at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This includes a new California civil CARE Court, which launched last fall in \u003ca href=\"https://www.kqed.org/news/11955211/californias-new-care-courts-prompt-orange-county-to-weigh-best-practices\">eight counties, including San Francisco\u003c/a>. It allows family members and first responders to ask judges to order people with psychotic illness into treatment.\u003c/p>\n\u003cp>Last year, California passed \u003ca href=\"https://www.kqed.org/news/11944448/a-war-of-compassion-debate-over-forced-treatment-of-mental-illness-splits-california-liberals\">SB 43\u003c/a>, a controversial update to its conservatorship law, which for decades has allowed involuntary holds and treatment for people who are a danger to themselves or others or if they are unable to seek food, clothing or shelter as a result of mental illness. With Gov. Gavin Newsom’s approval, it now covers people who cannot care for themselves because of a substance use disorder.\u003c/p>\n\u003cp>“We know, and as we see every single day, we have gaping holes in our safety net and it allows people to fall onto our sidewalks with a horrible splat,” said state Sen. Susan Talamantes Eggman, who authored the update.\u003c/p>\n\u003cp>\u003ca href=\"https://www.disabilityrightsca.org/\">Disability rights groups\u003c/a> pushed back, saying it deprived people of their liberty, privacy and civil rights.\u003c/p>\n\u003cp>Meanwhile, hospital officials said the efforts could create more problems for the facilities and health care workers who treat these individuals.\u003c/p>\n\u003cp>“Where are you going to take those patients? We’re not equipped to be a jail,” Van Gorder said. “They’re all going to go to the hospital, and I think we’ve got this looming crisis on our hands.”\u003c/p>\n\u003cp>Van Gorder pushed the San Diego County Board of Supervisors to delay the implementation of SB 43, which it did for a year. He also helped create a \u003ca href=\"https://www.scripps.org/news_items/7725-hospital-violence-task-force-makes-progress-on-protecting-health-care-workers\">hospital violence task force\u003c/a>, in partnership with San Diego County’s District Attorney, which allows police to make rounds through hospitals and improves training and tracking of violent cases.\u003c/p>\n\u003cp>San Francisco County, the first county in California to implement SB 43, began to submit people for conservatorship at the beginning of the year.\u003c/p>\n\u003ch2>‘I was not myself and spiraling’\u003c/h2>\n\u003cp>To hear Golomb tell it, the attack strained her relationship with her supervisors. She felt blamed for not de-escalating the situation before the attack and described her conversations with hospital officials about it as “volatile.”\u003c/p>\n\u003cfigure id=\"attachment_1991426\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991426\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\" alt=\"A woman wearing a red shirt plays with an animal in a home.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, repairs a quilt she made at her home, with her bunny Hanky nearby, in San Francisco on Feb. 9, 2024. Golomb makes art as a coping mechanism after experiencing workplace violence incidents where patients have attacked staff. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Golomb took a few more weeks off and then returned to work part time, leaving more work for her resident colleagues. “I felt very stressed, guilty, overwhelmed by that,” she said. “I was not myself and spiraling.”\u003c/p>\n\u003cp>Exhausted and suffering from head, neck and back pain, Golomb talked with her doctor and decided to take a second leave, this time for a full year. While she was out, Golomb said the hospital told her it couldn’t guarantee her position when she returned. She thought: “‘Oh my God, is my career jeopardized because of this?’”\u003c/p>\n\u003cp>Golomb tried all kinds of therapy: physical, occupational, speech, vestibular and neuromuscular. She unsuccessfully attempted to match with another residency program. Returning to work at Sutter “became my only option.”\u003c/p>\n\u003cp>“You have to fight tooth and nail to get here,” said Golomb, who is on course to graduate from her residency in June 2025 and plans to pursue a private psychiatry practice. “And that’s what I did, and that’s what I chose to do.”\u003c/p>\n\u003cp>When she returned to work at Sutter, two things helped her turn things around: art and labor organizing. She joined a support group for artists with head injuries and stitched quilts and hand-built ceramics.\u003c/p>\n\u003cp>“I’ve always been an artist way before I was interested in medicine,” she said. “It was just very tethering, making a blanket that’s going to keep you warm or a bowl that can hold your soup.”\u003c/p>\n\u003cp>Back at work, Golomb felt like she had something to prove and had to shake a reputation that she had dramatized the assault to get out of work. She dove into the effort to unionize residents at California Pacific Medical Center.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It was a way to demonstrate my care for others,” she said. “Having shared goals and putting the work in was really what allowed me to survive. Because going back was absolutely terrifying.”\u003c/p>\n\n","blocks":[],"excerpt":"Residents of the California Pacific Medical Center are pushing the Sutter Health network for increased security in an inpatient psych unit after a horrific assault.","status":"publish","parent":0,"modified":1710790309,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":54,"wordCount":2441},"headData":{"title":"Bay Area Psychiatry Resident Pushes for Hospital Safety After Violent Attack | KQED","description":"Residents of the California Pacific Medical Center are pushing the Sutter Health network for increased security in an inpatient psych unit after a horrific assault.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Bay Area Psychiatry Resident Pushes for Hospital Safety After Violent Attack","datePublished":"2024-03-07T12:00:32.000Z","dateModified":"2024-03-18T19:31:49.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-4[…]f-aaef00f5a073/64caf7a4-0ff3-44e0-b72f-b1370105a410/audio.mp3","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1991739/bay-area-medical-psychiatry-pushes-for-hospital-safety-after-violent-attack","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Dani Golomb started her shift on Sept. 5, 2020, she had no idea that she’d be beaten, dragged and knocked unconscious.\u003c/p>\n\u003cp>Like usual, the psychiatry resident reported to an inpatient unit at California Pacific Medical Center at 8 a.m. The hospital was extending one patient’s legal hold, and it fell on Golomb to deliver the news.\u003c/p>\n\u003cp>“Most of the patients we’re seeing are San Francisco’s sickest,” Golomb said, referring to what health care workers call “5150s,” a California legal code that allows people experiencing a mental health crisis to be involuntarily committed for 72 hours if they are a danger to others or themselves.\u003c/p>\n\u003cp>The patient had been violent before and had a temper.\u003c/p>\n\u003cp>“‘I know this isn’t what you wanted to hear, and I know you want to go home. I want to inform you that we are keeping you longer,’” Golomb, who was 33 at the time, recalled saying to the patient. “‘You will have the opportunity to meet with a judge on Monday.’”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The patient called her a thief and a liar, Golomb told KQED in a recent interview.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Chris Van Gorder, CEO, Scripps Health","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Golomb said she placed paperwork and the phone number for a patient advocacy line on the foot of the bed before slowly walking out of the room, closing the door behind her. She was seeing other patients when she heard someone yell “thief” and “liar.”\u003c/p>\n\u003cp>Suddenly, from behind, came a forceful shove and Golomb was on the ground being “punched in the head, neck and shoulders,” she said. The patient grabbed her metal clipboard, “smashing it repeatedly on my head, dragging me by my hair.”\u003c/p>\n\u003cp>Golomb suffered a concussion and a traumatic brain injury, but she wouldn’t find out about that until later.\u003c/p>\n\u003cp>“I came to, and there was one of our wonderful nurses kneeling before me,” she said. “I don’t know if he broke up what was happening or if another patient pulled [them off]. But I immediately ran off to go upstairs to collect myself and just cry.”\u003c/p>\n\u003cp>Health care workers suffer the highest rates of injury caused by violence on the job. They are five times as likely than workers overall to experience a violent injury, according to \u003ca href=\"https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm\">federal statistics\u003c/a>. California hospitals tallied roughly \u003ca href=\"https://www.dir.ca.gov/dosh/WPVIH_Annual_Reports.html\">10,000 incidents annually in recent years\u003c/a>.\u003c/p>\n\u003cp>In February, San Mateo County prosecutors charged an unhoused man with attempted murder after he \u003ca href=\"https://www.beckershospitalreview.com/legal-regulatory-issues/sutter-hospital-employee-stabbed-man-charged.html\">allegedly stabbed a health worker nine times with a pocket knife\u003c/a> at Sutter Health’s Mills-Peninsula Medical Center in Burlingame.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11955211,news_11944448","label":"Related Stories "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Nurses in the Santa Clara County health system have authorized a strike over what they describe as violent work conditions. James Mount, who works in the intensive care unit at the St. Louise Regional Hospital in Gilroy, said the vast majority of his colleagues don’t feel safe.\u003c/p>\n\u003cp>“They have witnessed the escalation of violence within hospitals since COVID,” he said. “It’s disheartening. Our challenge is to try and feel secure in our job and take care of our patients. That’s why we are there. What we are asking for is for someone to protect those frontline workers who are treating the patients.”\u003c/p>\n\u003cfigure id=\"attachment_1991425\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991425\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt='The outside of a building and sign that reads \"Sutter Health.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240208-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Sutter Health CPMC Davies Campus in San Francisco on Feb. 8, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Staff inside the Sutter Health inpatient psych unit in San Francisco where Golomb was attacked said they are regularly threatened and assaulted, including being pushed, punched and pulled to the ground, according to interviews with Golomb and more than a half dozen of her resident colleagues and nurses and a KQED review of internal documents.\u003c/p>\n\u003cp>In a survey conducted by the psych residents, three-quarters of those who responded and work on that unit said they are in “an unsafe situation on a daily or weekly basis.” They all report they have experienced violence or harassment from a patient.\u003c/p>\n\u003cp>“Violence in emergency rooms is not exactly new. But it is worse than it’s ever been, by far,” said Chris Van Gorder, the CEO of Scripps Health in San Diego. He attributes the uptick in violence to a surge in homelessness, a drug crisis and a lack of available care for behavioral health patients.\u003c/p>\n\u003cp>“The hospital is the end of the food chain,” he said. “Nobody else knows what to do with you. They bring you to the hospital emergency room and assume that we’re going to somehow be able to take care of you.”\u003c/p>\n\u003cp>Golomb and her colleagues said the hospital is not doing enough to ensure their safety, as 91% of the residents responded to the survey saying the security presence was “not at all adequate.”\u003c/p>\n\u003cfigure id=\"attachment_1991428\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991428\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg\" alt=\"A person's hand holds up a cellphone with an image of people holding signs.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-28-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, holds a photo of herself and fellow psych unit staff holding signs asking for more safety measures at their hospital at her home in San Francisco on Feb. 9, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s one of the reasons that Golomb and about 15 of her resident colleagues \u003ca href=\"https://sfstandard.com/2023/01/17/san-francisco-hospital-cpmc-residents-unionize/\">announced in January their plans to unionize\u003c/a> and join the Committee of Interns and Residents, which represents 30,000 resident and fellow physicians and is a local of the powerful Service Employees International Union.\u003c/p>\n\u003cp>As part of their bargaining with Sutter Health, residents demand round-the-clock security presence in the inpatient psych unit. At the time of Golomb’s attack, the unit was located in the Pacific Heights neighborhood across the street from the larger medical campus. Staff would call security, and they “would come running from a full city block away,” Golomb said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘They see their doctor get pummeled, dragged and beat up. What must that feel like as a patient?’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Dani Golomb, psychiatry resident, California Pacific Medical Center","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>In 2022, Sutter moved the inpatient psych unit to its California Pacific Medical Center Davies campus near the Duboce Triangle in San Francisco and, in a statement to KQED, Sutter said it had spent nearly $40 million to “enhance safety at the facility,” on things like cameras, panic buttons, duress alarms and secured doors. Staff can reach security by phone and a voice-operated device.\u003c/p>\n\u003cp>“Inpatient psychiatric units, in particular, are among the more challenging work environments to fully secure while providing therapeutic and compassionate care to the patients being served by them,” Sutter’s statement said.\u003c/p>\n\u003cp>But Golomb and other hospital staff said security officers at the new facility are often stationed on the lower floors of the hospital, on the other side of the building, which means they would have to run across the building and then ride an elevator up to the third-floor psych unit before badging through two sets of doors.\u003c/p>\n\u003cfigure id=\"attachment_1991429\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991429\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg\" alt=\"A man wearing glasses and a jacket over scrubs sits outside on a bench.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-05-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, poses for a portrait at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The security issue is particularly salient for us residents because we’re actively asking for [Sutter] to help us, and we’ve not been receiving that help,” said Eric Kalis, a second-year psychiatry resident with California Pacific Medical Center.\u003c/p>\n\u003cp>Sutter’s statement said the hospital had planned to staff the inpatient psych unit with a “dedicated in-unit security officer” from 11 a.m. to 7 p.m. when it moved into the Davies facility in 2022. However, that “proved challenging” and didn’t initially happen.\u003c/p>\n\u003cp>“Since late last year, this position has been consistently staffed,” the statement said.\u003c/p>\n\u003cp>The hospital said it recently extended the hours, beginning at 9 a.m.\u003c/p>\n\u003ch2>Fallout from the assault\u003c/h2>\n\u003cp>For days following her assault, Golomb “felt very surreal and odd and strange.” She had trouble with her vision, hearing, balance and sense of spatial relations. She had trouble multitasking and making decisions, and her mood was volatile.\u003c/p>\n\u003cp>A series of brain scans revealed that an abnormal cluster of blood vessels in her brain had bled either during or after the attack.\u003c/p>\n\u003cp>“And while all that was going on, I was desperately trying to find out what to do,” Golomb said. “What does a resident do when they are assaulted? And I couldn’t get any answers.”\u003c/p>\n\u003cp>After a week, Golomb returned to work and “white-knuckled it” for a while, powering through what she described as “excruciating headaches.” She felt embarrassed, having been “torn apart in front of my colleagues,” and worried about the attack’s impact on her patients.\u003c/p>\n\u003cp>“They see their doctor get pummeled, dragged and beat up,” she said. “What must that feel like as a patient?”\u003c/p>\n\u003ch2>California passes controversial plans to expand involuntary holds\u003c/h2>\n\u003cp>State lawmakers have passed a flurry of laws in recent years targeted at workplace violence in health care, including requiring \u003ca href=\"https://www.nationalnursesunited.org/press/california-senate-approves-rn-sponsored-bill-reduce-workplace-violence-hospitals\">hospitals to have a violence prevention plan\u003c/a> and \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1251-1300/sb_1299_cfa_20140609_152624_asm_comm.html\">report violent incidents to the state\u003c/a>. This year, an association of hospitals — including Sutter and Scripps — are pushing \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB977\">AB 977\u003c/a>, which would increase penalties on people who are violent toward patients or hospital staff.\u003c/p>\n\u003cp>Lawmakers have also thrown billions of dollars at trying to address the mental health issues at the root cause of some of that violence.\u003c/p>\n\u003cfigure id=\"attachment_1991430\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991430\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg\" alt='A purple button that says \"Doctors Uniting for Patient Care.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240213-HOSPITALVIOLENCE-06-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Kalis, a residency doctor at CPMC Sutter Davies Campus, wears a pin that says, ‘Doctors Uniting for Patient Care’ at the hospital in San Francisco on Feb. 13, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This includes a new California civil CARE Court, which launched last fall in \u003ca href=\"https://www.kqed.org/news/11955211/californias-new-care-courts-prompt-orange-county-to-weigh-best-practices\">eight counties, including San Francisco\u003c/a>. It allows family members and first responders to ask judges to order people with psychotic illness into treatment.\u003c/p>\n\u003cp>Last year, California passed \u003ca href=\"https://www.kqed.org/news/11944448/a-war-of-compassion-debate-over-forced-treatment-of-mental-illness-splits-california-liberals\">SB 43\u003c/a>, a controversial update to its conservatorship law, which for decades has allowed involuntary holds and treatment for people who are a danger to themselves or others or if they are unable to seek food, clothing or shelter as a result of mental illness. With Gov. Gavin Newsom’s approval, it now covers people who cannot care for themselves because of a substance use disorder.\u003c/p>\n\u003cp>“We know, and as we see every single day, we have gaping holes in our safety net and it allows people to fall onto our sidewalks with a horrible splat,” said state Sen. Susan Talamantes Eggman, who authored the update.\u003c/p>\n\u003cp>\u003ca href=\"https://www.disabilityrightsca.org/\">Disability rights groups\u003c/a> pushed back, saying it deprived people of their liberty, privacy and civil rights.\u003c/p>\n\u003cp>Meanwhile, hospital officials said the efforts could create more problems for the facilities and health care workers who treat these individuals.\u003c/p>\n\u003cp>“Where are you going to take those patients? We’re not equipped to be a jail,” Van Gorder said. “They’re all going to go to the hospital, and I think we’ve got this looming crisis on our hands.”\u003c/p>\n\u003cp>Van Gorder pushed the San Diego County Board of Supervisors to delay the implementation of SB 43, which it did for a year. He also helped create a \u003ca href=\"https://www.scripps.org/news_items/7725-hospital-violence-task-force-makes-progress-on-protecting-health-care-workers\">hospital violence task force\u003c/a>, in partnership with San Diego County’s District Attorney, which allows police to make rounds through hospitals and improves training and tracking of violent cases.\u003c/p>\n\u003cp>San Francisco County, the first county in California to implement SB 43, began to submit people for conservatorship at the beginning of the year.\u003c/p>\n\u003ch2>‘I was not myself and spiraling’\u003c/h2>\n\u003cp>To hear Golomb tell it, the attack strained her relationship with her supervisors. She felt blamed for not de-escalating the situation before the attack and described her conversations with hospital officials about it as “volatile.”\u003c/p>\n\u003cfigure id=\"attachment_1991426\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991426\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg\" alt=\"A woman wearing a red shirt plays with an animal in a home.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/02/240209-HOSPITALVIOLENCE-15-BL-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dani Golomb, psychiatry resident at CPMC Sutter Davies Campus, repairs a quilt she made at her home, with her bunny Hanky nearby, in San Francisco on Feb. 9, 2024. Golomb makes art as a coping mechanism after experiencing workplace violence incidents where patients have attacked staff. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Golomb took a few more weeks off and then returned to work part time, leaving more work for her resident colleagues. “I felt very stressed, guilty, overwhelmed by that,” she said. “I was not myself and spiraling.”\u003c/p>\n\u003cp>Exhausted and suffering from head, neck and back pain, Golomb talked with her doctor and decided to take a second leave, this time for a full year. While she was out, Golomb said the hospital told her it couldn’t guarantee her position when she returned. She thought: “‘Oh my God, is my career jeopardized because of this?’”\u003c/p>\n\u003cp>Golomb tried all kinds of therapy: physical, occupational, speech, vestibular and neuromuscular. She unsuccessfully attempted to match with another residency program. Returning to work at Sutter “became my only option.”\u003c/p>\n\u003cp>“You have to fight tooth and nail to get here,” said Golomb, who is on course to graduate from her residency in June 2025 and plans to pursue a private psychiatry practice. “And that’s what I did, and that’s what I chose to do.”\u003c/p>\n\u003cp>When she returned to work at Sutter, two things helped her turn things around: art and labor organizing. She joined a support group for artists with head injuries and stitched quilts and hand-built ceramics.\u003c/p>\n\u003cp>“I’ve always been an artist way before I was interested in medicine,” she said. “It was just very tethering, making a blanket that’s going to keep you warm or a bowl that can hold your soup.”\u003c/p>\n\u003cp>Back at work, Golomb felt like she had something to prove and had to shake a reputation that she had dramatized the assault to get out of work. She dove into the effort to unionize residents at California Pacific Medical Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It was a way to demonstrate my care for others,” she said. “Having shared goals and putting the work in was really what allowed me to survive. Because going back was absolutely terrifying.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1991739/bay-area-medical-psychiatry-pushes-for-hospital-safety-after-violent-attack","authors":["11608"],"categories":["science_39","science_40","science_4450"],"tags":["science_4417","science_4414","science_1648","science_249","science_5254"],"featImg":"science_1991427","label":"science"},"science_1981930":{"type":"posts","id":"science_1981930","meta":{"index":"posts_1591205157","site":"science","id":"1981930","score":null,"sort":[1680008405000]},"guestAuthors":[],"slug":"you-have-to-make-this-work-a-day-in-the-life-of-a-rural-emt-during-a-winter-of-atmospheric-rivers","title":"'You Have to Make This Work': A Day in the Life of a Rural EMT During California's Winter of Atmospheric River Storms","publishDate":1680008405,"format":"audio","headTitle":"‘You Have to Make This Work’: A Day in the Life of a Rural EMT During California’s Winter of Atmospheric River Storms | KQED","labelTerm":{},"content":"\u003cp>Hours into the rescue mission, paramedic Jessica Farmer realized her toes were completely numb.\u003c/p>\n\u003cp>It was a late afternoon in early March, and Farmer and her partner found themselves standing in thigh-deep snow above a steep canyon in the Sierra foothills outside of Grass Valley. The pair were still dressed in their standard uniforms, without snow pants or heavy socks, heading slowly toward a cabin deep in the woods, where a man had called hours earlier complaining of severe chest pain.\u003c/p>\n\u003cp>“Any other situation in life, and I think I would have given up at that point,” said Farmer, 36, a seasoned emergency responder and homeschool teacher to her two children. “This is too hard. But this is a 911 call. This is a patient having a heart attack.”\u003c/p>\n\u003cp>Earlier that afternoon, Farmer and her partner, Clarence Ortega, sped out of Sierra Nevada Memorial Hospital in their Mercedes van ambulance, snow pelting the windshield. They eventually reached an unplowed road and were forced to stop several times to help local fire department crews shovel out stranded cars blocking their route and chain saw fallen trees into heavy rounds and toss them off the hill.\u003c/p>\n\u003cfigure id=\"attachment_1982007\" class=\"wp-caption alignright\" style=\"max-width: 480px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1982007 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023.jpg\" alt=\"Five emergency workers pull a man wrapped in a blue tarp on a makeshift sled.\" width=\"480\" height=\"640\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023.jpg 480w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023-160x213.jpg 160w\" sizes=\"(max-width: 480px) 100vw, 480px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jessica Farmer (left) and other emergency workers pull a man having a heart attack down a snow-covered road. \u003ccite>(Courtesy of Jessica Farmer)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At that point, her radio crackled, and dispatch notified her that the patient’s pain was getting worse.\u003c/p>\n\u003cp>“You have to make this work,” Farmer told herself, she said. “This is going to be the hardest day of your life. But you have to make this work.”\u003c/p>\n\u003cp>Farmer and Ortega abandoned the ambulance on the slushy road and started trudging on foot through fresh powder, sinking like a posthole with each step.\u003c/p>\n\u003cp>Eventually, about a mile down the blanketed road, a large cabin with a wraparound deck came into view.\u003c/p>\n\u003cp>Seeing it was “just pure happiness,” Farmer said.\u003c/p>\n\u003cp>They rushed into the house and found a man in his 70s lying in bed grabbing his chest, his skin strikingly pale, sweat glistening on his forehead. Farmer quickly checked his pulse and then explained that the road was “disastrous” and they would have to walk him out.\u003c/p>\n\u003cp>“He then tells us that he has a broken hip,” she said.\u003c/p>\n\u003cp>Farmer took a deep breath, pulled off her wet socks, replacing them with a few dry pairs borrowed from the patient, and wrapped her feet in plastic bags and duct tape in an effort to keep them dry.\u003c/p>\n\u003cp>In the man’s garage, Farmer found a small kid’s sled pinned high in the rafters, along with a large blue tarp, which she and Ortega used to wrap the patient up like a burrito.\u003c/p>\n\u003cp>“We pulled him out like a dogsled team,” she said, describing the hour-long ordeal of dragging him on the sled through the snow back to the ambulance — with the help of the fire department emergency crew. They quickly loaded him inside and headed over slick roads back to the hospital, about five hours since they had left earlier that day.\u003c/p>\n\u003cp>Farmer helped admit the man to the emergency room. She later learned he had been transferred to the ICU and recovered, and was discharged several days later.\u003c/p>\n\u003cp>Such an extraordinary rescue has become par for the course this winter for a growing number of emergency responders in rural communities in California, which has been pummeled by \u003ca href=\"https://www.kqed.org/news/11943031/atmospheric-river-storm-san-francisco-bay-area-impacts-march-9-2023\">12 massive atmospheric river storms\u003c/a> since the beginning of the year, and is bracing for a 13th on Tuesday. The storms have delivered hurricane-force winds and a seemingly endless amount of precipitation, washing out roads, toppling trees, and isolating many residents — leaving those in need of immediate medical care in a particularly tenuous position.[aside label=\"related coverage\" tag=\"atmospheric-rivers\"]Retaining and hiring new paramedics — particularly those, like Farmer, willing to do whatever it takes to rescue people in need — has become a daunting challenge for the health care industry. Most hospitals and other medical emergency facilities in the state are struggling with \u003ca href=\"https://www.kqed.org/news/11940555/hospitals-struggling-to-stay-afloat-across-california\">severe staffing shortages\u003c/a>, amid rampant burnout and pandemic-related delays in many training programs.\u003c/p>\n\u003cp>During that particular storm, Farmer said, a number of her colleagues slept at the hospital because they were concerned they would get stuck at home and not be able to make it back in time for their next shift. One doctor, she added, even snowshoed on shut-down roads to care for a sick child trapped at home.\u003c/p>\n\u003cp>Weeks later, Farmer said she still hasn’t had time to fully process what happened in the woods that day in early March. Less than an hour after returning to the hospital from the rescue, another call came in: A 24-year-old man had accidentally shot himself in the pelvis. Farmer and Ortega hopped back in their ambulance and headed out once again into the storm, attempting yet another rescue.\u003c/p>\n\u003cp>“I am proud that I can wake up every single day and do this job,” she said. “Like, it’s a lot, right? But I’m just not letting it beat me down. Every day I just stay positive for my children.”\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"A paramedic in the Sierra foothills recently found herself trudging a mile on foot through thigh-deep snow to rescue a patient suffering from a heart attack — the kind of mission that's become par for the course for many first responders in California's rural communities this season.\r\n","status":"publish","parent":0,"modified":1704846069,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":889},"headData":{"title":"'You Have to Make This Work': A Day in the Life of a Rural EMT During California's Winter of Atmospheric River Storms | KQED","description":"A paramedic in the Sierra foothills recently found herself trudging a mile on foot through thigh-deep snow to rescue a patient suffering from a heart attack — the kind of mission that's become par for the course for many first responders in California's rural communities this season.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"'You Have to Make This Work': A Day in the Life of a Rural EMT During California's Winter of Atmospheric River Storms","datePublished":"2023-03-28T13:00:05.000Z","dateModified":"2024-01-10T00:21:09.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"source":"Snow","audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-4[…]f-aaef00f5a073/1b3f790b-583c-483c-a766-afcc0108156e/audio.mp3","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/science/1981930/you-have-to-make-this-work-a-day-in-the-life-of-a-rural-emt-during-a-winter-of-atmospheric-rivers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Hours into the rescue mission, paramedic Jessica Farmer realized her toes were completely numb.\u003c/p>\n\u003cp>It was a late afternoon in early March, and Farmer and her partner found themselves standing in thigh-deep snow above a steep canyon in the Sierra foothills outside of Grass Valley. The pair were still dressed in their standard uniforms, without snow pants or heavy socks, heading slowly toward a cabin deep in the woods, where a man had called hours earlier complaining of severe chest pain.\u003c/p>\n\u003cp>“Any other situation in life, and I think I would have given up at that point,” said Farmer, 36, a seasoned emergency responder and homeschool teacher to her two children. “This is too hard. But this is a 911 call. This is a patient having a heart attack.”\u003c/p>\n\u003cp>Earlier that afternoon, Farmer and her partner, Clarence Ortega, sped out of Sierra Nevada Memorial Hospital in their Mercedes van ambulance, snow pelting the windshield. They eventually reached an unplowed road and were forced to stop several times to help local fire department crews shovel out stranded cars blocking their route and chain saw fallen trees into heavy rounds and toss them off the hill.\u003c/p>\n\u003cfigure id=\"attachment_1982007\" class=\"wp-caption alignright\" style=\"max-width: 480px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1982007 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023.jpg\" alt=\"Five emergency workers pull a man wrapped in a blue tarp on a makeshift sled.\" width=\"480\" height=\"640\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023.jpg 480w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/RS63832_002_Winter2_SierraFoothills_03052023-160x213.jpg 160w\" sizes=\"(max-width: 480px) 100vw, 480px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jessica Farmer (left) and other emergency workers pull a man having a heart attack down a snow-covered road. \u003ccite>(Courtesy of Jessica Farmer)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At that point, her radio crackled, and dispatch notified her that the patient’s pain was getting worse.\u003c/p>\n\u003cp>“You have to make this work,” Farmer told herself, she said. “This is going to be the hardest day of your life. But you have to make this work.”\u003c/p>\n\u003cp>Farmer and Ortega abandoned the ambulance on the slushy road and started trudging on foot through fresh powder, sinking like a posthole with each step.\u003c/p>\n\u003cp>Eventually, about a mile down the blanketed road, a large cabin with a wraparound deck came into view.\u003c/p>\n\u003cp>Seeing it was “just pure happiness,” Farmer said.\u003c/p>\n\u003cp>They rushed into the house and found a man in his 70s lying in bed grabbing his chest, his skin strikingly pale, sweat glistening on his forehead. Farmer quickly checked his pulse and then explained that the road was “disastrous” and they would have to walk him out.\u003c/p>\n\u003cp>“He then tells us that he has a broken hip,” she said.\u003c/p>\n\u003cp>Farmer took a deep breath, pulled off her wet socks, replacing them with a few dry pairs borrowed from the patient, and wrapped her feet in plastic bags and duct tape in an effort to keep them dry.\u003c/p>\n\u003cp>In the man’s garage, Farmer found a small kid’s sled pinned high in the rafters, along with a large blue tarp, which she and Ortega used to wrap the patient up like a burrito.\u003c/p>\n\u003cp>“We pulled him out like a dogsled team,” she said, describing the hour-long ordeal of dragging him on the sled through the snow back to the ambulance — with the help of the fire department emergency crew. They quickly loaded him inside and headed over slick roads back to the hospital, about five hours since they had left earlier that day.\u003c/p>\n\u003cp>Farmer helped admit the man to the emergency room. She later learned he had been transferred to the ICU and recovered, and was discharged several days later.\u003c/p>\n\u003cp>Such an extraordinary rescue has become par for the course this winter for a growing number of emergency responders in rural communities in California, which has been pummeled by \u003ca href=\"https://www.kqed.org/news/11943031/atmospheric-river-storm-san-francisco-bay-area-impacts-march-9-2023\">12 massive atmospheric river storms\u003c/a> since the beginning of the year, and is bracing for a 13th on Tuesday. The storms have delivered hurricane-force winds and a seemingly endless amount of precipitation, washing out roads, toppling trees, and isolating many residents — leaving those in need of immediate medical care in a particularly tenuous position.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"related coverage ","tag":"atmospheric-rivers"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Retaining and hiring new paramedics — particularly those, like Farmer, willing to do whatever it takes to rescue people in need — has become a daunting challenge for the health care industry. Most hospitals and other medical emergency facilities in the state are struggling with \u003ca href=\"https://www.kqed.org/news/11940555/hospitals-struggling-to-stay-afloat-across-california\">severe staffing shortages\u003c/a>, amid rampant burnout and pandemic-related delays in many training programs.\u003c/p>\n\u003cp>During that particular storm, Farmer said, a number of her colleagues slept at the hospital because they were concerned they would get stuck at home and not be able to make it back in time for their next shift. One doctor, she added, even snowshoed on shut-down roads to care for a sick child trapped at home.\u003c/p>\n\u003cp>Weeks later, Farmer said she still hasn’t had time to fully process what happened in the woods that day in early March. Less than an hour after returning to the hospital from the rescue, another call came in: A 24-year-old man had accidentally shot himself in the pelvis. Farmer and Ortega hopped back in their ambulance and headed out once again into the storm, attempting yet another rescue.\u003c/p>\n\u003cp>“I am proud that I can wake up every single day and do this job,” she said. “Like, it’s a lot, right? But I’m just not letting it beat me down. Every day I just stay positive for my children.”\u003cbr>\n\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1981930/you-have-to-make-this-work-a-day-in-the-life-of-a-rural-emt-during-a-winter-of-atmospheric-rivers","authors":["11229"],"categories":["science_31","science_40","science_4450","science_98"],"tags":["science_2227","science_1648","science_107"],"featImg":"science_1982006","label":"source_science_1981930"},"science_1928155":{"type":"posts","id":"science_1928155","meta":{"index":"posts_1591205157","site":"science","id":"1928155","score":null,"sort":[1533142843000]},"guestAuthors":[],"slug":"redding-medical-staff-scrambling-to-provide-care","title":"Redding Medical Staff Scrambling to Provide Care","publishDate":1533142843,"format":"standard","headTitle":"Redding Medical Staff Scrambling to Provide Care | KQED","labelTerm":{"site":"science"},"content":"\u003cp>Medical staff near Redding have been scrambling to provide necessary care, some while dealing with the mandatory evacuations of their own homes in the face of the explosive Carr Fire.\u003c/p>\n\u003cp>[emailsignup newslettername='science' align='right']Shasta Community Health Center supports Shasta County at its six locations. But Chief Operations Officer Brandon Thornock says last Friday alone, dozens of employees were unable to come to work. Still, he says, enough employees showed up that the health center can staff two facilities: their medical center in Anderson and a consolidated team of medical professionals operating out of Redding.\u003c/p>\n\u003cp>Some of their physicians and staff have also been sent to the evacuation center established at Shasta College to help fire evacuees with anxiety and smoke inhalation problems.\u003c/p>\n\u003cp>At Dignity Health Mercy Medical Center, one of the most sensitive operations was the transfer of six babies from the hospital’s neonatal intensive care unit, says Mike Mangas, a communications manager for the hospital. It can take three to four hours to prepare the babies to move.\u003c/p>\n\u003cp>Five babies were taken to the UC Davis Medical Center, while a sixth was transferred to Mercy San Juan. All arrived in good health and Mangas says they’re doing well.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In addition, he says Mercy has seen several burn and smoke-related injuries, including 3 firefighters, but none were serious and all have now been discharged.\u003c/p>\n\u003cp>[contextly_sidebar id=”PKSsgbdsFAc8xVRhDXbPq7h565rX5IHh”]The hospital is ready to remove additional patients if needed, but Mangas noted that a shift this week in the direction of the active front of the fire might spare them more damage.\u003c/p>\n\u003cp>“We had people who work at the hospital who lost their homes,” Mangas says, “but many of them still showed up for work.”\u003c/p>\n\u003cp>The Carr Fire has burned more than 112,000 acres, destroyed more than 900 homes, and is still just 30 percent contained. Fire officials are beginning to \u003ca href=\"http://www.fire.ca.gov/current_incidents/incidentdetails/Index/2164\" target=\"_blank\" rel=\"noopener\">allow residents back\u003c/a> in some areas, while continuing \u003ca href=\"http://www.fire.ca.gov/current_incidents/incidentdetails/Index/2164\" target=\"_blank\" rel=\"noopener\">mandatory evacuations\u003c/a> in others.\u003cbr>\n \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"A Redding hospital evacuated the neonatal intensive care unit, but is still caring for firefighters and others with fire-related injuries.","status":"publish","parent":0,"modified":1704927625,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":342},"headData":{"title":"Redding Medical Staff Scrambling to Provide Care | KQED","description":"A Redding hospital evacuated the neonatal intensive care unit, but is still caring for firefighters and others with fire-related injuries.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Redding Medical Staff Scrambling to Provide Care","datePublished":"2018-08-01T17:00:43.000Z","dateModified":"2024-01-10T23:00:25.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"sticky":false,"path":"/science/1928155/redding-medical-staff-scrambling-to-provide-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medical staff near Redding have been scrambling to provide necessary care, some while dealing with the mandatory evacuations of their own homes in the face of the explosive Carr Fire.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"emailsignup","attributes":{"named":{"newslettername":"science","align":"right","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Shasta Community Health Center supports Shasta County at its six locations. But Chief Operations Officer Brandon Thornock says last Friday alone, dozens of employees were unable to come to work. Still, he says, enough employees showed up that the health center can staff two facilities: their medical center in Anderson and a consolidated team of medical professionals operating out of Redding.\u003c/p>\n\u003cp>Some of their physicians and staff have also been sent to the evacuation center established at Shasta College to help fire evacuees with anxiety and smoke inhalation problems.\u003c/p>\n\u003cp>At Dignity Health Mercy Medical Center, one of the most sensitive operations was the transfer of six babies from the hospital’s neonatal intensive care unit, says Mike Mangas, a communications manager for the hospital. It can take three to four hours to prepare the babies to move.\u003c/p>\n\u003cp>Five babies were taken to the UC Davis Medical Center, while a sixth was transferred to Mercy San Juan. All arrived in good health and Mangas says they’re doing well.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In addition, he says Mercy has seen several burn and smoke-related injuries, including 3 firefighters, but none were serious and all have now been discharged.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The hospital is ready to remove additional patients if needed, but Mangas noted that a shift this week in the direction of the active front of the fire might spare them more damage.\u003c/p>\n\u003cp>“We had people who work at the hospital who lost their homes,” Mangas says, “but many of them still showed up for work.”\u003c/p>\n\u003cp>The Carr Fire has burned more than 112,000 acres, destroyed more than 900 homes, and is still just 30 percent contained. Fire officials are beginning to \u003ca href=\"http://www.fire.ca.gov/current_incidents/incidentdetails/Index/2164\" target=\"_blank\" rel=\"noopener\">allow residents back\u003c/a> in some areas, while continuing \u003ca href=\"http://www.fire.ca.gov/current_incidents/incidentdetails/Index/2164\" target=\"_blank\" rel=\"noopener\">mandatory evacuations\u003c/a> in others.\u003cbr>\n \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1928155/redding-medical-staff-scrambling-to-provide-care","authors":["11520"],"categories":["science_31","science_35","science_40","science_3730"],"tags":["science_1648","science_113"],"featImg":"science_1928423","label":"science"},"science_1920887":{"type":"posts","id":"science_1920887","meta":{"index":"posts_1591205157","site":"science","id":"1920887","score":null,"sort":[1520546096000]},"guestAuthors":[],"slug":"prescription-opioids-fail-rigorous-new-test-for-chronic-pain","title":"Prescription Opioids Fail Rigorous New Test for Chronic Pain","publishDate":1520546096,"format":"standard","headTitle":"Prescription Opioids Fail Rigorous New Test for Chronic Pain | KQED","labelTerm":{"site":"science"},"content":"\u003cp>A year long study offers rigorous new evidence against using prescription opioids for chronic pain.\u003c/p>\n\u003cp>In patients with stubborn back aches or hip or knee arthritis, opioids worked no better than over-the-counter drugs or other nonopioids at reducing problems with walking or sleeping. And they provided slightly less pain relief.[contextly_sidebar id=”DeI5FTobRIDirMlmfHpXOBtry0YyTRp9″]\u003c/p>\n\u003cp>Opioids tested included generic Vicodin, oxycodone or fentanyl patches although few patients needed the most potent opioids. Nonopioids included generic Tylenol, ibuprofen and prescription pills for nerve or muscle pain. The study randomly assigned patients to take opioids or other painkillers. That’s the gold standard design for research.\u003c/p>\n\u003cp>If they don’t work better than less risky drugs, there’s no reason to use opioids given “their really nasty side effects — death and addiction,” said lead author Dr. Erin Krebs, a physician and researcher with the Minneapolis Veterans Affairs Health Care System.\u003c/p>\n\u003cp>The results likely will surprise many people “because opioids have this reputation as being really powerful painkillers, and that is not what we found,” Krebs said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The results echo less rigorous studies and bolster guidelines against routine use of opioids for chronic pain.\u003c/p>\n\u003cp>The study was published Tuesday in the \u003ca href=\"https://jamanetwork.com/journals/jama\" target=\"_blank\" rel=\"noopener\">Journal\u003c/a> of the American Medical Association.\u003c/p>\n\u003cp>\u003cstrong>Overdose Deaths\u003c/strong>\u003cbr>\nAbout 42,000 drug overdose deaths in the U.S. in 2016 involved opioids, including prescription painkillers, heroin and fentanyl. Many people get hooked while taking opioids prescribed for injuries or other short-term pain and move on to cheaper, more accessible illicit drugs like heroin.\u003c/p>\n\u003cp>A report released Tuesday by the Centers for Disease Control and Prevention found emergency rooms saw a big jump in overdoses from opioids last year. Opioid overdoses increased 30 percent late last summer, compared to the same three-month period in 2016. The biggest jumps were in the Midwest and in cities, but increases occurred nationwide. The report did not break down overdoses by type of opioid.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-841668 alignleft\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-800x533.jpg\" alt=\"\" width=\"378\" height=\"252\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-960x640.jpg 960w\" sizes=\"(max-width: 378px) 100vw, 378px\">U.S. government guidelines in 2016 said opioids are not the preferred treatment for chronic pain, and they recommend non-drug treatment or nonopioid painkillers instead. Opioids should only be used if other methods don’t work for chronic pain, the guidelines recommend. Prescribing rates have declined slightly in recent years although they are still much higher than two decades ago.\u003c/p>\n\u003cp>Krebs said the strongest evidence from other studies shows that physical therapy, exercise or rehabilitation therapy works best for chronic pain. And she said noted that there are a variety of nonopioid drugs to try if one type doesn’t work.\u003c/p>\n\u003cp>The study involved 234 patients from Minneapolis-area VA clinics who were assigned to use generic versions of opioids or nonopioids for a year. Follow-up ended in 2016.\u003c/p>\n\u003cp>“This is a very important study,” said Dr. David Reuben, geriatrics chief at UCLA’s medical school. “It will likely change the approach to managing long-term back, hip and knee pain.”\u003c/p>\n\u003cp>\u003cstrong>Study Participants\u003c/strong>\u003cbr>\nHe noted one limitation — most study participants were men, but Krebs said the results in women studied were similar.\u003c/p>\n\u003cp>The study’s opioid patients started on relatively low daily doses of morphine, oxycodone or generic Vicodin. They switched to higher doses if needed or to long-acting opioids or fentanyl patches. The nonopioid group started on acetaminophen, ibuprofen or similar anti-inflammatory drugs. They also could switch to higher doses or prescription nonopioid pain pills. Few in either group used the strongest medicines.[contextly_sidebar id=”O6pDbM1ee8t0UncZ6dP9CFNxvb3diHPM”]\u003c/p>\n\u003cp>Patients reported changes in function or pain on questionnaires. Function scores improved in each group by about two points on an 11-point scale, where higher scores meant worse function. Both groups started out with average pain and function scores of about 5.5 points.\u003c/p>\n\u003cp>Pain intensity dropped about two points in the nonopioid group and slightly less in the opioid patients.\u003c/p>\n\u003cp>Other research has shown that over-the-counter medicines can also work as well as opioids at treating short-term pain, including from broken bones, kidney stones or dental work.\u003cbr>\n___\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>AP reporter Mike Stobbe in New York contributed to this report.\u003c/p>\n\n","blocks":[],"excerpt":"In some cases, opioids worked no better than over-the-counter drugs or other nonopioids.","status":"publish","parent":0,"modified":1704928134,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":697},"headData":{"title":"Prescription Opioids Fail Rigorous New Test for Chronic Pain | KQED","description":"In some cases, opioids worked no better than over-the-counter drugs or other nonopioids.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Prescription Opioids Fail Rigorous New Test for Chronic Pain","datePublished":"2018-03-08T21:54:56.000Z","dateModified":"2024-01-10T23:08:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"sticky":false,"nprByline":"Lindsey Tanner\u003cbr />The Associated Press","path":"/science/1920887/prescription-opioids-fail-rigorous-new-test-for-chronic-pain","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A year long study offers rigorous new evidence against using prescription opioids for chronic pain.\u003c/p>\n\u003cp>In patients with stubborn back aches or hip or knee arthritis, opioids worked no better than over-the-counter drugs or other nonopioids at reducing problems with walking or sleeping. And they provided slightly less pain relief.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Opioids tested included generic Vicodin, oxycodone or fentanyl patches although few patients needed the most potent opioids. Nonopioids included generic Tylenol, ibuprofen and prescription pills for nerve or muscle pain. The study randomly assigned patients to take opioids or other painkillers. That’s the gold standard design for research.\u003c/p>\n\u003cp>If they don’t work better than less risky drugs, there’s no reason to use opioids given “their really nasty side effects — death and addiction,” said lead author Dr. Erin Krebs, a physician and researcher with the Minneapolis Veterans Affairs Health Care System.\u003c/p>\n\u003cp>The results likely will surprise many people “because opioids have this reputation as being really powerful painkillers, and that is not what we found,” Krebs said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The results echo less rigorous studies and bolster guidelines against routine use of opioids for chronic pain.\u003c/p>\n\u003cp>The study was published Tuesday in the \u003ca href=\"https://jamanetwork.com/journals/jama\" target=\"_blank\" rel=\"noopener\">Journal\u003c/a> of the American Medical Association.\u003c/p>\n\u003cp>\u003cstrong>Overdose Deaths\u003c/strong>\u003cbr>\nAbout 42,000 drug overdose deaths in the U.S. in 2016 involved opioids, including prescription painkillers, heroin and fentanyl. Many people get hooked while taking opioids prescribed for injuries or other short-term pain and move on to cheaper, more accessible illicit drugs like heroin.\u003c/p>\n\u003cp>A report released Tuesday by the Centers for Disease Control and Prevention found emergency rooms saw a big jump in overdoses from opioids last year. Opioid overdoses increased 30 percent late last summer, compared to the same three-month period in 2016. The biggest jumps were in the Midwest and in cities, but increases occurred nationwide. The report did not break down overdoses by type of opioid.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-841668 alignleft\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-800x533.jpg\" alt=\"\" width=\"378\" height=\"252\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/35/2016/07/iStock_18222596_XXXLARGE-960x640.jpg 960w\" sizes=\"(max-width: 378px) 100vw, 378px\">U.S. government guidelines in 2016 said opioids are not the preferred treatment for chronic pain, and they recommend non-drug treatment or nonopioid painkillers instead. Opioids should only be used if other methods don’t work for chronic pain, the guidelines recommend. Prescribing rates have declined slightly in recent years although they are still much higher than two decades ago.\u003c/p>\n\u003cp>Krebs said the strongest evidence from other studies shows that physical therapy, exercise or rehabilitation therapy works best for chronic pain. And she said noted that there are a variety of nonopioid drugs to try if one type doesn’t work.\u003c/p>\n\u003cp>The study involved 234 patients from Minneapolis-area VA clinics who were assigned to use generic versions of opioids or nonopioids for a year. Follow-up ended in 2016.\u003c/p>\n\u003cp>“This is a very important study,” said Dr. David Reuben, geriatrics chief at UCLA’s medical school. “It will likely change the approach to managing long-term back, hip and knee pain.”\u003c/p>\n\u003cp>\u003cstrong>Study Participants\u003c/strong>\u003cbr>\nHe noted one limitation — most study participants were men, but Krebs said the results in women studied were similar.\u003c/p>\n\u003cp>The study’s opioid patients started on relatively low daily doses of morphine, oxycodone or generic Vicodin. They switched to higher doses if needed or to long-acting opioids or fentanyl patches. The nonopioid group started on acetaminophen, ibuprofen or similar anti-inflammatory drugs. They also could switch to higher doses or prescription nonopioid pain pills. Few in either group used the strongest medicines.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Patients reported changes in function or pain on questionnaires. Function scores improved in each group by about two points on an 11-point scale, where higher scores meant worse function. Both groups started out with average pain and function scores of about 5.5 points.\u003c/p>\n\u003cp>Pain intensity dropped about two points in the nonopioid group and slightly less in the opioid patients.\u003c/p>\n\u003cp>Other research has shown that over-the-counter medicines can also work as well as opioids at treating short-term pain, including from broken bones, kidney stones or dental work.\u003cbr>\n___\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>AP reporter Mike Stobbe in New York contributed to this report.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/1920887/prescription-opioids-fail-rigorous-new-test-for-chronic-pain","authors":["byline_science_1920887"],"categories":["science_39","science_3424","science_40"],"tags":["science_5181","science_1648","science_3072"],"featImg":"science_1920888","label":"science"},"science_22398":{"type":"posts","id":"science_22398","meta":{"index":"posts_1591205157","site":"science","id":"22398","score":null,"sort":[1413205246000]},"guestAuthors":[],"slug":"25-years-after-the-loma-prieta-earthquake-are-we-safer","title":"25 Years After the Loma Prieta Earthquake, Are We Safer?","publishDate":1413205246,"format":"aside","headTitle":"25 Years After the Loma Prieta Earthquake, Are We Safer? | KQED","labelTerm":{"site":"science"},"content":"\u003cdiv class=\"audio-wrap\">\n\u003ch2>Listen:\u003c/h2>\n\u003cp>http://www.kqed.org/.stream/anon/radio/science/2014/10/20141013science.mp3\u003c/p>\n\u003c/div>\n\u003cfigure id=\"attachment_22449\" class=\"wp-caption alignleft\" style=\"max-width: 758px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/cypress-viaduct.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-22449\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/cypress-viaduct.jpeg\" alt=\"Side view of support-column failure and collapsed upper deck, Cypress viaduct. [H.G. Wilshire, U.S. Geological Survey]\" width=\"758\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Cypress viaduct in Oakland collapsed in the Loma Prieta earthquake. (H.G. Wilshire/U.S. Geological Survey) \u003ccite>(H.G. Wilshire/U.S. Geological Survey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Twenty-five years ago this Friday, the Loma Prieta earthquake tore across the Bay Area landscape. The quake ruptured the Bay Bridge and ripped through buildings, killing 63 people and injuring more than 3,000 others. More than 11,000 homes were destroyed … more than 12,000 people left homeless.\u003c/p>\n\u003cp>Thousands of people \u003ca href=\"http://ww2.kqed.org/news/2013/12/19/candlestick-park-loma-prieta-earthquake\">were in Candlestick Park\u003c/a> when the quake hit at 5:04, just before the start of Game 3 in the World Series Battle of the Bay, the San Francisco Giants playing the Oakland A’s. The quake \u003ca href=\"http://www.youtube.com/watch?v=YUKNvoAAa8s\">shut down the broadcast\u003c/a> and halted the Series for a record 10 days. (The A’s won.)\u003c/p>\n\u003cp>Since Loma Prieta, billions of dollars have gone into making the Bay Area safer for the next Big One. So, a quarter-century later, how are we doing?\u003c/p>\n\u003cp>“I think there’s really a lot to celebrate,” says Dr. Mary Lou Zoback, a consulting professor in geophysics at Stanford University and a widely recognized authority on earthquakes and risk management. “In fact I’ve been telling people I think the Bay Area is an epicenter of resilience.”\u003c/p>\n\u003cp>“Resilience” is the word that gets risk managers excited. It’s the idea that the roads, buildings and services people need the most can be made ready for a big shake. \u003c/p>\n\u003caside class=\"pullquote alignleft\">“The damage and destruction can’t be avoided, but it doesn’t have to be life-stopping.”\u003ccite>— Dr. Mary Lou Zoback, Stanford University\u003c/cite>\u003c/aside>\n\u003cp> Then, after an earthquake, emergency centers could be up and running right away and power and water could be back up within days instead of months. People could stay in their homes, return to work and shop at their corner grocery store. \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a resilient city, fewer small businesses would fail after a major earthquake, because the residents they rely on would still be there. Schools could re-open, so fewer families would have to leave in order to send their children back to school. The economy could rebound a bit more readily.\u003c/p>\n\u003cp>“The damage and destruction can’t be avoided,” Zoback says, “but it doesn’t have to be life-stopping.”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Work Done\u003c/strong>\u003c/p>\n\u003cp>While experts agree the Bay Area still has a lot of work to do to be resilient in all these ways, they also say we’re in much better shape today than we were 25 years ago.\u003c/p>\n\u003cp>“Loma Prieta was a game-changer, particularly for Northern California,” says Dr. David Schwartz, a senior geologist with the U.S. Geological Service, and Co-Chairman of the Bay Area Earthquake Alliance. “It led to a tremendous number of changes regarding infrastructure.”\u003c/p>\n\u003cfigure id=\"attachment_22465\" class=\"wp-caption alignleft\" style=\"max-width: 1024px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/RS6229_IMG_5691-1024x768.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/RS6229_IMG_5691-1024x768.jpg\" alt=\"The new eastern span of the Bay Bridge. The eastbound deck (center) is exposed, no longer underneath westbound deck. (Andrew Stelzer/KQED)\" width=\"1024\" height=\"768\" class=\"size-large wp-image-22465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The new eastern span of the Bay Bridge. The eastbound deck (center) is exposed, no longer underneath westbound deck. (Andrew Stelzer/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"http://baybridgeinfo.org/\">Bay Bridge\u003c/a>, at $6.5 billion dollars, is one of the best-known infrastructure retrofits. Another is the \u003ca href=\"http://www.sfwater.org/index.aspx?page=115\">Hetch-Hetchy water system upgrade\u003c/a>. That’s a $4.6 billion project to ensure a reliable water supply for 2.6 million Bay Area residents, in the event of an earthquake — and it’s roughly 80 percent done.\u003c/p>\n\u003cp>Then, there are unheralded miles of other bridges, pipelines and tunnels, retrofitted by public agencies and private companies. Zoback says the leader was the \u003ca href=\"http://www.ebmud.com/sites/default/files/pdfs/Earthquake_Readiness_0.pdf\">East Bay Municipal Utility District\u003c/a>. They provide water for more than a million people in Alameda and Contra Costa counties, and, says Zoback, they got to work immediately after Loma Prieta, identifying where the pipelines were vulnerable.\u003c/p>\n\u003cp>“In many cases they had single lines crossing faults,” Zoback says, “so if that line went down the whole system would go down. So they set about very early on a retrofit program that was not only looking at their actual pipelines and dams, but also the administrative buildings that need to be running.”\u003c/p>\n\u003cp>By prioritizing operations, as well as pipelines, and then financing the work with bonds that are paid back by rate increases, Zoback says East Bay MUD set the model for infrastructure retrofits in the Bay Area, and other utilities followed suit.\u003c/p>\n\u003cp>“Overall, the San Francisco Bay Area has made amazing progress,” Zoback says. “We’ve invested on the order of $50 billion in strengthening buildings and infrastructure, just in that past 25 years.”\u003c/p>\n\u003cp>Part of that money has gone into strengthening city halls, where many cities have their emergency command centers. These buildings have been retrofitted to keep emergency centers functional after an earthquake. That’s more than the law requires.\u003c/p>\n\u003cp>“Because our building code standard is really something we call Life Safety standard,” Zoback says, “which means the building could largely collapse but people would be able to get out.”\u003c/p>\n\u003cp>Water, power, bridges, emergency command centers – here’s where the Bay Area has made the biggest strides in the 25 years since Loma Prieta. The areas that still have a way to go?\u003c/p>\n\u003cfigure id=\"attachment_22447\" class=\"wp-caption alignright\" style=\"max-width: 765px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/building-and-water.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-22447\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/building-and-water.jpeg\" alt=\"Ground view of collapsed building and burned area shown in photo 4, Beach and Divisadero, Marina District. [C.E. Meyer, U.S. Geological Survey]\" width=\"765\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Liquefaction in the soil substrate caused many buildings in San Francisco’s Marina neighborhood to collapse. (C.E. Meyer/USGS)\u003c/figcaption>\u003c/figure>\n\u003cp>“The greatest challenge for the next 25 years are private facilities,” says Danielle Mieler, Resilience Program Coordinator for the \u003ca href=\"http://resilience.abag.ca.gov/\">Association of Bay Area Governments\u003c/a> (ABAG). “Homes, private schools and businesses.”\u003c/p>\n\u003cp>Part of the reason it’s a challenge is that many private property owners are individuals and small businesses who can’t simply float a bond measure or raise rates to get funding for a seismic retrofit.\u003c/p>\n\u003cp>“The city is able to find financing mechanisms that aren’t available to the private sector,” says Patrick Otellini, chief resilience officer for San Francisco.\u003c/p>\n\u003cp>Three categories on the top of risk managers’ minds? Private schools, hospitals and soft-story buildings.\u003c/p>\n\u003cp>\u003cstrong>How Many Private Schools Could Collapse?\u003c/strong>\u003c/p>\n\u003cp>Private schools tend to be located in old or historic buildings, says Mieler, and when a private school takes over a building, there’s no law requiring the building be brought up to code.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I don’t think it’s understood by many people that private school and public school standards are different.”\u003ccite>— Danielle Mieler, Association of Bay Area Governments\u003c/cite>\u003c/aside>\n\u003cp>Furthermore, while public schools are required by state law to meet certain design and seismic standards, private schools are not subject to these laws.\u003c/p>\n\u003cp>“I don’t think it’s understood by many people that private school and public school standards are different,” Mieler says.\u003c/p>\n\u003cp>Whether the Bay Area’s private schools could survive a quake is a mystery, because hardly any have been inspected. San Francisco, where one-third of school children attend private schools, only just passed an ordinance requiring these schools have earthquake inspections. That was after a \u003ca href=\"http://www.sfgsa.org/index.aspx?page=6047\">task force report\u003c/a> found that one-third of private schools in the city would “perform poorly” in an earthquake.\u003c/p>\n\u003cp>\u003cstrong>Hospitals: Upgraded, But Not Necessarily Functional\u003c/strong>\u003c/p>\n\u003cp>Hospitals have been scrambling to raise funds for and complete seismic upgrades since a 2008 law requiring that all acute care buildings be brought up to the Life Safety standard by 2013. Hospitals could choose between retrofitting, rebuilding, or removing the building from service. Governor Brown recently signed legislation giving a few hospitals until 2015 to meet the standard.\u003c/p>\n\u003cp>The Office of Statewide Health Planning and Development says 88 percent of California’s acute care hospital buildings are now no longer in danger of collapsing in an earthquake.\u003c/p>\n\u003cp>But hospitals have until 2030 to show they can provide medical care right after a quake.\u003c/p>\n\u003cp>“Until they all reach this performance standard that they can function within hours, we’re going to have a case where some hospitals are just not going to be able to provide services,” Zoback says. “It may be because they don’t have the power or the water, or it may be portions collapse, and it could just be stairwells, or the elevators don’t work, and some of those things can cripple a hospital, even though the building itself is still standing.”\u003c/p>\n\u003cp>The biggest question for hospitals is where the money will come from to do the next level of retrofits, and right now, there’s not a clear answer to that.\u003c/p>\n\u003cfigure id=\"attachment_22461\" class=\"wp-caption aligncenter\" style=\"max-width: 760px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/soft-story.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-22461\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/soft-story.jpeg\" alt=\"Absence of adequate shear walls on the garage level exacerbated damage to this structure at the corner of Beach and Divisadero Streets, Marina District. [J.K. Nakata, U.S. Geological Survey]\" width=\"760\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This collapse at the garage level shows what can happen to a soft-story building in an earthquake. (J.K. Nakata, USGS) \u003ccite>(J.K. Nakata, U.S. Geological Survey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Soft-Story Buildings: In Process\u003c/strong>\u003c/p>\n\u003cp>Think of an apartment building with three or four stories over a garage, or over a retail space with large windows; that’s a soft-story building. It’s a building where the lower level isn’t reinforced as strongly as the upper levels, and these buildings are prone to “soft-story collapse” in an earthquake.\u003c/p>\n\u003cp>Bay Area cities are tackling the problem in various ways, says ABAG’s Mieler. Berkeley is mandating retrofits Alameda required owners to evaluate their buildings and Oakland is figuring out how to get retrofits done, after a survey that showed about 1,400 soft-story buildings in need of upgrades. There was a study done several years back on South Bay soft-story buildings, Mieler says, but no action yet on upgrades.\u003c/p>\n\u003cp>San Francisco just completed its survey, Otellini says, and found 4,800 soft-story buildings in need of a retrofit. The biggest obstacle is money, since private owners simply have to pay for it. So Otellini says he’s putting together a series of agreements with local banks to finance the retrofits using a range of loan options the banks will create.\u003c/p>\n\u003cp>\u003cstrong>Anticipating the Success Stories\u003c/strong>\u003c/p>\n\u003cp>One of the stories Zoback likes to tell is about an historic building on the Stanford campus. Roble Hall, built in 1918, is a 3-story dorm with ivy draping the windows, and hollow clay tile walls. Zoback says the building was at risk of collapsing in an earthquake. \u003c/p>\n\u003cfigure id=\"attachment_22470\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/140402-85301-e1412989143371.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/140402-85301-e1412989143371.jpg\" alt=\"Stanford University completed the retrofit on Roble Dorm and re-opened the doors to 300 students just weeks before Loma Prieta, likely saving hundreds of lives. (Linda A. Cicero / Stanford News Service)\" width=\"640\" height=\"372\" class=\"size-full wp-image-22470\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Consulting geosciences professor and risk management expert Dr. Mary Lou Zoback says Stanford’s timely retrofit of Roble Hall likely saved hundreds of lives. (Linda A. Cicero / Stanford News Service)\u003c/figcaption>\u003c/figure>\n\u003cp>Stanford completed a retrofit and opened Roble’s doors to 300 students, as classes began in the fall of 1989. A few weeks later, the earthquake shook the campus.\u003c/p>\n\u003cp>“Most of the students would have been in dorm rooms waiting to go to dinner,” Zoback says. “And we could have had several hundred deaths in this one building alone. So, these are the stories we want to be reporting on in the next earthquake is the success of the retrofits that have been done.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And there’s no doubt that one or more serious earthquakes is in the Bay Area’s future. “We’ve reached a point where the stress from the movement of the plates has built up and they have to release it,” says Schwartz of USGS. “The faults have to fail.”\u003c/p>\n\n","blocks":[],"excerpt":"Bay Area taxpayers have spent billions of dollars over the last quarter-century to make our bridges, water pipes and power supplies safer in an earthquake. Experts say that means the Bay Area is much better off now. At the same time, the work is far from over.","status":"publish","parent":0,"modified":1704932772,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":1912},"headData":{"title":"25 Years After the Loma Prieta Earthquake, Are We Safer? | KQED","description":"Bay Area taxpayers have spent billions of dollars over the last quarter-century to make our bridges, water pipes and power supplies safer in an earthquake. Experts say that means the Bay Area is much better off now. At the same time, the work is far from over.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"25 Years After the Loma Prieta Earthquake, Are We Safer?","datePublished":"2014-10-13T13:00:46.000Z","dateModified":"2024-01-11T00:26:12.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"http://www.kqed.org/.stream/anon/radio/science/2014/10/20141013science.mp3","sticky":false,"path":"/science/22398/25-years-after-the-loma-prieta-earthquake-are-we-safer","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cdiv class=\"audio-wrap\">\n\u003ch2>Listen:\u003c/h2>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audioLink","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/science/2014/10/20141013science.mp3"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/div>\n\u003cfigure id=\"attachment_22449\" class=\"wp-caption alignleft\" style=\"max-width: 758px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/cypress-viaduct.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-22449\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/cypress-viaduct.jpeg\" alt=\"Side view of support-column failure and collapsed upper deck, Cypress viaduct. [H.G. Wilshire, U.S. Geological Survey]\" width=\"758\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Cypress viaduct in Oakland collapsed in the Loma Prieta earthquake. (H.G. Wilshire/U.S. Geological Survey) \u003ccite>(H.G. Wilshire/U.S. Geological Survey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Twenty-five years ago this Friday, the Loma Prieta earthquake tore across the Bay Area landscape. The quake ruptured the Bay Bridge and ripped through buildings, killing 63 people and injuring more than 3,000 others. More than 11,000 homes were destroyed … more than 12,000 people left homeless.\u003c/p>\n\u003cp>Thousands of people \u003ca href=\"http://ww2.kqed.org/news/2013/12/19/candlestick-park-loma-prieta-earthquake\">were in Candlestick Park\u003c/a> when the quake hit at 5:04, just before the start of Game 3 in the World Series Battle of the Bay, the San Francisco Giants playing the Oakland A’s. The quake \u003ca href=\"http://www.youtube.com/watch?v=YUKNvoAAa8s\">shut down the broadcast\u003c/a> and halted the Series for a record 10 days. (The A’s won.)\u003c/p>\n\u003cp>Since Loma Prieta, billions of dollars have gone into making the Bay Area safer for the next Big One. So, a quarter-century later, how are we doing?\u003c/p>\n\u003cp>“I think there’s really a lot to celebrate,” says Dr. Mary Lou Zoback, a consulting professor in geophysics at Stanford University and a widely recognized authority on earthquakes and risk management. “In fact I’ve been telling people I think the Bay Area is an epicenter of resilience.”\u003c/p>\n\u003cp>“Resilience” is the word that gets risk managers excited. It’s the idea that the roads, buildings and services people need the most can be made ready for a big shake. \u003c/p>\n\u003caside class=\"pullquote alignleft\">“The damage and destruction can’t be avoided, but it doesn’t have to be life-stopping.”\u003ccite>— Dr. Mary Lou Zoback, Stanford University\u003c/cite>\u003c/aside>\n\u003cp> Then, after an earthquake, emergency centers could be up and running right away and power and water could be back up within days instead of months. People could stay in their homes, return to work and shop at their corner grocery store. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a resilient city, fewer small businesses would fail after a major earthquake, because the residents they rely on would still be there. Schools could re-open, so fewer families would have to leave in order to send their children back to school. The economy could rebound a bit more readily.\u003c/p>\n\u003cp>“The damage and destruction can’t be avoided,” Zoback says, “but it doesn’t have to be life-stopping.”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Work Done\u003c/strong>\u003c/p>\n\u003cp>While experts agree the Bay Area still has a lot of work to do to be resilient in all these ways, they also say we’re in much better shape today than we were 25 years ago.\u003c/p>\n\u003cp>“Loma Prieta was a game-changer, particularly for Northern California,” says Dr. David Schwartz, a senior geologist with the U.S. Geological Service, and Co-Chairman of the Bay Area Earthquake Alliance. “It led to a tremendous number of changes regarding infrastructure.”\u003c/p>\n\u003cfigure id=\"attachment_22465\" class=\"wp-caption alignleft\" style=\"max-width: 1024px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/RS6229_IMG_5691-1024x768.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/RS6229_IMG_5691-1024x768.jpg\" alt=\"The new eastern span of the Bay Bridge. The eastbound deck (center) is exposed, no longer underneath westbound deck. (Andrew Stelzer/KQED)\" width=\"1024\" height=\"768\" class=\"size-large wp-image-22465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The new eastern span of the Bay Bridge. The eastbound deck (center) is exposed, no longer underneath westbound deck. (Andrew Stelzer/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"http://baybridgeinfo.org/\">Bay Bridge\u003c/a>, at $6.5 billion dollars, is one of the best-known infrastructure retrofits. Another is the \u003ca href=\"http://www.sfwater.org/index.aspx?page=115\">Hetch-Hetchy water system upgrade\u003c/a>. That’s a $4.6 billion project to ensure a reliable water supply for 2.6 million Bay Area residents, in the event of an earthquake — and it’s roughly 80 percent done.\u003c/p>\n\u003cp>Then, there are unheralded miles of other bridges, pipelines and tunnels, retrofitted by public agencies and private companies. Zoback says the leader was the \u003ca href=\"http://www.ebmud.com/sites/default/files/pdfs/Earthquake_Readiness_0.pdf\">East Bay Municipal Utility District\u003c/a>. They provide water for more than a million people in Alameda and Contra Costa counties, and, says Zoback, they got to work immediately after Loma Prieta, identifying where the pipelines were vulnerable.\u003c/p>\n\u003cp>“In many cases they had single lines crossing faults,” Zoback says, “so if that line went down the whole system would go down. So they set about very early on a retrofit program that was not only looking at their actual pipelines and dams, but also the administrative buildings that need to be running.”\u003c/p>\n\u003cp>By prioritizing operations, as well as pipelines, and then financing the work with bonds that are paid back by rate increases, Zoback says East Bay MUD set the model for infrastructure retrofits in the Bay Area, and other utilities followed suit.\u003c/p>\n\u003cp>“Overall, the San Francisco Bay Area has made amazing progress,” Zoback says. “We’ve invested on the order of $50 billion in strengthening buildings and infrastructure, just in that past 25 years.”\u003c/p>\n\u003cp>Part of that money has gone into strengthening city halls, where many cities have their emergency command centers. These buildings have been retrofitted to keep emergency centers functional after an earthquake. That’s more than the law requires.\u003c/p>\n\u003cp>“Because our building code standard is really something we call Life Safety standard,” Zoback says, “which means the building could largely collapse but people would be able to get out.”\u003c/p>\n\u003cp>Water, power, bridges, emergency command centers – here’s where the Bay Area has made the biggest strides in the 25 years since Loma Prieta. The areas that still have a way to go?\u003c/p>\n\u003cfigure id=\"attachment_22447\" class=\"wp-caption alignright\" style=\"max-width: 765px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/building-and-water.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-22447\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/building-and-water.jpeg\" alt=\"Ground view of collapsed building and burned area shown in photo 4, Beach and Divisadero, Marina District. [C.E. Meyer, U.S. Geological Survey]\" width=\"765\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Liquefaction in the soil substrate caused many buildings in San Francisco’s Marina neighborhood to collapse. (C.E. Meyer/USGS)\u003c/figcaption>\u003c/figure>\n\u003cp>“The greatest challenge for the next 25 years are private facilities,” says Danielle Mieler, Resilience Program Coordinator for the \u003ca href=\"http://resilience.abag.ca.gov/\">Association of Bay Area Governments\u003c/a> (ABAG). “Homes, private schools and businesses.”\u003c/p>\n\u003cp>Part of the reason it’s a challenge is that many private property owners are individuals and small businesses who can’t simply float a bond measure or raise rates to get funding for a seismic retrofit.\u003c/p>\n\u003cp>“The city is able to find financing mechanisms that aren’t available to the private sector,” says Patrick Otellini, chief resilience officer for San Francisco.\u003c/p>\n\u003cp>Three categories on the top of risk managers’ minds? Private schools, hospitals and soft-story buildings.\u003c/p>\n\u003cp>\u003cstrong>How Many Private Schools Could Collapse?\u003c/strong>\u003c/p>\n\u003cp>Private schools tend to be located in old or historic buildings, says Mieler, and when a private school takes over a building, there’s no law requiring the building be brought up to code.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“I don’t think it’s understood by many people that private school and public school standards are different.”\u003ccite>— Danielle Mieler, Association of Bay Area Governments\u003c/cite>\u003c/aside>\n\u003cp>Furthermore, while public schools are required by state law to meet certain design and seismic standards, private schools are not subject to these laws.\u003c/p>\n\u003cp>“I don’t think it’s understood by many people that private school and public school standards are different,” Mieler says.\u003c/p>\n\u003cp>Whether the Bay Area’s private schools could survive a quake is a mystery, because hardly any have been inspected. San Francisco, where one-third of school children attend private schools, only just passed an ordinance requiring these schools have earthquake inspections. That was after a \u003ca href=\"http://www.sfgsa.org/index.aspx?page=6047\">task force report\u003c/a> found that one-third of private schools in the city would “perform poorly” in an earthquake.\u003c/p>\n\u003cp>\u003cstrong>Hospitals: Upgraded, But Not Necessarily Functional\u003c/strong>\u003c/p>\n\u003cp>Hospitals have been scrambling to raise funds for and complete seismic upgrades since a 2008 law requiring that all acute care buildings be brought up to the Life Safety standard by 2013. Hospitals could choose between retrofitting, rebuilding, or removing the building from service. Governor Brown recently signed legislation giving a few hospitals until 2015 to meet the standard.\u003c/p>\n\u003cp>The Office of Statewide Health Planning and Development says 88 percent of California’s acute care hospital buildings are now no longer in danger of collapsing in an earthquake.\u003c/p>\n\u003cp>But hospitals have until 2030 to show they can provide medical care right after a quake.\u003c/p>\n\u003cp>“Until they all reach this performance standard that they can function within hours, we’re going to have a case where some hospitals are just not going to be able to provide services,” Zoback says. “It may be because they don’t have the power or the water, or it may be portions collapse, and it could just be stairwells, or the elevators don’t work, and some of those things can cripple a hospital, even though the building itself is still standing.”\u003c/p>\n\u003cp>The biggest question for hospitals is where the money will come from to do the next level of retrofits, and right now, there’s not a clear answer to that.\u003c/p>\n\u003cfigure id=\"attachment_22461\" class=\"wp-caption aligncenter\" style=\"max-width: 760px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/soft-story.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-22461\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/soft-story.jpeg\" alt=\"Absence of adequate shear walls on the garage level exacerbated damage to this structure at the corner of Beach and Divisadero Streets, Marina District. [J.K. Nakata, U.S. Geological Survey]\" width=\"760\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This collapse at the garage level shows what can happen to a soft-story building in an earthquake. (J.K. Nakata, USGS) \u003ccite>(J.K. Nakata, U.S. Geological Survey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Soft-Story Buildings: In Process\u003c/strong>\u003c/p>\n\u003cp>Think of an apartment building with three or four stories over a garage, or over a retail space with large windows; that’s a soft-story building. It’s a building where the lower level isn’t reinforced as strongly as the upper levels, and these buildings are prone to “soft-story collapse” in an earthquake.\u003c/p>\n\u003cp>Bay Area cities are tackling the problem in various ways, says ABAG’s Mieler. Berkeley is mandating retrofits Alameda required owners to evaluate their buildings and Oakland is figuring out how to get retrofits done, after a survey that showed about 1,400 soft-story buildings in need of upgrades. There was a study done several years back on South Bay soft-story buildings, Mieler says, but no action yet on upgrades.\u003c/p>\n\u003cp>San Francisco just completed its survey, Otellini says, and found 4,800 soft-story buildings in need of a retrofit. The biggest obstacle is money, since private owners simply have to pay for it. So Otellini says he’s putting together a series of agreements with local banks to finance the retrofits using a range of loan options the banks will create.\u003c/p>\n\u003cp>\u003cstrong>Anticipating the Success Stories\u003c/strong>\u003c/p>\n\u003cp>One of the stories Zoback likes to tell is about an historic building on the Stanford campus. Roble Hall, built in 1918, is a 3-story dorm with ivy draping the windows, and hollow clay tile walls. Zoback says the building was at risk of collapsing in an earthquake. \u003c/p>\n\u003cfigure id=\"attachment_22470\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/140402-85301-e1412989143371.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/10/140402-85301-e1412989143371.jpg\" alt=\"Stanford University completed the retrofit on Roble Dorm and re-opened the doors to 300 students just weeks before Loma Prieta, likely saving hundreds of lives. (Linda A. Cicero / Stanford News Service)\" width=\"640\" height=\"372\" class=\"size-full wp-image-22470\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Consulting geosciences professor and risk management expert Dr. Mary Lou Zoback says Stanford’s timely retrofit of Roble Hall likely saved hundreds of lives. (Linda A. Cicero / Stanford News Service)\u003c/figcaption>\u003c/figure>\n\u003cp>Stanford completed a retrofit and opened Roble’s doors to 300 students, as classes began in the fall of 1989. A few weeks later, the earthquake shook the campus.\u003c/p>\n\u003cp>“Most of the students would have been in dorm rooms waiting to go to dinner,” Zoback says. “And we could have had several hundred deaths in this one building alone. So, these are the stories we want to be reporting on in the next earthquake is the success of the retrofits that have been done.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And there’s no doubt that one or more serious earthquakes is in the Bay Area’s future. “We’ve reached a point where the stress from the movement of the plates has built up and they have to release it,” says Schwartz of USGS. “The faults have to fail.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/22398/25-years-after-the-loma-prieta-earthquake-are-we-safer","authors":["235"],"categories":["science_46","science_89","science_38","science_40","science_43"],"tags":["science_64","science_1648","science_1842"],"featImg":"science_22449","label":"science"},"science_18120":{"type":"posts","id":"science_18120","meta":{"index":"posts_1591205157","site":"science","id":"18120","score":null,"sort":[1402320624000]},"guestAuthors":[],"slug":"saline-shortage-plagues-hospitals","title":"Saline Shortage Plagues Hospitals","publishDate":1402320624,"format":"aside","headTitle":"Saline Shortage Plagues Hospitals | KQED","labelTerm":{"site":"science"},"content":"\u003cdiv class=\"audio-wrap\">\n\u003ch2>Listen:\u003c/h2>\n\u003cp>http://www.kqed.org/.stream/anon/radio/science/2014/06/20140609science.mp3\u003c/p>\n\u003c/div>\n\u003cp>Hospitals across the country are struggling to deal with a shortage of one of their essential medical supplies. Manufacturers are rationing saline — a product used all over the hospital to clean wounds, mix medications or treat dehydration. Now drug companies say they won’t be able to catch up with demand until next year.\u003c/p>\n\u003cp>That leaves San Francisco General Hospital’s materials manager, Reid Kennedy, in a fix. Kennedy is in charge of managing all the gloves, bandages, bedpans and IV solutions for all the medical floors, emergency room and operating room.\u003c/p>\n\u003cfigure id=\"attachment_18169\" class=\"wp-caption alignleft\" style=\"max-width: 374px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/06/RS10685_IMG_6906-hpf.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-18169 \" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/06/RS10685_IMG_6906-hpf.jpg\" alt=\"Reid Kennedy, materials manager at San Francisco General Hospital, stands next to racks of saline solution. (Mark Andrew Boyer/KQED)\" width=\"374\" height=\"249\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Reid Kennedy, materials manager at San Francisco General Hospital, stands next to racks of saline solution. (Mark Andrew Boyer/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>He first got a call last year from his vendor telling him they might not be able to deliver his full order.\u003c/p>\n\u003cp>“We were put on notice that it was going to be tight,” he said, walking through the basement warehouse.\u003c/p>\n\u003cp>Then things got worse in January. The flu season hit much harder than expected, and sick people flooded into hospitals. Saline bags flew off the shelves to treat dehydration. Demand far outstripped supply.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The flu season knocked us out as an industry,” Kennedy said. Though hospital administrators say the shortage hasn’t affected the quality of patient care, Kennedy uses the word “crisis” to describe the shortage.\u003c/p>\n\u003cp>\u003cstrong>It’s Harder to Make Than You Think\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignleft\">‘To make one of these drugs is very complex, even though the drug itself is simple.’\u003ccite>Valerie Jensen, FDA\u003c/cite>\u003c/aside>\n\u003cp>But can salty water really be that hard to come by? Kennedy pays $1.57 per bag. Why can’t drug companies just whip up some more?\u003c/p>\n\u003cp>“To make one of these drugs is very complex, even though the drug itself is simple,” said Valerie Jensen, the director of the drug shortage program at the Food and Drug Administration. “It takes about three weeks to make one batch of normal saline from start to finish.”\u003c/p>\n\u003cp>She says the key challenge is making sure saline products are sterile. If you swallow a pill with a little bit of dirt on it, you’ll be fine. But if a nurse injects saline into your vein that’s even a little bit contaminated, you have a big problem. More than 30 steps and a range of supplies are involved in producing sterile saline. Jensen says FDA inspectors have reason to keep a close eye on any drug injected intravenously. She says they’ve found some nasty things in IV drugs: bacteria, mold, glass particles.\u003c/p>\n\u003cp>“These are issues that absolutely would be a safety risk for patients,” she said.\u003c/p>\n\u003cp>That’s why the FDA sets strict quality standards for the facilities that manufacture saline and other IV drugs. But the agency has to find a delicate balance between safety and supply.\u003c/p>\n\u003cp>Some suppliers suggest keeping up with the FDA’s standards is too onerous and may be playing a part in the shortage.\u003c/p>\n\u003cp>“A lot of variables came together to create this,” said Scott Crandall, director of medical supply contracts at Novation, a group buying organization in Texas that manages contracts for SF General and 2,000 other hospitals across the country. He’s been hearing from manufacturers that increased FDA scrutiny is interfering with drug production.\u003c/p>\n\u003cp>“During the last year, all suppliers had issues in their facilities where they had to correct certain things the FDA found.”\u003c/p>\n\u003cp>Some of those things were serious. Hospira, one manufacturer of saline, issued a recall earlier this year because of leaks in its saline bags. Before that, Baxter found particles in its saline vials and had to recall four lots. Both companies say the recalls had no bearing on the current shortage.\u003c/p>\n\u003cp>\u003cstrong>Flu Season Causes Headaches\u003c/strong>\u003c/p>\n\u003cp>But Crandall says inspections and maintenance require shutting down machines. And when machines aren’t operating, less saline is getting shipped. Last winter, he says maintenance closures “slowed production down, 10 to 20 percent.”\u003c/p>\n\u003cp>So the industry was already behind when the flu season hit.\u003c/p>\n\u003cp>The procurement director for a group of dialysis centers says his supplier, Baxter, told him the main problem was winter weather. Snow and ice storms in the Midwest were delaying trucks headed for California.\u003c/p>\n\u003cp>“As the weather got worse, we began to see more and more back-order issues,” said Colin Carthen of Satellite Healthcare, which runs 70 dialysis centers across California and the U.S. Each patient comes in three or four times a week, and each time goes through one to two liters of saline to clean the blood and prevent clotting. At the worst of the shortage, Carthen realized the health of 6,000 patients depended on the administrative magic tricks he could perform behind the scenes.\u003c/p>\n\u003cp>“I called up a clinical person that I knew, at like 11:30 at night and said, ‘Well, what happens if we run out of saline?’ Because I was really afraid,” he remembers. “And they were just like, ‘Yeah, it gets ugly, fast.’”\u003c/p>\n\u003cp>Carthen says he’s lucky that didn’t happen. Every day, he spent hours on the phone with suppliers and clinical staff, juggling and rerouting supplies so everyone had what they needed.\u003c/p>\n\u003cp>\u003cstrong>Keeping the Supply from Drying Up\u003c/strong>\u003c/p>\n\u003cp>Hospitals have developed new clinical protocols to conserve supplies during the shortage. Nurses at SF General are using smaller saline bags when possible, and transitioning patients who still need hydration to drink water from cups a little sooner than they did in the past. Kennedy has spent hours talking with pharmaceutical and clinical staff about when to use these conservation measures, to make sure there is enough saline to go around.\u003c/p>\n\u003cp>“Pie is a good analogy. Now I’m going to use 16 slices of pie instead of eight slices of pie, and I’ll be able to feed 16 people instead of eight,” he said.\u003c/p>\n\u003cp>The FDA is trying to mitigate the shortage by importing saline from Spain and Norway. But FDA economist Marta Wosinska says that’s not a sustainable solution, since those countries have to supply their own hospitals.\u003c/p>\n\u003cp>“There is no spot market. You can’t buy it like pork bellies or grains or oil. You cannot go on a marketplace and order a certain amount,” she said.\u003c/p>\n\u003cp>U.S. companies also don’t have the capacity to ramp up production. They only have so many machines, and a lot of them are tied up producing other essential drugs. Building new facilities is hardly an option.\u003c/p>\n\u003cp>“We’re talking about hundreds of millions of dollars and it would take three to five years,” Wosinska said.\u003c/p>\n\u003cp>The drug companies don’t face any real penalties if they don’t come through with saline supplies. Contract loopholes release them from paying any fees to their customers if a drug shortage is industry-wide, as this one is.\u003c/p>\n\u003cp>Both Baxter and Hospira, the top two saline producers in the country, say they are doing all they can to maximize production. Each points a finger at the other for contributing to the shortage.\u003c/p>\n\u003cp>“We saw increased demand amid decreased product availability from competitors as the main driver,” a Baxter spokesman wrote in an email.\u003c/p>\n\u003cp>A Hospira spokesman countered: “Hospira began seeing stronger demand for its saline products in late 2013 when another manufacturer began to experience manufacturing issues.”\u003c/p>\n\u003cp>Hospira reported a 20 percent increase in U.S. net sales of its injectable drugs between January and March, citing “increased volume due to competitor supply issues,” in its latest quarterly financial report.\u003c/p>\n\u003cp>\u003cstrong>“The Most Expensive Drug Shortage in History”\u003c/strong>\u003c/p>\n\u003cp>The burden ultimately lands on hospitals, clinics, and dialysis centers to come up with their own workarounds. And all that staff time adds up. Hospitals spend $216 million a year on the labor costs of managing drug shortages, according to Erin Fox, a professor at the University of Utah College of Pharmacy.\u003c/p>\n\u003cp>Now that the industry has indicated the saline shortage will extend through the end of the year, Fox estimates this will be the most expensive drug shortage in history.\u003c/p>\n\u003cp>“IV fluids are used as a supply as well as a treatment, so the shortage impacts the largest number of hospital personnel, as well as patients, compared to any other shortage we have followed,” she said. “IV fluids impact almost every single patient and every single floor. That means you have to educate and get a message out to multiple groups of people rather than a selected group, like for an anesthesia drug or a cancer drug.”\u003c/p>\n\u003cfigure id=\"attachment_18167\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-18167\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/06/saline.jpg\" alt=\"Bags of saline solution in the materials storage room at San Francisco General Hospital. (Mark Andrew Boyer/KQED)\" width=\"640\" height=\"360\">\u003cfigcaption class=\"wp-caption-text\">Bags of saline solution in the materials storage room at San Francisco General Hospital. (Mark Andrew Boyer/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>For now, the actual cost of saline is steady. Hospitals are protected under contracts that keep prices locked through next year. But Novation’s Scott Crandall says that is very likely to change when those contracts expire.\u003c/p>\n\u003cp>“The suppliers have already signaled to the market that they plan on increasing price significantly,” he said. “And when I say that, it could double and triple in some aspects.”\u003c/p>\n\u003cp>Fox says that would be far better than the current situation.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It is far cheaper for hospitals to pay $3 a bag for saline and have a consistent and quality product — not recalled due to contaminants, or leakage,” she said, “than it is to potentially delay elective surgeries or make workarounds that change weekly or daily due to inconsistent supply.”\u003c/p>\n\n","blocks":[],"excerpt":"Hospitals use saline for everything from wound care to surgeries, but it could be next year before drug companies can catch up with demand. Turns out, it's not as simple to manufacture salty water as you might think.\r\n","status":"publish","parent":0,"modified":1704933526,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":1651},"headData":{"title":"Saline Shortage Plagues Hospitals | KQED","description":"Hospitals use saline for everything from wound care to surgeries, but it could be next year before drug companies can catch up with demand. Turns out, it's not as simple to manufacture salty water as you might think.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Saline Shortage Plagues Hospitals","datePublished":"2014-06-09T13:30:24.000Z","dateModified":"2024-01-11T00:38:46.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"audioUrl":"http://www.kqed.org/.stream/anon/radio/science/2014/06/20140609science.mp3","sticky":false,"path":"/science/18120/saline-shortage-plagues-hospitals","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cdiv class=\"audio-wrap\">\n\u003ch2>Listen:\u003c/h2>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audioLink","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/science/2014/06/20140609science.mp3"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/div>\n\u003cp>Hospitals across the country are struggling to deal with a shortage of one of their essential medical supplies. Manufacturers are rationing saline — a product used all over the hospital to clean wounds, mix medications or treat dehydration. Now drug companies say they won’t be able to catch up with demand until next year.\u003c/p>\n\u003cp>That leaves San Francisco General Hospital’s materials manager, Reid Kennedy, in a fix. Kennedy is in charge of managing all the gloves, bandages, bedpans and IV solutions for all the medical floors, emergency room and operating room.\u003c/p>\n\u003cfigure id=\"attachment_18169\" class=\"wp-caption alignleft\" style=\"max-width: 374px\">\u003ca href=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/06/RS10685_IMG_6906-hpf.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-18169 \" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/06/RS10685_IMG_6906-hpf.jpg\" alt=\"Reid Kennedy, materials manager at San Francisco General Hospital, stands next to racks of saline solution. (Mark Andrew Boyer/KQED)\" width=\"374\" height=\"249\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Reid Kennedy, materials manager at San Francisco General Hospital, stands next to racks of saline solution. (Mark Andrew Boyer/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>He first got a call last year from his vendor telling him they might not be able to deliver his full order.\u003c/p>\n\u003cp>“We were put on notice that it was going to be tight,” he said, walking through the basement warehouse.\u003c/p>\n\u003cp>Then things got worse in January. The flu season hit much harder than expected, and sick people flooded into hospitals. Saline bags flew off the shelves to treat dehydration. Demand far outstripped supply.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The flu season knocked us out as an industry,” Kennedy said. Though hospital administrators say the shortage hasn’t affected the quality of patient care, Kennedy uses the word “crisis” to describe the shortage.\u003c/p>\n\u003cp>\u003cstrong>It’s Harder to Make Than You Think\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignleft\">‘To make one of these drugs is very complex, even though the drug itself is simple.’\u003ccite>Valerie Jensen, FDA\u003c/cite>\u003c/aside>\n\u003cp>But can salty water really be that hard to come by? Kennedy pays $1.57 per bag. Why can’t drug companies just whip up some more?\u003c/p>\n\u003cp>“To make one of these drugs is very complex, even though the drug itself is simple,” said Valerie Jensen, the director of the drug shortage program at the Food and Drug Administration. “It takes about three weeks to make one batch of normal saline from start to finish.”\u003c/p>\n\u003cp>She says the key challenge is making sure saline products are sterile. If you swallow a pill with a little bit of dirt on it, you’ll be fine. But if a nurse injects saline into your vein that’s even a little bit contaminated, you have a big problem. More than 30 steps and a range of supplies are involved in producing sterile saline. Jensen says FDA inspectors have reason to keep a close eye on any drug injected intravenously. She says they’ve found some nasty things in IV drugs: bacteria, mold, glass particles.\u003c/p>\n\u003cp>“These are issues that absolutely would be a safety risk for patients,” she said.\u003c/p>\n\u003cp>That’s why the FDA sets strict quality standards for the facilities that manufacture saline and other IV drugs. But the agency has to find a delicate balance between safety and supply.\u003c/p>\n\u003cp>Some suppliers suggest keeping up with the FDA’s standards is too onerous and may be playing a part in the shortage.\u003c/p>\n\u003cp>“A lot of variables came together to create this,” said Scott Crandall, director of medical supply contracts at Novation, a group buying organization in Texas that manages contracts for SF General and 2,000 other hospitals across the country. He’s been hearing from manufacturers that increased FDA scrutiny is interfering with drug production.\u003c/p>\n\u003cp>“During the last year, all suppliers had issues in their facilities where they had to correct certain things the FDA found.”\u003c/p>\n\u003cp>Some of those things were serious. Hospira, one manufacturer of saline, issued a recall earlier this year because of leaks in its saline bags. Before that, Baxter found particles in its saline vials and had to recall four lots. Both companies say the recalls had no bearing on the current shortage.\u003c/p>\n\u003cp>\u003cstrong>Flu Season Causes Headaches\u003c/strong>\u003c/p>\n\u003cp>But Crandall says inspections and maintenance require shutting down machines. And when machines aren’t operating, less saline is getting shipped. Last winter, he says maintenance closures “slowed production down, 10 to 20 percent.”\u003c/p>\n\u003cp>So the industry was already behind when the flu season hit.\u003c/p>\n\u003cp>The procurement director for a group of dialysis centers says his supplier, Baxter, told him the main problem was winter weather. Snow and ice storms in the Midwest were delaying trucks headed for California.\u003c/p>\n\u003cp>“As the weather got worse, we began to see more and more back-order issues,” said Colin Carthen of Satellite Healthcare, which runs 70 dialysis centers across California and the U.S. Each patient comes in three or four times a week, and each time goes through one to two liters of saline to clean the blood and prevent clotting. At the worst of the shortage, Carthen realized the health of 6,000 patients depended on the administrative magic tricks he could perform behind the scenes.\u003c/p>\n\u003cp>“I called up a clinical person that I knew, at like 11:30 at night and said, ‘Well, what happens if we run out of saline?’ Because I was really afraid,” he remembers. “And they were just like, ‘Yeah, it gets ugly, fast.’”\u003c/p>\n\u003cp>Carthen says he’s lucky that didn’t happen. Every day, he spent hours on the phone with suppliers and clinical staff, juggling and rerouting supplies so everyone had what they needed.\u003c/p>\n\u003cp>\u003cstrong>Keeping the Supply from Drying Up\u003c/strong>\u003c/p>\n\u003cp>Hospitals have developed new clinical protocols to conserve supplies during the shortage. Nurses at SF General are using smaller saline bags when possible, and transitioning patients who still need hydration to drink water from cups a little sooner than they did in the past. Kennedy has spent hours talking with pharmaceutical and clinical staff about when to use these conservation measures, to make sure there is enough saline to go around.\u003c/p>\n\u003cp>“Pie is a good analogy. Now I’m going to use 16 slices of pie instead of eight slices of pie, and I’ll be able to feed 16 people instead of eight,” he said.\u003c/p>\n\u003cp>The FDA is trying to mitigate the shortage by importing saline from Spain and Norway. But FDA economist Marta Wosinska says that’s not a sustainable solution, since those countries have to supply their own hospitals.\u003c/p>\n\u003cp>“There is no spot market. You can’t buy it like pork bellies or grains or oil. You cannot go on a marketplace and order a certain amount,” she said.\u003c/p>\n\u003cp>U.S. companies also don’t have the capacity to ramp up production. They only have so many machines, and a lot of them are tied up producing other essential drugs. Building new facilities is hardly an option.\u003c/p>\n\u003cp>“We’re talking about hundreds of millions of dollars and it would take three to five years,” Wosinska said.\u003c/p>\n\u003cp>The drug companies don’t face any real penalties if they don’t come through with saline supplies. Contract loopholes release them from paying any fees to their customers if a drug shortage is industry-wide, as this one is.\u003c/p>\n\u003cp>Both Baxter and Hospira, the top two saline producers in the country, say they are doing all they can to maximize production. Each points a finger at the other for contributing to the shortage.\u003c/p>\n\u003cp>“We saw increased demand amid decreased product availability from competitors as the main driver,” a Baxter spokesman wrote in an email.\u003c/p>\n\u003cp>A Hospira spokesman countered: “Hospira began seeing stronger demand for its saline products in late 2013 when another manufacturer began to experience manufacturing issues.”\u003c/p>\n\u003cp>Hospira reported a 20 percent increase in U.S. net sales of its injectable drugs between January and March, citing “increased volume due to competitor supply issues,” in its latest quarterly financial report.\u003c/p>\n\u003cp>\u003cstrong>“The Most Expensive Drug Shortage in History”\u003c/strong>\u003c/p>\n\u003cp>The burden ultimately lands on hospitals, clinics, and dialysis centers to come up with their own workarounds. And all that staff time adds up. Hospitals spend $216 million a year on the labor costs of managing drug shortages, according to Erin Fox, a professor at the University of Utah College of Pharmacy.\u003c/p>\n\u003cp>Now that the industry has indicated the saline shortage will extend through the end of the year, Fox estimates this will be the most expensive drug shortage in history.\u003c/p>\n\u003cp>“IV fluids are used as a supply as well as a treatment, so the shortage impacts the largest number of hospital personnel, as well as patients, compared to any other shortage we have followed,” she said. “IV fluids impact almost every single patient and every single floor. That means you have to educate and get a message out to multiple groups of people rather than a selected group, like for an anesthesia drug or a cancer drug.”\u003c/p>\n\u003cfigure id=\"attachment_18167\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-18167\" src=\"http://ww2.kqed.org/science/wp-content/uploads/sites/35/2014/06/saline.jpg\" alt=\"Bags of saline solution in the materials storage room at San Francisco General Hospital. (Mark Andrew Boyer/KQED)\" width=\"640\" height=\"360\">\u003cfigcaption class=\"wp-caption-text\">Bags of saline solution in the materials storage room at San Francisco General Hospital. (Mark Andrew Boyer/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>For now, the actual cost of saline is steady. Hospitals are protected under contracts that keep prices locked through next year. But Novation’s Scott Crandall says that is very likely to change when those contracts expire.\u003c/p>\n\u003cp>“The suppliers have already signaled to the market that they plan on increasing price significantly,” he said. “And when I say that, it could double and triple in some aspects.”\u003c/p>\n\u003cp>Fox says that would be far better than the current situation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It is far cheaper for hospitals to pay $3 a bag for saline and have a consistent and quality product — not recalled due to contaminants, or leakage,” she said, “than it is to potentially delay elective surgeries or make workarounds that change weekly or daily due to inconsistent supply.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/science/18120/saline-shortage-plagues-hospitals","authors":["3205"],"categories":["science_46","science_39","science_40","science_43"],"tags":["science_64","science_1648"],"featImg":"science_18167","label":"science"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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You ask the questions. You decide what Bay Curious investigates. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. 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