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And critics say the proposed change could lead to higher levels of exposure for workers at nuclear installations and oil and gas drilling sites, medical workers doing X-rays and CT scans, people living next to Superfund sites and any members of the public who one day might find themselves exposed to a radiation release.\u003c/p>\n\u003cp>The Trump administration already has targeted a range of other regulations on toxins and pollutants, including coal power plant emissions and car exhaust, that it sees as costly and burdensome for businesses. Supporters of the EPA’s proposal argue the government’s current model that there is no safe level of radiation — the so-called linear no-threshold model — forces unnecessary spending for handling exposure in accidents, at nuclear plants, in medical centers and at other sites.\u003c/p>\n\u003cp>At issue is Environmental Protection Agency’s proposed rule on transparency in science.\u003c/p>\n\u003cp>EPA spokesman John Konkus said Tuesday: “The proposed regulation doesn’t talk about radiation or any particular chemicals. And as we indicated in our response, EPA’s policy is to continue to use the linear-no-threshold model for population-level radiation protection purposes which would not, under the proposed regulation that has not been finalized, trigger any change in that policy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But in an April news release announcing the proposed rule the agency quoted Edward Calabrese, a toxicologist at the University of Massachusetts who has said weakening limits on radiation exposure would save billions of dollars and have a positive impact on human health.\u003c/p>\n\u003cp>The proposed rule would require regulators to consider “various threshold models across the exposure range” when it comes to dangerous substances. While it doesn’t specify radiation, the release quotes Calabrese calling the proposal “a major scientific step forward” in assessing the risk of “chemicals and radiation.”[contextly_sidebar id=\"pvuvFDruvbEw4lxZxen1FpcGPNcaahIo\"]\u003c/p>\n\u003cp>Konkus said the release was written during the tenure of former EPA Administrator Scott Pruitt. He could not explain why Calabrese was quoted citing the impact on radiation levels if the agency does not believe there would be any.\u003c/p>\n\u003cp>Calabrese was to be the lead witness at a congressional hearing Wednesday on the EPA proposal.\u003c/p>\n\u003cp>Radiation is everywhere, from potassium in bananas to the microwaves popping our popcorn. Most of it is benign. But what’s of concern is the higher-energy, shorter-wave radiation, like X-rays, that can penetrate and disrupt living cells, sometimes causing cancer.\u003c/p>\n\u003cp>As recently as this March, the EPA’s online guidelines for radiation effects advised: “Current science suggests there is some cancer risk from any exposure to radiation.”\u003c/p>\n\u003cp>“Even exposures below 100 millisieverts” — an amount roughly equivalent to 25 chest X-rays or about 14 CT chest scans — “slightly increase the risk of getting cancer in the future,” the agency’s guidance said.\u003c/p>\n\u003cp>But that online guidance — separate from the rule-change proposal — was edited in July to add a section emphasizing the low individual odds of cancer: “According to radiation safety experts, radiation exposures of ... 100 millisieverts usually result in no harmful health effects, because radiation below these levels is a minor contributor to our overall cancer risk,” the revised policy says.[contextly_sidebar id=\"2HUuLSRwi8YSbfJRvPXEnS9z0Y0PfoLc\"]\u003c/p>\n\u003cp>Calabrese and his supporters argue that smaller exposures of cell-damaging radiation and other carcinogens can serve as stressors that activate the body’s repair mechanisms and can make people healthier. They compare it to physical exercise or sunlight.\u003c/p>\n\u003cp>Mainstream scientific consensus on radiation is based on deceptive science, says Calabrese, who argued in a 2014 essay for “righting the past deceptions and correcting the ongoing errors in environmental regulation.”\u003c/p>\n\u003cp>EPA spokesman Konkus said in an email that the proposed rule change is about “increasing transparency on assumptions” about how the body responds to different doses of dangerous substances and that the agency “acknowledges uncertainty regarding health effects at low doses” and supports more research on that.\u003c/p>\n\u003cp>The radiation regulation is supported by Steven Milloy, a Trump transition team member for the EPA who is known for challenging widely accepted ideas about manmade climate change and the health risks of tobacco. He has been promoting Calabrese’s theory of healthy radiation on his blog.\u003c/p>\n\u003cp>But Jan Beyea, a physicist whose work includes research with the National Academies of Science on the 2011 Fukushima nuclear power plant accident, said the EPA science proposal represents voices “generally dismissed by the great bulk of scientists.”\u003c/p>\n\u003cp>The EPA proposal would lead to “increases in chemical and radiation exposures in the workplace, home and outdoor environment, including the vicinity of Superfund sites,” Beyea wrote.\u003c/p>\n\u003cp>[contextly_sidebar id=\"OkuppunSHp3SM2JTUqdGMPaVNCwP9BBK\"]At the level the EPA website talks about, any one person’s risk of cancer from radiation exposure is perhaps 1 percent, Beyea said.\u003c/p>\n\u003cp>“The individual risk will likely be low, but not the cumulative social risk,” Beyea said.\u003c/p>\n\u003cp>“If they even look at that — no, no, no,” said Terrie Barrie, a resident of Craig, Colorado, and an advocate for her husband and other workers at the now-closed Rocky Flats nuclear-weapons plant, where the U.S. government is compensating certain cancer victims regardless of their history of exposure.\u003c/p>\n\u003cp>“There’s no reason not to protect people as much as possible,” said Barrie.\u003c/p>\n\u003cp>U.S. agencies for decades have followed a policy that there is no threshold of radiation exposure that is risk-free.\u003c/p>\n\u003cp>The National Council on Radiation Protection and Measurements reaffirmed that principle this year after a review of 29 public health studies on cancer rates among people exposed to low-dose radiation, via the U.S. atomic bombing of Japan in World War II, leak-prone Soviet nuclear installations, medical treatments and other sources.\u003c/p>\n\u003cp>Twenty of the 29 studies directly support the principle that even low-dose exposures cause a significant increase in cancer rates, said Roy Shore, chief of research at the Radiation Effects Research Foundation, a joint project of the United States and Japan. Scientists found most of the other studies were inconclusive and decided one was flawed.\u003c/p>\n\u003cp>None supported the theory there is some safe threshold for radiation, said Shore, who chaired the review.\u003c/p>\n\u003cp>If there were a threshold that it’s safe to go below, “those who profess that would have to come up with some data,” Shore said in an interview.\u003c/p>\n\u003cp>“Certainly the evidence did not point that way,” he said.\u003c/p>\n\u003cp>The U.S. Food and Drug Administration, which regulates electronic devices that emit radiation, advises, broadly, that a single CT scan with a dose of 10 millisieverts may increase risks of a fatal cancer by about 1 chance in 2,000.\u003c/p>\n\u003cp>Supporters of the proposal say it’s time to rethink radiation regulation.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Right now we spend an enormous effort trying to minimize low doses” at nuclear power plants, for example, said Brant Ulsh, a physicist with the California-based consulting firm M.H. Chew and Associates. “Instead, let’s spend the resources on minimizing the effect of a really big event.”\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1538554376,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1277},"headData":{"title":"Trump EPA Set to Weaken Limits on Radiation Exposure | KQED","description":"The EPA is pursuing rule changes that experts say would weaken the way radiation exposure is regulated, turning to scientific outliers who argue that a bit of radiation damage is actually good for you — like a little bit of sunlight. The government’s current, decades-old guidance says that any exposure to harmful radiation is","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444810 https://ww2.kqed.org/futureofyou/?p=444810","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/03/trump-epa-set-to-weaken-limits-on-radiation-exposure/","disqusTitle":"Trump EPA Set to Weaken Limits on Radiation Exposure","source":"Health","nprByline":"Ellen Knickmeyer\u003cbr />The Associated Press","path":"/futureofyou/444810/trump-epa-set-to-weaken-limits-on-radiation-exposure","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The EPA is pursuing rule changes that experts say would weaken the way radiation exposure is regulated, turning to scientific outliers who argue that a bit of radiation damage is actually good for you — like a little bit of sunlight.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The government’s current, decades-old guidance says that any exposure to harmful radiation is a cancer risk. And critics say the proposed change could lead to higher levels of exposure for workers at nuclear installations and oil and gas drilling sites, medical workers doing X-rays and CT scans, people living next to Superfund sites and any members of the public who one day might find themselves exposed to a radiation release.\u003c/p>\n\u003cp>The Trump administration already has targeted a range of other regulations on toxins and pollutants, including coal power plant emissions and car exhaust, that it sees as costly and burdensome for businesses. Supporters of the EPA’s proposal argue the government’s current model that there is no safe level of radiation — the so-called linear no-threshold model — forces unnecessary spending for handling exposure in accidents, at nuclear plants, in medical centers and at other sites.\u003c/p>\n\u003cp>At issue is Environmental Protection Agency’s proposed rule on transparency in science.\u003c/p>\n\u003cp>EPA spokesman John Konkus said Tuesday: “The proposed regulation doesn’t talk about radiation or any particular chemicals. And as we indicated in our response, EPA’s policy is to continue to use the linear-no-threshold model for population-level radiation protection purposes which would not, under the proposed regulation that has not been finalized, trigger any change in that policy.”\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>But in an April news release announcing the proposed rule the agency quoted Edward Calabrese, a toxicologist at the University of Massachusetts who has said weakening limits on radiation exposure would save billions of dollars and have a positive impact on human health.\u003c/p>\n\u003cp>The proposed rule would require regulators to consider “various threshold models across the exposure range” when it comes to dangerous substances. While it doesn’t specify radiation, the release quotes Calabrese calling the proposal “a major scientific step forward” in assessing the risk of “chemicals and radiation.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Konkus said the release was written during the tenure of former EPA Administrator Scott Pruitt. He could not explain why Calabrese was quoted citing the impact on radiation levels if the agency does not believe there would be any.\u003c/p>\n\u003cp>Calabrese was to be the lead witness at a congressional hearing Wednesday on the EPA proposal.\u003c/p>\n\u003cp>Radiation is everywhere, from potassium in bananas to the microwaves popping our popcorn. Most of it is benign. But what’s of concern is the higher-energy, shorter-wave radiation, like X-rays, that can penetrate and disrupt living cells, sometimes causing cancer.\u003c/p>\n\u003cp>As recently as this March, the EPA’s online guidelines for radiation effects advised: “Current science suggests there is some cancer risk from any exposure to radiation.”\u003c/p>\n\u003cp>“Even exposures below 100 millisieverts” — an amount roughly equivalent to 25 chest X-rays or about 14 CT chest scans — “slightly increase the risk of getting cancer in the future,” the agency’s guidance said.\u003c/p>\n\u003cp>But that online guidance — separate from the rule-change proposal — was edited in July to add a section emphasizing the low individual odds of cancer: “According to radiation safety experts, radiation exposures of ... 100 millisieverts usually result in no harmful health effects, because radiation below these levels is a minor contributor to our overall cancer risk,” the revised policy says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Calabrese and his supporters argue that smaller exposures of cell-damaging radiation and other carcinogens can serve as stressors that activate the body’s repair mechanisms and can make people healthier. They compare it to physical exercise or sunlight.\u003c/p>\n\u003cp>Mainstream scientific consensus on radiation is based on deceptive science, says Calabrese, who argued in a 2014 essay for “righting the past deceptions and correcting the ongoing errors in environmental regulation.”\u003c/p>\n\u003cp>EPA spokesman Konkus said in an email that the proposed rule change is about “increasing transparency on assumptions” about how the body responds to different doses of dangerous substances and that the agency “acknowledges uncertainty regarding health effects at low doses” and supports more research on that.\u003c/p>\n\u003cp>The radiation regulation is supported by Steven Milloy, a Trump transition team member for the EPA who is known for challenging widely accepted ideas about manmade climate change and the health risks of tobacco. He has been promoting Calabrese’s theory of healthy radiation on his blog.\u003c/p>\n\u003cp>But Jan Beyea, a physicist whose work includes research with the National Academies of Science on the 2011 Fukushima nuclear power plant accident, said the EPA science proposal represents voices “generally dismissed by the great bulk of scientists.”\u003c/p>\n\u003cp>The EPA proposal would lead to “increases in chemical and radiation exposures in the workplace, home and outdoor environment, including the vicinity of Superfund sites,” Beyea wrote.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>At the level the EPA website talks about, any one person’s risk of cancer from radiation exposure is perhaps 1 percent, Beyea said.\u003c/p>\n\u003cp>“The individual risk will likely be low, but not the cumulative social risk,” Beyea said.\u003c/p>\n\u003cp>“If they even look at that — no, no, no,” said Terrie Barrie, a resident of Craig, Colorado, and an advocate for her husband and other workers at the now-closed Rocky Flats nuclear-weapons plant, where the U.S. government is compensating certain cancer victims regardless of their history of exposure.\u003c/p>\n\u003cp>“There’s no reason not to protect people as much as possible,” said Barrie.\u003c/p>\n\u003cp>U.S. agencies for decades have followed a policy that there is no threshold of radiation exposure that is risk-free.\u003c/p>\n\u003cp>The National Council on Radiation Protection and Measurements reaffirmed that principle this year after a review of 29 public health studies on cancer rates among people exposed to low-dose radiation, via the U.S. atomic bombing of Japan in World War II, leak-prone Soviet nuclear installations, medical treatments and other sources.\u003c/p>\n\u003cp>Twenty of the 29 studies directly support the principle that even low-dose exposures cause a significant increase in cancer rates, said Roy Shore, chief of research at the Radiation Effects Research Foundation, a joint project of the United States and Japan. Scientists found most of the other studies were inconclusive and decided one was flawed.\u003c/p>\n\u003cp>None supported the theory there is some safe threshold for radiation, said Shore, who chaired the review.\u003c/p>\n\u003cp>If there were a threshold that it’s safe to go below, “those who profess that would have to come up with some data,” Shore said in an interview.\u003c/p>\n\u003cp>“Certainly the evidence did not point that way,” he said.\u003c/p>\n\u003cp>The U.S. Food and Drug Administration, which regulates electronic devices that emit radiation, advises, broadly, that a single CT scan with a dose of 10 millisieverts may increase risks of a fatal cancer by about 1 chance in 2,000.\u003c/p>\n\u003cp>Supporters of the proposal say it’s time to rethink radiation regulation.\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>“Right now we spend an enormous effort trying to minimize low doses” at nuclear power plants, for example, said Brant Ulsh, a physicist with the California-based consulting firm M.H. Chew and Associates. “Instead, let’s spend the resources on minimizing the effect of a really big event.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444810/trump-epa-set-to-weaken-limits-on-radiation-exposure","authors":["byline_futureofyou_444810"],"categories":["futureofyou_452","futureofyou_1"],"tags":["futureofyou_1176","futureofyou_38","futureofyou_61","futureofyou_1424"],"featImg":"futureofyou_444815","label":"source_futureofyou_444810"},"news_11695653":{"type":"posts","id":"news_11695653","meta":{"index":"posts_1591205157","site":"news","id":"11695653","score":null,"sort":[1538371096000]},"guestAuthors":[],"slug":"brown-rejects-supervised-injection-site-for-san-francisco","title":"Brown Rejects Supervised Injection Site for San Francisco","publishDate":1538371096,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>Gov. Jerry Brown rejected legislation on Sunday that would have allowed San Francisco to open what would've been the nation's first supervised drug injection site under a pilot program.\u003c/p>\n\u003cp>Advocates of \"safe injection\" sites say the locations would save lives by preventing drug overdoses and providing access to counseling. But the U.S. government and other critics say taxpayers should not be helping users shoot up heroin, methamphetamine or other illegal drugs.\u003c/p>\n\u003cp>\"Fundamentally I do not believe that enabling illegal drug use in government sponsored injection centers — with no corresponding requirement that the use undergo treatment — will reduce drug addiction,\" Brown said in his \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2018/09/AB-186-veto-9.30.pdf\" rel=\"noopener\" target=\"_blank\">announcement of the veto\u003c/a>.\u003c/p>\n\u003cp>San Francisco Mayor London Breed has vowed to \u003ca href=\"https://www.kqed.org/news/11690409/s-f-safe-injection-site-supporters-urge-gov-brown-to-sign-bill\" rel=\"noopener\" target=\"_blank\">open a supervised injection site\u003c/a>, saying the status quo is not acceptable in a city known for rampant drug use. It's not uncommon to see people injecting drugs in public, and used needles are a major source of trash.\u003c/p>\n\u003cp>\"Safe injection sites save lives,\" she said Sunday. \"If we are going to prevent overdoses and connect people to services and treatment that they badly need to stop using drugs in the first place, we need safe injection sites.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The country is struggling with an opioid epidemic that has led to rising overdose deaths. The increase has been attributed to the painkiller fentanyl and similar drugs that are powerful but relatively cheap and cut into street drugs without buyers' knowledge.\u003c/p>\n\u003cp>San Francisco has reported about 200 overdose deaths annually in recent years, largely from opioids. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB186\" rel=\"noopener\" target=\"_blank\">AB 186\u003c/a> would have protected staff and participants from state prosecution related to illegal narcotics. But it gave no legal cover from federal laws, including a \"crack house\" statute that makes it a felony to knowingly maintain a place for using a controlled substance.\u003c/p>\n\u003cp>San Francisco has not shied away from confronting the U.S. government and has repeatedly sued the Trump administration, including one lawsuit over sanctuary protections for people in the country illegally. The issue of drug injection sites would likely wind up before a federal judge if San Francisco opens a clinic, legal experts say.\u003c/p>\n\u003cp>Robert Mikos, who teaches federalism and drug law at Vanderbilt Law School, said a quasi-medical facility where the goal is to reduce harm sounds well-intentioned but appears to violate a statute used to go after people who run drug dens.\u003c/p>\n\u003cp>\"It would depend on whether federal prosecutors are willing to prosecute this violation,\" he said. \"Federal prosecutors always have some discretion, and they have some independence from Washington, D.C., and the attorney general, but this is a tricky situation.\"\u003c/p>\n\u003cp>Leo Beletsky, an associate professor of law and health sciences at Northeastern University, said a federal judge might find in San Francisco's favor.\u003c/p>\n\u003cp>\"If you got it before a judge, it's anyone's guess,\" he said. \"You can make a very reasonable argument that a health care facility of this sort is not something that was ever intended to be covered under the crack house statute.\"\u003c/p>\n\u003cp>There are supervised injection sites in Canada and Europe, but none in the United States.\u003c/p>\n\u003cp>Days after California lawmakers sent the legislation to the governor in August, U.S. Deputy Attorney General Rod Rosenstein \u003ca href=\"https://www.nytimes.com/2018/08/27/opinion/opioids-heroin-injection-sites.html\" rel=\"noopener\" target=\"_blank\">wrote in The New York Times\u003c/a> that the federal government would take aggressive action against any supervised injection sites.\u003c/p>\n\u003cp>\"Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,\" he wrote.\u003c/p>\n\u003cp>State Sen. Scott Wiener (D-San Francisco) who co-authored the legislation, says the city has no qualms about taking on the federal government over what he calls a failed war on drugs. He noted that the city has long led the country on health and safety policy as well as on challenging the federal government.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We implemented needle exchange before it was legal. We implemented medical cannabis before it was legal, and we have always been on the forefront of the sanctuary city movement,\" he said.\u003c/p>\n\n","blocks":[],"excerpt":"The first-of-its-kind legislation would have protected staff and participants from state prosecution related to illegal narcotics.","status":"publish","parent":0,"modified":1538371096,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":670},"headData":{"title":"Brown Rejects Supervised Injection Site for San Francisco | KQED","description":"The first-of-its-kind legislation would have protected staff and participants from state prosecution related to illegal narcotics.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11695653 https://ww2.kqed.org/news/?p=11695653","disqusUrl":"https://ww2.kqed.org/news/2018/09/30/brown-rejects-supervised-injection-site-for-san-francisco/","disqusTitle":"Brown Rejects Supervised Injection Site for San Francisco","source":"Associated Press","nprByline":"\u003cstrong>Janie Har\u003c/br>Associated Press\u003c/strong>","path":"/news/11695653/brown-rejects-supervised-injection-site-for-san-francisco","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Jerry Brown rejected legislation on Sunday that would have allowed San Francisco to open what would've been the nation's first supervised drug injection site under a pilot program.\u003c/p>\n\u003cp>Advocates of \"safe injection\" sites say the locations would save lives by preventing drug overdoses and providing access to counseling. But the U.S. government and other critics say taxpayers should not be helping users shoot up heroin, methamphetamine or other illegal drugs.\u003c/p>\n\u003cp>\"Fundamentally I do not believe that enabling illegal drug use in government sponsored injection centers — with no corresponding requirement that the use undergo treatment — will reduce drug addiction,\" Brown said in his \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2018/09/AB-186-veto-9.30.pdf\" rel=\"noopener\" target=\"_blank\">announcement of the veto\u003c/a>.\u003c/p>\n\u003cp>San Francisco Mayor London Breed has vowed to \u003ca href=\"https://www.kqed.org/news/11690409/s-f-safe-injection-site-supporters-urge-gov-brown-to-sign-bill\" rel=\"noopener\" target=\"_blank\">open a supervised injection site\u003c/a>, saying the status quo is not acceptable in a city known for rampant drug use. It's not uncommon to see people injecting drugs in public, and used needles are a major source of trash.\u003c/p>\n\u003cp>\"Safe injection sites save lives,\" she said Sunday. \"If we are going to prevent overdoses and connect people to services and treatment that they badly need to stop using drugs in the first place, we need safe injection sites.\"\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 country is struggling with an opioid epidemic that has led to rising overdose deaths. The increase has been attributed to the painkiller fentanyl and similar drugs that are powerful but relatively cheap and cut into street drugs without buyers' knowledge.\u003c/p>\n\u003cp>San Francisco has reported about 200 overdose deaths annually in recent years, largely from opioids. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB186\" rel=\"noopener\" target=\"_blank\">AB 186\u003c/a> would have protected staff and participants from state prosecution related to illegal narcotics. But it gave no legal cover from federal laws, including a \"crack house\" statute that makes it a felony to knowingly maintain a place for using a controlled substance.\u003c/p>\n\u003cp>San Francisco has not shied away from confronting the U.S. government and has repeatedly sued the Trump administration, including one lawsuit over sanctuary protections for people in the country illegally. The issue of drug injection sites would likely wind up before a federal judge if San Francisco opens a clinic, legal experts say.\u003c/p>\n\u003cp>Robert Mikos, who teaches federalism and drug law at Vanderbilt Law School, said a quasi-medical facility where the goal is to reduce harm sounds well-intentioned but appears to violate a statute used to go after people who run drug dens.\u003c/p>\n\u003cp>\"It would depend on whether federal prosecutors are willing to prosecute this violation,\" he said. \"Federal prosecutors always have some discretion, and they have some independence from Washington, D.C., and the attorney general, but this is a tricky situation.\"\u003c/p>\n\u003cp>Leo Beletsky, an associate professor of law and health sciences at Northeastern University, said a federal judge might find in San Francisco's favor.\u003c/p>\n\u003cp>\"If you got it before a judge, it's anyone's guess,\" he said. \"You can make a very reasonable argument that a health care facility of this sort is not something that was ever intended to be covered under the crack house statute.\"\u003c/p>\n\u003cp>There are supervised injection sites in Canada and Europe, but none in the United States.\u003c/p>\n\u003cp>Days after California lawmakers sent the legislation to the governor in August, U.S. Deputy Attorney General Rod Rosenstein \u003ca href=\"https://www.nytimes.com/2018/08/27/opinion/opioids-heroin-injection-sites.html\" rel=\"noopener\" target=\"_blank\">wrote in The New York Times\u003c/a> that the federal government would take aggressive action against any supervised injection sites.\u003c/p>\n\u003cp>\"Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,\" he wrote.\u003c/p>\n\u003cp>State Sen. Scott Wiener (D-San Francisco) who co-authored the legislation, says the city has no qualms about taking on the federal government over what he calls a failed war on drugs. He noted that the city has long led the country on health and safety policy as well as on challenging the federal government.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We implemented needle exchange before it was legal. We implemented medical cannabis before it was legal, and we have always been on the forefront of the sanctuary city movement,\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11695653/brown-rejects-supervised-injection-site-for-san-francisco","authors":["byline_news_11695653"],"programs":["news_72"],"categories":["news_457","news_6188","news_8","news_13"],"tags":["news_30","news_22774","news_24074","news_24226"],"featImg":"news_11695655","label":"source_news_11695653"},"news_11695471":{"type":"posts","id":"news_11695471","meta":{"index":"posts_1591205157","site":"news","id":"11695471","score":null,"sort":[1538250643000]},"guestAuthors":[],"slug":"with-climate-change-valley-fever-spreads-in-california-and-this-year-could-be-the-worst-yet","title":"With Climate Change, Valley Fever Spreads in California—and This Year Could Be the Worst Yet","publishDate":1538250643,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>Rob Purdie is an upbeat guy. You can hear it in his unfailingly positive statements, his voice tinged with a Central Valley twang from a life spent in Bakersfield. \u003c/p>\n\u003cp>You wouldn’t guess this is a man with a reservoir surgically built into the top of his skull, and that he spends one full day a month with antifungal drugs pumping directly into his brain.\u003c/p>\n\u003cp>Purdie has Valley fever, or coccidioidomycosis, a disease he caught in 2012 that’s caused by an airborne soil fungus. In his case, the fungus gave him meningitis, a swelling of the membranes that line the brain and spinal cord. The pain in his head has been intense, and the monthly drug injections are even more excruciating, he said.\u003c/p>\n\u003cp>“It sounds horrible, and it is,” Purdie said. But “lucky for me, Valley fever meningitis can be treated.”\u003c/p>\n\u003cp>The number of reported Valley fever cases set a record in California in 2016, with more than 6,000 infections. That number jumped to 8,103 in 2017, an increase of more than a third—growth many experts link to climate change. This year could be the worst yet.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Valley fever season starts this month. Most cases surface between September and November, but through\u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciinCAProvisionalMonthlyReport.pdf#search=valley%20fever\" rel=\"noopener\" target=\"_blank\"> August this year more than 5,000 cases were reported\u003c/a> in California, putting the state on pace for a new record.\u003c/p>\n\u003cp>“We’re seeing a huge increase in new cases in the past two-and-a-half years. It’s striking,” said Ian McHardy, co-director of the Center for Valley Fever at UC Davis. “We’re seeing double and triple the cases. It’s a catastrophic change, and it’s getting worse.”\u003c/p>\n\u003cp>The fungus typically infects the lungs after spores are inhaled (it is not contracted person-to-person), producing a persistent cough and chest pain or other flu-like symptoms that can require months of treatment. In some cases—like Purdie’s—it can spread. It can be hard to diagnose because it can mimic those of other ailments, and in many people symptoms fade away on their own.\u003c/p>\n\u003cp>This month, Gov. Jerry Brown signed three bills into law to help combat Valley fever. The current state budget includes $8 million for research and education, to keep more Californians from catching the infection and to foster better diagnoses so symptoms can be treated accurately.\u003c/p>\n\u003cp>But despite the state response, experts say the disease likely will continue to expand, with more people getting it in more areas of the state. \u003c/p>\n\u003cp>\u003ca href=\"https://agupubs.onlinelibrary.wiley.com/doi/pdf/10.1002/2017GL073524\" rel=\"noopener\" target=\"_blank\">One big reason\u003c/a>, McHardy said, is climate change. A growing number of dust storms in California have spread the fungal spores far beyond the Central Valley, where the infections traditionally have been concentrated. \u003c/p>\n\u003cp>“We know there’s \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" rel=\"noopener\" target=\"_blank\">a direct correlation\u003c/a> between these dust storms and Valley fever, and we know climate change is increasing the \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" rel=\"noopener\" target=\"_blank\">extreme weather patterns here\u003c/a>, including the dust storms,” he said.\u003c/p>\n\u003cp>\u003cimg src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws.jpg\" alt=\"\" width=\"2200\" height=\"2820\" class=\"alignright size-full wp-image-11695473\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws.jpg 2200w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-160x205.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-800x1025.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-1020x1307.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-936x1200.jpg 936w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-1920x2461.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-1180x1513.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-960x1231.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-240x308.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-375x481.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-520x667.jpg 520w\" sizes=\"(max-width: 2200px) 100vw, 2200px\">\u003c/p>\n\u003cp>Valley fever is no longer strictly a Valley phenomenon. It has \u003ca href=\"https://www.ucdavis.edu/news/climate-change-threats-and-solutions-sacramento-valley/\" rel=\"noopener\" target=\"_blank\">spread north to Sacramento\u003c/a> and west all the way to the coast.\u003c/p>\n\u003cp>“(In places) like Monterey, Los Angeles and San Luis Obispo counties, where we don’t expect to find it, it’s becoming much more common,” McHardy said.\u003c/p>\n\u003cp>Democratic Assemblyman Rudy Salas Jr. of Hanford wrote the three Valley fever bills the governor signed. He said the infection has been reported in 53 of California’s 58 counties, and he has family members and friends who have contracted it.\u003c/p>\n\u003cp>The state’s health care costs have spiraled higher with the increase in infections, he said. “The costs to our health care system ... were around $2 billion” in a 10-year period ending in 2011, Salas said, citing the most recent \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810749/\" rel=\"noopener\" target=\"_blank\">state cost study\u003c/a>. “And we have only seen an increase in cases since then.”\u003c/p>\n\u003cp>The $8 million is “the largest allocation in our state’s history specifically targeting Valley fever,” he said. About $3 million of it will go toward expansion of the Valley Fever Center in Kern County and its research on why some people who inhale the fungus get sick and others don’t. \u003c/p>\n\u003cp>Because Valley fever can resemble the flu, many physicians outside of the Central Valley don’t consider it in their diagnoses, even though the blood test to identify it is inexpensive and simple. \u003c/p>\n\u003cp>The federal Centers for Disease Control and Prevention estimated there are about 150,000 undiagnosed cases a year, and McHardy said he thinks the number is higher.\u003c/p>\n\u003cp>The most dangerous manifestation is meningitis, he said—“and by the time they go to the hospital it’s too late, and I think a lot of people die from it without ever being diagnosed,” McHardy said. \u003c/p>\n\u003cp>The California Department of Public Health doesn’t regularly track deaths from Valley fever but did compile statistics \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937113/\" rel=\"noopener\" target=\"_blank\">in one study\u003c/a>. Officials concluded that 1,098 people died of the disease in California from 2000 to 2013, averaging about 73 deaths a year statewide. \u003c/p>\n\u003cp>The downside is obvious and can be terrifying, Purdie said. But he circled back to the bright side, saying that educating both patients and physicians to better recognize the infection could make a huge difference. Once people figure out they have Valley fever, especially in the earlier stages of the infection, he noted, it’s treatable.\u003c/p>\n\u003cp>And “fortunately,” he added, “most people won’t get it as severely as I did.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/\" rel=\"noopener\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Experts say a drier climate means more dust storms, which carry the fungus that causes the disease. New laws and money address the issue. Is that enough?","status":"publish","parent":0,"modified":1538247173,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":955},"headData":{"title":"With Climate Change, Valley Fever Spreads in California—and This Year Could Be the Worst Yet | KQED","description":"Experts say a drier climate means more dust storms, which carry the fungus that causes the disease. New laws and money address the issue. Is that enough?","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11695471 https://ww2.kqed.org/news/?p=11695471","disqusUrl":"https://ww2.kqed.org/news/2018/09/29/with-climate-change-valley-fever-spreads-in-california-and-this-year-could-be-the-worst-yet/","disqusTitle":"With Climate Change, Valley Fever Spreads in California—and This Year Could Be the Worst Yet","source":"CALmatters","sourceUrl":"https://calmatters.org/","path":"/news/11695471/with-climate-change-valley-fever-spreads-in-california-and-this-year-could-be-the-worst-yet","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Rob Purdie is an upbeat guy. You can hear it in his unfailingly positive statements, his voice tinged with a Central Valley twang from a life spent in Bakersfield. \u003c/p>\n\u003cp>You wouldn’t guess this is a man with a reservoir surgically built into the top of his skull, and that he spends one full day a month with antifungal drugs pumping directly into his brain.\u003c/p>\n\u003cp>Purdie has Valley fever, or coccidioidomycosis, a disease he caught in 2012 that’s caused by an airborne soil fungus. In his case, the fungus gave him meningitis, a swelling of the membranes that line the brain and spinal cord. The pain in his head has been intense, and the monthly drug injections are even more excruciating, he said.\u003c/p>\n\u003cp>“It sounds horrible, and it is,” Purdie said. But “lucky for me, Valley fever meningitis can be treated.”\u003c/p>\n\u003cp>The number of reported Valley fever cases set a record in California in 2016, with more than 6,000 infections. That number jumped to 8,103 in 2017, an increase of more than a third—growth many experts link to climate change. This year could be the worst yet.\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>Valley fever season starts this month. Most cases surface between September and November, but through\u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciinCAProvisionalMonthlyReport.pdf#search=valley%20fever\" rel=\"noopener\" target=\"_blank\"> August this year more than 5,000 cases were reported\u003c/a> in California, putting the state on pace for a new record.\u003c/p>\n\u003cp>“We’re seeing a huge increase in new cases in the past two-and-a-half years. It’s striking,” said Ian McHardy, co-director of the Center for Valley Fever at UC Davis. “We’re seeing double and triple the cases. It’s a catastrophic change, and it’s getting worse.”\u003c/p>\n\u003cp>The fungus typically infects the lungs after spores are inhaled (it is not contracted person-to-person), producing a persistent cough and chest pain or other flu-like symptoms that can require months of treatment. In some cases—like Purdie’s—it can spread. It can be hard to diagnose because it can mimic those of other ailments, and in many people symptoms fade away on their own.\u003c/p>\n\u003cp>This month, Gov. Jerry Brown signed three bills into law to help combat Valley fever. The current state budget includes $8 million for research and education, to keep more Californians from catching the infection and to foster better diagnoses so symptoms can be treated accurately.\u003c/p>\n\u003cp>But despite the state response, experts say the disease likely will continue to expand, with more people getting it in more areas of the state. \u003c/p>\n\u003cp>\u003ca href=\"https://agupubs.onlinelibrary.wiley.com/doi/pdf/10.1002/2017GL073524\" rel=\"noopener\" target=\"_blank\">One big reason\u003c/a>, McHardy said, is climate change. A growing number of dust storms in California have spread the fungal spores far beyond the Central Valley, where the infections traditionally have been concentrated. \u003c/p>\n\u003cp>“We know there’s \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" rel=\"noopener\" target=\"_blank\">a direct correlation\u003c/a> between these dust storms and Valley fever, and we know climate change is increasing the \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" rel=\"noopener\" target=\"_blank\">extreme weather patterns here\u003c/a>, including the dust storms,” he said.\u003c/p>\n\u003cp>\u003cimg src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws.jpg\" alt=\"\" width=\"2200\" height=\"2820\" class=\"alignright size-full wp-image-11695473\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws.jpg 2200w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-160x205.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-800x1025.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-1020x1307.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-936x1200.jpg 936w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-1920x2461.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-1180x1513.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-960x1231.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-240x308.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-375x481.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2018/09/Graphic_-Valley-fever-laws-520x667.jpg 520w\" sizes=\"(max-width: 2200px) 100vw, 2200px\">\u003c/p>\n\u003cp>Valley fever is no longer strictly a Valley phenomenon. It has \u003ca href=\"https://www.ucdavis.edu/news/climate-change-threats-and-solutions-sacramento-valley/\" rel=\"noopener\" target=\"_blank\">spread north to Sacramento\u003c/a> and west all the way to the coast.\u003c/p>\n\u003cp>“(In places) like Monterey, Los Angeles and San Luis Obispo counties, where we don’t expect to find it, it’s becoming much more common,” McHardy said.\u003c/p>\n\u003cp>Democratic Assemblyman Rudy Salas Jr. of Hanford wrote the three Valley fever bills the governor signed. He said the infection has been reported in 53 of California’s 58 counties, and he has family members and friends who have contracted it.\u003c/p>\n\u003cp>The state’s health care costs have spiraled higher with the increase in infections, he said. “The costs to our health care system ... were around $2 billion” in a 10-year period ending in 2011, Salas said, citing the most recent \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810749/\" rel=\"noopener\" target=\"_blank\">state cost study\u003c/a>. “And we have only seen an increase in cases since then.”\u003c/p>\n\u003cp>The $8 million is “the largest allocation in our state’s history specifically targeting Valley fever,” he said. About $3 million of it will go toward expansion of the Valley Fever Center in Kern County and its research on why some people who inhale the fungus get sick and others don’t. \u003c/p>\n\u003cp>Because Valley fever can resemble the flu, many physicians outside of the Central Valley don’t consider it in their diagnoses, even though the blood test to identify it is inexpensive and simple. \u003c/p>\n\u003cp>The federal Centers for Disease Control and Prevention estimated there are about 150,000 undiagnosed cases a year, and McHardy said he thinks the number is higher.\u003c/p>\n\u003cp>The most dangerous manifestation is meningitis, he said—“and by the time they go to the hospital it’s too late, and I think a lot of people die from it without ever being diagnosed,” McHardy said. \u003c/p>\n\u003cp>The California Department of Public Health doesn’t regularly track deaths from Valley fever but did compile statistics \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937113/\" rel=\"noopener\" target=\"_blank\">in one study\u003c/a>. Officials concluded that 1,098 people died of the disease in California from 2000 to 2013, averaging about 73 deaths a year statewide. \u003c/p>\n\u003cp>The downside is obvious and can be terrifying, Purdie said. But he circled back to the bright side, saying that educating both patients and physicians to better recognize the infection could make a huge difference. Once people figure out they have Valley fever, especially in the earlier stages of the infection, he noted, it’s treatable.\u003c/p>\n\u003cp>And “fortunately,” he added, “most people won’t get it as severely as I did.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/\" rel=\"noopener\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11695471/with-climate-change-valley-fever-spreads-in-california-and-this-year-could-be-the-worst-yet","authors":["8656"],"programs":["news_72"],"categories":["news_19906","news_457","news_8"],"tags":["news_255","news_20548"],"featImg":"news_11695474","label":"source_news_11695471"},"futureofyou_444621":{"type":"posts","id":"futureofyou_444621","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444621","score":null,"sort":[1538001170000]},"guestAuthors":[],"slug":"is-the-end-of-hiv-transmission-in-the-u-s-near","title":"Is the End of HIV Transmission in the U.S. Near?","publishDate":1538001170,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp class=\"danger-zone\">\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">A \u003c/span>\u003c/span>mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.[contextly_sidebar id=\"lO0syDiO3AlElegX7fRdQulfH7k681UG\"]\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.[contextly_sidebar id=\"wauS1YFripUOWbpsTIa7lXm8j8pGcJjw\"]\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.[contextly_sidebar id=\"cMA1JnuuPTnJDbxO5uh5Kz0WejZJ8v2u\"]\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1538001420,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":43,"wordCount":2173},"headData":{"title":"Is the End of HIV Transmission in the U.S. Near? | KQED","description":"A mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS. And yet, today, the struggle against HIV may be undergoing a sea change.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444621 https://ww2.kqed.org/futureofyou/?p=444621","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/26/is-the-end-of-hiv-transmission-in-the-u-s-near/","disqusTitle":"Is the End of HIV Transmission in the U.S. Near?","source":"Health","nprByline":"Helen Branswell\u003cbr />STAT","path":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">A \u003c/span>\u003c/span>mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\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>\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\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","authors":["byline_futureofyou_444621"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_141","futureofyou_1275","futureofyou_61","futureofyou_651","futureofyou_835"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444626","label":"source_futureofyou_444621"},"news_11695075":{"type":"posts","id":"news_11695075","meta":{"index":"posts_1591205157","site":"news","id":"11695075","score":null,"sort":[1538095086000]},"guestAuthors":[],"slug":"a-psychiatrists-5-tips-for-dealing-with-the-kavanaugh-hearing","title":"A Psychiatrist's 5 Tips for Dealing With the Kavanaugh Hearing","publishDate":1538095086,"format":"audio","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>Dr. Lynn Ponton, a psychiatrist in San Francisco and a professor of psychiatry at UCSF, said she wasn't surprised when she started getting phone calls from clients on Thursday during the \u003ca href=\"https://www.kqed.org/news/11694933/watch-live-kavanaugh-ford-testify-about-sexual-assault-allegation\" target=\"_blank\" rel=\"noopener\">Blasey-Kavanaugh hearing before the Senate Judiciary Committee\u003c/a>. And she says other Bay Area psychiatrists she's been talking with are also seeing their phones light up.\u003c/p>\n\u003cp>\"Many of my patients have experienced very significant trauma in their own lives,\" Ponton said. \"And just watching this and having it so intensified by the media, they are being re-triggered. So they are calling me. They are having more symptoms. Some are turning to substances. Some are talking to their friends.\"\u003c/p>\n\u003cp>Ponton has advice for people who are feeling upset and emotional after watching and listening to Christine Blasey Ford describe allegedly being sexually assaulted by U.S. Supreme Court nominee Judge Brett Kavanaugh, and the subsequent questioning of both Ford and Kavanaugh.\u003c/p>\n\u003cp>Here's Ponton's guide for her clients and anyone experiencing stress from this:\u003c/p>\n\u003col>\n\u003cli>Monitor your own viewing, listening and cellphone use. The vocal triggers can be especially strong with this type of hearing. So stay alert to that and protect yourself. You will know you are having symptoms if your heart rate goes up, your anxiety level increases, your thinking seems unclear. Those are all clues you are having trouble with it.\u003c/li>\n\u003cli>Reach out to others for support. Even with a text. You might establish a group text to support one another while following the coverage. That's what Ponton did with members of her family. It's important to know others are out there you can connect with.\u003c/li>\n\u003cli>Keep up your regular activities. Rather than stay up all night thinking you have to keep up with the coverage and staying on top of it all the way, know it's more important to get sleep and make sure to eat and exercise regularly.\u003c/li>\n\u003cli>Keep a journal of your thoughts and feelings through these days so you can go back to them at a later point. It's a way to put them aside, and frame them so you can maybe tackle them when you have more energy.\u003c/li>\n\u003cli>Use grounding techniques such as listening to soothing music or taking walks in nature, gardening, cooking or anything else you know can reduce your anxiety or ground you.\u003c/li>\n\u003c/ol>\n\u003cp>Ponton says another group reacting to the hearings are those who are rethinking their own behavior and whether they behaved appropriately.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"One of my teen patients reached out to me today already, called me about a situation that had happened a year ago with a girl in his high school. And wondered how he should handle it,\" Ponton said. \"Should he go back and apologize to her? He's really been rethinking it. So he was stimulated by Dr. Ford's testimony.\"\u003c/p>\n\u003cp>She's also been talking with older clients today.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They are looking back on their lives 30 and 40 years ago and having some very difficult thoughts about how they treated others sexually,\" Ponton said. \"I think for many of us, men and women, we are having some of those thoughts and this brings it up for us.\"\u003c/p>\n\n","blocks":[],"excerpt":"Advice for people feeling upset and emotional after watching and listening to Christine Blasey Ford describe allegedly being sexually assaulted by U.S. Supreme Court nominee Judge Brett Kavanaugh, and the subsequent questioning of both.","status":"publish","parent":0,"modified":1538172340,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":10,"wordCount":536},"headData":{"title":"A Psychiatrist's 5 Tips for Dealing With the Kavanaugh Hearing | KQED","description":"Advice for people feeling upset and emotional after watching and listening to Christine Blasey Ford describe allegedly being sexually assaulted by U.S. Supreme Court nominee Judge Brett Kavanaugh, and the subsequent questioning of both.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11695075 https://ww2.kqed.org/news/?p=11695075","disqusUrl":"https://ww2.kqed.org/news/2018/09/27/a-psychiatrists-5-tips-for-dealing-with-the-kavanaugh-hearing/","disqusTitle":"A Psychiatrist's 5 Tips for Dealing With the Kavanaugh Hearing","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2018/09/WattHearingReax.mp3","audioTrackLength":441,"path":"/news/11695075/a-psychiatrists-5-tips-for-dealing-with-the-kavanaugh-hearing","audioDuration":428000,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Lynn Ponton, a psychiatrist in San Francisco and a professor of psychiatry at UCSF, said she wasn't surprised when she started getting phone calls from clients on Thursday during the \u003ca href=\"https://www.kqed.org/news/11694933/watch-live-kavanaugh-ford-testify-about-sexual-assault-allegation\" target=\"_blank\" rel=\"noopener\">Blasey-Kavanaugh hearing before the Senate Judiciary Committee\u003c/a>. And she says other Bay Area psychiatrists she's been talking with are also seeing their phones light up.\u003c/p>\n\u003cp>\"Many of my patients have experienced very significant trauma in their own lives,\" Ponton said. \"And just watching this and having it so intensified by the media, they are being re-triggered. So they are calling me. They are having more symptoms. Some are turning to substances. Some are talking to their friends.\"\u003c/p>\n\u003cp>Ponton has advice for people who are feeling upset and emotional after watching and listening to Christine Blasey Ford describe allegedly being sexually assaulted by U.S. Supreme Court nominee Judge Brett Kavanaugh, and the subsequent questioning of both Ford and Kavanaugh.\u003c/p>\n\u003cp>Here's Ponton's guide for her clients and anyone experiencing stress from this:\u003c/p>\n\u003col>\n\u003cli>Monitor your own viewing, listening and cellphone use. The vocal triggers can be especially strong with this type of hearing. So stay alert to that and protect yourself. You will know you are having symptoms if your heart rate goes up, your anxiety level increases, your thinking seems unclear. Those are all clues you are having trouble with it.\u003c/li>\n\u003cli>Reach out to others for support. Even with a text. You might establish a group text to support one another while following the coverage. That's what Ponton did with members of her family. It's important to know others are out there you can connect with.\u003c/li>\n\u003cli>Keep up your regular activities. Rather than stay up all night thinking you have to keep up with the coverage and staying on top of it all the way, know it's more important to get sleep and make sure to eat and exercise regularly.\u003c/li>\n\u003cli>Keep a journal of your thoughts and feelings through these days so you can go back to them at a later point. It's a way to put them aside, and frame them so you can maybe tackle them when you have more energy.\u003c/li>\n\u003cli>Use grounding techniques such as listening to soothing music or taking walks in nature, gardening, cooking or anything else you know can reduce your anxiety or ground you.\u003c/li>\n\u003c/ol>\n\u003cp>Ponton says another group reacting to the hearings are those who are rethinking their own behavior and whether they behaved appropriately.\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>\"One of my teen patients reached out to me today already, called me about a situation that had happened a year ago with a girl in his high school. And wondered how he should handle it,\" Ponton said. \"Should he go back and apologize to her? He's really been rethinking it. So he was stimulated by Dr. Ford's testimony.\"\u003c/p>\n\u003cp>She's also been talking with older clients today.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They are looking back on their lives 30 and 40 years ago and having some very difficult thoughts about how they treated others sexually,\" Ponton said. \"I think for many of us, men and women, we are having some of those thoughts and this brings it up for us.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11695075/a-psychiatrists-5-tips-for-dealing-with-the-kavanaugh-hearing","authors":["231"],"programs":["news_72"],"categories":["news_457","news_6188","news_8","news_13"],"tags":["news_23686","news_24150"],"featImg":"news_11694942","label":"news_72"},"news_11694626":{"type":"posts","id":"news_11694626","meta":{"index":"posts_1591205157","site":"news","id":"11694626","score":null,"sort":[1537922338000]},"guestAuthors":[],"slug":"the-kingdom-of-contract-negotiations","title":"The Kingdom of Contract Negotiations","publishDate":1537922338,"format":"standard","headTitle":"Mark Fiore: Drawn to the Bay | KQED News","labelTerm":{"term":18515,"site":"news"},"content":"\u003cp>After unions representing workers at Disneyland in Anaheim called out \u003ca href=\"https://www.kqed.org/news/11653499/the-not-so-magic-kingdom\" target=\"_blank\" rel=\"noopener\">low wages and homelessness\u003c/a>, more than 2,700 members of Unite Here Local 11 \u003ca href=\"http://bit.ly/fioredisneyraise\" target=\"_blank\" rel=\"noopener\">ratified a new five-year contract\u003c/a>.\u003c/p>\n\u003cp>The new deal will raise the minimum wage to $15 an hour and raise wages 40 percent over the next two years for workers in Disneyland's three hotels.\u003c/p>\n\u003cp>But not all workers at Disneyland will get a raise.\u003c/p>\n\u003cp>Workers United Local 50, which represents 6,500 food service workers in the \"Magic Kingdom,\" will continue to make a $12 minimum wage and face contract renegotiation in 2020.\u003c/p>\n\u003cp>The website for Local 50 currently announces a \u003ca href=\"https://www.wulocal50.org/single-post/2018/09/05/SEPTEMBER-FOOD-BANK\" target=\"_blank\" rel=\"noopener\">monthly food bank\u003c/a> that provides free food for members if they show their Disneyland identification card.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"After unions representing workers at Disneyland in Anaheim called out low wages and homelessness, more than 2,700 members of Unite Here Local 11 ratified a new five-year contract.","status":"publish","parent":0,"modified":1537922338,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":7,"wordCount":125},"headData":{"title":"The Kingdom of Contract Negotiations | KQED","description":"After unions representing workers at Disneyland in Anaheim called out low wages and homelessness, more than 2,700 members of Unite Here Local 11 ratified a new five-year contract.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11694626 https://ww2.kqed.org/news/?p=11694626","disqusUrl":"https://ww2.kqed.org/news/2018/09/25/the-kingdom-of-contract-negotiations/","disqusTitle":"The Kingdom of Contract Negotiations","path":"/news/11694626/the-kingdom-of-contract-negotiations","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>After unions representing workers at Disneyland in Anaheim called out \u003ca href=\"https://www.kqed.org/news/11653499/the-not-so-magic-kingdom\" target=\"_blank\" rel=\"noopener\">low wages and homelessness\u003c/a>, more than 2,700 members of Unite Here Local 11 \u003ca href=\"http://bit.ly/fioredisneyraise\" target=\"_blank\" rel=\"noopener\">ratified a new five-year contract\u003c/a>.\u003c/p>\n\u003cp>The new deal will raise the minimum wage to $15 an hour and raise wages 40 percent over the next two years for workers in Disneyland's three hotels.\u003c/p>\n\u003cp>But not all workers at Disneyland will get a raise.\u003c/p>\n\u003cp>Workers United Local 50, which represents 6,500 food service workers in the \"Magic Kingdom,\" will continue to make a $12 minimum wage and face contract renegotiation in 2020.\u003c/p>\n\u003cp>The website for Local 50 currently announces a \u003ca href=\"https://www.wulocal50.org/single-post/2018/09/05/SEPTEMBER-FOOD-BANK\" target=\"_blank\" rel=\"noopener\">monthly food bank\u003c/a> that provides free food for members if they show their Disneyland identification card.\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>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11694626/the-kingdom-of-contract-negotiations","authors":["3236"],"series":["news_18515"],"categories":["news_223","news_1758","news_24114","news_457","news_6266","news_8"],"tags":["news_20356","news_22568","news_4020","news_19904","news_20482","news_20949","news_2141","news_1585"],"featImg":"news_11694635","label":"news_18515"},"stateofhealth_364223":{"type":"posts","id":"stateofhealth_364223","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"364223","score":null,"sort":[1534295909000]},"guestAuthors":[],"slug":"beloved-san-francisco-zen-hospice-project-confronts-its-own-end","title":"Beloved San Francisco Zen Hospice Project Confronts Its Own End","publishDate":1534295909,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>It was late May when the body of the last person to die in the guest house of the \u003ca href=\"https://www.zenhospice.org/\" target=\"_blank\" rel=\"noopener\">Zen Hospice Project\u003c/a> was carried down the stairs and through the back garden, then sprinkled with flower petals.\u003c/p>\n\u003cp>The San Francisco institution was founded during the height of the AIDS crisis, a time when sick men were left to die alone in the hallways of county hospitals because staff were afraid to touch them. Buddhist practitioners bought the Victorian on Page Street to create a place where men could get compassionate care and die with dignity.\u003c/p>\n\u003cp>Now, after 30 years of caring for people with all kinds of illnesses, the house is closing its doors. The organization no longer has enough money to keep the program going.\u003c/p>\n\u003cp>“It’s a little chaotic in here,” says George Kellar, the executive director of the last two and a half years, as we walk through the foyer of the house. “It’s in total transition.”\u003c/p>\n\u003cp>All the furniture is gone. The floors are covered with canvas tarps. Blue tape lines the perimeter of the living room. Men in jumpsuits and face masks are painting the fireplace, tearing up the carpet on the stairway and power washing the windows.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the hospice issued its press release last week about this turn in the nonprofit’s fortunes, I noted the careful wording — that the guest house was “suspending” caregiving services, that they hoped they could “offer them again, at some point.” The implication was clear: Maybe a local tech billionaire could step in with a Hail Mary donation.\u003c/p>\n\u003cp>But this is a house that’s being primed for a realtor to stage it and put it up for sale.\u003c/p>\n\u003cp>“Five bedrooms, three bathrooms. It has a boarding house feel to it,” Kellar says as he gives me a tour of the upstairs. “It probably has that kind of history.”\u003c/p>\n\u003cp>Before the beds were cleared out, before all the nurses were laid off, the guest house had room for six residents. They called them “residents” not “patients.” This was their home, not a hospice. And they came here not to die, but to live fully until the end of their lives.\u003c/p>\n\u003cp>A corps of volunteers would sit with patients, sometimes for hours — just holding their hand, telling stories, singing songs. Kitchen staff prepared three meals a day to order for each resident, even when they could no longer eat.\u003c/p>\n\u003cp>“They can smell it, they can see it, if they want to taste that they can,\" Kellar says, adding that it's about letting the residents know \"they’re not discarded and ignored and not important.\"\u003c/p>\n\u003cp>The organization became a pioneer in what it means to die well. It helped shape a national movement away from sterile hospital deaths — hooked up to machines — to a mindful, aesthetic end that emphasized being present with what was happening.\u003c/p>\n\u003cp>Donors loved the mission and they were generous. Until the 2016 election.\u003c/p>\n\u003cp>“We’ve been struggling through 2017,” Kellar says.\u003c/p>\n\u003cp>This year, they’re more than $1 million short on their $2 million annual budget. Donors have been telling Kellar they have to cut back on their gifts to the hospice because they need to support issues that have come under attack during the Trump administration.\u003c/p>\n\u003cp>“Voting rights, or women in politics, or immigration help,” Kellar lists the other causes drawing donations instead of his organization. “And homeless, there’s a lot of interest in helping the homeless situation.”\u003c/p>\n\u003cfigure id=\"attachment_364227\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364227\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/George-Kellar-looks-at-ZHP-art-book-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Kellar flips through a binder of art and embroidery pieces created by residents who died at the Zen Hospice Project's guest house. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nationally, philanthropy experts are waiting to see if this is a broader trend. The economy is strong right now and charitable giving has increased since the 2016 election, says Stacy Palmer, editor of the Chronicle of Philanthropy. But it’s unclear if people are giving more overall or shifting their dollars to issues that are in the news a lot.\u003c/p>\n\u003cp>“People really have to make choices about which charities they care about the most,” Palmer says, and in a time of shifting priorities, it can be harder to get people to open their wallets when it comes to end-of-life issues.\u003c/p>\n\u003cp>“People don’t really like to hear about death, even though what hospices do is really make death so much easier. It’s a tough conversation,” she says. “Sometimes really important causes are the ones that suffer just because they are dealing with difficult subjects.”\u003c/p>\n\u003cp>But some of the blame sits with the Zen Hospice Project itself. It relied too much on loyal donors, and didn’t cultivate enough new ones, Kellar says. And, for all these years, the hospice has declined to get licensed under the government’s Medicare and Medicaid programs, closing the door on a steady stream of reimbursement payments.\u003c/p>\n\u003cp>“We don’t want to compromise our commitment to this compassionate model,” Kellar explains. “And if that commitment is compromised by the reporting requirements or by the regulatory requirements, we don’t want to go there.”\u003c/p>\n\u003cp>But idealism doesn’t pay the bills. And that’s one of the reasons Kellar was brought in four years ago: to bring some business savvy to the nonprofit. He’s a Zen Buddhist, and he’s also a Silicon Valley guy — a software engineer with a background in sales and operations.\u003c/p>\n\u003cp>At first, he became right-hand man to the executive director at the time, BJ Miller, a doctor and a charismatic visionary who put the Zen Hospice Project in the national conscience through a high-profile New York Times \u003ca href=\"https://www.nytimes.com/2017/01/03/magazine/one-mans-quest-to-change-the-way-we-die.html\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> and a \u003ca href=\"https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life\">TED talk\u003c/a> that’s been viewed more than 7.5 million times. In it, Miller talks about the importance of “sensuous, aesthetic gratification” at the end of life and how the Zen Hospice Project wants to help people enjoy the last of their time by way of the five senses.\u003c/p>\n\u003cp>“Seriously, with all the heavy-duty stuff happening under our roof, one of the most tried and true interventions we know of is to bake cookies,” he said, the smell providing sustenance on so many levels. “As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.”\u003c/p>\n\u003cfigure id=\"attachment_364225\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364225\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/ZHP-Cookie-Book-close-up-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Zen Hospice Project's cookie recipe book sits with other nostalgic items moved out of the guest house as it is readied for sale. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kellar, on the other hand, talks about marketing and distribution and “scaling” operations.\u003c/p>\n\u003cp>“I am using businesslike terms to talk about it, but I think you have to,” he says.\u003c/p>\n\u003cp>When he took over the executive director position, the budget troubles were officially his responsibility.\u003c/p>\n\u003cp>One strategy he pursued was negotiating a partnership with some private insurance companies to have them reimburse for some of the hospice’s services. It’s an appealing value proposition for insurers: It costs $850 a day to care for each patient at the hospice, compared to the thousands and thousands of dollars in daily costs for someone to die in an ICU.\u003c/p>\n\u003cp>But after 18 months, there was still no agreement.\u003c/p>\n\u003cp>“We could no longer wait,” Kellar says.\u003c/p>\n\u003cp>Kellar presented the numbers to the board of directors, and they agreed they could no longer afford to keep the guest house going.\u003c/p>\n\u003cp>“As difficult and sad as it is, which it is, we’re letting it go,” Kellar says. “And that will create another space for something else to present itself. And maybe that something else is this massive opportunity.”\u003c/p>\n\u003cp>That could be an opportunity presented by the \u003ca href=\"https://www.caregiver.org/caregiver-statistics-demographics\" target=\"_blank\" rel=\"noopener\">43 million\u003c/a> informal caregivers in the U.S. — people taking care of their own ailing parents, spouses, or children — who need help. Kellar says if Zen Hospice Project sells the guest house, the organization can reinvest that money into its other programs: the volunteer program, which sends people to sit with the dying in the hospice floor of Laguna Honda Hospital, and the\u003ca href=\"https://www.zenhospice.org/education-training/mce/\" target=\"_blank\" rel=\"noopener\">Mindful Caregiver Education program\u003c/a>, which emphasizes caregivers taking care of themselves so they can take better care of others.\u003c/p>\n\u003cp>“Our mission is to transform the experience of dying and caregiving,” Kellar says. “And while we started at the bedside and continue at the bedside at Laguna Honda, it is now a time to focus on helping other people at the bedside by training and education.”\u003c/p>\n\u003cp>But selling this iconic San Francisco institution to as a private residence for 5 or 6 million dollars?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It’s not what I expected,” Kellar says, shifting from business guy to Zen guy. “I guess it’s a lesson in impermanence. And a lesson in ‘things change' and to not get as attached as we are because everybody here is very attached to this.”\u003c/p>\n\n","blocks":[],"excerpt":"Since the 2016 election, donors have been shifting their charitable dollars away from the hospice.","status":"publish","parent":0,"modified":1534296654,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":38,"wordCount":1555},"headData":{"title":"Beloved San Francisco Zen Hospice Project Confronts Its Own End | KQED","description":"Since the 2016 election, donors have been shifting their charitable dollars away from the hospice.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"364223 https://ww2.kqed.org/stateofhealth/?p=364223","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/08/14/beloved-san-francisco-zen-hospice-project-confronts-its-own-end/","disqusTitle":"Beloved San Francisco Zen Hospice Project Confronts Its Own End","audioTrackLength":366,"path":"/stateofhealth/364223/beloved-san-francisco-zen-hospice-project-confronts-its-own-end","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcrmag/2018/08/DemboskyZenHospiceProject.mp3","audioDuration":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was late May when the body of the last person to die in the guest house of the \u003ca href=\"https://www.zenhospice.org/\" target=\"_blank\" rel=\"noopener\">Zen Hospice Project\u003c/a> was carried down the stairs and through the back garden, then sprinkled with flower petals.\u003c/p>\n\u003cp>The San Francisco institution was founded during the height of the AIDS crisis, a time when sick men were left to die alone in the hallways of county hospitals because staff were afraid to touch them. Buddhist practitioners bought the Victorian on Page Street to create a place where men could get compassionate care and die with dignity.\u003c/p>\n\u003cp>Now, after 30 years of caring for people with all kinds of illnesses, the house is closing its doors. The organization no longer has enough money to keep the program going.\u003c/p>\n\u003cp>“It’s a little chaotic in here,” says George Kellar, the executive director of the last two and a half years, as we walk through the foyer of the house. “It’s in total transition.”\u003c/p>\n\u003cp>All the furniture is gone. The floors are covered with canvas tarps. Blue tape lines the perimeter of the living room. Men in jumpsuits and face masks are painting the fireplace, tearing up the carpet on the stairway and power washing the windows.\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>When the hospice issued its press release last week about this turn in the nonprofit’s fortunes, I noted the careful wording — that the guest house was “suspending” caregiving services, that they hoped they could “offer them again, at some point.” The implication was clear: Maybe a local tech billionaire could step in with a Hail Mary donation.\u003c/p>\n\u003cp>But this is a house that’s being primed for a realtor to stage it and put it up for sale.\u003c/p>\n\u003cp>“Five bedrooms, three bathrooms. It has a boarding house feel to it,” Kellar says as he gives me a tour of the upstairs. “It probably has that kind of history.”\u003c/p>\n\u003cp>Before the beds were cleared out, before all the nurses were laid off, the guest house had room for six residents. They called them “residents” not “patients.” This was their home, not a hospice. And they came here not to die, but to live fully until the end of their lives.\u003c/p>\n\u003cp>A corps of volunteers would sit with patients, sometimes for hours — just holding their hand, telling stories, singing songs. Kitchen staff prepared three meals a day to order for each resident, even when they could no longer eat.\u003c/p>\n\u003cp>“They can smell it, they can see it, if they want to taste that they can,\" Kellar says, adding that it's about letting the residents know \"they’re not discarded and ignored and not important.\"\u003c/p>\n\u003cp>The organization became a pioneer in what it means to die well. It helped shape a national movement away from sterile hospital deaths — hooked up to machines — to a mindful, aesthetic end that emphasized being present with what was happening.\u003c/p>\n\u003cp>Donors loved the mission and they were generous. Until the 2016 election.\u003c/p>\n\u003cp>“We’ve been struggling through 2017,” Kellar says.\u003c/p>\n\u003cp>This year, they’re more than $1 million short on their $2 million annual budget. Donors have been telling Kellar they have to cut back on their gifts to the hospice because they need to support issues that have come under attack during the Trump administration.\u003c/p>\n\u003cp>“Voting rights, or women in politics, or immigration help,” Kellar lists the other causes drawing donations instead of his organization. “And homeless, there’s a lot of interest in helping the homeless situation.”\u003c/p>\n\u003cfigure id=\"attachment_364227\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364227\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/George-Kellar-looks-at-ZHP-art-book-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Kellar flips through a binder of art and embroidery pieces created by residents who died at the Zen Hospice Project's guest house. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nationally, philanthropy experts are waiting to see if this is a broader trend. The economy is strong right now and charitable giving has increased since the 2016 election, says Stacy Palmer, editor of the Chronicle of Philanthropy. But it’s unclear if people are giving more overall or shifting their dollars to issues that are in the news a lot.\u003c/p>\n\u003cp>“People really have to make choices about which charities they care about the most,” Palmer says, and in a time of shifting priorities, it can be harder to get people to open their wallets when it comes to end-of-life issues.\u003c/p>\n\u003cp>“People don’t really like to hear about death, even though what hospices do is really make death so much easier. It’s a tough conversation,” she says. “Sometimes really important causes are the ones that suffer just because they are dealing with difficult subjects.”\u003c/p>\n\u003cp>But some of the blame sits with the Zen Hospice Project itself. It relied too much on loyal donors, and didn’t cultivate enough new ones, Kellar says. And, for all these years, the hospice has declined to get licensed under the government’s Medicare and Medicaid programs, closing the door on a steady stream of reimbursement payments.\u003c/p>\n\u003cp>“We don’t want to compromise our commitment to this compassionate model,” Kellar explains. “And if that commitment is compromised by the reporting requirements or by the regulatory requirements, we don’t want to go there.”\u003c/p>\n\u003cp>But idealism doesn’t pay the bills. And that’s one of the reasons Kellar was brought in four years ago: to bring some business savvy to the nonprofit. He’s a Zen Buddhist, and he’s also a Silicon Valley guy — a software engineer with a background in sales and operations.\u003c/p>\n\u003cp>At first, he became right-hand man to the executive director at the time, BJ Miller, a doctor and a charismatic visionary who put the Zen Hospice Project in the national conscience through a high-profile New York Times \u003ca href=\"https://www.nytimes.com/2017/01/03/magazine/one-mans-quest-to-change-the-way-we-die.html\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> and a \u003ca href=\"https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life\">TED talk\u003c/a> that’s been viewed more than 7.5 million times. In it, Miller talks about the importance of “sensuous, aesthetic gratification” at the end of life and how the Zen Hospice Project wants to help people enjoy the last of their time by way of the five senses.\u003c/p>\n\u003cp>“Seriously, with all the heavy-duty stuff happening under our roof, one of the most tried and true interventions we know of is to bake cookies,” he said, the smell providing sustenance on so many levels. “As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.”\u003c/p>\n\u003cfigure id=\"attachment_364225\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364225\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/ZHP-Cookie-Book-close-up-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Zen Hospice Project's cookie recipe book sits with other nostalgic items moved out of the guest house as it is readied for sale. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kellar, on the other hand, talks about marketing and distribution and “scaling” operations.\u003c/p>\n\u003cp>“I am using businesslike terms to talk about it, but I think you have to,” he says.\u003c/p>\n\u003cp>When he took over the executive director position, the budget troubles were officially his responsibility.\u003c/p>\n\u003cp>One strategy he pursued was negotiating a partnership with some private insurance companies to have them reimburse for some of the hospice’s services. It’s an appealing value proposition for insurers: It costs $850 a day to care for each patient at the hospice, compared to the thousands and thousands of dollars in daily costs for someone to die in an ICU.\u003c/p>\n\u003cp>But after 18 months, there was still no agreement.\u003c/p>\n\u003cp>“We could no longer wait,” Kellar says.\u003c/p>\n\u003cp>Kellar presented the numbers to the board of directors, and they agreed they could no longer afford to keep the guest house going.\u003c/p>\n\u003cp>“As difficult and sad as it is, which it is, we’re letting it go,” Kellar says. “And that will create another space for something else to present itself. And maybe that something else is this massive opportunity.”\u003c/p>\n\u003cp>That could be an opportunity presented by the \u003ca href=\"https://www.caregiver.org/caregiver-statistics-demographics\" target=\"_blank\" rel=\"noopener\">43 million\u003c/a> informal caregivers in the U.S. — people taking care of their own ailing parents, spouses, or children — who need help. Kellar says if Zen Hospice Project sells the guest house, the organization can reinvest that money into its other programs: the volunteer program, which sends people to sit with the dying in the hospice floor of Laguna Honda Hospital, and the\u003ca href=\"https://www.zenhospice.org/education-training/mce/\" target=\"_blank\" rel=\"noopener\">Mindful Caregiver Education program\u003c/a>, which emphasizes caregivers taking care of themselves so they can take better care of others.\u003c/p>\n\u003cp>“Our mission is to transform the experience of dying and caregiving,” Kellar says. “And while we started at the bedside and continue at the bedside at Laguna Honda, it is now a time to focus on helping other people at the bedside by training and education.”\u003c/p>\n\u003cp>But selling this iconic San Francisco institution to as a private residence for 5 or 6 million dollars?\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’s not what I expected,” Kellar says, shifting from business guy to Zen guy. “I guess it’s a lesson in impermanence. And a lesson in ‘things change' and to not get as attached as we are because everybody here is very attached to this.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/364223/beloved-san-francisco-zen-hospice-project-confronts-its-own-end","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_1"],"tags":["stateofhealth_3260","stateofhealth_3023","stateofhealth_2519","stateofhealth_3030","stateofhealth_3261"],"featImg":"stateofhealth_364226","label":"stateofhealth"},"stateofhealth_363815":{"type":"posts","id":"stateofhealth_363815","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363815","score":null,"sort":[1528414394000]},"guestAuthors":[],"slug":"modoc-voters-agree-to-sell-their-rural-hospital-to-denver-entrepreneur","title":"Modoc Voters Agree to Sell Their Rural Hospital to Denver Entrepreneur","publishDate":1528414394,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>Voters in a tiny northeastern California community this week agreed to sell their bankrupt hospital — struggling like many rural facilities nationally — to a Denver entrepreneur with a \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">controversial plan for its revival\u003c/a>.\u003c/p>\n\u003cp>Beau Gertz, who owns Denver-based lab-testing and nutraceutical companies, will buy 26-bed Surprise Valley Community Hospital in Cedarville, Calif., taking over its debt of \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">at least $4 million.\u003c/a> Another out-of-town investor had managed it for a few months then “abandoned” it, according to bankruptcy documents. Gertz’s offer, already accepted by the district hospital’s board and approved by a federal bankruptcy judge, required the approval of local residents in Tuesday’s election.\u003c/p>\n\u003cp>Nearly 84 percent of those who voted backed the deal, although turnout was light.\u003c/p>\n\u003cp>The woes of Surprise Valley exemplify the brutal environment faced by America’s rural hospitals, which are disappearing by the dozens due to declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Some Surprise Valley voters felt they had little choice but to approve the sale: Had they rejected it, the hospital almost certainly would have closed immediately, since no other “white knight” has come forward with a plan to rescue it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Bonnie Madrigal, a former certified nursing assistant at the hospital, said Gertz convinced her that he could help.\u003c/p>\n\u003cp>“Now that I have children, keeping the hospital is the most important thing to me,” said Madrigal, 26, of nearby Eagleville. “I know how much improvement the hospital needs … but once I listened to Beau, I heard hope. I feel like with Beau, the debt is going to be off our shoulders, and we’ll work together as a community to make things better.”\u003c/p>\n\u003cp>Gertz has told residents he wants to create a “wellness center” offering vitamin infusions, genetic testing, personalized medicine and other health services for well-heeled patients. He has promised to keep the hospital’s nursing home wing open and preserve its emergency room and ambulance services.\u003c/p>\n\u003cp>But some in the community worry that his plans will fail and the local residents will be responsible for even more debt. Gertz said that to help Surprise Valley Community pay for it all, he would bill for lab tests on patients who’ve never set foot in the hospital. He said they will be treated through telemedicine, by doctors who connect with them through video and other technology.\u003c/p>\n\u003cp>“We felt that to vote yes would be to bail out the [hospital] board and forgive it for all the mistakes it’s made,” said Ray March, 83, of Cedarville, who owns a trade and travel publishing company with his wife, Barbara. “It’s much better in our opinion to shut the hospital down, start clean and listen to some other good advice, which they never did. Now it’s a marriage and they’ve got to figure out how in hell they are going to make it work.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">Some experts contend\u003c/a> that, in general, lab billing for faraway patients is legally questionable — and the practice has drawn lawsuits and government scrutiny in other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Gertz, who has not faced such suits, did not respond to a request for comment.\u003c/p>\n\n","blocks":[],"excerpt":"Residents of Surprise Valley, in the state’s northeastern corner, voted to sell its hospital to a businessman with a controversial plan to bring in revenue. ","status":"publish","parent":0,"modified":1528414394,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":563},"headData":{"title":"Modoc Voters Agree to Sell Their Rural Hospital to Denver Entrepreneur | KQED","description":"Residents of Surprise Valley, in the state’s northeastern corner, voted to sell its hospital to a businessman with a controversial plan to bring in revenue. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"363815 https://ww2.kqed.org/stateofhealth/?p=363815","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/06/07/modoc-voters-agree-to-sell-their-rural-hospital-to-denver-entrepreneur/","disqusTitle":"Modoc Voters Agree to Sell Their Rural Hospital to Denver Entrepreneur","nprByline":"\u003cstrong>Barbara Feder Ostrov\u003c/strong>\u003c/b> California Healthline","path":"/stateofhealth/363815/modoc-voters-agree-to-sell-their-rural-hospital-to-denver-entrepreneur","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Voters in a tiny northeastern California community this week agreed to sell their bankrupt hospital — struggling like many rural facilities nationally — to a Denver entrepreneur with a \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">controversial plan for its revival\u003c/a>.\u003c/p>\n\u003cp>Beau Gertz, who owns Denver-based lab-testing and nutraceutical companies, will buy 26-bed Surprise Valley Community Hospital in Cedarville, Calif., taking over its debt of \u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">at least $4 million.\u003c/a> Another out-of-town investor had managed it for a few months then “abandoned” it, according to bankruptcy documents. Gertz’s offer, already accepted by the district hospital’s board and approved by a federal bankruptcy judge, required the approval of local residents in Tuesday’s election.\u003c/p>\n\u003cp>Nearly 84 percent of those who voted backed the deal, although turnout was light.\u003c/p>\n\u003cp>The woes of Surprise Valley exemplify the brutal environment faced by America’s rural hospitals, which are disappearing by the dozens due to declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Some Surprise Valley voters felt they had little choice but to approve the sale: Had they rejected it, the hospital almost certainly would have closed immediately, since no other “white knight” has come forward with a plan to rescue it.\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>Bonnie Madrigal, a former certified nursing assistant at the hospital, said Gertz convinced her that he could help.\u003c/p>\n\u003cp>“Now that I have children, keeping the hospital is the most important thing to me,” said Madrigal, 26, of nearby Eagleville. “I know how much improvement the hospital needs … but once I listened to Beau, I heard hope. I feel like with Beau, the debt is going to be off our shoulders, and we’ll work together as a community to make things better.”\u003c/p>\n\u003cp>Gertz has told residents he wants to create a “wellness center” offering vitamin infusions, genetic testing, personalized medicine and other health services for well-heeled patients. He has promised to keep the hospital’s nursing home wing open and preserve its emergency room and ambulance services.\u003c/p>\n\u003cp>But some in the community worry that his plans will fail and the local residents will be responsible for even more debt. Gertz said that to help Surprise Valley Community pay for it all, he would bill for lab tests on patients who’ve never set foot in the hospital. He said they will be treated through telemedicine, by doctors who connect with them through video and other technology.\u003c/p>\n\u003cp>“We felt that to vote yes would be to bail out the [hospital] board and forgive it for all the mistakes it’s made,” said Ray March, 83, of Cedarville, who owns a trade and travel publishing company with his wife, Barbara. “It’s much better in our opinion to shut the hospital down, start clean and listen to some other good advice, which they never did. Now it’s a marriage and they’ve got to figure out how in hell they are going to make it work.”\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/outsiders-swoop-in-vowing-to-rescue-rural-hospitals-short-on-hope-and-money/\">Some experts contend\u003c/a> that, in general, lab billing for faraway patients is legally questionable — and the practice has drawn lawsuits and government scrutiny in other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Gertz, who has not faced such suits, did not respond to a request for comment.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363815/modoc-voters-agree-to-sell-their-rural-hospital-to-denver-entrepreneur","authors":["byline_stateofhealth_363815"],"categories":["stateofhealth_11","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_3251","stateofhealth_3252"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_363779","label":"stateofhealth_3036"},"stateofhealth_363769":{"type":"posts","id":"stateofhealth_363769","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363769","score":null,"sort":[1528176296000]},"guestAuthors":[],"slug":"on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county","title":"On the Ballot: The Fate of a Troubled Hospital in Modoc County","publishDate":1528176296,"format":"audio","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“He’s got something we haven’t got — which is money,” Bostic said.\u003c/p>\n\n","blocks":[],"excerpt":"Voters in Surprise Valley, Calif. must decide whether to sell their public hospital to an outside investor with an unusual business plan.","status":"publish","parent":0,"modified":1528309938,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":58,"wordCount":2924},"headData":{"title":"On the Ballot: The Fate of a Troubled Hospital in Modoc County | KQED","description":"Voters in Surprise Valley, Calif. must decide whether to sell their public hospital to an outside investor with an unusual business plan.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"363769 https://ww2.kqed.org/stateofhealth/?p=363769","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/06/04/on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county/","disqusTitle":"On the Ballot: The Fate of a Troubled Hospital in Modoc County","nprByline":"Barbara Feder Ostrov, California Healthline","path":"/stateofhealth/363769/on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/06/TCRamRuralHospitals.mp3","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\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>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\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>“He’s got something we haven’t got — which is money,” Bostic said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363769/on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county","authors":["byline_stateofhealth_363769"],"categories":["stateofhealth_11","stateofhealth_14","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_3250","stateofhealth_2808","stateofhealth_2519","stateofhealth_3249"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_363775","label":"stateofhealth_3036"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. 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. 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