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tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I guess it's true, build it and they will come,” Morris says.\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-29a-tcr.mp3\" Image=\"https://u.s.kqed.net/2017/06/29/Stethoscope.jpg\" Title=\"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal\" program=\"The California Report\"]\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uO0r77wi0xkfHFV79VI4jRtVOZYGMW8u\"]\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n","blocks":[],"excerpt":"Dismantling Obamacare could force layoffs and shrink local business revenues in small, rural towns.","status":"publish","parent":0,"modified":1498772451,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":944},"headData":{"title":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal | KQED","description":"Dismantling Obamacare could force layoffs and shrink local business revenues in small, rural towns.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal","datePublished":"2017-06-29T13:00:45.000Z","dateModified":"2017-06-29T21:40:51.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"348513 https://ww2.kqed.org/stateofhealth/?p=348513","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/29/small-town-clinics-and-businesses-fear-economics-of-obamacare-repeal/","disqusTitle":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal","path":"/stateofhealth/348513/small-town-clinics-and-businesses-fear-economics-of-obamacare-repeal","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\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>“I guess it's true, build it and they will come,” Morris says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-29a-tcr.mp3","image":"https://u.s.kqed.net/2017/06/29/Stethoscope.jpg","title":"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348513/small-town-clinics-and-businesses-fear-economics-of-obamacare-repeal","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_3123","stateofhealth_2808","stateofhealth_2519","stateofhealth_365","stateofhealth_251"],"featImg":"stateofhealth_348514","label":"stateofhealth"},"stateofhealth_348243":{"type":"posts","id":"stateofhealth_348243","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348243","score":null,"sort":[1498647659000]},"guestAuthors":[],"slug":"obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory","title":"Obamacare Inspires Unlikely Political Action in Red California","publishDate":1498647659,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-28a-tcr.mp3\" Image=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/BloodPressure-768x512.jpg\" Title=\"Obamacare Inspires Unlikely Political Action in Red California\" program=\"The California Report\"]\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Nl4j8x6j7iRmpWflZsVooGaqsbbbOLuA\"]\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"swxoiuaBwIFNHC8PbxRB3kfDYxOKFLOH\"]\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n","blocks":[],"excerpt":"Under the ACA, 75,000 people enrolled in Medi-Cal in the state's northeast. 'The data shows it’s the rural communities that have greatly benefited from the Medicaid expansion.'","status":"publish","parent":0,"modified":1498838553,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":973},"headData":{"title":"Obamacare Inspires Unlikely Political Action in Red California | KQED","description":"Under the ACA, 75,000 people enrolled in Medi-Cal in the state's northeast. 'The data shows it’s the rural communities that have greatly benefited from the Medicaid expansion.'","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Obamacare Inspires Unlikely Political Action in Red California","datePublished":"2017-06-28T11:00:59.000Z","dateModified":"2017-06-30T16:02:33.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"348243 https://ww2.kqed.org/stateofhealth/?p=348243","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/","disqusTitle":"Obamacare Inspires Unlikely Political Action in Red California","audioUrl":"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-28a-tcr.mp3","path":"/stateofhealth/348243/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-28a-tcr.mp3","image":"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/BloodPressure-768x512.jpg","title":"Obamacare Inspires Unlikely Political Action in Red California","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348243/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_3057","stateofhealth_2808","stateofhealth_2519","stateofhealth_365","stateofhealth_251"],"featImg":"stateofhealth_348436","label":"stateofhealth"},"stateofhealth_141585":{"type":"posts","id":"stateofhealth_141585","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"141585","score":null,"sort":[1453482708000]},"guestAuthors":[],"slug":"lifesaving-flights-can-come-with-life-changing-bills","title":"Lifesaving Flights Can Come With Life-Changing Bills","publishDate":1453482708,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>Butte is an old mining town, tucked away in the southwest corner of Montana with a population of about 34,000. Locals enjoy many things you can't find elsewhere — campgrounds a quick drive from downtown and gorgeous mountain ranges nearby. But in Butte, as in much of rural America, advanced medical care is absent.\u003c/p>\n\u003caside class=\"pullquote alignright\">The air ambulance company was not in their insurance network, and they got a bill for $56,000.\u003c/aside>\n\u003cp>People in Butte who experience serious trauma or need specialty care rely on air ambulance flights to get them the help they need.\u003c/p>\n\u003cp>There were close to 3,000 air ambulance flights in Montana in 2014, and Amy Thomson was on one of them, curled up among the medical bags in the back of the fixed-wing plane. Her 2-month-old daughter, Isla, had a failing heart, and the hospital that could help her was 600 miles away.\u003c/p>\n\u003cp>\"They did such wonderful care of her, and they tried to take great care of me, but in that moment I couldn't let go,\" Thomson says. \"I was so afraid that if I closed my eyes that would be my last vision of her.\"\u003c/p>\n\u003cp>Thomson watched as Isla was placed in a small box strapped to a gurney inside the air ambulance flown by Airlift Northwest.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Seattle Children's Hospital saved Isla's life. Her family's health insurance took care of the costs beyond her deductible — except for that critical air ambulance ride to Seattle.\u003c/p>\n\u003cp>The Thomsons read their insurance plan and interpreted it to mean that any emergency medical transportation was covered.\u003c/p>\n\u003cp>But it turned out the air ambulance company was out of their network, and they got a bill for $56,000.\u003c/p>\n\u003cp>Thomson remembers looking at the bill and thinking, \" 'You've got to be kidding me!' Here is the flight that ultimately saved Isla's life by getting her to where she needs to be. And yet is going to put us potentially in financial ruin. Or at least kill our future dreams as a family.\"\u003c/p>\n\u003cp>When a patient needs an air ambulance, the first priority is getting needed care as fast as possible. Patients don't always know who is going to pick them up or if the ambulance is an in-network provider.\u003c/p>\n\u003cp>That can make a huge difference — and lead to huge bills.\u003c/p>\n\u003cp>\"Of all the complaints we have received in our office, not one person was uninsured,\" says Jesse Laslovich, legal counsel for Montana's insurance commissioner. \"They're all insured. And they are frustrated as heck that they're still getting $50,000-balance bills.\"\u003c/p>\n\u003cfigure id=\"attachment_141589\" class=\"wp-caption aligncenter\" style=\"max-width: 1266px\">\u003cimg class=\"size-full wp-image-141589\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png\" alt=\"Isla Thomson with her older sister. Isla turned 2 years old in November. \" width=\"1266\" height=\"952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png 1266w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-400x301.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-800x602.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-768x578.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-1180x887.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-960x722.png 960w\" sizes=\"(max-width: 1266px) 100vw, 1266px\">\u003cfigcaption class=\"wp-caption-text\">Isla Thomson with her older sister. Isla turned 2 years old in November. \u003ccite>(Courtesy of the Thomson family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>States can regulate some medical aspects of air ambulances, but federal laws prevent states from limiting aviation rates, routes and services.\u003c/p>\n\u003cp>The cost of an air ambulance bill is split into two main parts, according to \u003ca href=\"http://leg.mt.gov/content/Committees/Interim/2015-2016/Economic-Affairs/Meetings/Dec-2015/hjr29-survey-responses.pdf\">a study completed by the Montana Legislature\u003c/a>. First, a liftoff fee, which ranges from $8,500 to $15,200 in Montana, plus a per-mile charge for the flight, which ranges from $26 to $133 a mile.\u003c/p>\n\u003cp>Some air ambulance companies offer membership programs as protection from big bills. For an annual fee of about $60 to $100, patients who use that company's services face no cost beyond what their health insurance pays.\u003c/p>\n\u003cp>But Laslovich says that doesn't always work, because patients can't always know who is coming to pick them up.\u003c/p>\n\u003cp>\"You want to know what my personal opinion is about what the problem is?\" Laslovich asks. \"It's money.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/aside>\n\u003cp>There is a lack of understanding about the actual costs of running an air ambulance business, says \u003ca href=\"http://aams.org/our-staff/rick-sherlock/\">Rick Sherlock\u003c/a>, the president of the Association of Air Medical Services. The costs include specialized labor, training, equipment and fuel.\u003c/p>\n\u003cp>\"So those cost drivers are there, and [it's necessary] to maintain readiness to respond 24 hours a day, seven days a week, 365 days a year,\" Sherlock says.\u003c/p>\n\u003cp>He says some air ambulance companies remain out of insurance networks because they can't always reach in-network deals that allow them to stay profitable.\u003c/p>\n\u003cp>\"I think what you also have to look at is that negotiations between [air ambulance] companies and insurance companies take place when there's good negotiations on both sides,\" Sherlock says. \"In situations where there may be only one or two insurance options in an area, it's harder and harder to negotiate on a level playing field.\"\u003c/p>\n\u003cp>There are only three health insurance companies operating in Montana, and at least 14 air ambulance providers. At the time of Isla's trip to Seattle Children's Hospital, the Thomsons' insurer, PacificSource, had no in-network agreements with any air ambulance company in the family's area. (\u003ca href=\"https://pacificsource.com/about-us/overview.aspx\">PacificSource\u003c/a> didn't return calls seeking comment.)\u003c/p>\n\u003cp>For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/p>\n\u003cp>A Montana interim legislative committee is now investigating the wide range of pricing by air ambulance companies within the state. The state of Maryland has taken on a \u003ca href=\"http://www.bizjournals.com/baltimore/news/2015/08/21/maryland-insurance-administration-investigating-20.html\">similar investigation\u003c/a>.\u003c/p>\n\u003cp>In North Dakota an air ambulance company \u003ca href=\"http://bismarcktribune.com/news/state-and-regional/n-d-law-test-case-for-preventing-air-ambulance-price/article_2ad667ea-9fcb-534a-a88d-7225551e56a2.html\">is suing the state\u003c/a> for adding \u003ca href=\"http://www.legis.nd.gov/assembly/64-2015/documents/15-0688-02000.pdf?20151223141631\">regulations\u003c/a> on the industry.\u003c/p>\n\u003cp>Thomson ended up not having to pay for her flight, but only after repeated appeals. According to Thomson, on the same day they were arranging a time to meet with a lawyer, she was notified by her insurance company that it would pay an additional amount of about $30,000, as well as the $13,000 out-of-network fee to the air ambulance company. The air ambulance firm waived the rest of its fee.\u003c/p>\n\u003cp>Isla turned 2 in November. She's a healthy child with big blue eyes, but at times her mother still worries.\u003c/p>\n\u003cp>\"Nobody takes a life flight for a joy ride,\" she says. \"You're not going on Kayak.com and booking a life flight.\"\u003c/p>\n\u003cp>Thomson didn't think the flight should be free but says the huge bill felt wrong. \"I ethically believe this is a part of health care,\" she says. \"This is not some separate entity. There is something ethically wrong that these companies are profiteering off of people's worst moments in their lives.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with \u003c/em>\u003ca href=\"http://mtpr.org/\">Montana Public Radio\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"People in big, sparsely populated states like Montana rely on air ambulances to get to medical specialists they need. But the lifesaving flights can be hugely expensive and not covered by insurance.","status":"publish","parent":0,"modified":1453483559,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1105},"headData":{"title":"Lifesaving Flights Can Come With Life-Changing Bills | KQED","description":"People in big, sparsely populated states like Montana rely on air ambulances to get to medical specialists they need. But the lifesaving flights can be hugely expensive and not covered by insurance.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Lifesaving Flights Can Come With Life-Changing Bills","datePublished":"2016-01-22T17:11:48.000Z","dateModified":"2016-01-22T17:25:59.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"141585 http://ww2.kqed.org/stateofhealth/?p=141585","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/01/22/lifesaving-flights-can-come-with-life-changing-bills/","disqusTitle":"Lifesaving Flights Can Come With Life-Changing Bills","source":"NPR","sourceUrl":"http://www.npr.org/sections/health-shots/2016/01/18/460848383/lifesaving-flights-can-come-with-life-changing-bills","nprByline":"Corin Cates-Carney","nprImageAgency":"Courtesy of the Thomson family","nprStoryId":"460848383","nprApiLink":"http://api.npr.org/query?id=460848383&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/01/18/460848383/lifesaving-flights-can-come-with-life-changing-bills?ft=nprml&f=460848383","nprRetrievedStory":"1","nprPubDate":"Wed, 20 Jan 2016 12:06:00 -0500","nprStoryDate":"Mon, 18 Jan 2016 15:21:00 -0500","nprLastModifiedDate":"Wed, 20 Jan 2016 12:06:55 -0500","nprAudio":"http://pd.npr.org/anon.npr-mp3/npr/atc/2016/01/20160118_atc_lifesaving_flights_can_come_with_life-changing_bills.mp3?orgId=214&topicId=1128&d=264&p=2&story=460848383&t=progseg&e=463448622&seg=17&ft=nprml&f=460848383","nprAudioM3u":"http://api.npr.org/m3u/1463503928-109e67.m3u?orgId=214&topicId=1128&d=264&p=2&story=460848383&t=progseg&e=463448622&seg=17&ft=nprml&f=460848383","path":"/stateofhealth/141585/lifesaving-flights-can-come-with-life-changing-bills","audioUrl":"http://pd.npr.org/anon.npr-mp3/npr/atc/2016/01/20160118_atc_lifesaving_flights_can_come_with_life-changing_bills.mp3?orgId=214&topicId=1128&d=264&p=2&story=460848383&t=progseg&e=463448622&seg=17&ft=nprml&f=460848383","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Butte is an old mining town, tucked away in the southwest corner of Montana with a population of about 34,000. Locals enjoy many things you can't find elsewhere — campgrounds a quick drive from downtown and gorgeous mountain ranges nearby. But in Butte, as in much of rural America, advanced medical care is absent.\u003c/p>\n\u003caside class=\"pullquote alignright\">The air ambulance company was not in their insurance network, and they got a bill for $56,000.\u003c/aside>\n\u003cp>People in Butte who experience serious trauma or need specialty care rely on air ambulance flights to get them the help they need.\u003c/p>\n\u003cp>There were close to 3,000 air ambulance flights in Montana in 2014, and Amy Thomson was on one of them, curled up among the medical bags in the back of the fixed-wing plane. Her 2-month-old daughter, Isla, had a failing heart, and the hospital that could help her was 600 miles away.\u003c/p>\n\u003cp>\"They did such wonderful care of her, and they tried to take great care of me, but in that moment I couldn't let go,\" Thomson says. \"I was so afraid that if I closed my eyes that would be my last vision of her.\"\u003c/p>\n\u003cp>Thomson watched as Isla was placed in a small box strapped to a gurney inside the air ambulance flown by Airlift Northwest.\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>Seattle Children's Hospital saved Isla's life. Her family's health insurance took care of the costs beyond her deductible — except for that critical air ambulance ride to Seattle.\u003c/p>\n\u003cp>The Thomsons read their insurance plan and interpreted it to mean that any emergency medical transportation was covered.\u003c/p>\n\u003cp>But it turned out the air ambulance company was out of their network, and they got a bill for $56,000.\u003c/p>\n\u003cp>Thomson remembers looking at the bill and thinking, \" 'You've got to be kidding me!' Here is the flight that ultimately saved Isla's life by getting her to where she needs to be. And yet is going to put us potentially in financial ruin. Or at least kill our future dreams as a family.\"\u003c/p>\n\u003cp>When a patient needs an air ambulance, the first priority is getting needed care as fast as possible. Patients don't always know who is going to pick them up or if the ambulance is an in-network provider.\u003c/p>\n\u003cp>That can make a huge difference — and lead to huge bills.\u003c/p>\n\u003cp>\"Of all the complaints we have received in our office, not one person was uninsured,\" says Jesse Laslovich, legal counsel for Montana's insurance commissioner. \"They're all insured. And they are frustrated as heck that they're still getting $50,000-balance bills.\"\u003c/p>\n\u003cfigure id=\"attachment_141589\" class=\"wp-caption aligncenter\" style=\"max-width: 1266px\">\u003cimg class=\"size-full wp-image-141589\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png\" alt=\"Isla Thomson with her older sister. Isla turned 2 years old in November. \" width=\"1266\" height=\"952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM.png 1266w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-400x301.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-800x602.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-768x578.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-1180x887.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-22-at-9.01.09-AM-960x722.png 960w\" sizes=\"(max-width: 1266px) 100vw, 1266px\">\u003cfigcaption class=\"wp-caption-text\">Isla Thomson with her older sister. Isla turned 2 years old in November. \u003ccite>(Courtesy of the Thomson family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>States can regulate some medical aspects of air ambulances, but federal laws prevent states from limiting aviation rates, routes and services.\u003c/p>\n\u003cp>The cost of an air ambulance bill is split into two main parts, according to \u003ca href=\"http://leg.mt.gov/content/Committees/Interim/2015-2016/Economic-Affairs/Meetings/Dec-2015/hjr29-survey-responses.pdf\">a study completed by the Montana Legislature\u003c/a>. First, a liftoff fee, which ranges from $8,500 to $15,200 in Montana, plus a per-mile charge for the flight, which ranges from $26 to $133 a mile.\u003c/p>\n\u003cp>Some air ambulance companies offer membership programs as protection from big bills. For an annual fee of about $60 to $100, patients who use that company's services face no cost beyond what their health insurance pays.\u003c/p>\n\u003cp>But Laslovich says that doesn't always work, because patients can't always know who is coming to pick them up.\u003c/p>\n\u003cp>\"You want to know what my personal opinion is about what the problem is?\" Laslovich asks. \"It's money.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/aside>\n\u003cp>There is a lack of understanding about the actual costs of running an air ambulance business, says \u003ca href=\"http://aams.org/our-staff/rick-sherlock/\">Rick Sherlock\u003c/a>, the president of the Association of Air Medical Services. The costs include specialized labor, training, equipment and fuel.\u003c/p>\n\u003cp>\"So those cost drivers are there, and [it's necessary] to maintain readiness to respond 24 hours a day, seven days a week, 365 days a year,\" Sherlock says.\u003c/p>\n\u003cp>He says some air ambulance companies remain out of insurance networks because they can't always reach in-network deals that allow them to stay profitable.\u003c/p>\n\u003cp>\"I think what you also have to look at is that negotiations between [air ambulance] companies and insurance companies take place when there's good negotiations on both sides,\" Sherlock says. \"In situations where there may be only one or two insurance options in an area, it's harder and harder to negotiate on a level playing field.\"\u003c/p>\n\u003cp>There are only three health insurance companies operating in Montana, and at least 14 air ambulance providers. At the time of Isla's trip to Seattle Children's Hospital, the Thomsons' insurer, PacificSource, had no in-network agreements with any air ambulance company in the family's area. (\u003ca href=\"https://pacificsource.com/about-us/overview.aspx\">PacificSource\u003c/a> didn't return calls seeking comment.)\u003c/p>\n\u003cp>For people who think they are protected from crippling health care bills because they have insurance, the cost of an ambulance ride can be a shock.\u003c/p>\n\u003cp>A Montana interim legislative committee is now investigating the wide range of pricing by air ambulance companies within the state. The state of Maryland has taken on a \u003ca href=\"http://www.bizjournals.com/baltimore/news/2015/08/21/maryland-insurance-administration-investigating-20.html\">similar investigation\u003c/a>.\u003c/p>\n\u003cp>In North Dakota an air ambulance company \u003ca href=\"http://bismarcktribune.com/news/state-and-regional/n-d-law-test-case-for-preventing-air-ambulance-price/article_2ad667ea-9fcb-534a-a88d-7225551e56a2.html\">is suing the state\u003c/a> for adding \u003ca href=\"http://www.legis.nd.gov/assembly/64-2015/documents/15-0688-02000.pdf?20151223141631\">regulations\u003c/a> on the industry.\u003c/p>\n\u003cp>Thomson ended up not having to pay for her flight, but only after repeated appeals. According to Thomson, on the same day they were arranging a time to meet with a lawyer, she was notified by her insurance company that it would pay an additional amount of about $30,000, as well as the $13,000 out-of-network fee to the air ambulance company. The air ambulance firm waived the rest of its fee.\u003c/p>\n\u003cp>Isla turned 2 in November. She's a healthy child with big blue eyes, but at times her mother still worries.\u003c/p>\n\u003cp>\"Nobody takes a life flight for a joy ride,\" she says. \"You're not going on Kayak.com and booking a life flight.\"\u003c/p>\n\u003cp>Thomson didn't think the flight should be free but says the huge bill felt wrong. \"I ethically believe this is a part of health care,\" she says. \"This is not some separate entity. There is something ethically wrong that these companies are profiteering off of people's worst moments in their lives.\"\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>\u003cem>This story is part of NPR's reporting partnership with \u003c/em>\u003ca href=\"http://mtpr.org/\">Montana Public Radio\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/141585/lifesaving-flights-can-come-with-life-changing-bills","authors":["byline_stateofhealth_141585"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_251"],"featImg":"stateofhealth_141586","label":"source_stateofhealth_141585"},"stateofhealth_103118":{"type":"posts","id":"stateofhealth_103118","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"103118","score":null,"sort":[1446846224000]},"guestAuthors":[],"slug":"the-mendocino-coast-fears-losing-its-only-hospital","title":"The Mendocino Coast Fears Losing Its Only Hospital","publishDate":1446846224,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Board meetings for the Mendocino Coast District Hospital are usually pretty dismal affairs. The facility in Fort Bragg, California, has been running at a deficit for a decade, and barely survived a recent bankruptcy. But finally, this September, the report from the finance committee wasn’t terrible.\u003c/p>\n\u003cp>“This is probably the first good news that I’ve experienced since I’ve been here,” said Bill Rohr, a doctor at the hospital for 11 years. “This is the first black ink that I’ve seen at the end of the month in quite some time.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Nobody can live here without that hospital. The nearest hospital is an hour and a half away on treacherous mountain roads.'\u003cbr>\n\u003ccite>Sue Gibson, Mendocino resident\u003c/cite>\u003c/aside>\n\u003cp>The committee erupted into applause, even a few cheers. But the joy was short-lived. By the next month, the hospital was back in the red.\u003c/p>\n\u003cp>Things first started going badly for the hospital in 2002, when the lumber mill in Fort Bragg closed down. People lost their jobs -- and their health insurance, which paid good rates to the hospital. Today, about 7,000 people are left in the blue-collar town, and the economy is propped up by tourists who come to the rugged Mendocino coastline to hike or fish. Visiting the hospital does not usually make it onto their itinerary.\u003c/p>\n\u003cp>By 2012, the hospital declared bankruptcy. Now it’s barely hanging on. And some locals are worried that the only hospital in the area might close for good.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Nobody can live here without that hospital,” says Sue Gibson, 78, a Mendocino resident. “I mean the nearest hospital is an hour and a half away on treacherous mountain roads.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/231924129\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>It’s not only her family’s and the community’s health that Gibson is concerned about. She’s afraid the local economy would be wrecked. The hospital is the largest employer.\u003c/p>\n\u003cp>“It has probably the best-paying jobs, and if they close that, all of that income would go away,” she says.\u003c/p>\n\u003cp>That means less money spread around to the local bait shops and seafood restaurants.\u003c/p>\n\u003cp>Also, Gibson says, people's property values would plummet.\u003c/p>\n\u003cp>Across the country, rural communities share similar fears. Small rural hospitals everywhere have been struggling to survive. Many people who live in these areas are older or low income -- not a great customer base for a hospital to make good money.\u003c/p>\n\u003cfigure id=\"attachment_104334\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png\">\u003cimg class=\"size-thumbnail wp-image-104334\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png\" alt=\"Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open.\" width=\"400\" height=\"207\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-800x415.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png 858w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open. \u003ccite>(Google Street View)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The government used to pay these small \u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/CritAccessHospfctsht.pdf\" target=\"_blank\">critical access hospitals\u003c/a> extra to account for that. Medicare reimbursed them 101 percent of their reasonable costs. But after the recession, the government trimmed payments down to 99 percent of costs. Medicaid pays much less, sometimes just half the cost of providing the care.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>At the Mendocino Coast Hospital, more than 80 percent of patients are covered by Medicare or Medicaid.\u003c/p>\n\u003cp>“The general health care reimbursement environment is to do more with less,” says Bob Edwards, the hospital’s CEO. “And I would even go as far to say, it’s a starvation model.”\u003c/p>\n\u003cp>Plus, the government excludes a lot of expenses from its cost calculation, says Wade Sturgeon, CFO, like doctors’ fees or janitorial services. Medicare basically tells the hospital what it will pay.\u003c/p>\n\u003cp>“So it’d be like going in to Safeway and saying, ‘Hey, there’s a jug of milk. I really want that jug of milk, I’ll give you $2,’ ” Sturgeon explains. “But the price says $3.50. 'You’re only going to get $2.' Often times, that’s what happens to us.”\u003c/p>\n\u003cp>So, many hospitals that never had to worry about controlling costs -- now they do. They have to learn to compete in an open market, just like other hospitals, just like many other profit-driven businesses.\u003c/p>\n\u003cp>Some hospitals have planned ahead and adapted. Down the long winding road from Fort Bragg, the Frank R. Howard Memorial Hospital in Willits just finished a $64 million renovation, complete with modern technology and a full organic garden that supplies the hospital cafeteria.\u003c/p>\n\u003cp>But some hospitals haven’t adapted. In the last five years, 57 rural hospitals in the United States have closed, according to data from the \u003ca href=\"https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">Rural Health Research Program \u003c/a>at the University of North Carolina. Others have declared bankruptcy, like the Mendocino Coast District Hospital.\u003c/p>\n\u003cp>\u003cstrong>Battles Over How to Keep Hospital Afloat\u003c/strong>\u003c/p>\n\u003cp>The financial failure led to a lot of finger-pointing in this small town. Administrators blame the policy changes and payment reforms. Some doctors blame the administrators.\u003c/p>\n\u003cp>“It was economic mismanagement, to put a single label over all these things,” says Dr. Peter Glusker, a neurologist based in Fort Bragg for 37 years. “Because of people who just didn’t know any better.”\u003c/p>\n\u003cfigure id=\"attachment_104332\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-e1446845198328.jpg\">\u003cimg class=\"wp-image-104332 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-400x300.jpg\" alt=\"Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting.\" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The public hospital is governed by a five-member board of directors, elected from and by the community. Glusker says some past directors knew nothing about finance or nothing about health care. Some just stopped caring.\u003c/p>\n\u003cp>So he and another doctor ran their own campaign, promising to shake things up on the board and change things. They were elected last year.\u003c/p>\n\u003cp>“There’s a segment of the population that says, ‘Oh good, it’s about bloody time,’ ” Glusker says. “But there’s another segment of the population, in the institution, that says, ‘Hey, you’re rocking the boat and this is bad.’ ”\u003c/p>\n\u003cp>Glusker’s running mate and ally on the board is Dr. Bill Rohr, a steely orthopedist with long gray hair tied back in a tight ponytail. He spent many years in the corporate world and vowed to bring the kind of financial discipline he learned there to the tiny public hospital in Fort Bragg. A lot of people are afraid of him.\u003c/p>\n\u003cp>“Look, this is not about being ruthless,” he says. “It’s about keeping this business alive, and it’s only alive if it makes money, OK.”\u003c/p>\n\u003cp>A lot of his sentences are punctuated like this, with a sometimes impatient “OK,” which seems aimed at making sure you don’t miss his point. Like when he’s giving a presentation at a finance committee meeting, staring daggers down at the CEO.\u003c/p>\n\u003cp>“We keep saying $870,000 loss. Not acceptable, OK.”\u003c/p>\n\u003cp>The current CEO, Bob Edwards, has been on the job six months. He’s the hospital’s fourth chief executive in a year. His right-hand man is Wade Sturgeon, the brand-new CFO, who started in September.\u003c/p>\n\u003cp>On days the financial committee meets, Sturgeon wears a mint-green shirt and a tie with a $100 bill on it. He says things like, “Do the math.”\u003c/p>\n\u003cp>Right now, the hospital administrators and the doctors on the board are pitted against each other in a battle over how to keep the hospital doors open -– a battle that is echoed at small hospitals across the nation.\u003c/p>\n\u003caside class=\"pullquote alignright\">Cut costs or raise prices? Board members disagree on best approach\u003c/aside>\n\u003cp>CFO Sturgeon and CEO Edwards say the hospital should focus on increasing revenues. It should find more patients to come to the hospital, maybe develop new services to attract then.\u003c/p>\n\u003cp>“If you’re not growing, you’re dying,” Sturgeon says.\u003c/p>\n\u003cp>He says the hospital should also charge more money for services provided to patients who have private insurance -- currently about 15 percent of the hospital’s patients.\u003c/p>\n\u003cp>“Anytime we don’t raise prices, we’re leaving money on the table,” he says.\u003c/p>\n\u003cp>But Rohr says that would put an unfair burden on the small business owners in town, the ones who typically buy their own private insurance.\u003c/p>\n\u003cp>He and Glusker say the hospital should be focused on controlling costs.\u003c/p>\n\u003cp>“It’s obviously an expense problem,” Rohr says. \"And you can come to that conclusion very quickly, just by looking at the data.\"\u003c/p>\n\u003cp>He says the hospital is going to have to make some very difficult decisions to balance its budget. He offers this analogy:\u003c/p>\n\u003cp>“There’s 20 people in the water about to drown. And there’s a rowboat there, but the rowboat can only hold 10,” he says. “If 11 people get in that rowboat, it sinks and all die, OK.”\u003c/p>\n\u003cp>At the hospital, this means choosing between a cardiologist and an ophthalmologist, a cafeteria and a new X-ray machine.\u003c/p>\n\u003cp>“It’s horrible to make the decision that 10 are going to drown,” he says. “But I’ve got to pick the 10. OK.”\u003c/p>\n\u003cp>One area Rohr thinks could be ripe for trimming? Administrative positions.\u003c/p>\n\u003cp>“I walk into the hospital to do rounds in the morning, and there’s more people standing around with clipboards than with stethoscopes, and that doesn't feel like the right formula to me,” he says.\u003c/p>\n\u003cp>But CFO Sturgeon says there’s not enough management.\u003c/p>\n\u003cp>“Physicians always think there’s too much management,” he says. “You have some people with 50 direct reports. Does that make sense?”\u003c/p>\n\u003cp>There are some cuts both sides agree on. All say there needs to be some serious culling of the health benefits for hospital staff. Years ago, the nurses union negotiated to have the hospital pay full health benefits for any full-time or part-time nurse and their entire families. Nurses pay nothing toward their monthly premiums.\u003c/p>\n\u003cp>“Do the math. How many people are we paying for to have full family coverage?” Sturgeon says. “I’ve never worked in a hospital that provided the type of health insurance benefits that we have at this facility.”\u003c/p>\n\u003cp>\u003cstrong>Meanwhile, Need for New Hospital\u003c/strong>\u003c/p>\n\u003cp>To understand exactly how dire the financial situation is, one need only walk into the lobby of the hospital itself. It’s like stepping back into 1971. The main patient floor is lined with drab brown carpets. The smell of Salisbury steak spills out of patient rooms.\u003c/p>\n\u003cp>“I’ve been in Third World countries. This is pretty basic, OK,” Rohr says, walking by the operating suite.\u003c/p>\n\u003cp>Through the maternity ward and the emergency room, Rohr says the flooring is layered with asbestos. The concrete isn’t strong enough to hold the weight of modern-day CAT scanners and MRI machines. On top of all that, in 2030 new state requirements kick in for earthquake readiness. It all points to one conclusion.\u003c/p>\n\u003cp>“We’re going to have to build a new hospital,” Rohr says.\u003c/p>\n\u003cp>So, not only is the hospital struggling to maintain a balanced budget through normal hospital operations, it also has to come up with tens of millions of dollars to replace itself in 15 years.\u003c/p>\n\u003cp>It's an especially tall order for a hospital that just posted its first monthly profit in a decade, then slipped into the red again right away.\u003c/p>\n\u003cp>If you ask the Washington policymakers in charge of payment reform, some will say it’s just a harsh reality that some hospitals will have to close. Some previous local administrators have predicted that the Fort Bragg hospital will one day be replaced by a helicopter landing pad. People will be airlifted out for heart attacks and other emergencies. For other planned surgeries, like hip replacements, people will have to drive “over the hill” to another hospital.\u003c/p>\n\u003cp>But the people who live in Fort Bragg and Mendocino don’t like that scenario. Sue Gibson has been hosting community meetings in her living room, where people spread out on the pink Victorian sofas to talk about how to save the hospital.\u003c/p>\n\u003cp>She’s rallying support for a possible solution to the hospital’s financial woes, and it’s one the administrators and doctors are united around: a new tax on homeowners. Local residents will likely vote on it in November 2016.\u003c/p>\n\u003cp>“The only way we're going to be able to save this place, really, is with a parcel tax,” she says. “But they can't even think about that until they clean up their act.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>After the Wall Street meltdown, banks were too big to fail. The feeling here is that the local hospital is too important to fail. And the residents will be tapped to fund the bailout.\u003c/p>\n\n","blocks":[],"excerpt":"Saving the Fort Bragg hospital from bankruptcy has sparked a small town drama, pitting hospital administrators and doctors against each other. \r\n","status":"publish","parent":0,"modified":1447202097,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":64,"wordCount":2200},"headData":{"title":"The Mendocino Coast Fears Losing Its Only Hospital | KQED","description":"Saving the Fort Bragg hospital from bankruptcy has sparked a small town drama, pitting hospital administrators and doctors against each other. \r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"The Mendocino Coast Fears Losing Its Only Hospital","datePublished":"2015-11-06T21:43:44.000Z","dateModified":"2015-11-11T00:34:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"103118 http://ww2.kqed.org/stateofhealth/?p=103118","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/11/06/the-mendocino-coast-fears-losing-its-only-hospital/","disqusTitle":"The Mendocino Coast Fears Losing Its Only Hospital","path":"/stateofhealth/103118/the-mendocino-coast-fears-losing-its-only-hospital","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Board meetings for the Mendocino Coast District Hospital are usually pretty dismal affairs. The facility in Fort Bragg, California, has been running at a deficit for a decade, and barely survived a recent bankruptcy. But finally, this September, the report from the finance committee wasn’t terrible.\u003c/p>\n\u003cp>“This is probably the first good news that I’ve experienced since I’ve been here,” said Bill Rohr, a doctor at the hospital for 11 years. “This is the first black ink that I’ve seen at the end of the month in quite some time.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Nobody can live here without that hospital. The nearest hospital is an hour and a half away on treacherous mountain roads.'\u003cbr>\n\u003ccite>Sue Gibson, Mendocino resident\u003c/cite>\u003c/aside>\n\u003cp>The committee erupted into applause, even a few cheers. But the joy was short-lived. By the next month, the hospital was back in the red.\u003c/p>\n\u003cp>Things first started going badly for the hospital in 2002, when the lumber mill in Fort Bragg closed down. People lost their jobs -- and their health insurance, which paid good rates to the hospital. Today, about 7,000 people are left in the blue-collar town, and the economy is propped up by tourists who come to the rugged Mendocino coastline to hike or fish. Visiting the hospital does not usually make it onto their itinerary.\u003c/p>\n\u003cp>By 2012, the hospital declared bankruptcy. Now it’s barely hanging on. And some locals are worried that the only hospital in the area might close for good.\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>“Nobody can live here without that hospital,” says Sue Gibson, 78, a Mendocino resident. “I mean the nearest hospital is an hour and a half away on treacherous mountain roads.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/231924129&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/231924129'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>It’s not only her family’s and the community’s health that Gibson is concerned about. She’s afraid the local economy would be wrecked. The hospital is the largest employer.\u003c/p>\n\u003cp>“It has probably the best-paying jobs, and if they close that, all of that income would go away,” she says.\u003c/p>\n\u003cp>That means less money spread around to the local bait shops and seafood restaurants.\u003c/p>\n\u003cp>Also, Gibson says, people's property values would plummet.\u003c/p>\n\u003cp>Across the country, rural communities share similar fears. Small rural hospitals everywhere have been struggling to survive. Many people who live in these areas are older or low income -- not a great customer base for a hospital to make good money.\u003c/p>\n\u003cfigure id=\"attachment_104334\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png\">\u003cimg class=\"size-thumbnail wp-image-104334\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png\" alt=\"Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open.\" width=\"400\" height=\"207\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-800x415.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png 858w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open. \u003ccite>(Google Street View)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The government used to pay these small \u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/CritAccessHospfctsht.pdf\" target=\"_blank\">critical access hospitals\u003c/a> extra to account for that. Medicare reimbursed them 101 percent of their reasonable costs. But after the recession, the government trimmed payments down to 99 percent of costs. Medicaid pays much less, sometimes just half the cost of providing the care.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>At the Mendocino Coast Hospital, more than 80 percent of patients are covered by Medicare or Medicaid.\u003c/p>\n\u003cp>“The general health care reimbursement environment is to do more with less,” says Bob Edwards, the hospital’s CEO. “And I would even go as far to say, it’s a starvation model.”\u003c/p>\n\u003cp>Plus, the government excludes a lot of expenses from its cost calculation, says Wade Sturgeon, CFO, like doctors’ fees or janitorial services. Medicare basically tells the hospital what it will pay.\u003c/p>\n\u003cp>“So it’d be like going in to Safeway and saying, ‘Hey, there’s a jug of milk. I really want that jug of milk, I’ll give you $2,’ ” Sturgeon explains. “But the price says $3.50. 'You’re only going to get $2.' Often times, that’s what happens to us.”\u003c/p>\n\u003cp>So, many hospitals that never had to worry about controlling costs -- now they do. They have to learn to compete in an open market, just like other hospitals, just like many other profit-driven businesses.\u003c/p>\n\u003cp>Some hospitals have planned ahead and adapted. Down the long winding road from Fort Bragg, the Frank R. Howard Memorial Hospital in Willits just finished a $64 million renovation, complete with modern technology and a full organic garden that supplies the hospital cafeteria.\u003c/p>\n\u003cp>But some hospitals haven’t adapted. In the last five years, 57 rural hospitals in the United States have closed, according to data from the \u003ca href=\"https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">Rural Health Research Program \u003c/a>at the University of North Carolina. Others have declared bankruptcy, like the Mendocino Coast District Hospital.\u003c/p>\n\u003cp>\u003cstrong>Battles Over How to Keep Hospital Afloat\u003c/strong>\u003c/p>\n\u003cp>The financial failure led to a lot of finger-pointing in this small town. Administrators blame the policy changes and payment reforms. Some doctors blame the administrators.\u003c/p>\n\u003cp>“It was economic mismanagement, to put a single label over all these things,” says Dr. Peter Glusker, a neurologist based in Fort Bragg for 37 years. “Because of people who just didn’t know any better.”\u003c/p>\n\u003cfigure id=\"attachment_104332\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-e1446845198328.jpg\">\u003cimg class=\"wp-image-104332 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-400x300.jpg\" alt=\"Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting.\" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The public hospital is governed by a five-member board of directors, elected from and by the community. Glusker says some past directors knew nothing about finance or nothing about health care. Some just stopped caring.\u003c/p>\n\u003cp>So he and another doctor ran their own campaign, promising to shake things up on the board and change things. They were elected last year.\u003c/p>\n\u003cp>“There’s a segment of the population that says, ‘Oh good, it’s about bloody time,’ ” Glusker says. “But there’s another segment of the population, in the institution, that says, ‘Hey, you’re rocking the boat and this is bad.’ ”\u003c/p>\n\u003cp>Glusker’s running mate and ally on the board is Dr. Bill Rohr, a steely orthopedist with long gray hair tied back in a tight ponytail. He spent many years in the corporate world and vowed to bring the kind of financial discipline he learned there to the tiny public hospital in Fort Bragg. A lot of people are afraid of him.\u003c/p>\n\u003cp>“Look, this is not about being ruthless,” he says. “It’s about keeping this business alive, and it’s only alive if it makes money, OK.”\u003c/p>\n\u003cp>A lot of his sentences are punctuated like this, with a sometimes impatient “OK,” which seems aimed at making sure you don’t miss his point. Like when he’s giving a presentation at a finance committee meeting, staring daggers down at the CEO.\u003c/p>\n\u003cp>“We keep saying $870,000 loss. Not acceptable, OK.”\u003c/p>\n\u003cp>The current CEO, Bob Edwards, has been on the job six months. He’s the hospital’s fourth chief executive in a year. His right-hand man is Wade Sturgeon, the brand-new CFO, who started in September.\u003c/p>\n\u003cp>On days the financial committee meets, Sturgeon wears a mint-green shirt and a tie with a $100 bill on it. He says things like, “Do the math.”\u003c/p>\n\u003cp>Right now, the hospital administrators and the doctors on the board are pitted against each other in a battle over how to keep the hospital doors open -– a battle that is echoed at small hospitals across the nation.\u003c/p>\n\u003caside class=\"pullquote alignright\">Cut costs or raise prices? Board members disagree on best approach\u003c/aside>\n\u003cp>CFO Sturgeon and CEO Edwards say the hospital should focus on increasing revenues. It should find more patients to come to the hospital, maybe develop new services to attract then.\u003c/p>\n\u003cp>“If you’re not growing, you’re dying,” Sturgeon says.\u003c/p>\n\u003cp>He says the hospital should also charge more money for services provided to patients who have private insurance -- currently about 15 percent of the hospital’s patients.\u003c/p>\n\u003cp>“Anytime we don’t raise prices, we’re leaving money on the table,” he says.\u003c/p>\n\u003cp>But Rohr says that would put an unfair burden on the small business owners in town, the ones who typically buy their own private insurance.\u003c/p>\n\u003cp>He and Glusker say the hospital should be focused on controlling costs.\u003c/p>\n\u003cp>“It’s obviously an expense problem,” Rohr says. \"And you can come to that conclusion very quickly, just by looking at the data.\"\u003c/p>\n\u003cp>He says the hospital is going to have to make some very difficult decisions to balance its budget. He offers this analogy:\u003c/p>\n\u003cp>“There’s 20 people in the water about to drown. And there’s a rowboat there, but the rowboat can only hold 10,” he says. “If 11 people get in that rowboat, it sinks and all die, OK.”\u003c/p>\n\u003cp>At the hospital, this means choosing between a cardiologist and an ophthalmologist, a cafeteria and a new X-ray machine.\u003c/p>\n\u003cp>“It’s horrible to make the decision that 10 are going to drown,” he says. “But I’ve got to pick the 10. OK.”\u003c/p>\n\u003cp>One area Rohr thinks could be ripe for trimming? Administrative positions.\u003c/p>\n\u003cp>“I walk into the hospital to do rounds in the morning, and there’s more people standing around with clipboards than with stethoscopes, and that doesn't feel like the right formula to me,” he says.\u003c/p>\n\u003cp>But CFO Sturgeon says there’s not enough management.\u003c/p>\n\u003cp>“Physicians always think there’s too much management,” he says. “You have some people with 50 direct reports. Does that make sense?”\u003c/p>\n\u003cp>There are some cuts both sides agree on. All say there needs to be some serious culling of the health benefits for hospital staff. Years ago, the nurses union negotiated to have the hospital pay full health benefits for any full-time or part-time nurse and their entire families. Nurses pay nothing toward their monthly premiums.\u003c/p>\n\u003cp>“Do the math. How many people are we paying for to have full family coverage?” Sturgeon says. “I’ve never worked in a hospital that provided the type of health insurance benefits that we have at this facility.”\u003c/p>\n\u003cp>\u003cstrong>Meanwhile, Need for New Hospital\u003c/strong>\u003c/p>\n\u003cp>To understand exactly how dire the financial situation is, one need only walk into the lobby of the hospital itself. It’s like stepping back into 1971. The main patient floor is lined with drab brown carpets. The smell of Salisbury steak spills out of patient rooms.\u003c/p>\n\u003cp>“I’ve been in Third World countries. This is pretty basic, OK,” Rohr says, walking by the operating suite.\u003c/p>\n\u003cp>Through the maternity ward and the emergency room, Rohr says the flooring is layered with asbestos. The concrete isn’t strong enough to hold the weight of modern-day CAT scanners and MRI machines. On top of all that, in 2030 new state requirements kick in for earthquake readiness. It all points to one conclusion.\u003c/p>\n\u003cp>“We’re going to have to build a new hospital,” Rohr says.\u003c/p>\n\u003cp>So, not only is the hospital struggling to maintain a balanced budget through normal hospital operations, it also has to come up with tens of millions of dollars to replace itself in 15 years.\u003c/p>\n\u003cp>It's an especially tall order for a hospital that just posted its first monthly profit in a decade, then slipped into the red again right away.\u003c/p>\n\u003cp>If you ask the Washington policymakers in charge of payment reform, some will say it’s just a harsh reality that some hospitals will have to close. Some previous local administrators have predicted that the Fort Bragg hospital will one day be replaced by a helicopter landing pad. People will be airlifted out for heart attacks and other emergencies. For other planned surgeries, like hip replacements, people will have to drive “over the hill” to another hospital.\u003c/p>\n\u003cp>But the people who live in Fort Bragg and Mendocino don’t like that scenario. Sue Gibson has been hosting community meetings in her living room, where people spread out on the pink Victorian sofas to talk about how to save the hospital.\u003c/p>\n\u003cp>She’s rallying support for a possible solution to the hospital’s financial woes, and it’s one the administrators and doctors are united around: a new tax on homeowners. Local residents will likely vote on it in November 2016.\u003c/p>\n\u003cp>“The only way we're going to be able to save this place, really, is with a parcel tax,” she says. “But they can't even think about that until they clean up their act.”\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>After the Wall Street meltdown, banks were too big to fail. The feeling here is that the local hospital is too important to fail. And the residents will be tapped to fund the bailout.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/103118/the-mendocino-coast-fears-losing-its-only-hospital","authors":["3205"],"categories":["stateofhealth_11"],"tags":["stateofhealth_73","stateofhealth_2519","stateofhealth_251"],"featImg":"stateofhealth_104338","label":"stateofhealth"},"stateofhealth_83818":{"type":"posts","id":"stateofhealth_83818","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"83818","score":null,"sort":[1443451543000]},"guestAuthors":[],"slug":"need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","title":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","publishDate":1443451543,"format":"image","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\n\u003cp>https://vimeo.com/140479930\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>[contextly_sidebar id=\"2KQd30QKKYZZL3bwvUkl6icTu31wfvST\"]\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/225965640\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n","blocks":[],"excerpt":"One in three California farmworkers speaks an indigenous language and barely understands Spanish. ","status":"publish","parent":0,"modified":1443477793,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":67,"wordCount":1896},"headData":{"title":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters | KQED","description":"One in three California farmworkers speaks an indigenous language and barely understands Spanish. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","datePublished":"2015-09-28T14:45:43.000Z","dateModified":"2015-09-28T22:03:13.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"83818 http://ww2.kqed.org/stateofhealth/?p=83818","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/","disqusTitle":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","path":"/stateofhealth/83818/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"vimeoLink","attributes":{"named":{"vimeoId":"140479930"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\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>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/225965640&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/225965640'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","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>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/83818/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","authors":["230"],"categories":["stateofhealth_11"],"tags":["stateofhealth_280","stateofhealth_249","stateofhealth_407","stateofhealth_325","stateofhealth_53","stateofhealth_2519","stateofhealth_251"],"featImg":"stateofhealth_83922","label":"stateofhealth"},"stateofhealth_57815":{"type":"posts","id":"stateofhealth_57815","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"57815","score":null,"sort":[1439049734000]},"guestAuthors":[],"slug":"more-obamacare-choices-for-consumers-in-rural-northern-california","title":"More Obamacare Choices for Rural Northern California Consumers","publishDate":1439049734,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>People who live in rural Northern California will see more choice and competition in the health insurance marketplace next year, giving consumers a better chance of finding a plan -- and a doctor -- that can meet their needs.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\" target=\"_blank\">The changes\u003c/a>, unveiled last month by the state’s Affordable Care Act marketplace Covered California, will now allow some consumers to cross state lines for care. That means Californians living near the Oregon or Nevada borders can get subsidies to buy plans that pay for routine care in those states, something that previously was allowed only in emergencies.\u003c/p>\n\u003cp>In addition, all 22 counties that had areas with only one choice of insurer in 2015 and 2014 will now have at least three insurers selling plans.\u003c/p>\n\u003cp>Northern California customers may notice a jump in their premium costs next year, however. Region-wide, they will have a 10.6 percent increase over this year, while the statewide average increase is 4 percent.\u003c/p>\n\u003cfigure id=\"attachment_559016\" class=\"wp-caption alignright\" style=\"max-width: 370px\">\u003cimg class=\"wp-image-559016 size-khn-article-small\" src=\"https://kaiserhealthnews.files.wordpress.com/2015/08/bartolone-california-lomas-570.jpg?w=370&h=247&crop=1\" alt=\"Lori Lomas, an insurance agent with Feather Financial in Quincy, California, has noticed that her clients in San Francisco have many more health carrier options than her mountain neighbors. (Photo by Pauline Bartolone/Capital Public Radio).\" width=\"370\" height=\"247\">\u003cfigcaption class=\"wp-caption-text\">Lori Lomas, an insurance agent with Feather Financial in Quincy, California, welcomes the increased choices Covered California will have for mountain communities in 2016. (Photo by Pauline Bartolone)\u003c/figcaption>\u003c/figure>\n\u003cp>Lori Lomas, a health insurance agent with Feather Financial in Quincy, California, said not being able to travel to Reno, Nevada for medical care has been a hardship for many of her clients who live in isolated communities in the Sierra Nevada mountains.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s disrupted their care,” she said. “It’s affected people’s relationship with their doctors and it’s affected their trust in their insurance companies, big time.”\u003c/p>\n\u003cp>Next year, the two major insurers in the area, Anthem Blue Cross and Blue Shield of California, will offer routine out-of-state doctor coverage in 2016 individual policies.\u003c/p>\n\u003cp>A minimum of three insurers will be offering plans in each ZIP code of a 22 county region, a vast rural area that stretches south from the border of Oregon to the Sacramento County line. Two additional insurers will be selling in some parts of the area.\u003c/p>\n\u003cp>[contextly_sidebar id=\"veGNr4nvAF4rcegfdnCuKBnobHzY4S8o\"]Anthem Blue Cross, which has 91.7 percent of the health exchange’s market share in the Northern California region, says it made the decision to reinstate out-of-state coverage after hearing from consumers that they wanted the benefit.\u003c/p>\n\u003cp>“At the earliest opportunity to make substantive changes to our Covered California policies, we did,” says Darrel Ng, spokesman for Anthem Blue Cross.\u003c/p>\n\u003cp>Consumer demand also motivated Blue Shield of California to expand into areas where they had retreated from in 2014. Before new market rules under the Affordable Care Act, it had sold individual policies in all areas of the state. After Jan. 1, 2014, it stopped selling in about 250 ZIP codes, including vast areas of Northern California, in order to keep “premiums low.”\u003c/p>\n\u003cp>The company now says that decision “created a lot of disruption in the marketplace,” and in 2016 the company will be selling again in all ZIP codes.\u003c/p>\n\u003cp>“We’ve been able to now provide a network that would support us offering coverage in those ZIP codes that we didn’t have covered in 2015,” said Jeff Smith, general manager and vice president for Individual and Family Plans for Blue Shield of California.\u003c/p>\n\u003cp>[contextly_sidebar id=\"vPbPrbLkhNceuPvuX4550TQeJ66OM6lF\"]In the individual market next year, the company will be offering statewide preferred provider organizations (PPOs) and will discontinue the exclusive provider organizations (EPOs) offered this year, which restricted coverage to doctors only in a fixed geographic area.\u003c/p>\n\u003cp>Covered California would not comment on how its negotiations with insurers may have influenced the companies’ decision-making, but the exchange says it is pleased that consumers will get more choices next year.\u003c/p>\n\u003cp>“It’s no secret that Covered California looked to plans to expand and provide stronger and more comprehensive value to consumers, ” says Dana Howard, deputy director of communications for Covered California.\u003c/p>\n\u003cp>United Healthcare and Health Net will also be selling policies in Northern California next year. Covered California consumers may take a good look at those new options next open enrollment period. Lomas says the restricted doctor coverage and Blue Shield’s black out in certain ZIP codes had given the two companies a “bad name.”\u003c/p>\n\u003cp>“Now I’m going to show people the screen and it will be [more] choices for everyone,” says Lomas about the next open enrollment period.\u003c/p>\n\u003cp>In some areas of Northern California, health insurance shoppers will see even more options.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is from \u003ca href=\"http://khn.org\">Kaiser Health News\u003c/a>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"For starters, people living near Oregon or Nevada will now be able to travel there for routine care, which wasn't covered in past years.","status":"publish","parent":0,"modified":1439000181,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":819},"headData":{"title":"More Obamacare Choices for Rural Northern California Consumers | KQED","description":"For starters, people living near Oregon or Nevada will now be able to travel there for routine care, which wasn't covered in past years.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"More Obamacare Choices for Rural Northern California Consumers","datePublished":"2015-08-08T16:02:14.000Z","dateModified":"2015-08-08T02:16:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"57815 http://ww2.kqed.org/stateofhealth/?p=57815","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/08/08/more-obamacare-choices-for-consumers-in-rural-northern-california/","disqusTitle":"More Obamacare Choices for Rural Northern California Consumers","nprByline":"Pauline Bartolone","path":"/stateofhealth/57815/more-obamacare-choices-for-consumers-in-rural-northern-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>People who live in rural Northern California will see more choice and competition in the health insurance marketplace next year, giving consumers a better chance of finding a plan -- and a doctor -- that can meet their needs.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/27/covered-california-2016-premiums-to-increase-modestly/\" target=\"_blank\">The changes\u003c/a>, unveiled last month by the state’s Affordable Care Act marketplace Covered California, will now allow some consumers to cross state lines for care. That means Californians living near the Oregon or Nevada borders can get subsidies to buy plans that pay for routine care in those states, something that previously was allowed only in emergencies.\u003c/p>\n\u003cp>In addition, all 22 counties that had areas with only one choice of insurer in 2015 and 2014 will now have at least three insurers selling plans.\u003c/p>\n\u003cp>Northern California customers may notice a jump in their premium costs next year, however. Region-wide, they will have a 10.6 percent increase over this year, while the statewide average increase is 4 percent.\u003c/p>\n\u003cfigure id=\"attachment_559016\" class=\"wp-caption alignright\" style=\"max-width: 370px\">\u003cimg class=\"wp-image-559016 size-khn-article-small\" src=\"https://kaiserhealthnews.files.wordpress.com/2015/08/bartolone-california-lomas-570.jpg?w=370&h=247&crop=1\" alt=\"Lori Lomas, an insurance agent with Feather Financial in Quincy, California, has noticed that her clients in San Francisco have many more health carrier options than her mountain neighbors. (Photo by Pauline Bartolone/Capital Public Radio).\" width=\"370\" height=\"247\">\u003cfigcaption class=\"wp-caption-text\">Lori Lomas, an insurance agent with Feather Financial in Quincy, California, welcomes the increased choices Covered California will have for mountain communities in 2016. (Photo by Pauline Bartolone)\u003c/figcaption>\u003c/figure>\n\u003cp>Lori Lomas, a health insurance agent with Feather Financial in Quincy, California, said not being able to travel to Reno, Nevada for medical care has been a hardship for many of her clients who live in isolated communities in the Sierra Nevada mountains.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s disrupted their care,” she said. “It’s affected people’s relationship with their doctors and it’s affected their trust in their insurance companies, big time.”\u003c/p>\n\u003cp>Next year, the two major insurers in the area, Anthem Blue Cross and Blue Shield of California, will offer routine out-of-state doctor coverage in 2016 individual policies.\u003c/p>\n\u003cp>A minimum of three insurers will be offering plans in each ZIP code of a 22 county region, a vast rural area that stretches south from the border of Oregon to the Sacramento County line. Two additional insurers will be selling in some parts of the area.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Anthem Blue Cross, which has 91.7 percent of the health exchange’s market share in the Northern California region, says it made the decision to reinstate out-of-state coverage after hearing from consumers that they wanted the benefit.\u003c/p>\n\u003cp>“At the earliest opportunity to make substantive changes to our Covered California policies, we did,” says Darrel Ng, spokesman for Anthem Blue Cross.\u003c/p>\n\u003cp>Consumer demand also motivated Blue Shield of California to expand into areas where they had retreated from in 2014. Before new market rules under the Affordable Care Act, it had sold individual policies in all areas of the state. After Jan. 1, 2014, it stopped selling in about 250 ZIP codes, including vast areas of Northern California, in order to keep “premiums low.”\u003c/p>\n\u003cp>The company now says that decision “created a lot of disruption in the marketplace,” and in 2016 the company will be selling again in all ZIP codes.\u003c/p>\n\u003cp>“We’ve been able to now provide a network that would support us offering coverage in those ZIP codes that we didn’t have covered in 2015,” said Jeff Smith, general manager and vice president for Individual and Family Plans for Blue Shield of California.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In the individual market next year, the company will be offering statewide preferred provider organizations (PPOs) and will discontinue the exclusive provider organizations (EPOs) offered this year, which restricted coverage to doctors only in a fixed geographic area.\u003c/p>\n\u003cp>Covered California would not comment on how its negotiations with insurers may have influenced the companies’ decision-making, but the exchange says it is pleased that consumers will get more choices next year.\u003c/p>\n\u003cp>“It’s no secret that Covered California looked to plans to expand and provide stronger and more comprehensive value to consumers, ” says Dana Howard, deputy director of communications for Covered California.\u003c/p>\n\u003cp>United Healthcare and Health Net will also be selling policies in Northern California next year. Covered California consumers may take a good look at those new options next open enrollment period. Lomas says the restricted doctor coverage and Blue Shield’s black out in certain ZIP codes had given the two companies a “bad name.”\u003c/p>\n\u003cp>“Now I’m going to show people the screen and it will be [more] choices for everyone,” says Lomas about the next open enrollment period.\u003c/p>\n\u003cp>In some areas of Northern California, health insurance shoppers will see even more options.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is from \u003ca href=\"http://khn.org\">Kaiser Health News\u003c/a>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/57815/more-obamacare-choices-for-consumers-in-rural-northern-california","authors":["byline_stateofhealth_57815"],"categories":["stateofhealth_2442","stateofhealth_15"],"tags":["stateofhealth_368","stateofhealth_251"],"featImg":"stateofhealth_57826","label":"stateofhealth"},"stateofhealth_24088":{"type":"posts","id":"stateofhealth_24088","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"24088","score":null,"sort":[1425146533000]},"guestAuthors":[],"slug":"when-health-care-is-far-from-home","title":"When Health Care Is Far From Home","publishDate":1425146533,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_24091\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-e1425075174221.jpg\">\u003cimg class=\"size-large wp-image-24091\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-640x427.jpg\" alt=\"Richard Sandor, 65, of Hayfork, took the hour long bus ride to Mad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Richard Sandor, 65, of Hayfork, took the hour-long bus ride to illad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>\u003cstrong>The biggest barrier to treatment for residents of a tiny town in the mountains of Northern California isn’t insurance coverage -- it’s distance.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Daniela Hernandez,\u003c/strong> \u003cem>Kaiser Health News\u003c/em>\u003c/p>\n\u003cp>HAYFORK, Calif. -- It’s Tuesday morning, half past eight and already hot, when the small bus pulls up to the community clinic. Most of the passengers are waiting in front -- an old man with a cane, two mothers with four kids between them, packed lunches in hand.\u003c/p>\n\u003cp>Two more arrive. A gray-bearded man with a pirate bandana steps from the shelter of his Subaru. A sunken-cheeked woman rushes up on her bike.\u003c/p>\n\u003cp>“Woohoo! We have a full car!” the driver says brightly after they’ve all climbed aboard. The riders smile back, some with a hint of resignation. It’s time for the weekly trip to the clinic in Mad River, about 30 miles down a winding mountain road. The tight twists and turns are hard on the stomach, but even harder on the joints -- especially if you have chronic Lyme disease, as more than a few of these riders do.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jeff Clarke is one of them. He acquired Lyme long ago from deer ticks that dwell in the region’s sprawling forests. But today he’s going to ask about a lump that’s been growing in his left breast. It’s starting to hurt, and he’s worried. His fellow riders list their own ailments matter-of-factly: asthma, dental decay, diabetes, drug addiction, heart disease and much more.\u003c!--more-->\u003c/p>\n\u003cfigure id=\"attachment_24094\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-e1425076091597.jpg\">\u003cimg class=\"wp-image-24094 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-300x200.jpg\" alt=\"Hayfork-24_C\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeff Clarke, 57, at his trailer in Hayfork, Calif. Clarke says the lack of health care in Hayfork makes it hard to treat his high blood pressure, hepatitis C and Lyme disease. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>They wouldn’t be making this trip if they didn’t have to. In Hayfork, “we’re down to the remnants of the medical personnel,” says Clarke, 58, a well-spoken musician with a love for science and cats. “It just came to the point where if I needed to deal with anything important I just felt much more comfortable going over to Mad River.\u003c/p>\n\u003cp>Like so many American small towns, Hayfork has lost its vitality and much of its youth to bigger places. Nestled midway between Redding and Eureka, it’s not near anything. Even Weaverville, the tiny county seat, is 45 minutes away. There are no retail stores, theaters, museums, fancy restaurants. What the town has is star-filled skies and tree-lined ridges.\u003c/p>\n\u003cp>“We were all just fine with that,” says Shannon Barnett, a 41-year-old a former school teacher who grew up here. “Now it’s different.”\u003c/p>\n\u003cp>She’s referring to the dearth of basic health services.\u003c/p>\n\u003cp>There’s a local clinic but it’s staffed by doctors who rotate in from Weaverville once or twice a week, and otherwise it’s run by physician’s assistants. There are no hospitals for miles.\u003c/p>\n\u003cp>The Mad River clinic is bigger than Hayfork’s and offers a wider array of services but Clarke says it’s so backed up with patients it can take weeks to get an appointment.\u003c/p>\n\u003cp>In 2012, according to state data, there were \u003ca href=\"http://www.oshpd.ca.gov/HWDD/HWC/FactSheets/PhysiciansSurgeonsMD.pdf\">11 medical doctors\u003c/a> practicing in all of Trinity County, roughly one per 1,200 residents. Statewide, the ratio is closer to one per 300. Specialists like dentists and psychiatrists are nearly non-existent in the county.\u003c/p>\n\u003cp>A county behavioral office offers counseling in Hayfork, but a counselor isn't there every day and sessions are by appointment only. Sometimes the most expedient treatment comes in jail -- Clarke calls it the “nudge from the judge.”\u003c/p>\n\u003cp>He mentions an acquaintance named Robbie, who suffers from paranoid schizophrenia. Since being released from jail, he’s been off his meds, Clarke says. He walks up and down Hayfork’s main strip, muttering to passers-by about the many people who are after him.\u003c/p>\n\u003cp>In these tiny towns of California’s far north, lacking insurance is not the biggest obstacle to care. Most people are insured, a good number are on Medi-Cal.\u003c/p>\n\u003cp>What’s ailing these people is geography – that, and poverty. The median household income in \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_B19013&prodType=table\">Hayfork is about $34,000 a year\u003c/a>, well below the \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_1YR_S1901&prodType=table\">statewide figure of about $60,000\u003c/a>,.. Unemployment is extraordinarily high – estimates range between \u003ca href=\"http://www.homefacts.com/unemployment/California/Trinity-County/Hayfork.html\">9\u003c/a> and \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_S2301&prodType=table\">26 percent\u003c/a>. Many people lack a sturdy car to drive, or even money for gas.\u003c/p>\n\u003cp>In the federal government’s parlance, Hayfork is a “medically underserved” community – one of 170 in California and roughly 3,500 in the country.\u003c/p>\n\u003cp>By definition, these areas have too few primary care providers, high infant mortality, pervasive poverty or a significant elderly population. Some medically underserved areas are islands of deprivation within otherwise well-stocked urban areas. Others are dots on the map like Hayfork, far from where doctors and medical services are clustered. According to the National Rural Health Association, \u003ca href=\"http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care\">only about ten percent of physicians practice in rural America, where nearly a quarter of the population lives.\u003c/a>\u003c/p>\n\u003cp>For Hayforkers, health care is available – just on the other side of the mountain. “The problem, says Greg Schneider, a 65-year-old writer and band mate of Clarke’s, “is getting there.”\u003c/p>\n\u003cp>\u003cstrong>Lumberjacks and Janes\u003c/strong>\u003c/p>\n\u003cp>For decades\u003cstrong>,\u003c/strong> Hayfork had been fortunate. Well after the rise of urban health systems and their intricate business arrangements, it had a tight-knit local “system” founded on the simple, generous commitment of two people: a general practitioner and a pharmacist.\u003c/p>\n\u003cp>“He was everybody’s doctor,” Barnettsays of Dr. Earl Mercill, a GP who moved up from the Central Valley almost 50 years ago. “You never thought about going to anyone else.”\u003c/p>\n\u003cp>Mercill moved his large family to Hayfork in 1967 on a friend’s recommendation. It was still a mill town then, filled with lumberjacks and Janes, as the women were known, though it also had restaurants, shops and even a thriving art and music scene.\u003c/p>\n\u003cp>They built a house and settled on 40 acres. Mercill opened a clinic downtown.\u003c/p>\n\u003cfigure id=\"attachment_24096\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-e1425076271333.jpg\">\u003cimg class=\"wp-image-24096 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-300x200.jpg\" alt=\"Hayfork-18\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Earl Mercill moved his family to Hayfork in 1967. He opened the town's first clinic and was the only doctor for decades until he retired in the late 1990s. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>He was beloved almost from the beginning. He made house calls -- sometimes walking over precariously narrow log bridges or shuttling to his patients’ homes by snowmobile. He delivered babies by flashlight after storms knocked down power and waited by his patients’ bedsides for hours, sometimes charging little more than a slice of cake.\u003c/p>\n\u003cp>“If they didn’t have any money, I saw them,” recalls Mercill, who’s now 91 years old. “If they could pay later, fine.\" If they didn’t, they didn’t.”\u003c/p>\n\u003cp>In 1982, Gerry Reichelderfer, a genial pharmacist from Marin County, came up and fell in love with mountain life. He took over the drug store next to Mercill’s clinic.\u003c/p>\n\u003cp>Reichelderfer lived just seven minutes and a single stop sign away from his shop. He’d open up anytime people needed a prescription. If they couldn’t pay right then, he’d put it on an I.O.U.\u003c/p>\n\u003cp>The men joined forces, talking daily by intercom. The partnership would last nearly two decades.\u003c/p>\n\u003cp>Mercill officially retired in the late 1990s, though he kept seeing patients for some time afterward. The town dedicated a clock to him in the square.\u003c/p>\n\u003cp>Eventually he sold his clinic to a doctor based in Weaverville. That doctor recently sold it again, to a district hospital.\u003c/p>\n\u003cp>“It was like a limb being cut off,” Barnett says of Mercill’s retirement. “I know at first I didn’t have another doctor for a long time. Other people didn’t either.”\u003c/p>\n\u003cp>\u003cstrong>A Turn of Fortune\u003c/strong>\u003c/p>\n\u003cp>After Hayfork’s mill closed in the early-1990s, the town's population -- never higher than the low thousands -- dwindled. Homelessness, poverty and drug addiction took hold.\u003c/p>\n\u003cp>Clarke, a runaway and hitchhiker in his youth, was in some ways typical of Hayfork’s new generation. He arrived in the 1980s, in the clutches of methamphetamine addiction, a habit he picked up in the bars where he played guitar. For years, he landed jobs and lost them -- working as a wood chopper, sandwich maker and cabinet craftsman. He started seeing a woman he met in rehab, then split with her, but not before they had a daughter. They named her Stormy Brooke. He gained custody and lost it more than once.\u003c/p>\n\u003cp>The 12-step meetings at Hayfork’s Solid Rock Church saved his life, he says. He goes every Monday and has been sober 10 years.\u003c/p>\n\u003cp>His health is ok, considering. He lost his teeth. His bottom denture wore out long ago and his top one is breaking\u003cstrong>. \u003c/strong>He has high blood pressure and hepatitis C, plus the Lyme disease that became chronic because it wasn’t treated right away.\u003c/p>\n\u003cp>Clarke lives in a two-room trailer next to the town cemetery. Supported by $889 a month in disability insurance, he spends his time organizing 12-step meetings, reading and volunteering as a sound engineer at a local coffee shop. On good nights, he gets paid a little. He wants to stay as healthy as possible, hesays, so he can look after 23-year-old Stormy and her 2-year-old son, Tony, who lives with his dad.\u003c/p>\n\u003cp>Stormy Clarke, a tall beauty too insecure to know it, cuts herself and has made several attempts at suicide. Her porcelain arms bear the scars.\u003c/p>\n\u003cp>“She has no self-esteem,” Jeff Clarke says. “She has no faith in love, or trust for any other human beings. She has some real darkness inside her, you know? I’m sure I’m responsible for a majority of that.”\u003c/p>\n\u003cp>Stormy Clarke has tried to get help, she says, but it's only sporadically available and hasn't helped much.\u003c/p>\n\u003cp>In June, during a fight with her father, Stormy had what Jeff thought was a stroke. En route to Redding in an ambulance, she started seizing so they put her on a chopper. At the hospital, the doctors said she’d had a stress-induced seizure\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>After three hours, the doctors released her with a prescription to control her seizures and panic attacks, and told her to follow-up with her primary care physician.\u003c/p>\n\u003cp>“I had to laugh,” Jeff Clarkesays. “We’re in Hayfork!”\u003c/p>\n\u003cp>\u003cobject id=\"flashObj\" width=\"486\" height=\"412\" classid=\"D27CDB6E-AE6D-11cf-96B8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,47,0\">\u003cparam name=\"movie\" value=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\">\u003cparam name=\"bgcolor\" value=\"#FFFFFF\">\u003cparam name=\"flashVars\" value=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"base\" value=\"http://admin.brightcove.com\">\u003cparam name=\"seamlesstabbing\" value=\"false\">\u003cparam name=\"allowFullScreen\" value=\"true\">\u003cparam name=\"swLiveConnect\" value=\"true\">\u003cparam name=\"allowScriptAccess\" value=\"always\">\u003cembed src=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\" bgcolor=\"#FFFFFF\" flashvars=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\" base=\"http://admin.brightcove.com\" name=\"flashObj\" width=\"486\" height=\"412\" seamlesstabbing=\"false\" type=\"application/x-shockwave-flash\" pluginspage=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003cstrong>Back on the Bus\u003c/strong>\u003c/p>\n\u003cp>After the bus pulls into the Mad River clinic -- a remodeled blue cottage that used to serve as the local forest service office -- the riders start their wait. They are used to it by now: The kids pull out games and books; the adults chat in the waiting room or by a weathered picnic table on the back lawn.\u003c/p>\n\u003cp>Everybody has to be seen before the bus can head back.\u003c/p>\n\u003cp>On this day, Clarke is among the first in line. The physician’s assistant on duty examines his chest lump and advises against a biopsy, an invasive procedure, because he wants to run more tests. Clarke takes the news with some concern.\u003c/p>\n\u003cp>“I was pretty freaked out. I went in there with the agenda of the biopsy. They wanted to explore other options,” he says afterward.\u003c/p>\n\u003cp>By the time the bus gets back to Hayfork, it’s mid-afternoon. He drives back to his trailer, frustrated and spent.\u003c/p>\n\u003cp>A few Tuesdays later, he takes the bus back to Mad River and is referred to a specialist in Weaverville.\u003c/p>\n\u003cp>It is another two months before he learns the lump is a side effect of the medications he’s taking -- a hypothesis he’d mentioned earlier to physicians and their assistants in Hayfork and Mad River\u003c/p>\n\u003cp>Now he has to start thinking about replacing those dentures, which means another bus trip -- or several – around the mountain.\u003c/p>\n\u003cp>\u003cstrong>The Final Loss\u003c/strong>\u003c/p>\n\u003cp>Reichelderfer, 82 and in failing health, began looking for a buyer for his shop last year. Even the independents weren’t interested. Pharmacists’ family members didn’t want to move to Hayfork, and his business model wasn’t working.\u003c/p>\n\u003cp>Always generous about cutting patients like Clarke a break on payment, he wasn’t recouping enough from insurers. The clinic next door, Mercill’s former base, was referring patients to Weaverville.\u003c/p>\n\u003cp>With great sadness, he shut his doors on Sept. 18.\u003c/p>\n\u003cp>“I wish I could have been able to sell it to somebody,” he says, “for the convenience of the people.\"\u003c/p>\n\u003cp>From now on, Hayforkers will havto e to get a ride to Owens Pharmacy in Weaverville or Wal-Mart or CVS in Redding.\u003c/p>\n\u003cp>It took only a few days to board up a drug store open for 32 years.\u003c/p>\n\u003cp>It’s a relic now, standing just yards from the clock the town dedicated to Mercill, with his years of service gratefully memorialized on a plaque.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>Heidi De Marco and Carol Eisenberg contributed reporting.\u003c/strong>\u003c/p>\n\n","blocks":[],"excerpt":"The biggest barrier to health care for residents in tiny Hayfork isn’t insurance coverage -- it’s distance.","status":"publish","parent":0,"modified":1425322878,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":66,"wordCount":2285},"headData":{"title":"When Health Care Is Far From Home | KQED","description":"The biggest barrier to health care for residents in tiny Hayfork isn’t insurance coverage -- it’s distance.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"When Health Care Is Far From Home","datePublished":"2015-02-28T18:02:13.000Z","dateModified":"2015-03-02T19:01:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"24088 http://blogs.kqed.org/stateofhealth/?p=24088","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/02/28/when-health-care-is-far-from-home/","disqusTitle":"When Health Care Is Far From Home","path":"/stateofhealth/24088/when-health-care-is-far-from-home","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24091\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-e1425075174221.jpg\">\u003cimg class=\"size-large wp-image-24091\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-640x427.jpg\" alt=\"Richard Sandor, 65, of Hayfork, took the hour long bus ride to Mad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Richard Sandor, 65, of Hayfork, took the hour-long bus ride to illad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>\u003cstrong>The biggest barrier to treatment for residents of a tiny town in the mountains of Northern California isn’t insurance coverage -- it’s distance.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Daniela Hernandez,\u003c/strong> \u003cem>Kaiser Health News\u003c/em>\u003c/p>\n\u003cp>HAYFORK, Calif. -- It’s Tuesday morning, half past eight and already hot, when the small bus pulls up to the community clinic. Most of the passengers are waiting in front -- an old man with a cane, two mothers with four kids between them, packed lunches in hand.\u003c/p>\n\u003cp>Two more arrive. A gray-bearded man with a pirate bandana steps from the shelter of his Subaru. A sunken-cheeked woman rushes up on her bike.\u003c/p>\n\u003cp>“Woohoo! We have a full car!” the driver says brightly after they’ve all climbed aboard. The riders smile back, some with a hint of resignation. It’s time for the weekly trip to the clinic in Mad River, about 30 miles down a winding mountain road. The tight twists and turns are hard on the stomach, but even harder on the joints -- especially if you have chronic Lyme disease, as more than a few of these riders do.\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>Jeff Clarke is one of them. He acquired Lyme long ago from deer ticks that dwell in the region’s sprawling forests. But today he’s going to ask about a lump that’s been growing in his left breast. It’s starting to hurt, and he’s worried. His fellow riders list their own ailments matter-of-factly: asthma, dental decay, diabetes, drug addiction, heart disease and much more.\u003c!--more-->\u003c/p>\n\u003cfigure id=\"attachment_24094\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-e1425076091597.jpg\">\u003cimg class=\"wp-image-24094 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-300x200.jpg\" alt=\"Hayfork-24_C\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeff Clarke, 57, at his trailer in Hayfork, Calif. Clarke says the lack of health care in Hayfork makes it hard to treat his high blood pressure, hepatitis C and Lyme disease. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>They wouldn’t be making this trip if they didn’t have to. In Hayfork, “we’re down to the remnants of the medical personnel,” says Clarke, 58, a well-spoken musician with a love for science and cats. “It just came to the point where if I needed to deal with anything important I just felt much more comfortable going over to Mad River.\u003c/p>\n\u003cp>Like so many American small towns, Hayfork has lost its vitality and much of its youth to bigger places. Nestled midway between Redding and Eureka, it’s not near anything. Even Weaverville, the tiny county seat, is 45 minutes away. There are no retail stores, theaters, museums, fancy restaurants. What the town has is star-filled skies and tree-lined ridges.\u003c/p>\n\u003cp>“We were all just fine with that,” says Shannon Barnett, a 41-year-old a former school teacher who grew up here. “Now it’s different.”\u003c/p>\n\u003cp>She’s referring to the dearth of basic health services.\u003c/p>\n\u003cp>There’s a local clinic but it’s staffed by doctors who rotate in from Weaverville once or twice a week, and otherwise it’s run by physician’s assistants. There are no hospitals for miles.\u003c/p>\n\u003cp>The Mad River clinic is bigger than Hayfork’s and offers a wider array of services but Clarke says it’s so backed up with patients it can take weeks to get an appointment.\u003c/p>\n\u003cp>In 2012, according to state data, there were \u003ca href=\"http://www.oshpd.ca.gov/HWDD/HWC/FactSheets/PhysiciansSurgeonsMD.pdf\">11 medical doctors\u003c/a> practicing in all of Trinity County, roughly one per 1,200 residents. Statewide, the ratio is closer to one per 300. Specialists like dentists and psychiatrists are nearly non-existent in the county.\u003c/p>\n\u003cp>A county behavioral office offers counseling in Hayfork, but a counselor isn't there every day and sessions are by appointment only. Sometimes the most expedient treatment comes in jail -- Clarke calls it the “nudge from the judge.”\u003c/p>\n\u003cp>He mentions an acquaintance named Robbie, who suffers from paranoid schizophrenia. Since being released from jail, he’s been off his meds, Clarke says. He walks up and down Hayfork’s main strip, muttering to passers-by about the many people who are after him.\u003c/p>\n\u003cp>In these tiny towns of California’s far north, lacking insurance is not the biggest obstacle to care. Most people are insured, a good number are on Medi-Cal.\u003c/p>\n\u003cp>What’s ailing these people is geography – that, and poverty. The median household income in \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_B19013&prodType=table\">Hayfork is about $34,000 a year\u003c/a>, well below the \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_1YR_S1901&prodType=table\">statewide figure of about $60,000\u003c/a>,.. Unemployment is extraordinarily high – estimates range between \u003ca href=\"http://www.homefacts.com/unemployment/California/Trinity-County/Hayfork.html\">9\u003c/a> and \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_S2301&prodType=table\">26 percent\u003c/a>. Many people lack a sturdy car to drive, or even money for gas.\u003c/p>\n\u003cp>In the federal government’s parlance, Hayfork is a “medically underserved” community – one of 170 in California and roughly 3,500 in the country.\u003c/p>\n\u003cp>By definition, these areas have too few primary care providers, high infant mortality, pervasive poverty or a significant elderly population. Some medically underserved areas are islands of deprivation within otherwise well-stocked urban areas. Others are dots on the map like Hayfork, far from where doctors and medical services are clustered. According to the National Rural Health Association, \u003ca href=\"http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care\">only about ten percent of physicians practice in rural America, where nearly a quarter of the population lives.\u003c/a>\u003c/p>\n\u003cp>For Hayforkers, health care is available – just on the other side of the mountain. “The problem, says Greg Schneider, a 65-year-old writer and band mate of Clarke’s, “is getting there.”\u003c/p>\n\u003cp>\u003cstrong>Lumberjacks and Janes\u003c/strong>\u003c/p>\n\u003cp>For decades\u003cstrong>,\u003c/strong> Hayfork had been fortunate. Well after the rise of urban health systems and their intricate business arrangements, it had a tight-knit local “system” founded on the simple, generous commitment of two people: a general practitioner and a pharmacist.\u003c/p>\n\u003cp>“He was everybody’s doctor,” Barnettsays of Dr. Earl Mercill, a GP who moved up from the Central Valley almost 50 years ago. “You never thought about going to anyone else.”\u003c/p>\n\u003cp>Mercill moved his large family to Hayfork in 1967 on a friend’s recommendation. It was still a mill town then, filled with lumberjacks and Janes, as the women were known, though it also had restaurants, shops and even a thriving art and music scene.\u003c/p>\n\u003cp>They built a house and settled on 40 acres. Mercill opened a clinic downtown.\u003c/p>\n\u003cfigure id=\"attachment_24096\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-e1425076271333.jpg\">\u003cimg class=\"wp-image-24096 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-300x200.jpg\" alt=\"Hayfork-18\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Earl Mercill moved his family to Hayfork in 1967. He opened the town's first clinic and was the only doctor for decades until he retired in the late 1990s. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>He was beloved almost from the beginning. He made house calls -- sometimes walking over precariously narrow log bridges or shuttling to his patients’ homes by snowmobile. He delivered babies by flashlight after storms knocked down power and waited by his patients’ bedsides for hours, sometimes charging little more than a slice of cake.\u003c/p>\n\u003cp>“If they didn’t have any money, I saw them,” recalls Mercill, who’s now 91 years old. “If they could pay later, fine.\" If they didn’t, they didn’t.”\u003c/p>\n\u003cp>In 1982, Gerry Reichelderfer, a genial pharmacist from Marin County, came up and fell in love with mountain life. He took over the drug store next to Mercill’s clinic.\u003c/p>\n\u003cp>Reichelderfer lived just seven minutes and a single stop sign away from his shop. He’d open up anytime people needed a prescription. If they couldn’t pay right then, he’d put it on an I.O.U.\u003c/p>\n\u003cp>The men joined forces, talking daily by intercom. The partnership would last nearly two decades.\u003c/p>\n\u003cp>Mercill officially retired in the late 1990s, though he kept seeing patients for some time afterward. The town dedicated a clock to him in the square.\u003c/p>\n\u003cp>Eventually he sold his clinic to a doctor based in Weaverville. That doctor recently sold it again, to a district hospital.\u003c/p>\n\u003cp>“It was like a limb being cut off,” Barnett says of Mercill’s retirement. “I know at first I didn’t have another doctor for a long time. Other people didn’t either.”\u003c/p>\n\u003cp>\u003cstrong>A Turn of Fortune\u003c/strong>\u003c/p>\n\u003cp>After Hayfork’s mill closed in the early-1990s, the town's population -- never higher than the low thousands -- dwindled. Homelessness, poverty and drug addiction took hold.\u003c/p>\n\u003cp>Clarke, a runaway and hitchhiker in his youth, was in some ways typical of Hayfork’s new generation. He arrived in the 1980s, in the clutches of methamphetamine addiction, a habit he picked up in the bars where he played guitar. For years, he landed jobs and lost them -- working as a wood chopper, sandwich maker and cabinet craftsman. He started seeing a woman he met in rehab, then split with her, but not before they had a daughter. They named her Stormy Brooke. He gained custody and lost it more than once.\u003c/p>\n\u003cp>The 12-step meetings at Hayfork’s Solid Rock Church saved his life, he says. He goes every Monday and has been sober 10 years.\u003c/p>\n\u003cp>His health is ok, considering. He lost his teeth. His bottom denture wore out long ago and his top one is breaking\u003cstrong>. \u003c/strong>He has high blood pressure and hepatitis C, plus the Lyme disease that became chronic because it wasn’t treated right away.\u003c/p>\n\u003cp>Clarke lives in a two-room trailer next to the town cemetery. Supported by $889 a month in disability insurance, he spends his time organizing 12-step meetings, reading and volunteering as a sound engineer at a local coffee shop. On good nights, he gets paid a little. He wants to stay as healthy as possible, hesays, so he can look after 23-year-old Stormy and her 2-year-old son, Tony, who lives with his dad.\u003c/p>\n\u003cp>Stormy Clarke, a tall beauty too insecure to know it, cuts herself and has made several attempts at suicide. Her porcelain arms bear the scars.\u003c/p>\n\u003cp>“She has no self-esteem,” Jeff Clarke says. “She has no faith in love, or trust for any other human beings. She has some real darkness inside her, you know? I’m sure I’m responsible for a majority of that.”\u003c/p>\n\u003cp>Stormy Clarke has tried to get help, she says, but it's only sporadically available and hasn't helped much.\u003c/p>\n\u003cp>In June, during a fight with her father, Stormy had what Jeff thought was a stroke. En route to Redding in an ambulance, she started seizing so they put her on a chopper. At the hospital, the doctors said she’d had a stress-induced seizure\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>After three hours, the doctors released her with a prescription to control her seizures and panic attacks, and told her to follow-up with her primary care physician.\u003c/p>\n\u003cp>“I had to laugh,” Jeff Clarkesays. “We’re in Hayfork!”\u003c/p>\n\u003cp>\u003cobject id=\"flashObj\" width=\"486\" height=\"412\" classid=\"D27CDB6E-AE6D-11cf-96B8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,47,0\">\u003cparam name=\"movie\" value=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\">\u003cparam name=\"bgcolor\" value=\"#FFFFFF\">\u003cparam name=\"flashVars\" value=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"base\" value=\"http://admin.brightcove.com\">\u003cparam name=\"seamlesstabbing\" value=\"false\">\u003cparam name=\"allowFullScreen\" value=\"true\">\u003cparam name=\"swLiveConnect\" value=\"true\">\u003cparam name=\"allowScriptAccess\" value=\"always\">\u003cembed src=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\" bgcolor=\"#FFFFFF\" flashvars=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\" base=\"http://admin.brightcove.com\" name=\"flashObj\" width=\"486\" height=\"412\" seamlesstabbing=\"false\" type=\"application/x-shockwave-flash\" pluginspage=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003cstrong>Back on the Bus\u003c/strong>\u003c/p>\n\u003cp>After the bus pulls into the Mad River clinic -- a remodeled blue cottage that used to serve as the local forest service office -- the riders start their wait. They are used to it by now: The kids pull out games and books; the adults chat in the waiting room or by a weathered picnic table on the back lawn.\u003c/p>\n\u003cp>Everybody has to be seen before the bus can head back.\u003c/p>\n\u003cp>On this day, Clarke is among the first in line. The physician’s assistant on duty examines his chest lump and advises against a biopsy, an invasive procedure, because he wants to run more tests. Clarke takes the news with some concern.\u003c/p>\n\u003cp>“I was pretty freaked out. I went in there with the agenda of the biopsy. They wanted to explore other options,” he says afterward.\u003c/p>\n\u003cp>By the time the bus gets back to Hayfork, it’s mid-afternoon. He drives back to his trailer, frustrated and spent.\u003c/p>\n\u003cp>A few Tuesdays later, he takes the bus back to Mad River and is referred to a specialist in Weaverville.\u003c/p>\n\u003cp>It is another two months before he learns the lump is a side effect of the medications he’s taking -- a hypothesis he’d mentioned earlier to physicians and their assistants in Hayfork and Mad River\u003c/p>\n\u003cp>Now he has to start thinking about replacing those dentures, which means another bus trip -- or several – around the mountain.\u003c/p>\n\u003cp>\u003cstrong>The Final Loss\u003c/strong>\u003c/p>\n\u003cp>Reichelderfer, 82 and in failing health, began looking for a buyer for his shop last year. Even the independents weren’t interested. Pharmacists’ family members didn’t want to move to Hayfork, and his business model wasn’t working.\u003c/p>\n\u003cp>Always generous about cutting patients like Clarke a break on payment, he wasn’t recouping enough from insurers. The clinic next door, Mercill’s former base, was referring patients to Weaverville.\u003c/p>\n\u003cp>With great sadness, he shut his doors on Sept. 18.\u003c/p>\n\u003cp>“I wish I could have been able to sell it to somebody,” he says, “for the convenience of the people.\"\u003c/p>\n\u003cp>From now on, Hayforkers will havto e to get a ride to Owens Pharmacy in Weaverville or Wal-Mart or CVS in Redding.\u003c/p>\n\u003cp>It took only a few days to board up a drug store open for 32 years.\u003c/p>\n\u003cp>It’s a relic now, standing just yards from the clock the town dedicated to Mercill, with his years of service gratefully memorialized on a plaque.\u003cstrong> \u003c/strong>\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>\u003cstrong>Heidi De Marco and Carol Eisenberg contributed reporting.\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/24088/when-health-care-is-far-from-home","authors":["8344"],"categories":["stateofhealth_11"],"tags":["stateofhealth_68","stateofhealth_251"],"featImg":"stateofhealth_24091","label":"stateofhealth"},"stateofhealth_13110":{"type":"posts","id":"stateofhealth_13110","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"13110","score":null,"sort":[1370458951000]},"guestAuthors":[],"slug":"distance-a-barrier-for-rural-californians-with-health-problems","title":"Distance a Barrier for Rural Californians with Health Problems","publishDate":1370458951,"format":"aside","headTitle":"Vital Signs | State of Health | KQED News","labelTerm":{"term":2363,"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_13118\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://www.flickr.com/photos/62116165@N00/2171603420/in/photolist-4iU33h-48fK3N-48bMSr-48bs1x-48fzE3-48fteA-48bQg8-48fFXU-48fmCo-48fEZd-48fGD9-48frsy-48fC5A-48bybH-48foEb-48bt3t-48bPA2-48brtR-48bAuZ-48fsCh-48brcB-cg45CS-48bPjg-48bzLB-48bkde-48bnvX-48bnaT-48fmS1-48bBAX-48bBWR-48bFpn-48bNbB-48bHGe-48bGnc-48bwPr-48bKgF-48fRTA-48fwqm-48bLFv-48fpay-48bRFR-48bKAa-48fMW9-48bEGp-48bqmZ-48boY8-48bCZF-48bCgX-48fnpE-48bpGV-48foPN\">\u003cimg class=\"size-medium wp-image-13118\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/2171603420_20e91f454a_o-300x225.jpg\" alt=\"If you live in a small far-northern California town like Susanville, seen here, you may need to travel more than one hundred miles for health care. (ceiling/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">If you live in a small far-northern California town like Susanville, seen here, you may need to travel more than one hundred miles for health care. (ceiling/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: The barriers to getting health care can be bad enough in urban areas, where poverty, lack of insurance and cultural divides are serious barriers to care. But if you live in rural parts of California there’s a serious barrier of a different kind: distance. As part of our first-person series \"\u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">What's Your Story?\u003c/a>\" we hear from Kelly Frost of Redding about how the care you need may be hours away from your home.\u003c/em>\u003c/p>\n\u003cp>Being on dialysis is tough enough without having to travel two or three hours each way just to get to the clinic. But when you live in the far reaches of Northern California, that is exactly what you must do. I sometimes sit with my wife when she does her dialysis treatment. We are lucky because we live only about 10 minutes away from the clinic in Redding. But every morning, the “remotes,” people who live on farms or in rural towns, climb into the mini-vans and come from Trinity County to the west; Mount Shasta, Weed, and Alturas to the North; and some from as far away as Susanville, near Reno.\u003c/p>\n\u003cp>They get up in the middle of the night, travel several hours, sometimes in bad weather, sit for treatment for three hours, and go home. Then in two days they do it all over again. When the weather turns, or there is an accident which closes the interstate, the problem compounds. Sometimes, they can’t get to Redding, or worse yet, they get here and can’t get home. Packing a lunch and three days of meds is standard fare for most. You’ve got to think ahead. Have a plan, a place to stay until the roads open. The dialysis center has some funds to help with a motel or a meal, but not much. Not for everyone, and not for more than a day.\u003c!--more-->\u003c/p>\n\u003cp>Some are lucky to have family nearby, but not the others. They have to fend for themselves, and some are in wheelchairs or otherwise can’t get around. Better have some money for a room. And with most of them on Medi-Cal that’s not easy.\u003c/p>\n\u003cp>The social worker tells me that missing a treatment or two can also be extremely dangerous. Fluid overload, shortness of breath, nausea. Even death if you miss too many. It’s a bad deal. Some consider moving to Redding to be closer to the clinic or stay near family. Others can’t afford to move. Others just like the rural lifestyle and feel they couldn’t make it in the big city.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>I never thought of Redding as the big city, but I suppose when it’s the only place to have dialysis for several hundred miles in each direction, it is. And with the only hospital around that can deal with their chronic condition it makes living so far away hard as well. What if they need to get to the ER? An ambulance could take several hours. A helicopter? That takes time too. And money. Medi-Cal pays for those who qualify. But some are paying $50 or more each way. And those who drive are paying even more than that. Plus the cost of meals.\u003c/p>\n\u003cp>A lot is made of the virtue of giving people more choices in health care. Usually they’re talking about insurance plans, deductibles and such. But in this part of California, choice has a different meaning, as in ‘you don’t really have one’ when you or a loved one is ill. You do what you have to do, go where you have to go, even if that means going very far and doing what you never dreamed you’d have to do.\u003c/p>\n\u003cp>\u003cstrong>Listen to Kelly Frost on The California Report:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201306030850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201306030850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n","blocks":[],"excerpt":"The barriers to getting health care can be bad enough in urban areas, where poverty, lack of insurance and cultural divides are serious barriers to care. But if you live in rural parts of California there’s another, really serious barrier - distance. As part of our first-person series \"What's Your Story?\" we hear from Kelly Frost of Redding about how the care you need may be a hours away from your home.","status":"publish","parent":0,"modified":1392158901,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":682},"headData":{"title":"Distance a Barrier for Rural Californians with Health Problems | KQED","description":"The barriers to getting health care can be bad enough in urban areas, where poverty, lack of insurance and cultural divides are serious barriers to care. But if you live in rural parts of California there’s another, really serious barrier - distance. As part of our first-person series "What's Your Story?" we hear from Kelly Frost of Redding about how the care you need may be a hours away from your home.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Distance a Barrier for Rural Californians with Health Problems","datePublished":"2013-06-05T19:02:31.000Z","dateModified":"2014-02-11T22:48:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"13110 http://blogs.kqed.org/stateofhealth/?p=13110","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/06/05/distance-a-barrier-for-rural-californians-with-health-problems/","disqusTitle":"Distance a Barrier for Rural Californians with Health Problems","path":"/stateofhealth/13110/distance-a-barrier-for-rural-californians-with-health-problems","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13118\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://www.flickr.com/photos/62116165@N00/2171603420/in/photolist-4iU33h-48fK3N-48bMSr-48bs1x-48fzE3-48fteA-48bQg8-48fFXU-48fmCo-48fEZd-48fGD9-48frsy-48fC5A-48bybH-48foEb-48bt3t-48bPA2-48brtR-48bAuZ-48fsCh-48brcB-cg45CS-48bPjg-48bzLB-48bkde-48bnvX-48bnaT-48fmS1-48bBAX-48bBWR-48bFpn-48bNbB-48bHGe-48bGnc-48bwPr-48bKgF-48fRTA-48fwqm-48bLFv-48fpay-48bRFR-48bKAa-48fMW9-48bEGp-48bqmZ-48boY8-48bCZF-48bCgX-48fnpE-48bpGV-48foPN\">\u003cimg class=\"size-medium wp-image-13118\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/2171603420_20e91f454a_o-300x225.jpg\" alt=\"If you live in a small far-northern California town like Susanville, seen here, you may need to travel more than one hundred miles for health care. (ceiling/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">If you live in a small far-northern California town like Susanville, seen here, you may need to travel more than one hundred miles for health care. (ceiling/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: The barriers to getting health care can be bad enough in urban areas, where poverty, lack of insurance and cultural divides are serious barriers to care. But if you live in rural parts of California there’s a serious barrier of a different kind: distance. As part of our first-person series \"\u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">What's Your Story?\u003c/a>\" we hear from Kelly Frost of Redding about how the care you need may be hours away from your home.\u003c/em>\u003c/p>\n\u003cp>Being on dialysis is tough enough without having to travel two or three hours each way just to get to the clinic. But when you live in the far reaches of Northern California, that is exactly what you must do. I sometimes sit with my wife when she does her dialysis treatment. We are lucky because we live only about 10 minutes away from the clinic in Redding. But every morning, the “remotes,” people who live on farms or in rural towns, climb into the mini-vans and come from Trinity County to the west; Mount Shasta, Weed, and Alturas to the North; and some from as far away as Susanville, near Reno.\u003c/p>\n\u003cp>They get up in the middle of the night, travel several hours, sometimes in bad weather, sit for treatment for three hours, and go home. Then in two days they do it all over again. When the weather turns, or there is an accident which closes the interstate, the problem compounds. Sometimes, they can’t get to Redding, or worse yet, they get here and can’t get home. Packing a lunch and three days of meds is standard fare for most. You’ve got to think ahead. Have a plan, a place to stay until the roads open. The dialysis center has some funds to help with a motel or a meal, but not much. Not for everyone, and not for more than a day.\u003c!--more-->\u003c/p>\n\u003cp>Some are lucky to have family nearby, but not the others. They have to fend for themselves, and some are in wheelchairs or otherwise can’t get around. Better have some money for a room. And with most of them on Medi-Cal that’s not easy.\u003c/p>\n\u003cp>The social worker tells me that missing a treatment or two can also be extremely dangerous. Fluid overload, shortness of breath, nausea. Even death if you miss too many. It’s a bad deal. Some consider moving to Redding to be closer to the clinic or stay near family. Others can’t afford to move. Others just like the rural lifestyle and feel they couldn’t make it in the big city.\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>I never thought of Redding as the big city, but I suppose when it’s the only place to have dialysis for several hundred miles in each direction, it is. And with the only hospital around that can deal with their chronic condition it makes living so far away hard as well. What if they need to get to the ER? An ambulance could take several hours. A helicopter? That takes time too. And money. Medi-Cal pays for those who qualify. But some are paying $50 or more each way. And those who drive are paying even more than that. Plus the cost of meals.\u003c/p>\n\u003cp>A lot is made of the virtue of giving people more choices in health care. Usually they’re talking about insurance plans, deductibles and such. But in this part of California, choice has a different meaning, as in ‘you don’t really have one’ when you or a loved one is ill. You do what you have to do, go where you have to go, even if that means going very far and doing what you never dreamed you’d have to do.\u003c/p>\n\u003cp>\u003cstrong>Listen to Kelly Frost on The California Report:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201306030850b.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201306030850b.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/13110/distance-a-barrier-for-rural-californians-with-health-problems","authors":["46"],"series":["stateofhealth_2363"],"categories":["stateofhealth_11"],"tags":["stateofhealth_251","stateofhealth_2373"],"label":"stateofhealth_2363"},"stateofhealth_5591":{"type":"posts","id":"stateofhealth_5591","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"5591","score":null,"sort":[1336081338000]},"guestAuthors":[],"slug":"rural-california-hospitals-slow-to-digitize","title":"Rural California Hospitals Slow to Digitize","publishDate":1336081338,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5596\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5596\" title=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr-300x308.jpg\" alt=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" width=\"292\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fall colors in Quincy. (Somesh Kumar: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>High in the Sierra in the town of Quincy, doctors at \u003ca title=\"http://www.pdh.org/\" href=\"http://www.pdh.org/\" target=\"_blank\">Plumas District Hospital\u003c/a> are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.\u003c/p>\n\u003cp>Plumas District joins a digitizing trend at least partially sparked by financial incentives in the\u003ca href=\"http://www.healthcare.gov/law/full/index.html\" target=\"_blank\"> federal health care law\u003c/a>. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”\u003c/p>\n\u003cp>But in contrast to his own prior experience in major, urban hospitals, Lafferty said most of the Plumas District staff have never worked anywhere else. Sure, the iPads are welcome, but when it comes to the nitty-gritty of implementing an electronic system of medical records, change can be painful. The culture of “consistency” leaves no doubt that he is “a change agent,” Lafferty said.\u003c/p>\n\u003cp>While Plumas District has been fortunate to have the capital and leadership to make this change, other California towns are not so lucky. A recent \u003ca href=\"http://content.healthaffairs.org/content/early/2012/04/19/hlthaff.2012.0153.full\">nationwide report\u003c/a> confirmed the widely-held concern that small, nonteaching and rural hospitals are lagging behind their urban counterparts in adoption of electronic health records.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->That lag has a direct effect on the five million Californians who live in rural areas. Only about half of the state’s \u003ca title=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" href=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" target=\"_blank\">293 designated rural health centers \u003c/a>are already using or in the process of implementing an EHR system, according to a recent \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?\">report\u003c/a> by The California Healthcare Foundation (CHCF).\u003c/p>\n\u003cp>Resources are an issue. In California, large clinics are more likely to use EHRs than small clinics. Many rural clinics are feeling financially unstable, CHCF wrote, and limited resources are the most important obstacle to increased adoption of EHRs. Initial purchase cost is the biggest barrier cited by rural hospitals, although the perceived cost and difficulty of implementing an EHR system was a close second, CHCF reported.\u003c/p>\n\u003cp>There is a federal financial incentive, but there are other reasons to digitize, too. Lafferty said trading paper files for digital can result in a more complete medical record. EHR software makes charting, billing and ordering labs easier because “it prompts the physician” to record information in a very specific format. “It’s readable and more consistent,” Lafferty said.\u003c/p>\n\u003cp>EHRs improve the collaboration with providers who are at a distance -- a great advantage in rural areas of the state. Plumas patients in need of specialty care travel to Chico or Reno “a lot,” said Lafferty, but now their medical records can go with them on a thumb drive. Most rural clinics with EHRs use them to record and track patient information; more than half also order and track prescriptions and lab tests electronically, according to the CHCF report. These functions were among the most easily adopted at Plumas and are \u003ca href=\"http://weill.cornell.edu/news/releases/wcmc/wcmc_2011/05_25_11.shtml\">likely to save time and reduce errors\u003c/a>.\u003c/p>\n\u003cp>Although high speed Internet access has improved in recent years, a persistent challenge in rural parts of the state is the relative \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?view=print\">shortage of IT professionals\u003c/a>. Lafferty said “many pieces came together” to create the strong IT staff working on EHR implementation. The Plumas Hospital's in-house information systems director, for example, “has spent countless hours” on the project, he said.\u003c/p>\n\u003cp>And additional tech support? “Well, it’s not too hard to recruit,” Lafferty said, “because this has got to be one of the most gorgeous places in California.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Lafferty acknowledged that updating the care delivery systems at Plumas District presented challenges. “It’s a culture change,” he said, “but it’s the right choice for the future.”\u003c/p>\n\n","blocks":[],"excerpt":"High in the Sierra in the town of Quincy, doctors at Plumas District Hospital are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.\r\n\r\nPlumas District joins a digitizing trend at least partially sparked by financial incentives in the federal health care law. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”","status":"publish","parent":0,"modified":1336506063,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":649},"headData":{"title":"Rural California Hospitals Slow to Digitize | KQED","description":"High in the Sierra in the town of Quincy, doctors at Plumas District Hospital are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.\r\n\r\nPlumas District joins a digitizing trend at least partially sparked by financial incentives in the federal health care law. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Rural California Hospitals Slow to Digitize","datePublished":"2012-05-03T21:42:18.000Z","dateModified":"2012-05-08T19:41:03.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"5591 http://blogs.kqed.org/stateofhealth/?p=5591","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/05/03/rural-california-hospitals-slow-to-digitize/","disqusTitle":"Rural California Hospitals Slow to Digitize","path":"/stateofhealth/5591/rural-california-hospitals-slow-to-digitize","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_5596\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-5596\" title=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/QuincyCA_SomeshKumar_Flickr-300x308.jpg\" alt=\"Fall colors in Quincy. (Somesh Kumar: Flickr)\" width=\"292\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fall colors in Quincy. (Somesh Kumar: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>High in the Sierra in the town of Quincy, doctors at \u003ca title=\"http://www.pdh.org/\" href=\"http://www.pdh.org/\" target=\"_blank\">Plumas District Hospital\u003c/a> are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.\u003c/p>\n\u003cp>Plumas District joins a digitizing trend at least partially sparked by financial incentives in the\u003ca href=\"http://www.healthcare.gov/law/full/index.html\" target=\"_blank\"> federal health care law\u003c/a>. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”\u003c/p>\n\u003cp>But in contrast to his own prior experience in major, urban hospitals, Lafferty said most of the Plumas District staff have never worked anywhere else. Sure, the iPads are welcome, but when it comes to the nitty-gritty of implementing an electronic system of medical records, change can be painful. The culture of “consistency” leaves no doubt that he is “a change agent,” Lafferty said.\u003c/p>\n\u003cp>While Plumas District has been fortunate to have the capital and leadership to make this change, other California towns are not so lucky. A recent \u003ca href=\"http://content.healthaffairs.org/content/early/2012/04/19/hlthaff.2012.0153.full\">nationwide report\u003c/a> confirmed the widely-held concern that small, nonteaching and rural hospitals are lagging behind their urban counterparts in adoption of electronic health records.\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!--more-->That lag has a direct effect on the five million Californians who live in rural areas. Only about half of the state’s \u003ca title=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" href=\"http://www.statehealthfacts.org/profileind.jsp?ind=423&cat=8&rgn=6\" target=\"_blank\">293 designated rural health centers \u003c/a>are already using or in the process of implementing an EHR system, according to a recent \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?\">report\u003c/a> by The California Healthcare Foundation (CHCF).\u003c/p>\n\u003cp>Resources are an issue. In California, large clinics are more likely to use EHRs than small clinics. Many rural clinics are feeling financially unstable, CHCF wrote, and limited resources are the most important obstacle to increased adoption of EHRs. Initial purchase cost is the biggest barrier cited by rural hospitals, although the perceived cost and difficulty of implementing an EHR system was a close second, CHCF reported.\u003c/p>\n\u003cp>There is a federal financial incentive, but there are other reasons to digitize, too. Lafferty said trading paper files for digital can result in a more complete medical record. EHR software makes charting, billing and ordering labs easier because “it prompts the physician” to record information in a very specific format. “It’s readable and more consistent,” Lafferty said.\u003c/p>\n\u003cp>EHRs improve the collaboration with providers who are at a distance -- a great advantage in rural areas of the state. Plumas patients in need of specialty care travel to Chico or Reno “a lot,” said Lafferty, but now their medical records can go with them on a thumb drive. Most rural clinics with EHRs use them to record and track patient information; more than half also order and track prescriptions and lab tests electronically, according to the CHCF report. These functions were among the most easily adopted at Plumas and are \u003ca href=\"http://weill.cornell.edu/news/releases/wcmc/wcmc_2011/05_25_11.shtml\">likely to save time and reduce errors\u003c/a>.\u003c/p>\n\u003cp>Although high speed Internet access has improved in recent years, a persistent challenge in rural parts of the state is the relative \u003ca href=\"http://www.chcf.org/publications/2012/03/ca-rural-clinics-obstacles?view=print\">shortage of IT professionals\u003c/a>. Lafferty said “many pieces came together” to create the strong IT staff working on EHR implementation. The Plumas Hospital's in-house information systems director, for example, “has spent countless hours” on the project, he said.\u003c/p>\n\u003cp>And additional tech support? “Well, it’s not too hard to recruit,” Lafferty said, “because this has got to be one of the most gorgeous places in California.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Lafferty acknowledged that updating the care delivery systems at Plumas District presented challenges. “It’s a culture change,” he said, “but it’s the right choice for the future.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/5591/rural-california-hospitals-slow-to-digitize","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_251"],"featImg":"stateofhealth_5596","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. 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