Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed
On the Ballot: The Fate of a Troubled Hospital in Modoc County
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A Firefighter in San Diego Confronts the Trauma of the Job
A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks
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Labor Union Pressures Kaiser Permanente with Protests Across the State
California Nurses Warn That Losing Supreme Court Case Could Gut Unions
Doctors Prepare for Possible Immigration Enforcement Visits At Hospitals
A Rush to Get Health Insurance for 2018, Before California Deadline
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She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"},"lklivans":{"type":"authors","id":"8648","meta":{"index":"authors_1591205172","id":"8648","found":true},"name":"Laura Klivans","firstName":"Laura","lastName":"Klivans","slug":"lklivans","email":"lklivans@kqed.org","display_author_email":true,"staff_mastheads":["news","science"],"title":"Reporter and Host","bio":"Laura Klivans is a science reporter and the host of KQED's video series about tiny, amazing animals, \u003cem>Deep Look\u003c/em>. Her work can also be heard on NPR, \u003cem>Here & Now, \u003c/em>and PRI. Before working in audio, she taught, leading groups of students abroad. One of her favorite jobs was teaching on the Thai-Burmese border, working with immigrants and refugees.\r\n\r\nLaura has won three Northern California Area Emmys along with her Deep Look colleagues. She's won the North Gate Award for Excellence in Audio Reporting and the Gobind Behari Lal Award for a radio documentary about adults with imaginary friends. She's a fellowship junkie, completing the USC Center for Health Journalism's California Fellowship, UC Berkeley's Human Rights Fellowship and the Coro Fellowship in Public Affairs. Laura has a master’s in journalism from UC Berkeley and a master’s in education from Harvard.\r\n\r\nShe likes to eat chocolate for breakfast. She's also open to eating it all day long.","avatar":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twitter":"lauraklivans","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["contributor","editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"Laura Klivans | KQED","description":"Reporter and Host","ogImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lklivans"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_363769":{"type":"posts","id":"stateofhealth_363769","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363769","score":null,"sort":[1528176296000]},"guestAuthors":[],"slug":"on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county","title":"On the Ballot: The Fate of a Troubled Hospital in Modoc County","publishDate":1528176296,"format":"audio","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“He’s got something we haven’t got — which is money,” Bostic said.\u003c/p>\n\n","blocks":[],"excerpt":"Voters in Surprise Valley, Calif. must decide whether to sell their public hospital to an outside investor with an unusual business plan.","status":"publish","parent":0,"modified":1528309938,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":58,"wordCount":2924},"headData":{"title":"On the Ballot: The Fate of a Troubled Hospital in Modoc County | KQED","description":"Voters in Surprise Valley, Calif. must decide whether to sell their public hospital to an outside investor with an unusual business plan.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"363769 https://ww2.kqed.org/stateofhealth/?p=363769","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/06/04/on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county/","disqusTitle":"On the Ballot: The Fate of a Troubled Hospital in Modoc County","nprByline":"Barbara Feder Ostrov, California Healthline","path":"/stateofhealth/363769/on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/06/TCRamRuralHospitals.mp3","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>CEDARVILLE, Calif. — Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital.\u003c/p>\n\u003cp>In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones.\u003c/p>\n\u003cp>\u003ca href=\"https://www.linkedin.com/in/beau-gertz-22528015b/\">Gertz\u003c/a> said that if they vote June 5 to let him buy their tiny public hospital, he will retain vital medical services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders — one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, even massage. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.\u003c/p>\n\u003cp>Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.\u003c/p>\n\u003cfigure id=\"attachment_363787\" class=\"wp-caption alignnone\" style=\"max-width: 7039px\">\u003cimg class=\"size-full wp-image-363787\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-16.jpg\" alt=\"\" width=\"7039\" height=\"4698\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16.jpg 7039w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-16-520x347.jpg 520w\" sizes=\"(max-width: 7039px) 100vw, 7039px\">\u003cfigcaption class=\"wp-caption-text\">Businessman Beau Gertz faced a tough crowd of worried locals at a recent board meeting in Cedarville, Calif. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal — only to disappear.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Outsiders “come in and promise the moon,” said Jeanne Goldman, 72, a retired businesswoman. “The [hospital’s] board is just so desperate with all the debt, and they pray this angel’s going to come along and fix it. If this was a shoe store in Surprise Valley, I could care less, but it’s a hospital.”\u003c/p>\n\u003cfigure id=\"attachment_363779\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363779\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-7.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-7-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Surprise Valley’s hospital has 22 skilled nursing beds, one acute bed and three “swing” beds that can be used as needs arise. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Looking For Salvation\u003c/strong>\u003c/p>\n\u003cp>The woes of Surprise Valley Community Hospital reflect an increasingly brutal environment for America’s rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">83 of 2,375\u003c/a> rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program. These often-remote hospitals — some with 10, 15, 25 beds — have been targeted by management companies or potential buyers who promise much but often deliver little while lining their own pockets, according to allegations in court cases, a Missouri state audit and media reports.\u003c/p>\n\u003cp>Enticed by such outsiders, some struggling rural hospitals around the country have embraced lab billing for faraway patients as a rescue plan. That’s because Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs. In general, this kind of remote billing is controversial and legally murky, and it recently has resulted in allegations of fraud in several states, according to government documents and media reports.\u003c/p>\n\u003cp>Rural hospital boards, however, tend not to have expertise in the health care business. The president of Surprise Valley Community’s board, for instance, is a rancher. Another board member owns a local motel; a third, a construction company. That lack of experience “leaves them vulnerable in many cases,” said Terry Hill of the nonprofit National Rural Health Resource Center, based in Duluth, Minn.\u003c/p>\n\u003cfigure id=\"attachment_363791\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363791\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-5.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-5-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Jean Bilodeaux, 74, a journalist who lives in Cedarville, Calif., says members of the hospital board \"blew up\" at her when she raised important questions about the hospital’s finances in stories she wrote for the Modoc County Record, a weekly newspaper. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to distinguish himself from other would-be rescuers who ran into legal trouble, Gertz described his proposal to residents as perfectly legal — a legitimate use of telemedicine, essentially remote treatment via electronic communication such as video. “If you do it correctly,” he said in an interview with Kaiser Health News, “there is a nice profit margin. There [are] extra visits you can get from telemedicine but … it has to be billed correctly and it can’t be abused.”\u003c/p>\n\u003cp>Gertz runs several companies — founded within the last four years — including two labs, SeroDynamics and Cadira Labs, as well as a wellness company called CadiraMD.\u003c/p>\n\u003cp>He pledged in \u003ca href=\"https://www.documentcloud.org/documents/4450993-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p9/a426112\">court documents\u003c/a> to buy the bankrupt hospital for $4 million and cover its debts, saying he had lined up a $4 billion New York company as a financial backer. Kaiser Health News was unable to locate the company under the name Gertz cited, Next Genesis Development Group. He did not respond to emails seeking clarification on the issue.\u003c/p>\n\u003cp>Gertz, who acknowledged that he had never before run a hospital, was asked at the same \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">gathering\u003c/a> whether he had disclosed his “financials” to the hospital board. “As a private entity, I don’t have to show my financials and I have not provided my financials to the board,” he replied.\u003c/p>\n\u003cp>It was not clear whether board members had ever asked. Surprise Valley Health Care District board President John Erquiaga declined to comment.\u003c/p>\n\u003cp>\u003cstrong>A Sad Decline\u003c/strong>\u003c/p>\n\u003cp>Surrounded by the Warner and Modoc mountains and forests in California’s northeastern corner, Surprise Valley is home to four small communities. The largest is Cedarville, population 514, at last count.\u003c/p>\n\u003cp>The valley, covered in sagebrush and greasewood, is part of Modoc County, one of California’s poorest, with \u003ca href=\"https://www.ftb.ca.gov/Data/Individuals/Median-income.shtml\">a median income of about $30,000\u003c/a>. The closest hospital with an emergency room is roughly 25 miles away, over a mountain pass.\u003c/p>\n\u003cfigure id=\"attachment_363784\" class=\"wp-caption alignnone\" style=\"max-width: 6360px\">\u003cimg class=\"size-full wp-image-363784\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-2.jpg\" alt=\"\" width=\"6360\" height=\"4245\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2.jpg 6360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-2-520x347.jpg 520w\" sizes=\"(max-width: 6360px) 100vw, 6360px\">\u003cfigcaption class=\"wp-caption-text\">Cedarville, a hamlet of about 514 residents, is in one of California’s poorest counties, with a median income of roughly $30,000. The closest hospital with an emergency room is about 25 miles away over a mountain pass. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of hundreds of rural hospitals built with help from the 1946 federal \u003ca href=\"https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation\">Hill-Burton Act\u003c/a>, the Surprise Valley hospital opened in 1952 to serve a thriving ranching community. But it has struggled since, closing in 1981, reopening as a health clinic in 1985, then reconverting to a hospital in 1986.\u003c/p>\n\u003cp>A county grand jury \u003ca href=\"http://gsmall.us/GJ/FinalReports/2014-2015/GrandJuryReport2014-2015-MCR.pdf\">report\u003c/a> in 2014-15 found that “mismanagement of the [hospital district] has been evident for at least the past five years.”\u003c/p>\n\u003cp>By last summer, those in charge didn’t seem up to the task of running a modern hospital. By then, it was hardly a hospital at all. Crushed by debt, it primarily offered nursing home care, an emergency room, a volunteer ambulance service and just one acute care bed, with three others available if needed.\u003c/p>\n\u003cfigure id=\"attachment_363780\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363780\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-12.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-12-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">Besides its ER and volunteer-staffed ambulance service, Surprise Valley’s hospital in recent years has functioned mostly as a nursing home, saddled with crushing debt. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When state inspectors arrived last June, they found chaos. The hospital’s chief nursing officer resigned during the inspection. Staffers reported unpaid checks to vendors hidden in drawers. Inspectors learned that the hospital had sent home temporary nurses because it couldn’t pay them, according to their \u003ca href=\"https://www.documentcloud.org/documents/4375718-Surprise-Valley-Community-Hospital-CDPH.html\">report\u003c/a>.\u003c/p>\n\u003cp>The hospital’s then-chief administrator, Richard Cornwell — who staffers said had instructed them to hide the checks, according to the report — had taken a leave of absence and was nowhere to be found. Cornwell, a health care accountant from Montana, was later \u003ca href=\"https://www.documentcloud.org/documents/4475172-Surprise-Valley-Community-Hospital-Board-Meeting.html#document/p1/a424645\">fired\u003c/a> and replaced with the hospital’s lab director, who in turn resigned, according to public records. Reached by Kaiser Health News, Cornwell declined to comment.\u003c/p>\n\u003cp>Federal regulators \u003ca href=\"https://www.documentcloud.org/documents/4361541-Surprise-Valley-DPNA-Ltr.html\">suspended\u003c/a> Medicare and Medicaid payments to the hospital — a rarely invoked financial penalty — over concerns about patient care. Those payments have since been reinstated, but a follow-up state \u003ca href=\"https://www.documentcloud.org/documents/4376728-Surprise-Valley-Community-Hospital-CDPH-11-14-17.html\">inspection\u003c/a> in November 2017 identified more patient care concerns.\u003c/p>\n\u003cfigure id=\"attachment_363792\" class=\"wp-caption alignnone\" style=\"max-width: 4912px\">\u003cimg class=\"size-full wp-image-363792\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-27.jpg\" alt=\"\" width=\"4912\" height=\"7360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27.jpg 4912w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-27-520x779.jpg 520w\" sizes=\"(max-width: 4912px) 100vw, 4912px\">\u003cfigcaption class=\"wp-caption-text\">Eric Shpilman, a retired probation officer who lives in Fort Bidwell, Calif., works at a ranch in Cedarville. He says his wife received “unspeakable” treatment at the hospital before she died. But he also believes that “if the hospital closes, it’s irreplaceable.” \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Infighting ensued, with some residents fiercely committed to keeping the hospital open and others favoring closure, perhaps replacing it with a small clinic. Local journalist Jean Bilodeaux, 74, said board members often kept the public in the dark, failing to show up for their own meetings and sometimes making decisions outside public view.\u003c/p>\n\u003cp>When Bilodeaux raised questions about the hospital’s finances in the \u003ca href=\"http://www.modocrecord.com/\">Modoc County Record\u003c/a>, a weekly newspaper, she recalled, board members “started screaming at me,” she said. Now “I don’t even step foot in that hospital.”\u003c/p>\n\u003cp>Ben Zandstra, 65, a pastor in Cedarville, said that while Cornwell was in charge, he too got a chilly reception at the hospital, where he had long played guitar for patients on Christmas Eve. “I became persona non grata. It’s the most divisive thing I’ve seen in the years I’ve lived here.”\u003c/p>\n\u003cfigure id=\"attachment_363781\" class=\"wp-caption alignnone\" style=\"max-width: 4712px\">\u003cimg class=\"size-full wp-image-363781\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-25.jpg\" alt=\"\" width=\"4712\" height=\"3145\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25.jpg 4712w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-25-520x347.jpg 520w\" sizes=\"(max-width: 4712px) 100vw, 4712px\">\u003cfigcaption class=\"wp-caption-text\">Ben Zandstra, pastor of the Surprise Valley Community Church in Cedarville, Calif., says the hospital’s administrators made clear he was no longer welcome at the hospital after he voiced concerns about its financial management. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A White Knight, Vanished\u003c/strong>\u003c/p>\n\u003cp>Even residents who say they have experienced poor care at Surprise Valley Community believe its continued existence in some form is crucial — for its 50 or so jobs, for its ER, and because it puts the region on the map.\u003c/p>\n\u003cp>Eric Shpilman, 61, a retired probation officer, said his now-deceased wife received “unspeakable” treatment at Surprise Valley. But to shut it down? “It would take out the heart of Surprise Valley, the heart out of Cedarville.”\u003c/p>\n\u003cp>Last summer, the board turned to an outside management company for help.\u003c/p>\n\u003cp>Jorge Perez, CEO of Kansas City-based EmpowerHMS — which promises on its \u003ca href=\"http://empowerhms.com/\">website\u003c/a> to “rescue rural hospitals” — agreed to take over Surprise Valley’s debt and operate the hospital for three years, according to a \u003ca href=\"https://www.documentcloud.org/documents/4380014-SVHCD-Management-Agreement-With-EmpowerHMS-LLC.html\">management agreement\u003c/a> with the board.\u003c/p>\n\u003cp>In the two months after EmpowerHMS took over management, Surprise Valley’s revenue more than doubled, according to financial \u003ca href=\"https://www.documentcloud.org/documents/4486153-Surprise-Valley-Community-Hospital-Financials.html\">documents\u003c/a> provided by the hospital.\u003c/p>\n\u003cp>Then, according to hospital officials’ public statements, the company stopped making the promised payments, and they haven’t been able to contact EmpowerHMS or Perez since. In January, when Surprise Valley filed for bankruptcy, documents filed in court said EmpowerHMS had \u003ca href=\"https://www.documentcloud.org/documents/4361505-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p5/a424651\">“abandoned”\u003c/a> the hospital.\u003c/p>\n\u003cfigure id=\"attachment_363795\" class=\"wp-caption alignnone\" style=\"max-width: 7289px\">\u003cimg class=\"size-full wp-image-363795\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-9.jpg\" alt=\"\" width=\"7289\" height=\"4865\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9.jpg 7289w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-9-520x347.jpg 520w\" sizes=\"(max-width: 7289px) 100vw, 7289px\">\u003cfigcaption class=\"wp-caption-text\">The interior of Surprise Valley Community Hospital. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Around the time Perez took over, he and companies with which he was involved were \u003ca href=\"http://kcur.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes#stream/0\">dogged by allegations\u003c/a> of improper laboratory billing at facilities in \u003ca href=\"https://www.documentcloud.org/documents/4389070-BCBS-v-Sharkey-Issaquena-Hospital-Mission.html\">Mississippi\u003c/a>, \u003ca href=\"https://www.cbsnews.com/news/how-some-rural-hospitals-were-used-to-score-huge-paydays/\">Florida\u003c/a>, \u003ca href=\"https://www.documentcloud.org/documents/4359356-Aetna-v-People-s-Choice-Hospital-COMPLAINT.html\">Oklahoma\u003c/a> and \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html\">Missouri\u003c/a>, according to ongoing \u003ca href=\"https://www.documentcloud.org/documents/4431631-RightChoice-Managed-Care-Aetna-BCBS-v-Hospital.html#document/p3/a426046\">lawsuits\u003c/a> by insurers and others, a state \u003ca href=\"https://app.auditor.mo.gov/Repository/Press/2017074829206.pdf\">audit\u003c/a> and media reports. Missouri’s attorney general in May opened an investigation into one of the hospitals Perez managed, and Sen. Claire McCaskill (D-Mo.) recently \u003ca href=\"http://kcur.org/post/mccaskill-calls-federal-investigation-billing-practices-missouri-hospital#stream/0\">called for a federal investigation\u003c/a> into lab billing practices at one of the hospitals.\u003c/p>\n\u003cp>Medicare rules and commercial insurance contracts, with some exceptions, require people to be treated on an inpatient or outpatient basis by the hospitals that are billing for their lab tests. But insurers have alleged in court documents that hospitals Perez was involved with billed for tests — to the tune of at least $175 million — on patients never seen at those facilities. Perez \u003ca href=\"http://sideeffectspublicmedia.org/post/vulnerable-rural-hospitals-face-tough-decisions-profitable-questionable-billing-schemes\">has maintained\u003c/a> that what he is doing is legal and that it generates revenue that rural hospitals desperately need, according to Side Effects Public Media.\u003c/p>\n\u003cp>Experts say insurers are catching on to voluminous billing by hospitals in communities that typically have generated a tiny number of tests. At one Sonoma County district hospital not associated with Perez, an insurer recently demanded repayment for $13.5 million in suspect billings, forcing the hospital to suspend the lucrative program and \u003ca href=\"http://www.pressdemocrat.com/news/8329877-181/palm-drive-health-care-district\">put itself up for sale.\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_363796\" class=\"wp-caption alignnone\" style=\"max-width: 7360px\">\u003cimg class=\"size-full wp-image-363796\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/06/rural-hospital-10.jpg\" alt=\"\" width=\"7360\" height=\"4912\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10.jpg 7360w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/06/rural-hospital-10-520x347.jpg 520w\" sizes=\"(max-width: 7360px) 100vw, 7360px\">\u003cfigcaption class=\"wp-caption-text\">The Surprise Valley Health Care District is a public facility and supported by taxes on homeowners. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lab tests for out-of-town patients have “been a growing scheme in the last year, slightly longer,” said Karen Weintraub, executive vice president of Healthcare Fraud Shield, which consults for insurers. “There’s an incentive to bill for things not necessary or even services not rendered. It also may not be proper based on contracts with insurers. The dollars are getting large.”\u003c/p>\n\u003cp>Some residents were aware of controversy surrounding Perez and his companies and said they tried to warn the hospital district board. “All they wanted to hear was, ‘We will pay the bills,’” Bilodeaux said.\u003c/p>\n\u003cp>Neither Perez nor EmpowerHMS returned requests for comment. However, Michael Murtha, president of the \u003ca href=\"http://ruralhospitalalliance.com/\">National Alliance of Rural Hospitals\u003c/a>, said in an email that he was responding on behalf of Perez, who chairs the coalition’s board.\u003c/p>\n\u003cp>“The mission to rescue rural hospitals and set them on a path of sustainability is a difficult undertaking, and it would be a disservice to their communities to preclude struggling facilities from availing themselves of every legal and regulatory means to generate badly needed revenue,” Murtha wrote, in part.\u003c/p>\n\u003cp>“Such pioneering efforts are not always welcomed by those who have benefited from the status quo,” he said.\u003c/p>\n\u003cp>Regarding Perez’s role at Surprise Valley, Murtha wrote that Perez tried to help save the facility by “effectively” donating over $250,000 but then discovered it faced “more challenges than had been initially realized.” Murtha said Perez worked to attract others who might be better able to help the hospital.\u003c/p>\n\u003cp>\u003cstrong>A New Savior?\u003c/strong>\u003c/p>\n\u003cp>One of those “others” in Perez’s orbit was Gertz, the Denver entrepreneur, who arrived in Surprise Valley several months ago.\u003c/p>\n\u003cp>The Denver executive told residents and Kaiser Health News that he operated a lab that previously performed tests for hospitals owned or managed by Perez’s companies. At one hospital board meeting, Gertz also said he had \u003ca href=\"https://www.dropbox.com/sh/1ahmugqny8sa6nj/AAD0IuNkT-Pn-mqXUCGBVDAEa?dl=0&preview=ambi-board-meeting-2.wav\">handled marketing for Perez companies for 1½ years.\u003c/a>\u003c/p>\n\u003cp>However, he said he had parted ways with Perez after learning of his controversial dealings in other states, and Gertz said Perez now owes him more than $14 million. (Gertz and his companies have not been named as defendants in lawsuits reviewed by Kaiser Health News involving Perez and his companies.)\u003c/p>\n\u003cp>“I come in with a certain guilt by association,” he told the Modoc County Board of Supervisors in April, according to a \u003ca href=\"http://modoccountyca.iqm2.com/Citizens/SplitView.aspx?Mode=Video&MeetingID=1770&Format=Agenda\">recording\u003c/a> of the meeting. But Gertz sought to assuage any concerns, telling the supervisors he had a “passion” for rural life. He’d grown up on a farm, he said, where he “hung out with the chickens” and cleaned the stables every morning.\u003c/p>\n\u003cp>Gertz said his plan was different from Perez’s and legal because the hospital and one of his Denver labs, SeroDynamics, had become one business. With the hospital board’s approval earlier this year, he loaned the district $2.5 million for it to buy SeroDynamics — effectively an advance on the hospital’s purchase price of $4 million, according to bankruptcy court \u003ca href=\"https://www.documentcloud.org/documents/4451070-Surprise-Valley-Community-Hospital-Bankruptcy.html#document/p34/a424718\">documents\u003c/a>. SeroDynamics’ \u003ca href=\"https://www.serodyn.com/\">website\u003c/a> now proclaims the lab a “wholly-owned subsidiary” of the Surprise Valley hospital, with “national reach.”\u003c/p>\n\u003cp>Robert Michel, a clinical laboratory management consultant who learned of the terms of the transaction from a reporter, offered a critical assessment. “The essence of this arrangement is to use the hospital’s existing managed-care contracts with generous payment terms for lab tests as a vehicle to bill for claims in other states,” said Michel, editor-in-chief of \u003ca href=\"https://www.darkintelligencegroup.com/\">a trade magazine\u003c/a> for the lab industry. This arrangement “should ring all sorts of bells” for the hospital board, he said.\u003c/p>\n\u003cp>For now, Gertz has said, dollars are flowing in. According to the journalist Jean Bilodeaux, Gertz phoned in to a Surprise Valley hospital board meeting last month to report that the lab billing so far had netted about $300,000. According to bankruptcy court documents, 80 percent of the profits will go to his companies, 20 percent to the hospital.\u003c/p>\n\u003cp>Those are terms some in Surprise Valley are willing to live with.\u003c/p>\n\u003cp>The next step, for Gertz, is taking ownership of Surprise Valley’s entire operation. For the 1,500 district residents, voting no on Tuesday almost certainly means closure, leaving taxpayers with potentially more debt, including any money they may owe Gertz.\u003c/p>\n\u003cp>That is good enough reason to go with the Denver entrepreneur, said acting hospital administrator Bill Bostic.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“He’s got something we haven’t got — which is money,” Bostic said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363769/on-the-ballot-the-fate-of-a-troubled-hospital-in-modoc-county","authors":["byline_stateofhealth_363769"],"categories":["stateofhealth_11","stateofhealth_14","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_3250","stateofhealth_2808","stateofhealth_2519","stateofhealth_3249"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_363775","label":"stateofhealth_3036"},"stateofhealth_363411":{"type":"posts","id":"stateofhealth_363411","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363411","score":null,"sort":[1525991676000]},"guestAuthors":[],"slug":"where-do-you-go-when-you-leave-the-hospital-but-are-homeless","title":"Where Do You Go When You Leave the Hospital But Are Homeless?","publishDate":1525991676,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">Suzanne Adams stood outside \u003ca href=\"http://www.catsinc.org/a-woman-s-place.html\" target=\"_blank\" rel=\"noopener\">A Woman’s Place\u003c/a>, a homeless drop-in center in San Francisco. Adams, who works there as a psychologist, pointed to the curb near the front entrance. It's where taxis regularly drop off homeless patients who have just been discharged from the hospital. \u003c/span>\u003c/p>\n\u003cp>\"Generally speaking the driver is kind enough to assist some of these women in exiting the vehicle and grabbing some of their belongings,\" Adams said. \"The patient or client enters in through our door sometimes bewildered and confused as to why they’re here.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Many of the women are elderly. Some have never been to A Woman's Place before the taxi drops them off, while others are regulars. Whatever the case, the center just isn’t prepared to take in medically fragile patients straight from the hospital, according to Adams. It’s not a clinic, and it’s not even a shelter. Women and families can stop in to take showers, do laundry or get counseling. There aren’t any beds, just a television set and lots of chairs. \u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1152\" target=\"_blank\" rel=\"noopener\">A bill\u003c/a> under consideration in Sacramento aims to address this practice, which some advocates call \"patient dumping.\" They say hospitals commonly discharge homeless patients by sending them to social service agencies or other nonprofits, and they do this without contacting those locations first.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams said this “dumping” happens at least once a week at A Woman's Place. One of the cases that haunts her involves an elderly woman who has a serious mental illness. Recently, the client had deteriorated so much that she couldn’t use the toilet alone. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"She wasn’t leaving the building under her own accord,\" Adams said. \"She wasn’t accessing food or water without the assistance of other people. She tried to pay me a dollar the other day to go buy her some ramen so that she could eat.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams sent the woman to the hospital, hoping psychiatric services would help. \u003c/span>\u003c/p>\n\u003cp>\"Unfortunately, less than 24 hours later, she returned here,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The same client was resting at the center on the day a KQED reporter visited, sitting in a black chair that she favors. Adams said the woman’s mental illness still wasn't well-controlled, so she couldn't speak coherently or consent to an interview. \u003c/span>\u003c/p>\n\u003cp>\"In an ideal world, she would be transferred to a 'board and care' or an assisted living facility, where they could manage her mental health as well as her medical health in a fashion that we simply don’t have the infrastructure for,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation moving through the state Senate would require that patients be discharged to one of four \"safe and appropriate\" locations: their primary dwelling (as identified by the homeless patient), another health center or hospital, a nonprofit or social service agency that has given written consent to accept the patient, or an alternative spot that the patient has consented to go to, in writing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://sd22.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Sen. Ed Hernandez\u003c/a>, D-West Covina, introduced the bill. He said hospitals, as part of society, have obligations to homeless Californians. \u003c/span>\u003c/p>\n\u003cp>\"If they fall down and have a heart attack, and somebody sends them to the hospital, we’re required by law -- which is the humane thing to do -- to treat those individuals,\" said Hernandez, who is an optometrist and chair of the Senate Health Committee. He was referring to a federal law called \u003ca href=\"https://www.acep.org/news-media-top-banner/emtala/#sm.000005tj0xf3geeirxddg2ghqr9qa\" target=\"_blank\" rel=\"noopener\">EMTALA\u003c/a>, which mandates that emergency rooms accept and treat everyone, regardless of ability to pay.\u003c/p>\n\u003cp>But EMTALA doesn't address how patients are discharged from ERs. \"Once they’re treated, the humane thing is to figure out where we’re going to place them, as opposed to just leaving them out in the street immediately,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">His bill would require some additional work on the part of ER staffers at California hospitals, such as getting consent from a shelter where the hospital wants to send the patient. \u003c/span>\u003c/p>\n\u003cp>\"I can’t imagine that it’s going to be that costly to pick up the phone,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation also lays out a checklist of things to do before discharge. For example, the patient must be hydrated, have recently eaten and be dressed in weather-appropriate clothing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But hospitals are pushing back, saying the list is too specific, and doesn’t give hospital workers enough flexibility to decide what’s right for each patient. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.calhospital.org/profile/peggy-broussard-wheeler\" target=\"_blank\" rel=\"noopener\">Peggy Wheeler\u003c/a> is the vice president for rural health and governance for the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>. She said the bill would put yet another burden on emergency care. \u003c/span>\u003c/p>\n\u003cp>\"Hospital ERs are overcrowded,\" Wheeler said. \"If we had to hold on to a patient in a bed in the ER, that’s one less bed, two less beds, three less beds that would be available for other members of the community that need to come in and use the ER.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams, the psychologist at A Woman’s Place, thinks the bill is a good step. But she said it doesn’t get at the \u003c/span>\u003cspan style=\"font-weight: 400\">root \u003c/span>\u003cspan style=\"font-weight: 400\">problem, which is that the Bay Area doesn’t have enough options for patients who still need help \u003c/span>\u003cspan style=\"font-weight: 400\">after\u003c/span>\u003cspan style=\"font-weight: 400\"> they leave the hospital. There aren’t enough nursing homes, rehabilitation units or assisted care programs for elderly, low-income or disabled patients. \u003c/span>\u003c/p>\n\u003cp>\"It’s a health insurance issue, it’s an aging issue, it’s a lack of infrastructure and funding,\" Adams said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Until that gets fixed, Adams fears many patients will continue to shuttle between hospitals, the shelter system and the street. \u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"Legislation moving through the state Senate would require patients to be released to one of four \"safe and appropriate\" locations.","status":"publish","parent":0,"modified":1525994461,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":957},"headData":{"title":"Where Do You Go When You Leave the Hospital But Are Homeless? | KQED","description":"Legislation moving through the state Senate would require patients to be released to one of four "safe and appropriate" locations.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"363411 https://ww2.kqed.org/stateofhealth/?p=363411","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/05/10/where-do-you-go-when-you-leave-the-hospital-but-are-homeless/","disqusTitle":"Where Do You Go When You Leave the Hospital But Are Homeless?","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2018/05/KlivansPatientDumping.mp3","path":"/stateofhealth/363411/where-do-you-go-when-you-leave-the-hospital-but-are-homeless","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Suzanne Adams stood outside \u003ca href=\"http://www.catsinc.org/a-woman-s-place.html\" target=\"_blank\" rel=\"noopener\">A Woman’s Place\u003c/a>, a homeless drop-in center in San Francisco. Adams, who works there as a psychologist, pointed to the curb near the front entrance. It's where taxis regularly drop off homeless patients who have just been discharged from the hospital. \u003c/span>\u003c/p>\n\u003cp>\"Generally speaking the driver is kind enough to assist some of these women in exiting the vehicle and grabbing some of their belongings,\" Adams said. \"The patient or client enters in through our door sometimes bewildered and confused as to why they’re here.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Many of the women are elderly. Some have never been to A Woman's Place before the taxi drops them off, while others are regulars. Whatever the case, the center just isn’t prepared to take in medically fragile patients straight from the hospital, according to Adams. It’s not a clinic, and it’s not even a shelter. Women and families can stop in to take showers, do laundry or get counseling. There aren’t any beds, just a television set and lots of chairs. \u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1152\" target=\"_blank\" rel=\"noopener\">A bill\u003c/a> under consideration in Sacramento aims to address this practice, which some advocates call \"patient dumping.\" They say hospitals commonly discharge homeless patients by sending them to social service agencies or other nonprofits, and they do this without contacting those locations first.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams said this “dumping” happens at least once a week at A Woman's Place. One of the cases that haunts her involves an elderly woman who has a serious mental illness. Recently, the client had deteriorated so much that she couldn’t use the toilet alone. \u003c/span>\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>\"She wasn’t leaving the building under her own accord,\" Adams said. \"She wasn’t accessing food or water without the assistance of other people. She tried to pay me a dollar the other day to go buy her some ramen so that she could eat.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams sent the woman to the hospital, hoping psychiatric services would help. \u003c/span>\u003c/p>\n\u003cp>\"Unfortunately, less than 24 hours later, she returned here,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The same client was resting at the center on the day a KQED reporter visited, sitting in a black chair that she favors. Adams said the woman’s mental illness still wasn't well-controlled, so she couldn't speak coherently or consent to an interview. \u003c/span>\u003c/p>\n\u003cp>\"In an ideal world, she would be transferred to a 'board and care' or an assisted living facility, where they could manage her mental health as well as her medical health in a fashion that we simply don’t have the infrastructure for,\" Adams said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation moving through the state Senate would require that patients be discharged to one of four \"safe and appropriate\" locations: their primary dwelling (as identified by the homeless patient), another health center or hospital, a nonprofit or social service agency that has given written consent to accept the patient, or an alternative spot that the patient has consented to go to, in writing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://sd22.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Sen. Ed Hernandez\u003c/a>, D-West Covina, introduced the bill. He said hospitals, as part of society, have obligations to homeless Californians. \u003c/span>\u003c/p>\n\u003cp>\"If they fall down and have a heart attack, and somebody sends them to the hospital, we’re required by law -- which is the humane thing to do -- to treat those individuals,\" said Hernandez, who is an optometrist and chair of the Senate Health Committee. He was referring to a federal law called \u003ca href=\"https://www.acep.org/news-media-top-banner/emtala/#sm.000005tj0xf3geeirxddg2ghqr9qa\" target=\"_blank\" rel=\"noopener\">EMTALA\u003c/a>, which mandates that emergency rooms accept and treat everyone, regardless of ability to pay.\u003c/p>\n\u003cp>But EMTALA doesn't address how patients are discharged from ERs. \"Once they’re treated, the humane thing is to figure out where we’re going to place them, as opposed to just leaving them out in the street immediately,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">His bill would require some additional work on the part of ER staffers at California hospitals, such as getting consent from a shelter where the hospital wants to send the patient. \u003c/span>\u003c/p>\n\u003cp>\"I can’t imagine that it’s going to be that costly to pick up the phone,\" Hernandez said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The legislation also lays out a checklist of things to do before discharge. For example, the patient must be hydrated, have recently eaten and be dressed in weather-appropriate clothing. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But hospitals are pushing back, saying the list is too specific, and doesn’t give hospital workers enough flexibility to decide what’s right for each patient. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.calhospital.org/profile/peggy-broussard-wheeler\" target=\"_blank\" rel=\"noopener\">Peggy Wheeler\u003c/a> is the vice president for rural health and governance for the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>. She said the bill would put yet another burden on emergency care. \u003c/span>\u003c/p>\n\u003cp>\"Hospital ERs are overcrowded,\" Wheeler said. \"If we had to hold on to a patient in a bed in the ER, that’s one less bed, two less beds, three less beds that would be available for other members of the community that need to come in and use the ER.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Adams, the psychologist at A Woman’s Place, thinks the bill is a good step. But she said it doesn’t get at the \u003c/span>\u003cspan style=\"font-weight: 400\">root \u003c/span>\u003cspan style=\"font-weight: 400\">problem, which is that the Bay Area doesn’t have enough options for patients who still need help \u003c/span>\u003cspan style=\"font-weight: 400\">after\u003c/span>\u003cspan style=\"font-weight: 400\"> they leave the hospital. There aren’t enough nursing homes, rehabilitation units or assisted care programs for elderly, low-income or disabled patients. \u003c/span>\u003c/p>\n\u003cp>\"It’s a health insurance issue, it’s an aging issue, it’s a lack of infrastructure and funding,\" Adams said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Until that gets fixed, Adams fears many patients will continue to shuttle between hospitals, the shelter system and the street. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363411/where-do-you-go-when-you-leave-the-hospital-but-are-homeless","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_3012","stateofhealth_14","stateofhealth_2746"],"tags":["stateofhealth_3244","stateofhealth_3243","stateofhealth_2808","stateofhealth_719","stateofhealth_68","stateofhealth_2519","stateofhealth_3241","stateofhealth_3242"],"featImg":"stateofhealth_363413","label":"stateofhealth"},"stateofhealth_363257":{"type":"posts","id":"stateofhealth_363257","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"363257","score":null,"sort":[1523662153000]},"guestAuthors":[],"slug":"a-firefighter-in-san-diego-confronts-the-trauma-of-the-job","title":"A Firefighter in San Diego Confronts the Trauma of the Job","publishDate":1523662153,"format":"audio","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" rel=\"noopener\" target=\"_blank\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>At 7:30 on a recent morning, Jeremy Forte, a firefighter in Imperial Beach, California, had just wrapped up a 48-hour shift. As the seven-member crew headed home, Forte drove right past a local bar that used to be a favorite haunt. A few years ago, he would have stopped for a drink, or two, or three -- and perhaps stayed on for hours. And he would have had plenty of company.\u003c/p>\n\u003cp>\"There’s nurses from the hospital there getting off work at the same time,\" Forte recalled. \"We’d be drinking with nurses, partying, having a good old time. And we didn’t think anything was wrong. That’s what people do, right? They get off work and have some drinks.\"\u003c/p>\n\u003cp>Jeremy is tall and lanky, with a thin mustache. He’s been a firefighter for 19 years. It’s grueling work, both physically and mentally. For a long time, drinking was how he coped.\u003c/p>\n\u003cp>\"Our motto was work hard, party hard,\" said Forte, now 39. \"We put in 16-hour days and then we’d go drink the rest of the night, and then probably get two hours of sleep. Wake up, you know, half-drunk and go back out on the fire line and fight these fires.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A few years ago, Forte's drinking got heavier. He started dabbling in cocaine. But he felt he still had it all under control, until he failed a random drug test at work.\u003c/p>\n\u003cp>Forte's station is part of the federal government: his crew fights fires and responds to emergencies in and around a \u003ca href=\"https://www.cnic.navy.mil/regions/cnrsw/installations/navbase_coronado.html\" target=\"_blank\" rel=\"noopener\">naval base\u003c/a> in Imperial Beach. The federal firefighting force has a zero-tolerance policy, and Forte was in danger of losing his job immediately.\u003c/p>\n\u003cp>\"They really could have ended my whole life by turning their backs on me and firing me,\" Forte said. \"And then at that point, I would lose my wife as well, and probably be living with my parents.\"\u003c/p>\n\u003cp>Forte grew up in West Covina. Two \u003ca href=\"http://www.lafd.org/\" target=\"_blank\" rel=\"noopener\">LAFD\u003c/a> firefighters lived on his block. Forte admired them, and loved seeing his next-door neighbors on the local news.\u003c/p>\n\u003cp>\"Doing that sort of thing really intrigued me,\" he recalled. Not only was the job itself exciting, but it also allowed the firefighters to spend plenty of time with their families when they were off-duty.\u003c/p>\n\u003cp>But not everyone believed he could do it. Forte was born with a birth defect: He’s missing some fingers on both hands, and others aren’t fully formed. His whole career, he’s had to prove that he can do everything a firefighter has to do: drive rigs, grip and haul hoses, rescue people.\u003c/p>\n\u003cp>Forte proved the doubters wrong.\u003c/p>\n\u003cfigure id=\"attachment_363270\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363270\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, California, has been a firefighter for 19 years and struggles with PTSD and depression. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 19 years as a firefighter, it has become crucial to his identity. Losing that career would have been absolutely devastating. After the drug test, Forte hired a private lawyer and asked the department and union for a second chance. He agreed to every condition of a yearlong probation, including enrolling in a recovery program and beginning therapy.\u003c/p>\n\u003cp>\"By the grace of God, I still have my job,\" Forte said. \"I still have people backing me.\"\u003c/p>\n\u003cp>During his recovery, Jeremy was diagnosed with post-traumatic stress disorder and depression. He wasn’t surprised to hear it, and he's not alone.\u003c/p>\n\u003cp>First responders have increased rates of PTSD, depression, substance abuse and suicide due to the stresses they are exposed to on the job. In a \u003ca href=\"http://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a>, 85 percent of first responders reported symptoms related to mental health issues, but only about a third of them sought out professional help.\u003c/p>\n\u003cp>Another \u003ca href=\"http://www.jems.com/articles/print/volume-40/issue-10/features/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-suicide.html?c=1\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> revealed 6.6 percent of first responders had attempted suicide, and more than a third had considered suicide. In both cases, those rates are 10 times the national average.\u003c/p>\n\u003cp>\"I always thought, it’s a job, you go do it and you just deal with it, it goes away,\" Forte said. \"But it doesn’t.\"\u003c/p>\n\u003cp>The pain lingers and haunts. Forte learned that when he was 22, at his first job with the forest service. His team fought fires but also rescued backpackers -- and he was surprised by the violence that nature can cause.\u003c/p>\n\u003cp>\"There was a gentleman out camping in the middle of the forest in New Mexico,\" he recalled. \"A piece of the tree broke off and hit him in the neck and broke his neck. And as he hit the ground, he broke his leg. We had to fly there in a helicopter, basically to rescue him.\"\u003c/p>\n\u003cp>But by the time they got there, the hiker had died. It was the first time Forte saw a dead body on the job, a victim of a violent, random accident. The helicopter extracted the body, but then it grew too dark to come back for the hiker's friend, who was uninjured but traumatized and covered in blood. So Forte volunteered to stay with him all night in the woods.\u003c/p>\n\u003cp>After that incident, Forte started having nightmares.\u003c/p>\n\u003cp>\"The things that we see on the job aren’t what everyday people see and so they wouldn’t understand completely what we deal with, and how it can haunt us and stay with us the rest of our lives.\"\u003c/p>\n\u003cfigure id=\"attachment_363276\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363276\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jeremy Forte prepares to perform drills on Jan. 9, 2018. Forte has been a firefighter for 19 years and says the job is grueling, both physically and mentally. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not that firefighters never talk about what they see. They do, but they don’t talk about the pain inside.\u003c/p>\n\u003cp>\"You don’t want to be seen as weak,\" he said. \"So instead ... we’d go have some drinks and joke about it, or, you know, talk about the situation still, but it’s over alcohol.\"\u003c/p>\n\u003cp>After hitting bottom, Jeremy moved his family to a wood cabin in Lake Arrowhead. It’s quiet there, and he can decompress when he isn’t at work.\u003c/p>\n\u003cp>Jeremy is now sober and back in the firehouse full-time. He tries to set an example for younger colleagues by sharing his story, and talking about his emotions more often.\u003c/p>\n\u003cp>\"The current fire crew that I work with now, we’re all very open together,\" he said. \"We’re very tight-knit and we talk about the stuff we see. ... We’re almost like our own counselors.\"\u003c/p>\n\u003cp>Often the men gather in the kitchen to make breakfast before the shift formally starts at 7:30 a.m. Some of the men set the table, while others slice mushrooms, make hash browns or scramble eggs.\u003c/p>\n\u003cp>It ends up being a slow shift, with no emergency calls, so the seven men on duty spend the day checking gear and running drills.\u003c/p>\n\u003cp>Before turning in for the night, they gather again at the kitchen table. Things get serious when the talk turns to suicide among firefighters.\u003c/p>\n\u003cp>Everyone in the room knows a firefighter who killed him or herself, or at least has heard about a recent case.\u003c/p>\n\u003cp>The shift captain, Richard Hernandez, complained that mental health information wasn’t part of the firefighter training.\u003c/p>\n\u003cp>\"There really hasn’t been any direction on how to work with that if somebody is having an issue,\" he said.\u003c/p>\n\u003cp>Hernandez said that his firefighters can get three visits with a counselor per year, but that’s not enough.\u003c/p>\n\u003cp>Another firefighter, Lindsey Nolan, said he wants to learn how to recognize signs or symptoms of PTSD in a co-worker.\u003c/p>\n\u003cp>\"I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on\" if he had some training in it, Nolan said.\u003c/p>\n\u003cp>Another firefighter, Devin Boler, admitted it’s hard to know how -- or when -- to intervene.\u003c/p>\n\u003cp>\"Because we live together, and we’re with each other through Christmas and Thanksgiving and stuff like that, we have to be professional,\" Boler said. But there's also \"a family side to it, where you kind of have to check in with guys and see what’s going on, if they’re having a rough day.\"\u003c/p>\n\u003cp>Firefighters began talking about these issues more after the increase in mass public shootings, according to the \u003ca href=\"http://www.ffbha.org/\" target=\"_blank\" rel=\"noopener\">Firefighter Behavioral Health Alliance\u003c/a>, an Arizona-based nonprofit that provides mental health support and training for firefighters.\u003c/p>\n\u003ch2>A Bittersweet Milestone\u003c/h2>\n\u003cp>Forte has been making the long drive to a drug screening center, in National City, at least twice a month for the past year. It's part of his probation: submitting to a full year of random, and frequent, drug tests.\u003c/p>\n\u003cp>Today was his last visit, though. His probation is ending. Forte will still get random drug tests, but not as often.\u003c/p>\n\u003cp>\"I feel great,\" he said as he drove. \"Not like I’m going to go out and celebrate, if you know what I mean.\"\u003c/p>\n\u003cp>During the drive, Jeremy downed two large coffees. But despite the caffeine, he's too wound up to provide a urine sample. After a few hours, he succeeds, and finally walks out of that clinic for the last time.\u003c/p>\n\u003cp>\"It was a humbling process,\" he reflected, looking back at his year of probation. \"Ultimately, I wanted to get back on track for my family, for my job, for myself.\"\u003c/p>\n\u003cp>\"The biggest reason is my kids,\" he added. \"I wasn’t going to allow this to keep me down, and be some deadbeat dad that didn’t seek help.\"\u003c/p>\n\u003cp>Forte said the culture of silence among first responders has to end. So does the idea that emergency work is about being tough at all costs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Guys shouldn’t feel that way,\" he said. He wants firefighters to think about seeking counseling or mental health assistance as \"the manly thing to do.\"\u003c/p>\n\u003cfigure id=\"attachment_363271\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363271\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, Calif., has been a firefighter for 19 years and struggles with PTSD and depression. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\n","blocks":[],"excerpt":"Firefighter Jeremy Forte, who has battled PTSD, depression and substance abuse, says the culture of suffering in silence among first responders has to end.","status":"publish","parent":0,"modified":1523667364,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":50,"wordCount":1732},"headData":{"title":"A Firefighter in San Diego Confronts the Trauma of the Job | KQED","description":"Firefighter Jeremy Forte, who has battled PTSD, depression and substance abuse, says the culture of suffering in silence among first responders has to end.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"363257 https://ww2.kqed.org/stateofhealth/?p=363257","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/04/13/a-firefighter-in-san-diego-confronts-the-trauma-of-the-job/","disqusTitle":"A Firefighter in San Diego Confronts the Trauma of the Job","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcrmag/2018/04/FirefighterTrauma.mp3","nprByline":"\u003cstrong>\u003ca href=\"https://khn.org/news/author/heidi-de-marco/\">Heidi de Marco\u003c/a>\u003c/strong>\u003cbr>California Healthline","path":"/stateofhealth/363257/a-firefighter-in-san-diego-confronts-the-trauma-of-the-job","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" rel=\"noopener\" target=\"_blank\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>At 7:30 on a recent morning, Jeremy Forte, a firefighter in Imperial Beach, California, had just wrapped up a 48-hour shift. As the seven-member crew headed home, Forte drove right past a local bar that used to be a favorite haunt. A few years ago, he would have stopped for a drink, or two, or three -- and perhaps stayed on for hours. And he would have had plenty of company.\u003c/p>\n\u003cp>\"There’s nurses from the hospital there getting off work at the same time,\" Forte recalled. \"We’d be drinking with nurses, partying, having a good old time. And we didn’t think anything was wrong. That’s what people do, right? They get off work and have some drinks.\"\u003c/p>\n\u003cp>Jeremy is tall and lanky, with a thin mustache. He’s been a firefighter for 19 years. It’s grueling work, both physically and mentally. For a long time, drinking was how he coped.\u003c/p>\n\u003cp>\"Our motto was work hard, party hard,\" said Forte, now 39. \"We put in 16-hour days and then we’d go drink the rest of the night, and then probably get two hours of sleep. Wake up, you know, half-drunk and go back out on the fire line and fight these fires.\"\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>A few years ago, Forte's drinking got heavier. He started dabbling in cocaine. But he felt he still had it all under control, until he failed a random drug test at work.\u003c/p>\n\u003cp>Forte's station is part of the federal government: his crew fights fires and responds to emergencies in and around a \u003ca href=\"https://www.cnic.navy.mil/regions/cnrsw/installations/navbase_coronado.html\" target=\"_blank\" rel=\"noopener\">naval base\u003c/a> in Imperial Beach. The federal firefighting force has a zero-tolerance policy, and Forte was in danger of losing his job immediately.\u003c/p>\n\u003cp>\"They really could have ended my whole life by turning their backs on me and firing me,\" Forte said. \"And then at that point, I would lose my wife as well, and probably be living with my parents.\"\u003c/p>\n\u003cp>Forte grew up in West Covina. Two \u003ca href=\"http://www.lafd.org/\" target=\"_blank\" rel=\"noopener\">LAFD\u003c/a> firefighters lived on his block. Forte admired them, and loved seeing his next-door neighbors on the local news.\u003c/p>\n\u003cp>\"Doing that sort of thing really intrigued me,\" he recalled. Not only was the job itself exciting, but it also allowed the firefighters to spend plenty of time with their families when they were off-duty.\u003c/p>\n\u003cp>But not everyone believed he could do it. Forte was born with a birth defect: He’s missing some fingers on both hands, and others aren’t fully formed. His whole career, he’s had to prove that he can do everything a firefighter has to do: drive rigs, grip and haul hoses, rescue people.\u003c/p>\n\u003cp>Forte proved the doubters wrong.\u003c/p>\n\u003cfigure id=\"attachment_363270\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-363270\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, California, has been a firefighter for 19 years and struggles with PTSD and depression. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 19 years as a firefighter, it has become crucial to his identity. Losing that career would have been absolutely devastating. After the drug test, Forte hired a private lawyer and asked the department and union for a second chance. He agreed to every condition of a yearlong probation, including enrolling in a recovery program and beginning therapy.\u003c/p>\n\u003cp>\"By the grace of God, I still have my job,\" Forte said. \"I still have people backing me.\"\u003c/p>\n\u003cp>During his recovery, Jeremy was diagnosed with post-traumatic stress disorder and depression. He wasn’t surprised to hear it, and he's not alone.\u003c/p>\n\u003cp>First responders have increased rates of PTSD, depression, substance abuse and suicide due to the stresses they are exposed to on the job. In a \u003ca href=\"http://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a>, 85 percent of first responders reported symptoms related to mental health issues, but only about a third of them sought out professional help.\u003c/p>\n\u003cp>Another \u003ca href=\"http://www.jems.com/articles/print/volume-40/issue-10/features/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-suicide.html?c=1\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> revealed 6.6 percent of first responders had attempted suicide, and more than a third had considered suicide. In both cases, those rates are 10 times the national average.\u003c/p>\n\u003cp>\"I always thought, it’s a job, you go do it and you just deal with it, it goes away,\" Forte said. \"But it doesn’t.\"\u003c/p>\n\u003cp>The pain lingers and haunts. Forte learned that when he was 22, at his first job with the forest service. His team fought fires but also rescued backpackers -- and he was surprised by the violence that nature can cause.\u003c/p>\n\u003cp>\"There was a gentleman out camping in the middle of the forest in New Mexico,\" he recalled. \"A piece of the tree broke off and hit him in the neck and broke his neck. And as he hit the ground, he broke his leg. We had to fly there in a helicopter, basically to rescue him.\"\u003c/p>\n\u003cp>But by the time they got there, the hiker had died. It was the first time Forte saw a dead body on the job, a victim of a violent, random accident. The helicopter extracted the body, but then it grew too dark to come back for the hiker's friend, who was uninjured but traumatized and covered in blood. So Forte volunteered to stay with him all night in the woods.\u003c/p>\n\u003cp>After that incident, Forte started having nightmares.\u003c/p>\n\u003cp>\"The things that we see on the job aren’t what everyday people see and so they wouldn’t understand completely what we deal with, and how it can haunt us and stay with us the rest of our lives.\"\u003c/p>\n\u003cfigure id=\"attachment_363276\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363276\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-5-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jeremy Forte prepares to perform drills on Jan. 9, 2018. Forte has been a firefighter for 19 years and says the job is grueling, both physically and mentally. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not that firefighters never talk about what they see. They do, but they don’t talk about the pain inside.\u003c/p>\n\u003cp>\"You don’t want to be seen as weak,\" he said. \"So instead ... we’d go have some drinks and joke about it, or, you know, talk about the situation still, but it’s over alcohol.\"\u003c/p>\n\u003cp>After hitting bottom, Jeremy moved his family to a wood cabin in Lake Arrowhead. It’s quiet there, and he can decompress when he isn’t at work.\u003c/p>\n\u003cp>Jeremy is now sober and back in the firehouse full-time. He tries to set an example for younger colleagues by sharing his story, and talking about his emotions more often.\u003c/p>\n\u003cp>\"The current fire crew that I work with now, we’re all very open together,\" he said. \"We’re very tight-knit and we talk about the stuff we see. ... We’re almost like our own counselors.\"\u003c/p>\n\u003cp>Often the men gather in the kitchen to make breakfast before the shift formally starts at 7:30 a.m. Some of the men set the table, while others slice mushrooms, make hash browns or scramble eggs.\u003c/p>\n\u003cp>It ends up being a slow shift, with no emergency calls, so the seven men on duty spend the day checking gear and running drills.\u003c/p>\n\u003cp>Before turning in for the night, they gather again at the kitchen table. Things get serious when the talk turns to suicide among firefighters.\u003c/p>\n\u003cp>Everyone in the room knows a firefighter who killed him or herself, or at least has heard about a recent case.\u003c/p>\n\u003cp>The shift captain, Richard Hernandez, complained that mental health information wasn’t part of the firefighter training.\u003c/p>\n\u003cp>\"There really hasn’t been any direction on how to work with that if somebody is having an issue,\" he said.\u003c/p>\n\u003cp>Hernandez said that his firefighters can get three visits with a counselor per year, but that’s not enough.\u003c/p>\n\u003cp>Another firefighter, Lindsey Nolan, said he wants to learn how to recognize signs or symptoms of PTSD in a co-worker.\u003c/p>\n\u003cp>\"I’d be a lot more comfortable approaching them and talking to them about what may or may not be going on\" if he had some training in it, Nolan said.\u003c/p>\n\u003cp>Another firefighter, Devin Boler, admitted it’s hard to know how -- or when -- to intervene.\u003c/p>\n\u003cp>\"Because we live together, and we’re with each other through Christmas and Thanksgiving and stuff like that, we have to be professional,\" Boler said. But there's also \"a family side to it, where you kind of have to check in with guys and see what’s going on, if they’re having a rough day.\"\u003c/p>\n\u003cp>Firefighters began talking about these issues more after the increase in mass public shootings, according to the \u003ca href=\"http://www.ffbha.org/\" target=\"_blank\" rel=\"noopener\">Firefighter Behavioral Health Alliance\u003c/a>, an Arizona-based nonprofit that provides mental health support and training for firefighters.\u003c/p>\n\u003ch2>A Bittersweet Milestone\u003c/h2>\n\u003cp>Forte has been making the long drive to a drug screening center, in National City, at least twice a month for the past year. It's part of his probation: submitting to a full year of random, and frequent, drug tests.\u003c/p>\n\u003cp>Today was his last visit, though. His probation is ending. Forte will still get random drug tests, but not as often.\u003c/p>\n\u003cp>\"I feel great,\" he said as he drove. \"Not like I’m going to go out and celebrate, if you know what I mean.\"\u003c/p>\n\u003cp>During the drive, Jeremy downed two large coffees. But despite the caffeine, he's too wound up to provide a urine sample. After a few hours, he succeeds, and finally walks out of that clinic for the last time.\u003c/p>\n\u003cp>\"It was a humbling process,\" he reflected, looking back at his year of probation. \"Ultimately, I wanted to get back on track for my family, for my job, for myself.\"\u003c/p>\n\u003cp>\"The biggest reason is my kids,\" he added. \"I wasn’t going to allow this to keep me down, and be some deadbeat dad that didn’t seek help.\"\u003c/p>\n\u003cp>Forte said the culture of silence among first responders has to end. So does the idea that emergency work is about being tough at all costs.\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>\"Guys shouldn’t feel that way,\" he said. He wants firefighters to think about seeking counseling or mental health assistance as \"the manly thing to do.\"\u003c/p>\n\u003cfigure id=\"attachment_363271\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" class=\"size-medium wp-image-363271\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-1200x801.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/first-responder-trauma-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jeremy Forte, at fire station No. 14 in Imperial Beach, Calif., has been a firefighter for 19 years and struggles with PTSD and depression. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/363257/a-firefighter-in-san-diego-confronts-the-trauma-of-the-job","authors":["byline_stateofhealth_363257"],"categories":["stateofhealth_11","stateofhealth_3012","stateofhealth_14","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_3240","stateofhealth_2519"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_363272","label":"stateofhealth_3036"},"stateofhealth_362982":{"type":"posts","id":"stateofhealth_362982","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362982","score":null,"sort":[1522082717000]},"guestAuthors":[],"slug":"a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","title":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks","publishDate":1522082717,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly listed the quality-care targets hospitals would have to meet to be included in Covered California insurance plans. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Covered California, the state's insurance marketplace, has been actively focused on cost control for years. Now the agency is demanding more on quality measures such as C-section rates and hospital-acquired infections. ","status":"publish","parent":0,"modified":1534298703,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1464},"headData":{"title":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks | KQED","description":"Covered California, the state's insurance marketplace, has been actively focused on cost control for years. Now the agency is demanding more on quality measures such as C-section rates and hospital-acquired infections. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362982 https://ww2.kqed.org/stateofhealth/?p=362982","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/03/26/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks/","disqusTitle":"A New Message for California Hospitals: Shape Up, or Get Kicked Out of Obamacare Networks","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/03/DemboskyHospitalQuality.mp3","audioTrackLength":214,"path":"/stateofhealth/362982/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>While most of the recent debate around health care has been around cost -- especially the predictions about skyrocketing Obamacare premiums -- there are 100 pages in the Affordable Care Act devoted solely to improving the \u003ca href=\"https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/\" target=\"_blank\" rel=\"noopener\">\u003cem>quality \u003c/em>of the health care\u003c/a> Americans are paying so much for.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s Obamacare marketplace, is taking that mandate under the law seriously, and is now making a bold move to improve quality in a concrete way, and ultimately, ensure that California consumers get more value for their premium dollars.\u003c/p>\n\u003cp>In the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace.\u003c/p>\n\u003cp>“We’re saying ‘time’s up,’” said \u003ca href=\"https://www.bizjournals.com/sacramento/news/2015/05/22/covered-california-hires-chief-medical-officer.html\" target=\"_blank\" rel=\"noopener\">Lance Lang\u003c/a>, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019, we want networks to only include hospitals that have achieved that target.”\u003c/p>\n\u003cp>Lang says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. The chosen targets require hospitals to perform fewer unnecessary C-sections, reduce hospital-acquired infections, improve patient experience, and reduce excessive costs.\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>For example, C-sections. Hospitals get paid more to do them, and they usually take less time: 40 minutes for a scheduled procedure versus 24-hour on-call staffing for vaginal deliveries. Although C-sections are often medically prudent when the mother or fetus has a high risk of complication, many women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section.\u003c/p>\n\u003cp>“That means that when a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a cesarean section, not so much her own health,” said Lang.\u003c/p>\n\u003cp>Unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.\u003c/p>\n\u003cp>That’s not quality health care, said Lang, and that’s why Covered California is telling hospitals they need to reduce their C-section rates to 23.9 percent or lower, for low-risk births. \"Low risk\" is defined as a healthy, first-time mom carrying a single baby with its head down, all the way to full term (\u003ca href=\"https://www.nichd.nih.gov/news/resources/spotlight/102413-redefining-term\" target=\"_blank\" rel=\"noopener\">39 weeks gestation\u003c/a>).\u003c/p>\n\u003cp>Covered California is joined by \u003ca href=\"https://www.coveredca.com/medi-cal/\" target=\"_blank\" rel=\"noopener\">Medi-Cal\u003c/a>, the state health program for low-income residents, \u003ca href=\"https://www.calpers.ca.gov/\" target=\"_blank\" rel=\"noopener\">CalPERS\u003c/a>, the retirement program for state employees, and the \u003ca href=\"http://www.pbgh.org/\" target=\"_blank\" rel=\"noopener\">Pacific Business Group on Health\u003c/a>, which represents self-insured employers. Together, these groups pay for the health care of 16 million Californians, or 40 percent of the state, which gives them substantial leverage with hospitals.\u003c/p>\n\u003cp>But only Covered California is telling hospitals that if don’t play by the rules, they’ll be benched.\u003c/p>\n\u003cp>“It’s probably the boldest move we’ve seen in maternity care ever,” said Leah Binder, CEO of the \u003ca href=\"http://www.leapfroggroup.org/\" target=\"_blank\" rel=\"noopener\">Leapfrog Group\u003c/a>, a Washington, DC-based nonprofit that rates hospitals on quality.\u003c/p>\n\u003cp>Quality control for hospitals is a recent phenomenon, and still largely voluntary, she said.\u003c/p>\n\u003cp>“Back in the '80s and '90s, nobody ever thought that hospitals should have to report to anyone on how they were doing,” she said. “There’s never been a culture of accountability.”\u003c/p>\n\u003cp>Covered California’s move is nationally significant, Binder said, given the consequences for hospitals, and the agency’s reach – 1.4 million people buy coverage through the marketplace, and they shop among plans offered by 11 state-approved insurance companies.\u003c/p>\n\u003cp>Insurers and business groups across the country are already keeping an eye on California’s effort, she said, to see how they might band together to demand similar change from the hospitals in their regions.\u003c/p>\n\u003cp>“The Northeast Business Group on Health, which covers New York and Massachusetts and Connecticut, they will definitely be watching this to see what could be done,” Binder said.\u003c/p>\n\u003cp>Overall, California’s hospitals are on board with the goal. Of the 243 maternity hospitals in the state, 40 percent have already met the target, Lang said, and another 40 percent have taken advantage of coaching and consulting, to help educate the doctors on how they can adjust their practice, and to educate patients who request C-sections about the risks.\u003c/p>\n\u003cp>“While many may prefer that, when having the full information about the risk that they may be putting themselves and their babies in, they elect not to move in that direction,” said Julie Morath, CEO of the \u003ca href=\"http://www.hqinstitute.org/\" target=\"_blank\" rel=\"noopener\">Hospital Quality Institute\u003c/a>, a subsidiary of the \u003ca href=\"https://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>, both of which support the C-section reduction goals as “the right thing to do.”\u003c/p>\n\u003cp>The effort has raised some concerns among mothers who hear about the 23.9 percent target and worry about rationing.\u003c/p>\n\u003cp>“We don't just chase rates,” Morath said, in counter to that concern, “but rather look at what the clinical needs are and best respond to those. So if there is an indication for a cesarean section, the mother will receive a cesarean section.”\u003c/p>\n\u003cp>But the coaching, and the kind of system change and staffing levels that can be required to lower C-section rates, might be too costly for some hospitals. State data show there are about 40 hospitals that are still far off the target, including a cluster of hospitals in East Los Angeles that treat low-income, often uninsured, patients.\u003c/p>\n\u003cp>The target rate may not be fair for these hospitals, said Malini Nijagal, an OB/GYN at Zuckerberg San Francisco General Hospital. Her hospital’s C-section rate is already below the target, but she said it won’t be easy for others with more diverse patients.\u003c/p>\n\u003cp>“So if you have somebody who is on methamphetamines and is homeless and has not gotten any prenatal care, her chance of a C-section is way higher than someone who is not all those things,” she said. “And so the problem is, how do you adjust for the patient population of a hospital?”\u003c/p>\n\u003cp>At Memorial Hospital of Gardena, the C-section rate is 45.2 percent. At East Los Angeles Doctors Hospital, the rate is 48.1 percent, according to publicly-available state data listed on \u003ca href=\"http://calhospitalcompare.org/\" target=\"_blank\" rel=\"noopener\">CalHospital Compare\u003c/a> and \u003ca href=\"https://www.kqed.org/stateofhealth/358760/yelp-adds-c-section-rates-and-childbirth-data-to-reviews-of-california-hospitals\" target=\"_blank\" rel=\"noopener\">Yelp\u003c/a>.\u003c/p>\n\u003cp>Both hospitals are working diligently to lower the rates, according to Amie Boersma, director for communications for \u003ca href=\"http://avantihospitals.com/\" target=\"_blank\" rel=\"noopener\">Avanti Hospitals\u003c/a>, which owns both hospitals.\u003c/p>\n\u003cp>She said the hospitals will meet the 23.9 percent benchmark and are committed to doing so for the sake of their patients. Being excluded from Covered California health plan networks, she added, would make it even more difficult for those patients to get care. They would either have to pay \"out-of-network\" fees to be seen there, or they would have to travel farther to another facility that was still in the network.\u003c/p>\n\u003cp>“We are in under-served, economically challenged urban neighborhoods and it is vitally important that we continue to provide appropriate, high-quality care for our communities,” Boersma said.\u003c/p>\n\u003cp>Health plans can request exceptions to Covered California’s contract rules, in order to keep non-complying hospitals in their networks, as long as they document their reasoning.\u003c/p>\n\u003cp>“That is flexibility that we asked for to ensure that we maintain adequate access to providers,” said Charles Bacchi, CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener\">California Association of Health Plans\u003c/a>, a trade group for insurers. “Any major changes to health plan networks must be filed with regulators, and health plans have to ensure that patients continue to receive services in a timely manner.”\u003c/p>\n\u003cp>So far, the prospect of exclusion, plus the coaching and education, have functioned as an effective motivator. By the 2020 deadline, Covered California’s Dr. Lang believes all hospitals will either have met the target or be on their way. While the consequences are real, and while it may take some awkward conversations to get there, he said the ultimate goal is to get hospitals to deliver better, safer care to patients.\u003c/p>\n\u003cp>“It's a quality improvement project,” Lang said, “but with a deadline.”\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>CORRECTION: An earlier version of this story incorrectly listed the quality-care targets hospitals would have to meet to be included in Covered California insurance plans. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362982/a-new-message-for-california-hospitals-shape-up-or-get-kicked-out-of-obamacare-networks","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_15","stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_38","stateofhealth_3138","stateofhealth_368","stateofhealth_2808","stateofhealth_3231","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_363029","label":"stateofhealth"},"stateofhealth_362850":{"type":"posts","id":"stateofhealth_362850","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362850","score":null,"sort":[1520240430000]},"guestAuthors":[],"slug":"to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing","title":"To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing","publishDate":1520240430,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Lawmakers will begin debate next month on a bill that would require doctors to screen new moms for mental health problems – once while they’re pregnant and again, after giving birth.\u003c/p>\n\u003cp>But a lot of doctors don’t like the idea. Many obstetricians and pediatricians are afraid to screen new moms for depression and anxiety.\u003c/p>\n\u003cp>“What are you going to do with those people who screen positive?” said Laura Sirott, an OB/GYN who practices in Pasadena. “Some providers have nowhere to send them.”\u003c/p>\n\u003cp>Of women who screen positive for postpartum depression, 78 percent don’t get mental health treatment, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618720/\" target=\"_blank\" rel=\"noopener\">2015 study review\u003c/a> published in the journal \u003cem>Obstetrics & Gynecology\u003c/em>. Dr. Sirott’s patients have told her the range of reasons why they don’t take her up on a referral to a psychologist.\u003c/p>\n\u003cp>“Oh, they don’t take my insurance. Or my insurance pays for three visits. I can’t take time off of work to go to those visits. It’s a three-month wait to get in to that person,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And, it’s hard to find a psychiatrist who is trained in the complexities of prescribing medications to pregnant or breastfeeding women, and who is willing to treat them, especially in rural areas.\u003c/p>\n\u003cp>“So it’s very frustrating to ask patients about a problem and then not have any way to solve that problem,” Sirott said.\u003c/p>\n\u003cp>But moms are frustrated, too. After the baby comes, no one asks about them anymore. Wendy Root Askew struggled for years to get pregnant, and when she finally did, her anxiety got worse. She couldn’t stop worrying that something would go wrong.\u003c/p>\n\u003cp>“And then after I had my son, I would have these dreams where someone would come to the door and they would say ‘Well, you know, we’re just going to wait two weeks to see if you get to keep your baby or not,’” she said. “And it really impacted my ability to bond with him.”\u003c/p>\n\u003cp>She likes the bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB2193\" target=\"_blank\" rel=\"noopener\">AB 2193\u003c/a>, because it goes beyond mandated screening. It requires health insurance companies to set up case management programs to help moms find a therapist, and to connect obstetricians or pediatricians with a psychiatric expert.\u003c/p>\n\u003cp>“Just like we have case management programs for patients who have diabetes or sleep issues or back pain, a case management program requires the insurance company to take some ownership of making sure their patients are getting the treatment they need to be healthy,” said Root Askew, who is now advocating for the bill on behalf of the group \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener\">2020 Mom\u003c/a>.\u003c/p>\n\u003cp>Health insurance companies haven’t taken a position on the legislation. It’s unclear how much it will cost them to comply, because some already have infrastructure in place for case management programs and some don’t. But there is consensus among insurers and health advocates that such programs save money in the long run.\u003c/p>\n\u003cp>“The sooner that you can get good treatment for a mom, the less expensive that condition will be to manage over the course of the woman’s life and over the course of that child’s life,” Root Askew said.\u003c/p>\n\u003cp>Doctors still have their objections. Under the bill, they could be disciplined for not screening. And screening takes time. Sometimes a doctor asks a mom how she’s sleeping, and she’s in tears for the next 30 minutes.\u003c/p>\n\u003cp>The health care system, and the incentives, aren’t set up for this, said Dr. Sirott.\u003c/p>\n\u003cp>“Currently, I get six dollars for screening a patient,” she said. “By the time I put it on a piece of paper and print it, it’s not worth it.”\u003c/p>\n\u003cp>And it’s not clear it’s worth it to the patients either. Four other states – Illinois, Massachusetts, New Jersey, and West Virginia – have tried mandated screening, and it made no difference in patient outcomes, according to \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201300505?code=ps-site\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> published in \u003cem>Psychiatric Services\u003c/em> in 2015.\u003c/p>\n\u003cp>Even with California’s extra requirements on insurance companies to facilitate care, women could still face high co-pays or limits on therapy sessions. Or, they’re so overwhelmed caring for a newborn, they never leave the house.\u003c/p>\n\u003cp>What does seem to work, according to the study, is when nurses or mental health providers visit new moms at home.\u003c/p>\n\u003cp>“Despite abundant good will, there is no evidence that state policies are addressing this great need,” the study authors wrote.\u003c/p>\n\u003cp>But supporters of the proposed bill say doctors need to start somewhere. Screening is the first step in recognizing the full scope of the problem, said Mountain View psychiatrist \u003ca href=\"https://www.elcaminohospital.org/doctors/nirmaljit-dhami\" target=\"_blank\" rel=\"noopener\">Nirmaljit Dhami\u003c/a>, adding that women should be screened on an ongoing basis throughout pregnancy and for a year after birth, not just once or twice as the bill requires.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I often tell doctors that if you don't know that somebody is suicidal it doesn't mean that their suicidality will go away,” she said. “If you don't ask, the risk is the same.”\u003c/p>\n\n","blocks":[],"excerpt":"A proposed bill would require doctors to screen new moms for depression, and require health insurers to help them get care.","status":"publish","parent":0,"modified":1521474114,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":891},"headData":{"title":"To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing | KQED","description":"A proposed bill would require doctors to screen new moms for depression, and require health insurers to help them get care.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362850 https://ww2.kqed.org/stateofhealth/?p=362850","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/03/05/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing/","disqusTitle":"To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/03/MandatedPostPartumScreeningDembosky.mp3","path":"/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lawmakers will begin debate next month on a bill that would require doctors to screen new moms for mental health problems – once while they’re pregnant and again, after giving birth.\u003c/p>\n\u003cp>But a lot of doctors don’t like the idea. Many obstetricians and pediatricians are afraid to screen new moms for depression and anxiety.\u003c/p>\n\u003cp>“What are you going to do with those people who screen positive?” said Laura Sirott, an OB/GYN who practices in Pasadena. “Some providers have nowhere to send them.”\u003c/p>\n\u003cp>Of women who screen positive for postpartum depression, 78 percent don’t get mental health treatment, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618720/\" target=\"_blank\" rel=\"noopener\">2015 study review\u003c/a> published in the journal \u003cem>Obstetrics & Gynecology\u003c/em>. Dr. Sirott’s patients have told her the range of reasons why they don’t take her up on a referral to a psychologist.\u003c/p>\n\u003cp>“Oh, they don’t take my insurance. Or my insurance pays for three visits. I can’t take time off of work to go to those visits. It’s a three-month wait to get in to that person,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And, it’s hard to find a psychiatrist who is trained in the complexities of prescribing medications to pregnant or breastfeeding women, and who is willing to treat them, especially in rural areas.\u003c/p>\n\u003cp>“So it’s very frustrating to ask patients about a problem and then not have any way to solve that problem,” Sirott said.\u003c/p>\n\u003cp>But moms are frustrated, too. After the baby comes, no one asks about them anymore. Wendy Root Askew struggled for years to get pregnant, and when she finally did, her anxiety got worse. She couldn’t stop worrying that something would go wrong.\u003c/p>\n\u003cp>“And then after I had my son, I would have these dreams where someone would come to the door and they would say ‘Well, you know, we’re just going to wait two weeks to see if you get to keep your baby or not,’” she said. “And it really impacted my ability to bond with him.”\u003c/p>\n\u003cp>She likes the bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB2193\" target=\"_blank\" rel=\"noopener\">AB 2193\u003c/a>, because it goes beyond mandated screening. It requires health insurance companies to set up case management programs to help moms find a therapist, and to connect obstetricians or pediatricians with a psychiatric expert.\u003c/p>\n\u003cp>“Just like we have case management programs for patients who have diabetes or sleep issues or back pain, a case management program requires the insurance company to take some ownership of making sure their patients are getting the treatment they need to be healthy,” said Root Askew, who is now advocating for the bill on behalf of the group \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener\">2020 Mom\u003c/a>.\u003c/p>\n\u003cp>Health insurance companies haven’t taken a position on the legislation. It’s unclear how much it will cost them to comply, because some already have infrastructure in place for case management programs and some don’t. But there is consensus among insurers and health advocates that such programs save money in the long run.\u003c/p>\n\u003cp>“The sooner that you can get good treatment for a mom, the less expensive that condition will be to manage over the course of the woman’s life and over the course of that child’s life,” Root Askew said.\u003c/p>\n\u003cp>Doctors still have their objections. Under the bill, they could be disciplined for not screening. And screening takes time. Sometimes a doctor asks a mom how she’s sleeping, and she’s in tears for the next 30 minutes.\u003c/p>\n\u003cp>The health care system, and the incentives, aren’t set up for this, said Dr. Sirott.\u003c/p>\n\u003cp>“Currently, I get six dollars for screening a patient,” she said. “By the time I put it on a piece of paper and print it, it’s not worth it.”\u003c/p>\n\u003cp>And it’s not clear it’s worth it to the patients either. Four other states – Illinois, Massachusetts, New Jersey, and West Virginia – have tried mandated screening, and it made no difference in patient outcomes, according to \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201300505?code=ps-site\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> published in \u003cem>Psychiatric Services\u003c/em> in 2015.\u003c/p>\n\u003cp>Even with California’s extra requirements on insurance companies to facilitate care, women could still face high co-pays or limits on therapy sessions. Or, they’re so overwhelmed caring for a newborn, they never leave the house.\u003c/p>\n\u003cp>What does seem to work, according to the study, is when nurses or mental health providers visit new moms at home.\u003c/p>\n\u003cp>“Despite abundant good will, there is no evidence that state policies are addressing this great need,” the study authors wrote.\u003c/p>\n\u003cp>But supporters of the proposed bill say doctors need to start somewhere. Screening is the first step in recognizing the full scope of the problem, said Mountain View psychiatrist \u003ca href=\"https://www.elcaminohospital.org/doctors/nirmaljit-dhami\" target=\"_blank\" rel=\"noopener\">Nirmaljit Dhami\u003c/a>, adding that women should be screened on an ongoing basis throughout pregnancy and for a year after birth, not just once or twice as the bill requires.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I often tell doctors that if you don't know that somebody is suicidal it doesn't mean that their suicidality will go away,” she said. “If you don't ask, the risk is the same.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing","authors":["3205"],"categories":["stateofhealth_2442","stateofhealth_3012","stateofhealth_14"],"tags":["stateofhealth_3067","stateofhealth_2582","stateofhealth_2947","stateofhealth_2808","stateofhealth_28","stateofhealth_3229","stateofhealth_3212","stateofhealth_68","stateofhealth_3230","stateofhealth_2519","stateofhealth_3228"],"featImg":"stateofhealth_362852","label":"stateofhealth"},"stateofhealth_362825":{"type":"posts","id":"stateofhealth_362825","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362825","score":null,"sort":[1519949839000]},"guestAuthors":[],"slug":"labor-union-pressures-kaiser-permanente-with-protests-across-the-state","title":"Labor Union Pressures Kaiser Permanente with Protests Across the State","publishDate":1519949839,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">Ever since Dwayne Ealy was a kid, he really wanted to work for \u003ca href=\"https://healthy.kaiserpermanente.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Permanente\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\"I grew up right here by Kaiser Oakland, in this neighborhood, so I’d walk by Kaiser every day,\" he said while rallying outside Kaiser's \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/facilities/Oakland-Medical-Center-100344\" target=\"_blank\" rel=\"noopener\">Oakland Medical Center\u003c/a>. \"I went to Oakland Technical High School, it’s right down the street. I wanted to work at Kaiser a long time.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After burning out on his first career as a youth counselor, Ealy finally did get a Kaiser job, as an Integrated Courier at a distribution center in Livermore. He delivers medications to Kaiser Permanente hospitals and pharmacies.\u003c/span>\u003c/p>\n\u003cp>\"It’s a good job, and I can do things for my family, and be successful in my community,\" Ealy said. \"People are happy to work for Kaiser.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy's enjoyed the work so much that he's been at Kaiser Permanente for 13 years, his longest stint with any one employer. Since the fall, however, Ealy senses his position is on shaky ground. His fears that his work will be outsourced led him to this protest outside the hospital two weeks ago. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Union workers employed by Kaiser Permanente are staging a series of protests across California. They say the health care provider is thriving financially, but still plans to outsource some jobs, and cut wages for some new hires.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy joined more than a hundred other employees who chanted and marched. Some dressed in hospital scrubs, others in street clothes, and many in the deep purple color associated with their union, Service Employees International Union - United Healthcare Workers West (SEIU-UHW). They chanted \"Who's got the power? We got the power! What kind of power? Union power!\" The rally was one of 32 demonstrations that SEIU-UHW is organizing around California between Feb. 14 - Mar. 9. \u003c/span>\u003c/p>\n\u003cp>SEIU-UHW\u003cspan style=\"font-weight: 400\"> represents roughly 55,000 positions at Kaiser facilities across the state, including medical assistants, housekeeping aides, and pharmacy clerks. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The union's contract with the health care provider expires in September, and union representatives say Kaiser is considering 20 percent wage cuts for new hires in the Central Valley, and ten percent cuts in the Sacramento area. The union points out that in 2017 Kaiser made $3.8 billion, after expenses. \u003c/span>\u003c/p>\n\u003cp>\"We work hard for Kaiser, Kaiser you’re making a lot of money,\" Ealy said. \"Don’t be unfair to us.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser plans to hire an outside company to take over storage and distribution of pharmaceuticals in Oakland, and representatives say they fear the loss of 55 jobs there. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But John Nelson, Vice President of Communications at Kaiser Permanente, wrote in a statement that \"The exact number of positions affected by this decision has not yet been determined.\" \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He called the union's claims \"premature\" and potentially wrong. Nelson also wrote that when there are job changes, Kaiser works to \"reassign and retain our employees first.\"\u003c/span>\u003c/p>\n\u003cp>Union members say they have information that more than 700 other jobs around the state are threatened too, including positions at call centers in Southern California, and warehouse jobs like Ealy’s in Livermore.\u003c/p>\n\u003cp>Nelson stated that Kaiser will not be laying off 700 call center workers, but will \"improve our call center agents' ability to manage member calls and schedule appointments across Southern California.\" He added that the health care provider will make \"additional improvements and changes in the future,\" but will communicate those ahead of time.\u003c/p>\n\u003cp>Nelson also wrote that the union's claims about outsourcing of jobs in the Livermore distribution center are wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Contract negotiations between SEIU-UHW and Kaiser Permanente begin at the end of March, ahead of the current contract's expiration in September. \u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"Representatives of SEIU-UHW say Kaiser has plans to outsource jobs and cut some wages. Negotiations for a new contract begin at the end of March. ","status":"publish","parent":0,"modified":1519949839,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":625},"headData":{"title":"Labor Union Pressures Kaiser Permanente with Protests Across the State | KQED","description":"Representatives of SEIU-UHW say Kaiser has plans to outsource jobs and cut some wages. Negotiations for a new contract begin at the end of March. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362825 https://ww2.kqed.org/stateofhealth/?p=362825","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/03/01/labor-union-pressures-kaiser-permanente-with-protests-across-the-state/","disqusTitle":"Labor Union Pressures Kaiser Permanente with Protests Across the State","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/02/KaiserProtestKlivans180228.mp3","path":"/stateofhealth/362825/labor-union-pressures-kaiser-permanente-with-protests-across-the-state","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Ever since Dwayne Ealy was a kid, he really wanted to work for \u003ca href=\"https://healthy.kaiserpermanente.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Permanente\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\"I grew up right here by Kaiser Oakland, in this neighborhood, so I’d walk by Kaiser every day,\" he said while rallying outside Kaiser's \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/facilities/Oakland-Medical-Center-100344\" target=\"_blank\" rel=\"noopener\">Oakland Medical Center\u003c/a>. \"I went to Oakland Technical High School, it’s right down the street. I wanted to work at Kaiser a long time.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After burning out on his first career as a youth counselor, Ealy finally did get a Kaiser job, as an Integrated Courier at a distribution center in Livermore. He delivers medications to Kaiser Permanente hospitals and pharmacies.\u003c/span>\u003c/p>\n\u003cp>\"It’s a good job, and I can do things for my family, and be successful in my community,\" Ealy said. \"People are happy to work for Kaiser.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy's enjoyed the work so much that he's been at Kaiser Permanente for 13 years, his longest stint with any one employer. Since the fall, however, Ealy senses his position is on shaky ground. His fears that his work will be outsourced led him to this protest outside the hospital two weeks ago. \u003c/span>\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>Union workers employed by Kaiser Permanente are staging a series of protests across California. They say the health care provider is thriving financially, but still plans to outsource some jobs, and cut wages for some new hires.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ealy joined more than a hundred other employees who chanted and marched. Some dressed in hospital scrubs, others in street clothes, and many in the deep purple color associated with their union, Service Employees International Union - United Healthcare Workers West (SEIU-UHW). They chanted \"Who's got the power? We got the power! What kind of power? Union power!\" The rally was one of 32 demonstrations that SEIU-UHW is organizing around California between Feb. 14 - Mar. 9. \u003c/span>\u003c/p>\n\u003cp>SEIU-UHW\u003cspan style=\"font-weight: 400\"> represents roughly 55,000 positions at Kaiser facilities across the state, including medical assistants, housekeeping aides, and pharmacy clerks. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The union's contract with the health care provider expires in September, and union representatives say Kaiser is considering 20 percent wage cuts for new hires in the Central Valley, and ten percent cuts in the Sacramento area. The union points out that in 2017 Kaiser made $3.8 billion, after expenses. \u003c/span>\u003c/p>\n\u003cp>\"We work hard for Kaiser, Kaiser you’re making a lot of money,\" Ealy said. \"Don’t be unfair to us.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser plans to hire an outside company to take over storage and distribution of pharmaceuticals in Oakland, and representatives say they fear the loss of 55 jobs there. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But John Nelson, Vice President of Communications at Kaiser Permanente, wrote in a statement that \"The exact number of positions affected by this decision has not yet been determined.\" \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He called the union's claims \"premature\" and potentially wrong. Nelson also wrote that when there are job changes, Kaiser works to \"reassign and retain our employees first.\"\u003c/span>\u003c/p>\n\u003cp>Union members say they have information that more than 700 other jobs around the state are threatened too, including positions at call centers in Southern California, and warehouse jobs like Ealy’s in Livermore.\u003c/p>\n\u003cp>Nelson stated that Kaiser will not be laying off 700 call center workers, but will \"improve our call center agents' ability to manage member calls and schedule appointments across Southern California.\" He added that the health care provider will make \"additional improvements and changes in the future,\" but will communicate those ahead of time.\u003c/p>\n\u003cp>Nelson also wrote that the union's claims about outsourcing of jobs in the Livermore distribution center are wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Contract negotiations between SEIU-UHW and Kaiser Permanente begin at the end of March, ahead of the current contract's expiration in September. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362825/labor-union-pressures-kaiser-permanente-with-protests-across-the-state","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_2607","stateofhealth_2519","stateofhealth_3227"],"featImg":"stateofhealth_362828","label":"stateofhealth"},"stateofhealth_362779":{"type":"posts","id":"stateofhealth_362779","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362779","score":null,"sort":[1519435129000]},"guestAuthors":[],"slug":"california-nurses-warn-supreme-court-decision-could-gut-unions","title":"California Nurses Warn That Losing Supreme Court Case Could Gut Unions","publishDate":1519435129,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Nurses protested outside \u003ca href=\"https://www.smchealth.org/san-mateo-medical-center\" target=\"_blank\" rel=\"noopener\">San Mateo Medical Center\u003c/a> in front of a sign that read “Patient safety comes from union strength\" last week. They wore the characteristic bright red shirts of their own union: the \u003ca href=\"https://www.nationalnursesunited.org/california-nurses-association\" target=\"_blank\" rel=\"noopener\">California Nurses Association (CNA)\u003c/a>.\u003c/p>\n\u003cp>They were calling attention to the U.S. Supreme Court case \u003ca style=\"color: #41a62a\" href=\"https://ww2.kqed.org/forum/2018/02/20/u-s-supreme-court-hearing-on-union-dues-has-california-labor-leaders-on-edge/\" target=\"_blank\" rel=\"noopener\">Janus vs. American Federation of State, County and Municipal Employees.\u003c/a> The outcome of the case could dramatically weaken public sector unions if the court overturns a rule that requires non-union employees at union-affiliated workplaces to pay \"fair share\" fees.\u003c/p>\n\u003cp>Public sector employees who are not union members are required to pay these fees because the union's collective bargaining is meant to benefit all employees equally, whether they're full-fledged union members or not. Opponents of this rule say mandatory union fees violate First Amendment rights.\u003c/p>\n\u003cp>In addition to San Mateo Medical Center, nurses demonstrated at six other hospitals around the state to advocate for the preservation of the current union rule.\u003c/p>\n\u003cp>Margarita Harrington is a nurse with the \u003ca href=\"https://www.smchealth.org/\" target=\"_blank\" rel=\"noopener\">San Mateo County Health System\u003c/a>. She thinks that if people do not have to pay \"fair share\" fees, they probably won't. And that will squeeze unions like hers, despite CNA's 86,000-person member base.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"If suddenly people just stop paying dues, then how will the union be able to sustain itself?\" Harrington asked. \"It’s sort of like they’re gonna starve the union. And then it eventually impacts us.\"\u003c/p>\n\u003cp>Harrington said having the union behind her has helped her bring up concerns with hospital management in her 22 years with the San Mateo County Health System. She said stronger unions keep patients safer because nurses can bring up problems in hospitals without fear of retaliation. For example, unions set limits on nurses' workloads and work hours. Without those, nurses could be unable to adequately attend to patients.\u003c/p>\n\u003cp>The Supreme Court heard a similar case in 2016: \u003ca href=\"https://ww2.kqed.org/forum/2016/01/12/supreme-court-justices-skeptical-of-union-arguments-in-friedrichs-v-california-teachers-association/\" target=\"_blank\" rel=\"noopener\">Friedrichs v. California Teachers Association.\u003c/a>\u003c/p>\n\u003cp>The lead plaintiff was an elementary school teacher based in Orange County. When Justice Antonin Scalia died in February 2016, however, the case ended in a tie, so nothing changed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Oral arguments begin in the Supreme Court on Monday. \u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"Nurses say patient safety is at stake.","status":"publish","parent":0,"modified":1519672833,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":378},"headData":{"title":"California Nurses Warn That Losing Supreme Court Case Could Gut Unions | KQED","description":"Nurses say patient safety is at stake.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362779 https://ww2.kqed.org/stateofhealth/?p=362779","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/02/23/california-nurses-warn-supreme-court-decision-could-gut-unions/","disqusTitle":"California Nurses Warn That Losing Supreme Court Case Could Gut Unions","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/02/JanusvAFSCMEKlivans180226.mp3","path":"/stateofhealth/362779/california-nurses-warn-supreme-court-decision-could-gut-unions","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nurses protested outside \u003ca href=\"https://www.smchealth.org/san-mateo-medical-center\" target=\"_blank\" rel=\"noopener\">San Mateo Medical Center\u003c/a> in front of a sign that read “Patient safety comes from union strength\" last week. They wore the characteristic bright red shirts of their own union: the \u003ca href=\"https://www.nationalnursesunited.org/california-nurses-association\" target=\"_blank\" rel=\"noopener\">California Nurses Association (CNA)\u003c/a>.\u003c/p>\n\u003cp>They were calling attention to the U.S. Supreme Court case \u003ca style=\"color: #41a62a\" href=\"https://ww2.kqed.org/forum/2018/02/20/u-s-supreme-court-hearing-on-union-dues-has-california-labor-leaders-on-edge/\" target=\"_blank\" rel=\"noopener\">Janus vs. American Federation of State, County and Municipal Employees.\u003c/a> The outcome of the case could dramatically weaken public sector unions if the court overturns a rule that requires non-union employees at union-affiliated workplaces to pay \"fair share\" fees.\u003c/p>\n\u003cp>Public sector employees who are not union members are required to pay these fees because the union's collective bargaining is meant to benefit all employees equally, whether they're full-fledged union members or not. Opponents of this rule say mandatory union fees violate First Amendment rights.\u003c/p>\n\u003cp>In addition to San Mateo Medical Center, nurses demonstrated at six other hospitals around the state to advocate for the preservation of the current union rule.\u003c/p>\n\u003cp>Margarita Harrington is a nurse with the \u003ca href=\"https://www.smchealth.org/\" target=\"_blank\" rel=\"noopener\">San Mateo County Health System\u003c/a>. She thinks that if people do not have to pay \"fair share\" fees, they probably won't. And that will squeeze unions like hers, despite CNA's 86,000-person member base.\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>\"If suddenly people just stop paying dues, then how will the union be able to sustain itself?\" Harrington asked. \"It’s sort of like they’re gonna starve the union. And then it eventually impacts us.\"\u003c/p>\n\u003cp>Harrington said having the union behind her has helped her bring up concerns with hospital management in her 22 years with the San Mateo County Health System. She said stronger unions keep patients safer because nurses can bring up problems in hospitals without fear of retaliation. For example, unions set limits on nurses' workloads and work hours. Without those, nurses could be unable to adequately attend to patients.\u003c/p>\n\u003cp>The Supreme Court heard a similar case in 2016: \u003ca href=\"https://ww2.kqed.org/forum/2016/01/12/supreme-court-justices-skeptical-of-union-arguments-in-friedrichs-v-california-teachers-association/\" target=\"_blank\" rel=\"noopener\">Friedrichs v. California Teachers Association.\u003c/a>\u003c/p>\n\u003cp>The lead plaintiff was an elementary school teacher based in Orange County. When Justice Antonin Scalia died in February 2016, however, the case ended in a tie, so nothing changed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Oral arguments begin in the Supreme Court on Monday. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362779/california-nurses-warn-supreme-court-decision-could-gut-unions","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_3225","stateofhealth_2519","stateofhealth_3224"],"featImg":"stateofhealth_362781","label":"stateofhealth"},"stateofhealth_362633":{"type":"posts","id":"stateofhealth_362633","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362633","score":null,"sort":[1518028888000]},"guestAuthors":[],"slug":"doctors-prepare-for-immigration-enforcement-visits-at-hospitals","title":"Doctors Prepare for Possible Immigration Enforcement Visits At Hospitals","publishDate":1518028888,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Pediatricians across California are calling on Congress to pass legislation protecting immigrants brought to the U.S. as children, saying their patients are skipping appointments because they’re afraid a visit to the hospital will get them deported.\u003c/p>\n\u003cp>Doctors and hospital administrators have started formulating protocols so that staff members will know what to do if immigration agents enter hospitals or clinics to search for, or arrest, people who are in the country illegally.\u003c/p>\n\u003cp>“We want to be prepared if agents do show up and say ‘I need to see the father of the child in Bed Four,’” said Dr. Michael Anderson, president of UCSF Benioff Children’s Hospitals in Oakland and San Francisco. “Legally, we can ask the agents to leave and say ‘This is a place where we care for kids and families. This is not a place for these sorts of interactions.’”\u003c/p>\n\u003cp>Anderson was one of about 50 doctors, and a handful of students, lawyers and politicians, including the city’s mayor, who rallied outside the Oakland hospital on Tuesday, carrying signs that read: “We Stand With Dreamers” and “You Are Welcome Here.”\u003c/p>\n\u003cp>Similar rallies were held at hospitals in San Francisco and Los Angeles, with the goal of urging national lawmakers to come up with an immigration fix by the end of the day February 8, when Congress must pass a spending bill to keep the government running. But Democrats agreed that they will not force a shutdown, as they did last month, because of \u003ca href=\"https://www.vox.com/policy-and-politics/2018/2/6/16973762/senate-democrats-daca-shutdown-february-8\" target=\"_blank\" rel=\"noopener\">a commitment from Republicans\u003c/a> to debate an immigration bill separately from the budget.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Oakland Mayor Libby Schaff criticized the aggressive tactics taken by Immigration and Customs Enforcement (ICE) under the Trump administration: “We have heard from officials that ICE is going to purposely target communities like Oakland that are standing up for our families, standing up for our valued immigrant communities. This is vindictive. It is not befitting of a democratic society.”\u003c/p>\n\u003cp>ICE did not respond to requests for comment, but the agency does have a policy against making arrests at “sensitive locations,” including hospitals, schools, or churches. There are exceptions for \"exigent circumstances,\" or when other law enforcement actions have led agents to the sensitive location.\u003c/p>\n\u003cp>For example, last October, agents in Texas \u003ca href=\"https://www.nytimes.com/2017/10/25/us/girl-cerebral-palsy-detained-immigration.html?_r=0\" target=\"_blank\" rel=\"noopener\">detained\u003c/a> an undocumented 10-year old girl with cerebral palsy at a San Antonio hospital. Border Patrol agents first encountered her when they stopped her hospital-bound ambulance at a security checkpoint. After discovering her immigration status, the agents followed the ambulance to the hospital and waited while the girl had emergency gallbladder surgery. When she was ready for medical discharge, the agents detained her and sent her to a facility for migrant children. The girl was later allowed to return to her parents in Laredo.\u003c/p>\n\u003cp>Doctors say even isolated stories like this one stoke fear in immigrant communities, making families too scared to seek medical care when they need it.\u003c/p>\n\u003cp>Children who are sick and don’t get care could become even sicker, said Anderson. They could die from a preventable or curable disease, or not get a vaccine that protects them, and the community at large, from infection.\u003c/p>\n\u003cp>California and the rest of the country are right now experiencing the worst flu season of the last decade.\u003c/p>\n\u003cp>“Our clinics and emergency departments have just been overwhelmed with the number of sick patients,” Anderson said. “If you think a child is ill, the last thing on your mind should be ‘Is it safe for me to go to that hospital?’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But hospitals only have so much power. Staff can ask immigration agents to leave - unless they have a warrant. That’s why the doctors held signs at the rally that said “You Are Welcome Here,\" because they cannot completely guarantee, “You Are Safe Here.”\u003c/p>\n\n","blocks":[],"excerpt":"At rallies in Oakland, SF and Los Angeles, health care workers call on Congress to help the \"Dreamers\" and rein in immigration enforcement","status":"publish","parent":0,"modified":1518042463,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":664},"headData":{"title":"Doctors Prepare for Possible Immigration Enforcement Visits At Hospitals | KQED","description":"At rallies in Oakland, SF and Los Angeles, health care workers call on Congress to help the "Dreamers" and rein in immigration enforcement","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362633 https://ww2.kqed.org/stateofhealth/?p=362633","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/02/07/doctors-prepare-for-immigration-enforcement-visits-at-hospitals/","disqusTitle":"Doctors Prepare for Possible Immigration Enforcement Visits At Hospitals","path":"/stateofhealth/362633/doctors-prepare-for-immigration-enforcement-visits-at-hospitals","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Pediatricians across California are calling on Congress to pass legislation protecting immigrants brought to the U.S. as children, saying their patients are skipping appointments because they’re afraid a visit to the hospital will get them deported.\u003c/p>\n\u003cp>Doctors and hospital administrators have started formulating protocols so that staff members will know what to do if immigration agents enter hospitals or clinics to search for, or arrest, people who are in the country illegally.\u003c/p>\n\u003cp>“We want to be prepared if agents do show up and say ‘I need to see the father of the child in Bed Four,’” said Dr. Michael Anderson, president of UCSF Benioff Children’s Hospitals in Oakland and San Francisco. “Legally, we can ask the agents to leave and say ‘This is a place where we care for kids and families. This is not a place for these sorts of interactions.’”\u003c/p>\n\u003cp>Anderson was one of about 50 doctors, and a handful of students, lawyers and politicians, including the city’s mayor, who rallied outside the Oakland hospital on Tuesday, carrying signs that read: “We Stand With Dreamers” and “You Are Welcome Here.”\u003c/p>\n\u003cp>Similar rallies were held at hospitals in San Francisco and Los Angeles, with the goal of urging national lawmakers to come up with an immigration fix by the end of the day February 8, when Congress must pass a spending bill to keep the government running. But Democrats agreed that they will not force a shutdown, as they did last month, because of \u003ca href=\"https://www.vox.com/policy-and-politics/2018/2/6/16973762/senate-democrats-daca-shutdown-february-8\" target=\"_blank\" rel=\"noopener\">a commitment from Republicans\u003c/a> to debate an immigration bill separately from the budget.\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>Oakland Mayor Libby Schaff criticized the aggressive tactics taken by Immigration and Customs Enforcement (ICE) under the Trump administration: “We have heard from officials that ICE is going to purposely target communities like Oakland that are standing up for our families, standing up for our valued immigrant communities. This is vindictive. It is not befitting of a democratic society.”\u003c/p>\n\u003cp>ICE did not respond to requests for comment, but the agency does have a policy against making arrests at “sensitive locations,” including hospitals, schools, or churches. There are exceptions for \"exigent circumstances,\" or when other law enforcement actions have led agents to the sensitive location.\u003c/p>\n\u003cp>For example, last October, agents in Texas \u003ca href=\"https://www.nytimes.com/2017/10/25/us/girl-cerebral-palsy-detained-immigration.html?_r=0\" target=\"_blank\" rel=\"noopener\">detained\u003c/a> an undocumented 10-year old girl with cerebral palsy at a San Antonio hospital. Border Patrol agents first encountered her when they stopped her hospital-bound ambulance at a security checkpoint. After discovering her immigration status, the agents followed the ambulance to the hospital and waited while the girl had emergency gallbladder surgery. When she was ready for medical discharge, the agents detained her and sent her to a facility for migrant children. The girl was later allowed to return to her parents in Laredo.\u003c/p>\n\u003cp>Doctors say even isolated stories like this one stoke fear in immigrant communities, making families too scared to seek medical care when they need it.\u003c/p>\n\u003cp>Children who are sick and don’t get care could become even sicker, said Anderson. They could die from a preventable or curable disease, or not get a vaccine that protects them, and the community at large, from infection.\u003c/p>\n\u003cp>California and the rest of the country are right now experiencing the worst flu season of the last decade.\u003c/p>\n\u003cp>“Our clinics and emergency departments have just been overwhelmed with the number of sick patients,” Anderson said. “If you think a child is ill, the last thing on your mind should be ‘Is it safe for me to go to that hospital?’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But hospitals only have so much power. Staff can ask immigration agents to leave - unless they have a warrant. That’s why the doctors held signs at the rally that said “You Are Welcome Here,\" because they cannot completely guarantee, “You Are Safe Here.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362633/doctors-prepare-for-immigration-enforcement-visits-at-hospitals","authors":["3205"],"categories":["stateofhealth_14","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_3218","stateofhealth_3219","stateofhealth_2808","stateofhealth_2519"],"featImg":"stateofhealth_362640","label":"stateofhealth"},"stateofhealth_362576":{"type":"posts","id":"stateofhealth_362576","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362576","score":null,"sort":[1517442197000]},"guestAuthors":[],"slug":"a-rush-to-get-health-insurance-for-2018-before-california-deadline","title":"A Rush to Get Health Insurance for 2018, Before California Deadline","publishDate":1517442197,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">The open enrollment period to get insurance through \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a> closes at midnight tonight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Agents like Monica Tracht are feeling the looming deadline. \u003c/span>Tracht is a certified insurance agent for Covered California, based in San Francisco. She's spent recent nights fielding calls, at home, even past 10 p.m. At her office, she's booked back-to-back appointments, between which she accommodates walk-ins.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco insurance brokers like Tracht are logging extra hours to sign up new enrollees for Covered California in 2018. These enrollment numbers, which \u003ca href=\"https://coveredcanews.blogspot.com/2018/01/covered-california-announces-continued.html\" target=\"_blank\" rel=\"noopener\">surpass last year's numbers\u003c/a>, are strong — despite actions by President Trump and Congressional Republicans that have weakened the Affordable Care Act (ACA). \u003c/span>\u003c/p>\n\u003cp>Tracht runs a \u003ca href=\"http://storefronts.coveredca.com/agent-signage/\" target=\"_blank\" rel=\"noopener\">Covered California \"Storefront,\"\u003c/a> a permanent location open to walk-in traffic with Covered California signage. The \"Storefront\" designation also means her office is prominently listed on the health care exchange website. Tracht says that's how most of her clients find her.\u003c/p>\n\u003cp>\"I'd advertised in a local magazine in Spanish,\" Tracht said, \"A couple people came because of the magazine.\" But Tracht realized she could save her advertising money, because Covered California was promoting the health care coverage for her. \"They're everywhere,\" she said. \"The TV, the radio, the newspapers.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While the Trump Administration cut advertising budgets for the ACA, Covered California officials boosted their own marketing budget, to more than $100 million.\u003c/p>\n\u003cfigure id=\"attachment_362588\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-362588 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg\" alt=\"Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marie Crinnion had an appointment with Tracht the day before the deadline. Crinnion is currently enrolled in\u003cspan style=\"font-weight: 400\"> \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\" rel=\"noopener\">Medi-Cal,\u003c/a> a government insurance program for low-income people, but thinks she will no longer qualify this year because her income will increase. Crinnion's mother died recently and now, Crinnion will collect rent from a property she inherited. \u003c/span>\u003c/p>\n\u003cp>\"I looked online for an actual person to be able to talk to, because my insurance situation is changing and it’s a little complicated,\" Crinnion said. \"I wanted to be able to explain it to a live person and get advice.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Crinnion wants to avoid a lapse in coverage because she has chronic immune problems and is partially blind. After going over her options with Tracht for a half hour, she learned her income will be too high this year to qualify for any insurance subsidies offered through Covered California. Crinnion felt she'd get a better deal by shopping outside of the Covered California exchange. She was especially interested in some of the individual plans offered by a local organization, \u003ca href=\"https://www.cchphealthplan.com/\" target=\"_blank\" rel=\"noopener\">Chinese Community Health Plan\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In many other states, where consumers are using the federally-run marketplace, enrollment ended on Dec. 15. The Trump Administration shortened the enrollment period on the federal exchange from three months to six weeks. \u003c/span>\u003c/p>\n\u003cp>But all states will be affected by another new change to the ACA -- the Congressional tax bill, which removed the penalty for not having health insurance, starting in 2019.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tracht said some consumers were a bit confused about the different deadlines, but said no one had questions about whether the penalty was still in effect. It is for 2018. \u003c/span>\u003c/p>\n\u003cp>Covered California officials are trying to accommodate last-minute sign-ups. Although the official deadline is January 31st, if consumers have started an application before midnight, but are struggling to complete it, they \"will be allowed to finish the process on Thursday or Friday with a certified enroller,\" according to James Scullary, a spokesman for Covered California.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>People who complete applications by February 2 will have coverage beginning on March 1.\u003c/p>\n\n","blocks":[],"excerpt":"Midnight on January 31 is the cutoff for enrolling in a Covered California plan this year.","status":"publish","parent":0,"modified":1517448156,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":637},"headData":{"title":"A Rush to Get Health Insurance for 2018, Before California Deadline | KQED","description":"Midnight on January 31 is the cutoff for enrolling in a Covered California plan this year.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362576 https://ww2.kqed.org/stateofhealth/?p=362576","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/01/31/a-rush-to-get-health-insurance-for-2018-before-california-deadline/","disqusTitle":"A Rush to Get Health Insurance for 2018, Before California Deadline","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/01/CoveredCADeadlineKlivans.mp3","path":"/stateofhealth/362576/a-rush-to-get-health-insurance-for-2018-before-california-deadline","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">The open enrollment period to get insurance through \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a> closes at midnight tonight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Agents like Monica Tracht are feeling the looming deadline. \u003c/span>Tracht is a certified insurance agent for Covered California, based in San Francisco. She's spent recent nights fielding calls, at home, even past 10 p.m. At her office, she's booked back-to-back appointments, between which she accommodates walk-ins.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco insurance brokers like Tracht are logging extra hours to sign up new enrollees for Covered California in 2018. These enrollment numbers, which \u003ca href=\"https://coveredcanews.blogspot.com/2018/01/covered-california-announces-continued.html\" target=\"_blank\" rel=\"noopener\">surpass last year's numbers\u003c/a>, are strong — despite actions by President Trump and Congressional Republicans that have weakened the Affordable Care Act (ACA). \u003c/span>\u003c/p>\n\u003cp>Tracht runs a \u003ca href=\"http://storefronts.coveredca.com/agent-signage/\" target=\"_blank\" rel=\"noopener\">Covered California \"Storefront,\"\u003c/a> a permanent location open to walk-in traffic with Covered California signage. The \"Storefront\" designation also means her office is prominently listed on the health care exchange website. Tracht says that's how most of her clients find her.\u003c/p>\n\u003cp>\"I'd advertised in a local magazine in Spanish,\" Tracht said, \"A couple people came because of the magazine.\" But Tracht realized she could save her advertising money, because Covered California was promoting the health care coverage for her. \"They're everywhere,\" she said. \"The TV, the radio, the newspapers.\"\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>While the Trump Administration cut advertising budgets for the ACA, Covered California officials boosted their own marketing budget, to more than $100 million.\u003c/p>\n\u003cfigure id=\"attachment_362588\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-362588 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg\" alt=\"Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2018/01/RS29076_mon2-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monica Tracht used to advertise her health insurance business in a local, Spanish language magazine. But she's found she no longer needs to. Her clients find her through Covered California's own marketing efforts. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Marie Crinnion had an appointment with Tracht the day before the deadline. Crinnion is currently enrolled in\u003cspan style=\"font-weight: 400\"> \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\" rel=\"noopener\">Medi-Cal,\u003c/a> a government insurance program for low-income people, but thinks she will no longer qualify this year because her income will increase. Crinnion's mother died recently and now, Crinnion will collect rent from a property she inherited. \u003c/span>\u003c/p>\n\u003cp>\"I looked online for an actual person to be able to talk to, because my insurance situation is changing and it’s a little complicated,\" Crinnion said. \"I wanted to be able to explain it to a live person and get advice.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Crinnion wants to avoid a lapse in coverage because she has chronic immune problems and is partially blind. After going over her options with Tracht for a half hour, she learned her income will be too high this year to qualify for any insurance subsidies offered through Covered California. Crinnion felt she'd get a better deal by shopping outside of the Covered California exchange. She was especially interested in some of the individual plans offered by a local organization, \u003ca href=\"https://www.cchphealthplan.com/\" target=\"_blank\" rel=\"noopener\">Chinese Community Health Plan\u003c/a>. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In many other states, where consumers are using the federally-run marketplace, enrollment ended on Dec. 15. The Trump Administration shortened the enrollment period on the federal exchange from three months to six weeks. \u003c/span>\u003c/p>\n\u003cp>But all states will be affected by another new change to the ACA -- the Congressional tax bill, which removed the penalty for not having health insurance, starting in 2019.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tracht said some consumers were a bit confused about the different deadlines, but said no one had questions about whether the penalty was still in effect. It is for 2018. \u003c/span>\u003c/p>\n\u003cp>Covered California officials are trying to accommodate last-minute sign-ups. Although the official deadline is January 31st, if consumers have started an application before midnight, but are struggling to complete it, they \"will be allowed to finish the process on Thursday or Friday with a certified enroller,\" according to James Scullary, a spokesman for Covered California.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>People who complete applications by February 2 will have coverage beginning on March 1.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362576/a-rush-to-get-health-insurance-for-2018-before-california-deadline","authors":["8648"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_368","stateofhealth_2808","stateofhealth_2519","stateofhealth_3217"],"featImg":"stateofhealth_362589","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. 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No other part of the globe has experienced such dynamic political and social change in recent years.","airtime":"SAT 3am-4am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/insideEurope.jpg","meta":{"site":"news","source":"Deutsche Welle"},"link":"/radio/program/inside-europe","subscribe":{"apple":"https://itunes.apple.com/us/podcast/inside-europe/id80106806?mt=2","tuneIn":"https://tunein.com/radio/Inside-Europe-p731/","rss":"https://partner.dw.com/xml/podcast_inside-europe"}},"latino-usa":{"id":"latino-usa","title":"Latino USA","airtime":"MON 1am-2am, SUN 6pm-7pm","info":"Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg","officialWebsiteLink":"http://latinousa.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/latino-usa","subscribe":{"npr":"https://rpb3r.app.goo.gl/xtTd","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Latino-USA-p621/","rss":"https://feeds.npr.org/510016/podcast.xml"}},"live-from-here-highlights":{"id":"live-from-here-highlights","title":"Live from Here Highlights","info":"Chris Thile steps to the mic as the host of Live from Here (formerly A Prairie Home Companion), a live public radio variety show. 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We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2022/02/mindshift2021-tile-3000x3000-1-scaled-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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