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She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"One woman returns to her rural hometown to kick an addiction, but finds no medical treatment options.","status":"publish","parent":0,"modified":1502827229,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":39,"wordCount":1877},"headData":{"title":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’ | KQED","description":"One woman returns to her rural hometown to kick an addiction, but finds no medical treatment options.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"360808 https://ww2.kqed.org/stateofhealth/?p=360808","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/15/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert/","disqusTitle":"A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’","nprByline":"\u003ca href=\"http://khn.org/news/author/brian-rinker/\">\u003cstrong>Brian Rinker\u003c/strong>\u003c/a>","path":"/stateofhealth/360808/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\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>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\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>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360808/a-long-and-winding-road-kicking-heroin-in-an-opioid-treatment-desert","authors":["byline_stateofhealth_360808"],"categories":["stateofhealth_1"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2972","stateofhealth_2519","stateofhealth_2656"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_360810","label":"stateofhealth_3007"},"stateofhealth_351133":{"type":"posts","id":"stateofhealth_351133","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"351133","score":null,"sort":[1499378023000]},"guestAuthors":[],"slug":"half-of-nursing-homes-scrutinized-on-safety-still-treacherous","title":"Half of Nursing Homes Scrutinized on Safety Still Treacherous","publishDate":1499378023,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"Nursing homes that have graduated from an unsafe status by Medicare and are still operating have harmed patients.","status":"publish","parent":0,"modified":1499378023,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["//datawrapper.dwcdn.net/Sfw8o/12/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":1762},"headData":{"title":"Half of Nursing Homes Scrutinized on Safety Still Treacherous | KQED","description":"Nursing homes that have graduated from an unsafe status by Medicare and are still operating have harmed patients.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"351133 https://ww2.kqed.org/stateofhealth/?p=351133","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/06/half-of-nursing-homes-scrutinized-on-safety-still-treacherous/","disqusTitle":"Half of Nursing Homes Scrutinized on Safety Still Treacherous","nprByline":"\u003ca href=\"http://khn.org/news/author/jordan-rau/\" target=\"_blank\">Jordan Rau\u003c/a>","path":"/stateofhealth/351133/half-of-nursing-homes-scrutinized-on-safety-still-treacherous","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\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>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/351133/half-of-nursing-homes-scrutinized-on-safety-still-treacherous","authors":["byline_stateofhealth_351133"],"categories":["stateofhealth_11","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_2972","stateofhealth_2519","stateofhealth_2829"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_20482","label":"stateofhealth_3007"},"stateofhealth_349025":{"type":"posts","id":"stateofhealth_349025","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"349025","score":null,"sort":[1498928455000]},"guestAuthors":[],"slug":"kaiser-permanente-cited-again-for-mental-health-access-problems","title":"Kaiser Permanente Cited -- Again -- For Mental Health Access Problems","publishDate":1498928455,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Despite three warnings and a multimillion-dollar fine a few years ago, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_full%20service-behavioral%20health_061217.pdf\">a recent survey\u003c/a> of the HMO by the state of California.\u003c/p>\n\u003cp>The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\">with “timely access” to behavioral health treatment\u003c/a>, in violation of state law. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The matter has now been referred back to the state Office of Enforcement for further action, which could include an additional fine.\u003c/p>\n\u003cp>California’s timely access laws require insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue. Kaiser patients, however, often have to wait longer, according to the department.\u003c/p>\n\u003cp>The survey looked at Kaiser’s behavioral health files through Jan. 1, 2015. The department found that while the HMO had “undertaken extensive and meaningful efforts” to improve access to mental health care, the problems remain.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Headquartered in Oakland, \u003ca href=\"https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/\">Kaiser Permanente\u003c/a> is one of the largest not-for-profit managed health care plans in the country, with an annual operating revenue of $64.6 billion and 8.5 million members in California.\u003c/p>\n\u003cp>In a formal response to the watchdog agency, Kaiser listed more than 10 changes it has made to improve members’ access to mental health care, including contracting with providers outside of the organization and aggressively recruiting and hiring clinicians. The plan cited internal audits finding that they complied with timely access laws more than 90 percent of the time and stated “a corrective action plan is not warranted.”\u003c/p>\n\u003cp>“We have made great progress over the nearly two years since this survey was begun to improve access by hiring over 1,030 new psychiatrists and therapists, expanding our network of community practitioners, and introducing more convenient ways to access treatment,” John Nelson, vice president of government relations for Kaiser, wrote in an email to Kaiser Health News.\u003c/p>\n\u003cp>The department, however, responded in its report that while Kaiser Permanente has been working with Office of Enforcement to correct the problems, “the access issues remain unresolved.”\u003c/p>\n\u003cp>In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan’s delivery of mental health services — one of the largest ever paid by an insurer in the state. In 2015, the department found that \u003ca href=\"http://khn.org/news/kaiser-permanente-faulted-again-for-mental-health-care-in-california/\">some Kaiser patients still had to wait\u003c/a> weeks or even months to see a psychiatrist or a therapist.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral%20follow%20up_021315.pdf\">one case cited by the department\u003c/a> in a 2015 survey, a child was brought in by her father because of “aggressive behaviors, sexualized behaviors and significant behavioral problems in both the home and school environment.” The family told providers that they were “in crisis” and “pleaded for treatment.” The child, however, was not seen for therapy until seven weeks later.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"California’s HMO watchdog agency says Kaiser Permanente is making mental health patients wait too long for treatment.","status":"publish","parent":0,"modified":1498863699,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":543},"headData":{"title":"Kaiser Permanente Cited -- Again -- For Mental Health Access Problems | KQED","description":"California’s HMO watchdog agency says Kaiser Permanente is making mental health patients wait too long for treatment.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"349025 https://ww2.kqed.org/stateofhealth/?p=349025","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/01/kaiser-permanente-cited-again-for-mental-health-access-problems/","disqusTitle":"Kaiser Permanente Cited -- Again -- For Mental Health Access Problems","nprByline":"\u003ca href=\"http://khn.org/news/author/jenny-gold/\" target=\"_blank\">Jenny Gold\u003c/a>","path":"/stateofhealth/349025/kaiser-permanente-cited-again-for-mental-health-access-problems","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite three warnings and a multimillion-dollar fine a few years ago, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_full%20service-behavioral%20health_061217.pdf\">a recent survey\u003c/a> of the HMO by the state of California.\u003c/p>\n\u003cp>The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\">with “timely access” to behavioral health treatment\u003c/a>, in violation of state law. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The matter has now been referred back to the state Office of Enforcement for further action, which could include an additional fine.\u003c/p>\n\u003cp>California’s timely access laws require insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue. Kaiser patients, however, often have to wait longer, according to the department.\u003c/p>\n\u003cp>The survey looked at Kaiser’s behavioral health files through Jan. 1, 2015. The department found that while the HMO had “undertaken extensive and meaningful efforts” to improve access to mental health care, the problems remain.\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>Headquartered in Oakland, \u003ca href=\"https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/\">Kaiser Permanente\u003c/a> is one of the largest not-for-profit managed health care plans in the country, with an annual operating revenue of $64.6 billion and 8.5 million members in California.\u003c/p>\n\u003cp>In a formal response to the watchdog agency, Kaiser listed more than 10 changes it has made to improve members’ access to mental health care, including contracting with providers outside of the organization and aggressively recruiting and hiring clinicians. The plan cited internal audits finding that they complied with timely access laws more than 90 percent of the time and stated “a corrective action plan is not warranted.”\u003c/p>\n\u003cp>“We have made great progress over the nearly two years since this survey was begun to improve access by hiring over 1,030 new psychiatrists and therapists, expanding our network of community practitioners, and introducing more convenient ways to access treatment,” John Nelson, vice president of government relations for Kaiser, wrote in an email to Kaiser Health News.\u003c/p>\n\u003cp>The department, however, responded in its report that while Kaiser Permanente has been working with Office of Enforcement to correct the problems, “the access issues remain unresolved.”\u003c/p>\n\u003cp>In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan’s delivery of mental health services — one of the largest ever paid by an insurer in the state. In 2015, the department found that \u003ca href=\"http://khn.org/news/kaiser-permanente-faulted-again-for-mental-health-care-in-california/\">some Kaiser patients still had to wait\u003c/a> weeks or even months to see a psychiatrist or a therapist.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral%20follow%20up_021315.pdf\">one case cited by the department\u003c/a> in a 2015 survey, a child was brought in by her father because of “aggressive behaviors, sexualized behaviors and significant behavioral problems in both the home and school environment.” The family told providers that they were “in crisis” and “pleaded for treatment.” The child, however, was not seen for therapy until seven weeks later.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/349025/kaiser-permanente-cited-again-for-mental-health-access-problems","authors":["byline_stateofhealth_349025"],"categories":["stateofhealth_3012","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_2972","stateofhealth_2607","stateofhealth_68","stateofhealth_2519"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_349026","label":"stateofhealth_3007"},"stateofhealth_348976":{"type":"posts","id":"stateofhealth_348976","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348976","score":null,"sort":[1498850801000]},"guestAuthors":[],"slug":"patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals","title":"Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals","publishDate":1498850801,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"After testing to see if they're at risk of disease, people fear they'll be discriminated against under proposed legislation.","status":"publish","parent":0,"modified":1498850801,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":1266},"headData":{"title":"Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals | KQED","description":"After testing to see if they're at risk of disease, people fear they'll be discriminated against under proposed legislation.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"348976 https://ww2.kqed.org/stateofhealth/?p=348976","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/30/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals/","disqusTitle":"Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals","nprByline":"\u003ca href=\"http://khn.org/news/author/charlotte-huff/\" target=\"_blank\">Charlotte Huff\u003c/a>","path":"/stateofhealth/348976/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\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>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348976/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals","authors":["byline_stateofhealth_348976"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_294","stateofhealth_3104","stateofhealth_2808","stateofhealth_2972","stateofhealth_2519","stateofhealth_3088"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_348980","label":"stateofhealth_3007"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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