Latest Blog Entries

With less than a year to go before the full rollout of Obamacare, many business owners are still scratching their heads over what it will mean for them.

In fact, most still wrongly believe they’ll have to offer health insurance to their employees, according to a recent eHealth survey.

Mental illness continues to haunt our society. I’m reminded of that by a fine piece of investigative reporting that appeared in The Sacramento Bee this week. What The Bee’s reporters uncovered is a telling illustration of how little we’ve progressed in our attitudes toward people with mental illness. More about that in a minute.

Last year, the Center explored that place where mental illness and government responsibility meet through the lens of state funding cuts to mental health services.

A Modesto Bee reporter joined with two of ours to chronicle, up close and personal, the havoc wrought by severe cuts in county health services.

 The California Medical Association is no wallflower in the conversation about the state’s health reform future. A power in the halls of the Legislature for decades, the CMA certainly doesn’t plan to sit out the important discussions now taking place in Sacramento about the shape of Obamacare in California.

As one of several blogs I’ll be penning on the players in California health reform, I talked recently to Dustin Corcoran, the association’s CEO, about the CMA’s role.

Without hesitation, he pointed to “change” as the organization’s biggest issue. How does the organization help its members grapple with “the rapidity of change that is coming at physicians, and helping them through the most significant change in decades – at least since Medicare.”

Listen to Martina Castillo's story in her own words.

One in five.

That’s how many elderly patients on Medicare find themselves back at the hospital within 30 days of their discharge, according to the U.S. Centers for Medicare and Medicaid Services.

The troubling statistic not only places an estimated 2.6 million seniors on a turnstile of care; it cost the Medicare system $26 billion a year, according to CMS.

But a novel program made possible by the Affordable Care Act will use those 30 days to instead provide seniors additional services – all designed to keep them from unnecessarily returning to our crowded, expensive hospitals.

Father Calin Tamiian hopes one day spirituality will be recognized as a vital sign.

“It’s not just body,” said the Byzantine Catholic priest, who is also a board certified chaplain for St. John’s hospitals in Camarillo and Oxnard. “It’s body, soul and mind.”

Tamiian was part of a pilot course last year that taught spiritual care providers about delivering palliative care to patients and families. That nine-week online course will debut in full in March with a certificate program from HealthCare Chaplaincy and The California State University Institute for Palliative Care at Cal State San Marcos.

With President Obama promising that immigration reform will be a signature effort of his second term, a natural question has been asked by health care experts and immigrant advocates alike.

What would a path to legal residency and citizenship mean for immigrant participation in the signature effort of Obama’s first term: Health Reform?

January 1, 2014.

“That is the date that is equivalent to when Medicare took effect 50 years ago,” said Peter Lee, executive director of the California Health Benefit Exchange.

“It’s a new day. … It’s a BFD, to quote the Vice President,” he added.  

On that day, the exchange will debut as a new health insurance marketplace for millions of Californians.

The exchange is a major piece of President Obama’s signature health care law, and will provide federally subsidized health coverage to individuals and families making between 138 and 400 percent of the federal poverty level, which was up to $92,200 for a family of four in 2012.

To the greater public, CAPG could be a sports team, a medical procedure or a test to get into college. But take a closer look at the California Association of Physician Groups and you'll find an increasingly powerful player in the state's new world of health reform.

CAPG doesn't look important, with only 160 members. Then you do the math and discover that it represents huge organizations like Kaiser Permanente health plans that employ thousands of California doctors. In fact, says CAPG's president and CEO, Donald Crane, his members' coordinated care model serves around 20 million California patients, more than half the state's population.

Probably the most important health care legislation in a half-century sprang to life just a few days after I joined the California HealthCare Foundation Center for Health Reporting.

On March 21, 2010, the United States Senate gave final congressional approval to the Affordable Care Act.  Two days later, President Obama signed it into law.

All around us, we’re watching friends and relatives fall prey to head colds, and worse, this year’s fierce strain of flu.

My next-door neighbor went down before Christmas with her eight-year-old son, trapped at home until last weekend.  My office mate John Gonzales, couch-bound for five days, wobbled into work Wednesday with Kleenex, a faint voice and ragged cough.

So I called the California Department of Public Health with a question:  Are we engulfed in the same flu epidemic sweeping the East, South and Midwest?

Not quite yet, I learned. We’re in the “calm before the storm,” and that gives us a second chance to get flu shots if we haven’t already.

The last influx of federal funds to boost California’s school health centers came just before the New Year. 

Through the Affordable Care Act 31 California school health centers received more than $14 million in December.

This final round of grants brought California’s total federal funding to more than $30 million since 2011, the most of any state.

Over the past month, in a front-page series of stories, the Los Angeles Times has exposed how the state of California’s Medical Board has “failed to protect patients from reckless prescribing by doctors.” The result, the paper found, has been at least 30 patient drug overdose deaths since 2005.

The paper’s investigation points to serious problems in the board’s oversight function, which the Times says is limited by its investigations process and also by the reduced ranks of Medical Board investigators.

I’ve spent many months reporting on dental care for poor California children, looking into what kind of access they have to treatment.

(Answer: About half of kids in the Medi-Cal dental program see a dentist annually, although figures vary wildly by county.)

But I haven’t focused as much on the dentists who participate in the program, called Denti-Cal.

A new report by health care consultant Barbara Aved does just that. Based on her research, Aved concludes that 25 percent of California’s general dentists participate.

Evidence of economic hard times abounds, but none is quite as graphic as the lines of people snaking around blocks, stadiums and arenas desperately seeking free health care.

Free health care clinics have sprouted all over the state, and they make the news because of their visual impact. Here it is, folks, all the evidence you need that people are hurting -- a lot of them.

There it is, right on the California Department of Public Health home page. It’s listed there -- no irony intended, I suspect -- under “Other Hot Topics.”

The headline reads: “Extreme Heat Guidance: Preventing and Preparing for Climate Change.”

Now, it sounds like another in the endless string of reports and studies looking at what climate change might do. But this report gets frighteningly close to home, as in WHERE WE LIVE.

When I heard Wednesday that the last 300 patients were being evacuated at New York City’s Bellevue Hospital Center, I began thinking of what an earthquake could do to hospitals here in Los Angeles.

In storm-stricken New York, other hospitals scrambled to find space for patients. National Guard troops carried many of them down hundreds of stairs in a behemoth 828-bed public hospital building crippled by power outages and flooding.

Over the last three years, the CHCF Center for Health Reporting has produced 70 news projects about California health, collaborating with more than 60 different news partners.

Now it’s official.  The California HealthCare Foundation has approved a $3.725 million grant to extend the center’s work for another three years.

The news was posted at the USC Annenberg School for Communication and Journalism, where the center is headquartered.

SAN DIEGO--I made the mistake of clicking “print” on my computer when I saw the link to the IDWeek2012 final program.

Our office printer nearly choked.  Out spewed 164 pages, most in small print, listing thousands of events happening this week at the mammoth gathering of infectious disease experts in San Diego.

The words Clostridium difficile show up on page after page.  An on-line search shows the deadly infection is the topic of 150 events--symposia, oral abstract sessions and poster sessions--here at IDWEEK.

Something unusual happened inside California’s public health agency last month, unbeknownst to the general public.

An agency advisory panel shut down. It put itself out of business after approving new rules for its own makeup. The state’s Healthcare Associated Infection Advisory Committee is kaput.

Now the state Department of Public Health is looking for fresh blood for a new panel, people who want to curb infections that can sicken, maim or even kill hospital patients. If that describes you, the deadline to apply is Oct. 19.

I’ve begun looking into how campaign contributions are shaping health policy in California.  And yes, I know the appropriate response to that sentence is:  Good luck with that!

Yet given the enormous changes that are underway in health policy, and with California taking arguably the lead position nationally, this ambitious question is worth an answer or two. 

The approaching convulsions of the Affordable Care Act will fundamentally change the way many Californians are insured and how they obtain medical care.  So what role do the millions of dollars going annually to California state Senate and Assembly members play in these big changes?

Every year, California’s community health clinics are required to report important data to the state, including details about their finances, their patients and the type of care they provide.

But county-run health clinics, a key piece of the state’s health care safety net, don’t have to do the same.

"It’s definitely a gap,” said Jonathan Teague, manager of the Healthcare Information Resource Center at the Office of Statewide Health Planning and Development (OSHPD).

That and other gaps in state health care data could gain more significance as the state implements President Obama’s health care law.

Who doesn’t remember running to the school nurse’s office with a nosebleed or ear ache? But how many among us have gone to a nurse-managed clinic for our adult health care?

In this era of experimentation in health delivery, the nurse-led clinic is part of the conversation about how best to medically serve us, particularly the poor and uninsured populations.

These safety net clinics fly pretty far beneath the general public’s radar, despite the fact most have been around for a decade or more. In California, there are now at least seven of them, mostly in the Bay Area.

“Those that can stand up, please stand up. Those that cannot stand up, please sing along with us.”

So begins the day at an adult day health care center in San Marcos, California. Many of the participants stay seated in their wheelchairs for the morning Star Spangled Banner. But, they still sing along.

Since last fall, we have been following the saga of the thousands of poor elderly and disabled Californians who attended such centers where they received meals, therapy and medical care, as well as companionship and a sense of community. Last year, the money-starved state eliminated this Medi-Cal Adult Day Health Care (ADHC) benefit, replacing it with a leaner program called Community-Based Adult Services (CBAS).

When I first telephoned infection expert Dr. Silvia Gnass in early 2011, a new state report had just rated her Riverside area hospital among the worst facilities in California for a deadly kind of catheter-related infection.

Clearly, this was a bad time to call.  At a number of other hospitals that got poor ratings, officials had either criticized the data or never returned my calls.

To my surprise, Gnass promptly called back.  With refreshing candor, she acknowledged that the ratings were dismal. But just wait, she said. Change is afoot. Next time, the ratings would change.

In a recent blog, my colleague Richard Kipling wrote about a funding threat to a popular program that introduced dozens of doctors to medically needy areas with no more carrot than a $700 stipend. 

As California braces for the demands of health reform amid a physician shortage in rural and inner city areas, health professionals are trying to keep such efforts alive -- and introduce new ones.

The past couple years, we’ve witnessed a seeming contradiction in state health policy.

On the one hand, we’ve had an unending march of state health programs to the budgetary cutting block, victims of California’s impoverished financial condition; on the other, that same state government has busily prepared for the Affordable Care Act, set to hit ground in January 2014.

While glancing at data on the website of the Office of Statewide Health Planning and Development (better known as OSHPD), I thought I’d found a program that was another example of California preparing for reform and decided to dig deeper.

Medicare users in the Santa Cruz area boast the lowest rate of avoidable emergency room visits in the state. They also happen to have the lowest rate in the nation.

This statistical tidbit comes from the health-focused Commonwealth Fund’s “Scorecard on Local Health System Performance,” released earlier this year, which offers a treasure trove of data on numerous health measures, from rates of uninsured residents to infant mortality. The data can be compared across states and regions.

Interesting, right? But so what?

It’s no best-kept secret that the United States is a growing-older population, matching its compatriots among the established industrialized nations. But it was surprising to me that California, the Golden State of youth, energy and beauty, is on the same path. In fact, according to a Stanford researcher, in three decades the state’s population will be older than the country’s as a whole.

I assembled my makeshift photo studio in a windowless office just big enough for a desk and two chairs. Wax paper covered the Home Depot work lights. Electrical tape held up the white sheet I had borrowed from my Modesto hotel room.

My subjects walked in one at a time and sat in the chair in front of the sheet, facing my camera and tripod.

Name. Age. Residence. Mental illness diagnosis. They rattled off their stats.

They sat for photographs and told me their stories. One lost a father when she was seven-years-old to a bullet from a bar’s bouncer. Another served five years in prison. Another met his girlfriend through his treatment and therapy.

From the start, I kept a journalist’s sharp eye trained on the nurses’ hands. Did hospital workers pull on fresh gloves before touching me?

How many of them asked for my birth date? Did they grill me about what condition brought me to this pre-surgery unit at 5:30 a.m.?

Some patients get annoyed at such inquiries. Not me.

As a health care writer, I’ve written too many stories about hospital-acquired infections, wrong-side surgeries, even wrong-patient surgeries in which a patient lost a healthy gallbladder or unscathed knee.

So go right ahead and ask me again: The procedure will remove the cataract in which eye?

Last month, I walked into a Los Angeles area hospital for cataract surgery that I had successfully postponed for years.

For an upcoming story on California’s unrepentant effort to implement health reform -- even as the Supreme Court draws nearer to deciding its fate -- I have been spending time with patients enrolled in our state’s precursor to the Affordable Care Act.

The program variously has been called “The Bridge to Reform,” the Low Income Health Program, the Health Care Coverage Initiative, and other acronym-worthy titles in the individual counties charged with providing care.

No matter the name or location, they were all made possible by a federally approved Section 1115 waiver, essentially a petition to establish a sweeping Medicaid expansion ahead of an even larger expansion scheduled for reform’s big push in 2014.

Crystal Goakey didn’t smile too big when she told me she’s 37 weeks pregnant. She was too self-conscious.

All of Goakey’s top front teeth are rotted to her gums, as are many of her bottom teeth. In fact, the Oakdale resident only has two teeth she can chew with.

Goakey dragged herself out of bed at 3 a.m. this morning and arrived in downtown Modesto one hour later for a free dental clinic put on by the California Dental Association, the CDA Foundation and America’s Dentists Care Foundation.

When it comes to health care in California, low cost is not the first thing that comes to mind. But it turns out that the Golden State spends less than most others on health care.

That’s according to a new report from the California HealthCare Foundation. California’s per-capita spending on health care is the ninth lowest in the nation.

California’s growth in health care spending is slowing as well. In 2003 it peaked at 9.7 percent; in 2009 spending growth was 4.5 percent, in line with the national average.

The man known as Ralph DeAngelo had just turned 70 when his wife spotted a local hospital’s newspaper ad for free prostate cancer screening, billed as a test that saves lives.

To appease her, he went for a free PSA test, and was mailed a letter stating that his results were “significantly abnormal.”  In clockwork fashion, Ralph received12 biopsies, a cancer diagnosis, prostate removal, radiation, a hole between his rectum and his bladder, a colostomy. He died of a related urinary tract infection.

If you work at a small business and have health insurance, odds are about 50-50 that you’ll have a high-deductible health plan according to a Kaiser Family Foundation survey.

This kind of coverage asks employees to pick up more of the tab for their health care costs. Workers pay out-of-pocket for health care expenses until they reach the deductible. Then the insurance kicks in.

The idea is to make consumers savvier about health care costs by asking them to spend their own money first. At the same time, the employer can save money by shifting more of the costs to the consumer.

In our ongoing coverage of Sacramento County’s dental plan for poor kids, we’ve reported on proposals to fix its performance, including a measure in the Legislature that would fundamentally change the way the Medi-Cal program works there.

But there’s another, earlier bill that advocates say would have statewide impact, especially for Californians who live in places where dental treatment is difficult to access.

The debate in Washington over how to find savings in the mammoth Medicare program has been going on for years. In its latest incarnation, the agency that assists Medicare in making policy recommendations – the Medicare Payment Advisory Commission or MedPAC – is focusing on out-of-pocket expenses.

MedPAC commissioners have universally approved a plan for Congress now to consider:

--A limit on out-of-pocket costs.

--Combining deductibles for in-patient and outpatient services.

--Creating flat rate “copayments” for certain services, instead of a percentage of the cost of care called “coinsurance.”

--Charging supplemental insurance plans.

Every year thousands of patients get free prescription drugs to manage illnesses ranging from diabetes to heart disease. Pharmaceutical companies donate the medications that are usually set aside for low-income patients who don’t have health insurance.

But this can involve a burdensome paperwork process.

That’s where Damon Taugher, director of the non-profit humanitarian group Direct Relief USA, comes in. His organization has decades of experience getting medical aid to disaster-stricken areas – as in Haiti after the earthquake that hit two years ago.

Taugher says he wanted to apply the same principles to what he calls a domestic health care crisis in the United States.

When I spent time at the Grace Adult Day Health Care Center in Sunnyvale last spring, the fate of California’s adult day health program – and of Grace itself – was unclear.

It’s one year later, and in some ways, the situation remains unsettled. Look no further than today’s federal court hearing on the issue. 

One year ago, proposed state budget cuts seemed so grim that Grace’s co-owners, Manooch and Suzanne Pouransari, were considering closing down their center and opening a nursing home instead.

 Measles.

It was during a break at a UCLA Graduate school of public health seminar that the word came up.

Measles…

It sounds almost archaic, from another era, a term describing a once hugely contagious respiratory disease that now has all but disappeared, at least in the United States.

Or has it? I’d just described to students what the Center is all about and referred to a project we’d produced for the Santa Cruz Sentinel and San Jose Mercury News on vaccination refusal. A student approached me and said measles was a likely future vaccination problem. She predicted an almost certain major outbreak here within the next five years.

Even the experts are confused.

At two public hearings this week to discuss problems with Sacramento County’s dental care program for poor kids, not all the expert witnesses agreed on which California counties provide Medi-Cal dental services via managed care.

Let’s start with what they did agree on: Sacramento.

Sacramento has been exclusively a “geographic managed care” county for nearly two decades, debuting as a pilot project in 1994. Under geographic managed care, the state contracts directly with private dental plans, paying them a monthly fee – about $12 – for each Sacramento County Medi-Cal child assigned to them.

My friend had been pushing for four hours.

“You have a size nine baby coming out of a size seven pelvis,” her doctor said.

I heard several similar stories while reporting on elective deliveries. The baby is too big to push out.

My friend’s daughter was 8 pounds 11.5 ounces. She was born, eventually, by Cesarean section.

Not, technically, a “big baby.” 

Big Baby Syndrome is also known as Large for Gestational Age or fetal macrosomia. Sometimes, it’s defined as babies born weighing 4,000 grams - 8 pounds 13 ounces - or more. Sometimes, the cutoff is 4,500 grams - 9 pounds 15 ounces.

When I heard that high school students were regularly missing class because cockroaches were lodged in their ears, it was shocking.

This came up in a story I’m working on about school-based health centers. There are nearly 200 around California – the majority in underprivileged areas, where almost all of the students qualify for free lunches and Medi-Cal.

The high school I recently visited in Los Angeles had a full-fledged medical clinic on campus. That’s right – doctors, nurses, medical office equipment, all of it. It’s open to students and community members during the week and on Saturday and provides free primary care, dental and mental health services.

Sometimes good things get cut out of good stories. This happened on my editing watch recently, when a story by Jocelyn Wiener on poor kids’ dental health access in Sacramento grew too big and had to be pared back.

This is where blogs come in handy. I can reach in, restore and expand on a relevant piece of information that otherwise would be lost to the cutting room floor or, more accurately, the delete key.

California is quietly abandoning a pilot project that would have brought automatic medication dispensers into the homes of thousands of Medi-Cal recipients, saying the experiment would cost more than it would save.

In an analysis of the potential costs, the state Department of Health Care Services determined that the pilot wouldn’t come close to saving the $140 million annually that legislators banked on when they approved it last year. 

“There was a great risk that not only would it not achieve the savings, but it might actually generate costs,” said Norman Williams, DHCS spokesman.

Andy Gee says he never thought he would see his crushing medical debt basically disappear.

We profiled Gee, of San Francisco, as part of a KQED series on medical debt in the fall. When I interviewed him he wasn’t working. And he had trouble sleeping at night because he was so worried about how he would possibly pay off $72,000 in debt to San Francisco General Hospital and the SFGH Medical Group.

He was hit by a car in October 2010 and was rushed to San Francisco General Hospital for emergency surgery. After a six-day hospital stay he was on the hook for $72,000. Gee says the most shocking thing about all of this was that he had health insurance.

It’s a triumph, no doubt about it.

There was not a single California death from whooping cough in 2011, one year after a record 10 infants died from the disease. This is truly good news, the first time since 1991 that no one in the Golden State has succumbed to the highly infectious illness.

So how did California go from such an awful record to such a good one? Let’s turn to the experts for an explanation.

Most people have never heard of the infection nicknamed “C.diff.” Others heard of it first at the worst of times—during a hospital stay, or at the bedside of an ailing relative or friend.

I first learned about the severity of Clostridium difficile last spring while writing a story about Tony Lewis, whose broken femur brought him to a Sacramento hospital. Within days, he was diagnosed with the infection that killed him. 

This story originally aired on KQED Public Radio.

Sometimes when a reporter listens in on a panel discussion, the eyes glaze over and the journalistic instincts shift into cruise control. That’s particularly true on a topic like health care reform, which our CHCF Center for Health Reporting has covered from its passage, to its currently tenuous fate before the U.S. Supreme Court.

We’ve reported what the law means to people with pre-existing medical conditions, what it means to medically isolated rural communities and what it will do to the health insurance landscape statewide. It’s sometimes easy to think that we’ve run out of things to write – particularly as the law winds toward an uncertain future.

California is famous nationally for combating air pollution and its ill effects on public health.

Much of the state is also touted for balmy winter weather and blue skies.  Ironically, sometimes those sunny, mild days can produce unhealthy air.

Take this winter, when residents at two ends of the state--the Los Angeles area and Chico—are navigating new rules governing when they can fire up wood-burning stoves and fireplaces.

It’s been two years since I directed a Center for Health Reporting project in partnership with the Santa Cruz Sentinel. We examined the future of a county-wide health insurance program for poor children aged 0-18, most of whom are undocumented. Part of a loose statewide network called Healthy Kids, it participated in First 5 funding but otherwise took no money from any state agency. It was supported by the county, foundation grants, community dollars and community sweat.

Last summer, Chuck Magner’s father had a massive stroke during a surgery that was intended to prevent stroke, and died almost two weeks later.

One of Chuck’s lingering concerns is that the hospital and surgeon hardly communicated with him or his family before the procedure. Chuck, who was in St. Louis on business at the time, only managed to get the hospital on the phone when his father, Jerry Magner, was already being prepped for surgery.

“You are putting yourself in these people’s hands and they should keep you informed at all times of everything possible,” said Chuck, 55, of Concord.

San Francisco Chronicle readers made 130 thoughtful, funny, snarky and often informative online comments in response to my story about high rates of two common elective heart procedures among residents of the Clearlake area.

One of those comments in particular jumped out.

At 11:38 a.m. on September 6, 2011, “l8erg8or” posted this:

What is it with nurses? Are there too few of them, with shortages looming? Or are there plenty to go around? Which is it?

A decade ago, the specter of the baby boom generation approaching old age led to predictions of a looming nursing shortage.

The AMA’s journal weighed in at the end of 2008 with a dire prediction from Dr. Peter Buerhaus, a top workforce analyst. “…A large and prolonged shortage of nurses is expected to hit the US in the latter half of the next decade,” he said.

Now, a few years later, a number of recent studies leave us wondering, well, what’s up with nurses?

From salad safety to surgeries, from debt to dialysis, CHCF Center for Health Reporting journalists traveled the state pursuing stories on health and health policy.