Monthly Archives: September 2013

Recruiting – and Retaining – Doctors in California’s San Joaquin Valley

Maureen Williams (L) seen here with her daughter Carol Baskin, is 95 years old. Williams recently moved away from Firebaugh, but she returns to see Dr. Oscar Sablan. "He saved my life several times," she says. (Photo: Lisa Morehouse)

Maureen Williams is 95 years old (seen with her daughter Carol Baskin) moved away from Firebaugh recently to be closer to family, but she returns to see Dr. Oscar Sablan. “He saved my life several times,” she says. (Photo: Lisa Morehouse)

By Lisa Morehouse

In 1999, in the tiny town of Five Points, 29 farmworkers accidentally entered a field that had just been treated with dangerous organophosphate insecticides. They started vomiting. The labor contractor in charge bypassed local hospitals and brought the crew to his own doctors 50 miles away in the town of Firebaugh. He simply trusted Marcia and Oscar Sablan more.

“We have seen a lot of other cases,” said Oscar Sablan, an internist, “and so we were familiar with the symptoms and we knew what to do.”

They had lots of atropine on hand, a drug used to treat poison victims if they go into respiratory or cardiac arrest. The farmworkers stripped and lined up to rinse the pesticides off in the clinic’s shower, built just for this type of incident. But with so many patients, Oscar Sablan had to recruit help.

“The firemen in town were able to get a kiddie pool and at least wash the people down,” he said.

Firebaugh is surrounded by crops, and the Sablans estimate that 75 percent of their patients work in the fields, like that labor contractor.

Marcia Sablan, who specializes in family medicine, explained, “He knew he could come here. He knew that we would take care of him, so be brought those 29 people over here.”

Patients have relied on the Sablans and the Sablan Medical Clinic for more than 30 years, since the couple moved to Firebaugh as young physicians in the National Health Service Corps. They say they wanted to practice where they were needed. Continue reading

A Hospital Tells Police Where Fights Happen, and Crime Drops

An ambulance makes its way through revelers in Cardiff city center in Wales in 2010. New measures in the city have reduced injuries caused by violence.

An ambulance makes its way through revelers in Cardiff city center in Wales in 2010. New measures in the city have reduced injuries caused by violence. (Matt Cardy/Getty Images)

By Nancy Shute, NPR

On Saturday night, the emergency room staff knows all too well what’s coming — people showing up with a broken jaw, a knife wound or a bashed-in face, often after too many hours in a pub. Doctors at the emergency department in Cardiff, Wales, realized that many of the people who were injured in fights never reported it to the police. That realization led to a simple program that has radically reduced the toll of violence.

The hospital already had information on where and how people in the emergency room had been injured — “which bar, which club, which street, which park, which school,” says Dr. Jonathan Shepherd, a professor of oral and maxillofacial surgery at Cardiff University and an author of the study.

Many people who are injured in a fight never reported it to police, it turned out. That was particularly true with fights happening inside pubs and clubs. “They don’t know who the perpetrator was, so what’s the point of going to the police?” Shepherd tells Shots. “And they’re afraid of having their own conduct scrutinized. If it’s a fist fight or gang related or drug related, nobody’s going to want to go to the police.” Continue reading

Student Nurses Fight to Curb TB on LA’s Skid Row

Family nurse-practitioner Hannah Bampton and medical assistant Antonio Vera of the  UCLA School of Nursing Public Health Center administer a skin test for tuberculosis to Craig Mason at the Union Rescue Mission in Los Angeles. (Photo/Chris Richard)

Family nurse-practitioner Hannah Bampton and medical assistant Antonio Vera of the UCLA School of Nursing Public Health Center administer a skin test for tuberculosis to Craig Mason at the Union Rescue Mission in Los Angeles. (Photo/Chris Richard)

By Chris Richard

In his four months on Los Angeles’ Skid Row, Matthew Morales says he’s learned what clothes to wear so he doesn’t stand out too much, how to keep clean, how to travel light. He’s learned to trust those survival skills.

But, when I met him, he was rattled. He was waiting in line for a tuberculosis test. He takes the disease seriously.

“I worry about it a lot,” he said. “You just never know when you’re going to come in contact with the wrong person, somebody who could be a carrier.”

A scourge in much of the world, tuberculosis has long been seen in this country as a relic of the past. In 2011, the most recent year for which national statistics are available, the Centers for Disease Control and Prevention reported slightly more than three cases per 100,000 people. Continue reading

A Dozen Hospitals Are Laying Off Staff and Blaming Obamacare; Don’t Believe Them

John Muir Medical Center in Walnut Creek, part of John Muir Health, which recently announced voluntary buyouts ahead of full implementation of the Affordable Care Act. (cseeman/Flickr)

John Muir Medical Center in Walnut Creek, part of John Muir Health, which recently announced voluntary buyouts ahead of full implementation of the Affordable Care Act. (cseeman/Flickr)

By Dan Diamond, California Healthline‘s Road to Reform

Hospitals tend to be among the largest employers in their communities — which means that any individual decision to lay off staff can have an outsized local impact. And taken together, a dozen recent announcements seem to paint an especially dire picture for hospitals (and their communities) around the nation.

In Contra Costa County John Muir Health is offering staff voluntary buyouts ahead of ACA implementation. “We’re being paid less, and we either stick our head in the sand or make changes for the future so patients can continue to access us for their care,” according to John Muir spokesperson Ben Drew.

The ACA is just one factor affecting hospital finances, and its impact isn’t consistently negative for providers.
NorthShore in Illinois says it will lay off 1 percent of its workforce. The staffing cuts “ensure NorthShore remains well positioned to deal with the unprecedented changes brought on by the Affordable Care Act,” according to a memo from the health system’s chief human resources executive.

When Obamacare was being debated in Congress, its opponents tried to tar it with a deadly label: “the job-killing health law.” So is the ACA finally living down to its sobriquet? Continue reading

Living in an RV in Palo Alto — as Ban Goes into Effect

Fred Smith lives in his RV in Palo Alto. (Ryder Diaz/KQED)

Fred Smith lives in his RV in Palo Alto. (Ryder Diaz/KQED)

Editor’s note: On Sept. 19, Palo Alto joins many other cities in Silicon Valley in preventing people from legally living in their vehicles. As part of our ongoing series of first-person health profiles called “What’s Your Story?” 69-year-old Fred Smith talks about living in his RV after being a software engineer in Silicon Valley for nearly thirty years. Smith gives us a tour of his home.

By Fred Smith

It’s an ’85 Winnebago, Chieftain. And there’s clothes and books, and those are pictures of my wife.

We’re in the bedroom right now and it’s a decent sized queen bed, I guess you’d call it. Actually, it’s a better bed than a lot of people have.

Back in 2003, I was doing well, getting $145,000 a year. Then I got caught in the tail end of the dot-com crash and never recovered from that. Unemployment had ran out and I realized that I couldn’t afford to keep the apartment I had. Actually, I ended up living in my car with my cat for a couple weeks here in the alley behind Happy Donuts. You know, you got these seats that fold down, and you’re half in the trunk and half in the back seat. Continue reading

Why School Lunch Matters in State’s New Education Funding Formula

(Getty Images)

(Getty Images)

By Jane Meredith Adams, EdSource

Never has school lunch meant so much for California education.

Delivering significantly more money to schools based on the number of low-income children they serve is at the heart of the sweeping new K-12 finance system approved by the state Legislature in June. The new system defines “low income” as those students eligible for the school’s free and reduced-price meals program.

If the demand for new paperwork jeopardizes funding for needy children in any way, after years of work to pass Proposition 30, “People will become unglued.”

But two months into the rollout of the reforms, which Gov. Jerry Brown praised as a victory for the neediest students, two of the largest districts –- Los Angeles Unified and Fresno Unified –- are in a dispute with the state over a last-minute change in how children who receive free meals are counted. Instead of moving into the school year confident of how much new funding they’ll receive for low-income students, the two districts, as well as scores of other districts in the state, are now being asked to submit new data from hundreds of thousands of low-income families before the funding will be released.

“We didn’t bargain for this and we were not told this,” said John Deasy, superintendent of Los Angeles Unified School District, the state’s largest district with more than 650,000 students, more than half of whom –- 384,000 students –- attend 466 district schools that are being asked to certify low-income students again. If the demand for new paperwork jeopardizes funding for needy children in any way, after years of work to pass Proposition 30 to fund education and to pass the new education finance system, Deasy said, there will be an outcry from educators, advocates, students, parents and legislators. “People will become unglued,” he said. Continue reading

How a Video Game Can Make an Aging Brain Young(er) Again

By Angela Hart

Who knew playing video games might be good for you?

A provocative new study from researchers at UC San Francisco shows that playing a specially designed video game increased the ability to multitask for people in their 60s, 70s and 80s.

Adam Gazzaley of UCSF’s Neuroscience Imaging Center led the study. He recruited 174 people over 60 to play NeuroRacer, a custom-built game that forced participants to navigate winding roads, quickly turn left and right, go uphill and downhill — and then click a button whenever a distracting green sign pops up. Take a look:

The participants played the video game three times a week for a month and improved cognitive functions of the brain, not only in multitasking but also in paying attention for longer time spans. In fact, they improved so much that they reached the level of an untrained 20-year-old. This is the first time this kind of improvement has been demonstrated, the researchers noted in their study.

Gazzaley explained more on KQED’s “Forum” recently. He said the idea is to identify the brain’s “plasticity,” meaning its ability to change even as it ages — a concept that brain researchers haven’t always thought possible. Continue reading

Midwifery, Physical Therapy, Pharmacist Bills Move to Governor’s Desk

(Getty Images)

(Getty Images)

California’s legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These “scope-of-practice” bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown’s desk.

Here’s a recap of some of the bills and where they stand now:

Midwifery Bill (AB 1308) — headed to governor’s desk

The Center for Health Reporting writes that the bill passed unanimously Thursday night and is now on the governor’s desk. From the Center:

(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.

The bill removes the requirement for licensed midwives to be supervised by a physician.

“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”

Physical Therapy (AB 1000) — headed to governor’s desk Continue reading

The Primary Care Crunch: Not Enough Doctors and More Patients Coming

(Getty Images)

(Getty Images)

The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: Will young, healthy people really sign up? How much will my premium be? How does the Affordable Care Act work anyway?

Floating around in all those Obamacare discussions is another question: Who is going to treat all the newly insured? After all, we already have a shortage of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.

To address this question, San Francisco’s Commonwealth Club invited me to moderate a discussion about the shortage of primary care providers. Kevin Grumbach, a family physician and co-director at UC San Francisco’s Center for Excellence in Primary Care, started off by defining the subject at hand. Continue reading

Valley Fever Hospitalizations Increase Dramatically in California

Fungal spores that cause valley fever are carried in the dust. Activities including farming in the Central Valley contribute to the spread of the spores. (Robin Beck/Getty Images)

Fungal spores that cause valley fever are carried in the dust. Activities including farming in the Central Valley contribute to the spread of the spores. (Robin Beck/Getty Images)

(AP) – The annual rate of hospitalizations for valley fever, a potentially lethal but often misdiagnosed disease, has doubled over the past 12 years in California, according to a study published on Wednesday by the Centers for Disease Control and Prevention.

California’s rates of reported fever cases increased by more than six-fold over the past decade. 
The fever — which is caused by a fungus found in soil and can be contracted by simply breathing in the spores from dust disturbed by wind or other activity — has cost more than $2 billion in hospital charges over about a decade, the study found.

The study, conducted by researchers at the California Department of Public Health, was published in the October 2013 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal.

Valley fever is prevalent in arid regions of the U.S., especially in California and Arizona, as well as in Mexico, Central and South America. It is not spread person-to-person. Continue reading