Author Archives: April Dembosky

April Dembosky covers health care news and trends across California for KQED's local news and its statewide program The California Report. She has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, and aging and end-of-life issues. Her work is regularly rebroadcast on NPR and has been recognized with awards from the Third Coast International Audio Festival, the Society for Professional Journalists, and the Association of Health Care Journalists.

Rural Doctor Launches Start-Up to Ease Pain of Dying Patients

Palliative medicine physician Michael Fratkin gets off a plane after visiting a patient on the Hoopa Valley Native American reservation. He wants to launch a start-up to support this kind of work. (April Dembosky/KQED)

Palliative medicine physician Michael Fratkin gets off a plane after visiting a patient on the Hoopa Valley Native American reservation. He wants to launch a start-up to support this kind of work. (April Dembosky/KQED)

This isn’t Michael Fratkin’s typical commute.

“It’s an old plane. Her name’s ‘Thumper,’” says pilot Mark Harris, as he revs the engine of the tiny 1957 Cessna 182. “Clear prop!”

“After the bad news, but before death, there’s a lot to be done.”    

It’s a 30 minute flight from our starting point in Eureka to the Hoopa Valley Native American reservation where Dr. Fratkin’s going to visit a man named Paul James. He’s dying of liver cancer.

“A good number of patients in my practice are cared for in communities that have no access to hospice services,” Fratkin says, shouting over the voices on the plane’s intercom.

Fratkin is a palliative medicine physician. He’s the guy who comes in when the cancer doctors first deliver a serious diagnosis. Continue reading

Cooking Class Shows Ex-Cons How to Shop and Cook on a Budget

Staff from Transitions Housing Clinic, a health center for former inmates, gathered in San Francisco to learn to cook on a budget with Chef Hollie Greene. (Jeremy Raff/KQED)

Staff from the Transitions Clinic, a nationwide network of health clinics for former inmates, gathered in San Francisco to learn to cook on a budget. (Jeremy Raff/KQED)

The chef has thrown down the challenge. There are five teams, ten people each, that must make their own version of veggie chili. Juanita Alvarado stirs the secret ingredient into the pot for Team 1. They call themselves the SuperHots.

“Let’s let that caramelize,” she says, tapping the wooden spoon on the edge of the saucepan.

This simmering pot of fresh black beans, zucchini, and carrots is a far cry from what Alvarado ate when she was in prison. Late nights in the bunks, inmates would pool their goods from the commissary to make a prison concoction called The Spread.

“It’s a ramen noodle. It consists of pickle juice, tuna, Velveeta cheese. Sausages, hot chips, some hot sauce, pork rinds, mayonnaise,” she says.

Then they mixed it all together and cooked it – sort of. Continue reading

Kaiser Mental Health Clinicians Authorize Strike

Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)

Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)

A union of 2,500 mental health clinicians at Kaiser have voted to authorize a strike, just one week after Kaiser’s nurses went on strike for two days.

In September, Kaiser agreed to pay a $4-million fine levied by state regulators. The Department of Managed Health Care found patients were subject to excessively long wait times to get a therapy appointment, or were shuttled into groups when they wanted individual therapy.

Psychiatric social worker Clement Papazian says various fixes, like after-hours appointments, still aren’t meeting demand. Continue reading

Nurses to Resume Talks with Kaiser After Strike

Nurses carry signs as they strike outside of Kaiser Permanente hospital in San Francisco last week. (Justin Sullivan/Getty Images)

Nurses carry signs as they strike outside of Kaiser Permanente hospital in San Francisco last week. (Justin Sullivan/Getty Images)

Nurses are gearing up to return to the bargaining table with Kaiser, after walking off the job for a two-day strike.

Though the nurses emphasized the stalemate over more than 35 operational proposals in their call for the strike – over things like staffing levels and Ebola protections – several nurses on the picket lines expressed concerns about economic issues. Many of them wore pins that said “No TakeAways.”

Nurse Ama Jackson says they are afraid Kaiser will try to cut their pensions and health care benefits.

“They want to do takeaways, because they want to increase their profits,” she said, as hundreds of nurses marched up and down the sidewalk outside Kaiser’s hospital in Oakland last Tuesday. “But nurses are saying, ‘That’s not fair. That’s not fair to how hard we work.’” Continue reading

Kaiser Nurses Plan 2-Day Strike: Premature Move or Strategic Step?

Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)

Kaiser’s Oakland Medical Center. (Lisa Aliferis/KQED)

As many as 18,000 Kaiser Permanente nurses are preparing for a two-day strike that will start Tuesday. Nurses plan to leave their posts at 7 a.m. and picket outside 21 medical centers and clinics across Northern California.

The placards nurses carry and the chants they repeat will say little about salaries or pensions. No economic proposals have even been put on the bargaining table yet.

“This seems awfully quick to go to a strike,” says Joanne Spetz, an economics professor at the UC San Francisco School of Nursing. “I can’t recall a situation where a strike has come up where there has not been some kind of disagreement about wages and benefits as part of the package.” Continue reading

Prop. 45 Defeated by Health Insurance Industry

The law would require health insurers to publicly disclose and justify their rates. (Getty Images)

The law would require health insurers to publicly disclose and justify their rates. (Getty Images)

Update, 12:30 a.m.
At first glance, Proposition 45 seemed like a no-brainer for consumers. The measure would have given the state’s insurance commissioner the authority to reject excessive rate hikes in health insurance sold on the individual and small-business markets.

Consumers who had seen their premiums go up by double digits year after year clung to Prop. 45 as the savior.

“I felt like a frog in hot water that got hotter and hotter until it was boiling,” says Josh Libresco, a market researcher who has bought health insurance for his family on the individual market for 20 years.

Continue reading

Money a Huge Factor in Defeat of Proposition 46

The central fight in this complex initiative is whether to raise California’s 39-year-old cap on the amount of money that courts can award for pain and suffering to a victim of medical malpractice.  (Getty Images)

The central fight in this complex initiative is whether to raise California’s 39-year-old cap on the amount of money that courts can award for pain and suffering to a victim of medical malpractice. (Getty Images)

Update, 10:50 p.m.
By far the most expensive race in the state this election was Proposition 46. The three-part “patient safety measure” inspired close to $60 million in spending from the No side, seven times the spending on the Yes side. Medical malpractice insurers wanted to make sure this one went down – and early voter returns indicate that it will.

“It’s apparent that people are being influenced by biased advertising,” says Daniel G. Newman, president and co-founder of MapLight, a nonpartisan research organization that tracks the influence of money on politics. “These political ads have very little to do with the substance of the measure. They have very simple messaging that is often misleading.”

The key piece of Prop. 46 would have adjusted the cap on medical malpractice awards for inflation, from $250,000 – an amount set in 1975 – to $1.1 million. This would have applied only to pain and suffering awards. Victims of medical malpractice, and their lawyers, pushed to raise the cap because they say it limits victims’ ability to find representation, especially when that victim is elderly or a child and cannot claim lost wages or other economic damages. Insurers said this would drive up the costs of premiums. Continue reading

Five UC Hospitals Now Designated for Ebola Care

UCSF is one of the five centers designated. (Niall Kennedy/Flickr)

UCSF is one of the five centers designated. (Niall Kennedy/Flickr)

The five medical centers of the University of California will serve as designated Ebola treatment centers should a person in the state become ill from the virus.

While public health officials are calling on all hospitals in California to redouble preparations for screening and isolating patients at risk for Ebola, those who are confirmed to have the virus will be transferred to a UC medical center in San Francisco, Davis, Irvine, Los Angeles, or San Diego.

“As a public university, stepping up to a public health crisis, like a potential Ebola outbreak, is what we do,” says Brooke Converse, spokesperson for the UC Office of the President. “Our overall mission as the University of California is to serve Californians and serve the taxpayers and the public.” Continue reading

Genetic Variant Linked to Lower Breast Cancer Rates in Latinas

(Getty Images)

(Getty Images)

Researchers have long known that Latina women have lower rates of breast cancer compared to African-American and white women. They have mainly pointed to lifestyle and environmental factors to explain why –- Latinas tend to have more children, breast feed longer, and drink less alcohol, all factors that are associated with lower disease rates.

Now, an international study led by scientists at UC San Francisco shows that a genetic variant unique to Latina women with indigenous ancestry plays a significant role, too.

“When we were accounting for all the non-genetic risk factors in our analysis, it was not enough to explain that women with more indigenous American ancestry tended to have less breast cancer,” says lead author Prof. Laura Fejerman, a member of UCSF’s Institute of Human Genetics. Continue reading

California Hospitals Prepare for Ebola

Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)

Kaiser’s new hospital in Oakland is one of two sites that Kaiser has chosen to treat any Ebola patient that might present in its system. (Lisa Aliferis/KQED)

Hospitals in California are adapting to evolving guidelines from the Centers for Disease Control on how to best prepare for a possible Ebola patient. There are no known — or suspected — cases of the virus in California, but the infection of two nurses in Texas has hospitals here revamping their protocols.

Responsibility ultimately falls on each individual hospital to incorporate CDC guidelines into its own Ebola response plan. The California Department of Public Health (CDPH) is providing guidance, but the state’s chief of communicable disease control, James Watt, says state help can only go so far.

“The reality is that every hospital situation is unique. The physical layout of the hospital is unique and needs to be taken into account. Also the equipment that (each) hospital has,” he said during a press briefing last week. “That’s why it’s really important for the training and the planning to be done at the facility level. That’s not something that can be one-size-fits-all.” Continue reading