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.

Ethnic Differences Thwart End-of-Life Conversations

There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.

A new poll shows nearly one in five Hispanics has not discussed the kind of care they want as they get older. (Photo: Getty Images)

Virtually all doctors have difficulty talking to their patients about death, and those conversations are even harder when the patient’s ethnicity is different from the doctor’s, according to a study published Wednesday in the online journal Plos One.

Dr. VJ Periyakoil, author of the study, outlines a typical scenario that’s troubling to doctors. She describes a 65-year-old patient, an Asian woman who is smart and thinking clearly. But whenever the doctor asks her a question, it’s always the patient’s son who answers.

“As a doctor I would really struggle with what to do in a situation like that,” Periyakoil says, “where the patient has no voice, if you will.” Continue reading

Death in Secret: California’s Underground World of Assisted Suicide

When J.D. Arnold was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: Hope Arnold)

When J.D. Falk was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: Hope Arnold)

Physician-assisted suicide is illegal in California. But that doesn’t mean it doesn’t happen. Sick patients sometimes ask for help in hastening their deaths, and some doctors will explain, vaguely, how to do it.

“I remember standing there with syringes in my hand. Just standing there, with my hands shaking, and I was all alone.”

This leads to bizarre, veiled conversations between medical professionals who want to help, but also want to avoid prosecution, and overwhelmed family members who are left to interpret euphemisms at one of the most confusing times of their lives.

That’s what still frustrates Hope Arnold. She says throughout the 10 months her husband J.D. Falk was being treated for stomach cancer in 2011, no one would talk straight with them.

“All the nurses, all the doctors,” says Hope, “everybody we ever interacted with, no one said, ‘You’re dying.’ ” Continue reading

Posthumous Brittany Maynard Video Supports Calif. ‘Death with Dignity’ Bill

State senators heard testimony today on a proposed bill that would allow doctors to prescribe lethal medication to terminally ill patients who request it. The testimony included a video from Brittany Maynard recorded 19 days before she took life-ending drugs.

 

In the video, Maynard implored California lawmakers to legalize “aid in dying.” Maynard, who had been diagnosed with terminal brain cancer, took lethal medication last year in Oregon, where the practice is legal.

“The decision about how I end my dying process should be up to me and my family under a doctor’s care. How dare the government make decisions or limit options for terminally ill people like me. Unfortunately, California law prevented me from getting the end-of life-option I deserved,” said Maynard, who died Nov. 1 at age 29. Continue reading

Feinstein and Boxer Say Pregnant Women Should Get Special Obamacare Enrollment

(Getty Images)

(Getty Images)

U.S. Senators Barbara Boxer and Dianne Feinstein are calling on California’s health insurance marketplace, Covered California, to allow women to sign up for coverage when they become pregnant.

Under the current rules of the Affordable Care Act, uninsured women who discover they’re pregnant outside of open enrollment periods can only sign up for coverage once the baby is born. The senators sent a letter to Covered California on Wednesday urging the agency to change the policy to make pregnancy a “qualifying life event” that allows women to enroll in coverage at that time.

“Allowing women to purchase health insurance during pregnancy will increase access to care and has the potential to improve health, save lives, and reduce future health costs,” the senators wrote. Continue reading

Is Bay Area Boom Driving Up Cost of Therapy?

(Getty Images)

(Getty Images)

Going out to dinner is really stressful for Carolyn Desimone. She has a lot of friends who work in the tech sector, and they always want to go to trendy places.

“I went out for ramen with some startup kids and it was 30 bucks a person. It was stupid,” she says. “Everyone at the table is making twice as much as I do.”

And they’re willing to spend twice as much on food. It’s an economic dynamic she notices in the cost of therapy, too. Desimone pays $65 an hour at a community clinic to get help with her anxiety.

‘Geek whisperers’ needed now more than ever as the price of mental health services rises.

“The pool of my friends, they’re all $100, $120 per appointment,” she says. “I’d never be able to do that. I couldn’t do that and pay my rent.”

The influx of tech workers to the Bay Area has had a profound effect on the local economy: Affordable housing is nearly impossible to find. Dining out has become a competitive sport. And now, it seems the tech sector is applying upward pressure on the cost of some mental health services, too.

“One big variable is money,” says Michael Klein, a clinical psychologist in San Francisco. “The other is stress.” Continue reading

Cancer Patients, Doctors Sue State to Allow Aid in Dying

Brittany Maynard, 29, terminally ill with brain cancer, ended her own life on Nov. 1, 2014 in Oregon. (Compassion and Choices/BrittanyFund.org)

Brittany Maynard, 29, terminally ill with brain cancer, ended her own life on Nov. 1, 2014, in Oregon.
(Compassion and Choices/BrittanyFund.org)

Cancer patients and doctors are suing the state of California to allow physicians to prescribe lethal medication to terminally ill patients who request it. The lawsuit was filed Wednesday, just three weeks after lawmakers proposed an “aid in dying” bill.

“I want to be in control of my life and die a peaceful death here in California, which is my home,” said Christie White, a plaintiff in the case.

She spent two years in the hospital battling leukemia. She’s in partial remission now, but the sense of helplessness she felt during her treatment haunts her. She says she’s suing the state so she can have more say over when and where she dies.

Continue reading

Health Officials Discourage ‘Measles Parties’

Vial of Measles Mumps and Rubella (MMR) vaccine. (Geoff Caddick/AFP/Getty Images)

Vial of Measles Mumps and Rubella (MMR) vaccine. (Geoff Caddick/AFP/Getty Images)

Julie Schiffman is a mother of two in Marin County. The choice to not vaccinate her kids, now 6 and 8, was a long and difficult one, she said. But deciding whether to intentionally expose them to measles was easy.

“I would never do that to my kid,” she said.

She was approached recently by a friend who knew her kids were unvaccinated. The friend offered to help set up a play date with another child who was sick.

“She said, ‘I know someone who has the measles, would you like to be connected with them?’” Schiffman said.

Continue reading

California Considers Raising Smoking Age to 21

Ninety percent of current smokers tried their first cigarette before turning 18. (Dave Whelan/Flickr)

Ninety percent of current smokers tried their first cigarette before turning 18. (Dave Whelan/Flickr)

State lawmakers want to raise the legal smoking age in California from 18 to 21, arguing the change would reduce smoking rates overall and lower health care costs associated with tobacco use.

State Sen. Ed Hernandez (D-West Covina) introduced Senate Bill 151 on Thursday, saying the new legislation would increase protection for kids under 18 as well.

“It is much easier for someone who is 17 to get cigarettes from a friend who is 18,” he said. “Someone who is 21 is more likely to be in the workforce or in college, and unlikely to have a younger set of friends.”

Studies show that 90 percent of current smokers tried their first cigarette before turning 18. About 95 percent tried smoking before age 21. Continue reading

Kaiser Nurses Reach Agreement, Call Off Strike

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

Kaiser nurses staged a two-day strike in November, citing concerns about Ebola preparedness. (Justin Sullivan/Getty Images)

The California Nurses’ Association has called off a two-day strike scheduled to begin Wednesday after reaching a tentative agreement with Kaiser Permanente on a new three-year contract.

The nurses’ bargaining team is recommending ratification of the proposed contract that would affect 18,000 registered nurses and nurse practitioners at 86 Kaiser sites throughout Northern and Central California.

“It’s really, really a good deal,” said Diane McClure, a nurse at Kaiser’s South Sacramento facility and a member of the bargaining team, adding that the strike threat strengthened the nurses’ position with Kaiser. “They saw the momentum the nurses had. They didn’t want us out in the public, because they knew the public was behind us.”

Kaiser issued a statement saying it was pleased with the economic priorities accomplished by the agreement, including “slowing the growth of our long-term liabilities,” and offering benefits to nurses that are “consistent with our commitment to affordability.” Continue reading

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