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Tiny Central Valley Community Tests California's Clean-Water Law
Bill Requiring Disciplined Physicians to Notify Patients Advances in Sacramento
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\u003ca href=\"http://kvpr.org/people/kerry-klein\" target=\"_blank\">Kerry Klein\u003c/a>\u003c/strong>\u003c/br>\u003ca href=\"http://kvpr.org/\" target=\"_blank\">Valley Public Radio\u003c/a>","isLoading":false},"byline_stateofhealth_177403":{"type":"authors","id":"byline_stateofhealth_177403","meta":{"override":true},"slug":"byline_stateofhealth_177403","name":"Kerry Klein\u003cbr />\u003ca href=\"hhttp://kvpr.org/post/new-state-law-bring-arsenic-free-drinking-water-tulare-county-community\">KVPR\u003c/a>","isLoading":false},"lizagross":{"type":"authors","id":"6322","meta":{"index":"authors_1591205172","id":"6322","found":true},"name":"Liza Gross","firstName":"Liza","lastName":"Gross","slug":"lizagross","email":"lizagross@gmail.com","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Liza Gross, an award-winning independent journalist and senior editor at the biomedical journal PLOS Biology, writes mostly about conservation and public and environmental health. She was a 2013 recipient of the NYU Reporting Award, a 2013 Dennis Hunt Health Journalism fellow and a 2015 USC Data Journalism fellow.\r\n\r\nRead her \u003ca href=\"http://science.kqed.org/quest/author/lizagross/\">previous contributions\u003c/a> to \u003ca href=\"science.kqed.org/quest/\">QUEST\u003c/a>, a project dedicated to exploring the Science of Sustainability.","avatar":"https://secure.gravatar.com/avatar/1f7d36efc78088d63466cef5f10c4c7a?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"stateofhealth","roles":["author"]},{"site":"science","roles":["author"]},{"site":"quest","roles":["subscriber"]}],"headData":{"title":"Liza Gross | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/1f7d36efc78088d63466cef5f10c4c7a?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/1f7d36efc78088d63466cef5f10c4c7a?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lizagross"},"lisafine":{"type":"authors","id":"11105","meta":{"index":"authors_1591205172","id":"11105","found":true},"name":"Lisa Fine","firstName":"Lisa","lastName":"Fine","slug":"lisafine","email":"lisacfine@gmail.com","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Lisa Fine is a veteran journalist who's written for papers including the Washington Post, Philadelphia Inquirer, Richmond (Va.) Times-Dispatch and Education Week.\r\n\r\n ","avatar":"https://secure.gravatar.com/avatar/a9390ffc82e66cee761ae45f61cef865?s=600&d=blank&r=g","twitter":"@Lisa_Fine","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"Lisa Fine | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/a9390ffc82e66cee761ae45f61cef865?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/a9390ffc82e66cee761ae45f61cef865?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisafine"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_291413":{"type":"posts","id":"stateofhealth_291413","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"291413","score":null,"sort":[1487192784000]},"guestAuthors":[],"slug":"california-prisons-fight-to-reduce-dangerous-valley-fever-infections-among-inmates","title":"California Prisons Fight to Reduce Dangerous 'Valley Fever' Infections Among Inmates","publishDate":1487192784,"format":"standard","headTitle":"Valley Public Radio | State of Health | KQED News","labelTerm":{"term":3043,"site":"stateofhealth"},"content":"\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/307877957\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>\u003cstrong>\"Just One Breath\"\u003c/strong>: Read More \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">Investigations\u003c/a> About Valley Fever\u003c/h2>\n\u003cp>The \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">“Just One Breath”\u003c/a> project results from an innovative reporting venture, the Center for Health Journalism Collaborative, which currently involves the Bakersfield Californian, Radio Bilingüe in Fresno, Valley Public Radio in Fresno and Bakersfield, Vida en el Valle in Fresno, Hanford Sentinel, the Voice of OC in Santa Ana, the Arizona Daily Star in Tucson and La Estrella de Tucsón. The collaborative is an initiative of the \u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">Center for Health Journalism\u003c/a> at the University of Southern California’s Annenberg School for Communication and Journalism.\u003c/p>\n\u003c/aside>\n\u003cp>When the wind kicks up in the town of Coalinga, dust devils whirl over almond orchards and pumpjacks. You can even see the narrow brown funnels from the grounds of Pleasant Valley State Prison, on the outskirts of town.\u003c/p>\n\u003cp>But at the prison itself, there’s hardly any dust. That's evidence of years of work by the California Department of Corrections and Rehabilitation to reduce and control the San Joaquin Valley's ubiquitous wind-borne dust. The dust carries the spores of the debilitating fungal disease known as \u003ca href=\"https://www.cdc.gov/fungal/diseases/coccidioidomycosis/\" target=\"_blank\">coccidioidomycosis\u003c/a>, or \"valley fever.\"\u003c/p>\n\u003cp>“As you can see, it’s a slight breeze but there’s nothing blowing around,” says prison spokesman Matt Martin, gesturing toward dirt-packed exercise yards and the unpaved shoulders of nearby roads. \"It’s a dirt spray, it’ll keep the dust down.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Inhaling the dust can be deadly. Spores of the dangerous fungus lurk inside the dust, and if prisoners inhale those spores, they can get sick.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">By 2011, hundreds of state prisoners were falling ill with the disease every year. Annual prisoner deaths from the disease ranged between six to nine. Pleasant Valley had the most cases; in 2011, the prison's diagnosis rate was more than 600 times the general California rate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Prisoners are especially vulnerable to valley fever. They can’t install new air filters or double-paned windows. And they obviously can’t leave.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_291432\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291432\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg\" alt=\"Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Preventing this disease is challenging because we all breathe, and many of us live in areas where this fungus is found,” says Dr. Tom Chiller, chief of the \u003ca href=\"https://www.cdc.gov/ncezid/dfwed/mycotics/\" target=\"_blank\">mycotic diseases branch \u003c/a>of the Centers for Disease Control and Prevention.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But in the last few years, California’s state prisons have made progress. They’ve worked to screen out the prisoners most vulnerable to the disease and have taken measures to lower the risk to inmates incarcerated there. Between 2011 and 2015, while background valley fever rates in the southwest dropped by 30 to 50 percent, rates in state prisons fell close to 90 percent overall. Those improvements did not happen quickly or easily, and some required intervention by outsiders.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Some prisoners more vulnerable than others\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Richard Nuwintore was barely three weeks into his sentence at Taft Correctional Institution when he began to cough and experience chest pain. Within a few days, it was obvious something was wrong.\u003c/span>\u003c/p>\n\u003cp>\u003cb>“\u003c/b>\u003cspan style=\"font-weight: 400\">I could touch my skin and I was really hot,” Nuwintore recalls. “I had the coughing, the night sweats. My appetite was gone. I couldn't eat. I couldn't swallow, and I was losing weight really, really fast.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Valley fever is endemic to dusty areas of the southwestern United States. Most who inhale the spores overcome the disease without ever knowing it. Some develop symptoms resembling pneumonia or bronchitis. In a small minority, the disease causes severe lung infection or disseminates throughout the body, requiring lifelong treatment. In the worst cases, the infection leads to fatal meningitis. \u003c/span>\u003c/p>\n\u003cp>The disease draws its name from the San Joaquin Valley, the agricultural belt in the center of the state where the disease is concentrated. Kern County — where Nuwintore was incarcerated at Taft — has the highest valley fever incidence of any California county.\u003c/p>\n\u003cp>Originally a refugee from the east African country of Burundi, Nuwintore had never heard of the disease before arriving at Taft.\u003c/p>\n\u003cp>“Other inmates were telling me about valley fever, and I was like, ‘What is it? What is it?’ ” he says. “It was something scary, you know?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nuwintore was a victim of confinement in an endemic area, but weather and genetics also played a role. In 2011, when he was diagnosed, valley fever rates in Arizona and California were skyrocketing — a peak experts largely attribute to\u003c/span>\u003ca href=\"http://www.bakersfield.com/special/just-one-breath/valley-fever-cases-spike-is-it-the-weather/article_7ce6b232-d0a0-5674-bdf6-e512a3d46d42.html\"> \u003cspan style=\"font-weight: 400\">weather cycles of rain and drought\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And research shows that individuals of African-American or African descent, like Nuwintore, are especially prone to the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Taft is a federal prison and its health data have not been made available. But in state prisons all around Taft, the disease simmered. Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever — many of whom, like Nuwintore, still struggle to manage the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Prisons take steps to reduce risk\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The California Department of Corrections and Rehabilitation began taking steps to prevent valley fever long before the alarming 2011 spike in cases.\u003c/span>\u003c/p>\n\u003cp>Beginning in 2006, prison officials began excluding inmates with weakened immune systems — due to factors such as HIV or chemotherapy — from all eight prisons in the Central Valley. But valley fever rates still rose among prisoners.\u003c/p>\n\u003cfigure id=\"attachment_291430\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291430\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg\" alt=\"Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">More sweeping interventions arrived in 2013, at the behest of federal officials who by that time had taken over the administration of prison health care in California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal oversight officials added a new rule specifically for prisoners who are African-American or Filipino, another group that is especially susceptible to the disease. The rule held that inmates from those two ethnic groups could \u003cem>not\u003c/em> be sent to the two most affected prisons, Pleasant Valley and nearby Avenal State Prison.\u003c/span>\u003c/p>\n\u003cp>At those two prisons, officials have distributed dust masks that inmates can wear outside. Prisoners also have the option to stay indoors when wind speeds are high.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think [valley fever] is one of the biggest issues that we've had in this system,” says Janet Mohle-Boetani, a health administrator with the California Department of Corrections and Rehabilitation. “We're taking precautions for every prison in the Central Valley, and we're taking extra special precautions for the two prisons that have the very high rates of valley fever.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The most significant change, perhaps, arrived in 2015 on the recommendation of the Centers for Disease Control and Prevention. It’s\u003c/span>\u003ca href=\"http://kvpr.org/post/new-valley-fever-skin-test-shows-promise-obstacles-remain\"> \u003cspan style=\"font-weight: 400\">a skin test called Spherusol\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that can detect valley fever immunity, and it’s offered to every inmate entering the state prison system. An individual who tests positive has already been exposed to the fungus and fought it off successfully, and is henceforth immune. Inmates who test negative are still at risk. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If they inhale the dust with the fungus in it and they've tested negative, they're much more likely to get the disease than someone who has a positive test,” says Mohle-Boetani. “So if someone comes into the reception center and then they test negative, we put a medical restriction on those patients so they are not sent to live in Avenal or Pleasant Valley State Prison.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">People gain immunity after successfully fighting off the disease. In a mass screening in early 2015, around 35,000 inmates in the California prison system took the test and roughly 9 percent were shown to be immune.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The CDC recommended Spherusol to the state prison system shortly after the test became commercially available in 2014. The FDA has not actually approved Spherusol for this purpose, but like other medical products, it is being used off-label to sort the prisoners by risk.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Given the fact that they were having such high rates of cocci, we knew that we needed to do whatever we could to try to help them lower the risk,” says the CDC’s Tom Chiller, referring to valley fever by its scientific nickname, cocci. “We immediately thought 'Maybe this could be used to understand which prisoners could exist in an area with the fungal spores but not get infected, or at least have an extremely low risk of getting infected.'”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">John Galgiani, director of the University of Arizona’s Valley Fever Center for Excellence, is optimistic about the decline in valley fever reported in California’s prisons, but he says it’s too early to determine the exact reasons.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think they should be given credit for the drop to some extent,” Galgiani says, “but it'll take time to see if it stays low, to see if it's because of the policies that are now put in place.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Health impacts linger after prison sentence\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Today, Richard Nuwintore lives on a suburban cul-de-sac outside Sacramento with his mother and girlfriend.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He may be free from prison, but he’s not free of the disease. He’s too sick to work, and he’ll probably be on antifungal medications for the rest of his life. The fat pink and blue pills keep him alive, but their side effects are almost as bad as the disease itself.\u003c/span>\u003c/p>\n\u003cp>“You wake up, you have a little bit of energy, but as the day goes by you start to just feel pain in the joints,” he says. “Of course, your stomach is still on fire because the medicine is kind of powerful. And [there's] fatigue, and sometimes you get dizzy.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Last year, Nuwintore and another inmate won a landmark case that established the right of prisoners to sue the federal government for damages related to the disease, even though Taft is managed by a private contractor. They’ve now filed a second lawsuit to recoup their medical costs and lost earnings — a sum that could reach millions.\u003c/p>\n\n","blocks":[],"excerpt":"Fungal spores swirling within the dust of the San Joaquin Valley have forced state prisons to ramp up prevention efforts.","status":"publish","parent":0,"modified":1487717974,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":40,"wordCount":1744},"headData":{"title":"California Prisons Fight to Reduce Dangerous 'Valley Fever' Infections Among Inmates | KQED","description":"Fungal spores swirling within the dust of the San Joaquin Valley have forced state prisons to ramp up prevention efforts.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Prisons Fight to Reduce Dangerous 'Valley Fever' Infections Among Inmates","datePublished":"2017-02-15T21:06:24.000Z","dateModified":"2017-02-21T22:59:34.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"291413 https://ww2.kqed.org/stateofhealth/?p=291413","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/02/15/california-prisons-fight-to-reduce-dangerous-valley-fever-infections-among-inmates/","disqusTitle":"California Prisons Fight to Reduce Dangerous 'Valley Fever' Infections Among Inmates","nprByline":"\u003cstrong> \u003ca href=\"http://kvpr.org/people/kerry-klein\" target=\"_blank\">Kerry Klein\u003c/a>\u003c/strong>\u003c/br>\u003ca href=\"http://kvpr.org/\" target=\"_blank\">Valley Public Radio\u003c/a>","path":"/stateofhealth/291413/california-prisons-fight-to-reduce-dangerous-valley-fever-infections-among-inmates","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/307877957&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/307877957'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>\u003cstrong>\"Just One Breath\"\u003c/strong>: Read More \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">Investigations\u003c/a> About Valley Fever\u003c/h2>\n\u003cp>The \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">“Just One Breath”\u003c/a> project results from an innovative reporting venture, the Center for Health Journalism Collaborative, which currently involves the Bakersfield Californian, Radio Bilingüe in Fresno, Valley Public Radio in Fresno and Bakersfield, Vida en el Valle in Fresno, Hanford Sentinel, the Voice of OC in Santa Ana, the Arizona Daily Star in Tucson and La Estrella de Tucsón. The collaborative is an initiative of the \u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">Center for Health Journalism\u003c/a> at the University of Southern California’s Annenberg School for Communication and Journalism.\u003c/p>\n\u003c/aside>\n\u003cp>When the wind kicks up in the town of Coalinga, dust devils whirl over almond orchards and pumpjacks. You can even see the narrow brown funnels from the grounds of Pleasant Valley State Prison, on the outskirts of town.\u003c/p>\n\u003cp>But at the prison itself, there’s hardly any dust. That's evidence of years of work by the California Department of Corrections and Rehabilitation to reduce and control the San Joaquin Valley's ubiquitous wind-borne dust. The dust carries the spores of the debilitating fungal disease known as \u003ca href=\"https://www.cdc.gov/fungal/diseases/coccidioidomycosis/\" target=\"_blank\">coccidioidomycosis\u003c/a>, or \"valley fever.\"\u003c/p>\n\u003cp>“As you can see, it’s a slight breeze but there’s nothing blowing around,” says prison spokesman Matt Martin, gesturing toward dirt-packed exercise yards and the unpaved shoulders of nearby roads. \"It’s a dirt spray, it’ll keep the dust down.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Inhaling the dust can be deadly. Spores of the dangerous fungus lurk inside the dust, and if prisoners inhale those spores, they can get sick.\u003c/span>\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>\u003cspan style=\"font-weight: 400\">By 2011, hundreds of state prisoners were falling ill with the disease every year. Annual prisoner deaths from the disease ranged between six to nine. Pleasant Valley had the most cases; in 2011, the prison's diagnosis rate was more than 600 times the general California rate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Prisoners are especially vulnerable to valley fever. They can’t install new air filters or double-paned windows. And they obviously can’t leave.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_291432\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291432\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg\" alt=\"Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Preventing this disease is challenging because we all breathe, and many of us live in areas where this fungus is found,” says Dr. Tom Chiller, chief of the \u003ca href=\"https://www.cdc.gov/ncezid/dfwed/mycotics/\" target=\"_blank\">mycotic diseases branch \u003c/a>of the Centers for Disease Control and Prevention.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But in the last few years, California’s state prisons have made progress. They’ve worked to screen out the prisoners most vulnerable to the disease and have taken measures to lower the risk to inmates incarcerated there. Between 2011 and 2015, while background valley fever rates in the southwest dropped by 30 to 50 percent, rates in state prisons fell close to 90 percent overall. Those improvements did not happen quickly or easily, and some required intervention by outsiders.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Some prisoners more vulnerable than others\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Richard Nuwintore was barely three weeks into his sentence at Taft Correctional Institution when he began to cough and experience chest pain. Within a few days, it was obvious something was wrong.\u003c/span>\u003c/p>\n\u003cp>\u003cb>“\u003c/b>\u003cspan style=\"font-weight: 400\">I could touch my skin and I was really hot,” Nuwintore recalls. “I had the coughing, the night sweats. My appetite was gone. I couldn't eat. I couldn't swallow, and I was losing weight really, really fast.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Valley fever is endemic to dusty areas of the southwestern United States. Most who inhale the spores overcome the disease without ever knowing it. Some develop symptoms resembling pneumonia or bronchitis. In a small minority, the disease causes severe lung infection or disseminates throughout the body, requiring lifelong treatment. In the worst cases, the infection leads to fatal meningitis. \u003c/span>\u003c/p>\n\u003cp>The disease draws its name from the San Joaquin Valley, the agricultural belt in the center of the state where the disease is concentrated. Kern County — where Nuwintore was incarcerated at Taft — has the highest valley fever incidence of any California county.\u003c/p>\n\u003cp>Originally a refugee from the east African country of Burundi, Nuwintore had never heard of the disease before arriving at Taft.\u003c/p>\n\u003cp>“Other inmates were telling me about valley fever, and I was like, ‘What is it? What is it?’ ” he says. “It was something scary, you know?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nuwintore was a victim of confinement in an endemic area, but weather and genetics also played a role. In 2011, when he was diagnosed, valley fever rates in Arizona and California were skyrocketing — a peak experts largely attribute to\u003c/span>\u003ca href=\"http://www.bakersfield.com/special/just-one-breath/valley-fever-cases-spike-is-it-the-weather/article_7ce6b232-d0a0-5674-bdf6-e512a3d46d42.html\"> \u003cspan style=\"font-weight: 400\">weather cycles of rain and drought\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And research shows that individuals of African-American or African descent, like Nuwintore, are especially prone to the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Taft is a federal prison and its health data have not been made available. But in state prisons all around Taft, the disease simmered. Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever — many of whom, like Nuwintore, still struggle to manage the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Prisons take steps to reduce risk\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The California Department of Corrections and Rehabilitation began taking steps to prevent valley fever long before the alarming 2011 spike in cases.\u003c/span>\u003c/p>\n\u003cp>Beginning in 2006, prison officials began excluding inmates with weakened immune systems — due to factors such as HIV or chemotherapy — from all eight prisons in the Central Valley. But valley fever rates still rose among prisoners.\u003c/p>\n\u003cfigure id=\"attachment_291430\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291430\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg\" alt=\"Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">More sweeping interventions arrived in 2013, at the behest of federal officials who by that time had taken over the administration of prison health care in California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal oversight officials added a new rule specifically for prisoners who are African-American or Filipino, another group that is especially susceptible to the disease. The rule held that inmates from those two ethnic groups could \u003cem>not\u003c/em> be sent to the two most affected prisons, Pleasant Valley and nearby Avenal State Prison.\u003c/span>\u003c/p>\n\u003cp>At those two prisons, officials have distributed dust masks that inmates can wear outside. Prisoners also have the option to stay indoors when wind speeds are high.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think [valley fever] is one of the biggest issues that we've had in this system,” says Janet Mohle-Boetani, a health administrator with the California Department of Corrections and Rehabilitation. “We're taking precautions for every prison in the Central Valley, and we're taking extra special precautions for the two prisons that have the very high rates of valley fever.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The most significant change, perhaps, arrived in 2015 on the recommendation of the Centers for Disease Control and Prevention. It’s\u003c/span>\u003ca href=\"http://kvpr.org/post/new-valley-fever-skin-test-shows-promise-obstacles-remain\"> \u003cspan style=\"font-weight: 400\">a skin test called Spherusol\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that can detect valley fever immunity, and it’s offered to every inmate entering the state prison system. An individual who tests positive has already been exposed to the fungus and fought it off successfully, and is henceforth immune. Inmates who test negative are still at risk. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If they inhale the dust with the fungus in it and they've tested negative, they're much more likely to get the disease than someone who has a positive test,” says Mohle-Boetani. “So if someone comes into the reception center and then they test negative, we put a medical restriction on those patients so they are not sent to live in Avenal or Pleasant Valley State Prison.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">People gain immunity after successfully fighting off the disease. In a mass screening in early 2015, around 35,000 inmates in the California prison system took the test and roughly 9 percent were shown to be immune.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The CDC recommended Spherusol to the state prison system shortly after the test became commercially available in 2014. The FDA has not actually approved Spherusol for this purpose, but like other medical products, it is being used off-label to sort the prisoners by risk.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Given the fact that they were having such high rates of cocci, we knew that we needed to do whatever we could to try to help them lower the risk,” says the CDC’s Tom Chiller, referring to valley fever by its scientific nickname, cocci. “We immediately thought 'Maybe this could be used to understand which prisoners could exist in an area with the fungal spores but not get infected, or at least have an extremely low risk of getting infected.'”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">John Galgiani, director of the University of Arizona’s Valley Fever Center for Excellence, is optimistic about the decline in valley fever reported in California’s prisons, but he says it’s too early to determine the exact reasons.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think they should be given credit for the drop to some extent,” Galgiani says, “but it'll take time to see if it stays low, to see if it's because of the policies that are now put in place.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Health impacts linger after prison sentence\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Today, Richard Nuwintore lives on a suburban cul-de-sac outside Sacramento with his mother and girlfriend.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He may be free from prison, but he’s not free of the disease. He’s too sick to work, and he’ll probably be on antifungal medications for the rest of his life. The fat pink and blue pills keep him alive, but their side effects are almost as bad as the disease itself.\u003c/span>\u003c/p>\n\u003cp>“You wake up, you have a little bit of energy, but as the day goes by you start to just feel pain in the joints,” he says. “Of course, your stomach is still on fire because the medicine is kind of powerful. And [there's] fatigue, and sometimes you get dizzy.”\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>Last year, Nuwintore and another inmate won a landmark case that established the right of prisoners to sue the federal government for damages related to the disease, even though Taft is managed by a private contractor. They’ve now filed a second lawsuit to recoup their medical costs and lost earnings — a sum that could reach millions.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/291413/california-prisons-fight-to-reduce-dangerous-valley-fever-infections-among-inmates","authors":["byline_stateofhealth_291413"],"categories":["stateofhealth_11","stateofhealth_166","stateofhealth_2746"],"tags":["stateofhealth_2808","stateofhealth_2519","stateofhealth_3046","stateofhealth_2735","stateofhealth_356"],"affiliates":["stateofhealth_3043"],"featImg":"stateofhealth_291429","label":"stateofhealth_3043"},"stateofhealth_240260":{"type":"posts","id":"stateofhealth_240260","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"240260","score":null,"sort":[1475506826000]},"guestAuthors":[],"slug":"at-california-psychiatric-hospitals-epidemic-of-patients-assaults-on-staff-goes-untreated","title":"At California Psychiatric Hospitals, Epidemic of Patients’ Assaults on Staff Goes Untreated","publishDate":1475506826,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cem>California’s network of state psychiatric hospitals is charged with treating people with mental illness who pose a danger to themselves or others, but workers faced with ongoing assaults by patients have struggled to provide a therapeutic environment. In this in-depth account, veteran California journalist Liza Gross reports that injured workers at the five psychiatric hospitals, including Napa State Hospital, have lost tens of thousands of workdays while taxpayers pay millions of dollars in workers' compensation and overtime costs.\u003c/em>\u003c/p>\n\u003cp>Stephen Seager felt lucky when Napa State Hospital offered him a job as staff psychiatrist in the spring of 2011. His wife, also a physician, had already relocated to Northern California from their home in Utah, after cutbacks at their hospitals forced the couple to find new positions.\u003c/p>\n\u003cp>Seager had originally trained as an emergency room physician, but the continual stream of traumas burned him out. He switched to psychiatry for a change of pace. He’d been drawn to medicine to help those in need, and people with severe mental disorders certainly fit the bill.\u003c/p>\n\u003cp>Seager had treated patients in acute psychiatric distress at hospitals in Phoenix, Los Angeles and St. George, Utah, but, like most psychiatrists, he’d never set foot in a state mental hospital. He just knew they treated some of society’s sickest psychiatric patients and that most had been judged incompetent to stand trial or not guilty by reason of insanity. He thought he could help them.\u003c/p>\n\u003cp>When Seager took the job at Napa, he says he didn’t know that even people found to have committed violent acts were free to wander the hospital halls. He also didn’t know that the clinical staff doubled as security guards.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And he didn’t know that seven months before he showed up for work, a veteran psychiatric technician named Donna Gross had been murdered right outside his new office.\u003c/p>\n\u003cp>The exact details of Gross’ death are not known, but police investigators and state occupational safety inspectors were able to piece together the general outlines of what happened, the coroner’s and inspector’s reports show.\u003c/p>\n\u003cp>On Sept. 23, 2010, Gross (no relation to the author) was returning from a break for her second shift of the day, around 5:30 p.m., when she entered the hospital’s secure treatment area, which houses patients deemed criminally insane. She walked across the grounds, where many patients congregated unsupervised. Before she reached her unit, a patient grabbed her and dragged her behind a patio wall. Gross pressed the alarm on her belt, but nobody came to her aid. Staff alarms, according to court records, didn’t work outdoors.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>An hour after the 54-year-old grandmother had passed through security, her colleagues found her sprawled on the courtyard patio, dead. Police quickly determined that Gross had been strangled by Jess Massey, a 37-year-old patient known for his violent history and penchant for stalking.\u003c/p>\n\u003cp>Most patients who assault staff, according to Seager and other staff members, remain on the wards.\u003cstrong> \u003c/strong> After all, many came to California’s state psychiatric facilities because they committed violent crimes. Massey had been sent to Napa after pleading not guilty by reason of insanity after repeatedly stabbing a woman in a Sacramento parking garage. Police investigators said Massey confessed to killing Gross. He pleaded no contest in court and is now serving 25 years to life at Corcoran State Prison.\u003c/p>\n\u003cp>Gross’ murder forced California hospital administrators to respond to increasing pressure from employees who’d long protested perilous conditions at the state’s five psychiatric hospitals. \u003ca href=\"https://www.uapd.com/2010/11/uapd-president-dr-stuart-bussey-speaks-out-on-napa-state-hospital-violence/\" target=\"_blank\">Officials offered\u003c/a> shuttles so Napa employees didn’t have to walk through the grounds, and tightened restrictions on grounds passes.\u003c/p>\n\u003cp>A month before Seager started working at Napa State, the Occupational Safety and Health Administration fined the hospital $100,140 for “serious” and “willful” violations that led to Gross’ death. This time, hospital administrators agreed to deploy security teams to patrol the grounds and lifted a hiring ban.\u003cbr>\nIt wasn’t enough -- not for workers at Napa or the state’s other facilities. Since Gross’ death, employees at California’s five psychiatric hospitals have suffered thousands of assaults a year, resulting in tens of thousands of lost days on the job and costing taxpayers at least $135 million in workers' compensation and overtime.\u003c/p>\n\u003cp>As a new employee, Seager had barely stepped onto his unit when a burly patient batted the slightly built doctor aside like a fly, sending him crashing into a wall. Seager’s head hit with a thwack that split open his scalp. The man then grabbed a heavy wooden chair and smashed it over an older patient’s head. Seager, who’d just turned 61, tried to stanch the blood gushing from the man’s head until paramedics arrived. “I’ve kept up my ER skills as a psychiatrist because I have so many emergency beatings and traumas,” he says.\u003c/p>\n\u003cfigure id=\"attachment_240449\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-240449 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg\" width=\"800\" height=\"732\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-400x366.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-768x703.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-1180x1079.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-960x878.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1.jpg 1290w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Stephen Seager\u003c/figcaption>\u003c/figure>\n\u003cp>Seager’s colleagues convinced him to go to the county hospital. It took 10 stitches to close his wound. The patient never returned. Seager heard he’d been flown out to a nearby hospital. He found out the patient died only because a colleague’s relative worked at the hospital where he’d been treated.\u003c/p>\n\u003cp>At Napa State, violence was -- and still is -- just part of the routine, as the signs that are posted twice a week reporting assaults on staff indicate. There are steps officials could take to control the violence at California’s state hospitals, Seager says -- steps that would ultimately save taxpayers money. “But the administration and Sacramento don’t seem to care.”\u003c/p>\n\u003cp>\u003cstrong>Safety Measures Fall Short\u003c/strong>\u003c/p>\n\u003cp>Neither the measures taken before Seager’s arrival, nor those taken since, have stopped the bleeding at California’s five psychiatric hospitals. In the years following Gross’ death, workers at Napa, Patton, Metropolitan, Coalinga and Atascadero state hospitals have suffered on average 2,795 assaults a year, costing California taxpayers over $82.7 million in workers’ compensation claims over the past two fiscal years alone, according to data obtained through state public records requests.\u003c/p>\n\u003cp>Patients at the five hospitals committed nearly 26,000 assaults between 2011 and 2014, the latest year for which data are available, according to aggressive incident report records obtained from the Department of State Hospitals, which oversees the facilities.\u003c/p>\n\u003cp>Staff were the victims of 11,000 — more than 42 percent — of those assaults, the records show. Psychiatric technicians, nurses and their colleagues sustained 2,745 assaults at the five facilities in 2014, nearly 150 more than the year before. In the past two fiscal years, 2013-14 and 2014-15, they lost 105,108 days of work, the equivalent of 473 full-time employees.\u003c/p>\n\u003cp>Workers at Napa State alone endured 880 assaults in 2014, up from 866 the previous year. Employees were routinely kicked in the chest, punched in the face, shoved against walls and knocked to the ground, police logs obtained through public records requests show.\u003c/p>\n\u003cp>If you look at the rate of assaults based on the number of staff working at the facilities, it looks like safety has improved. The chances of an employee getting assaulted peaked at 30 percent in 2012, compared with 24 percent in 2014. But those figures are misleading, union reps say. For one thing, paperwork requirements for assaults increased while hospitals were required to report to a federal monitor (which ended in 2013), and it was not uncommon for assaulted staff to suffer in silence rather than fill out more forms.\u003c/p>\n\u003cp>[assaultsHospitals]\u003c/p>\n\u003cp>But perhaps more importantly, not everyone faces the same risks. Although any staff member runs the risk of a beating, says California Association of Psychiatric Technicians representative Coby Pizzotti, psych techs are especially vulnerable because they have the most contact with patients. The state doesn’t release the number of assaults on staff based on job category.\u003c/p>\n\u003cp>With 3,500 psych techs and over 2,700 assaults in a year, Pizzotti says, “It’s not a matter of if you get assaulted, it’s when you’re going to be assaulted and how severe.”\u003c/p>\n\u003cp>The year Gross was killed, staff at Napa State filed 289 workers' comp claims, according to the\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> L\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">os\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Ange\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">les\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Times\u003c/a>. Over the past two fiscal years, that number jumped to 517 and 519, state records show. As the abuse continued, Seager says, staff and administrators acted like daily assaults were all in a day’s work. “It’s horrifying to me that no one does anything about it or even talks about it,” he says. “It’s not mentioned. Ever.”\u003c/p>\n\u003cp>Frustrated by this culture of silence and the state’s unwillingness to address the rampant violence in its hospitals, Seager documented the ongoing beatings in a 2014 book, “Behind the Gates of Gomorrah: A Year with the Criminally Insane.” He wrote the book, he says, because he wanted the public to know that the people they send to state hospitals to get treatment can’t get better in the midst of so much violence. And staff can’t deliver the care they were trained to provide when they’re constantly worried about their safety.\u003c/p>\n\u003cp>Hospital administrators weren’t happy about it, Seager says. But they didn’t fire him.\u003c/p>\n\u003cp>“The safety of our patients and staff has always been among our top priorities,” says Ralph Montano, spokesman for the Department of State Hospitals. Among recent safety improvements, Montano points to a new personal alarm system, which alerts police and reveals an employee’s location, indoors or out, and what he describes as key pieces of legislation signed by Gov. Jerry Brown in 2014.\u003c/p>\n\u003cp>The laws were designed to improve safety by giving clinical staff the right to access a patient’s \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201320140AB1960\" target=\"_blank\">criminal history\u003c/a> for violence risk assessment and allowing medication orders to follow patients judged incompetent to stand trial. Patients can spend months in prison or jail without treatment before reaching the hospital, Seager says, increasing their risk for violent behavior.\u003c/p>\n\u003cp>Another law authorizes hospital officials to build enhanced treatment facilities, where the most dangerous patients receive treatment in secured areas as part of a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">pilot program\u003c/a>. The department reported last year that a quarter of patients had been involved in aggressive incidents but only a fraction of them were considered “repeatedly violent patients.” The hope is that segregating those prone to violence will make the hospitals safer.\u003c/p>\n\u003cp>\u003cstrong>Hospitals Take on More Mentally Ill Patients Charged with Crimes\u003c/strong>\u003c/p>\n\u003cp>Napa State wasn’t always such a violent place. When psych tech Michael Jarschke started working at the hospital in 1972, most patients came to Napa because they couldn’t take care of themselves, not because they’d committed a crime. In those days, he’d sometimes get clobbered by patients beset by fits, but brutal beatings were rare.\u003c/p>\n\u003cp>More patients started coming to California’s state hospitals through the criminal justice system in the mid-1990s, Jarschke says, just before Donna Gross hired on at Napa State.\u003c/p>\n\u003cp>To ease overcrowding in prisons and jails, Napa and other state hospitals took on more mentally ill patients charged with crimes. In 1995, forensic patients, who have been convicted or accused of a felony linked to mental illness, made up 60 percent of patients in state facilities, state records show.\u003c/p>\n\u003cp>Today, 96 percent of the state’s psychiatric patients came through criminal courts -- accounting for 37 percent of the nation’s criminally insane.\u003c/p>\n\u003cp>But staff weren’t trained to deal with “prison-minded” patients, says Jarschke, who served as president of the California Association of Psychiatric Technicians' Napa chapter until May. Over time, he’d see more and more patients with gang affiliations, anti-social personality disorders and, like Jess Massey, predatory tendencies.\u003c/p>\n\u003cp>In the old days, Jarschke invited patients to his house for dinner, to help them feel normal. “That’s not happening here,” he says. “It’s not the same. It’ll never be the same.”\u003c/p>\n\u003cp>Jarschke soon realized the tools he used in a bike repair class could turn deadly in the wrong hands. But he felt strongly that he should keep teaching his patients skills that would boost their self-worth, so he set up a wheelchair repair program, thinking it would help them get a job when they got out. Some of his patients had committed monstrous crimes, but to him, they were people with mental problems, not criminals.\u003c/p>\n\u003cp>Jarschke had just set up a wheelchair repair program when Gross was killed. Even the wheelchair program was too risky, he realized. He shut it down.\u003c/p>\n\u003cp>The day after Gross’ murder, Jarschke and his colleagues formed the Safety Now Coalition to protect both staff and patients.\u003c/p>\n\u003cp>One of the first things they did was push for fully functional personal alarms and more security and clinical staff at the hospital. In 2012, administrators added a police substation within the secured treatment area outside, where Massey had cornered Gross. The following year, department spokesman Montano says, they finished implementing the alarm system.\u003c/p>\n\u003cp>But police aren’t on the wards when fights break out, so it’s up to staff, usually psych techs, to intervene. Most psych techs at California’s state hospitals are women who routinely find themselves trying to restrain men twice their size.\u003c/p>\n\u003cp>The alarms don’t prevent assaults, Seager says. “They simply allow people to get you medical help faster. We’ve had social workers have their teeth kicked in and bones broken. We’ve had head injuries where they’ve never come back.”\u003c/p>\n\u003cp>Workers often showed up for a shift having no idea there had just been a brutal assault. Last year, Seager says, “Someone was strangled and left for dead, and [the administration] never said anything about it.”\u003c/p>\n\u003cp>Safety Now asked administrators if staff at Napa could post a sign when a peer suffers an injury that requires more than local first aid, Jarschke says. The request was granted.\u003c/p>\n\u003cp>\u003cstrong>Subsidizing Violence on the Job\u003c/strong>\u003c/p>\n\u003cp>Lupe Alonzo-Diaz, the Department of State Hospitals deputy director of administrative services, acknowledged the risks staff face before a state oversight agency last year. “The potential to be assaulted is a daily threat for nursing staff,” she told the Little Hoover Commission, an independent agency that monitors and proposes improvements to state government operations.\u003c/p>\n\u003cp>The Department of State Hospitals defines aggressive acts as “hitting, pushing, kicking or similar acts directed against another individual to cause potential or actual injury.”\u003c/p>\n\u003cp>Verbal assault is not included in statistics released by the state, even though studies show that workers can suffer greater psychological effects from \u003ca href=\"http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No1-Jan-2013/Measurement-and-Monitoring-Worker-Aggression-Exposure.html\" target=\"_blank\">threats of violence than from physical aggression\u003c/a>.\u003c/p>\n\u003cp>With so many battered workers unable to do their jobs (they're out on worker's comp due to the assaults), the Department of State Hospitals has asked psych techs and nurses to work more than 4.7 million hours of overtime — at time and a half — since 2012 to meet legal staffing requirements. Overtime hours for psych techs have increased more than a third since 2012, reaching 1.2 million hours last year at a cost of $53 million, Pizzotti testified before the Little Hoover Commission.\u003c/p>\n\u003cp>[overtimeTech]\u003c/p>\n\u003cp>Nearly 150,000 overtime hours were mandatory during the 2014-15 fiscal year, up from 92,000 the previous year, state records show.\u003c/p>\n\u003cp>The union is fighting mandatory overtime, CAPT’s Pizzotti says, because it leaves workers unable to prepare for an extra shift, by going to bed early the night before or arranging day care for their kids. Sometimes employees don’t know until two hours before they’re scheduled to leave that they have to stay on, he says. “That throws your world into complete upheaval.”\u003c/p>\n\u003cp>California banned mandatory overtime for \u003ca href=\"http://www.seiu1000.org/general-information/local-1000-nurses-call-legislature-stop-mandatory-overtime\" target=\"_blank\">nurses in the private sector\u003c/a> in 2001 because it compromises worker and patient safety. Since then, \u003ca href=\"http://jap.sagepub.com/content/21/1/19.full.pdf+html\" target=\"_blank\">overwhelming evidence\u003c/a> has linked long extended shifts to increased risks of clinical mistakes and \u003ca href=\"https://www.jointcommission.org/assets/1/18/SEA_48.pdf\" target=\"_blank\">higher rates of occupational injury.\u003c/a>\u003c/p>\n\u003cp>Fatigued staff faced with the constant threat of assault are ill-prepared to safeguard their patients. Weak and vulnerable psychiatric patients sustained over 3,400 assaults at the hands of their peers in 2014, state records show. Although the numbers dropped nearly a quarter between 2010 and 2013, they jumped by 100 assaults in the following year.\u003c/p>\n\u003cp>Hospital administrators are forced to rely on mandatory overtime or face serious consequences, such as loss of certification, court sanctions and fines, Alonzo-Diaz told the Little Hoover Commission. It’s difficult to hire new staff, she said, because the risks associated with the work, combined with lower wages compared with private hospitals -- as much as $63,000 less for nurses and $15,000 less for psych techs -- make it hard to attract and retain employees.\u003c/p>\n\u003cp>Pizzotti says the state could solve these problems in part by expediting a hiring process that is so drawn out that job seekers find work elsewhere before they hear if they’re in the running.\u003cbr>\nRelief appeared to be on the horizon in August, when the Legislature passed \u003ca href=\"http://www.psychtechs.net/uploads/eng/sb%20780_introduced.pdf\" target=\"_blank\">SB 780\u003c/a>, a bill prohibiting the state from using mandatory overtime as a staffing tool. But the bill was withdrawn after Gov. Jerry Brown signaled his opposition to the measure, Pizzotti says.\u003c/p>\n\u003cp>“We decided not to move the bill onto his desk, knowing that it would be vetoed,” he says. That means union representatives are back to bargaining with administrators to reduce mandatory overtime.\u003c/p>\n\u003cp>\u003cstrong>‘Everybody’s in the wrong place’\u003c/strong>\u003c/p>\n\u003cp>For psychiatrist Seager, improving safety over the long term requires coming to grips with the systemic failures that left state hospitals ill-equipped to deal with violent criminals. Homeless people with acute psychiatric conditions should be treated in state hospitals, he says, while the nonviolent mentally ill now in prisons and jails should be treated in community treatment centers and people convicted of violent crimes should be treated in prisons.\u003c/p>\n\u003cp>Instead, he says, “Every single person in the mental health care system is in the wrong place.”\u003c/p>\n\u003cp>Even so, the state could implement several reforms now. Every hospital should have enhanced treatment units as soon as possible, staff say, to protect workers and vulnerable patients from the subset of patients who commit the majority of assaults.\u003c/p>\n\u003cp>The state authorized funding for the program this year, and administrators expect to open units at Atascadero and Patton in 2018, says department spokesman Montano.\u003c/p>\n\u003cp>It could be several years before an enhanced unit comes to Napa. “That’s an ominous feeling for us,” says psych tech Jarschke.\u003c/p>\n\u003cp>For now, increasing staffing levels would go a long way toward reducing violence on the wards, union rep Pizzotti says. Last year, the Department of Public Health hit Napa with several citations for failing to protect patients, including one who sustained a head injury and another who suffered a broken jaw. According to police reports and sources, that’s almost inevitable when an alarm draws all hands from one unit, only to leave another unattended. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Taxpayers have been spending tens of millions of dollars a year in overtime that leaves workers exhausted, prone to making mistakes and even more vulnerable to injury, Pizzotti says. Last year, 18.4 million taxpayers filed with the California Franchise Tax Board. The money spent on overtime could have hired hundreds of full-time psych techs, he says, greatly reducing the risk of violence while allowing staff to focus on the therapeutic care they were trained to provide. It would have cost the average taxpayer less than the price of a latte at Starbucks.\u003c/p>\n\u003cp>But those positions remain unstaffed. Meanwhile, Seager says, the assaults at Napa grew bloodier and more frequent.\u003c/p>\n\u003cp>Next month marks the sixth anniversary of Donna Gross’ murder. This will be the first year Seager won’t be there to pay his respects. “I finally had enough of Napa,” he says. Seager left in June to freelance as an emergency services psychiatrist for several Bay Area hospitals.\u003c/p>\n\u003cp>“The medical care at Napa is first rate and the staff is terrific,” Seager says. “It’s just not safe.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was produced with the support of the California Data Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Injured workers at the five state hospitals have lost tens of thousands of workdays, costing millions to taxpayers.","status":"publish","parent":0,"modified":1475527656,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":72,"wordCount":3495},"headData":{"title":"At California Psychiatric Hospitals, Epidemic of Patients’ Assaults on Staff Goes Untreated | KQED","description":"Injured workers at the five state hospitals have lost tens of thousands of workdays, costing millions to taxpayers.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"At California Psychiatric Hospitals, Epidemic of Patients’ Assaults on Staff Goes Untreated","datePublished":"2016-10-03T15:00:26.000Z","dateModified":"2016-10-03T20:47:36.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"240260 http://ww2.kqed.org/stateofhealth/?p=240260","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/10/03/at-california-psychiatric-hospitals-epidemic-of-patients-assaults-on-staff-goes-untreated/","disqusTitle":"At California Psychiatric Hospitals, Epidemic of Patients’ Assaults on Staff Goes Untreated","path":"/stateofhealth/240260/at-california-psychiatric-hospitals-epidemic-of-patients-assaults-on-staff-goes-untreated","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>California’s network of state psychiatric hospitals is charged with treating people with mental illness who pose a danger to themselves or others, but workers faced with ongoing assaults by patients have struggled to provide a therapeutic environment. In this in-depth account, veteran California journalist Liza Gross reports that injured workers at the five psychiatric hospitals, including Napa State Hospital, have lost tens of thousands of workdays while taxpayers pay millions of dollars in workers' compensation and overtime costs.\u003c/em>\u003c/p>\n\u003cp>Stephen Seager felt lucky when Napa State Hospital offered him a job as staff psychiatrist in the spring of 2011. His wife, also a physician, had already relocated to Northern California from their home in Utah, after cutbacks at their hospitals forced the couple to find new positions.\u003c/p>\n\u003cp>Seager had originally trained as an emergency room physician, but the continual stream of traumas burned him out. He switched to psychiatry for a change of pace. He’d been drawn to medicine to help those in need, and people with severe mental disorders certainly fit the bill.\u003c/p>\n\u003cp>Seager had treated patients in acute psychiatric distress at hospitals in Phoenix, Los Angeles and St. George, Utah, but, like most psychiatrists, he’d never set foot in a state mental hospital. He just knew they treated some of society’s sickest psychiatric patients and that most had been judged incompetent to stand trial or not guilty by reason of insanity. He thought he could help them.\u003c/p>\n\u003cp>When Seager took the job at Napa, he says he didn’t know that even people found to have committed violent acts were free to wander the hospital halls. He also didn’t know that the clinical staff doubled as security guards.\u003cstrong>\u003cbr>\n\u003c/strong>\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>And he didn’t know that seven months before he showed up for work, a veteran psychiatric technician named Donna Gross had been murdered right outside his new office.\u003c/p>\n\u003cp>The exact details of Gross’ death are not known, but police investigators and state occupational safety inspectors were able to piece together the general outlines of what happened, the coroner’s and inspector’s reports show.\u003c/p>\n\u003cp>On Sept. 23, 2010, Gross (no relation to the author) was returning from a break for her second shift of the day, around 5:30 p.m., when she entered the hospital’s secure treatment area, which houses patients deemed criminally insane. She walked across the grounds, where many patients congregated unsupervised. Before she reached her unit, a patient grabbed her and dragged her behind a patio wall. Gross pressed the alarm on her belt, but nobody came to her aid. Staff alarms, according to court records, didn’t work outdoors.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>An hour after the 54-year-old grandmother had passed through security, her colleagues found her sprawled on the courtyard patio, dead. Police quickly determined that Gross had been strangled by Jess Massey, a 37-year-old patient known for his violent history and penchant for stalking.\u003c/p>\n\u003cp>Most patients who assault staff, according to Seager and other staff members, remain on the wards.\u003cstrong> \u003c/strong> After all, many came to California’s state psychiatric facilities because they committed violent crimes. Massey had been sent to Napa after pleading not guilty by reason of insanity after repeatedly stabbing a woman in a Sacramento parking garage. Police investigators said Massey confessed to killing Gross. He pleaded no contest in court and is now serving 25 years to life at Corcoran State Prison.\u003c/p>\n\u003cp>Gross’ murder forced California hospital administrators to respond to increasing pressure from employees who’d long protested perilous conditions at the state’s five psychiatric hospitals. \u003ca href=\"https://www.uapd.com/2010/11/uapd-president-dr-stuart-bussey-speaks-out-on-napa-state-hospital-violence/\" target=\"_blank\">Officials offered\u003c/a> shuttles so Napa employees didn’t have to walk through the grounds, and tightened restrictions on grounds passes.\u003c/p>\n\u003cp>A month before Seager started working at Napa State, the Occupational Safety and Health Administration fined the hospital $100,140 for “serious” and “willful” violations that led to Gross’ death. This time, hospital administrators agreed to deploy security teams to patrol the grounds and lifted a hiring ban.\u003cbr>\nIt wasn’t enough -- not for workers at Napa or the state’s other facilities. Since Gross’ death, employees at California’s five psychiatric hospitals have suffered thousands of assaults a year, resulting in tens of thousands of lost days on the job and costing taxpayers at least $135 million in workers' compensation and overtime.\u003c/p>\n\u003cp>As a new employee, Seager had barely stepped onto his unit when a burly patient batted the slightly built doctor aside like a fly, sending him crashing into a wall. Seager’s head hit with a thwack that split open his scalp. The man then grabbed a heavy wooden chair and smashed it over an older patient’s head. Seager, who’d just turned 61, tried to stanch the blood gushing from the man’s head until paramedics arrived. “I’ve kept up my ER skills as a psychiatrist because I have so many emergency beatings and traumas,” he says.\u003c/p>\n\u003cfigure id=\"attachment_240449\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-240449 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg\" width=\"800\" height=\"732\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-800x732.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-400x366.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-768x703.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-1180x1079.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1-960x878.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/09/seager-photo-1.jpg 1290w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Stephen Seager\u003c/figcaption>\u003c/figure>\n\u003cp>Seager’s colleagues convinced him to go to the county hospital. It took 10 stitches to close his wound. The patient never returned. Seager heard he’d been flown out to a nearby hospital. He found out the patient died only because a colleague’s relative worked at the hospital where he’d been treated.\u003c/p>\n\u003cp>At Napa State, violence was -- and still is -- just part of the routine, as the signs that are posted twice a week reporting assaults on staff indicate. There are steps officials could take to control the violence at California’s state hospitals, Seager says -- steps that would ultimately save taxpayers money. “But the administration and Sacramento don’t seem to care.”\u003c/p>\n\u003cp>\u003cstrong>Safety Measures Fall Short\u003c/strong>\u003c/p>\n\u003cp>Neither the measures taken before Seager’s arrival, nor those taken since, have stopped the bleeding at California’s five psychiatric hospitals. In the years following Gross’ death, workers at Napa, Patton, Metropolitan, Coalinga and Atascadero state hospitals have suffered on average 2,795 assaults a year, costing California taxpayers over $82.7 million in workers’ compensation claims over the past two fiscal years alone, according to data obtained through state public records requests.\u003c/p>\n\u003cp>Patients at the five hospitals committed nearly 26,000 assaults between 2011 and 2014, the latest year for which data are available, according to aggressive incident report records obtained from the Department of State Hospitals, which oversees the facilities.\u003c/p>\n\u003cp>Staff were the victims of 11,000 — more than 42 percent — of those assaults, the records show. Psychiatric technicians, nurses and their colleagues sustained 2,745 assaults at the five facilities in 2014, nearly 150 more than the year before. In the past two fiscal years, 2013-14 and 2014-15, they lost 105,108 days of work, the equivalent of 473 full-time employees.\u003c/p>\n\u003cp>Workers at Napa State alone endured 880 assaults in 2014, up from 866 the previous year. Employees were routinely kicked in the chest, punched in the face, shoved against walls and knocked to the ground, police logs obtained through public records requests show.\u003c/p>\n\u003cp>If you look at the rate of assaults based on the number of staff working at the facilities, it looks like safety has improved. The chances of an employee getting assaulted peaked at 30 percent in 2012, compared with 24 percent in 2014. But those figures are misleading, union reps say. For one thing, paperwork requirements for assaults increased while hospitals were required to report to a federal monitor (which ended in 2013), and it was not uncommon for assaulted staff to suffer in silence rather than fill out more forms.\u003c/p>\n\u003cp>[assaultsHospitals]\u003c/p>\n\u003cp>But perhaps more importantly, not everyone faces the same risks. Although any staff member runs the risk of a beating, says California Association of Psychiatric Technicians representative Coby Pizzotti, psych techs are especially vulnerable because they have the most contact with patients. The state doesn’t release the number of assaults on staff based on job category.\u003c/p>\n\u003cp>With 3,500 psych techs and over 2,700 assaults in a year, Pizzotti says, “It’s not a matter of if you get assaulted, it’s when you’re going to be assaulted and how severe.”\u003c/p>\n\u003cp>The year Gross was killed, staff at Napa State filed 289 workers' comp claims, according to the\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> L\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">os\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Ange\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\">les\u003c/a>\u003ca href=\"http://articles.latimes.com/2011/may/16/local/la-me-hospital-violence-20110516/2\" target=\"_blank\"> Times\u003c/a>. Over the past two fiscal years, that number jumped to 517 and 519, state records show. As the abuse continued, Seager says, staff and administrators acted like daily assaults were all in a day’s work. “It’s horrifying to me that no one does anything about it or even talks about it,” he says. “It’s not mentioned. Ever.”\u003c/p>\n\u003cp>Frustrated by this culture of silence and the state’s unwillingness to address the rampant violence in its hospitals, Seager documented the ongoing beatings in a 2014 book, “Behind the Gates of Gomorrah: A Year with the Criminally Insane.” He wrote the book, he says, because he wanted the public to know that the people they send to state hospitals to get treatment can’t get better in the midst of so much violence. And staff can’t deliver the care they were trained to provide when they’re constantly worried about their safety.\u003c/p>\n\u003cp>Hospital administrators weren’t happy about it, Seager says. But they didn’t fire him.\u003c/p>\n\u003cp>“The safety of our patients and staff has always been among our top priorities,” says Ralph Montano, spokesman for the Department of State Hospitals. Among recent safety improvements, Montano points to a new personal alarm system, which alerts police and reveals an employee’s location, indoors or out, and what he describes as key pieces of legislation signed by Gov. Jerry Brown in 2014.\u003c/p>\n\u003cp>The laws were designed to improve safety by giving clinical staff the right to access a patient’s \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201320140AB1960\" target=\"_blank\">criminal history\u003c/a> for violence risk assessment and allowing medication orders to follow patients judged incompetent to stand trial. Patients can spend months in prison or jail without treatment before reaching the hospital, Seager says, increasing their risk for violent behavior.\u003c/p>\n\u003cp>Another law authorizes hospital officials to build enhanced treatment facilities, where the most dangerous patients receive treatment in secured areas as part of a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140AB1340\" target=\"_blank\">pilot program\u003c/a>. The department reported last year that a quarter of patients had been involved in aggressive incidents but only a fraction of them were considered “repeatedly violent patients.” The hope is that segregating those prone to violence will make the hospitals safer.\u003c/p>\n\u003cp>\u003cstrong>Hospitals Take on More Mentally Ill Patients Charged with Crimes\u003c/strong>\u003c/p>\n\u003cp>Napa State wasn’t always such a violent place. When psych tech Michael Jarschke started working at the hospital in 1972, most patients came to Napa because they couldn’t take care of themselves, not because they’d committed a crime. In those days, he’d sometimes get clobbered by patients beset by fits, but brutal beatings were rare.\u003c/p>\n\u003cp>More patients started coming to California’s state hospitals through the criminal justice system in the mid-1990s, Jarschke says, just before Donna Gross hired on at Napa State.\u003c/p>\n\u003cp>To ease overcrowding in prisons and jails, Napa and other state hospitals took on more mentally ill patients charged with crimes. In 1995, forensic patients, who have been convicted or accused of a felony linked to mental illness, made up 60 percent of patients in state facilities, state records show.\u003c/p>\n\u003cp>Today, 96 percent of the state’s psychiatric patients came through criminal courts -- accounting for 37 percent of the nation’s criminally insane.\u003c/p>\n\u003cp>But staff weren’t trained to deal with “prison-minded” patients, says Jarschke, who served as president of the California Association of Psychiatric Technicians' Napa chapter until May. Over time, he’d see more and more patients with gang affiliations, anti-social personality disorders and, like Jess Massey, predatory tendencies.\u003c/p>\n\u003cp>In the old days, Jarschke invited patients to his house for dinner, to help them feel normal. “That’s not happening here,” he says. “It’s not the same. It’ll never be the same.”\u003c/p>\n\u003cp>Jarschke soon realized the tools he used in a bike repair class could turn deadly in the wrong hands. But he felt strongly that he should keep teaching his patients skills that would boost their self-worth, so he set up a wheelchair repair program, thinking it would help them get a job when they got out. Some of his patients had committed monstrous crimes, but to him, they were people with mental problems, not criminals.\u003c/p>\n\u003cp>Jarschke had just set up a wheelchair repair program when Gross was killed. Even the wheelchair program was too risky, he realized. He shut it down.\u003c/p>\n\u003cp>The day after Gross’ murder, Jarschke and his colleagues formed the Safety Now Coalition to protect both staff and patients.\u003c/p>\n\u003cp>One of the first things they did was push for fully functional personal alarms and more security and clinical staff at the hospital. In 2012, administrators added a police substation within the secured treatment area outside, where Massey had cornered Gross. The following year, department spokesman Montano says, they finished implementing the alarm system.\u003c/p>\n\u003cp>But police aren’t on the wards when fights break out, so it’s up to staff, usually psych techs, to intervene. Most psych techs at California’s state hospitals are women who routinely find themselves trying to restrain men twice their size.\u003c/p>\n\u003cp>The alarms don’t prevent assaults, Seager says. “They simply allow people to get you medical help faster. We’ve had social workers have their teeth kicked in and bones broken. We’ve had head injuries where they’ve never come back.”\u003c/p>\n\u003cp>Workers often showed up for a shift having no idea there had just been a brutal assault. Last year, Seager says, “Someone was strangled and left for dead, and [the administration] never said anything about it.”\u003c/p>\n\u003cp>Safety Now asked administrators if staff at Napa could post a sign when a peer suffers an injury that requires more than local first aid, Jarschke says. The request was granted.\u003c/p>\n\u003cp>\u003cstrong>Subsidizing Violence on the Job\u003c/strong>\u003c/p>\n\u003cp>Lupe Alonzo-Diaz, the Department of State Hospitals deputy director of administrative services, acknowledged the risks staff face before a state oversight agency last year. “The potential to be assaulted is a daily threat for nursing staff,” she told the Little Hoover Commission, an independent agency that monitors and proposes improvements to state government operations.\u003c/p>\n\u003cp>The Department of State Hospitals defines aggressive acts as “hitting, pushing, kicking or similar acts directed against another individual to cause potential or actual injury.”\u003c/p>\n\u003cp>Verbal assault is not included in statistics released by the state, even though studies show that workers can suffer greater psychological effects from \u003ca href=\"http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No1-Jan-2013/Measurement-and-Monitoring-Worker-Aggression-Exposure.html\" target=\"_blank\">threats of violence than from physical aggression\u003c/a>.\u003c/p>\n\u003cp>With so many battered workers unable to do their jobs (they're out on worker's comp due to the assaults), the Department of State Hospitals has asked psych techs and nurses to work more than 4.7 million hours of overtime — at time and a half — since 2012 to meet legal staffing requirements. Overtime hours for psych techs have increased more than a third since 2012, reaching 1.2 million hours last year at a cost of $53 million, Pizzotti testified before the Little Hoover Commission.\u003c/p>\n\u003cp>[overtimeTech]\u003c/p>\n\u003cp>Nearly 150,000 overtime hours were mandatory during the 2014-15 fiscal year, up from 92,000 the previous year, state records show.\u003c/p>\n\u003cp>The union is fighting mandatory overtime, CAPT’s Pizzotti says, because it leaves workers unable to prepare for an extra shift, by going to bed early the night before or arranging day care for their kids. Sometimes employees don’t know until two hours before they’re scheduled to leave that they have to stay on, he says. “That throws your world into complete upheaval.”\u003c/p>\n\u003cp>California banned mandatory overtime for \u003ca href=\"http://www.seiu1000.org/general-information/local-1000-nurses-call-legislature-stop-mandatory-overtime\" target=\"_blank\">nurses in the private sector\u003c/a> in 2001 because it compromises worker and patient safety. Since then, \u003ca href=\"http://jap.sagepub.com/content/21/1/19.full.pdf+html\" target=\"_blank\">overwhelming evidence\u003c/a> has linked long extended shifts to increased risks of clinical mistakes and \u003ca href=\"https://www.jointcommission.org/assets/1/18/SEA_48.pdf\" target=\"_blank\">higher rates of occupational injury.\u003c/a>\u003c/p>\n\u003cp>Fatigued staff faced with the constant threat of assault are ill-prepared to safeguard their patients. Weak and vulnerable psychiatric patients sustained over 3,400 assaults at the hands of their peers in 2014, state records show. Although the numbers dropped nearly a quarter between 2010 and 2013, they jumped by 100 assaults in the following year.\u003c/p>\n\u003cp>Hospital administrators are forced to rely on mandatory overtime or face serious consequences, such as loss of certification, court sanctions and fines, Alonzo-Diaz told the Little Hoover Commission. It’s difficult to hire new staff, she said, because the risks associated with the work, combined with lower wages compared with private hospitals -- as much as $63,000 less for nurses and $15,000 less for psych techs -- make it hard to attract and retain employees.\u003c/p>\n\u003cp>Pizzotti says the state could solve these problems in part by expediting a hiring process that is so drawn out that job seekers find work elsewhere before they hear if they’re in the running.\u003cbr>\nRelief appeared to be on the horizon in August, when the Legislature passed \u003ca href=\"http://www.psychtechs.net/uploads/eng/sb%20780_introduced.pdf\" target=\"_blank\">SB 780\u003c/a>, a bill prohibiting the state from using mandatory overtime as a staffing tool. But the bill was withdrawn after Gov. Jerry Brown signaled his opposition to the measure, Pizzotti says.\u003c/p>\n\u003cp>“We decided not to move the bill onto his desk, knowing that it would be vetoed,” he says. That means union representatives are back to bargaining with administrators to reduce mandatory overtime.\u003c/p>\n\u003cp>\u003cstrong>‘Everybody’s in the wrong place’\u003c/strong>\u003c/p>\n\u003cp>For psychiatrist Seager, improving safety over the long term requires coming to grips with the systemic failures that left state hospitals ill-equipped to deal with violent criminals. Homeless people with acute psychiatric conditions should be treated in state hospitals, he says, while the nonviolent mentally ill now in prisons and jails should be treated in community treatment centers and people convicted of violent crimes should be treated in prisons.\u003c/p>\n\u003cp>Instead, he says, “Every single person in the mental health care system is in the wrong place.”\u003c/p>\n\u003cp>Even so, the state could implement several reforms now. Every hospital should have enhanced treatment units as soon as possible, staff say, to protect workers and vulnerable patients from the subset of patients who commit the majority of assaults.\u003c/p>\n\u003cp>The state authorized funding for the program this year, and administrators expect to open units at Atascadero and Patton in 2018, says department spokesman Montano.\u003c/p>\n\u003cp>It could be several years before an enhanced unit comes to Napa. “That’s an ominous feeling for us,” says psych tech Jarschke.\u003c/p>\n\u003cp>For now, increasing staffing levels would go a long way toward reducing violence on the wards, union rep Pizzotti says. Last year, the Department of Public Health hit Napa with several citations for failing to protect patients, including one who sustained a head injury and another who suffered a broken jaw. According to police reports and sources, that’s almost inevitable when an alarm draws all hands from one unit, only to leave another unattended. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Taxpayers have been spending tens of millions of dollars a year in overtime that leaves workers exhausted, prone to making mistakes and even more vulnerable to injury, Pizzotti says. Last year, 18.4 million taxpayers filed with the California Franchise Tax Board. The money spent on overtime could have hired hundreds of full-time psych techs, he says, greatly reducing the risk of violence while allowing staff to focus on the therapeutic care they were trained to provide. It would have cost the average taxpayer less than the price of a latte at Starbucks.\u003c/p>\n\u003cp>But those positions remain unstaffed. Meanwhile, Seager says, the assaults at Napa grew bloodier and more frequent.\u003c/p>\n\u003cp>Next month marks the sixth anniversary of Donna Gross’ murder. This will be the first year Seager won’t be there to pay his respects. “I finally had enough of Napa,” he says. Seager left in June to freelance as an emergency services psychiatrist for several Bay Area hospitals.\u003c/p>\n\u003cp>“The medical care at Napa is first rate and the staff is terrific,” Seager says. “It’s just not safe.”\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>\u003cem>This article was produced with the support of the California Data Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/240260/at-california-psychiatric-hospitals-epidemic-of-patients-assaults-on-staff-goes-untreated","authors":["6322"],"categories":["stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_2939","stateofhealth_2938","stateofhealth_2969","stateofhealth_2808","stateofhealth_73","stateofhealth_2937","stateofhealth_2519","stateofhealth_2936","stateofhealth_2940","stateofhealth_2735"],"featImg":"stateofhealth_96497","label":"stateofhealth"},"stateofhealth_177403":{"type":"posts","id":"stateofhealth_177403","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"177403","score":null,"sort":[1461789686000]},"guestAuthors":[],"slug":"california-central-valley-clean-water-law-arsenic","title":"Tiny Central Valley Community Tests California's Clean-Water Law","publishDate":1461789686,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Here’s a statistic that, no matter how many times we report about it, still sounds shocking: \u003ca href=\"http://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/documents/dwdocuments/2014/2014_acr_final.pdf\" target=\"_blank\">More than a million Californians \u003c/a>lack access to safe, clean drinking water.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"When the doctor told me that I had high arsenic contamination in my body, I thought, 'If this is happening to me, then this must be happening to everyone.'\"\u003ccite>Reinelda Palma, resident Matheny Tract\u003c/cite>\u003c/aside>\n\u003cp>The crisis is particularly acute in the rural Central Valley, where some communities -- like tiny Matheny Tract outside Tulare -- have struggled with unsafe drinking water.\u003c/p>\n\u003cp>In Matheny Tract, the community's two wells are contaminated with arsenic. Reinelda Palma knows about it firsthand. She drank the tap water until a few years ago, when a doctor told her that she had been exposed to arsenic.\u003c/p>\n\u003cp>\"It was very traumatic when the doctor told me that I had high arsenic contamination in my body,\" she says in Spanish. \"And I thought, if this is happening to me, then this must be happening to everyone, including the children.\"\u003c/p>\n\u003cp>That’s when she became an advocate.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Matheny Tract is not a city or a town. It’s unincorporated, which means it has no elected government, and it’s hard to get services like sidewalks or streetlights. About 1,200 people live here, and almost a third of them live below the federal poverty line. Like Palma, most are Latino.\u003c/p>\n\u003cfigure id=\"attachment_177434\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-177434 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/IMG_0977_0-e1461788970527.jpg\" alt=\"This hydrant, installed over a year ago, is still not hooked up to running water.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">This hydrant, installed over a year ago, is still not hooked up to running water. \u003ccite>(Kerry Klein/KVPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Palma and her neighbor Javier Medina, took me on a tour of the neighborhood. We saw a lot of bright yellow fire hydrants that looked brand-new, but Palma and Medina said they didn't work.\u003c/p>\n\u003cp>That’s because they are waiting to be hooked up to water.\u003c/p>\n\u003cp>Ashley Werner of the nonprofit advocacy group the \u003ca href=\"http://www.leadershipcounsel.org/#!about/cjn9\">Leadership Counsel for Justice and Accountability\u003c/a> says people in unincorporated communities like Matheny Tract have been fighting for clean water for years.\u003c/p>\n\u003cp>\"Effectively in local government, often there’s no elected representatives claiming to have any responsibility to ensure that people have access to clean water,\" she says.\u003c/p>\n\u003cp>In Matheny’s case, getting water from the nearby city of Tulare seemed like an obvious solution. The city is so close, Palma can point to it from her backyard.\u003c/p>\n\u003cp>In 2009, Matheny and Tulare signed a contract to connect their water systems. Roads were dug up and hydrants put in place. But in 2014, the city sued to re-evaluate the contract. Construction stopped.\u003c/p>\n\u003cfigure id=\"attachment_177435\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-177435 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/IMG_1009_0-e1461789066582.jpg\" alt=\"Scars of dark pavement in Matheny Tract's roads remind residents of the water mains that are still not hooked up to water.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Scars of dark pavement in Matheny Tract's roads remind residents of the water mains that are still not hooked up to water. \u003ccite>(Kerry Klein/KVPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"We did not have capacity to serve 300 homes at a turn of the switch, \" says Martin Koczanowicz, Tulare's city attorney. \"We spent over half a million dollars in short-term fixes to our infrastructure, and we had jurisdictional issues which were a barrier.\"\u003c/p>\n\u003cp>But Ashley Werner says the community’s residents -- mostly immigrants, farmworkers, and minorities -- felt discriminated against. With the help of Werner’s group, Matheny countersued.\u003c/p>\n\u003cp>\"It was a lack of responsibility on the part of elected officials to the residents of Matheny Tract,\" says Werner. \"In a sense, by everybody involved, that they had no duty and no commitment to this community.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"3syvmgeeaRwdP3TVOQNBOwaofFQPiC0D\"]Matheny and Tulare remained in a legal stalemate until March of this year, when the state intervened under a new law. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB88\">Senate Bill 88\u003c/a> allows the state to order a city to share its water with communities that need it. Matheny Tract is the law’s first success. By June, Tulare will be forced to share its drinking water.\u003c/p>\n\u003cp>Getting clean water is a huge relief for Javier Medina. He’s a dairy worker, and his family of six has been using bottled water. He’s glad that the state stepped in. But he wishes it hadn’t been necessary.\u003c/p>\n\u003cp>\"We live in the best country in the world and everyone should be looking out for everyone’s well-being,\" says Medina. \"Everyone should try to find a way to help their neighbor.\"\u003c/p>\n\u003cp>Matheny Tract should have safe drinking water soon, but hundreds of California communities still don’t. Maybe some of them are your neighbors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/261171293\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\n","blocks":[],"excerpt":"The two community wells in Matheny Tract were contaminated with arsenic. Advocates turned to new state law to force nearby Tulare to share its clean drinking water. ","status":"publish","parent":0,"modified":1463419006,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":757},"headData":{"title":"Tiny Central Valley Community Tests California's Clean-Water Law | KQED","description":"The two community wells in Matheny Tract were contaminated with arsenic. Advocates turned to new state law to force nearby Tulare to share its clean drinking water. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Tiny Central Valley Community Tests California's Clean-Water Law","datePublished":"2016-04-27T20:41:26.000Z","dateModified":"2016-05-16T17:16:46.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"177403 http://ww2.kqed.org/stateofhealth/?p=177403","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/27/california-central-valley-clean-water-law-arsenic/","disqusTitle":"Tiny Central Valley Community Tests California's Clean-Water Law","nprByline":"Kerry Klein\u003cbr />\u003ca href=\"hhttp://kvpr.org/post/new-state-law-bring-arsenic-free-drinking-water-tulare-county-community\">KVPR\u003c/a>","path":"/stateofhealth/177403/california-central-valley-clean-water-law-arsenic","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Here’s a statistic that, no matter how many times we report about it, still sounds shocking: \u003ca href=\"http://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/documents/dwdocuments/2014/2014_acr_final.pdf\" target=\"_blank\">More than a million Californians \u003c/a>lack access to safe, clean drinking water.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"When the doctor told me that I had high arsenic contamination in my body, I thought, 'If this is happening to me, then this must be happening to everyone.'\"\u003ccite>Reinelda Palma, resident Matheny Tract\u003c/cite>\u003c/aside>\n\u003cp>The crisis is particularly acute in the rural Central Valley, where some communities -- like tiny Matheny Tract outside Tulare -- have struggled with unsafe drinking water.\u003c/p>\n\u003cp>In Matheny Tract, the community's two wells are contaminated with arsenic. Reinelda Palma knows about it firsthand. She drank the tap water until a few years ago, when a doctor told her that she had been exposed to arsenic.\u003c/p>\n\u003cp>\"It was very traumatic when the doctor told me that I had high arsenic contamination in my body,\" she says in Spanish. \"And I thought, if this is happening to me, then this must be happening to everyone, including the children.\"\u003c/p>\n\u003cp>That’s when she became an advocate.\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>Matheny Tract is not a city or a town. It’s unincorporated, which means it has no elected government, and it’s hard to get services like sidewalks or streetlights. About 1,200 people live here, and almost a third of them live below the federal poverty line. Like Palma, most are Latino.\u003c/p>\n\u003cfigure id=\"attachment_177434\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-177434 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/IMG_0977_0-e1461788970527.jpg\" alt=\"This hydrant, installed over a year ago, is still not hooked up to running water.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">This hydrant, installed over a year ago, is still not hooked up to running water. \u003ccite>(Kerry Klein/KVPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Palma and her neighbor Javier Medina, took me on a tour of the neighborhood. We saw a lot of bright yellow fire hydrants that looked brand-new, but Palma and Medina said they didn't work.\u003c/p>\n\u003cp>That’s because they are waiting to be hooked up to water.\u003c/p>\n\u003cp>Ashley Werner of the nonprofit advocacy group the \u003ca href=\"http://www.leadershipcounsel.org/#!about/cjn9\">Leadership Counsel for Justice and Accountability\u003c/a> says people in unincorporated communities like Matheny Tract have been fighting for clean water for years.\u003c/p>\n\u003cp>\"Effectively in local government, often there’s no elected representatives claiming to have any responsibility to ensure that people have access to clean water,\" she says.\u003c/p>\n\u003cp>In Matheny’s case, getting water from the nearby city of Tulare seemed like an obvious solution. The city is so close, Palma can point to it from her backyard.\u003c/p>\n\u003cp>In 2009, Matheny and Tulare signed a contract to connect their water systems. Roads were dug up and hydrants put in place. But in 2014, the city sued to re-evaluate the contract. Construction stopped.\u003c/p>\n\u003cfigure id=\"attachment_177435\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-177435 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/IMG_1009_0-e1461789066582.jpg\" alt=\"Scars of dark pavement in Matheny Tract's roads remind residents of the water mains that are still not hooked up to water.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Scars of dark pavement in Matheny Tract's roads remind residents of the water mains that are still not hooked up to water. \u003ccite>(Kerry Klein/KVPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"We did not have capacity to serve 300 homes at a turn of the switch, \" says Martin Koczanowicz, Tulare's city attorney. \"We spent over half a million dollars in short-term fixes to our infrastructure, and we had jurisdictional issues which were a barrier.\"\u003c/p>\n\u003cp>But Ashley Werner says the community’s residents -- mostly immigrants, farmworkers, and minorities -- felt discriminated against. With the help of Werner’s group, Matheny countersued.\u003c/p>\n\u003cp>\"It was a lack of responsibility on the part of elected officials to the residents of Matheny Tract,\" says Werner. \"In a sense, by everybody involved, that they had no duty and no commitment to this community.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Matheny and Tulare remained in a legal stalemate until March of this year, when the state intervened under a new law. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB88\">Senate Bill 88\u003c/a> allows the state to order a city to share its water with communities that need it. Matheny Tract is the law’s first success. By June, Tulare will be forced to share its drinking water.\u003c/p>\n\u003cp>Getting clean water is a huge relief for Javier Medina. He’s a dairy worker, and his family of six has been using bottled water. He’s glad that the state stepped in. But he wishes it hadn’t been necessary.\u003c/p>\n\u003cp>\"We live in the best country in the world and everyone should be looking out for everyone’s well-being,\" says Medina. \"Everyone should try to find a way to help their neighbor.\"\u003c/p>\n\u003cp>Matheny Tract should have safe drinking water soon, but hundreds of California communities still don’t. Maybe some of them are your neighbors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/261171293&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/261171293'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/177403/california-central-valley-clean-water-law-arsenic","authors":["byline_stateofhealth_177403"],"categories":["stateofhealth_14","stateofhealth_2746"],"tags":["stateofhealth_20","stateofhealth_2519","stateofhealth_461","stateofhealth_2735","stateofhealth_2610"],"featImg":"stateofhealth_177436","label":"stateofhealth"},"stateofhealth_171833":{"type":"posts","id":"stateofhealth_171833","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"171833","score":null,"sort":[1460483288000]},"guestAuthors":[],"slug":"bill-requiring-disciplined-physicians-to-notify-patients-advances-in-sacramento","title":"Bill Requiring Disciplined Physicians to Notify Patients Advances in Sacramento","publishDate":1460483288,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Doctors who are on probation after being disciplined by state regulators would have to share that information with patients before providing care under a bill making its way through the state Senate.\u003c/p>\n\u003cp>The measure, which would apply to physicians, podiatrists, acupuncturists and chiropractors, was passed by the Senate Business, Professions and Economic Development Committee this week.\u003c/p>\n\u003cp>About 600 of the 137,000 licensed physicians in California are on probation for serious offenses, including sexual misconduct involving patients or treatment and prescription errors that harmed patients.\u003c/p>\n\u003cp>The Medical Board of California in November voted down \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\">a similar proposal\u003c/a> that would have required doctors on probation to tell their patients verbally and in writing, saying it was too onerous and unnecessary because the information is posted on the board’s website.\u003c/p>\n\u003cp>In California, physicians on probation are already required to report the disciplinary status to their malpractice insurers and hospitals where they work, yet there is no rule requiring proactive notifications of patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Doctors on probation are not necessarily admitting they violated ethics rules. Some do it to avoid lengthy and costly legal battles.\u003c/p>\n\u003cp>While on probation, they may be temporarily barred from performing specific procedures or prescribing certain medicines. They might have to take classes or be supervised. In some cases it means a physician disciplined for sexual misconduct must be chaperoned in the exam room.\u003c/p>\n\u003cp>Patient advocate Tina Minasian, of Roseville, Calif., said such a law would have prevented her much pain and misery.\u003c/p>\n\u003cp>“Nearly 14 years after my botched surgery, I still suffer from the lingering effects with excruciating pain, spitting sutures, gaping holes, disfigurement and a mutilated body,” she said in written testimony to the committee. “I will be forever reminded of the harm this doctor caused me and how the Medical Board of California allowed him to destroy my body, my self-confidence and my womanhood. I know many patients who were victims of this same physician while he was on probation, in fact, some have died.”\u003c/p>\n\u003cp>Minasian, who works as an advocate with Consumer’s Union California Safe Patient Project, told the committee that, unbeknownst to her, Brian West, operated on her while on probation for alcohol abuse. She said his license was revoked seven years after her surgery.\u003c/p>\n\u003cp>The California Medical Association, which opposes the bill, said requiring doctors to inform patients directly would take up valuable time in which care could be provided, in a letter filed with the committee.\u003c/p>\n\u003cp>But advocacy groups like Consumers Union and Consumer Watchdog say it’s important for doctors to tell patients about their disciplinary status so patients can make informed choices about their own care.\u003c/p>\n\u003cp>“This is the kind of information every patient deserves to know about their doctor before they receive medical care,” Consumer Watchdog wrote in a letter to the committee. “The patients of these doctors deserve to be notified proactively.”\u003c/p>\n\u003cp>The bill needs to be passed by the appropriations committee and then by the full state Senate by June 3 in order to proceed to the Assembly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Doctors on probation are currently required to tell malpractice insurers and hospitals but not patients.","status":"publish","parent":0,"modified":1460493935,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":528},"headData":{"title":"Bill Requiring Disciplined Physicians to Notify Patients Advances in Sacramento | KQED","description":"Doctors on probation are currently required to tell malpractice insurers and hospitals but not patients.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Bill Requiring Disciplined Physicians to Notify Patients Advances in Sacramento","datePublished":"2016-04-12T17:48:08.000Z","dateModified":"2016-04-12T20:45:35.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"171833 http://ww2.kqed.org/stateofhealth/?p=171833","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/12/bill-requiring-disciplined-physicians-to-notify-patients-advances-in-sacramento/","disqusTitle":"Bill Requiring Disciplined Physicians to Notify Patients Advances in Sacramento","path":"/stateofhealth/171833/bill-requiring-disciplined-physicians-to-notify-patients-advances-in-sacramento","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Doctors who are on probation after being disciplined by state regulators would have to share that information with patients before providing care under a bill making its way through the state Senate.\u003c/p>\n\u003cp>The measure, which would apply to physicians, podiatrists, acupuncturists and chiropractors, was passed by the Senate Business, Professions and Economic Development Committee this week.\u003c/p>\n\u003cp>About 600 of the 137,000 licensed physicians in California are on probation for serious offenses, including sexual misconduct involving patients or treatment and prescription errors that harmed patients.\u003c/p>\n\u003cp>The Medical Board of California in November voted down \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\">a similar proposal\u003c/a> that would have required doctors on probation to tell their patients verbally and in writing, saying it was too onerous and unnecessary because the information is posted on the board’s website.\u003c/p>\n\u003cp>In California, physicians on probation are already required to report the disciplinary status to their malpractice insurers and hospitals where they work, yet there is no rule requiring proactive notifications of patients.\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>Doctors on probation are not necessarily admitting they violated ethics rules. Some do it to avoid lengthy and costly legal battles.\u003c/p>\n\u003cp>While on probation, they may be temporarily barred from performing specific procedures or prescribing certain medicines. They might have to take classes or be supervised. In some cases it means a physician disciplined for sexual misconduct must be chaperoned in the exam room.\u003c/p>\n\u003cp>Patient advocate Tina Minasian, of Roseville, Calif., said such a law would have prevented her much pain and misery.\u003c/p>\n\u003cp>“Nearly 14 years after my botched surgery, I still suffer from the lingering effects with excruciating pain, spitting sutures, gaping holes, disfigurement and a mutilated body,” she said in written testimony to the committee. “I will be forever reminded of the harm this doctor caused me and how the Medical Board of California allowed him to destroy my body, my self-confidence and my womanhood. I know many patients who were victims of this same physician while he was on probation, in fact, some have died.”\u003c/p>\n\u003cp>Minasian, who works as an advocate with Consumer’s Union California Safe Patient Project, told the committee that, unbeknownst to her, Brian West, operated on her while on probation for alcohol abuse. She said his license was revoked seven years after her surgery.\u003c/p>\n\u003cp>The California Medical Association, which opposes the bill, said requiring doctors to inform patients directly would take up valuable time in which care could be provided, in a letter filed with the committee.\u003c/p>\n\u003cp>But advocacy groups like Consumers Union and Consumer Watchdog say it’s important for doctors to tell patients about their disciplinary status so patients can make informed choices about their own care.\u003c/p>\n\u003cp>“This is the kind of information every patient deserves to know about their doctor before they receive medical care,” Consumer Watchdog wrote in a letter to the committee. “The patients of these doctors deserve to be notified proactively.”\u003c/p>\n\u003cp>The bill needs to be passed by the appropriations committee and then by the full state Senate by June 3 in order to proceed to the Assembly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/171833/bill-requiring-disciplined-physicians-to-notify-patients-advances-in-sacramento","authors":["11105"],"categories":["stateofhealth_14"],"tags":["stateofhealth_562","stateofhealth_2721","stateofhealth_2519","stateofhealth_2735"],"featImg":"stateofhealth_171834","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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