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LA’s First Heat Officer Says Helping Vulnerable Communities Is Key to Achieving Climate Goals

Kaiser Health News - 5 hours 43 min ago

As a child growing up in San Jose, California, Marta Segura heard horrific stories from her parents about women fainting on the factory lines and men overheating in the farm fields. They didn’t know those jobs exposed them to life-threatening conditions.

Then, it hit home.

“My dad, himself, got really sick one time and almost died,” said Segura, 58, the daughter of a bracero and a cannery worker. “That resonated with me as a kid.”

Segura, who serves as director of Los Angeles’ Climate Emergency Mobilization Office in the Department of Public Works, was given a second title this month: chief heat officer, the city’s first. She joins a number of heat officers around the world as cities from Athens, Greece, to Santiago, Chile, begin to coordinate a better response to extreme heat and develop sustainable cooling strategies. Phoenix and Miami are the only other U.S. cities with heat officers.

As Los Angeles continues to experience more frequent heat waves, Segura will work across city departments to help create an early-warning system for heat waves and develop long-term strategies to reduce heat exposure, such as planting trees and updating building codes. Her office will also launch a social media campaign in July in English and Spanish.

Extreme weather can cause cramps, stroke, and heat exhaustion. Extreme heat contributed to the deaths of around 12,000 people in the U.S. each year from 2010 to 2020, according to a study by the University of Washington. Those figures are likely to rise.

Low-income, majority-minority neighborhoods experience significantly more heat than wealthier, whiter neighborhoods, according to researchers from the University of California-San Diego’s School of Global Policy and Strategy. The research shows that surface temperatures in communities with higher rates of poverty can be up to 7 degrees Fahrenheit warmer, compared with the richest neighborhoods, during summer.

“Neighborhoods in South Los Angeles send an additional 20 to 30 people to the emergency room on heat days compared to 2 additional people from wealthier neighborhoods,” said Dr. David Eisenman, director of the Center for Public Health and Disasters at UCLA. Eisenman will work with Segura to identify climate-vulnerable communities.

Segura, 58, takes her new job as state lawmakers consider expanding heat warnings. Assembly Bill 2076 would establish California’s first chief heat officer position and create a statewide extreme-heat and community resilience program. Assembly Bill 2238 would create the nation’s first warning system for heat waves, just as existing systems warn of other natural disasters such as wildfires, tornadoes, and hurricanes.

KHN reporter Heidi de Marco met with Segura in her City Hall office to discuss her new role and how she plans to tackle the city’s climate risk. The interview has been edited for length and clarity.

Q: Why was this position created?

We’ve noticed a fivefold increase in extreme heat events and heat waves. There are more heat-related illnesses and more hospitalizations and deaths.

There are two goals. The first is changes to the system — the services and the infrastructure of the city. The other is education and awareness — that people know that extreme heat is more serious so they can take steps to protect themselves.

We’re tackling education with an extreme-heat campaign that will launch July 1. In terms of changing the system and services, the city is painting the roofs and roads with white, cool[ing] paint, planting more trees for maximum shade in vulnerable communities.

Q: You will be working to reduce heat-related hospitalizations and deaths, as well as working with different city agencies to implement a heat action plan. How will that work?

We’re already discussing updating our building codes for decarbonization and climate adaptation.

The other approach is through public works. For example, installing more shade structures, more kiosks, especially for metro and bus transportation furniture. They’re also installing more hydration stations.

So when you add that to our public facilities — parks, libraries, youth centers, which are all accessible during the day — you have a lot of opportunities to tell people where to go in the event of a heat storm or heat wave.

Q: How do you plan to address inequality?

It keeps me up at night. Addressing the most vulnerable community isn’t out of charity. And it isn’t because of moral reasons. It’s because if we don’t help the most vulnerable communities of Los Angeles, which are over 50% of the population, we’re not going to get to our climate solutions.

Landlords are less likely to invest in heat pumps or other air conditioning systems because that would only raise the rent and the rent would displace individuals. So we need a policy in the city of L.A. that prevents displacement and helps in some ways to subsidize those low-income housing units or find financing structures that allow landlords to be able to invest and keep our families healthy and safe.

Q: Is there a particular challenge in messaging to immigrant communities?

I think what I learned in my family is we tend to have the radio on as we go about our work. So it’s going to be important to use radio. It’s also going to be important to use text messaging services, like WhatsApp.

We want to make sure to get this information out to employers, so we probably need to come up with culturally relevant communications. It’s an evolving campaign.

Q: What kind of budget are you working with?

We will be allocating approximately 30% of our budget to heat-risk prevention work, and although our budget is not large, our impact on other partner departments, such as public works and the emergency management department, is significant.

We can’t look at my budget in a silo since the council has directed us to work collaboratively to combine the respective parts of our budgets for heat-risk prevention. However, I can say that my office will be doubling in size, from four to eight [employees], and this will give us the leverage and resources we need to make the kind of impact the city of L.A. seeks to make in the long run.

Q: How do you plan to address the homeless community?

What we actually would like to have are more pop-up units, where we have canopies and hydration.

So that’s a conversation I’m having with our deputy mayor of homelessness and housing so that we can coordinate together. And that’s a good example of something that my office can’t do alone because I need their expertise and their allocated resources to ensure that we’re providing the best available comprehensive resources for the city.

Q: You are the first Latina to hold such a position in the United States. How does that feel?

It’s significant because [Latinos] have been suffering disproportionately from climate hazards for a very long time, and we haven’t had positions like this in the past. If they see someone from their community, or that looks like they’re from their community, that speaks their language, that culturally relates to them, that has had similar experiences, I think it makes a big difference, right?

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

Big Employers Are Offering Abortion Benefits. Will the Information Stay Safe?

Kaiser Health News - 5 hours 43 min ago

In response to the Supreme Court’s overturning of Americans’ constitutional right to abortion, large employers thought they had found a way to help workers living in states where abortions would be banned: provide benefits to support travel to other states for services. But that solution is only triggering questions.

Experts warn that simply claiming the benefits may create paper trails for law enforcement officials in states criminalizing abortion.

“How will law enforcement react to health-related travel, and how will employers respond to that?” are just two of the questions that lawyers are asking themselves, said Lucia Savage, a former Obama administration official and the current chief privacy officer for Omada Health, a California startup that helps people manage chronic conditions, like hypertension and prediabetes.

Some regulations — like the Health Insurance Portability and Accountability Act, which governs health privacy; and other insurance laws — protect some parts of a patient’s private life. Human resources departments are required to keep some medical data closely held, but a determined law enforcement agent with a search warrant or subpoena could ultimately get access to patient data.

That will complicate life for the dozens of corporations promising to protect, or even expand, the abortion benefits for employees and their dependents.

A KHN review of publicly available statements identified at least 114 companies that had pledged to maintain abortion benefits or to expand benefits by offering paid time off or reimbursements for travel and lodging expenses so employees or dependents can obtain an abortion. They include some of the biggest, most prominent corporations in the U.S. For example, 54 of the companies — including Starbucks, Bank of America, and California-based Disney and Apple — are in the Fortune 500.

But some companies were reticent to describe what steps they’re taking to protect employees’ privacy. Only 28 firms replied to KHN inquiries about their confidentiality policies. Most declined to comment. “We don’t have anything to share beyond our statement,” said Erin Rolfes, a spokesperson for Kroger, which has supermarkets in 35 states. Microsoft spokesperson Amanda Devlin also declined to share information about how employees would claim reimbursements.

Others were slightly more specific about how their benefits would be administered. Ulta Beauty spokesperson Eileen Ziesemer said the Illinois-based company’s abortion benefits would be managed by its “health care plan and internal systems.”

Asked whether those internal systems would be vulnerable to a subpoena or search warrant, she said, “Given that each state will be implementing the Supreme Court’s decision to overturn Roe v. Wade and state-by-state laws are rapidly evolving, we are unable to comment on potential impacts at this time.”

Observers agreed that how companies will deal with the privacy implications of extending abortion benefits is uncertain.

“They’re all trying to build this bicycle while they’re riding it,” said Shelley Alpern, director of corporate engagement at Rhia Ventures, a nonprofit investor in reproductive and maternal health companies.

Employers are “going to try and take a punt on privacy,” predicted Owen Tripp, CEO of San Francisco-based Included Health, a startup that offers navigation services and virtual care for employers. Many companies clearly intend to expand benefits. “But how you do it is less clear,” he said. “Getting murkier every minute.”

Some employers will probably retain companies like Tripp’s to manage the benefits for them. Match, the dating conglomerate, has partnered with Planned Parenthood Los Angeles, and all arrangements and information will be routed through that group. Some startups are broadening their offerings: California-based Carrot Fertility, a company that offers fertility care services, will aid its employer clients that want to expand access to abortion, wrote CEO Tammy Sun.

That should solve some privacy problems, Tripp said. His company administers travel and paid time off for a range of procedures such as bariatric surgery and cancer treatment. A patient can claim those benefits through Tripp’s company, so the employer sees only aggregated information about the amounts paid for patients seeking care. That helps protect information from co-workers.

Still, there are several open questions, said Savage. Among them: How will an employee plan respond to requests from law enforcement? Will the U.S. Department of Health and Human Services’ Office for Civil Rights, which administers health privacy regulations, narrow the circumstances in which law enforcement can request data?

Currently, investigators can get access with a warrant or subpoena and in certain emergencies.

In practice, the uncertainty may dissuade pregnant patients from claiming the benefit, said Larry Levitt, executive vice president for health policy at KFF. “There is no doubt that people being concerned about disclosing an abortion to their employers will limit how often this benefit will be used, even when it’s available,” he said.

That was the case even while Roe was the law of the land, when patients often elected to pay out-of-pocket, rather than rely on their insurance. “The employers offering these abortion benefits are by definition supportive of reproductive rights, but that doesn’t mean employees wouldn’t still want privacy when they or a family member are having an abortion,” Levitt said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

How Much Health Insurers Pay for Almost Everything Is About to Go Public

Kaiser Health News - 5 hours 43 min ago

Consumers, employers, and just about everyone else interested in health care prices will soon get an unprecedented look at what insurers pay for care, perhaps helping answer a question that has long dogged those who buy insurance: Are we getting the best deal we can?

As of July 1, health insurers and self-insured employers must post on websites just about every price they’ve negotiated with providers for health care services, item by item. About the only thing excluded are the prices paid for prescription drugs, except those administered in hospitals or doctors’ offices.

The federally required data release could affect future prices or even how employers contract for health care. Many will see for the first time how well their insurers are doing compared with others.

The new rules are far broader than those that went into effect last year requiring hospitals to post their negotiated rates for the public to see. Now insurers must post the amounts paid for “every physician in network, every hospital, every surgery center, every nursing facility,” said Jeffrey Leibach, a partner at the consulting firm Guidehouse.

“When you start doing the math, you’re talking trillions of records,” he said. The fines the federal government could impose for noncompliance are also heftier than the penalties that hospitals face.

Federal officials learned from the hospital experience and gave insurers more direction on what was expected, said Leibach. Insurers or self-insured employers could be fined as much as $100 a day for each violation, for each affected enrollee if they fail to provide the data.

“Get your calculator out: All of a sudden you are in the millions pretty fast,” Leibach said.

Determined consumers, especially those with high-deductible health plans, may try to dig in right away and use the data to try comparing what they will have to pay at different hospitals, clinics, or doctor offices for specific services.

But each database’s enormous size may mean that most people “will find it very hard to use the data in a nuanced way,” said Katherine Baicker, dean of the University of Chicago Harris School of Public Policy.

At least at first.

Entrepreneurs are expected to quickly translate the information into more user-friendly formats so it can be incorporated into new or existing services that estimate costs for patients. And starting Jan. 1, the rules require insurers to provide online tools that will help people get upfront cost estimates for about 500 so-called “shoppable” services, meaning medical care they can schedule ahead of time.

Once those things happen, “you’ll at least have the options in front of you,” said Chris Severn, CEO of Turquoise Health, an online company that has posted price information made available under the rules for hospitals, although many hospitals have yet to comply.

With the addition of the insurers’ data, sites like his will be able to drill down further into cost variation from one place to another or among insurers.

“If you’re going to get an X-ray, you will be able to see that you can do it for $250 at this hospital, $75 at the imaging center down the road, or your specialist can do it in office for $25,” he said.

Everyone will know everyone else’s business: for example, how much insurers Aetna and Humana pay the same surgery center for a knee replacement.

The requirements stem from the Affordable Care Act and a 2019 executive order by then-President Donald Trump.

“These plans are supposed to be acting on behalf of employers in negotiating good rates, and the little insight we have on that shows it has not happened,” said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health, an affiliation of employers who offer job-based health benefits to workers. “I do believe the dynamics are going to change.”

Other observers are more circumspect.

“Maybe at best this will reduce the wide variance of prices out there,” said Zack Cooper, director of health policy at the Yale University Institution for Social and Policy Studies. “But it won’t be unleashing a consumer revolution.”

Still, the biggest value of the July data release may well be to shed light on how successful insurers have been at negotiating prices. It comes on the heels of research that has shown tremendous variation in what is paid for health care. A recent study by the Rand Corp., for example, shows that employers that offer job-based insurance plans paid, on average, 224% more than Medicare for the same services.

Tens of thousands of employers who buy insurance coverage for their workers will get this more-complete pricing picture — and may not like what they see.

“What we’re learning from the hospital data is that insurers are really bad at negotiating,” said Gerard Anderson, a professor in the department of health policy at the Johns Hopkins Bloomberg School of Public Health, citing research that found that negotiated rates for hospital care can be higher than what the facilities accept from patients who are not using insurance and are paying cash.

That could add to the frustration that Mitchell and others say employers have with the current health insurance system. More might try to contract with providers directly, only using insurance companies for claims processing.

Other employers may bring their insurers back to the bargaining table.

“For the first time, an employer will be able to go to an insurance company and say, ‘You have not negotiated a good-enough deal, and we know that because we can see the same provider has negotiated a better deal with another company,’” said James Gelfand, president of the ERISA Industry Committee, a trade group of self-insured employers.

If that happens, he added, “patients will be able to save money.”

That’s not necessarily a given, however.

Because this kind of public release of pricing data hasn’t been tried widely in health care before, how it will affect future spending remains uncertain. If insurers are pushed back to the bargaining table or providers see where they stand relative to their peers, prices could drop. However, some providers could raise their prices if they see they are charging less than their peers.

“Downward pressure may not be a given,” said Kelley Schultz, vice president of commercial policy for AHIP, the industry’s trade lobby.

Baicker, of the University of Chicago, said that even after the data is out, rates will continue to be heavily influenced by local conditions, such as the size of an insurer or employer — providers often give bigger discounts, for example, to the insurers or self-insured employers that can send them the most patients. The number of hospitals in a region also matters — if an area has only one, for instance, that usually means the facility can demand higher rates.

Another unknown: Will insurers meet the deadline and provide usable data?

Schultz, at AHIP, said the industry is well on the way, partly because the original deadline was extended by six months. She expects insurers to do better than the hospital industry. “We saw a lot of hospitals that just decided not to post files or make them difficult to find,” she said.

So far, more than 300 noncompliant hospitals received warning letters from the government. But they could face $300-a-day fines for failing to comply, which is less than what insurers potentially face, although the federal government has recently upped the ante to up to $5,500 a day for the largest facilities.

Even after the pricing data is public, “I don’t think things will change overnight,” said Leibach. “Patients are still going to make care decisions based on their doctors and referrals, a lot of reasons other than price.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

How to Get Rid of Medical Debt — Or Avoid It in the First Place

Kaiser Health News - 5 hours 43 min ago

Lori Mangum was 32 when apple-size tumors sprouted on her head. Now — six years and 10 surgeries later — the skin cancer is gone. But her pain lives on, in the form of medical debt.

Even with insurance, Mangum paid $36,000 out-of-pocket, charges that stemmed from the hospital, the surgeon, the anesthesiologist, the pharmacy, and follow-up care. And she still has about $7,000 more to pay.

While she was trying to manage her treatment and medical costs, Mangum remembers thinking, “I should be able to figure this out. I should be able to do this for myself.”

But medical billing and health insurance systems in the U.S. are complex, and many patients have difficulty navigating them.

“It’s incredibly humbling — and sometimes even to the point of humiliating — to feel like you have no idea what to do,” Mangum said.

If you’re worried about incurring debt during a health crisis or are struggling to deal with bills you already have, you’re not alone. Some 100 million people — including 41% of U.S. adults — have health care debt, according to a recent survey by KFF.

But you can inform and protect yourself. KHN and NPR spoke with patients, consumer advocates, and researchers to glean their hard-won insights on how to avoid or manage medical debt.

“It shouldn’t be on the patients who are experiencing the medical issues to navigate this complicated system,” said Nicolas Cordova, a health care lawyer with the New Mexico Center on Law and Poverty. But consumers who inform themselves have a better chance of avoiding debt traps.

That means knowing the ins and outs of various policies — whether it’s your insurance coverage, or a hospital’s financial assistance program, or a state’s consumer protection laws. Ask a lot of questions and persist. “Don’t take ‘no’ for an answer,” said Cordova, “because sometimes you might get a ‘yes.’”

Even people with health insurance can land in debt; indeed, one of the biggest problems, consumer advocates said, is that so many people are underinsured, which means they can get hit with huge out-of-pocket costs from coinsurance and high deductibles.

Here is some practical advice about facing down medical debt, at every stage of care and after.

Before You Get Care

Get familiar with your insurance coverage and out-of-pocket costs. Get the best insurance coverage you can afford — even when you’re healthy. Make sure you know what the copays, coinsurance, and deductibles will be. Don’t hesitate to call the insurer and ask someone to walk you through all the potential out-of-pocket costs. Keep in mind that you cannot make changes to your policy except during certain windows of time, such as open enrollment (typically in the fall or early winter) or after a major life event.

Sign up for public insurance if you qualify. If you’re uninsured but need health care, you might qualify for public insurance like Medicaid or Medicare. Ask the provider or hospital if they can help you check your eligibility before you commit to a care plan — and then stay with providers who participate in those programs.

Check whether the specifics of your care are covered. After your doctors map out your treatment plan, check whether all the providers you need to see are in-network and whether any part of the treatment needs to be preauthorized. Ask lots of questions of your insurance provider, doctor’s office, or hospital, especially for planned procedures, said Joy Dockter, a lawyer at Central California Legal Services, a public interest law firm. “‘Are my authorizations in place? What are my copays going to be?’ Find all that out beforehand, if you can,” she said.

Additionally, said Mark Rukavina, a program director at health equity advocacy group Community Catalyst, if the drug you want isn’t covered by your insurance, ask whether the drugmaker has a patient assistance program; many do, though eligibility requirements vary.

Get a cost estimate. If you’re uninsured, ask for a cost estimate in advance. Rukavina noted that the federal No Surprises Act, which took effect in January, requires providers to give uninsured patients “good faith” estimates of what planned care will cost.

Find out whether you’re eligible for financial assistance — and come prepared to make your case. Almost every hospital offers some form of financial assistance, or “charity care.” Each hospital sets its own eligibility requirements but typically will waive or discount bills for patients earning less than two to three times the federal poverty level. (Three times the federal poverty level for a household of four in 2022 would be $83,250.)

People who are employed often still qualify for a discount, if not for free care, said Jared Walker, founder of Dollar For, a nonprofit group that helps patients secure charity care. His group developed a database of hospital charity care policies and has an online tool that allows patients to check their eligibility.

Even if you’re not sure whether you qualify, it’s worth trying. Gather up documents such as pay stubs or income tax returns. Do not expect this to be an easy process. For example, Walker said, health care providers often require documentation to be faxed. “One of the most common refrains I heard from experts: Persistence pays,” Walker said.

If you’ve already qualified for government benefits like the Supplemental Nutrition Assistance Program, or SNAP, that may streamline applying for a hospital’s financial aid.

If you’re not a U.S. citizen or legal resident, check whether your state bars the hospital from considering immigration status, as is the case in New Mexico and Maryland.

Check for other forms of financial assistance. Ambulance services, which can lead to huge bills, might offer charity care programs, so ask whether you qualify. Also ask your medical providers if they know of other charitable programs that would cover costs for things like rides to medical appointments.

During Treatment or Soon After

Ask for line items of the costs for every service, prescription, or treatment you receive. Keep an eye on costs as they come up, said Louisville cancer patient Lori Mangum, who is now chief operating officer of Gilda’s Club Kentuckiana, a cancer support group she relied on. Ask a family member or a support group to help you keep track, she said. And never assume that just because insurance covers one part of your treatment, that goes for everything else.

Scrutinizing your care can help you avoid costs. Mangum said she realized too late that she could’ve taken her own Tylenol, instead of paying “exorbitant” markups on the same medicine at the hospital. She said self-advocacy begins with pressing for answers about how much each service, treatment, and medication will cost — in advance, if possible.

Check whether providers are in-network. Consumer protections in the No Surprises Act should help limit out-of-network charges. That law bans “surprise” billing for most emergency care, as well as for some routine care with out-of-network providers. It also limits what providers can bill for out-of-network doctors, Rukavina said, and gives patients greater ability to dispute charges.

Make sure all your providers — including an anesthesiologist, for example — are in-network for your insurance. If it wasn’t disclosed to you in advance, that charge may be worth appealing.

Rukavina noted that if you are not insured or not using your insurance and asked for an estimate in advance, you can dispute bills that exceed the estimates by $400. For patients seeking more information about the No Surprises Act and what it covers, Rukavina recommended calling the government’s No Surprises Help Desk at 1-800-985-3059. For patients with complaints, he recommended filing an online complaint with the Consumer Financial Protection Bureau.

Check for double billing. Go through each item on your bill. Mangum said that “it’s not infrequent for something to be double-billed.” Even if you’ve already been discharged and gotten behind on payments, it is worth checking to make sure you weren’t overcharged.

Negotiate with the hospital directly. Consumer advocates said people mistakenly think medical costs are fixed and nonnegotiable. That was the case for John DeAnda, who fainted while working as a cleaner at a New Mexico hospital. Doctors couldn’t figure out what was wrong with him after four days of tests, but the hospital billed him for $8,000, which he’s still trying to pay off, with interest, nine years later.

“I actually didn’t realize you could negotiate,” said DeAnda. “What I would’ve done differently is I would’ve talked to the hospital first, to see if they could work out a deal with me” before the bills were sent to collections.

If you know you cannot pay the bill, negotiate with the hospital administration or billing department. “That’s almost always possible” because hospitals want to avoid the costly administrative burden of sending bills to collections, said Ge Bai, a professor of accounting and health care policy at Johns Hopkins University.

Ask repeatedly about any other forms of financial assistance the hospital might offer. Negotiate the terms of payment to a monthly level that is affordable for you. This also saves the hospital the administrative headaches of unpaid bills, and it might help you avoid having bills sent to collections.

Prioritize paying for food and shelter over medical bills. Financial institutions and lenders treat medical debt differently than unpaid consumer bills. People choose to take a loan to buy a car; they don’t choose to get ill or injured. So just because people have medical debt does not mean they are unreliable or less likely to pay their bills in general. The three major credit-rating agencies recently agreed that unpaid medical bills will not affect people’s credit scores for a year. Once a bill is paid, it should come off your credit report immediately. Starting in 2023, unpaid medical debt under $500 should not appear on reports either.

That means you should focus first on paying for life necessities — rent or mortgage, gas to get to work, and food, said Marceline White, executive director of the Maryland Consumer Rights Coalition.

Do not sign up for credit cards that offer to pay medical bills for you. Experts warn against using credit cards offered by dentists, hospitals, and doctors’ offices to pay medical charges. Once you take out credit cards, personal loans, or second mortgages, the debt will get lumped in with any other form of consumer debt — the same as if you overspent on clothes or a luxury SUV. That’s one reason medical debt is often underreported; a lot of it masquerades as other forms of debt. Once you convert a medical bill to a credit card or personal loan, it’s more likely to hurt your credit score and therefore your ability to borrow in the future.

If You Are Already in Debt or in Collections

Try to qualify, even after the fact, for charity care. Hospitals sometimes overlook or fail to screen patients eligible for their financial assistance programs. Nonprofit hospitals are required by law to offer charity care and other community benefits. This is where self-advocacy can make the biggest difference. Sometimes hospitals will retroactively qualify patients and write off their debts. Volunteers at Dollar For will help patients push for that.

Dispute your bill if it is inaccurate. Rukavina said that under the Fair Debt Collection Practices Act, debt collectors are required to provide a written notice, within five days of contacting a patient, detailing the amount owed, the name of the creditor, and how to dispute the bill. Patients can dispute inaccurate bills if they respond within 30 days. Rukavina said even patients whose bills are in collections can tell bill collectors they wish to apply for financial assistance if they haven’t already. If the patient qualifies, the collector cannot charge more than what the patient would’ve had to pay.

Contact free legal aid services. Lawyers around the country will represent consumers free of charge to resolve legal cases, including medical debt cases. They often have experience dealing with hospitals and third-party collections companies and might be able to argue your case on your behalf, especially if one or both have violated your state’s consumer protection laws.

Do not ignore the issue. The impulse is understandable, but it will not help and will likely make the debt even more complicated to address, said Rukavina. As daunting as it might be, try to keep advocating for yourself and your family and get help.

About This Project

“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on the “KFF Health Care Debt Survey,” a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

KHN’s ‘What the Health?’: A World Without ‘Roe’

Kaiser Health News - Thu, 06/30/2022 - 3:25pm

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It’s been less than a week since the Supreme Court struck down the constitutional right to abortion and each passing day has produced more questions than answers. Doctors, employers, lawmakers, district attorneys, and women are all confused about what is allowed and when. And things won’t be sorted out for some time, it appears.

Meanwhile, Congress passed and President Joe Biden signed a gun bill that’s likely to do more on the mental health front than it is to curb mass shooting incidents. But if it curbs gun suicides, that would be a big step forward for public health.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Sarah Karlin-Smith of the Pink Sheet, and Victoria Knight of KHN.

Among the takeaways from this week’s episode:

  • As the country grapples with the repercussions of the Supreme Court’s decision last week, conservative states are moving quickly to outlaw abortion. Ambiguities in many state laws have slowed down the march, but about 21 to 26 states seem likely to largely or totally ban abortion within weeks or months.
  • Even in the states that don’t move quickly to make the details of the restrictions firm, many providers who perform abortions are concerned about their liability and have closed up shop.
  • The Biden administration has offered tough talk about the need to keep access to abortion care, but officials have not provided specifics about what the federal government can do to help residents in states with bans.
  • Some progressive Democrats are calling for the federal government to allow abortions on federal property in those states, but that would likely conflict with long-standing prohibitions on federal funding for most abortions — common in many spending laws.
  • Some key leaders of the anti-abortion movement, including former Vice President Mike Pence, are pushing to continue their campaign, including promoting a measure to make it illegal nationwide. That risks a strong backlash since nearly two-thirds of Americans say in polling that they support the right to abortion in some form.
  • Abortion rights supporters are looking to medication that can end a pregnancy early on as a strategy to help women in states banning abortion. But many of those states are trying to outlaw the use of those pills, and the conflict will likely end up in court.
  • The FDA on Thursday endorsed a recommendation from an advisory panel that the covid vaccine be reconfigured this fall to include protection against the original virus and new strains of the omicron variant. That will mean the vaccine will be offered without clinical trials in humans.
  • The FDA announcement did not say who would be the target audience for the new vaccine. That will be determined by the Centers for Disease Control and Prevention.

Also this week, Rovner interviews KHN’s Angela Hart, who reported and wrote the latest KHN-NPR “Bill of the Month” about identical eye surgeries that came with two very different bills. If you have an enormous or outrageous medical bill you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Washington Post’s “Women Are Still Underrepresented in Clinical Trials,” by Erin Blakemore

Margot Sanger-Katz: The Washington Post’s “This Texas Teen Wanted an Abortion. She Now Has Twins,” by Caroline Kitchener

Sarah Karlin-Smith: The Miami Herald’s “Why Should You Stop Frolicking in Miami-Dade Floodwater? It’s Probably Full of Poop,” by Alex Harris

Victoria Knight: Insider’s “2,000 Leaked Documents and Employees Say Silicon Valley Healthcare Startup Cerebral Harmed Hundreds of Patients and Prescribed Serious Medication with Abandon,” by Shelby Livingston and Blake Dodge

Also discussed on this week’s podcast:

The Atlantic’s “America Is Sliding Into the Long Pandemic Defeat,” by Ed Yong

Health Services Research’s “Medication Abortion: A Perfect Solution?” by Nichole Austin

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

FALQs: The Exercise of Universal Jurisdiction in Germany

In Custodia Legis - Thu, 06/30/2022 - 9:30am

The following is a guest post by Lena Fleischmann, a foreign law intern working with Foreign Law Specialist Jenny Gesley at the Global Legal Research Directorate of the Law Library of Congress. It is part of our Frequently Asked Legal Questions series.   

This FALQ examines how Germany is fighting impunity by exercising universal jurisdiction under its Code of Crimes Against International Law, demonstrating why this principle is considered such an important and effective tool in the fight against impunity. Universal jurisdiction is a way of holding the perpetrators of human rights violations accountable irrespective of where the crime was committed and whether the act has any relation to the country in question. Germany has been in the spotlight due to its efforts to pursue accountability for crimes against international law in its national courts.

Justitia. Photo by Flickr user Tim Reckmann. July 16, 2015. Used under Attribution 2.0 Generic (CC BY 2.0).

1. What is Universal Jurisdiction?

Universal jurisdiction provides a state with the authority to prosecute individuals for atrocities, such as crimes against humanity, war crimes, genocide, and torture, based on the idea of the responsibility to protect the international community. It allows for prosecution without any reference to the place of perpetration, the nationality of the suspect or the victim, or any other basis to exercise jurisdiction – potentially opening the door to lawsuits from all over the world, which is why the exercise of universal jurisdiction has been quite controversial in some instances.

2. Where is Universal Jurisdiction Codified?

Universal jurisdiction is one of the key principles codified in the German Code of Crimes Against International Law (CCAIL) (Völkerstrafgesetzbuch, VStGB). The CCAIL regulates crimes against public international law, including the criminal offenses of genocide, crimes against humanity, war crimes, and the crime of aggression. It came into force in Germany on June 30, 2002, to bring the German criminal law into accordance with the Rome Statute of the International Criminal Court. It supplements the German Criminal Code (Strafgesetzbuch, StGB) (CCAIL, art. 2). Universal jurisdiction was broadened by the Geneva Conventions and underlies other human rights treaties, such as the 1984 Convention against Torture (CAT).

3. What Other Principles Provide a Basis to Exercise Extraterritorial Jurisdiction?

Besides the principle of universal jurisdiction, there are four more key principles that provide Germany with jurisdiction to prosecute crimes. The territoriality principle provides states with jurisdiction for crimes committed on their own soil (StGB, § 3). The active personality principle provides states with jurisdiction for crimes committed by their nationals abroad, for example when the perpetrator is a German citizen (id. § 7, para. 2). The passive personality principle provides states with jurisdiction for crimes committed against their nationals while they are abroad (id. § 7, para. 1). Lastly, the protection principle provides states with jurisdiction for crimes that involve extraterritorial activities that threaten national security, among other reasons (id. § 5).

4. What Are the Jurisdictional Requirements for Exercising Universal Jurisdiction?

Germany has genuine universal jurisdiction, meaning that its laws do not require any connection between grave international crimes committed abroad and Germany before prosecutors can investigate and prosecute (CCAIL, art. 1). However, the prosecutor has discretion whether to open a case if there is no direct connection to Germany. While prosecutorial discretion is intended to be a safeguard against overly burdensome complaints, it has led to significant criticism, because the prosecutor is part of the executive branch and there is a risk that the exercise of universal jurisdiction could be abused by the nation’s highest officials. Delegates at the UN General Assembly’s Sixth Committee meeting highlighted the potential for misuse due to the lack of a universal clear definition.

5. For What Crimes Can Universal Jurisdiction Be Invoked?

The crime of genocide is set forth in section 6 of the CCAIL and is punishable with life imprisonment. A person can be found guilty of genocide if he or she

with the intention of destroying all or part of a national, racial, religious or ethnic group as such, (1) kills a member of the group, (2) causes serious bodily or mental harm to a member of the group, […], (3) inflicts on the group conditions of life calculated to bring about their physical destruction in whole or in part, (4) imposes measures intended to prevent births within the group, or (5) forcibly transfers a child of the group to another group.

The language differs slightly from the relevant provision in the Rome Statute, because it refers to any single member of any of the relevant groups rather than to the group as such.

Crimes against humanity are set forth in section 7 of the CCAIL and punish “anyone who commits (the crimes listed in section 7) in the context of an extensive or systematic attack against a civilian population.” Crimes against humanity include crimes such as willful killing, extermination, enslavement, deportation or forced transfer of persons, torture, sexual violence, enforced disappearance, and persecution. They are punishable with a minimum sentence of three years in prison and up to life in prison.

War crimes are set forth in sections 8-12 of the CCAIL. Section 8 lists war crimes against persons. Section 9 contains war crimes against property and other rights. Section 10 lists crimes against humanitarian operations and emblems. Section 11 lists war crimes in connection with the use of prohibited methods of warfare, whereas section 12 lists war crimes with regard to using prohibited means of warfare. The crimes listed in section 8, paragraph 3, section 9, paragraph 2, and section 11, paragraph 3 only apply in the context of an international armed conflict.

The crime of aggression is set forth in section 13 of the CCAIL and punishes “anyone who wages a war of aggression or commits any other act of aggression that, by its nature, gravity, and extent, constitutes a manifest violation of the Charter of the United Nations […].” On the other hand, article 8 bis, paragraph 1 of the Rome Statute defines it as “the planning, preparation, initiation or execution, by a person in a position effectively to exercise control over or to direct the political or military action of a State.”

6. What are Some Recent Cases in Germany?

The universal jurisdiction cases in German courts have attracted a lot of international media attention and have been well documented. I would like to highlight the following:

In 2015, two Rwandan leaders of the Hutu militia group “Forces Démocratiques de Libération du Rwanda” (FDLR) were on trial at the Higher Regional Court (OLG) in Stuttgart for committing crimes against humanity in the Eastern Democratic Republic of Congo from 2008 to 2009. The FDLR had enjoyed impunity for widespread atrocities and this trial marked the first time anyone had been held accountable. President of the FDLR Ignace Murwanashyaka was accused of being responsible for crimes against humanity, in particular for killing and sexual coercion or rape. He also faced accusations of war crimes, in particular the killing, cruel or inhumane treatment, sexual coercion, or rape of a person protected under international humanitarian law, as well as forcibly recruiting child soldiers and perpetrating war crimes against property. Even though he did not commit these acts himself, he was held liable under the principle of command responsibility for failing to take action to prevent his subordinates from carrying out the acts in question. Murwanyashaka was found guilty of leading a terrorist organization but acquitted of war crimes and crimes against humanity. Ultimately, the OLG Stuttgart sentenced Ignace Murwanyashaka to 13 years and Straton Musoni, his vice president, to eight years in prison in September 2015.

In 2020, the Higher Regional Court Frankfurt (OLG Frankfurt) started proceedings against 29-year-old ISIS fighter Taha Al-J. for crimes against humanity and war crimes for causing the death of a five-year-old girl he had bought as a slave. His wife, Jennifer W., who left Germany for Iraq and joined ISIS there, was prosecuted in Munich and was sentenced to 10 years in prison. The couple was accused of beating the child and ultimately killing her by chaining her outdoors in the backyard in the heat. This was the first genocide conviction of an ISIS soldier. Ultimately, the OLG Frankfurt sentenced Taha Al-J. to life in prison and ordered him to pay roughly $57,000 in compensation to the girl’s mother.

For almost two years, the Higher Regional Court Koblenz (OLG Koblenz) held court proceedings for two Syrians who worked for the Syrian secret service. They were on trial for committing crimes against humanity and torture on more than 4,000 counts under the Assad regime in Syria from 2011 to 2012. Anwar R. was accused of being responsible for the torture of more than 4,000 prisoners in Damascus during the civil war, having aided and abetted crimes against humanity in arresting and transporting protestors to an interrogation center known for torture. The victims were hanging from the ceiling from their hands, hit, and electrocuted when they were about to fall asleep. To prove the accusations, the court relied on the so-called “Caesar files,” which are pictures taken by a Syrian military photographer, documenting the crimes. Eyad A. arrested more than 30 people who were fleeing after a protest came to a violent end in 2011 and was accused of beating them on the way to the prison and being responsible for the torture they had to endure during their confinement. The defendants tried to raise a defense under section 35 of the German Criminal Code, arguing that they and their families would have been killed if they had not followed the orders they had been given. Ultimately, the OLG Koblenz sentenced 58-year-old Anwar R. to life in prison and 43-year-old Eyad A. to four years and six months in prison. This was a historic trial because it was the first ever criminal trial for governmental torture in Syria.

7. Why is Germany Exercising Universal Jurisdiction?

The German delegation at a meeting of the Sixth Committee of the United Nations General Assembly (Legal Committee) in October 2021 stated that “[t]he message is clear: those who commit atrocities cannot feel safe. They will eventually be held accountable. There is no safe haven for perpetrators of international crimes against criminal prosecution in Germany.” The trials in Germany have symbolic power and the “pioneering work” of the judiciary might set an example for other states all over the world. The trial at the OLG Koblenz mentioned above, for example, was the first criminal trial worldwide on state torture in Syria.

Furthermore, a new legal framework on international arrest warrants against high-ranking government officials could have a deterrent effect. The United Nations has established ad hoc international criminal tribunals for former Yugoslavia and Rwanda to prosecute those responsible for genocide, war crimes, and other atrocities and serious humanitarian violations in those particular conflicts. A mechanism for investigating and prosecuting serious crimes has been set up for Syria, but its work is being blocked over concerns regarding the basis for its creation.

Subscribe to In Custodia Legis – it’s free! – to receive interesting posts drawn from the Law Library of Congress’s vast collections and our staff’s expertise in U.S., foreign, and international law.

Categories: Research & Litigation

California May Require Labels on Pot Products to Warn of Mental Health Risks

Kaiser Health News - Thu, 06/30/2022 - 5:00am

Liz Kirkaldie’s grandson was near the top of his class in high school and a talented jazz bassist when he started smoking pot. The more serious he got about music, the more serious he got about pot.

And the more serious he got about pot, the more paranoid, even psychotic, he became. He started hearing voices.

“They were going to kill him and there were people coming to eat his brain. Weird, weird stuff,” Kirkaldie said. “I woke up one morning, and no Kory anywhere. Well, it turns out, he’d been running down Villa Lane here totally naked.”

Kory went to live with his grandmother for a couple of years in Napa, California. She thought maybe she could help. Now, she says that was naive.

Kory was diagnosed with schizophrenia. Kirkaldie blames the pot.

“The drug use activated the psychosis, is what I really think,” she said.

Indeed, many scientific studies have linked marijuana use to an increased risk of developing psychiatric disorders, including schizophrenia. The risk is more than four times as great for people who use high-potency marijuana daily than for those who have never used, according to a study published in The Lancet Psychiatry in 2019. One study found eliminating marijuana use in adolescents could reduce global rates of schizophrenia by 10%.

Doctors and lawmakers in California want cannabis producers to warn consumers of this and other health risks on their packaging labels and in advertising, similar to requirements for cigarettes. They also want sellers to distribute health brochures to first-time customers outlining the risks cannabis poses to youths, drivers, and those who are pregnant, especially for pot that has high concentrations of THC, the chemical primarily responsible for marijuana’s mental effects.

“Today’s turbocharged products are turbocharging the harms associated with cannabis,” said Dr. Lynn Silver with the Public Health Institute, a nonprofit sponsoring the proposed labeling legislation, SB 1097, the Cannabis Right to Know Act.

Californians voted to legalize recreational pot in 2016. Three years later, emergency room visits for cannabis-induced psychosis went up 54% across the state, from 682 to 1,053, according to state hospital data. For people who already have a psychotic disorder, cannabis makes things worse — leading to more ER visits, more hospitalizations, and more legal troubles, said Dr. Deepak Cyril D’Souza, a psychiatry professor at Yale University School of Medicine who also serves on the physicians’ advisory board for Connecticut’s medical marijuana program.

But D’Souza faces great difficulty convincing his patients of the dangers, especially as 19 states and the District of Columbia have legalized recreational marijuana.

“My patients with schizophrenia and also adolescents hear very conflicting messages that it’s legal; in fact, there may be medical uses for it,” he said. “If there are medical uses, how can we say there’s anything wrong with it?”

Legalization is not the problem, he said; rather, it’s the commercialization of cannabis — the heavy marketing, which can be geared toward attracting young people to become customers for life, and the increase in THC from 4% on average up to between 20% and 35% in today’s varieties.

Limiting the amount of THC in pot products and putting health warnings on labels could help reduce the health harms associated with cannabis use, D’Souza said, the same way those methods worked for cigarettes.

He credits warning labels, education campaigns, and marketing restrictions for the sharp drop in smoking rates among kids and teens in the past decade.

“We know how to message them,” D’Souza said. “But I don’t think we have the will or the resources, as yet.”

Some states, including Colorado, Oregon, and New York, have dabbled with cannabis warning-label requirements. California’s proposed rules are modeled after comprehensive protocols established in Canada: Rotating health warnings would be set against a bright-yellow background, use black 12-point type, and take up a third of the package front. The bill suggests language for 10 distinct warnings.

Opponents of the proposed labels say the requirements are excessive and expensive, especially since marketing to children is already prohibited in California and people must be 21 to buy.

“This bill is really duplicative and puts unnecessary burdens on the legal cannabis industry, as we already have incredibly restrictive packaging and advertising requirements,” said Lindsay Robinson, executive director of the California Cannabis Industry Association.

The state should focus more on combating the illicit pot market rather than further regulating the legal one, she said. Legal dispensaries are already struggling to keep up with existing rules and taxes — the state’s 1,500 licensed pot retailers generated $1.3 billion in state tax revenue last year. Adding more requirements makes it harder for them to compete with the illicit market, she said, and more likely to go out of business.

“The only real option if they fail out of the legal system is to shutter their businesses altogether or to operate underground. And I don’t think the state of California, with the tax revenue, wants either of those to happen,” Robinson said. “The heart of the issue is that there’s a massive, unregulated market in the state.”

Some people are skeptical that the labels will work. Liz Kirkaldie’s grandson, Kory, is stable now, living with his dad. But she’s not sure a yellow warning would’ve stopped him when he was a teen.

“They’re just not going to pay attention,” she said. “But if it helps even one person? Great.”

Scientists still do not know what causes schizophrenia, but they believe multiple factors are at play, including genetics, family history, trauma, and other influences in a person’s environment, like smoking pot. Some scientists believe having schizophrenia in the first place predisposes people to smoking pot. While it’s difficult to prove a direct causal link between cannabis use and schizophrenia, the associations are strong enough to warrant action, said D’Souza, and, importantly, pot use is one of the few risk factors people can control.

“Not everyone who smoked cigarettes developed lung cancer, and not everyone who has lung cancer smoked cigarettes,” he said. “But I think we would all agree that one of the most preventable causes of lung cancer is cigarette smoking.”

Applying the same health education strategies to cannabis that were used for tobacco, he said, is long overdue.

This story is part of a partnership that includes KQEDNPR, and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

Montana’s Blackfeet Tribe to Use Dogs to Sniff Out Disease and Contaminants

Kaiser Health News - Thu, 06/30/2022 - 5:00am

BROWNING, Mont. — Kenneth Cook used a mallet and a chisel to crack into a pig’s skull in the gravel driveway outside his home on the Blackfeet Indian Reservation in northwestern Montana.

Cook planned to use the pig’s brains in brain tanning, practiced by Indigenous people for thousands of years.

The brains are mushed up in water and worked into deer and elk hides to make leather. Cook said the brain’s fatty acids both soften the hide and give it a beautiful white color before it’s smoked for waterproofing.

“Brain will give you the strongest, longest-lasting leather. So, that’s why people prefer it,” he said.

Cook uses the hides he tans to make drums, moccasins, and tribal regalia. Typically, Indigenous people like Cook use the brains of animals they hunt to tan the hides. But Cook has switched to pig brains for all his tanning, in part because of chronic wasting disease, which afflicts deer, elk, and moose.

Chronic wasting disease is caused by misfolded proteins called prions, which deteriorate an infected animal’s brain and bodily functions until it dies — typically within a couple of years of infection. The disease has spread among herds across North America since it was first discovered in wild animals more than 40 years ago in Colorado and Wyoming.

Chronic wasting disease has been detected in just one white-tailed deer on the Blackfeet reservation, but once it’s present, it’s impossible to eradicate, according to wildlife managers. The disease is already forcing tribal members to alter or abandon traditional practices like brain tanning, said Souta Calling Last, a Blackfeet researcher and executive director of the nonprofit cultural and educational organization Indigenous Vision.

Calling Last also worries the spread of chronic wasting disease will prevent tribal members from eating wild game. Some families depend on meat from the deer, elk, or moose they can hunt several months out of the year.

That’s where the dogs come in. Calling Last received a $75,000 federal grant to run a yearlong study to train dogs to sniff out chronic wasting disease and toxic waste that might otherwise be ingested by people who hunt wild game and gather traditional plants. The project aims to protect tribal members’ health by letting them know where the disease has been detected and where toxic waste has been found to preserve safe spaces to conduct traditional practices.

The Centers for Disease Control and Prevention recommends that people don’t eat meat from animals that test positive, though there’s no proof the disease can be transmitted to humans. Rocky Mountain Laboratories researcher Brent Race said the possibility of the prions infecting humans hasn’t been ruled out. He noted brain matter would be especially dangerous to handle, as Cook does in his brain tanning, since it holds the highest concentration of the prions that cause the disease.

“It’s definitely high-risk,” he said.

Standing near a wetland full of cattails, Calling Last said the dogs trained by the nonprofit organization Working Dogs for Conservation will detect chronic wasting disease in deer and elk scat at such sites that serve as watering holes for herds. The idea is to help alert wildlife managers of the disease’s presence as early as possible.

The dogs also will sniff out mink and otter scat so it can be tested for chemicals and contaminants in illegal dumpsites of old cars, furniture, and appliances.

Detecting those toxic substances will help protect tribal members who utilize plants like mint for tea or willows burned in sweat lodges, Calling Last said.

“For us to be healthy and strong, people in good spirit and good mind, we’re supposed to be eating these foods to stay healthy and strong,” she said.

Calling Last plans to send scat, soil, and water samples for testing from locations where the dogs alert their handlers to confirm they found chronic wasting disease. If Calling Last’s project proves dogs can effectively do this work, Working Dogs for Conservation trainer Michele Vasquez said, the organization hopes to expand the effort across the country.

Researchers from the University of Pennsylvania’s veterinary school have been studying whether dogs can detect chronic wasting disease in the lab, but the project on the Blackfeet reservation is the first attempt to do so in the field, according to Vasquez.

The training was taking place at a special facility outside Missoula. There, Vasquez ran her 4-year-old black Labrador retriever, Charlie, through his paces detecting black-footed ferret scent hidden in one of several containers. It’s one of many scents the excitable Lab is trained to detect.

“They each have something different in them. So, we’ll have distracters,” she said. Those distracters could include food or scents of other animals the dogs will encounter in the field.

Joe Hagberg of the Blackfeet Fish and Wildlife Department said he hopes the dogs will be able to determine whether chronic wasting disease still is present where it was first detected on the eastern portion of the reservation.

“It will help us out tremendously,” he said, standing on the edge of a flooded creek near where the positive animal was shot. Following the 2020 detection, Hagberg shot several sickly-looking deer to understand how prevalent the disease was.

“We harvested 54 deer out of here all throughout … the area in a 10-mile perimeter,” he said. “We all had negative tests throughout those ones.”

Hagberg is happy with those results, but he said his resources to look for the disease in other areas of the 2,400-square-mile reservation are limited.

Calling Last hopes the soon-to-be working dogs will give officials like Hagberg an advantage in trying to contain the disease, which can spread undetected for years before it decimates a herd.

She plans to publish a study on her work and seek additional funding to replicate it for other tribal nations in Montana and Wyoming, many of which are in areas where chronic wasting disease is more prevalent.

Calling Last said the Blood Tribe, one of the Blackfeet’s sister tribes in Canada, has already obtained grant funding for a similar project.

“I think that just being able to monitor it, record it, and know definitively that you’re harvesting food that doesn’t contain the prion would be a big win for any nation,” Calling Last said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

For LGBTQ People, Recent Anti-Discrimination Advances Could Lessen Barriers to Economic Inclusion

Center on Budget and Policy Priorities - Wed, 06/29/2022 - 3:05pm
June is Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Pride Month, a time to celebrate LGBTQ individuals and families. It is also a time to honor leaders of the fight for LGBTQ rights and to commemorate those lost to anti-LGBTQ violence. Central to Pride Month, which started as a commemoration of the Stonewall Uprising against police brutality,[1] is the ongoing movement for LGBTQ justice. While the nation has made significant gains toward full social inclusion for LGBTQ people in the past two decades, there is more work to be done until every member of the LGBTQ community — and the
Categories: Benefits, Poverty

Housing and Health Problems Are Intertwined. So Are Their Solutions.

Center on Budget and Policy Priorities - Wed, 06/29/2022 - 2:14pm
This chart book describes the relationship between housing and health, then highlights cross-sector policy solutions that promote positive health outcomes, greater housing stability, and advancements in racial, health, and housing equity.
Categories: Benefits, Poverty

Watch: Crossing State Lines for Abortion Care

Kaiser Health News - Wed, 06/29/2022 - 1:15pm

Since last week’s Supreme Court ruling overturning Roe v. Wade, one state after another has outlawed abortion. Illinois is one of the few states in the middle of the country where people can still legally access abortion care.

In this report co-produced by PBS NewsHour, KHN senior correspondent Sarah Varney traveled from Illinois’ border with Missouri to its border with Wisconsin to talk to clinicians who provide abortion care. Dr. Erin King is the executive director of Hope Clinic for Women in Granite City, Illinois, across the Mississippi River from St. Louis.

King said she already sees more patients from outside Illinois who have traveled far to get care. “The distance has increased and people’s resources have decreased,” King said, adding that some patients think the procedure is illegal everywhere.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

Lo que debes saber sobre la viruela del simio

Kaiser Health News - Wed, 06/29/2022 - 11:20am

La Organización Mundial de la Salud dijo el 25 de junio que la viruela del simio aún no es una emergencia de salud pública que preocupe a nivel internacional. Se han informado más de 4,500 casos en todo el mundo, y ya superan los 300 en los Estados Unidos. Aunque es probable que haya un subregistro porque no se hace rastreo de contactos.

Todos deberían saber sobre los símtomas, cómo se disemina y los riesgos.

¿Debería preocuparme por la viruela del simio?

Actualmente, los estadounidenses tienen un bajo riesgo de contraer la viruela del simio. Se está extendiendo entre hombres que tienen sexo con hombres, pero es solo cuestión de tiempo antes de que pase a otros. Al 27 de junio, el Centro Europeo para la Prevención y el Control de Enfermedades había informado 10 casos en mujeres.

Generalmente es una enfermedad leve, pero puede ser grave o incluso mortal para las personas inmunodeprimidas, embarazadas, fetos o recién nacidos, mujeres lactantes, niños pequeños y personas con enfermedades de la piel, como eccema.

Podría volverse endémica en los Estados Unidos, y en todo el mundo, si continúa propagándose sin control.

¿Cómo se propaga?

La viruela del simio es una infección viral, prima cercana de la viruela. Pero causa una enfermedad mucho más leve.

Se transmite a través del contacto cercano, incluido el sexo, besos y masajes: cualquier tipo de contacto del pene, la vagina, el ano, la boca, la garganta o incluso la piel. En este brote, se ha transmitido principalmente por vía sexual.

Los condones y los protectores dentales reducirán, pero no evitarán, toda la transmisión porque solo protegen contra el contagio por piel, y por las mucosas cubiertas por estos dispositivos. Es importante saber que el virus puede entrar por una abertura en la piel, y penetrar las membranas mucosas de la nariz, la boca, los genitales y el ano.

Los científicos no saben si la viruela del simio se puede transmitir a través del semen o del fluido vaginal.

La viruela del simio se puede transmitir a través de gotitas respiratorias a unos pocos pies, pero no es un modo de transmisión particularmente eficiente. Todavía no se ha documentado transmission aérea, como covid-19.

No se sabe si la infección se puede transmitir cuando la persona no presenta síntomas.

¿Cuáles son los síntomas comunes?

Los síntomas pueden desarrollarse hasta 21 días después de la exposición y pueden incluir fiebre y escalofríos, ganglios linfáticos inflamados, sarpullido y dolores de cabeza.

No se sabe si siempre muestra alguno o todos esos síntomas.

Actualmente, los expertos creen que la viruela del simio, como la viruela, siempre causará al menos algunos de estos síntomas, pero esa creencia se basa en la ciencia anterior a 1980, antes de que existieran pruebas de diagnóstico más sofisticadas.

¿Cómo se ve la erupción de la viruela del simio?

La erupción generalmente comienza con manchas rojas. Luego se convierten en protuberancias llenas de líquido y después pus que pueden parecer ampollas o granos. Estas protuberancias luego se abren en llagas y forman costras. Las personas con viruela del simio se deben considerar infecciosas hasta que aparecen las costras y se caen.

Estas llagas son dolorosas. Antes, la erupción se observaba más en las palmas de las manos y las plantas de los pies, pero muchas personas en este brote presentan lesiones externas e internas en la boca, los genitales y el ano.

También dolor rectal o la sensación de necesitar defecar cuando sus intestinos están vacíos.

¿Cómo hacerse la prueba?

Si la persona tiene síntomas de viruela del simio, hay que hacerse una prueba en una clínica de salud sexual. Un profesional médico debe tomar una muestra de cualquier lesión sospechosa para su análisis. También hay evidencia emergente de que los frotis de garganta pueden detectar la viruela del simio, pero hasta ahora los funcionarios de salud no los recomiendan.

¿Hay una vacuna para la viruela del simio?

Sí. Dos vacunas son eficaces para prevenir la viruela del simio: la vacuna Jynneos y la vacuna ACAM2000. La FDA aprobó la vacuna Jynneos para prevenir la viruela del simio y la viruela en personas mayores de 18 años. ACAM2000 está aprobada por la FDA para prevenir la viruela. Actualmente, en el país se usa solo la vacuna Jynneos porque es más segura y tiene menos efectos secundarios.

La vacuna Jynneos es segura. Se ha probado en miles de personas, incluidas aquéllas inmunocomprometidas o con enfermedades de la piel. Los efectos secundarios comunes de la vacuna Jynneos son similares a los de otras vacunas: fiebre, fatiga, glándulas inflamadas e irritación en el lugar de la inyección.

La vacuna Jynneos es eficaz para prevenir la viruela del simio hasta cuatro días después de la exposición y puede reducir la gravedad de los síntomas si se administra hasta 14 días después de la exposición.

¿Puedo vacunarme contra la viruela del simio?

Actualmente, los Centros para el Control y la Prevención de Enfermedades (CDC) recomiendan la vacunación contra la viruela del simio solo para aquellos en mayor riesgo: personas que han tenido contacto cercano con alguien infectado; hombres que tienen relaciones sexuales con hombres y mujeres trans que recientemente han tenido múltiples parejas sexuales en un lugar donde la infección se está propagando; y algunos trabajadores de la salud, socorristas y militares que podrían entrar en contacto con los afectados.

Actualmente, los suministros de la vacuna Jynneos son limitados. El Departamento de Salud y Servicios Humanos liberará 56,000 dosis de la reserva nacional estratégica de inmediato. En las próximas semanas estarán disponibles 240,000 dosis adicionales, 750,000 a finales del Verano, y 500,000 este otoño. Un total de 1.5 millones de dosis.

¿Cuáles son otras formas de reducir el riesgo de transmisión de la viruela del simio?

La mejor manera es informarse. Si la persona está preocupada, el enlace de los CDC es el mejor recurso para encontrar una clínica de salud sexual: Muchas salas de emergencia o centros de urgencia, y otros centros de salud, todavía pueden no estar actualizados con lo ultimo sobre la viruela del simio.

Hay que abstenerse de tener relaciones sexuales si un miembro de la pareja está infectado. Los CDC también advierten sobre el riesgo de ir a raves u otras fiestas o lugares en donde la gente usa poca ropa. Y ofrece otros consejos de prevención, como el lavado de sábanas o juguetes sexuales.

¿Existe un tratamiento para la viruela del simio?

No existe un tratamiento seguro y probado específicamente para la viruela del simio. La mayoría de los casos son leves y mejoran sin tratamiento en un par de semanas. Medicamentos como el paracetamol y el ibuprofeno se pueden usar para reducir la fiebre y los dolores musculares. En casos raros, algunos pacientes desarrollarán una enfermedad más grave y pueden requerir un tratamiento más específico. Los médicos están probando terapias experimentales como cidofovir, brincidofovir, tecovirimat e inmunoglobulina vaccinia. Si se administran temprano en el curso de la infección, las vacunas Jynneos y ACAM2000 también pueden ayudar a reducir la gravedad de la enfermedad.

¿Qué información errónea circula sobre la viruela del simio?

Abundan las teorías conspirativas. Pero no es un engaño. Es real. Esta infección no fue inventada por Bill Gates ni por las farmacéuticas. El virus no salió de un laboratorio de China o Ucrania. Los migrantes que cruzan la frontera con México no traen la viruela del simio a los Estados Unidos. No hay mandato de vacunación ni cuarentenas establecidas para la viruela del simio.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

Join Us on 7/21 for Our Webinar: “Regulating Remote Work During the Pandemic and After: Global Perspectives”

In Custodia Legis - Wed, 06/29/2022 - 8:00am

Join us on July 21 at 2 p.m. EDT for a webinar titled, “Regulating Remote Work During the Pandemic and After: Global Perspectives.”

Please register here.

Our upcoming July Foreign and Comparative Law Webinar Series’ entry will provide an overview of the considerations undertaken by the U.S., the European Union (EU), and selected foreign countries in regulating offsite work. The webinar will focus on rules adopted by different jurisdictions prior to the onset of the COVID-19 pandemic for work performed outside of employers’ premises, often termed as “telework” or “remote work.”

Increased access to computer and communications technology had facilitated the growth of offsite work by enabling the use of computer and communications technologies away from a central location. The COVID-19 pandemic has accelerated global employment patterns involving offsite work and has further propelled faster adoption of automation and artificial intelligence (AI), especially in work areas with high physical proximity. These developments were necessitated by restrictions imposed on the labor force in numerous countries by closures, social distancing, and vaccination requirements. The technological ability in many parts of the world minimized the impact of state-wide closures and other measures taken by states to reduce transmission of the virus.

The July webinar will examine legal developments propelled by the pandemic, in legislation and in case law, and other initiatives regarding the place of telework and remote work post COVID-19.

The webinar will be presented by Senior Foreign Law Specialist Ruth Levush. Ruth conducts research on Israeli domestic law, as well as comparative and international law, for the U.S. Congress, executive agencies and the U.S. judiciary. Her work has been cited by the U.S. Supreme Court, and her reports have been admitted into evidence as expert testimony by various U.S. federal courts. She has presented to academic and foreign parliamentary audiences on topics such as foreign development assistance and parliamentary oversight and her articles on a variety of comparative law issues have been published in legal periodicals in the U.S. and abroad. Ruth previously served as a special assistant to Justice Aharon Barak, former president of Israel’s Supreme Court, and practiced law in Israel as an attorney both in government and in private practice. She holds a Master of Comparative Law (American Practice) from The George Washington University Law School and a Bachelor of Laws (LL.B) from Tel Aviv University Law School. Ruth is a member of the District of Columbia Bar and was admitted to the Israeli Bar.

Subscribe to In Custodia Legis – it’s free! – to receive interesting posts drawn from the Law Library of Congress’s vast collections and our staff’s expertise in U.S., foreign, and international law.

Categories: Research & Litigation

Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

Kaiser Health News - Wed, 06/29/2022 - 5:00am

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday.

Witnesses sharply criticized the fast-growing health plans at a hearing held by the Energy and Commerce subcommittee on oversight and investigations. They cited a slew of critical audits and other reports that described plans denying access to health care, particularly those with high rates of patients who were disenrolled in their last year of life while likely in poor health and in need of more services.

Rep. Diana DeGette (D-Colo.), chair of the subcommittee, said seniors should not be “required to jump through numerous hoops” to gain access to health care.

The watchdogs also recommended imposing limits on home-based “health assessments,” arguing these visits can artificially inflate payments to plans without offering patients appropriate care. They also called for the Centers for Medicare & Medicaid Services, or CMS, to revive a foundering audit program that is more than a decade behind in recouping billions in suspected overpayments to the health plans, which are run mostly by private insurance companies.

Related to denying treatment, Erin Bliss, a Department of Health and Human Services assistant inspector general, said one Medicare Advantage plan had refused a request for a computed tomography, or CT, scan that “was medically necessary to exclude a life-threatening diagnosis (aneurysm).”

The health plan required patients to have an X-ray first to prove a CT scan was needed.

Bliss said seniors “may not be aware that they may face greater barriers to accessing certain types of health care services in Medicare Advantage than in original Medicare.”

Leslie Gordon, of the Government Accountability Office, the watchdog arm of Congress, said seniors in their last year of life had dropped out of Medicare Advantage plans at twice the rate of other patients leaving the plans.

Rep. Frank Pallone Jr. (D-N.J.), who chairs the influential Energy and Commerce Committee, said he was “deeply concerned” to hear that some patients are facing “unwarranted barriers” to getting care.

Under original Medicare, patients can see any doctor they want, though they may need to buy a supplemental policy to cover gaps in coverage.

Medicare Advantage plans accept a set fee from the government for covering a person’s health care. The plans may provide extra benefits, such as dental care, and cost patients less out-of-pocket, though they limit the choice of medical providers as a trade-off.

Those trade-offs aside, Medicare Advantage is clearly proving attractive to consumers. Enrollment more than doubled over the past decade, reaching nearly 27 million people in 2021. That’s nearly half of all people on Medicare, a trend many experts predict will accelerate as legions of baby boomers retire.

James Mathews, who directs the Medicare Payment Advisory Commission, which advises Congress on Medicare policy, said Medicare Advantage could lower costs and improve medical care but “is not meeting this potential” despite its wide acceptance among seniors.

Notably absent from the hearing witness list was anyone from CMS, which runs the $350 billion-a-year program. The agency took a pass even though committee Republicans invited CMS Administrator Chiquita Brooks-LaSure to testify. Rep. Cathy Rodgers (R-Wash.) said she was “disappointed” CMS had punted, calling it a “missed opportunity.”

CMS did not respond to a request for comment in time for publication.

AHIP, which represents the health insurance industry, released a statement that said Medicare Advantage plans “deliver better service, access to care, and value for nearly 30 million seniors and people with disabilities and for American taxpayers.”

At Tuesday’s hearing, both Republicans and Democrats stressed a need for improvements to the program while staunchly supporting it. Still, the detail and degree of criticism were unusual.

More typically, hundreds of members of Congress argue against making cuts to Medicare Advantage and cite its growing popularity.

At the hearing, the watchdogs sharply criticized home visits, which have been controversial for years. Because Medicare Advantage pays higher rates for sicker patients, health plans can profit from making patients look sicker on paper than they are. Bliss said Medicare paid $2.6 billion in 2017 for diagnoses backed up only by the health assessments; she said 3.5 million members didn’t have any records of getting care for medical conditions diagnosed during those health assessment visits.

Although CMS chose not to appear at the hearing, officials clearly knew years ago that some health plans were abusing the payment system to boost profits yet for years ran the program as what one CMS official called an “honor system.”

CMS aimed to change things starting in 2007, when it rolled out an audit plan called “Risk Adjustment Data Validation,” or RADV. Health plans were directed to send CMS medical records that documented the health status of each patient and return payments when they couldn’t.

The results were disastrous, showing that 35 of 37 plans picked for audit had been overpaid, sometimes by thousands of dollars per patient. Common conditions that were overstated or unable to be verified ranged from diabetes with chronic complications to major depression.

Yet CMS still has not completed audits dating as far back as 2011, through which officials had expected to recoup more than $600 million in overpayments caused by unverified diagnoses.

In September 2019, KHN sued CMS under the Freedom of Information Act to compel the agency to release audits from 2011, 2012, and 2013 — audits the agency contends still aren’t finished. CMS is scheduled to release the audits later this year.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

Overdose Deaths Behind Bars Rise as Drug Crisis Swells

Kaiser Health News - Wed, 06/29/2022 - 5:00am

Annissa Holland should be excited her son is coming home from prison after four long years of incarceration. Instead, she’s researching rehab centers to send him to as soon as he walks out the gate.

She doesn’t know the person who’s coming home — the person who she said has been doing every drug he can get his hands on inside the Alabama prison system. She can hear it in the 34-year-old’s voice when he calls her on the prison phone.

Her son is one of almost 20,000 inmates in the Alabama prison system living in conditions the U.S. Department of Justice has called inhumane. In two investigations, it found that the rampant use of drugs causes sexual abuse and “severe” violence in the state’s prisons. The department has sued Alabama, alleging conditions in its prisons violate inmates’ civil rights. According to the Alabama Department of Corrections’ own report, almost 60 pounds of illicit drugs were confiscated from its prisons in the first three months of this year.

Even if Alabama’s prisons and jails are especially overrun by drugs, death, and violence, their problems are not unique in the U.S. Within three weeks this spring, incarcerated people died of overdoses in Illinois, Oklahoma, New York, and the District of Columbia.

The alcohol and drug overdose death rate increased fivefold in prisons from 2009 through 2019, according to a recent study from the Pew Research Center — a surge that outpaced the national drug overdose rate, which tripled in the same period.

As the opioid crisis ravages America, overdose deaths are sweeping through every corner of the nation, including jails and prisons. Criminal justice experts suggest that decades of using the legal system instead of community-based addiction treatment to address drug use have not led to a drop in drug use or overdoses. Instead, the rate of drug deaths behind bars in supposedly secure facilities has increased.

This rise comes amid the decriminalization of cannabis in many parts of the country and a drop in the overall number of people incarcerated for drug crimes, according to the Pew report.

“It certainly points to the need for alternative solutions that rely less on the criminal justice system to help people who are struggling with substance use disorders,” said Tracy Velázquez, senior manager for safety and justice programs at the Pew Charitable Trusts.

For decades, drug use in America has mainly been addressed through the penal system — 1 in 5 people behind bars are there for a drug offense. Drug crimes were behind 30% of new admissions to Alabama prisons in March. Nationally, they were the leading cause of arrest, and almost 90% of arrests were for possession of drugs, not sale or manufacturing, according to the Pew study. The researchers also found that fewer than 8% of arrested people with a drug dependency received treatment while incarcerated.

Velázquez said a lot of drug use is spurred by people with mental health issues attempting to self-medicate. Almost 40% of people in prisons and 44% in jails have a history of mental illness, according to the Bureau of Justice Statistics.

Holland said her son was diagnosed with schizophrenia and PTSD six years ago after struggling with drug use since his teens. The son, who asked that his name not be published for fear his comments could jeopardize his release from prison or subsequent parole, said a schizophrenic episode in 2017 led him to break into a house during a hurricane. He said he didn’t realize people were in the house until after he ate a sandwich, got a Coke from the fridge, and looked for dry clothes. They called the police. He was sent to prison on a charge of burglary.

“They don’t put the mental health patients where they should be; they put them in prison,” Holland said.

She’s not only frustrated by the lack of medical care and treatment her son has received, but also horrified at the access to drugs and the abuse she said her son has suffered in the overcrowded, understaffed Alabama prison system.

He told KHN he’s been raped and beaten because of drug debts and put on suicide watch more than a dozen times. He said he turned back to using heroin, meth, and the synthetic drug flakka while incarcerated.

“We need to really focus on not assuming that putting someone in jail or prison is going to make them abstinent from drug use,” Velázquez said. “We really need to provide treatment that not only addresses the chemical, substance use disorder, but also addresses some of the underlying issues.”

Beth Shelburne, who works with the American Civil Liberties Union, logged 19 drug-related deaths in Alabama prisons in 2021, the most she has seen since she started tracking them in 2018.

She said those numbers are just a snapshot of what is going on inside Alabama’s prisons. The Justice Department found the state corrections department failed to accurately report deaths in its facilities.

“A lot of the people that are dying, I would argue, don’t belong in prison,” Shelburne said. “What’s so disgusting about all this is we are sentencing people who are drug-addicted to time in these ‘correctional facilities,’ when we’re really just throwing them into drug dens.”

The corrections department’s reports reveal at least seven overdose deaths in 2021, three of which officials classified as natural deaths. It reported 97 deaths in the first three months of this year that have yet to be fully classified.

Though Republican Gov. Kay Ivey recently announced a grant of more than $500,000 for a program to help incarcerated people address drug use disorders, the number of graduates of drug treatment programs in the state’s prison system has plummeted in the past decade to record lows. About 3% of prisoners completed a treatment program in 2021, down from 14% in 2009.

In contrast, California reported a 60% reduction in overdose deaths in its prisons in 2020, which state officials attributed to the start of a substance use treatment program and the widespread availability of medication-assisted therapy.

Alabama’s system is developing a medication-assisted treatment plan with its health contractor, said Alabama Department of Corrections spokesperson Kelly Betts. Before 2019, medications that curb drug cravings or mute highs were given only to those who could be separated from the general prison population, according to Deborah Crook, the department’s health services deputy commissioner.

“The science has changed considerably and there are more medication options that are safer to prescribe — even in general population,” she wrote in a statement.

Though prison officials have long blamed visitors for bringing in drugs, the ban on visitation during the pandemic did not lead to a drop in drug use inside. Multiple officers were arrested in Alabama last year and accused of bringing drugs into jails and prisons, and the Department of Justice’s 2019 report found dozens of officers arrested in the previous two years on charges related to drug trafficking and other misconduct.

Illegal drugs are “a challenge faced by correctional systems across the country,” Betts wrote in an email. “The ADOC is committed to enforcing our zero-tolerance policy on contraband and works very hard to eradicate it from our facilities.”

Betts did not specify how these policies are enforced. The department also refused to respond to a detailed list of questions about drug use and overdoses in its prisons, citing the litigation with the Justice Department.

Holland doesn’t know what will happen when her son gets out. He said he hopes he can restart his business as an electrician and provide for his family. But the four years of his so-called rehabilitation have been a nightmare for both of them.

“They’re released messed-up, hurt, and deeply dysfunctional. What do you do with someone that’s been through all that?” Holland said. “That’s not rehabilitation. It’s not.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

What You Need to Know About Monkeypox

Kaiser Health News - Wed, 06/29/2022 - 5:00am

The World Health Organization said June 25 that monkeypox wasn’t yet a public health emergency of international concern. More than 4,500 cases have been reported worldwide, with more than 300 in the U.S. And with public health officials unable to follow all chains of transmission, they’re likely undercounting cases. Everyone should be aware of its symptoms, how it spreads, and the risks of it getting worse.

Q: Should I be worried about monkeypox?

The American public is currently at low risk for monkeypox. It is spreading among men who have sex with men, but it is only a matter of time before it spreads to others. As of June 27, the European Centre for Disease Prevention and Control had reported 10 cases among women. Monkeypox is generally a mild disease but can be serious or even deadly for people who are immunocompromised, pregnant women, a fetus or newborn, women who are breastfeeding, young children, and people with severe skin diseases such as eczema.

But monkeypox could become endemic in the U.S. and around the world if it continues to spread unchecked.

Q: How does monkeypox spread?

Monkeypox is a viral infection, a close cousin of smallpox. But it causes a much milder disease.

It is transmitted through close contact, including sex, kissing, and massage — any kind of contact of the penis, vagina, anus, mouth, throat, or even skin. In the current outbreak, monkeypox has primarily been transmitted sexually.

Condoms and dental dams will reduce but won’t prevent all transmission because they protect only against transmission to and from the skin and mucosal surfaces that are covered by those devices. It’s important to know that the virus can enter broken skin and penetrate mucous membranes, like in the eyes, nose, mouth, genitalia, and anus. Scientists don’t know whether monkeypox can be transmitted through semen or vaginal fluid.

Monkeypox can be transmitted through respiratory droplets or “sprays” within a few feet, but this is not thought to be a particularly efficient mode of transmission. Whether monkeypox could be transmitted through aerosols, as covid-19 is, is unknown, but it hasn’t been documented so far.

It is not known whether monkeypox can be transmitted when someone doesn’t have symptoms.

Q: What are the common symptoms of monkeypox?

Symptoms of monkeypox may develop up to 21 days after exposure and can include fevers and chills, swollen lymph nodes, rash, and headaches.

It is not known whether monkeypox always shows any or all of those symptoms.

Experts currently think monkeypox, like smallpox, will always cause at least some of these symptoms, but that belief is based on pre-1980 science, before there were more sophisticated diagnostic tests.

Q: What does the monkeypox rash look like?

The monkeypox rash usually starts with red spots and then evolves into fluid-filled and then pus-filled bumps that may look like blisters or pimples. The bumps then open into sores and scab over. People with monkeypox should be considered infectious until after the sores scab over and fall off. Monkeypox sores are painful. The rash was often seen on palms and soles in the past, but many people in this outbreak have experienced external and internal lesions of the mouth, genitalia, and anus. People may also experience rectal pain or the sensation of needing to have a bowel movement when their bowels are empty.

Q: How do I get tested for monkeypox?

If you have symptoms of monkeypox, including oral, genital, or anal lesions, go to your nearest sexual health clinic for testing. A medical professional should swab any suspicious lesion for testing. There’s also emerging evidence that throat swabs may be useful in screening for monkeypox, but health officials in the U.S. are so far not recommending them.

Q: Is there a vaccine for monkeypox?

Yes. Two vaccines are effective in preventing monkeypox: the Jynneos vaccine and the ACAM2000 vaccine. The FDA has approved the Jynneos vaccine for preventing monkeypox and smallpox among people 18 and older. The ACAM2000 is FDA-approved to prevent smallpox. The U.S. is currently using only the Jynneos vaccine because it’s safer and has fewer side effects.

The Jynneos vaccine is safe. It has been tested in thousands of people, including people who are immunocompromised or have skin conditions. Common side effects of the Jynneos vaccine are similar to those of other vaccines and include fevers, fatigue, swollen glands, and irritation at the injection site.

The Jynneos vaccine is effective in preventing monkeypox disease up to four days after exposure and may reduce the severity of symptoms if given up to 14 days after exposure.

Q: Can I be vaccinated against monkeypox?

The Centers for Disease Control and Prevention currently recommends vaccination against monkeypox only for those at heightened risk: people who have had close contact with someone with monkeypox; men who have sex with men and trans women who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading; and some health care workers, laboratory staffers, first responders, and members of the military who might come into contact with the affected.

Supplies of the Jynneos vaccine are currently limited. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response will release 56,000 doses from the strategic national stockpile immediately. An additional 240,000 doses will be made available in the coming weeks, 750,000 doses later this summer, and 500,000 this fall, for a total of more than 1.5 million doses.

Q: What are other ways to lower the risk of monkeypox transmission?

The best way is to educate yourself and your sex partners about monkeypox. If you’re worried you might have monkeypox, get tested at a sexual health clinic. Many emergency rooms, urgent care centers, and other health care facilities may not be up to date on monkeypox. The CDC link to find the nearest sexual health clinic is

Abstain from sex if you or your partner has monkeypox. And remember that condoms and dental dams can reduce but not eliminate the risk of transmission. The CDC also warns about the risk of going to raves or other parties where lots of people are wearing little clothing and of saunas and sex clubs. It has other suggestions like washing sex toys and bedding.

Q: Is there a treatment for monkeypox?

There is no proven, safe treatment specifically for monkeypox. Most cases of monkeypox are mild and improve without treatment over a couple of weeks. Medications like acetaminophen and ibuprofen can be used to reduce fevers and muscle aches, and medications like acetaminophen, ibuprofen, and opioids may be used for pain. In rare cases, some patients — such as immunocompromised people, pregnant women, a fetus or newborn, women who are breastfeeding, young children, and people with severe skin diseases — will develop more severe illness and may require more specific treatment. Doctors are trying experimental therapies like cidofovir, brincidofovir, tecovirimat, and vaccinia immune globulin. If administered early in the course of infection, the Jynneos and ACAM2000 vaccines may also help reduce the severity of disease.

Q: What misinformation is circulating about monkeypox?

Conspiracy theories about monkeypox abound. Monkeypox is not a hoax. Monkeypox is real. Covid vaccines can’t give you monkeypox. Monkeypox was not invented by Bill Gates or pharmaceutical companies. Monkeypox didn’t come from a lab in China or Ukraine. Migrants crossing the U.S.-Mexico border haven’t brought monkeypox into the U.S. Monkeypox isn’t a ploy to allow for mail-in ballots during elections. There is no need for a monkeypox vaccine mandate or lockdowns due to monkeypox.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care

What a Difference 17 Years Made

In Custodia Legis - Tue, 06/28/2022 - 9:23am

The following is a guest post by Alexander Salopek, a collection development specialist in the Collection Services Division of the Law Library of Congress. He previously wrote posts on Marriage Equality in the U.S., Miranda and the Rights of Suspects, Fred Korematsu’s Drive for Justice and Fred Korematsu Winning Justice.

Here is an accounting of two landmark Supreme Court cases that address LGBTQI rights and the rights of an individual to privacy in their home. With only 17 years between them, the court arrived at very different conclusions.

Bowers v. Hardwick

After working at a bar all night preparing for a discotheque being opened by the Cove, a gay bar in Atlanta, Georgia, Michael Hardwick threw a beer bottle into the trash (Murdoch & Price, 278). Keith Torick, an Atlanta police officer, saw Hardwick do that. Torick served Hardwick with a ticket for drinking in public, but Torick completed the ticket in a confusing way (Nussbaum, 77). Because of the confusing way Officer Torick completed the ticket, Torick came to Hardwick’s home to serve him with a warrant (Murdoch & Price, 278). Hardwick was not home however, and after he paid the fine, he believed the matter to be closed (Richards, 78). Weeks later, on August 3, 1982, Officer Torick came back to serve the warrant, but having been let in to Hardwick’s home somehow, found Hardwick in his own bedroom engaging in intimate behavior with another male adult (Richards, 78). The officer arrested Hardwick and his companion, not allowing them privacy to get dressed. Torick booked them making sure everyone at the police station knew the reason for their arrest. He charged them for violating a 1968 Georgia statute (Ga. L. 1968, p. 1249, § 1) making it a crime to engage in sodomy (Eskridge, 233). At this time, the American Civil Liberties Union (ACLU) was reviewing the arrest docket every day to find a test case for Georgia’s sodomy law, and Hardwick’s case looked like an option (Eskridge, 234). Hardwick’s employment working at gay bars wouldn’t be jeopardized by bringing such a case, and unlike most sodomy cases at the time, Michael Hardwick was arrested in the bedroom of his own home (Anderson, 84). After a hearing, Hardwick filed suit claiming the statute violated his right to privacy (Murdoch & Price, 278). The case worked its way to the Supreme Court.

The claim brought to the Supreme Court by Hardwick’s team was that the constitutional right of privacy extended to an individual’s private intimate associations in their own homes (Murdoch & Price, 287). The team defending the statute’s constitutionality focused on the fact that if this law were struck down, all criminal law that dealt with any sort of public decency would also need to be struck down, including coercive sexual behaviors (Richards, 80). Ultimately, the Court ruled against Hardwick, finding that there was no constitutional right to engage in homosexual sodomy. Justice Byron White delivered the opinion of the Court, joined with Chief Justice Burger and Justices Powell, Rehnquist, and O’Connor (Stone, 472). After losing his case, Michael Hardwick worked at creating beautiful fauna and flora decorations for different bars, and became a recluse (Eskridge, 264).

SCOTUS April 2015 LGBTQ 54663, Arguments at the United States Supreme Court for Same-Sex     Marriage on April 28, 2015. [Photo by Flickr user Ted Eytan. Used under CC 2.0 license.]

Lawrence v. Texas

On the night of September 17, 1998, Robert Eubanks placed a false report involving a crazed armed man in an apartment in Houston, Texas (Carpenter, 62). When the police arrived at the apartment, they were unable to locate said person with the gun, and while searching they found themselves intruding in John Lawrence’s bedroom (Law, 16). Accounts differ as to what was happening inside the bedroom, but afterwards John Lawrence and his companion, Tyron Garner, were arrested and charged under the Texas Penal Code Section 21.06, which outlawed sodomy between persons of the same sex (Eskridge, 264). When the charge was being processed it came to attention of the clerk, who happened to be gay. While discussing it at a bar they brought it to the attention of a bartender, who happened to recognize it as something that could be used to challenge Sec. 21.06 of the Texas Penal Code (Carpenter, 117). This bartender, Lane Lewis, was able to get John Lawrence and Tyron Garner excellent legal representation, because of the vested interest of the LGBT community in repealing sodomy laws, essentially legalizing LGBT romantic relationships (Carpenter, 130). After both Lawrence and Garner plead “no contest,” their attorneys filed an appeal that made it to the Supreme Court (Law, 178).

The claim that Lawrence and Garner’s attorneys made was that Equal Protection Clause of the Fourteenth Amendment protected homosexuals from the discriminatory “homosexuals only” sodomy law of Texas, and that the Due Process Clause of the Fourteenth Amendment protected all individuals from “unconstitutional burdens on the basic right of intimate life,” thus Bowers must be overruled and the statute should be struck down (Richards, 145). The State of Texas’s argument defending the statute was that it was passed in the state house, and such laws should be repealed by Texas legislators (Carpenter, 207). On June 26, 2003, the Supreme Court handed down a 6-3 decision written by Justice Kennedy, striking down the Texas statute and overruling Bowers, finding that the Due Process Clause protects individuals’ rights to liberty to express their intimate conduct with another person (Constitution Annotated, Amdt5. Private Sexual Activity, p. 9). Justice O’Connor had a concurring opinion that struck the law down using the Equal Protection Clause, since the Texas statute, unlike the one in Bowers v. Hardwick, applied only to homosexuals. After their case, John Lawrence and Tyron Garner retired to private life, having secured that “private and consensual conduct is within the liberty of all persons to choose without being branded as criminals” (Nussbaum, 87).


Anderson, Ellen Ann. (2006). Out of the Closets and into the Courts: Legal Opportunity Structure and Gay Rights Litigation.

Carpenter, Dale. (2012) Flagrant Conduct: the story of Lawrence v. Texas: how a bedroom arrest decriminalized gay Americans.

Eskridge, William N. (2008) Dishonorable Passions: Sodomy Laws in America 1861-2003.

Law, Janice. (2005) Sex Appealed: was the Supreme Court fooled?

Murdoch, Joyce and Price, Deb. (2001) Courting Justice: gay men and lesbians v. the Supreme Court.

Nussbaum, Martha C. (2010) From Disgust to Humanity: Sexual Orientation and Constitutional Law.

Richards, David A. (2009) The Sodomy Cases: Bowers v. Hardwick and Lawrence v. Texas.

Stone, Geoffrey R. (2017) Sex and the Constitution: Sex, Religion, and Law from America’s Origins to the Twenty-First Century.

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Categories: Research & Litigation

‘American Diagnosis’: Indigenous Advocates Work for Better Reproductive Care

Kaiser Health News - Tue, 06/28/2022 - 5:00am

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Episode 7: Fighting for Reproductive Sovereignty

Rachael Lorenzo works to address reproductive health disparities in Native communities. In 2018, they founded Indigenous Women Rising, a fund that provides financial help for Native people seeking an abortion.

Historically, the federal government has restricted Native people’s reproductive autonomy. Between 1973 and 1976, more than 3,500 Native people were sterilized without their consent.

Today, the chronic underfunding of the Indian Health Service and the remoteness of many reservations create barriers for Native people to access testing for sexually transmitted infections, prenatal care, and contraception.

Lorenzo is determined to fight for their community.

“My people deserve accessible health care, and I will make it happen no matter what, because this is our land,” they said.

Episode 7 explores efforts to protect and expand access to comprehensive reproductive and sexual health care in the face of historical and contemporary efforts of the government to control Native people’s fertility.

Voices from the episode:

Season 4 of “American Diagnosis” is a co-production of KHN and Just Human Productions.

Our Editorial Advisory Board includes Jourdan Bennett-BegayeAlastair Bitsóí, and Bryan Pollard.

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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


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Categories: Health Care

Three-Year Abortion Trends Vary Dramatically by State

Kaiser Health News - Tue, 06/28/2022 - 5:00am

A recent survey from the Guttmacher Institute documented an 8% rise in the number of abortions performed in the U.S. from 2017 to 2020, reversing what had been a nearly three-decade decline in women opting to terminate their pregnancies.

But a closer look at the findings, drawn from a comprehensive survey of every known facility providing abortions in the U.S., reveals wide variation in abortion trends among the states. While 33 states reported a rise in abortion numbers, 17 states reported declines. And the swings up or down are striking.

Among the states that saw the biggest increases: Oklahoma (+103%); Mississippi (+40%); Idaho (+31%); Kentucky (+28%); and New Mexico (+27%). Among the states with the biggest declines: Missouri (-96%); South Dakota (-74%); West Virginia (-31%); Wyoming (-29%); and Louisiana (-26%).

Notably, states such as California and New York, which have pushed to expand abortion funding and services in recent years, saw less dramatic gains of 16% and 5%, respectively.

Guttmacher, a research organization that supports abortion rights, noted that some of the state-level swings were interwoven, as women in states that have enacted laws restricting abortion access crossed into neighboring states to seek care. This is thought to be a driving factor behind the 103% surge in Oklahoma, where women from Texas — a state with some of the nation’s strictest abortion laws — sought care before Oklahoma in May adopted its own ban on nearly all abortions.

The report’s authors cited other factors, as well, including state-level variations in access to government funding for abortion care for low-income women, and regulations issued by the Trump administration that disrupted the nation’s network of Title X family planning clinics, a vital source of low- or no-cost contraception. The Biden administration has since replaced those regulations.

The stark disparities in state abortion trends is expected to magnify in the coming year, following the Supreme Court’s June 24 decision to strike down Roe v. Wade, eliminating the nation’s long-standing federally guaranteed right to abortion and leaving the issue in the hands of state lawmakers.

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


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Categories: Health Care

Sheriffs Who Denounced Colorado’s Red Flag Law Are Now Using It

Kaiser Health News - Tue, 06/28/2022 - 5:00am

Dolores County Sheriff Don Wilson never expected to use Colorado’s red flag law when it was passed in 2019. He thought the law made it too easy to take a person’s guns away.

The statute allows law enforcement officers or private citizens to petition a county court to confiscate firearms temporarily from people who pose an imminent threat to themselves or others.

“All it is is one person’s word against another,” said Wilson, whose sparsely populated territory is in southwestern Colorado near the Utah border.

Then, in August 2020, a Dove Creek man threatening to kill his neighbors and himself pointed a semiautomatic rifle at a deputy. Wilson petitioned for and was granted an extreme risk protection order to remove the man’s weapons, though the sheriff said his mistrust of the red flag law has not changed.

“If a gentleman pulls a rifle on my deputy and then comes and threatens to shoot up my courthouse and kill me, kill the judges, and kill the district attorney,” Wilson said, “I’ve got a problem with that person having a gun.”

The Uvalde, Texas, school shooting prompted a bipartisan gun control agreement in Congress that could provide funding to encourage more states to pass red flag laws. But in response to conservative objections, the bill Congress passed included funding for crisis intervention to states whether or not they establish red flag laws.

Similar opposition was seen in Colorado, where Dolores County and at least 36 other counties declared themselves “Second Amendment sanctuaries” after the red flag law was introduced.

But 2½ years later, those declarations appear to have had little effect on whether protection orders based on the law are filed or enforced. Petitions for protection orders have been filed in 20 of the 37 sanctuary counties, often by the very sheriffs who had previously denounced the law, according to a KHN analysis of the petitions obtained through county-by-county public records requests.

“These are sheriffs and law enforcement who were originally saying, ‘We want nothing to do with this law,’” said Lisa Geller, state affairs adviser for the Johns Hopkins Center for Gun Violence Solutions. “But in practice, they are using it, and this is not something that’s unique to Colorado. Law enforcement ended up realizing, ‘Hey, this is the best tool we have to protect ourselves.’”

Nineteen states and Washington, D.C., have implemented some form of red flag law while, according to the website, more than 62% of U.S. counties are now covered by either state or county Second Amendment sanctuary resolutions.

Research shows red flag laws save lives. Duke University researchers found that for every 10 gun removals, one death is prevented. An analysis from the University of Indianapolis found similar reductions in suicide rates after red flag laws were passed in Connecticut and Indiana.

Another analysis, by researchers with the Injury & Violence Prevention Center at the Colorado School of Public Health, found that in the first year of the Colorado red flag law, 85% of protection orders granted by judges had been filed by law enforcement.

“A lot of that is because the law enforcement petitions may have been more complete,” said Dr. Marian Betz, an epidemiologist and deputy director of the center. “They had the information that judges needed to move forward with it.”

Studies in California, Oregon, and Washington state also found the majority of petitions are filed by law enforcement. Although California’s red flag law has been in effect for more than five years, two-thirds of the Californians in a 2020 survey had never heard of it.

Betz and her team found the same hurdle in Colorado. “I hope there will be some improvement in awareness and education, both for the public and also for law enforcement,” she said, “making it easier for people to understand how they work and when you might want to get one and how you would do that.”

In Colorado counties where sheriffs have declined to use the red flag law, protection orders have been filed by other law enforcement agencies. Weld County Sheriff Steve Reams has been one of the more vocal critics of the law and made national news saying he’d rather go to jail than enforce it. Nonetheless, 12 petitions were filed in Weld County, including two by municipal police departments.

“My stance is still the same,” Reams said. “Under no circumstances am I going to take someone’s guns in violation of their constitutional rights.”

Reams describes the law as “shallow” and doing nothing to address the mental issues that might contribute to violence. “Our goal is to address the person and try to figure out how to get the person the help they need,” he said.

The process for citizens to file extreme risk protection order petitions can be challenging. Many of those reviewed by KHN showed filers didn’t understand the red flag law, including one petition that was filed in the wrong county.

Other petitions filed by citizens were clearly outside the intent of the law.

Prisoners in county jails filed petitions against their sheriff jailers, including one who accused the sheriff of slavery. A Larimer County woman falsely claimed she had a child in common with a police officer in a bid to have his guns taken away.

But judges rejected all those petitions, bolstering supporters’ argument that protections against misuse are built into the law.

“We documented the rare few cases of people misusing the law, but those petitions were not allowed,” said Betz, the Colorado epidemiologist. “That shows that the system worked.”

During the debate over the Colorado bill, opponents argued that the law would allow vindictive people to take guns away from others for no good reason.

“We’re just really not seeing that,” said Boulder County Sheriff Joe Pelle. “What we are seeing is that law enforcement has a tool to use in cases where someone is truly a risk to themselves or others and shouldn’t have a firearm.”

Even before the Colorado law was passed in 2019, Alamosa County’s Board of County Commissioners passed a Second Amendment sanctuary resolution reinforcing the county’s commitment to the right to bear arms. Afterward, Sheriff Robert Jackson issued a statement in support of the resolution, saying the red flag bill lacked due process, didn’t address mental health concerns, and would put his deputies at increased risk.

Since then, Alamosa County judges have granted two petitions under the law, one from the county sheriff’s office and one from the Alamosa Police Department.

Jackson said his concern was over the ability of private citizens to file for protection orders. Law enforcement, he said, files only after looking into the facts.

“Judges sometimes aren’t really good at investigating stuff,” he said.

Douglas County Sheriff Tony Spurlock, one of the most outspoken proponents of the Colorado law, said his office filed four protective orders in the first year of the law.

“Most of the time when we have people who have extreme mental health crises, unfortunately, there’s an outcome of either suicide or homicide,” he said. “The four cases that we’ve done, all four of those individuals are alive today and are productive members of our society and are working toward a healthier life.”

Spurlock said many sheriffs still refuse to make use of a law that’s saved lives. He said he has asked some of them pointed questions about what it means to be a Second Amendment sanctuary, such as whether armed robbers and rapists are entitled to guns.

“Then they get pissed at me,” Spurlock said. “My number of friends is dwindling.”

KHN reporter Jacob Owens contributed to this article.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: Health Care
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