Tagged California

Voices: How Should California Address The Needs Of Its Aging Population?

SACRAMENTO, Calif. — Demographers, gerontologists and government officials are counting down to 2030.

That’s the year America’s youngest baby boomers will reach retirement age.

The country already is feeling the effects of an aging population, but its most populous state is bracing for a hard hit as retirement collides with increasing poverty and the high cost of living. By 2030, an estimated 1 in 5 Californians will be 65 or older, representing a segment of the population growing faster than working-age Californians, according to the Public Policy Institute of California.

“As we grow in the number of older Californians, we actually shrink in the number of younger Californians” who will make up the workforce, Dr. Mark Ghaly, secretary of California’s Health and Human Services agency, said Monday at a forum hosted by The SCAN Foundation, which advocates for the welfare of older adults. (Kaiser Health News, which publishes California Healthline, receives support for its coverage of aging and long-term care issues from The SCAN Foundation.)

“We can’t just wait to watch it happen, but we have to plan ahead.”

The forum revolved around the creation of a statewide Master Plan for Aging, due in October 2020, that is intended to address how California must adapt to the needs of its aging residents. California Gov. Gavin Newsom issued an executive order in June calling for the plan, which would coordinate and improve the confusing web of existing programs — and create more, if necessary.

The committee that will formulate the master plan was set to meet for the first time Tuesday in Sacramento. The meeting is open to the public.

Newsom’s call for a master plan follows the lead of four other states — Colorado, Connecticut, Minnesota and Washington — which have published similar plans, according to The SCAN Foundation. All document the changes needed in every aspect of daily life, from finances to transportation, to help aging people remain as active, mobile and independent as possible.

Dr. Bruce Chernof (Anna Almendrala/KHN)

“The states that have something that looks like a master plan, or strategic plan around aging, perform better” on measures of long-term care services, said Dr. Bruce Chernof, president and CEO of the foundation.

This may be because states with master plans tend to measure how their programs are improving the lives of older adults and their families, which means local and state governments are more accountable when they invest public money, Chernof said.

California Healthline interviewed state and local officials, researchers, advocates and older adults who attended Monday’s forum to ask what they’d like to see in the master plan.

A key issue for several participants was California’s affordable housing crisis.

Jerome McIntosh (Anna Almendrala/KHN)

Oakland resident Jerome McIntosh, 62, went on disability three years ago after suffering a massive heart attack. He survives on $1,070 a month, and lives with eight other people in a transitional home for seniors operated by St. Mary’s Center in Oakland. McIntosh is looking for an affordable place of his own that costs about one-third of his income. But in the past year, he has received only one callback on an apartment application. The monthly rent was $1,065.

“Housing is about the hardest thing,” McIntosh said. “Right now I’m in a transitional house, but I’m still homeless.”

Janny Castillo is an organizer and program coordinator at St. Mary’s Center, which serves about 1,000 low-income seniors in Oakland, including some who are homeless. Many of them, like McIntosh, get by on about $1,000 a month, which makes it almost impossible to afford housing in the Bay Area, Castillo said. She believes rent subsidies could help solve the problem.

Janny Castillo (Anna Almendrala/KHN)

“One of the things that is really critical right now is to address the seniors that are living outside,” Castillo said. “We’re losing them earlier than we need to, because of how hard it is to live outside.”

Even Californians who aren’t at risk of homelessness may not be able to remain in their homes if they get sick.

Almost one-third of seniors in the U.S. have nothing saved for retirement, while two-thirds of baby boomers are carrying an average of about $110,000 in credit card, student loan or mortgage debt, according to the Stanford Center on Longevity.

If Californians don’t qualify for Medi-Cal, the state’s Medicaid program for low-income people, which funds some in-home care for eligible people, the high cost of in-home care falls on individuals and their families, said Lorna Van Ackeren, a marketing and community liaison at Hillendale Home Care, which hires out state licensed caregivers.

The business pays caregivers $15.50 to $19 per hour, based on experience, Van Ackeren said.

Lorna Van Ackeren (Anna Almendrala/KHN)

“But we charge the families $31 an hour, so it’s a real problem,” she said. The difference covers the agency’s legal obligations, such as maintaining their state licenses and insurance.

“It would be nice to have some kind of assistance for the middle class,” she said.

By 2030, more than 1 million seniors in California will require some in-home help, and more than 100,000 will need to live in a nursing home, according to the Public Policy Institute of California.

A severe labor shortage for caregivers also looms. By 2030, California will need as many as 3.2 million additional workers to care for seniors at home.

Richard Figueroa (Ana B. Ibarra/KHN)

Richard Figueroa, a deputy Cabinet secretary in Newsom’s administration, said the governor wants the plan to include recommendations on how to help people age at home. “What can we do to help people stay in their homes as long as they can? Because there will be more and more folks in that situation, and our services and programs and opportunities are going to have to adapt to that,” he said.

California already has services for its aging population, but “people need to be able to navigate the system more easily without jumping through hoops,” said Christina Mills, executive director of the California Foundation for Independent Living Centers.

Christina Mills (Ana B. Ibarra/KHN)

“Increasing the number of aging and disability resource centers across the state of California” could help, she said. “There are currently about eight, but there’s potential to be about 30,” she said.

State Assemblyman Joaquin Arambula (D-Fresno) said the needs of older Californians differ by region and cultural background. “I’d like to make sure that the needs and wishes of our immigrant and rural communities are taken care of,” he said. “We need to be both culturally and linguistically sensitive to the needs of various communities. We should make sure the surveys we are doing are reaching all communities and in languages they can understand.”

Joaquin Arambula (Ana B. Ibarra/KHN)

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Longtime Crusader Against OxyContin Begins To See The Fruits Of Her Struggle

In the 15 years since she lost her son to a single OxyContin pill, Barbara Van Rooyan has had but one up-close look at the people representing the company that made it.

It was in a small courthouse in Abingdon, Va., where Van Rooyan and other relatives of OxyContin victims gathered for a sentencing hearing in 2007. Three executives of Purdue Pharma had pleaded guilty to federal charges related to their misbranding and marketing of the powerful opioid. The company had pleaded guilty as well.

Van Rooyan and the others in her group spoke during the sentencing, giving voice to their grief and their pain. They wanted the executives sent to jail for knowingly expanding an opioid crisis fast engulfing the country.

Instead, Purdue paid fines totaling $634 million. The executives served no time. The company was allowed to continue aggressively marketing its product, and the following year, sales of OxyContin reached $2 billion.

From 1999 to 2017, more than 700,000 people in the U.S. died of drug overdoses, according to the Centers for Disease Control and Prevention. In 2017, nearly 68% of the more than 70,000 recorded overdose deaths involved opioids.

“I never really thought a whole lot about evil before this all happened,” Van Rooyan said recently, seated on a couch in the living room of her Irvine, Calif., home. “But to see this kind of malevolence or disregard for human life — I don’t know what else to call it but evil.”

The outcome in that Virginia courthouse was a far cry from last week’s news of a tentative mass settlement of many of the 2,000-plus lawsuits against the company, which could total upward of $12 billion and result in Purdue’s dissolution.

The potential settlement amount would include $3 billion from the Sackler family, owners of Purdue, whose fortune is estimated at $13 billion. The family has amassed that money over the past two decades, largely by selling OxyContin, an opioid painkiller.

Van Rooyan’s Purdue experience is a story of deception, sadness and frustration — yet when she tells it now, she emits a surprising spark of energy. That’s because Van Rooyan, part of the unlikely group of citizens who repeatedly took flailing swings at Purdue Pharma, is watching the giant fall.

Van Rooyan, who has studied the cases against Purdue closely, sees the paradox in the proffered settlement: Much of the payout would be financed by profits from the continued sale of OxyContin, under a new company that would be formed following a Chapter 11 bankruptcy.

Van Rooyan says she treasures this photo of herself holding son Patrick shortly after he was born.  (Ana Venegas for KHN)

But in some regard, she said, Purdue Pharma’s complicity in the opioid crisis has finally emerged into the general public’s view. “The world really knows now. They get it,” she said. “The lid is off, and all this stuff is bubbling out.”

That wasn’t the case on the night of July 4, 2004, when Van Rooyan and her husband, Kirk, got the call that changed their world. Barbara, then a professor of counseling at Folsom Lake College near Sacramento, was told that her son, Patrick Stewart, lay in a San Diego hospital, in a medically induced coma from which he was unlikely to emerge.

Patrick, a graduate of Oak Ridge High School in El Dorado Hills, Calif., and San Diego State University, died at age 24. His friends told Barbara they had attended an Independence Day party at which someone offered her son an OxyContin pill, telling him it “was kind of like a muscle relaxant and it was FDA approved, so it was safe,” she said. Patrick, who had also consumed a couple of beers, was opioid intolerant and suffered respiratory failure in his sleep.

“At the time,” Van Rooyan said, “all I knew about Oxy was that Rush Limbaugh had been addicted to it.”

She was about to learn a lot more.

Van Rooyan channeled her grief through intense research into Oxy’s vast potential for damage despite the company’s sales pitches to the contrary. A slow-release pain treatment with a heavy dose of the narcotic oxycodone, it could be easily crushed or dissolved for a more intense and addictive high. Rampant abuse already had begun to be reported, particularly in the Appalachian area, author Beth Macy wrote in her national bestseller “Dopesick.”

Later in 2004, Van Rooyan found Ed Bisch, a Philadelphia man who had begun a website to expose Oxy abuse in the wake of his teenage son’s death. The following year, Van Rooyan and her husband, a plastic surgeon, petitioned the Food and Drug Administration to require that OxyContin be made more abuse-resistant, and that its use be strictly limited to severe pain.

“This was an exhausting process, which she and Kirk did as a labor of love to try to save others,” Bisch recalled.

Van Rooyan became the California arm of a grassroots movement known as RAPP — Relatives Against Purdue Pharma. The group, originally just four in number, protested at physician meetings funded by pharmaceutical companies and testified before Congress. Van Rooyan enlisted the help of U.S. Sen. Dianne Feinstein (D-Calif.), who wrote the FDA on her behalf and later sent Van Rooyan a letter of commendation.

In the 15 years since she lost her son, Van Rooyan has since channeled her grief into intense research about Oxy’s vast potential for damage and has become one of the trailblazers of the anti-OxyContin movement.  (Ana Venegas for KHN)

But most members of Congress did not reply to Van Rooyan’s letters, she said. The FDA said its review needed more time — which turned out to be eight years. By then, Purdue already had reformulated OxyContin to make it more abuse resistant and to renew its patent, but the FDA declined to restrict its use to managing severe pain.

Van Rooyan pressed on, but for a long while, the opioid crisis felt to her like a topic hiding in plain sight. And fighting Purdue while still grieving the loss of son Patrick was taking a toll.

“Her determination was tireless,” Bisch said, “but eventually the frustration burned us out.”

And then came the turn.

A rash of high-profile opioid overdoses and deaths, from actor Heath Ledger to Tom Petty to Prince, put the topic squarely in the public eye — and 15 years after the death of Van Rooyan’s son, Purdue Pharma and other drugmakers were suddenly on the run.

Van Rooyan tracks every development related to Purdue, including a lawsuit in New York that alleges members of the Sackler family have been offloading their fortunes into private or offshore accounts to shield them from a settlement.

But she’s not out for vengeance. Her goals have changed.

“Do I want the records to be public? Do I want these people to have their business shut down? Yes, I do,” she said. “But more than vindictiveness, I want that money of theirs to go to treatment and rehab. If that happens, something good can come out of it.”

Van Rooyan touches a painting she co-created with artist Nick Simon in memory of Patrick. She says art is part of what saved her in the aftermath of her son’s death.  (Ana Venegas for KHN)

If she has a regret, it is that the case in Virginia ended in 2007 with no more than a fine. “If that result had been different — if people had gone to jail — it could have changed the trajectory of this,” she said.

But momentum finally appears to be gathering, and Van Rooyan finds herself identified as one of the trailblazers of the anti-OxyContin movement. She spends little time dwelling on that. Instead, she quotes her younger son, Andrew, who told her, “We didn’t want any of this — this is just the hand we were dealt. We need to play the cards the best we can.”

“She’s just a really strong person,” said Kirk Van Rooyan, who has been with Barbara throughout the ordeal, though he is not Patrick’s biological father. “There have been times when I’d think to myself, ‘How would I be doing if I were in her shoes?’ And the answer usually is, ‘Not as well as she’s doing.’”

Van Rooyan, a longtime artist, now spends much of her time volunteering with veterans in Orange County, Calif., helping them get back into the workforce and using art therapy to help them express themselves.

The art is special to Van Rooyan, she said, because it is part of what saved her in the aftermath of her son’s death.

“Patrick was the one who suggested I take my first class,” she said. After a few delays, she finally enrolled. It was about a month before that Fourth of July in 2004.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Purveyors Of Black-Market Pharmaceuticals Target Immigrants

The bootleg medications were smuggled across the border and sold to mostly Latino immigrants in public spaces throughout Los Angeles — at swap meets, parks, beauty salons and makeshift stands outside mom-and-pop grocery stores.

The drugs were cheap, and the customers — mostly from Mexico and Central America — did not need prescriptions to buy them. Some of the products featured brand names and colorful packaging that immigrants knew well from their home countries — including Ciprofloxacina, a potent antibiotic, and Dolo Nervi Doce — translated as “Pain Nerve 12” — an injectable B-complex vitamin taken for fatigue.

Many were sheer counterfeits. Others, though legal south of the border, were not approved for sale in the United States. Some had expired. Still others would have been legal if sold by people licensed to do so — but none of the sellers held pharmacist licenses or any other medical credential.

L.A. County authorities seized the drugs last month in an operation that led to the arrest of eight people. Their haul included 100,000 foreign-made pills, compounds and injectable medicines they said could have caused serious harm or even death to consumers.

Immigrants, not just from Hispanic countries but from all over the world — and some non-immigrants too — are purchasing a wide array of illegal medications in black markets that are common not only in Southern California but in states such as Arizona, Maryland, Texas, Virginia and Washington, according to law enforcement officials and others familiar with the trade.

“We’re seeing this in all communities across the country that don’t have access to health care services,” said Adolph Falcon, executive vice president of the Washington, D.C.-based National Alliance for Hispanic Health, which provides information and health-related assistance to Hispanic communities nationwide. “These products prey on the desperation of people who can’t afford to see a doctor or go to a legitimate pharmacy.”

The current political climate in the U.S. is also pushing some immigrants to the black market, doctors and researchers say.

“Many patients are afraid they’ll be deported if they come into our clinics, so they buy from the street, said Dr. Anjali Mahoney, the Orange County, Calif., regional medical director for AltaMed Health Services, a large chain of federally funded community clinics whose patients are primarily Latino.

“People are paying for something that doesn’t work and could even harm them, when they could have just as easily come to a clinic and get safe care with a doctor,” Mahoney said.

She added that every one of AltaMed’s 23 clinics in Southern California has reported problems with off-the-street medications. One Latina woman was hospitalized after taking an opiate advertised as blood pressure medicine, she noted.

These dubious products targeted by law enforcement are different from the legitimate prescription pharmaceuticals imported for personal use every year by millions of U.S. residents who cross the border into Canada and Mexico or use licensed online pharmacies abroad to buy their medications at a fraction of the price they would pay in this country.

Although those imports are also technically illegal, guidelines from the Food and Drug Administration allow federal agents to take a hands-off approach.

That’s not the case with wares peddled on the streets by often unscrupulous operators.

“Counterfeit medicines may contain the wrong ingredients, contain too little, too much or no active ingredient at all — or contain other, potentially life-threatening hidden ingredients,” said Jeremy Kahn, an FDA spokesman.

Drug companies and pharmacies also have an interest in disrupting the distribution of such medications. The nationwide value of this pharmaceutical black market is difficult to gauge, but it may displace billions of dollars’ worth of legally approved medicine, said Roger Bate, an economist at the American Enterprise Institute and author of the book “Phake: The Deadly World of Falsified and Substandard Medicines.”

Between October 2017 and July 2018, FDA officials confiscated nearly 22,000 packages containing illegal pharmaceuticals from international mail facilities, Kahn said. He said authorities routinely impound various opioids as well as dietary supplements laced with erectile dysfunction drugs and other dubious products. They come from India, China and across Europe — “just about everywhere,” Kahn said.

The medications seized by the FDA are just the tip of the iceberg. The agency estimates it is able inspect fewer than 0.2% of the packages sent via international mail that are believed to contain drugs. And many illicit products arrive not through the mail but in suitcases, cars, trucks or cargo ships, authorities say.

The purveyors of these “dodgy medicines” are “myriad and global,” including Chinese and Indian manufacturers, Russian mobsters, Mexican gangs and domestic U.S. groups, said Bate. “There are charlatans and odious actors who don’t mind if their product kills children, adults or breadwinners of entire families.”

Nationwide, many local police departments lack the resources or mandate to investigate sales of illicit pharmaceuticals; otherwise, the number of arrests would probably be much higher, public and industry officials say.

“Not enough attention is paid to this issue,” said Jon Roth, CEO of the California Pharmacists Association. “It’s probably largely operating in the dark shadows of every community. If we put the resources there, we’d see how wide it is.”

L.A. County is one jurisdiction paying attention. In 1999, it formed the Health Authority Law Enforcement Task Force (HALT), after two Latino infants died from taking illegal medications. HALT is the group that made the August arrests.

So far this year, it has arrested 34 people in 54 cases, 48 of them involving illegal pharmaceuticals sold to immigrants, said Erick Aguilar, one of the investigators.

Illegal pharmaceuticals are being sold to immigrants in “every rural swap meet you can find,” and the sellers are becoming more sophisticated, Aguilar said. “They’re better at hiding it,” and “they’re more careful who they sell to.”

In February 2019, three men – two in Southern California and one from Salem, Ore. – pleaded guilty to the illegal importation and sale of $11 million worth of pharmaceutical-grade erectile dysfunction drugs falsely marketed across the U.S. as herbal remedies for men. One of the perpetrators imported from China powdered tadalafil, the active ingredient in Cialis, and used it to make 5.5 million pills with up to 14 times the level contained in Cialis, according to the FDA.

In 2017 and 2018, the Phoenix police department’s organized-crime commercial unit raided 30 pharmacies in Latino neighborhoods, confiscating “millions of dosages of illegal medicines, some of them outdated by 15 years,” said Detective Sgt. David Lake, who led the unit.

But not all the sellers were members of organized crime. Lake recalled one woman who genuinely believed she was doing something positive for her community by distributing black-market birth control pills.

“She said local girls were having too many babies, and she wanted to help them, but the babies kept being born,” Lake recalled. “When I told her the drugs were counterfeit, she cried for a half-hour straight.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Vaping By The Numbers

The explosive rise in a serious lung illness linked to vaping spotlights the popularity of e-cigarettes among teens and young adults — and how little is known about the devices’ safety and use.

As of Tuesday, federal health officials were investigating at least 450 possible cases of the mysterious pulmonary illness across 33 states, including six cases that resulted in death. California has reported nearly 60 cases of lung illness since late June in patients with a history of vaping; one of those patients, in Los Angeles County, has died.

Vaping has surged in the past two years, particularly among teenagers and young adults. More than 20% of high school students reported vaping in 2018 — almost twice the 2017 rate — according to the federal Centers for Disease Control and Prevention. That translates to 3 million high school students using e-cigarettes in 2018 — well more than double the number who reported using traditional cigarettes.

Vaping is the popular shorthand for using electronic cigarettes to “vaporize” nicotine or an array of liquid concentrates. The devices initially were marketed as a way to inhale nicotine without the risks associated with burning tobacco. But they quickly evolved for use with hundreds of combinations of flavorings and chemical compounds, including THC, the psychoactive ingredient in marijuana, and other marijuana extracts.

Federal and state investigators say many of the people who have fallen ill said they had vaped THC, and officials are focusing on contaminants in black-market products containing THC as possible culprits. Other patients reported using nicotine cartridges, and authorities stress that they have yet to identify a specific device or chemical at play. For now, officials are warning people of all ages to avoid e-cigarettes, particularly products purchased on the street.

Vaping is now so pervasive among high school students that federal health officials say its use has fueled a sharp reversal in what had been a celebrated two-decade decline in overall tobacco use by teenagers. As of 2018, the CDC’s National Youth Tobacco Survey showed overall tobacco usage among high schoolers had reverted to levels not seen since 2004. Though marketed as a healthy alternative to traditional cigarettes, e-cigarettes can contain substantial levels of nicotine, which is highly addictive.

Juul, the San Francisco-based company that dominates the e-cigarette trade, and other manufacturers publicly market their devices as a tool to help adults quit smoking. But government surveys show the sleek devices — and multitude of copycat products — are far more popular among high school students than adults. While the legal age to buy e-cigarettes is 18 in most states — and 21 in California — the products are widely available online and not all sellers require proof of age. And vaping kits now come in the form of pens, flash drives, key fobs, even watches — making them both stylish and easy to disguise.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

California Hospitals And Nursing Homes Brace For Wildfire Blackouts

California has seen a relatively slow start to this year’s wildfire season, but Wanda Chaney still frets every time it’s hot and windy in Chico, a college town about two hours north of Sacramento. She’s far less worried about an actual wildfire than the power company shutting off her electricity to prevent one.

Chaney, 70, uses an oxygen machine at her apartment to treat chronic obstructive pulmonary disease, a lung disorder that makes it difficult to breathe.

“I can’t afford a generator,” Chaney said. “I’d probably end up going to the hospital if my electricity was cut off. There are people here on breathing machines; we got people who’ve got all kinds of medical problems who are scared to death if we lose power.”

In a controversial move approved by state regulators, Pacific Gas & Electric, which provides power to 16 million people in Northern and Central California, plans to be more aggressive in cutting power to broad regions of the state when the chance of wildfire is high. The utility — now in bankruptcy proceedings and facing billions of dollars in legal claims because of the role its equipment and power lines have played in a spate of deadly California wildfires — says it must limit risk to protect customers from fire.

The utility says it will try to provide 48 hours’ notice before the blackouts — which could span hours or days — and has launched a website where customers can check whether their community might be affected. California’s two other major investor-owned utilities, Southern California Edison and San Diego Gas & Electric, have adopted similar programs.

A PG&E shutoff over two days in June affected 22,000 Northern California customers across five counties. Hospitals in the region were not affected. But the potential for multiple prolonged shutoffs has prompted new disaster preparations by hospitals, nursing homes and home care providers charged with protecting the health of medically fragile patients.

Utility executives have broad discretion in ordering blackouts when forecasts call for extreme heat, high winds and low humidity in areas at risk of wildfire. Legislation introduced this month by state Sen. Scott Wiener (D-San Francisco) would use fines and other financial penalties to create an incentive for utilities to minimize the use of blackouts.

Jeff Smith, a PG&E spokesman, said the utility is doing “extensive outreach” to alert customers to potential shutoffs, particularly for its nearly 197,000 “medical baseline” customers who receive discounts because their health conditions require extra power, such as for a ventilator or home dialysis machine. The utility will try to reach those customers via phone, email or text, and even knock on doors if they don’t respond, Smith said.

Wanda Chaney uses an oxygen machine at home to treat chronic obstructive pulmonary disease and worries about losing her electricity if it’s shut off to prevent the spread of wildfires. (Courtesy of Wanda Chaney)

Bill Seguine, facilities management director for the 298-bed Enloe Medical Center in Chico, said the main hospital wasn’t affected during the June shutoff, but that power to an outpatient clinic was cut. Fortunately, he said, it was on a weekend when the clinic was closed.

The medical center’s subsequent emergency drill focused on power outages. Staff learned valuable lessons, Seguine said, including the need for a generator-powered office where they can quickly access online medical records and contact patients to reschedule surgeries or office visits. The hospital also arranged for PG&E to notify staff about power shutoffs in outpatient offices it leases; ordinarily, the utility would notify only a building’s owner.

Hospitals and nursing homes are required by law to maintain backup generators for critical functions. If the power goes out, hospitals can finish surgeries using generator power but can’t start new ones, Seguine said. That means during an outage some trauma patients may need to be transferred to hospitals outside the shutoff zone.

Both PG&E and health providers learned from the June shutoff, Seguine said. “It was new for them, so it was not the smoothest functioning thing,” Seguine said. “They’re making calls with very sketchy data 48 hours ahead. As conditions change, they’ll turn off more or less power, as the situation dictates.”

Seguine worries most about the potential burden on hospitals from patients like Wanda Chaney, who said she would go to her local ER to run her oxygen machine in the event of a shutoff.

“That is our No. 1 fear — that people in our community will come to us, when all they really need is power. If I’m inundated with people who just need to be plugged in or have health problems just because they lost power, it creates a second disaster,” he said. “They may not have family they can run to. What are they supposed to do?”

PG&E is working with Chico officials to set up a generator-powered center where patients with oxygen machines or ventilators could go to recharge and use their equipment.

Nursing home operators remain concerned about their ability to keep residents cool and food at safe temperatures during a power outage. Skilled nursing facilities in California are required to maintain generators for critical medical needs, but some homes do not have air conditioning or refrigerators connected to backup power, said Jason Belden, disaster preparedness manager for the California Association of Health Facilities, a nursing home trade group.

In the event of a shutoff, nursing homes have to weigh the risks of staying put versus evacuating their residents, some of whom may be cognitively impaired. The association has asked PG&E to make extra generators or other options available to nursing homes, Belden said, but that has yet to happen.

“Long-term care residents don’t traditionally do well in evacuations, especially those with dementia,” Belden said. “Nobody is considering how dangerous this could potentially be for residents.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Protesters Swarm Calif. Capitol In Last-Ditch Effort To Stop Governor From Signing Controversial Vaccination Bill

But despite some 11th-hour hesitations over the past week, Gov. Gavin Newsom signed the legislation cracking down on medical exemptions into law. Protesters forced delays in both the Assembly and Senate. They unfurled an upside-down American flag from the Senate’s public gallery in a traditional signal of distress and chanted “My kids, my choice” and “We will not comply.”

California Lawmakers Send Contested Vaccine Bill To Governor. Will He Sign It?

California lawmakers dropped this year’s most controversial public health bill into Gov. Gavin Newsom’s lap on Wednesday, but it’s not clear whether he will sign the measure, which would tighten the rules for exempting children from routine vaccinations.

The state Senate voted 28-11 to approve SB-276 by state Sen. Richard Pan (D-Sacramento), prompting protesters who were watching from the gallery to chant, “You are not representing California for all!” All Senate Republicans voted against the measure and all Democrats voted in favor, except for one who didn’t vote.

Newsom, a Democrat, said in June he would sign the bill after it had been amended at his request. But on Tuesday, a tweet from his office announced that he wants more changes.

Pan said he’s open to working with Newsom, but “this is the bill that the Governor’s office agreed to and said that they would commit to sign.”

As passed, the bill would give public health officials the authority to review vaccination exemptions issued by doctors and revoke any they deemed “inappropriate” or “invalid.” It is intended to curb what has been described by public health experts as a dangerous increase in questionable medical exemptions.

Previous amendments requested by the governor broadened the eligibility for children’s medical exemptions from vaccines and narrowed the circumstances under which state public health officials could review those exemptions.

Under that version of the legislation — the one passed by lawmakers Wednesday — the state Department of Public Health would automatically review exemptions for children at schools where more than 5% of students weren’t immunized, and from doctors who had written more than five medical exemptions in a calendar year.

Parents would be able to appeal rejected exemptions to an independent panel appointed by the secretary of California’s Health and Human Services Agency.

The changes Newsom now wants to make include clarifying that a doctor’s previous medical exemptions wouldn’t be considered by state officials; the state wouldn’t start counting them until the bill takes effect Jan. 1, his office said.

Newsom also wants to remove a provision that would require doctors to certify under penalty of perjury that their exemptions are accurate. And he is requesting that, in order to protect patients’ medical information, the legislation specify that exemption forms would not be accessible through the Public Records Act.

Additional amendments would be made in separate legislation that would have to be approved by the legislature before its Sept. 13 end-of-session deadline.

Vaccines have become an explosive topic in the legislature and around the country, even as numerous studies show they are safe and effective and complications are rare.

The debate over vaccines comes amid the biggest measles outbreak since 1992: More than 1,230 people have contracted measles nationally so far this year, including 67 confirmed cases in California.

Opposition to Pan’s bill has engendered raucous rallies outside the Capitol, aggressive and coordinated social media campaigns and disruptions of committee hearings by chanting and crying vaccine skeptics. Last month, Pan, who has faced numerous threats for carrying the bill, was pushed from behind by a man who confronted him about the ingredients in vaccines.

“Anti-vaxxers have attempted to dehumanize me and other public health advocates on social media while making death threats,” Pan said in a statement after the incident.

Vaccine skeptics argue that the bill is a form of government overreach and that the state’s ability to revoke medical exemptions would disrupt the patient-doctor relationship.

California already has some of the strictest vaccine laws in the country under a measure implemented in 2016 that banned vaccine exemptions based on religious and personal beliefs. Under that law, children can be exempted only on medical grounds, and those who don’t have their shots or a doctor’s exemption are barred from attending schools.

Since the law took effect, the number of medical exemptions has jumped, and they are clustered in many of the same parts of the state that previously had high rates of religious or personal belief exemptions, according to state data. Around the state, 117 schools reported that 10% or more of their kindergartners had been granted medical exemptions in the 2018-19 school year.

Exemptions should be rare, according to the Centers for Disease Control and Prevention. They are typically reserved for children with severely compromised immune systems, such as those being treated for cancer or those who are allergic to a vaccine component or have previously had a severe reaction to a vaccine.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Sweetgreen Makes Healthful Fast Food — But Can You Afford It?


Employees work the line at Sweetgreen, a chain restaurant that uses fresh ingredients from local farms to make fast food healthier, in Berkeley, Calif.

Employees work the line at Sweetgreen, a chain restaurant that uses fresh ingredients from local farms to make fast food healthier, in Berkeley, Calif.Credit Jason Henry for The New York Times

Healthful, fast and affordable food is the holy grail of the public health and nutrition community. A popular restaurant chain shows just how much of a challenge that is.

It began when three Georgetown University students were frustrated that they could not find a healthy fast-food restaurant near their campus. With money raised from family and friends, they started their own, renting a small storefront on M Street in Georgetown. The result was Sweetgreen, a restaurant that offered organic salads, wraps and frozen yogurt. Pretty soon, the daily line of lunchtime customers stretched out the door and around the corner.

Ten years later, the line is still there, but Sweetgreen has grown into a nationwide salad chain, with more than 40 locations. Sweetgreen is part of a small but growing breed of farm-to-table fast-food chains – like Chopt Creative Salad Company on the East Coast and Tender Greens in California – that are giving fast-food restaurants a plant-based makeover. Their mission: to fix fast food, which has long been fattening and heavily processed.


At Sweetgreen, fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site.

At Sweetgreen, fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site.Credit Jason Henry for The New York Times

Sweetgreen’s owners say their goal is to offer customers foods made with nutritious, sustainable and locally grown ingredients. The company has decentralized its food sourcing and production. Fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site. They don’t sell soda or use refined sugar.
Sweetgreen expects to open another 20 stores in major cities around the country this year, and eventually to expand to places where experts say healthy, delicious fast food is needed most — low-income neighborhoods.

But while the chain has proven there is a big appetite for more healthful fast food, the goal of taking this concept to poor areas may be a distant reality. The company and other chains like it operate almost exclusively in affluent communities, far from the low-income food deserts where obesity is rampant and farmers’ markets and healthy food stores are scarce. And with salads that typically cost between $9 and $14, some question whether a healthful fast-food chain like Sweetgreen can ever be affordable for average Americans.

Maegan George, a Columbia University student who lives near a Sweetgreen, calculated that for the price of one Sweetgreen salad, she could buy the same ingredients in bulk at a local market and make several similar salads at home.

“I’m a first-generation student and I’m on full financial aid,” she said. “Sweetgreen is delicious and I enjoy it. But there’s no way I could afford to eat there on a regular basis.”

Jackie Hajdenberg, another Columbia student, wrote about the restaurant for the campus newspaper, The Spectator, earlier this year, lamenting that on a per calorie basis, a salad at Sweetgreen was three times the price of a Big Mac at McDonald’s.

“Sweetgreen has not only made it easier for people to make healthy decisions – it has also illustrated the unequal socioeconomic landscape of the world in which we live,” she wrote.


Salad options at Sweetgreen change often, depending on what is available at local farms.

Salad options at Sweetgreen change often, depending on what is available at local farms.Credit Jason Henry for The New York Times

Sweetgreen says it prices its food so that it can compensate its suppliers and employees fairly, and that it expects nutritious fast food to become more affordable as the healthy food movement grows. Nicolas Jammet, a co-founder of Sweetgreen, said the company wants to serve lower-income customers, and has long-term plans to expand to low-income communities.

To get there, he said, the company will have to overcome hurdles involving its supply chain, the minimum wage and greater nutrition awareness and education among the public. For the past six years the company has been running a nutrition education program in schools that teaches children about healthier eating and locally grown food.

“It’s a long-term goal for us to be part of this larger systematic change that needs to happen,” he said. “But there are so many parts of this problem that need to be addressed.”

Mr. Jammet notes that the company was among the first to show that fast-food chains don’t need profits from soda and sugary drinks to succeed. He believes chains like Sweetgreen have caused a ripple effect throughout the fast-food industry.

In January, for example, Chick-fil-A unveiled a new kale, broccolini and nut “superfood” salad, responding to customer demands for “new tastes and healthier ways to eat in our restaurants.” McDonald’s is experimenting with kale salads, and Wendy’s is testing a spinach, chicken and quinoa salad.

“Companies like McDonald’s have more power to change the way that people eat than we do,” Mr. Jammet said. “We don’t see these companies as the enemy. We just have to force change on them.”

Public health experts say that such changes cannot come soon enough. A University of Toronto study recently showed that people have a higher risk of developing diabetes if they live in “food swamps” – an area with three or more fast-food restaurants and no healthy dining options.

Another study published in JAMA in June found that the percentage of Americans eating an unhealthy diet — high in sugar, refined grains, soft drinks and processed foods and low in fruits and vegetables — was on the decline, but the improvements in diet were much smaller for lower-income Americans.


Customers wait in line at Sweetgreen in Berkeley, Calif.

Customers wait in line at Sweetgreen in Berkeley, Calif.Credit Jason Henry for The New York Times

Overall about twice as many people from poor households have poor diets compared to those at higher income levels.
Why is traditional fast food so cheap? One reason is the underlying infrastructure of the industry. Many of the ingredients, like the soy that’s turned into oil for deep fryers, or the the corn that’s fed to animals and used to make high-fructose corn syrup, begin with crops that are heavily subsidized by the government. To make their food economical, many traditional fast-food chains mass-produce their food in large factories, often stripping it of fiber and other nutrients that decrease its shelf life, while adding salt, sugar and other flavorings and preservatives.

Then they freeze and ship the processed components, like burger patties, bread, pickles and sauce, to their restaurants. There they are reheated and assembled, often with minimal effort, ensuring that a Big Mac in Seattle looks and tastes the same as a Big Mac in Charlotte, N.C.

By comparison, every Sweetgreen location has a chalkboard that lists the farms where its organic arugula, peaches, yogurt or blueberries are produced. As a result, the menus vary by location and by season. In Boston, Sweetgreen stores use New England Hubbard squash. In Los Angeles, the menu features a different variety of squash grown locally in California.

Those differences mean fresher, more nutritious ingredients, but ultimately costlier food for customers — one of the obstacles that Sweetgreen and other chains like it will have to overcome if they hope to make their food more accessible to all income brackets.
Marion Nestle, a professor of nutrition, food studies and public health at New York University and the author of “Food Politics,’’ says restaurants like Sweetgreen offer an encouraging, but imperfect, model for making fast food more healthful.

“What’s not to like?” she asks. “The cost, maybe, but for people who can afford it the quality is worth it. Next step: Moving the concept into low-income areas.”