Tag: Colorado

This State Isn’t Waiting for Biden To Negotiate Drug Prices

As the federal government negotiates with drugmakers to lower the price of 10 expensive drugs for Medicare patients, impatient legislators in some states are trying to go even further. Leading the pack is Colorado, where a new Prescription Drug Affordability Review Board is set to recommend an “upper payment limit” for drugs it deems unaffordable.

In late February the board selected Enbrel, Amgen’s blockbuster drug for autoimmune conditions (list price $1,850 per week), as the first medication that would go through its processNovartis’s Cosentyx and Johnson & Johnson’s Stelara (both treat autoimmune conditions) will undergo affordability reviews later this year.

Enbrel and Stelara are also on the list of drugs whose prices the federal government is negotiating — but only for Medicare patients. Prices may be published Sept. 1 — in time for President Biden to cheer the results in his reelection campaign. But they won’t take effect until 2026, while the drug industry pursues a raft of lawsuits to stop the initiative.

Colorado’s plan is, in many ways, both broader and more prescriptive than the feds’, covering all patients and potentially fixing an upper price limit rather than squabbling with the industry over an acceptable figure.

Colorado’s government said it anticipates similar litigation. A spokesperson for the state’s Division of Insurance, which oversees the program, declined to make anyone available for an interview.

The Pharmaceutical Research and Manufacturers of America, the industry’s main trade group, said in a blog post: “Policymakers in Colorado have created a system in which patients may face significant barriers to lifesaving medicines because of government price setting.”

The state has already said 604 drugs met the first criteria to undergo an affordability review. The full list of drugs is linked from the board’s webpage, along with a list — in order — of those it has slated for priority review.

The Colorado board will spend the summer setting upper payment levels for drugs selected for price reviews. Drugmakers can then appeal.

The board plans to examine how manufacturers price — and raise prices — for drugs. For generics, the board’s director, Lila Cummings, said at a Feb. 23 meeting, the criteria could include whether the price paid by wholesalers before discounts has increased at least 200 percent in the past year and whether a 30-day supply costs more than $100. Branded drugs that cost more than $30,000 a year or whose wholesale price has increased at least 10 percent in the past year could land in the board’s sights, as could biosimilars that aren’t at least 15 percent cheaper than the brand-name biologics they’re intended to replace, Cummings said.

The five-member board, appointed by Gov. Jared Polis (D), includes two medical doctors, two pharmacists and a hospital executive. A 15-member advisory council includes patient advocates, insurers, pharmacists and representatives of drug manufacturers.

The Colorado law creating the board set out a lengthy process for any drugmaker that decides to withdraw its product from the state over the price caps. (Note that the state is also exploring importing cheaper drugs from Canada, without much success so far.)

More than a dozen states are attempting to rein in drug prices through a variety of tactics. It’s early in U.S. regulators’ work to control drug prices, and it’s unclear whether the federal or state efforts will prevail. 

What is clear is that patients need some relief: Over 30 percent of adults report not taking medications as prescribed because of costs, and 1 in 5 didn’t fill a prescription, according to KFF survey results published in August.


This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.


Journalists Track Efforts to Curb the Opioid Crisis and Put Catholic Hospitals Under the Scope

KFF Health News senior correspondent Aneri Pattani discussed her experiences reporting on addiction and offers advice to journalists starting on this beat for the American Society of Addiction Medicine’s “The Treat Addiction Save Lives Podcast” on March 18. She also discussed the spending questions surfacing as $1 billion flows into Massachusetts to fight opioids on WCVB NewsCenter 5’s “5 Investigates” on March 6.


KFF Health News correspondent Rachana Pradhan discussed the constraints on women’s health care at Catholic and Catholic-affiliated hospitals for PBS’ “PBS News Weekend” on March 17.


KFF Health News ethnic media editor Paula Andalo discussed how Colorado students are pushing for the ability to carry naloxone on Radio Bilingüe’s “Linea Abierta” on March 14.


Journalists Track Efforts to Curb the Opioid Crisis and Put Catholic Hospitals Under the Scope

KFF Health News senior correspondent Aneri Pattani discussed her experiences reporting on addiction and offers advice to journalists starting on this beat for the American Society of Addiction Medicine’s “The Treat Addiction Save Lives Podcast” on March 18. She also discussed the spending questions surfacing as $1 billion flows into Massachusetts to fight opioids on WCVB NewsCenter 5’s “5 Investigates” on March 6.


KFF Health News correspondent Rachana Pradhan discussed the constraints on women’s health care at Catholic and Catholic-affiliated hospitals for PBS’ “PBS News Weekend” on March 17.


KFF Health News ethnic media editor Paula Andalo discussed how Colorado students are pushing for the ability to carry naloxone on Radio Bilingüe’s “Linea Abierta” on March 14.


A medida que más estados desautorizan el diagnóstico de “delirio excitado”, grupos policiales retroceden

Luego de año crucial en el movimiento para desechar el término “delirio excitado”, en varios estados hay un impulso para prohibir el diagnóstico médico desacreditado en los certificados de defunción, la capacitación policial, los informes de incidentes policiales y el testimonio en los tribunales civiles.

En enero, California se convirtió en el primer estado en prohibir el término médico en muchos procedimientos oficiales. Ahora, legisladores de Colorado, Hawaii, Minnesota y Nueva York están considerando proyectos de ley que también limitarían cómo se utiliza el concepto de “delirio excitado”.

La nueva ola de propuestas estatales, impulsada por familias que perdieron familiares después de enfrentamientos con la policía, marca un paso importante para desterrar un término que los críticos dicen que incita a la policía a usar fuerza letal en exceso.

“Lo que queremos es ver es la ley siguiendo a la ciencia”, dijo Joanna Naples-Mitchell, abogada que trabajó en una influyente revisión de Physicians for Human Rights sobre cómo el término “delirio excitado” se convirtió en un concepto cuya legitimidad es en gran parte rechazada por la comunidad médica.

Pero el impulso inicial en las legislaturas estatales se encuentra con una resistencia renovada por parte de las agencias del orden y otros defensores, incluidos algunos que están de acuerdo en que el “delirio excitado” es un diagnóstico fraudulento.

Los proyectos de ley “claramente infringen la Primera Enmienda” y violan la libertad de expresión, dijo Bill Johnson, director ejecutivo de la National Association of Police Organizations. También argumentó que los agentes encuentran síntomas y comportamientos asociados con el “delirio excitado”.

El delirio excitado es una teoría diagnóstica de cuatro décadas que se ha utilizado para explicar cómo una persona que experimenta agitación grave puede morir repentinamente mientras está siendo controlada por la fuerza.

El año pasado, el American College of Emergency Physicians retiró un informe de 2009 que había sido el último pilar médico oficial de apoyo a la teoría utilizada cada vez más en los últimos 15 años para explicar la falta de responsabilidad de la policía en muchas muertes ocurridos bajo su custodia.

El “delirio excitado” se citó como defensa legal en las muertes de George Floyd en Minneapolis en 2020; Daniel Prude en Rochester, Nueva York; y Angelo Quinto en Antioch, California, entre otras. La teoría proponía que las personas en crisis de salud mental, a menudo bajo la influencia de drogas o alcohol, pueden exhibir una fuerza sobrehumana cuando la policía intenta controlarlas, y luego mueren repentinamente por la condición, no por la respuesta policial.

En 2021 y 2022, el Departamento de Policía de la Ciudad de Nueva York (NYPD) publicó materiales de capacitación que dicen a los oficiales que restrinjan y dejen sin sentido a las personas que encuentren y que muestren signos de “delirio excitado”, como “temperaturas corporales elevadas, aumento de la fuerza física y falta de fatiga física”, según New York Focus, una redacción sin fines de lucro. El NYPD no respondió a las solicitudes de comentarios sobre su capacitación o el nuevo proyecto de ley estatal.

“Siguen teniendo esto en los registros”, dijo Jessica González-Rojas, asambleísta estatal demócrata por Nueva York, quien presentó el proyecto de ley que pide prohibir el término en los certificados de defunción, autopsias, capacitación policial, informes de incidentes y procedimientos judiciales. “Y es bastante preocupante el tipo de restricciones que están recomendando, dada la falta de evidencia de que este sea un síndrome médico real”.

El Departamento de Policía de Minneapolis, que según el Star Tribune utilizó el término en capacitaciones, se negó a comentar sobre sus materiales de capacitación y la legislación estatal pendiente. Ese proyecto de ley prohibiría que el “delirio excitado” y términos similares se citen como causa de muerte, se utilicen como diagnóstico médico o se incluyan en el entrenamiento policial.

Sin embargo, la presencia de la teoría en los materiales de capacitación también puede estar comenzando a cambiar. En Colorado, donde el término se usó, en parte, para justificar la muerte en 2019 de Elijah McClain en Aurora, una junta estatal eliminó el término de la capacitación policial desde enero de este año. Los agentes de la ley inmovilizaron al joven de 23 años, y los paramédicos le inyectaron una dosis letal de ketamina.

Este año, los legisladores de Colorado están debatiendo una medida que se parece en gran medida al proyecto de ley de California, pero permite que el término permanezca en los procedimientos judiciales civiles.

En la audiencia del proyecto de ley ante el Comité Judicial de la Cámara de Representantes de Colorado el 6 de febrero, Rebecca De Luna describió la angustia de su familia por la muerte en 2017 del padre de su hija, Alejandro Gutiérrez, bajo custodia policial en Thornton. Dijo que se determinó que el “delirio excitado” había sido la causa de su muerte.

“Su rostro estaba magullado con la huella de un zapato. Su aspecto era irreconocible”, testificó De Luna. “El término se ha utilizado durante demasiado tiempo como una excusa para que las fuerzas del orden se protejan cuando alguien muere bajo su custodia, francamente, como resultado de una fuerza excesiva y lo que considero brutalidad policial que resulta en muerte”.

A family portrait taken on the steps of a beige building decorated with a large clay sun. Sheldon Haleck stands in front, on the lowest step, with his brother, Anthony behind him; next is his mother, Verdell; and father, William, on the tallest step.
Sheldon Haleck (al frente) con su hermano Anthony; su madre, Verdell; y su padre, William. El ex miembro de la Guardia Nacional Aérea de Hawaii tenía 38 años cuando murió después de un encuentro con la policía en 2015. Sus padres presentaron una demanda civil contra los oficiales, que los Haleck finalmente perdieron en gran parte debido a que se argumentó que Sheldon había muerto a causa del “delirio excitado”.(Aaron Reis)

Varios proveedores de servicios médicos y educadores testificaron en contra.

John Seward, gerente del programa de servicios médicos de emergencia de la Universidad de Denver, dijo al comité que no se oponía a prohibir “delirio excitado” en certificados de defunción y capacitación policial, ya que los policías no son profesionales de la salud. Pero prohibir el uso del término en la capacitación del personal médico sería legislar la medicina y obstaculizar la libertad académica, apuntó.

“Si no podemos estudiar y aprender del pasado, incluso cuando ese pasado es doloroso, ahora estamos condenándonos a repetirlo”, dijo Seward a los legisladores.

Julia Sherwin, abogada de derechos civiles de California que testificó a favor del proyecto de ley de Colorado, se sorprendió por los argumentos de los opositores de que dichos proyectos de ley podrían limitar la libertad de expresión y el debate sobre la historia de la idea.

“Eso para mí pareció un poco ridículo”, dijo Sherwin, quien fue coautora el informe de Physicians for Human Rights. Estos proyectos de ley impiden que una teoría desacreditada se utilice falsamente para responder a una crisis y mantienen la “pseudociencia” fuera de los registros oficiales, enfatizó.

El proyecto de ley de Colorado fue aprobado por la Cámara de Representantes estatal en una votación de 42-19 a mediados de febrero y ahora está ante el Senado estatal. Se enmendó para aclarar que se puede utilizar “delirio excitado” al enseñar sobre la historia del término y que se permiten cursos de Servicios Médicos de Emergencia (EMS) sobre “interacción médica segura y eficaz con personas que exhiben un estado mental alterado”, que presentan síntomas que incluyen agitación y agresión, o violencia.

Parte del impulso para esta legislación proviene de familias cuyos seres queridos murieron a causa del “delirio excitado”, en lugar de por el uso de la fuerza durante un encuentro policial.

El proyecto de ley de Hawaii se presentó después que William y Verdell Haleck supieran del esfuerzo de California y comenzaran a contactar a legisladores en el estado. Su hijo Sheldon murió allí en 2015 después de ser rociado con gas pimienta, electrocutado y restringido por la policía de Honolulu. En un juicio civil que los Haleck perdieron, los oficiales culparon de su muerte al “delirio excitado”.

El proyecto de ley de Hawaii prohibiría que se use el “delirio excitado” en los certificados de defunción, informes de incidentes policiales y casos civiles. Hasta mediados de marzo, no se había programado una audiencia del comité legislativo, pero los Haleck tienen la esperanza de que eventualmente sea aprobado.

“Nos daría cierto tipo de cierre y justicia”, dijo William Haleck.

El Departamento de Policía de Honolulu está monitoreando el proyecto de ley y no ha tomado una posición al respecto, dijo Michelle Yu, vocera del departamento. Y el proyecto tendría poco impacto en el Departamento de Medicina Forense de Honolulu, dijo su director, Masahiko Kobayashi, porque los médicos allí no usan el “delirio excitado” como causa de muerte.

Una razón por la que estos proyectos de ley siguen siendo importantes es porque evitan que las políticas fluctúen con cada cambio de liderazgo, dijo David Siffert, director legal del Surveillance Technology Oversight Project, que ayudó a redactar una legislación modelo que prohíbe el “delirio excitado” y está presionando por el proyecto de ley de Nueva York.

“Incluso si estás haciendo todo bien, no sabes si tu sucesor lo hará”, dijo Siffert. “Históricamente hemos visto esos altibajos en nuestras agencias”.

Los partidarios de la legislación estatal dicen que prohibir el término “delirio excitado” es solo un primer paso hacia la reducción de las muertes bajo custodia policial.

“El contexto subyacente no cambia solo con la legislación”, dijo Naples-Mitchell. “Va a tomar mucho tiempo abordar las causas profundas”.

El editor de KFF Health News, Matt Volz, colaboró con este artículo.

How a Friend’s Death Turned Colorado Teens Into Anti-Overdose Activists

Gavinn McKinney loved Nike shoes, fireworks, and sushi. He was studying Potawatomi, one of the languages of his Native American heritage. He loved holding his niece and smelling her baby smell. On his 15th birthday, the Durango, Colorado, teen spent a cold December afternoon chopping wood to help neighbors who couldn’t afford to heat their homes.

McKinney almost made it to his 16th birthday. He died of fentanyl poisoning at a friend’s house in December 2021. His friends say it was the first time he tried hard drugs. The memorial service was so packed people had to stand outside the funeral home.

Now, his peers are trying to cement their friend’s legacy in state law. They recently testified to state lawmakers in support of a bill they helped write to ensure students can carry naloxone with them at all times without fear of discipline or confiscation. School districts tend to have strict medication policies. Without special permission, Colorado students can’t even carry their own emergency medications, such as an inhaler, and they are not allowed to share them with others.

“We realized we could actually make a change if we put our hearts to it,” said Niko Peterson, a senior at Animas High School in Durango and one of McKinney’s friends who helped write the bill. “Being proactive versus being reactive is going to be the best possible solution.”

Individual school districts or counties in California, Maryland, and elsewhere have rules expressly allowing high school students to carry naloxone. But Jon Woodruff, managing attorney at the Legislative Analysis and Public Policy Association, said he wasn’t aware of any statewide law such as the one Colorado is considering. Woodruff’s Washington, D.C.-based organization researches and drafts legislation on substance use.

Naloxone is an opioid antagonist that can halt an overdose. Available over the counter as a nasal spray, it is considered the fire extinguisher of the opioid epidemic, for use in an emergency, but just one tool in a prevention strategy. (People often refer to it as “Narcan,” one of the more recognizable brand names, similar to how tissues, regardless of brand, are often called “Kleenex.”)

The Biden administration last year backed an ad campaign encouraging young people to carry the emergency medication.

Most states’ naloxone access laws protect do-gooders, including youth, from liability if they accidentally harm someone while administering naloxone. But without school policies explicitly allowing it, the students’ ability to bring naloxone to class falls into a gray area.

Ryan Christoff said that in September 2022 fellow staff at Centaurus High School in Lafayette, Colorado, where he worked and which one of his daughters attended at the time, confiscated naloxone from one of her classmates.

“She didn’t have anything on her other than the Narcan, and they took it away from her,” said Christoff, who had provided the confiscated Narcan to that student and many others after his daughter nearly died from fentanyl poisoning. “We should want every student to carry it.”

Boulder Valley School District spokesperson Randy Barber said the incident “was a one-off and we’ve done some work since to make sure nurses are aware.” The district now encourages everyone to consider carrying naloxone, he said.

Zoe Ramsey, a high school senior from Durango, Colorado, testified before state lawmakers in February 2024 about a bill to clarify that students may carry naloxone, a drug that can reverse opioid overdoses. (Rae Ellen Bichell/KFF Health News)

Community’s Devastation Turns to Action

In Durango, McKinney’s death hit the community hard. McKinney’s friends and family said he didn’t do hard drugs. The substance he was hooked on was Tapatío hot sauce — he even brought some in his pocket to a Rockies game.

After McKinney died, people started getting tattoos of the phrase he was known for, which was emblazoned on his favorite sweatshirt: “Love is the cure.” Even a few of his teachers got them. But it was classmates, along with their friends at another high school in town, who turned his loss into a political movement.

“We’re making things happen on behalf of him,” Peterson said.

The mortality rate has spiked in recent years, with more than 1,500 other children and teens in the U.S. dying of fentanyl poisoning the same year as McKinney. Most youth who die of overdoses have no known history of taking opioids, and many of them likely thought they were taking prescription opioids like OxyContin or Percocet — not the fake prescription pills that increasingly carry a lethal dose of fentanyl.

“Most likely the largest group of teens that are dying are really teens that are experimenting, as opposed to teens that have a long-standing opioid use disorder,” said Joseph Friedman, a substance use researcher at UCLA who would like to see schools provide accurate drug education about counterfeit pills, such as with Stanford’s Safety First curriculum.

Allowing students to carry a low-risk, lifesaving drug with them is in many ways the minimum schools can do, he said.

“I would argue that what the schools should be doing is identifying high-risk teens and giving them the Narcan to take home with them and teaching them why it matters,” Friedman said.

Writing in The New England Journal of Medicine, Friedman identified Colorado as a hot spot for high school-aged adolescent overdose deaths, with a mortality rate more than double that of the nation from 2020 to 2022.

“Increasingly, fentanyl is being sold in pill form, and it’s happening to the largest degree in the West,” said Friedman. “I think that the teen overdose crisis is a direct result of that.”

Gavinn McKinney died of fentanyl poisoning at a friend’s house in December 2021. McKinney was part of the Thunder Clan of the Citizen Potawatomi Nation. He also had Kickapoo and Assiniboine heritage. (Trennie Burch)

If Colorado lawmakers approve the bill, “I think that’s a really important step,” said Ju Nyeong Park, an assistant professor of medicine at Brown University, who leads a research group focused on how to prevent overdoses. “I hope that the Colorado Legislature does and that other states follow as well.”

Park said comprehensive programs to test drugs for dangerous contaminants, better access to evidence-based treatment for adolescents who develop a substance use disorder, and promotion of harm reduction tools are also important. “For example, there is a national hotline called Never Use Alone that anyone can call anonymously to be supervised remotely in case of an emergency,” she said.

Taking Matters Into Their Own Hands

Many Colorado school districts are training staff how to administer naloxone and are stocking it on school grounds through a program that allows them to acquire it from the state at little to no cost. But it was clear to Peterson and other area high schoolers that having naloxone at school isn’t enough, especially in rural places.

“The teachers who are trained to use Narcan will not be at the parties where the students will be using the drugs,” he said.

And it isn’t enough to expect teens to keep it at home.

“It’s not going to be helpful if it’s in somebody’s house 20 minutes outside of town. It’s going to be helpful if it’s in their backpack always,” said Zoe Ramsey, another of McKinney’s friends and a senior at Animas High School.

“We were informed it was against the rules to carry naloxone, and especially to distribute it,” said Ilias “Leo” Stritikus, who graduated from Durango High School last year.

But students in the area, and their school administrators, were uncertain: Could students get in trouble for carrying the opioid antagonist in their backpacks, or if they distributed it to friends? And could a school or district be held liable if something went wrong?

He, along with Ramsey and Peterson, helped form the group Students Against Overdose. Together, they convinced Animas, which is a charter school, and the surrounding school district, to change policies. Now, with parental permission, and after going through training on how to administer it, students may carry naloxone on school grounds.

Durango School District 9-R spokesperson Karla Sluis said at least 45 students have completed the training.

School districts in other parts of the nation have also determined it’s important to clarify students’ ability to carry naloxone.

“We want to be a part of saving lives,” said Smita Malhotra, chief medical director for Los Angeles Unified School District in California.

Gavinn McKinney’s mother, whose name is being withheld because they are part of a state confidentiality program for survivors of domestic violence, at the Colorado state Capitol for a hearing in February on a bill to clarify that students in the state may carry naloxone.( Rae Ellen Bichell/KFF Health News)

Los Angeles County had one of the nation’s highest adolescent overdose death tallies of any U.S. county: From 2020 to 2022, 111 teens ages 14 to 18 died. One of them was a 15-year-old who died in a school bathroom of fentanyl poisoning. Malhotra’s district has since updated its policy on naloxone to permit students to carry and administer it.

“All students can carry naloxone in our school campuses without facing any discipline,” Malhotra said. She said the district is also doubling down on peer support and hosting educational sessions for families and students.

Montgomery County Public Schools in Maryland took a similar approach. School staff had to administer naloxone 18 times over the course of a school year, and five students died over the course of about one semester.

When the district held community forums on the issue, Patricia Kapunan, the district’s medical officer, said, “Students were very vocal about wanting access to naloxone. A student is very unlikely to carry something in their backpack which they think they might get in trouble for.”

So it, too, clarified its policy. While that was underway, local news reported that high school students found a teen passed out, with purple lips, in the bathroom of a McDonald’s down the street from their school, and used Narcan to revive them. It was during lunch on a school day.

“We can’t Narcan our way out of the opioid use crisis,” said Kapunan. “But it was critical to do it first. Just like knowing 911.”

Now, with the support of the district and county health department, students are training other students how to administer naloxone. Jackson Taylor, one of the student trainers, estimated they trained about 200 students over the course of three hours on a recent Saturday.

“It felt amazing, this footstep toward fixing the issue,” Taylor said.

Each trainee left with two doses of naloxone.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Covid Closed the Nation’s Schools. Cleaner Air Can Keep Them Open.

Scientists and educators are searching for ways to improve air quality in the nation’s often dilapidated school buildings.

Community Resurrects Colorado Birth Center Closed by Private Equity Firm

When a private equity firm closed Seasons Midwifery and Birth Center in Thornton, Colorado, in October, the state lost one of its few non-hospital birthing centers and 53 families with pregnancy due dates in November and December were left scrambling to find providers.

But then staffers and community advocacy groups stepped in to fill the void for the suburban Denver community and its patients, many of whom rely on Medicaid, the federal-state insurance program for people with low incomes. They reorganized Seasons as a nonprofit organization and struck a note of triumph and defiance in announcing its reopening in January as the free-standing Seasons Community Birth Center. Seasons has five deliveries scheduled in February and 30 in March.

“With the closing, we decided we’re not going to let capitalism take us down,” said Justina Nazario, a Seasons birth assistant. “We’re going to bring these really important qualities that you don’t get in the medical-industrial complex.”

Over the past two decades, the number of at-home and birth center deliveries nationwide was on the rise — until the covid-19 pandemic hit. The number of out-of-hospital births increased 22% from 2019 to 2020 and an additional 12% from 2020 to 2021, according to a Centers for Disease Control and Prevention report.

Nationally, birth centers — medical facilities for labor and childbirth that rely on midwives to help with healthy, low-risk pregnancies — have lower rates of preterm births, low birth weights, and women transferred to hospitals for cesarean sections.

While C-sections can be lifesaving, they are major surgeries that come with significant risk and cost. A 2013 study of about 22,400 women who planned to give birth at a birth center found that 6% of those who entered labor at such a facility were sent to a hospital for a C-section. By contrast, about 26% of healthy, low-risk pregnancies in hospitals end in C-sections.

Before Seasons closed, staffers transferred about 8% of patients to a hospital for a C-section.

The funding model for birthing centers is complicated: In Colorado they are regulated and licensed by the state health department, yet because they’re not hospitals, they can’t bill insurance in the same way as a hospital. So Seasons, for example, receives about $4,000 per birth from private insurance, said Heather Prestridge, the clinic’s administrative director, while a hospital birth costs on average $19,000 and is reimbursed by insurance for about $16,000.

The only option for patients who don’t have private insurance and cannot pay out-of-pocket is to deliver in a hospital. Most birth centers don’t accept Medicaid, but Seasons is different. Before its closure, about 40% of its clients were on Medicaid, which reimburses less than other insurance providers, Prestridge said.

“Every time we take a Medicaid client on, we lose money,” Prestridge said. “It’s so important for everyone to have access to this kind of care, so we continue to do it anyway.”

Medicaid’s restrictions and low reimbursement rates have led to financial problems for birth centers, including Seasons, despite their being inundated with patients. In Colorado, 19% of the population and 36% of births were covered by Medicaid in 2022.

As a nonprofit, Seasons will need to lean on fundraising to fill the gaps, Prestridge said.

A photo shows workers at Seasons Community Birth Center.
Seasons Community Birth Center in Thornton, Colorado, rebranded and reopened in January as a nonprofit after a private equity firm closed it in October. Seasons is one of the state’s few non-hospital birthing centers.(Aubre Tompkins)

Colorado has seven birth centers, including Seasons, which often have rooms that look more like bedrooms than hospital rooms, and bathtubs as an option for delivery.

In 2018, two other Colorado birth centers — associated with hospital groups but owned by a for-profit parent company — closed. The two Denver-area practices primarily served patients who had low incomes or were refugees, according to The Colorado Sun.

“It came as a shock to us, but unfortunately it has become our reality,” Miki Tynan, co-founder and managing director of Colorado Birth and Wellness said of the birth center closures.

When Seasons closed Oct. 4, Colorado Birth and Wellness, a collaboration between two birth centers in the Denver area, took on more than 60 of its clients.

The physicians group that started Seasons in 2019, called Women’s Health Group, partnered with a private equity group, Shore Capital Partners, in late 2020 and became Elevate Women’s Health. Executives there determined that Seasons was unprofitable and closed it, said Aubre Tompkins, clinical director at Seasons Community Birth Center, and others who worked for Seasons at the time.

“It was pretty devastating,” Tompkins said. “There were a lot of tears, there was a lot of anger, there was a lot of confusion.”

After the closure was announced, Elephant Circle, a reproductive justice organization, reached out to Tompkins with a plan to raise money for Seasons to reopen as a nonprofit. The organization’s founder, Indra Lusero, said members wanted to save Seasons but also wanted to invest in making the nonprofit model work more broadly.

“There’s been some investment, there’s been federal studies, there’s great data — all the things saying, ‘Hey, I think this model looks like it could work. We should invest in this model,’” Lusero said.

As a nonprofit, Seasons plans to expand its services to include gender-affirming care and train more people as midwives and doulas to increase diversity in the field. Seasons offers annual gynecological exams, contraceptives, lactation services, and newborn care through the first two weeks of life.

Tompkins is a member of what she described as an emergency and temporary task force that reopened the facility with a reproductive justice mission. Nazario will also sit on the board, along with representatives from the Colorado Organization for Latina Opportunity and Reproductive Rights, or COLOR; Elephant Circle; and Soul 2 Soul Sisters, a racial justice organization.

Nazario, who describes herself as Afro-Latina, has experienced firsthand how essential her identity and experiences are to her work in birthing. Potential clients often reach out to her saying they had been looking for someone like her, someone like them.

Katherine Riley, who gave birth to her daughter at Seasons last year, is policy director at COLOR and a member of the Seasons Community Birth Center board. She said she’s excited to advance Seasons’ mission and expand teaching opportunities for future midwives.

“The practice of midwifery, I think, in itself is an act of resistance,” Riley said. “There’s a long history of racism and patriarchy in ousting midwives, and so I think returning as a community to that is so important.”

More Young Colorado Children Are Consuming Marijuana Despite Efforts to Stop Them

The number of children — especially very young ones — ingesting marijuana is rising in Colorado despite regulations meant to keep edibles out of kids’ hands, and state leaders said they have no plans to revisit those rules this year.

The number of reports the Rocky Mountain Poison and Drug Safety office received of kids age 5 or younger exposed to marijuana skyrocketed from 56 in 2017 to 151 in 2021. By 2021, this age group made up nearly half of all marijuana exposures — in which the drug is ingested, inhaled, or absorbed through the skin — reported to the office, which is part of the nonprofit Denver Health organization.

In each of those five years, children were most often accidentally exposed by eating edibles — gummies, cookies, drinks, and other products infused with the psychoactive chemical tetrahydrocannabinol, or THC — and not by inhaling smoke or consuming the drug in other forms, like capsules or tinctures. In 2017, 35 children age 5 or younger were unintentionally exposed to marijuana through edibles, compared with 97 in 2021. Exposures don’t necessarily mean the children were poisoned or overdosed, according to the poison and drug safety office.

Marijuana exposures among children are increasing nationwide, with Colorado playing a notable role in this trend. However, the federal government has yet to create uniform protocols, and Colorado health officials haven’t conveyed any plans to revise the regulations meant to prevent children from consuming marijuana.

“Marijuana laws and regulations are regularly evaluated by lawmakers, state agencies, local agencies and the various stakeholders,” Shannon Gray, a spokesperson at the Marijuana Enforcement Division, which regulates the marijuana industry in the state, wrote in an email to KHN. “A top priority is preventing youth access and to the extent we see opportunity in rules to address youth access, we do so.”

Since legalized recreational marijuana sales began in 2014, Colorado has implemented a handful of directives to stop children from mistaking these products for safe, delicious sweets.

Regulations state that:

  • No edibles may be manufactured in the shape of a human, an animal, or a fruit.
  • All edibles must be sold in child-resistant packaging.
  • “Candy” or “candies” isn’t allowed on packaging.
  • Advertising must not include cartoon characters, or anything else meant to appeal to children.
  • The universal THC symbol (! THC) must be on all packaging and stamped on all edible products.

Data from Rocky Mountain Poison and Drug Safety does not distinguish between incidents involving marijuana sold by licensed retailers and those involving marijuana from sources that don’t follow the state’s packaging rules, state health department spokesperson Gabi Johnston told KHN.

When asked whether the mandates are effective, Gray said the Marijuana Enforcement Division has “observed material compliance with these regulations” among marijuana businesses.

Regulation changes could be considered, including those proposed by state legislators, Gray said. But no forthcoming bills concern edible mandates, according to Jarrett Freedman, spokesperson for the Colorado House of Representatives majority. Democrats control both houses of the state legislature.

One limitation of regulating marijuana packaging is that most children 5 and younger can’t read, said Dr. Marit Tweet, a medical toxicologist at the Southern Illinois University School of Medicine. And, she said, many parents don’t know how to store marijuana safely.

The state health department has worked to address this knowledge gap through its Retail Marijuana Education program, established in 2014 to teach the public about safe, legal, and responsible cannabis use. One fact sheet advises parents to store marijuana in a locked area, keep products in child-resistant packaging, and avoid using marijuana around children.

Public health officials also launched a series of marijuana education campaigns in 2018 targeting new parents and adults who influence kids’ behavior. Between fiscal years 2015 and 2020, the department spent roughly $22.8 million on those efforts.

It’s hard to say exactly how well marijuana regulations in states like Colorado are working, said Tweet. “It’s possible if those regulations weren’t in place that the numbers would be even higher.”

What’s happening in Colorado is part of a national trend. In a study published in January, researchers looked at the number of children younger than 6 who ingested marijuana edibles nationwide from 2017 to 2021. They found 207 reported cases in 2017. In 2021, that number rose to 3,054 cases, according to data from the National Poison Data System.

The legalization of cannabis has likely played a significant role in the rise of accidental child exposures, said Tweet, a co-author of the study. “It’s more readily available and more of an opportunity for the children to get into.”

Parents may also feel less stigma nowadays in reaching out to poison centers and health clinics, she said.

To understand what factors are driving these numbers, more research is needed into marijuana regulations and the number of child exposures nationwide, said Tweet.

Decisiones financieras de los hospitales juegan un papel en la escasez de camas pediátricas para pacientes con VRS

La grave escasez de camas pediátricas que azota a la nación este otoño es en parte producto de las decisiones financieras tomadas por los hospitales durante la última década, como cerrar las salas infantiles, que a menudo operan en números rojos, y ampliar la cantidad de camas disponibles para proyectos más rentables como reemplazos articulares y atención del cáncer.

Para hacer frente a la avalancha de niños enfermos por una convergencia radical de virus desagradables, especialmente el virus respiratorio sincitial (VRS), la influenza y el coronavirus, los centros médicos de todo el país han desplegado carpas de triage, retrasado cirugías electivas y trasladado fuera del estado a menores gravemente enfermos.

Un factor importante en la escasez de camas es una tendencia de muchos años entre los hospitales de eliminar las unidades pediátricas, que tienden a ser menos rentables que las de adultos, dijo Mark Wietecha, director ejecutivo de la Children’s Hospital Association.

Los hospitales optimizan los ingresos tratando de mantener sus camas llenas al 100 %, y llenas de pacientes con condiciones que las aseguradoras reembolsan bien.

“Realmente tiene que ver con los dólares”, dijo el doctor Scott Krugman, vicepresidente de pediatría del Hospital Pediátrico Herman and Walter Samuelson en Baltimore. “Los hospitales dependen de procedimientos de alto volumen y alto reembolso de seguros que paguen bien para ganar dinero”.

El número de unidades pediátricas para pacientes internados en los hospitales cayó un 19% entre 2008 y 2018, según un estudio publicado en 2021 en la revista Pediatrics. Solo este año, los hospitales han cerrado unidades pediátricas en Boston y Springfield, Massachusetts; Richmond, Virginia; y Tulsa, Oklahoma.

El aumento actual de enfermedades respiratorias peligrosas para los niños es otro ejemplo de cómo covid-19 ha alterado el sistema de atención médica. Los bloqueos y el aislamiento que marcaron los primeros años de la pandemia dejaron a los niños en gran medida sin exposición, y aún vulnerables, a virus distintos al covid durante dos inviernos, y los médicos ahora están tratando esencialmente enfermedades respiratorias de varios años.

La pandemia también aceleró los cambios en la industria de la atención de salud que han dejado a muchas comunidades con menos camas de hospital disponibles para niños gravemente enfermos, junto con menos médicos y enfermeras para atenderlos.

Cuando las unidades de cuidados intensivos se inundaron con pacientes mayores con covid en 2020, algunos hospitales comenzaron a usar camas infantiles para tratar a adultos. Muchas de esas camas pediátricas no se han repuesto, dijo el doctor Daniel Rauch, presidente del comité de atención hospitalaria de la Academia Estadounidense de Pediatría.

“Simplemente no hay suficiente espacio para todos los niños que necesitan camas”, dijo la doctora Megan Ranney, quien trabaja en varios departamentos de emergencia en Providence, Rhode Island, incluido el Hasbro Children’s Hospital. La cantidad de niños que buscaron atención de emergencia en las últimas semanas fue un 25% más alta que el récord anterior del hospital.

“Tenemos médicos que limpian las camas para que podamos acomodar a los niños más rápido”, dijo Ranney, vicedecana de la Escuela de Salud Pública de la Universidad Brown.

No hay mucho dinero en el tratamiento de niños. Alrededor del 40% de los niños estadounidenses están cubiertos por Medicaid, un programa federal y estatal conjunto para pacientes de bajos ingresos y personas con discapacidades. Las tarifas básicas de Medicaid suelen ser más de un 20% inferiores a las que paga Medicare, el programa de seguro del gobierno para adultos mayores, y son aún más bajas en comparación con los seguros privados.

Si bien la atención especializada para una variedad de procedimientos comunes para adultos, desde reemplazos de rodilla y cadera hasta cirugías cardíacas y tratamientos contra el cáncer, genera importantes ganancias para los centros médicos, los hospitales se quejan de que generalmente pierden dinero en la atención pediátrica de pacientes hospitalizados.

Cuando Tufts Children’s Hospital cerró 41 camas pediátricas este verano, los funcionarios del hospital aseguraron a los residentes que los pacientes jóvenes podrían recibir atención en el cercano Boston Children’s Hospital. Ahora, Boston Children’s está retrasando algunas cirugías electivas para dejar espacio a los niños que están gravemente enfermos.

Rauch señaló que los hospitales infantiles, que se especializan en el tratamiento de enfermedades raras y graves como el cáncer pediátrico, la fibrosis quística y los defectos cardíacos, simplemente no están diseñados para manejar la avalancha de niños gravemente enfermos de esta temporada con virus respiratorios.

Incluso antes de la trifecta viral del otoño, las unidades pediátricas se esforzaban por absorber un número creciente de jóvenes con angustia mental aguda.

Abundan las historias de niños en crisis mentales que se quedan en el limbo durante semanas en las salas de emergencia mientras esperan ser transferidos a una unidad psiquiátrica pediátrica. En un buen día, dijo Ranney, el 20% de las camas de la sala de emergencias pediátrica del Hasbro Children’s Hospital están ocupadas por niños que experimentan problemas de salud mental.

Con la esperanza de aumentar la capacidad pediátrica, el mes pasado, la Academia Estadounidense de Pediatría se unió a la Asociación de Hospitales Infantiles para pedir a la Casa Blanca que declare una emergencia nacional debido a infecciones respiratorias infantiles y proporcione recursos adicionales para ayudar a cubrir los costos de la atención.

La administración Biden ha dicho que la flexibilidad que se les ha dado a los sistemas hospitalarios y a los proveedores durante la pandemia para eludir ciertos requisitos de personal también se aplica al VRS y la gripe.

El Doernbecher Children’s Hospital de Oregon Health & Science University ha cambiado a “estándares de atención de crisis”, lo que permite que las enfermeras de cuidados intensivos traten a más pacientes de los que normalmente se les asignan. Mientras tanto, los hospitales en Atlanta, Pittsburgh y Aurora, Colorado, han recurrido al tratamiento de pacientes jóvenes en carpas desbordadas en estacionamientos.

El doctor Alex Kon, pediatra de cuidados intensivos en el Centro Médico Comunitario en Missoula, Montana, dijo que los proveedores han hecho planes para cuidar a los niños mayores en la unidad de cuidados intensivos para adultos y desviar las ambulancias a otras instalaciones cuando sea necesario. Con solo tres UCI pediátricas en el estado, eso significa que los pacientes jóvenes pueden volar hasta Seattle o Spokane, Washington o Idaho.

Hollis Lillard llevó a su hijo de 1 año, Calder, a un hospital del ejército en el norte de Virginia el mes pasado después de experimentar varios días de fiebre, tos y dificultad para respirar. Pasaron siete horas angustiosas en la sala de emergencias antes de que el hospital encontrara una cama abierta y los trasladaran en ambulancia al Centro Médico Militar Nacional Walter Reed en Maryland.

Con la terapia adecuada y las instrucciones para el cuidado en el hogar, el virus de Calder fue fácilmente tratable: se recuperó después de que le administraran oxígeno y lo trataran con esteroides, que combaten la inflamación, y albuterol, que controla los broncoespasmos. Fue dado de alta al día siguiente.

Aunque las hospitalizaciones por VRS están disminuyendo, las tasas se mantienen muy por encima de la media para esta época del año. Y es posible que los hospitales no tengan mucho alivio.

Las personas pueden infectarse con este virus más de una vez al año, y Krugman se preocupa por un resurgimiento en los próximos meses. Debido al coronavirus, que compite con otros virus, “el patrón estacional habitual de virus se ha ido por la ventana”, dijo.

Al igual que el VRS, la influenza llegó temprano esta temporada. Ambos virus suelen alcanzar su punto máximo alrededor de enero. Tres cepas de la gripe están circulando y han causado aproximadamente 8,7 millones de casos, 78,000 hospitalizaciones y 4,500 muertes, según los Centros para el Control y la Prevención de Enfermedades (CDC).

Krugman duda que la industria de la atención de salud aprenda lecciones rápidas de la crisis actual. “A menos que haya un cambio radical en la forma en que pagamos la atención hospitalaria pediátrica”, dijo Krugman, “la escasez de camas solo empeorará”.

States Opting Out of a Federal Program That Tracks Teen Behavior as Youth Mental Health Worsens

As the covid-19 pandemic worsened a mental health crisis among America’s young people, a small group of states quietly withdrew from the nation’s largest public effort to track concerning behaviors in high school students.

Colorado, Florida, and Idaho will not participate in a key part of the Centers for Disease Control and Prevention’s Youth Risk Behavior surveys that reaches more than 80,000 students. Over the past 30 years, the state-level surveys, conducted anonymously during each odd-numbered year, have helped elucidate the mental health stressors and safety risks for high school students.

Each state has its own rationale for opting out, but their withdrawal — when suicides and feelings of hopelessness are up — has caught the attention of school psychologists and federal and state health officials.

Some questions on the state-level surveys — which can also ask students about their sexual orientation, gender identity, sexual activity, and drug use — clash with laws that have been passed in conservative states. The intense political attention on teachers and school curriculums has led to a reluctance among educators to have students participate in what were once considered routine mental and behavioral health assessments, some experts worry.

The reduction in the number of states that participate in the state-level CDC survey will make it harder for those states to track the conditions and behaviors that signal poor mental health, like depression, drug and alcohol misuse, and suicidal ideation, experts said.

“Having that kind of data allows us to say ‘do this, not that’ in really important ways,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, which oversees the series of health surveys known as the Youth Risk Behavior Surveillance System. “For any state to lose the ability to have that data and use that data to understand what’s happening with young people in their state is an enormous loss.”

The CDC developed the Youth Risk Behavior Surveillance System in 1990 to track the leading causes of death and injury among young people. It is made up of a nationally representative poll of students in grades nine through 12 and separate state and local school district-level questionnaires. The questions focus on behaviors that lead to unintentional injuries, violence, sexually transmitted infections, pregnancy, drug and alcohol misuse, physical inactivity, and more.

The decisions by Colorado, Florida, and Idaho not to participate in the state-level questionnaires will not affect the CDC’s national survey or the local school district surveys in the states that have them.

Part of what makes the survey a powerful tool is the diversity of information collected, said Norín Dollard, a senior analyst with the Florida Policy Institute, a nonprofit research and advocacy group. “It allows for the analysis of data by subgroups, including LGBTQ+ youth, so that the needs of these students, who are at a greater risk of depression, suicide, and substance abuse than their peers, are understood and can be supported by schools and community providers,” said Dollard, who is also director of Florida Kids Count, part of a national network of nonprofit programs focused on children in the United States.

The CDC is still processing the 2021 data and has not released the results because of pandemic-related delays, said Paul Fulton, an agency spokesperson. But trends from the 2009 to 2019 national surveys showed that the mental health of young people had deteriorated over the previous decade.

“So we started planning,” Ethier said. “When the pandemic hit, we were able to say, ‘Here are the things you should be looking out for.’”

The pandemic has further exacerbated the mental health problems young people face, said Angela Mann, president of the Florida Association of School Psychologists.

Nearly half of parents who responded to a recent KFF/CNN mental health survey said the pandemic had had a negative impact on their child’s mental health. Most said they were worried that issues like self-harm and loneliness stemming from the pandemic may affect teenagers.

But the CDC’s survey has shortcomings, said health officials from some states that pulled back from it. Not all high schools are included, for example. And the sample of students from each state is so small that some state officials said their schools received little actionable data despite decades of participation.

That was the case in Colorado, which decided not to participate next year, according to Emily Fine, school and youth survey manager at the Colorado health department. Instead, she said, the state will focus on improving a separate study called Healthy Kids Colorado, which includes questions similar to those in the CDC survey and Colorado-specific questions. The Colorado survey, which has been running for about a decade, covers about 100,000 students across the state — nearly 100 times the number that participated in the CDC’s state-level survey in 2019.

Minnesota, Oregon, Washington, and Wyoming, which also have their own youth surveys, either never participated or decided to skip the previous two CDC assessments. At least seven states will not participate in the 2023 state-level survey.

Fine said the state-run option is more beneficial because schools receive their own results.

In Leadville, a Colorado mountain town, a youth coalition used results from the Healthy Kids Colorado survey to conclude that the county had higher-than-average rates of substance use. They also learned that Hispanic students in particular didn’t feel comfortable sharing serious problems like suicidal thoughts with adults, suggesting that opportunities to flag issues early were being missed.

“I feel like most kids tell the truth on those surveys, so I feel like it’s a reliable source,” said high schooler Daisey Monge, who is part of the youth coalition, which proposed a policy to train adults in the community to make better connections with young people.

Education officials in Florida and Idaho said they plan to gather more state-specific data using newly created questionnaires. But neither state has designed a new survey, and what questions will be asked or what data will be captured is not clear.

Cassandra Palelis, a spokesperson for the Florida Department of Education, said in an email that Florida intends to assemble a “workgroup” to design its new system.

In recent years, Idaho officials cited the CDC survey data when they applied for and received $11 million in grants for a new youth suicide prevention program called the Idaho Lives Project. The data showed the share of high school students who had seriously considered attempting suicide increased from 15% in 2011 to 22% in 2019.

“That is concerning,” said Eric Studebaker, director of student engagement and safety coordination for the State Department of Education. Still, he said, the state is worried about taking up class time to survey students and about overstepping boundaries by asking questions that are not parent-approved.

Whatever the rationale, youth mental health advocates call opting out shortsighted and potentially harmful as the exodus erodes the national data collection. The pandemic exacerbated mental health stress for all high school students, especially those who are members of racial or ethnic minority groups and those who identify as LGBTQ+.

But since April, at least a dozen states have proposed bills that mirror Florida’s Parental Rights in Education law, which bans instruction about sexual orientation and gender identity in kindergarten through third grade.

The law, which critics call “Don’t Say Gay,” and the intense political attention it has focused on teachers and school curriculums are having a chilling effect on all age groups, said youth advocates like Mann, the Florida school psychologist. “Some of these discussions about schools indoctrinating kids has bled into discussions about mental health services in schools,” she said.

Since the law was adopted, some Florida school administrators have removed “safe space” stickers with the rainbow flag indicating support for LGBTQ+ students. Some teachers have resigned in protest of the law, while others have expressed confusion about what they’re allowed to discuss in the classroom.

With data showing that students need more mental health services, opting out of the state-level surveys now may do more harm than good, said Franci Crepeau-Hobson, a professor of school psychology at the University of Colorado-Denver, who has used the national youth risk behavior data to analyze trends.

“It’s going to make it more difficult to really get a handle on what’s happening nationally,” she said.

KHN Colorado correspondent Rae Ellen Bichell contributed to this report.