Utah Archives - 蘑菇影院 Health News /news/tag/utah/ Thu, 06 Jun 2024 11:36:35 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.4 /wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=32 Utah Archives - 蘑菇影院 Health News /news/tag/utah/ 32 32 161476233 End of Pandemic Internet Subsidies Threatens a Health Care Lifeline for Rural America /news/article/acp-federal-internet-discount-program-ends-tribes/ Wed, 05 Jun 2024 09:00:00 +0000 /?post_type=article&p=1859881 FORT HALL RESERVATION, Idaho 鈥 Myrna Broncho realized just how necessary an internet connection can be after she broke her leg.

In fall 2021, the 69-year-old climbed a ladder to the top of a shed in her pasture. The roof that protects her horses and cows needed to be fixed. So, drill in hand, she pushed down.

That’s when she slipped.

Broncho said her leg snapped between a pair of ladder rungs as she fell, “and my bone was sticking out, and the only thing was holding it was my sock.”

Broncho arm-crawled back to her house to reach her phone. She hadn’t thought to take it with her because, she said, “I never really dealt with phones.”

Broncho needed nine surgeries and rehabilitation that took months. Her hospital was more than two hours away in Salt Lake City and her home internet connection was vital for her to keep track of records and appointments, as well as communicate with her medical staff.

During the covid-19 pandemic, federal lawmakers launched the Affordable Connectivity Program with the goal of connecting more people to their jobs, schools, and doctors. More than 23 million low-income households, including Broncho’s, eventually signed on. The program provided $30 monthly subsidies for internet bills, or $75 discounts in tribal or high-cost areas like Broncho’s.

Now, the ACP is out of money.

In early May, Sen. John Thune (R-S.D.) challenged an effort to continue funding the program, saying during a commerce committee hearing that the program needed to be revamped.

“As is currently designed, ACP does a poor job of directing support to those who truly need it,” Thune said, adding that too many people who already had internet access used the subsidies.

There has been a flurry of activity on Capitol Hill, with lawmakers first attempting and failing to attach funding to the must-pass Federal Aviation Administration reauthorization. Afterward, Sen. Peter Welch (D-Vt.) traveled to his home state to tell constituents in tiny White River Junction that Congress was still working toward a solution.

As the program funding dwindled, both Democrats and Republicans pushed for new legislative action with proposals trying to address concerns like the ones Thune raised.

On May 31, as the program ended, President Joe Biden’s administration continued to call on Congress to take action. Meanwhile, the administration announced that more than a dozen companies 鈥 including AT&T, Verizon, and Comcast 鈥 would offer low-cost plans to ACP enrollees, and the administration said those plans could affect as many as 10 million households.

According to of participants released by the Federal Communications Commission, more than two-thirds of households had inconsistent or no internet connection before enrolling in the program.

Broncho had an internet connection before the subsidy, but on this reservation in rural southeastern Idaho, where she lives, about 40% of the 200 households enrolled in the program had no internet before the subsidy.

Nationwide, about 67% of nonurban residents reported having a broadband connection at home, compared with nearly 80% of urban residents, said John Horrigan, a national expert on technology adoption and senior fellow at the Benton Institute for Broadband & Society. Horrigan reviewed the data collected by a .

The FCC said on May 31 that ending the program will affect about 3.4 million rural and more than 300,000 households in tribal areas.

The end of federal subsidies for internet bills will mean “a lot of families who will have to make the tough choice not to have internet anymore,” said Amber Hastings, an AmeriCorps member serving the Shoshone-Bannock Tribes on the reservation. Some of the families Hastings enrolled had to agree to a plan to pay off past-due bills before joining the program. “So they were already in a tough spot,” Hastings said.

Matthew Rantanen, director of technology for the Southern California Tribal Chairmen’s Association, said the ACP was “extremely valuable.”

“Society has converted everything online. You cannot be in this society, as a societal member, and operate without a connection to broadband,” Rantanen said. Not being connected, he said, keeps Indigenous communities and someone like “Myrna at a disadvantage.”

Rantanen, who advises tribes nationwide about building broadband infrastructure on their land, said benefits from the ACP’s subsidies were twofold: They helped individuals get connected and encouraged providers to build infrastructure.

“You can guarantee a return on investment,” he said, explaining that the subsidies ensured customers could pay for internet service.

Since Broncho signed up for the program last year, her internet bill had been fully paid by the discount.

Broncho used the money she had previously budgeted for her internet bill to pay down credit card debt and a loan she took out to pay for the headstones of her mother and brother.

As the ACP’s funds ran low, the program distributed only partial subsidies. So, in May, Broncho received a bill for $46.70. In June, she expected to pay the full cost.

When asked if she would keep her internet connection without the subsidy, Broncho said, “I’m going to try.” Then she added, “I’m going to have to” even if it means taking a lesser service.

Broncho said she uses the internet for shopping, watching shows, banking, and health care.

The internet, Broncho said, is “a necessity.”

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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]]> 1859881 Medics at UCLA Protest Say Police Weapons Drew Blood and Cracked Bones /news/article/ucla-protest-gaza-israel-rubber-bullets-injuries-volunteer-medics/ Thu, 16 May 2024 09:00:00 +0000 /?post_type=article&p=1852778 Inside the protesters’ encampment at UCLA, beneath the glow of hanging flashlights and a deafening backdrop of exploding flash-bangs, OB-GYN resident Elaine Chan suddenly felt like a battlefield medic.

Police were pushing into the camp after an hours-long standoff. Chan, 31, a medical tent volunteer, said protesters limped in with severe puncture wounds, but there was little hope of getting them to a hospital through the chaos outside. Chan suspects the injuries were caused by rubber bullets or other “less lethal” projectiles, which police have confirmed were fired at protesters.

“It would pierce through skin and gouge deep into people’s bodies,” she said. “All of them were profusely bleeding. In OB-GYN we don’t treat rubber bullets. 鈥 I couldn’t believe that this was allowed to be [done to] civilians 鈥 students 鈥 without protective gear.”

The UCLA protest, which gathered thousands in opposition to Israel’s ongoing bombing of Gaza, began in April and grew to a dangerous crescendo this month when counterprotesters and police clashed with the activists and their supporters.

In interviews with 蘑菇影院 Health News, Chan and three other volunteer medics described treating protesters with bleeding wounds, head injuries, and suspected broken bones in a makeshift clinic cobbled together in tents with no electricity or running water. The medical tents were staffed day and night by a rotating team of doctors, nurses, medical students, EMTs, and volunteers with no formal medical training.

At times, the escalating violence outside the tent isolated injured protesters from access to ambulances, the medics said, so the wounded walked to a nearby hospital or were carried beyond the borders of the protest so they could be driven to the emergency room.

“I’ve never been in a setting where we’re blocked from getting higher level of care,” Chan said. “That was terrifying to me.”

Three of the medics interviewed by 蘑菇影院 Health News said they were present when police swept the encampment May 2 and described multiple injuries that appeared to have been caused by “less lethal” projectiles.

Less lethal projectiles 鈥 including beanbags filled with metal pellets, sponge-tipped rounds, and projectiles commonly known as rubber bullets 鈥 are used by police to subdue suspects or disperse crowds or protests. Police drew widespread condemnation for using the weapons against Black Lives Matter demonstrations that swept the country after the killing of George Floyd in 2020. Although the name of these weapons downplays their danger, less lethal projectiles can travel upward of 200 mph and have a documented potential to injure, maim, or kill.

The medics’ interviews directly contradict an account from the Los Angeles Police Department. After police cleared the encampment, LAPD Chief Dominic Choi on the social platform X that there were “no serious injuries to officers or protestors” as police moved in and made more than 200 arrests.

In response to questions from 蘑菇影院 Health News, both the LAPD and California Highway Patrol said in emailed statements that they would investigate how their officers responded to the protest. The LAPD statement said the agency was conducting a review of how it responded, which would lead to a “detailed report.”

The Highway Patrol statement said officers warned the encampment that “non-lethal rounds” may be used if protesters did not disperse, and after some became an “immediate threat” by “launching objects and weapons,” some officers used “kinetic specialty rounds to protect themselves, other officers, and members of the public.” One officer received minor injuries, according to the statement.

Video footage that circulated online after the protest appeared to show a Highway Patrol officer firing less lethal projectiles at protesters with a shotgun.

“The use of force and any incident involving the use of a weapon by CHP personnel is a serious matter, and the CHP will conduct a fair and impartial investigation to ensure that actions were consistent with policy and the law,” the Highway Patrol said in its statement.

The UCLA Police Department, which was also involved with the protest response, did not respond to requests for comment.

Jack Fukushima, 28, a UCLA medical student and volunteer medic, said he witnessed a police officer shoot at least two protesters with less lethal projectiles, including a man who collapsed after being hit “square in the chest.” Fukushima said he and other medics escorted the stunned man to the medical tent then returned to the front lines to look for more injured.

“It did really feel like a war,” Fukushima said. “To be met with such police brutality was so disheartening.”

Back on the front line, police had breached the borders of the encampment and begun to scrum with protesters, Fukushima said. He said he saw the same officer who had fired earlier shoot another protester in the neck.

The protester dropped to the ground. Fukushima assumed the worst and rushed to his side.

“I find him, and I’m like, 鈥楬ey, are you OK?’” Fukushima said. “To the point of courage of these undergrads, he’s like, 鈥榊eah, it’s not my first time.’ And then just jumps right back in.”

Sonia Raghuram, 27, another medical student stationed in the tent, said that during the police sweep she tended to a protester with an open puncture wound on their back, another with a quarter-sized contusion in the center of their chest, and a third with a “gushing” cut over their right eye and possible broken rib. Raghuram said patients told her the wounds were caused by police projectiles, which she said matched the severity of their injuries.

The patients made it clear the police officers were closing in on the medical tent, Raghuram said, but she stayed put.

“We will never leave a patient,” she said, describing the mantra in the medical tent. “I don’t care if we get arrested. If I’m taking care of a patient, that’s the thing that comes first.”

The UCLA protest is one of many that have been held on college campuses across the country as students opposed to Israel’s ongoing war in Gaza demand universities support a ceasefire or divest from companies tied to Israel. Police have used force to remove protesters at Columbia University, Emory University, and the universities of Arizona, Utah, and South Florida, among others.

At UCLA, student protesters set up a tent encampment on April 25 in a grassy plaza outside the campus’s Royce Hall theater, , according to the Los Angeles Times. Days later, a “violent mob” of counterprotesters “attacked the camp,” the Times reported, attempting to tear down barricades along its borders and throwing fireworks at the tents inside.

The following night, police issued an unlawful assembly order, then swept the encampment in the early hours of May 2, clearing tents and arresting hundreds by dawn.

Police have been widely criticized for not intervening as the clash between protesters and counterprotesters dragged on for hours. The University of California system announced it has to investigate the violence and “resolve unanswered questions about UCLA’s planning and protocols, as well as the mutual aid response.”

Charlotte Austin, 34, a surgery resident, said that as counterprotesters were attacking she also saw about 10 private campus security officers stand by, “hands in their pockets,” as students were bashed and bloodied.

Austin said she treated patients with cuts to the face and possible skull fractures. The medical tent sent at least 20 people to the hospital that evening, she said.

“Any medical professional would describe these as serious injuries,” Austin said. “There were people who required hospitalization 鈥 not just a visit to the emergency room 鈥 but actual hospitalization.”

Police Tactics 鈥楲awful but Awful’

UCLA protesters are far from the first to be injured by less lethal projectiles.

In recent years, police across the U.S. have repeatedly fired these weapons at protesters, with virtually no overarching standards governing their use or safety. Cities have spent millions to settle lawsuits from the injured. Some of the wounded have never been the same.

During the nationwide protests following the police killing of George Floyd in 2020, at least 60 protesters sustained serious injuries 鈥 including blinding and a broken jaw 鈥 from being shot with these projectiles, sometimes in apparent violations of police department policies, according to a by 蘑菇影院 Health News and USA Today.

In 2004, in Boston, a college student celebrating a Red Sox victory was killed by a projectile filled with pepper-based irritant when it tore through her eye and into her brain.

“They’re called less lethal for a reason,” said Jim Bueermann, a former police chief of Redlands, California, who now leads the Future Policing Institute. “They can kill you.”

Bueermann, who reviewed video footage of the police response at UCLA at the request of 蘑菇影院 Health News, said the footage shows California Highway Patrol officers firing beanbag rounds from a shotgun. Bueermann said the footage did not provide enough context to determine if the projectiles were being used “reasonably,” which is a standard established by federal courts, or being fired “indiscriminately,” which was outlawed by a California law in 2021.

“There is a saying in policing 鈥 鈥榣awful but awful’ 鈥 meaning that it was reasonable under the legal standards but it looks terrible,” Bueermann said. “And I think a cop racking multiple rounds into a shotgun, firing into protesters, doesn’t look very good.”

This article was produced by 蘑菇影院 Health News, which publishes , an editorially independent service of the .听

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]]> 1852778 Federal Panel Prescribes New Mental Health Strategy To Curb Maternal Deaths /news/article/postpartum-mental-health-federal-strategy-maternal-deaths/ Thu, 16 May 2024 09:00:00 +0000 /?post_type=article&p=1852717 For help, call or text the at 1-833-TLC-MAMA (1-833-852-6262) or contact the by dialing or texting “988.” are also available.

BRIDGEPORT, Conn. 鈥 Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, . In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in and .

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental Health Task Force 鈥 co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem 鈥 that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

Without warning, “a dark cloud came over me,” she said.

Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.

In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state .

Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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]]> 1852717 M茅dicos que atendieron a manifestantes en la protesta estudiantil en la UCLA dicen que la polic铆a dej贸 huesos rotos y hemorragias /news/article/medicos-que-atendieron-a-manifestantes-en-la-protesta-estudiantil-en-la-ucla-dicen-que-la-policia-dejo-huesos-rotos-y-hemorragias/ Thu, 16 May 2024 08:59:00 +0000 /?post_type=article&p=1854446 En el campamento que habían montado los estudiantes dentro del campus de la Universidad de California en Los Ángeles (UCLA), de repente la ginecóloga y obstetra residente Elaine Chan se sintió como una médica en un campo de batalla.

La policía avanzó hacia el campamento luego de horas de enfrentamiento y tensión.

Chan, de 31 años, voluntaria en el puesto de atención médica, dijo que los manifestantes llegaban con dificultades para caminar y con graves heridas punzantes. Pero, por el caos que reinaba afuera, había pocas posibilidades de trasladarlos a un hospital donde se les pudiera brindar otro tipo de cuidados.

Chan expresó su sospecha de que esas lesiones habían sido causadas por balas de goma u otros proyectiles “menos letales”. Después del desalojo del campamento, la policía confirmó que había usado estos dispositivos.

“Los proyectiles atravesaron la piel y se clavaron profundamente en el cuerpo de las personas”, explicó Chan. “Todos sangraban profusamente. Los médicos que nos especializamos en obstetricia y ginecología no hemos sido capacitados para atender heridos por balas de goma鈥 No podía creer que se permitiera atacar de ese modo a civiles, a estudiantes, que tenían ningún equipo de protección”.

La protesta de la UCLA, que reunió a miles de personas que se oponen a los continuos bombardeos de Israel sobre la Franja de Gaza, comenzó en abril y alcanzó un peligroso crescendo en mayo, cuando manifestantes pro Israel y la policía se enfrentaron a los activistas y a los que los apoyaban.

En entrevistas con 蘑菇影院 Health News, Chan y otros tres médicos voluntarios describieron cómo debieron atender a manifestantes con heridas sangrantes, lesiones en la cabeza y huesos presuntamente fracturados en una clínica improvisada en tiendas de campaña, sin electricidad ni agua corriente.

En los puestos sanitarios del campamento hubo día y noche médicos, enfermeras, estudiantes de medicina, paramédicos y voluntarios sin formación médica formal.

En muchos momentos, la escalada de la violencia fuera de la carpa sanitaria fue de tal magnitud que impedía que los manifestantes heridos llegaran hasta las ambulancias, explicaron los médicos. Esto obligó a que los heridos fueran caminando por sus propios medios hasta algún hospital cercano. A otros los llevaron más allá de los límites de la protesta para trasladarlos a una sala de emergencias.

“Nunca había estado en una situación en la que se nos impidiera ofrecer una atención de mayor nivel”, dijo Chan. “Y eso me aterrorizó”.

Tres de los médicos entrevistados por 蘑菇影院 Health News dijeron que estaban presentes el 2 de mayo, cuando la policía arrasó el campamento, y describieron que debieron ocuparse de múltiples lesiones que parecían haber sido causadas por proyectiles “menos letales”.

Estos proyectiles “menos letales” incluyen balas llenas de perdigones de metales pesados o plomo; y municiones comúnmente conocidas como balas de goma. Los utiliza la policía para controlar a sospechosos o para dispersar multitudes y protestas.

La policía recibió una condena generalizada por haber utilizado estas armas contra las manifestaciones del movimiento Black Lives Matter, que se extendieron por todo el país tras el asesinato de George Floyd en 2020.

Aunque el nombre de estas armas parece minimizar su peligrosidad, los proyectiles menos letales pueden viajar a más de 200 mph y está comprobada su capacidad de herir, mutilar o matar.听 听

Las entrevistas a los médicos que atendieron en la posta sanitaria contradicen directamente la versión del Departamento de Policía de Los Ángeles (LAPD). Después que los agentes desalojaran el campamento, el jefe de Policía, Dominic Choi, afirmó en una que “no hubo heridos graves entre los agentes ni entre los manifestantes” durante el operativo en el hubo más de 200 arrestos.

En las respuestas enviadas por correo electrónico a las preguntas de 蘑菇影院 Health News, tanto el Departamento de Policía de Los Ángeles como la Patrulla de Carreteras de California afirmaron que investigarían cómo habían actuado sus agentes durante la protesta en la UCLA. Esas indagaciones, dijeron, darán lugar a un “informe detallado”.

La declaración de la Patrulla de Carreteras asegura que los oficiales advirtieron previamente a los manifestantes que si no se dispersaban podrían utilizar “municiones no letales”.

Después que algunos manifestantes se convirtieran en una “amenaza inmediata” porque “lanzaban objetos y armas”, algunos oficiales utilizaron “balas cinéticas especiales para protegerse a sí mismos, a otros oficiales y a los miembros del público”. Un agente resultó con heridas leves, según el comunicado.

Las imágenes de un video que circuló por Internet después del desalojo del campamento parecían mostrar a un oficial de la Patrulla de Carreteras disparando con una escopeta estos proyectiles de menor letalidad contra los manifestantes.

“El uso de la fuerza y cualquier incidente que implique el uso de un arma por parte del personal de la CHP es un asunto serio, y la CHP llevará a cabo una investigación justa e imparcial para garantizar que las acciones fueron coherentes con la política y la ley”, respondió la Patrulla de Carreteras en su declaración.

El Departamento de Policía de la UCLA, que también participó en el operativo vinculado a la protesta, no respondió al pedido de testimonio de 蘑菇影院 Health News.

Jack Fukushima, de 28 años, estudiante de medicina de la UCLA y socorrista voluntario, contó que presenció cómo un agente de policía les disparó a por lo menos dos manifestantes con proyectiles de menor letalidad.

Entre ellos, a un hombre que se desplomó tras recibir un impacto “justo en el pecho”. Fukushima explicó que, junto con otros médicos, acompañaron al hombre, aturdido, a la carpa sanitaria. Luego volvieron a la zona de los enfrentamientos para buscar más heridos.

“Realmente lo sentí como una guerra”, aseguró Fukushima. “Encontrarse con semejante brutalidad policial fue muy descorazonador”.

Cuando los médicos estuvieron de regreso en la primera línea, la Policía ya había traspasado los límites del campamento y se encontraba forcejeando directamente con los manifestantes, recordó Fukushima.

En esa situación, el socorrista vio como el mismo policía que antes le había disparado al herido que habían llevado al puesto sanitario ahora le disparaba a otro manifestante en el cuello. El muchacho cayó al suelo. Fukushima supuso lo peor y corrió a su lado.

“Cuando logré acercarme le pregunté: 鈥極ye, 驴estás bien?’”, contó Fukushima. “Y él, con una valentía impresionante, me respondió: 鈥楽í, no es mi primera vez’. Y volvió de inmediato a la acción”.

Sonia Raghuram, de 27 años, otra estudiante de medicina que colaboró en la carpa sanitaria dijo que durante el operativo policial atendió a un manifestante que tenía una herida punzante abierta en la espalda, a otro con un moretón del tamaño de una moneda en el centro del pecho y a un tercero con un corte que sangraba “a borbotones” sobre el ojo derecho y que probablemente tenía una costilla rota.

Raghuram contó que los pacientes le dijeron que las heridas habían sido causadas por los proyectiles policiales, lo que, según ella, coincidía con la gravedad de sus lesiones.

Los pacientes les advirtieron claramente que los agentes de policía se estaban acercando a la posta sanitaria, dijo Raghuram, pero ella no se movió.

“Nunca abandonaremos a un paciente”, aseguró, aludiendo al mantra de la carpa médica. “No me importa que nos detengan. Si estoy atendiendo a un paciente, eso es lo prioritario”, concluyó.

La protesta de la UCLA es una de las muchas que se han organizado en campus universitarios de todo el país. Los estudiantes que se oponen a la guerra que Israel mantiene en Gaza exigen que la universidad apoye un alto el fuego y que se retiren las inversiones que pueda tener en empresas vinculadas a Israel.

La Policía utilizó la fuerza para desalojar a los manifestantes de campamentos en la Universidad de Columbia, la Universidad de Emory y las universidades de Arizona, Utah y el sur de Florida, entre otras.

En el campus de la UCLA, el 25 de abril los estudiantes que protestaban instalaron tiendas de campaña en una plaza cubierta de césped frente al teatro Royce Hall.

El asentamiento , según Los Angeles Times. Días más tarde, una “violenta turba” de manifestantes de signo contrario “atacó el campamento”, informó el Times, e intentó derribar las barricadas que protegían sus límites, arrojando fuegos artificiales contra las carpas que había en su interior.

La noche siguiente, la Policía declaró ilegal la demostración y luego desalojó el campamento en las primeras horas del 2 de mayo. Hubo cientos de arrestos.

La Policía ha sido muy criticada por no haber intervenido durante el enfrentamiento entre los manifestantes que acampaban y los que fueron a atacarlos, una confrontación que se prolongó durante horas.

La red de Universidades de California anunció que en materia policial para que investigara los actos de violencia y para “resolver las preguntas sin respuesta sobre la planificación y los protocolos de la UCLA, así como sobre el trabajo de colaboración interinstitucional”.

Charlotte Austin, de 34 años, residente de cirugía, dijo que cuando los manifestantes opositores atacaron el campamento de protesta, vio a unos 10 agentes de seguridad privada del campus de pie, “con las manos en los bolsillos”, mientras los estudiantes eran golpeados y ensangrentados.

Austin asegura que atendió a pacientes con cortes en la cara y posibles fracturas de cráneo. La posta médica envió al menos a 20 personas al hospital esa noche, agregó.

“Cualquier profesional de la medicina calificaría esas lesiones de graves”, dijo Austin. “Hubo personas que debieron ser internadas, no se limitó solo a una visita a la sala de emergencias, sino que necesitaron una hospitalización real”.

Tácticas policiales: “lícitas pero horribles”

Los manifestantes de la UCLA no son los primeros heridos por proyectiles de menor letalidad, ni mucho menos.

En los últimos años, la policía de todo Estados Unidos ha disparado cientos de veces estas armas contra manifestantes, sin que prácticamente exista una normativa general que regule su uso o su seguridad. Algunos de los heridos nunca han vuelto a ser los mismos y las ciudades han gastado millones para responder a las demandas de los damnificados.

Durante las protestas que se produjeron en todo el país tras la muerte de George Floyd a manos de la policía en 2020, al menos 60 manifestantes sufrieron lesiones graves 鈥incluso ceguera y fractura de mandíbula鈥 por disparos de estos proyectiles, a veces en aparente violación de las políticas de los departamentos de policía, según una de 蘑菇影院 Health News y USA Today.

En 2004, en Boston, una estudiante universitaria que celebraba la victoria de los Red Sox murió por el impacto de un proyectil lleno de gas pimienta, que le atravesó el ojo y le llegó al cerebro.

“Se llaman 鈥榤enos letales’ por una razón”, sentenció Jim Bueermann, ex jefe de policía de Redlands, en California, que ahora lidera el Future Policing Institute. “Pueden matarte”.

Bueermann, que a petición de 蘑菇影院 Health News revisó las imágenes de video de la intervención de la policía en la UCLA, dijo que muestran a agentes de la Patrulla de Carreteras de California disparando balas de salva con una escopeta.

Bueermann opinó que las imágenes no proporcionaban suficiente contexto como para determinar si los proyectiles se estaban utilizando “razonablemente”, según indica la norma establecida por los tribunales federales, o se estaban disparando “indiscriminadamente”, lo que fue prohibido por una ley de California en 2021.

“Hay un dicho en la Policía 鈥 “legal pero horrible”鈥 lo que significa que es razonable bajo los estándares legales, pero se ve terrible”, explicó Bueermann. “Y creo que un policía cargando múltiples balas en una escopeta y disparando contra los manifestantes, no es algo que se vea muy bien”.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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]]> 1854446 Proponen estrategia federal de salud mental para frenar muertes maternas /news/article/proponen-estrategia-federal-de-salud-mental-para-frenar-muertes-maternas/ Thu, 16 May 2024 08:59:00 +0000 /?post_type=article&p=1854431 Bridgeport, Connecticut.- Milagros Aquino buscaba un nuevo lugar para vivir y estaba intentando acostumbrarse a la comida después de mudarse a Bridgeport, desde Perú, con su esposo y su hijo pequeño en 2023.

Cuando Aquino, que ahora tiene 31 años, se quedó embarazada en mayo de ese año, “de repente todo fue peor que antes”, dijo. “Estaba muy triste y me pasaba el día en la cama. Me sentía realmente perdida y me limitaba a sobrevivir”.

El caso de Aquino no es único.

, la depresión perinatal afecta a un 20% de las mujeres en Estados Unidos durante el embarazo, el posparto o ambos. En algunos estados, la ansiedad o la depresión afectan a casi una cuarta parte de las madres primerizas o de las embarazadas.

Muchas mujeres en el país no reciben tratamiento porque no existe un sistema generalizado de detección de enfermedades mentales en las madres, a pesar de las recomendaciones. Expertos afirman que la falta de detección ha provocado un aumento de las tasas de enfermedad mental, suicidio y sobredosis de drogas, que ahora son las principales causas de muerte en el primer año después que una mujer da a luz.

“Se trata de un problema sistémico, médico y de derechos humanos”, afirmó Lindsay R. Standeven, psiquiatra perinatal y directora clínica y educativa del Johns Hopkins Reproductive Mental Health Center.

Según Standeven, entre las causas profundas del problema figuran las disparidades raciales y socioeconómicas en la atención materna y la falta de sistemas de apoyo para las nuevas madres.

También apuntó a la escasez de profesionales de salud mental, la insuficiente formación en salud mental materna de los proveedores y el insuficiente reembolso por estos servicios. Por último, Standeven señaló que el problema se ve agravado por la falta de políticas nacionales de licencia por maternidad y el acceso a las armas.

Estos factores contribuyeron a un de la depresión posparto entre 2010 y 2021, según el American Journal of Obstetrics & Gynecology.

En el caso de Aquino, no fue hasta las últimas semanas de su embarazo, cuando empezó a hacer acupuntura para aliviar su estrés. Una trabajadora social la ayudó a recibir atención a través de la Emme Coalition, una organización que conecta a niñas y mujeres con ayuda financiera, servicios de asesoramiento en salud mental y otros recursos.

Las madres a las que se diagnostica con depresión o ansiedad perinatal durante o después del embarazo corren un riesgo tres veces mayor de comportamiento suicida y seis veces mayor de suicidio que las madres sin un trastorno del estado de ánimo, según estudios recientes, estadounidenses e internacionales, publicados en y

Las consecuencias de la crisis de salud mental materna son especialmente graves en las comunidades rurales que se han convertido en desiertos para la atención de la maternidad, ya que los pequeños hospitales cierran sus unidades de parto por la caída de las tasas de natalidad o por problemas económicos o de personal.

Hace pocos días, el Grupo de Trabajo sobre Salud Mental Materna 鈥攃odirigido por la Oficina de Salud de la Mujer y la Administración de Servicios de Salud Mental y Abuso de Sustancias, y constituido en septiembre para dar respuesta a este problema鈥 que pudieran servir como núcleos de atención integrada, e instalaciones de parto, aprovechando los servicios y el personal ya existentes en las comunidades.

Según Joy Burkhard, miembro del grupo de trabajo y directora ejecutiva de la organización sin fines de lucro Policy Center for Maternal Mental Health, el grupo de trabajo determinará en breve qué partes del plan requerirán la intervención del Congreso y financiación para su puesta en práctica, y cuáles serán “las opciones más factibles”.

Para Burkhard, es esencial un acceso equitativo a la salud. El grupo de trabajo recomendó que los funcionarios federales determinen las zonas en las que deben ubicarse los centros de maternidad basándose en datos que identifiquen a las desatendidas. “La América rural”, dijo, “es lo primero y lo más importante”.

Hay escasez de atención en “zonas poco probables”, como el condado de Los Angeles, donde recientemente se han cerrado algunas maternidades, explicó Burkhard. Las zonas urbanas desatendidas también podrían er elegibles para los nuevos centros.

“Lo único que piden las madres es un atención de la maternidad que tenga sentido. Ahora mismo no existe nada de eso”, añadió.

Se han diseñado varios programas piloto para ayudar a las madres con dificultades, que consisten en formar y equipar a comadronas y doulas, personas que orientan y apoyan a las madres de recién nacidos.

En Montana, las tasas de depresión materna antes, durante y después del embarazo son superiores a la media nacional. De 2017 a 2020, aproximadamente el 15% de las madres experimentaron depresión posparto y el 27% experimentaron depresión perinatal, según el .

El estado tuvo la sexta tasa de mortalidad materna más alta del país en 2019, cuando recibió una subvención federal para comenzar a capacitar a las doulas.

Hasta la fecha, el programa ha capacitado a 108 doulas, muchas de las cuales son nativas americanas. Los nativos americanos representan el 6,6% de la población de Montana.

Según un estudio publicado en Obstetrics and Gynecology, las nativas, sobre todo las de zonas rurales, tienen que las mujeres blancas no hispanas a nivel nacional.

Stephanie Fitch, gestora de subvenciones de Montana Obstetrics & Maternal Support en la Clínica Billings, afirmó que la formación de doulas “tiene el potencial de contrarrestar las barreras sistémicas que afectan desproporcionadamente a nuestras comunidades tribales y mejorar la salud general de la comunidad”.

y Washington, DC tienen cobertura de Medicaid para la atención de doulas, según el National Health Law Program. Son California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, Nueva Jersey, Oklahoma, Oregon, Rhode Island y Virginia.

Medicaid paga alrededor del en Estados Unidos, según los Centros para el Control y Prevención de Enfermedades(CDC).

Jacqueline Carrizo, la doula asignada a Aquino a través de la Emme Coalition, desempeñó un papel importante en su recuperación. Según dijo Aquino, nunca podría haber pasado por un “momento tan oscuro sola”. Con el apoyo de Carrizo, “pude salir adelante”, afirmó.

Los factores genéticos y ambientales, o un trastorno mental previo, pueden aumentar el riesgo de depresión o ansiedad durante el embarazo. Pero los trastornos del estado de ánimo pueden afectar a cualquiera.

Teresa Martínez, de 30 años, de Price, Utah, había luchado contra la ansiedad y la infertilidad durante años antes de concebir a su primer hijo. Pero la alegría y el alivio de dar a luz en 2012 duraron poco.

Sin previo aviso, “una nube oscura se cernió sobre mí”, dijo.

Martínez tenía miedo de decírselo a su marido. “Como mujer, te sientes muy presionada y no quieres el estigma de no ser una buena madre”, explicó.

En los últimos años, se han puesto en marcha programas en todo el país para ayudar a los médicos a reconocer los trastornos del estado de ánimo de las madres y poder asistirlas antes de que se produzcan daños.

Uno de los programas más exitosos es el Massachusetts Child Psychiatry Access Program for Moms, que comenzó hace una década y desde entonces se ha extendido a 29 estados. El programa, financiado con fondos federales y estatales, proporciona herramientas y formación a médicos y otros profesionales para detectar e identificar trastornos, clasificar a los pacientes y ofrecer opciones de tratamiento.

Pero la expansión de los programas de salud mental materna se está produciendo en medio de la escasez de recursos en gran parte de la América rural. Muchos programas a lo largo del país se han quedado sin fondos.

El grupo de trabajo federal propuso que el Congreso financie y cree programas de consulta similares al de Massachusetts, pero no para sustituir a los que ya existen, dijo Burkhard.

En abril, Missouri se convirtió en el último estado en adoptar el modelo de Massachusetts.

Las residentes con Medicaid tienen 10 veces más probabilidades de morir en el primer año de embarazo que las que tienen seguro privado. De 2018 a 2020, un promedio de 70 mujeres de Missouri murieron cada año durante el embarazo o dentro del año posterior al parto, según las .

Wendy Ell, directora ejecutiva del Proyecto de Acceso a la Salud Materna en Missouri, calificó su servicio como un “recurso que salva vidas”, gratuito y de fácil acceso para cualquier proveedor de atención médica en el estado que atienda a pacientes en el período perinatal.

Unos 50 profesionales de salud se han inscrito en el programa de Ell desde su puesta en marcha. En los 30 minutos siguientes a la solicitud, los profesionales pueden consultar por teléfono a uno de los tres psiquiatras perinatales. Pero mientras los médicos pueden recibir asesoramiento de los psiquiatras, los recursos de salud mental para las pacientes no son tan fáciles de conseguir.

El grupo de trabajo pidió financiamiento federal para formar a más profesionales de la salud mental y ubicarlos en zonas con grandes necesidades, como Missouri. El grupo de trabajo también recomendó formar y certificar a una plantilla más diversa de trabajadores comunitarios de salud mental, asesores de pacientes, doulas y especialistas de apoyo a colegas en las zonas donde más se necesitan.

Se ha diseñado un nuevo sobre psiquiatría reproductiva para ayudar a los residentes, becarios y profesionales de la salud mental con escasa o nula formación sobre el tratamiento de las enfermedades psiquiátricas en el periodo perinatal.

Un reveló que el plan de estudios mejoraba significativamente la capacidad de los psiquiatras para tratar a las mujeres en el período perinatal con enfermedades mentales, afirmó Standeven, que contribuyó al programa de formación y es uno de los autores del sondeo.

Nancy Byatt, psiquiatra perinatal de la Facultad de Medicina Chan de la Universidad de Massachusetts, que dirigió el lanzamiento del Massachusetts Child Psychiatry Access Program for Moms en 2014, dijo que todavía hay mucho trabajo por hacer.

“Creo que lo más importante es que hemos avanzado mucho y, en ese sentido, tengo cierta esperanza”, señaló Byatt.

Los informes de Cheryl Platzman Weinstock cuentan con el apoyo de una subvención del National Institute for Health Care Management Foundation.

Para ayuda, se puede llamar o enviar un mensaje de texto a la al 1-833-TLC-MAMA (1-833-852-6262) o contactar a marcando o texteando “988”.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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]]> 1854431 Rural Jails Turn to Community Health Workers To Help the Newly Released Succeed /news/article/utah-rural-jails-community-health-workers-prevent-recidivism/ Mon, 22 Apr 2024 09:00:00 +0000 /?post_type=article&p=1841454 MANTI, Utah 鈥 Garrett Clark estimates he has spent about six years in the Sanpete County Jail, a plain concrete building perched on a dusty hill just outside this small, rural town where he grew up.

He blames his addiction. He started using in middle school, and by the time he was an adult he was addicted to meth and heroin. At various points, he’s done time alongside his mom, his dad, his sister, and his younger brother.

“That’s all I’ve known my whole life,” said Clark, 31, in December.

Clark was at the jail to pick up his sister, who had just been released. The siblings think this time will be different. They are both sober. Shantel Clark, 33, finished earning her high school diploma during her four-month stay at the jail. They have a place to live where no one is using drugs.

And they have Cheryl Swapp, the county sheriff’s new community health worker, on their side.

“She saved my life probably, for sure,” Garrett Clark said.

Swapp meets with every person booked into the county jail soon after they arrive and helps them create a plan for the day they get out.

She makes sure everyone has a state ID card, a birth certificate, and a Social Security card so they can qualify for government benefits, apply to jobs, and get to treatment and probation appointments. She helps nearly everyone enroll in Medicaid and apply for housing benefits and food stamps. If they need medication to stay off drugs, she lines that up. If they need a place to stay, she finds them a bed.

Then Swapp coordinates with the jail captain to have people released directly to the treatment facility. Nobody leaves the jail without a ride and a drawstring backpack filled with items like toothpaste, a blanket, and a personalized list of job openings.

“A missing puzzle piece,” Sgt. Gretchen Nunley, who runs educational and addiction recovery programming for the jail, called Swapp.

Swapp also assesses the addiction history of everyone held by the county. More than half arrive at the jail addicted to something.

Nationally, booked into local jails struggle with a substance use disorder 鈥 at least six times the rate of the general population, according to the federal Substance Abuse and Mental Health Services Administration. The incidence of mental illness in jails is more than twice the rate in the general population, federal data shows. At least 4.9 million people are arrested and jailed every year, according to an by the Prison Policy Initiative, a nonprofit organization that documents the harm of mass incarceration. Of those incarcerated, 25% are booked two or more times, the analysis found. And among those arrested twice, more than half had a substance use disorder and a quarter had a mental illness.

“We don’t lock people up for being diabetic or epileptic,” said David Mahoney, a retired sheriff in Dane County, Wisconsin, who served as president of the in 2020-21. “The question every community needs to ask is: 鈥楢re we doing our responsibility to each other for locking people up for a diagnosed medical condition?’”

The idea that county sheriffs might owe it to society to offer medical and mental health treatment to people in their jails is part of a broader shift in thinking among law enforcement officials that Mahoney said he has observed during the past decade.

“Don’t we have a moral and ethical responsibility as community members to address the reasons people are coming into the criminal justice system?” asked Mahoney, who has 41 years of experience in law enforcement.

Swapp previously worked as a teacher’s aide for those she calls the “behavior kids” 鈥 children who had trouble self-regulating in class. She feels her work at the jail is a way to change things for the parents of those kids. And it appears to be working.

Since the Sanpete County Sheriff’s Office hired Swapp last year, recidivism has dropped sharply. In the 18 months before she began her work, 599 of the people booked into Sanpete County Jail had been there before. In the 18 months after she started, that number dropped to 237.

In most places, people are released from county jails with no health care coverage, no job, nowhere to live, and no plan to stay off drugs or treat their mental illness. that people newly released from incarceration face a risk of overdose that is 10 times as high as that of the general public.

Sanpete wasn’t any different.

“For seven to eight years of me being here, we’d just release people and cross our fingers,” said Jared Hill, the clinical director for Sanpete County and a counselor at the jail.

Nunley, the programming sergeant, remembers watching people released from jail walk the mile to town with nothing but the clothes they’d worn on the day they were arrested 鈥 it was known as the “walk of shame.” Swapp hates that phrase. She said no one has made the trip on foot since she started in July 2022.

Swapp’s work was initially funded by a grant from the U.S. Health Resources and Services Administration, but it has proved so popular that commissioners in Sanpete County voted to use a portion of its to cover the position in the future.

Swapp doesn’t have formal medical or social work training. She is certified by the state of Utah as a community health worker, a job that has become more common nationwide. There were about 67,000 people working as community health workers in 2022, according to the .

Evidence is mounting that the model of training people to help their neighbors connect to government and health care services is sound, said Aditi Vasan, a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania who has on the relatively new role.

The day before Swapp coordinated Shantel Clark’s release, she sat with Robert Draper, a man in his 50s with long white hair and bright-blue eyes. Draper has been in and out of jail for decades. He was sober for a year and had been taking care of his ill mother. She kept getting worse. Then his daughter and her child came to help. It was all a little too much.

“I thought, if I can just go and get high, I can deal with this shit,” said Draper. “But after you’ve been using for 40 years, it’s kinda easy to slip back in.”

He didn’t blame his probation officer for throwing him back in jail when he tested positive for drugs, he said. But he thinks jail time is an overreaction to a relapse. Draper sent a note to Swapp through the jail staff asking to see her. He was hoping she could help him get out so he could be with his mom, who had just been sent to hospice. He had missed his father’s death years ago because he was in jail at the time.

Swapp listened to Draper’s story without interruptions or questions. Then she asked if she could run through her list with him so she would know what he needed.

“Do you have your Social Security card?”

“My card?” Draper shrugged. “I know my number.”

“Your birth certificate, you have it?”

“Yeah, I don’t know where it is.”

“Driver’s license?”

“No.”

“Was it revoked?”

“A long, long time ago,” Draper said. “DUI from 22 years ago. Paid for and everything.”

“Are you interested in getting it back?”

“Yeah!”

Swapp has some version of this conversation with every person she meets in the jail. She also runs through their history of addiction and asks them what they most need to get back on their feet.

She told Draper she would try to get him into intensive outpatient therapy. That would involve four to five classes a week and a lot of driving. He’d need his license back. She didn’t make promises but said she would talk to his probation officer and the judge. He sighed and thanked her.

“I’m your biggest fan here,” Swapp said. “I want you to succeed. I want you to be with your mom, too.”

The federal grant that funded the launch of Sanpete’s community health worker program is held by the regional health care services organization Intermountain Health. Intermountain took the idea to the county and has provided Swapp with support and training. Intermountain staff also administer the $1 million, three-year grant, which includes efforts to increase addiction recovery services in the area.

A similarly funded program in Kentucky called First Day Forward took the community health worker model a step further, using “peer support specialists” 鈥 people who have experienced the issues they are trying to help others navigate. Spokespeople from HRSA pointed to four programs, including the ones in Utah and Kentucky, that are using their grant money for people facing or serving time in local jails.

Back in Utah, Sanpete’s new jail captain, Jeff Nielsen, said people in small-town law enforcement weren’t so far removed from those serving time.

“We know these people,” Nielsen said. He has known Robert Draper since middle school. “They are friends, neighbors, sometimes family. We’d rather help than lock them up and throw away the key. We’d rather help give them a good life.”

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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]]> 1841454 Paris Hilton Backs California Bill Requiring Sunshine on 鈥楾roubled Teen Industry鈥 /news/article/paris-hilton-troubled-teen-industry-california-hearing/ Wed, 17 Apr 2024 09:00:00 +0000 /?post_type=article&p=1840862 Celebrity hotel heiress Paris Hilton is backing California lawmakers’ push to increase the transparency of residential teen therapeutic centers by requiring these programs to report the use of restraints or seclusion rooms in disciplining minors.

“We shouldn’t be placing youth in facilities without knowing what these children will be subjected to,” Hilton testified Monday to the Senate Human Services Committee in Sacramento. “The Accountability in Children’s Treatment Act is a simple transparency measure that would make a lasting impact and show the world what truly happens behind closed doors.”

Hilton, 43, has become a high-profile advocate for getting tough on what she describes as the “,” which promises to rehabilitate teenagers struggling with substance abuse, mental illness, and problematic behavior. Such programs lack federal oversight and for riots, assaults, and even deaths of minors, prompting a pushback to protect the rights of young people.

After releasing a she faced while attending Provo Canyon School in Provo, Utah, as a teenager, Hilton to the state, strengthening inspection and oversight of the industry. Advocates have successfully passed related laws in , , Montana, and .

Last year, Hilton went to Washington, D.C., to advocate for the federal , which would establish best practices and transparency in youth residential care programs. But national efforts have failed for and the latest proposal has been stalled for a year.

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Now, Hilton and others are eyeing the most populous state as an opportunity for change.

is a bipartisan bill by Republican state Sen. Shannon Grove and authored also by Democratic Sens. Aisha Wahab and Angelique Ashby. The bill aims to protect young people housed in short-term residential therapeutic programs licensed by the California Department of Social Services by requiring the agency to produce a public dashboard by 2026 on the use of restraint and seclusion rooms, and when it results in serious injuries or death. It would also require foster parents and guardians to be notified when restraints and seclusion rooms are used on minors.

“There are complaints of broken arms, slammed hands in doors,” said Grove, who noted that these facilities typically house vulnerable populations, including foster youth. “There’s no data to show what happened and what caused that. And so, the goal is to go after the data.”

There was no formal opposition. The National Association of Therapeutic Schools and Programs, the nation’s largest such member organization, told 蘑菇影院 Health News that it supports the California bill.

During Monday’s hearing, Hilton shared that while she was housed at facilities in California, Utah, and Montana, she was subjected to abuse disguised as therapy. She said if she tried to tell her parents about the abuse, facility staff would rip the phone from her hand, restrain her, and force her into solitary confinement.

“When I close my eyes at night, I still have nightmares about solitary confinement 20 years later,” Hilton said. “The sounds of my peers screaming as they were physically restrained by numerous staff members and injected with sedatives will also never leave me.”

Zoe Schreiber, another survivor, said she was sent at age 13 to a Utah facility, where she was restrained face down in the mud by six adults for hours in the rain. Schreiber described enduring seclusion, hard labor, and humiliation for four years.

Democratic state Sen. Marie Alvarado-Gil, who chairs the Human Services Committee, said she had worked in such residential treatment facilities and noticed that staff often didn’t have proper training.

“I don’t think they’re all bad, but I do think the ones that are bad, that impact the trauma of our children, that are unregulated, that are unstructured, that do not have evidence-based programming 鈥 I wonder how we get away with that here in California,” Alvarado-Gil said.

Wahab said it’s important for California to act in the absence of a federal bill. California to prevent the state from sending foster children to out-of-state facilities.

“I’m hoping that we do some justice to the kids here,” Wahab said.

The Senate Human Services Committee passed SB 1043 on a 5-0 vote. The bill now goes to the Appropriations Committee.

This article was produced by 蘑菇影院 Health News, which publishes , an editorially independent service of the .听

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]]> 1840862 Ten Doctors on FDA Panel Reviewing Abbott Heart Device Had Financial Ties With Company /news/article/abbott-triclip-fda-advisory-panel-payments-funding-conflict-of-interest/ Mon, 08 Apr 2024 09:00:00 +0000 /?post_type=article&p=1827874 When the FDA recently convened a committee of advisers to assess a cardiac device made by Abbott, the agency didn’t disclose that most of them had received payments from the company or conducted research it had funded 鈥 information readily available in a federal database.

One member of the FDA advisory committee was linked to hundreds of payments from Abbott totaling almost $200,000, according to a database maintained by the Department of Health and Human Services. Another was connected to 100 payments totaling about $100,000 and conducted research supported by about $50,000 from Abbott. A third member of the committee worked on research supported by more than $180,000 from the company.

The government database, called “,” records financial relationships between doctors and certain other health care providers and the makers of drugs and medical devices. 蘑菇影院 Health News found records of Abbott payments associated with 10 of the 14 voting members of the FDA advisory panel, which was weighing clinical evidence for a heart device called TriClip G4 System. The money, paid from 2016 through 2022 鈥 the most recent year for which the database shows payments 鈥 adds up to about $650,000.

The panel voted almost unanimously that the benefits of the device outweigh its risks. Abbott announced on April 2 that the FDA had approved TriClip, which is designed to treat leakage from the heart’s tricuspid valve.

The Abbott payments illustrate the reach of medical industry money and the limits of transparency at the FDA. They also shed light on how the agency weighs relationships between people who serve on its advisory panels and the makers of drugs and medical devices that those committees review as part of the regulatory approval process.

The payments do not reflect wrongdoing on the part of the agency, its outside experts, or the device manufacturer. The database does not show that any of the payments were related directly to the TriClip device.

But some familiar with the process, including people who have served on FDA advisory committees, said the payments should have been disclosed at the Feb. 13 meeting 鈥 if not as a regulatory requirement, then in the interest of transparency, because the money might call into question committee members’ objectivity.

“This is a problem,” Joel Perlmutter, a former FDA advisory committee member and a professor of neurology at Washington University School of Medicine in St. Louis, said by email. “They should or must disclose this due to bias.”

The records several kinds of payments from drug and device makers. One category, called “associated research funding,” supports research in which a physician is named a principal investigator in the database. Another category, called “general payments,” includes consulting fees, travel expenses and meals connected to physicians in the database. The money can flow from manufacturers to third parties, such as hospitals, universities, or other corporate entities, but the database explicitly connects doctors by name to the payments.

At the to consider the TriClip device, an FDA official announced that committee members had been screened for potential financial conflicts of interest and found in compliance with government requirements.

FDA spokesperson Audra Harrison said by email that the agency doesn’t comment on matters related to individual advisory committee members.

“The FDA followed all appropriate procedures and regulations in vetting these panel members and stands firmly by the integrity of the disclosure and vetting processes in place,” she said. “This includes ensuring advisory committee members do not have, or have the appearance of, a conflict of interest.”

Abbott “has no influence over who is selected to participate in FDA advisory committees,” a spokesperson for the company, Brent Tippen, said in a statement.

Diana Zuckerman, president of the National Center for Health Research, a think tank, said the FDA shouldn’t have allowed recipients of funding from Abbott in recent years to sit in judgment of the Abbott product. The agency takes too narrow a view of what should be disqualifying, she said.

One committee member was Craig Selzman, chief of the Division of Cardiothoracic Surgery at the University of Utah. The Open Payments database connects to Selzman about $181,000 in associated research funding from Abbott to the University of Utah Hospitals & Clinics.

Asked in an interview if a reasonable person could question the impartiality of committee members based on the Abbott payments, Selzman said: “People from the outside looking in would probably say yes.”

He noted that Abbott’s money went to the university, not to him personally. Participating in industry-funded clinical trials benefits doctors professionally, he said. He added: “There’s probably a better way to provide transparency.”

The FDA has a history of appointing people to advisory committees who had relationships with manufacturers of the products under review. For example, in 2020, the doctor who chaired an FDA advisory committee had been a Pfizer consultant.

Appearance Issues

FDA advisory committee candidates, selected to provide expert advice on often complicated drug and device applications, must complete a confidential disclosure report that asks about current and past financial interests as well as “anything that would give an 鈥榓ppearance’ of a conflict.”

The FDA has discretion to decide whether someone with an “appearance issue” can serve on a panel, according to a guidance document posted on the agency’s website. Relationships more than a year in the past generally don’t give rise to appearance problems, according to the document, unless they suggest close ties to a company or involvement with the product under review. The main question is whether financial interests would cause a reasonable person to question the member’s impartiality, the document says.

The FDA draws a distinction between appearance issues and financial conflicts of interest. Conflicts of interest occur when someone chosen to serve on an advisory committee has financial interests that “may be impacted” by their work on the committee, says.

If the FDA finds a conflict of interest but still wants the applicant on a panel, it can issue a public waiver. None of the panelists voting on TriClip received a waiver.

The FDA’s approach to disclosure contrasts with at which doctors earn credit for continuing medical education. For example, for a recent conference in Boston on technology for treatment of heart failure, including TriClip, the group holding the meeting directed speakers to include in their slide presentations disclosures .

Those disclosures 鈥 naming companies from which speakers had received consulting fees, grant support, travel expenses, and the like 鈥 also appeared on the conference website.

鈥Unbridled Enthusiasm’

The FDA has designated TriClip a “breakthrough” device with “the potential to provide more effective treatment or diagnosis of a life-threatening or irreversibly debilitating disease” compared with current treatments, an agency official, Megan Naber, .

Naber said that for breakthrough devices, the “totality of data must still provide a reasonable assurance of safety and effectiveness” but the FDA “may be willing to accept greater uncertainty” about the balance of risks and benefits.

In a for the advisory committee, FDA staff pointed out findings from a clinical trial that didn’t reflect well on TriClip. For example, patients treated with TriClip had “numerically higher” mortality and heart failure hospitalization rates during the 12 months after the procedure compared with a control group, according to the report. Tippen, the Abbott spokesperson, didn’t respond to a request for comment on those findings.

The committee voted 14-0 that TriClip was safe for its intended use. The panel voted 12-2 that the device was effective, and it voted 13-1 that the benefits of TriClip outweighed the risks.

The committee member to whom the database attributes the most money from Abbott, Paul Hauptman, cast one of the votes against the device on effectiveness and the sole vote against the device on the bottom-line question of its risks versus benefits.

Hauptman said during the meeting that the question of safety was “very, very clear” but added: “I just felt the need to pull back a little bit on unbridled enthusiasm.” Who will benefit from the device, he said, “needs better definition.”

Hauptman, dean of the University of Nevada-Reno School of Medicine, is connected to 268 general payments from Abbott in the Open Payments database. Some payments are listed as going to an entity called Keswick Cardiovascular.

Hauptman said in an email that he followed FDA guidance and added, “My impartiality speaks for itself based on my vote and critical comments.”

Some committee members voted in favor of the device despite concerns.

Marc Katz, chief of the Division of Cardiothoracic Surgery at the Medical University of South Carolina, is linked to 77 general about $53,000 from Abbott and worked on research supported by about $10,000 from the company, according to Open Payments.

“I voted yes for safety, no for effectiveness, but then caved and voted yes for the benefits outweighing the risks,” he said in the meeting.

In an email, he said of his Abbott payments: “All was disclosed and reviewed by the FDA.” He said that he “can be impartial” and that he “openly expressed 鈥 concerns about the treatment.”

Mitchell Krucoff, a professor at Duke University School of Medicine, is connected to 100 general about $105,000. Some went to a third party, HPIC Consulting. He also worked on research supported by about $51,000 from Abbott, according to Open Payments.

He said during the meeting that he voted in favor of the device on all three questions and added that doctors have “a lot to learn” once it’s on the market. For instance: By using the device to treat patients now, “do we set people up for catastrophes later?”

In an email, Krucoff said he completed a “very thorough conflict of interest screening by FDA for this panel,” which focused not only on Abbott but also on “any work done/payments received from any other manufacturer with devices in this space.”

John Hirshfeld Jr., an emeritus professor of medicine at the University of Pennsylvania, is linked by the database to six general payments from Abbott . Two of the payments linked to him went to a nonprofit, the Cardiovascular Research Foundation, according to the database. He voted yes on all three questions about TriClip but said at the meeting that he “would have liked to have seen more rigorous data to support efficacy.”

In an email, Hirshfeld said he disclosed the payments to the FDA. The agency did not deem him to have a conflict because he had no stake in Abbott’s success and his involvement with the company had ended, he said. Through the conflict-of-interest screening process, he said, he had been excluded from prior advisory panels.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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]]> 1827874 When Copay Assistance Backfires on Patients /news/article/drugmaker-copay-assistance-backfires-patient-deductibles/ Fri, 15 Mar 2024 10:00:00 +0000 /?post_type=article&p=1819827 In early 2019, Jennifer Hepworth and her husband were stunned by a large bill they unexpectedly received for their daughter’s prescription cystic fibrosis medication. Their payment had risen to $3,500 from the usual $30 for a month’s supply.

That must be a mistake, she told the pharmacy. But it wasn’t. It turned out that the health insurance plan through her husband’s job had a new program in which it stopped applying any financial assistance they received from drugmakers to the family’s annual deductible.

Insurers or employers can tap into funds provided to patients by drugmakers through copay assistance programs, which were designed by the companies to help patients afford increasingly expensive medications. But, because those payments are no longer counted toward the deductible, patients must pay an amount out-of-pocket, too, often for the same drugs. Those deductibles or other out-of-pocket costs can easily run into thousands of dollars.

Here’s what that meant for Hepworth, who lives in Utah. Before the change, the drugmaker’s copay assistance would almost immediately meet her family’s deductible for the year, because both Hepworth and her daughter need expensive medications. As a result, the family was responsible for copays of only 20% of their medical costs instead of the 100% required by their plan until they met their deductible. By the middle of the year, the family would have reached the plan’s out-of-pocket maximum of nearly $10,000 and would no longer owe any copays.

Hepworth ended up paying the $3,500 to the pharmacy, equivalent to the family’s annual deductible, because she didn’t want to stop giving her daughter a treatment that could extend her life. “We were struggling and everything went on credit cards.”

Why did the insurer do this?

Employers or the health insurance plans they hire are saving 10% to 15% of the cost of prescription plan claims by using these copay accumulator programs, said Edward Kaplan, a , a benefits consulting firm. Even so, Kaplan doesn’t recommend that his clients, who include public and private employers, take advantage of the program because of the increasing pushback from lawmakers and advocacy groups. However, are in plans governed by these types of programs, according to Avalere, a consulting firm.

now limit copay accumulator programs for some insurance plans. And patient advocacy groups against the programs. States’ limits on the practice, however, do not apply to larger, self-insured job-based plans, through which many Americans have coverage.

Bipartisan legislation has been introduced in both chambers of Congress that would require financial assistance to count toward deductibles and other out-of-pocket costs. Called the , it would govern plans that are exempt from state rules.

Change is unlikely to come soon.

Insurers and employers have long complained that copay assistance programs are mainly a marketing ploy by the drug industry that encourages patients to stay on costly drugs when lower-cost alternatives might be available. Insurers say capturing more of that money themselves can help slow the rising price of premiums.

In a , the Blue Cross Blue Shield Association called the practice “a vital tool in keeping health insurance affordable.”

Patient advocacy groups, including the and two diabetes groups, disagreed and took a case against copay accumulator programs to U.S. District Court last fall.

And “we won,” said Carl Schmid, executive director of the institute. The groups argued the practice can cause some patients to skip their medications because of the unexpected costs they must now shoulder.

Some critics say it’s a form of double dipping because even though the patient hasn’t personally paid out-of-pocket, “that payment was made, and it was made on your behalf. I think that should get counted,” said Rachel Klein, deputy executive director with the , an advocacy group.

, Schmid said, essentially overturns a 2021 provision in Centers for Medicare & Medicaid Services rules that allowed insurers to expand the practice to cover almost any drug. Previous rules from 2020 would now be in effect, said Schmid, and those rules say copay assistance should count toward the deductible for all drugs for which there is no medically appropriate generic alternative available.

Even so, billing changes for many insured patients may take a while.

While the Biden administration of the court decision, it has filed motions noting “it does not intend to take any enforcement action against issuers or plans” until regulators draw up new rules, said Ellen Montz, deputy administrator and director of the Center for Consumer Information and Insurance Oversight at CMS, in a written statement to 蘑菇影院 Health News.

A version of these programs being used by insurers, sometimes called a “maximizer,” works a bit differently.

Under a maximizer program, insurers partner with outside firms such as and . The programs declare certain drugs or classes of drugs “nonessential,” thus allowing them to circumvent some Affordable Care Act rules that limit patient cost sharing. That lets the insurer collect the maximum amount from a drugmaker’s assistance program, even if that is more than the patient would owe through deductibles or out-of-pocket maximums had the drugs remained essential benefits. These partner companies also work with large pharmacy benefit managers that oversee prescription services for employers.

Those maximizer payments do not count toward a patient’s deductible. Many insurers don’t charge patients an additional copay for the drugs deemed nonessential as a way of enticing them to sign up for the programs. If patients choose not to enroll, they could face a copayment far higher than usual because of the “nonessential” designation.

“This is a loophole in the ACA that they are exploiting,” said Schmid of the HIV+Hepatitis Policy Institute, referring to the Affordable Care Act. Johnson & Johnson filed a lawsuit in federal court in New Jersey in 2022 against such a maximizer program, saying it coerced patients into participating because if they didn’t they faced higher copays. The drugmaker warned it might reduce the amount of overall assistance available to patients because of the increasingly common practice.

Now, though, a provision in the governing health insurers says plans must consider any covered drug an “essential benefit.” If finalized, the provision would hamper insurers’ ability to collect the maximum amount of drugmaker assistance.

Employers are watching for the outcome of the lawsuit and the proposed federal rules and don’t yet have clarity on how rulings or regulations will affect their programs, said James Gelfand, president and chief executive of the ERISA Industry Committee, which advocates for large, self-insured employers.

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]]> 1819827 GOP-Led States Expand Crackdowns on Transgender Care /news/article/health-202-transgender-health-care-conservative-states/ Wed, 13 Mar 2024 13:11:19 +0000 /?p=1826428&post_type=article&preview_id=1826428 South Carolina’s legislature is poised to pass a bill prohibiting doctors from offering some health-care services to transgender minors 鈥 part of a new wave of anti-trans legislation from Republican-led states.

, which passed the state House of Representatives in January and is under consideration in the Senate, would bar health-care providers from performing gender-transition surgery, prescribing puberty-blocking drugs and overseeing hormone treatments for patients under 18.

It would also mandate that school officials notify parents of a student’s transgender identity and block the state Medicaid program from paying for gender-affirming care to patients under the age of 26.听

Nationwide, high-profile Republicans including Florida Gov. Ron DeSantis have made crackdowns on transgender rights central to their political agendas, which has helped encourage state-level legislation that critics call bigoted. as of the end of February, according to 蘑菇影院.

Anya Marino, director of LGBTQI equality at the National Women’s Law Center, a nonprofit that advocates for women’s rights, said apart from the legal concerns some of these bills raise, she also worries about other consequences, including acts of violence against transgender people.

“It’s part of a larger objective to control people through body policing to determine how they love and how they navigate their daily lives,” Marino said.

South Carolina and Virginia are the only two states in the South that haven’t passed laws or policies limiting youth access to gender-affirming care, according to 蘑菇影院.

Republican-led legislatures in other states are advancing bills to restrict medical care and access to public restrooms for transgender people 鈥 so-called “bathroom bills” that have been heavily criticized by Democrats and transgender people.

In January, Utah passed a law modeled after the “Women’s Bill of Rights” created by the conservative nonprofit Independent Women’s Law Center. The bill establishes strictly biological definitions for “male,” “female” and other terms related to sex that don’t include gender identities like nonbinary and trans.

Similar bills are under consideration in Arizona, Georgia, Idaho, Iowa, New Mexico and West Virginia. Last year, leaders in Kansas, Montana, Nebraska and Oklahoma approved versions of the policy through legislation or executive order.

South Carolina Gov. Henry McMaster (R), who signed a 2022 law that bans transgender students from playing girls’ or women’s sports in public schools and colleges, said at that he thought the transgender health-care bill was a “good idea.”

If children “want to make those decisions later when they’re adults, then that’s a different story,” McMaster said. “But we must protect our young people from making irreversible errors.”

South Carolina Senate Democratic leader Brad Hutto said the point of the bill is to boost Republican fundraising and predicted it would face immediate legal challenge if it became law. “It’s clearly a far-right agenda item that doesn’t have anything to do with reality or facts,” he said. “It’s just red meat for that segment of the far right.”

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