Annie Sciacca, Author at �鶹Ů�� Health News

The National Suicide Hotline For LGBTQ+ Youth Shut Down. States Are Scrambling To Help.

Annie Sciacca — Tue, 19 Aug 2025 09:00:00 +0000

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

On July 17, the option shut down for LGBTQ+ youth to access specialized mental health support from the national 988 Suicide & Crisis Lifeline.

The Substance Abuse and Mental Health Services Administration that it would no longer “silo” services and would instead “focus on serving all help seekers.” That meant the elimination of the “Press 3” option, the dedicated line answered by staff specifically trained to handle LGBTQ+ youth facing mental health issues ranging from anxiety to thoughts of suicide.

Now, states such as California, Colorado, Illinois, and Nevada are scrambling to backfill LGBTQ+ crisis support through training, fees, and other initiatives in response to what advocates say is the Trump administration’s hostile stance toward this group. In his first day back in the White House, President Donald Trump issued an executive order recognizing only two sexes, male and female, and while campaigning, he condemned gender ideology as “toxic poison.” And the administration omitted “T” for transgender and “Q” for queer or questioning in announcing the elimination of the 988 Press 3 option.

“Since the election, we’ve seen a clear increase in young people feeling devalued, erased, uncertain about their future, and seeing resources taken away,” said Becca Nordeen, senior vice president of crisis intervention at The Trevor Project, a national suicide prevention and crisis intervention nonprofit for LGBTQ+ youth.

Nordeen and other advocates for at-risk kids who helped staff the dedicated line said it has never been more critical for what The Trevor Project estimates are 5.2 million LGBTQ+ people ages 13-24 across the U.S. About 39% of LGBTQ+ young people seriously consider attempting suicide each year, including roughly half of transgender and nonbinary young people, according to a 2023 survey, reflecting a disproportionately high rate of risk.

The use of the dedicated line for LGBTQ+ youth had steadily increased, according to data from the federal substance abuse agency, with nearly , texts, or online chats since its , out of approximately 16.7 million contacts to the general line. The Press 3 option reached record monthly highs in May and June. In 2024, contacts to the line peaked in November, the month of the election.

Call-takers on the general 988 line do not necessarily have the specialized training that the staff on the Press 3 line had, causing fear among LGBTQ+ advocates that they don’t have the right context or language to support youth experiencing crises related to sexuality and gender.

“If a counselor doesn’t know what the concept of coming out is, or being outed, or the increased likelihood of family rejection and how those bring stressors and anxiety, it can inadvertently prevent the trust from being immediately built,” said Mark Henson, The Trevor Project’s interim vice president of advocacy and government affairs, adding that creating that trust at the beginning of calls was a critical “bridge for a youth in crisis to go forward.”

The White House’s Office of Management and Budget did not immediately respond to questions about why the Press 3 option was shut down, but spokesperson Rachel Cauley that the department’s budget would not “grant taxpayer money to a chat service where children are encouraged to embrace radical gender ideology by ‘counselors’ without consent or knowledge of their parents.”

Emily Hilliard, a spokesperson for the Department of Health and Human Services, said in a statement: “Continued funding of the Press 3 option threatened to put the entire 988 Suicide & Crisis Lifeline in danger of massive reductions in service.”

When someone calls 988, they are routed to a local crisis center if they are calling from a cellphone carrier that uses “georouting” — a process that routes calls based on approximate areas — unless they select one of the specialized services offered through the national network. While the Press 3 option is officially no longer part of that menu of options, which includes Spanish-language and veterans’ services, states can step in to increase training for their local crisis centers or establish their own options for specialized services.

California is among the states attempting to fill the new service gap, with Democratic Gov. Gavin Newsom’s office announcing a to provide training on LGBTQ+ youth issues for the crisis counselors in the state who answer calls to the general 988 crisis line. The state signed a $700,000 contract with the organization for the training program.

The Trevor Project’s Henson said the details still need to be figured out, including evaluating the training needs of California’s current 988 counselors. The partnership comes as the organization’s own 24/7 crisis line for LGBTQ+ youth faces a crisis of its own: The Trevor Project was one of several providers paid by the federal government to staff the Press 3 option, and the elimination of the service cut the organization’s capacity significantly, according to Henson.

Gordon Coombes, director of Colorado’s 988 hotline, said staff there are increasing outreach to let the public know that the general 988 service hasn’t gone away, even with the loss of the Press 3 option, and that its call-takers welcome calls from the LGBTQ+ population. Staff are promoting services at concerts, community events, and Rockies baseball games.

Coombes said the Colorado Behavioral Health Administration contracts with Solari Crisis & Human Services to answer 988 calls, and that the training had already been equipping call-takers on the general line to support LGBTQ+ young people.

The state supports the 988 services via a 7-cent annual fee on cellphone lines. Coombes said the department requested an increase in the fee to bolster its services. While the additional funds would benefit all 988 operations, the request was made in part because of the elimination of the Press 3 option, he said.

Nevada plans to ensure that all 988 crisis counselors get training on working with LGBTQ+ callers, according to state health department spokesperson Daniel Vezmar. Vezmar said Nevada’s $50 million investment in a new call center last November would help increase call capacity, and that the state’s Division of Public and Behavioral Health would monitor the impact of the closure of the Press 3 option and make changes as needed.

The Illinois Department of Human Services announced after the Press 3 option’s termination that it was existing call center counselors on supporting LGBTQ+ youth and promoting related affirming messages and imagery in its outreach about the 988 line. A July increase in a state telecommunications tax will help fund expanded efforts, and the agency is exploring additional financial options to fill in the new gap.

Kelly Crosbie, director of North Carolina’s Division of Mental Health, Developmental Disabilities and Substance Use Services, said the division has recently invested in partnerships with community organizations to increase mental health support for marginalized groups, including LGBTQ+ populations, through the state’s 988 call center and other programs.

“We’ve wanted to make sure we were beefing up the services,” Crosbie said, noting that North Carolina’s Republican legislature continues to restrict health care for transgender youth.

Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, said Congress could put the funding for the LGBTQ+ line in any final appropriations bill it passes. She also said states could individually codify permanent funding for an LGBTQ+ option, the way Washington state has created and funded a “Press 4” option for its Native American population to reach crisis counselors who are tribal members or descendants trained in cultural practices. The state created the option by some of its 988 funding. No state has publicly announced a plan to make such an investment for LGBTQ+ populations.

Federal lawmakers from both sides of the aisle have spoken out against the closure of the LGBTQ+ 988 option and urged that it be reinstated. At a alongside Democratic colleagues, Rep. Mike Lawler, a Republican who represents part of New York’s Hudson Valley, said he and Republican Rep. Young Kim of Orange County, California, Health and Human Services Secretary Robert F. Kennedy Jr., urging him to reverse course and keep the LGBTQ+ line.

“What we must agree on is that when a child is in crisis — when they are alone, when they are afraid, when they are unsure of where to turn to, when they are contemplating suicide — they need access to help right away,” Lawler said. “Regardless of where you stand on these issues, as Americans, as people, we must all agree there is purpose and worth to each and every life.”

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Push To Move OB-GYN Exam Out of Texas Is Piece of AGs’ Broader Reproductive Rights Campaign

Annie Sciacca — Tue, 24 Jun 2025 09:00:00 +0000

Democratic state attorneys general led by those from California, New York, and Massachusetts are pressuring medical professional groups to defend reproductive rights, including , , and for health care in response to recent increases in the number of abortion bans.

The American Medical Association adopted a June 9 recommending that medical certification exams be moved out of states with restrictive abortion policies or made virtual, after to protect physicians who fear legal repercussions because of their work. The petition focused on the American Board of Obstetrics and Gynecology’s certification exams in Dallas, and the subsequent AMA recommendation was hailed as a win for Democrats trying to regain ground after the fall of Roe v. Wade.

“It seems incremental, but there are so many things that go into expanding and maintaining access to care,” said Arneta Rogers, executive director of the Center on Reproductive Rights and Justice at the University of California-Berkeley’s law school. “We see AGs banding together, governors banding together, as advocates work on the ground. That feels somewhat more hopeful — that people are thinking about a coordinated strategy.”

Since the Supreme Court eliminated the constitutional right to an abortion in 2022, , including Texas, have implemented laws banning abortion almost entirely, and many of them impose criminal penalties on providers as well as options to sue doctors. restrict access to gender-affirming care for trans people, and six of them make it a felony to provide such care to youth.

That’s raised concern among some physicians who fear being charged if they go to those states, even if their home state offers protection to provide reproductive and gender-affirming health care.

Pointing to the recent fining and in New York who allegedly provided abortion pills to a woman in Texas and a teen in Louisiana, a coalition of physicians wrote in a letter to the American Board of Obstetrics and Gynecology that “the limits of shield laws are tenuous” and that “Texas laws can affect physicians practicing outside of the state as well.”

The campaign was launched by several Democratic attorneys general, including Rob Bonta of California, Andrea Joy Campbell of Massachusetts, and Letitia James of New York, who each have established a reproductive rights unit as a bulwark for their state following the Dobbs decision.

“Reproductive health care and gender-affirming care providers should not have to risk their safety or freedom just to advance in their medical careers,” James said in . “Forcing providers to travel to states that have declared war on reproductive freedom and LGBTQ+ rights is as unnecessary as it is dangerous.”

In their petition, the attorneys general included a letter from Joseph Ottolenghi, medical director at Choices Women’s Medical Center in New York City, who was denied his request to take the test remotely or outside of Texas. To be certified by the American Board of Obstetrics and Gynecology, physicians need to at its testing facility in Dallas. The board of its new testing facility last year.

“As a New York practitioner, I have made every effort not to violate any other state’s laws, but the outer contours of these draconian laws have not been tested or clarified by the courts,” Ottolenghi wrote.

Rachel Rebouché, the dean of Temple University’s law school and a reproductive law scholar, said “putting the heft” of the attorneys general behind this effort helps build awareness and a “public reckoning” on behalf of providers. Separately, some doctors have urged medical conferences to .

Anti-abortion groups, however, see the campaign as forcing providers to conform to abortion-rights views. Donna Harrison, an OB-GYN and the director of research at the American Association of Pro-Life Obstetricians and Gynecologists, described the petition as an “attack not only on pro-life states but also on life-affirming medical professionals.”

Harrison said the “OB-GYN community consists of physicians with values that are as diverse as our nation’s state abortion laws,” and that this diversity “fosters a medical environment of debate and rigorous thought leading to advancements that ultimately serve our patients.”

The AMA’s new policy urges specialty medical boards to host exams in states without restrictive abortion laws, offer the tests remotely, or provide exemptions for physicians. However, the decision to implement any changes to the administration of these exams is up to those boards. There is no deadline for a decision to be made.

The OB-GYN board did not respond to requests for comment, but after the public petition from the attorneys general criticizing it for refusing exam accommodations, the that in-person exams conducted at its national center in Dallas “provide the most equitable, fair, secure, and standardized assessment.”

The OB-GYN board emphasized that Texas’ laws apply to doctors licensed in Texas and to medical care within Texas, specifically. And it noted that its exam dates are kept under wraps, and that there have been “no incidents of harm to candidates or examiners across thousands of in-person examinations.”

Democratic state prosecutors, however, warned in their petition that the “web of confusing and punitive state-based restrictions creates a legal minefield for medical providers.” Texas is among the states that have from providing gender-affirming care to transgender youth, and it has to get records from medical facilities and professionals in other states who may have provided that type of care to Texans.

The Texas attorney general’s office did not respond to requests for comment.

States such as and have laws to block doctors from being extradited under other states’ laws and to prevent sharing evidence against them. But instances that require leveraging these laws could still mean lengthy legal proceedings.

“We live in a moment where we’ve seen actions by executive bodies that don’t necessarily square with what we thought the rules provided,” Rebouché said.

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Newsom’s Push To Block Law Could Save California Nursing Homes Over $1 Billion

Annie Sciacca — Wed, 04 Jun 2025 09:00:00 +0000

Gov. Gavin Newsom wants to block a California law from taking effect next year that will require nursing homes to have a 96-hour backup power supply, potentially giving the industry a reprieve from having to spend over $1 billion in capital investments.

The Democratic governor tucked into his budget update to address a projected $12 billion state deficit. If lawmakers go along, it will be nursing homes have forestalled spending on generators or other power supplies required to keep ventilators, feeding and IV pumps, and medication dispensing machines running during emergencies, such as wildfires.

“Really? After what just happened earlier this year in Los Angeles, we think fire safety and emergency preparedness is where we want to make cuts?” said Tony Chicotel, a senior staff attorney with the California Advocates for Nursing Home Reform. “The timing is really just shocking.”

California law requires skilled nursing facilities to provide six hours of backup power, from generators or other sources, to run heating and cooling systems and lifesaving medical equipment when utilities shut off power to prevent wildfires or when power is lost. Federal guidelines require nursing homes to have emergency response plans that include or building evacuation.

Starting next year, most of California’s roughly 1,200 facilities must extend their backup power capability to 96 hours under , which lawmakers passed and Newsom signed in 2022. The bill was a victory for patient advocates who for years had urged the state to stretch the requirement, with power shutoffs becoming more frequent and lasting longer. Shutoffs in October 2019 lasted days, cutting power to more than in the state.

The governor’s office did not return multiple requests for comment.

Since the 96-hour bill became law, the long-term care sector has made multiple requests for an extension, citing costs over $1 billion to make capital investments. They won a two-year extension last year. Only 34 nursing homes comply with the law, according to the California Department of Health Care Access and Information.

Corey Egel, a spokesperson for the California Association of Health Facilities, said nursing facilities are asking for funding to make the changes. He said that between 800 and 900 of the state’s 1,241 nursing facilities will need “substantial modifications,” costing at least $1 million per facility, to meet the requirements of AB 2511. He added that some building upgrades will cost as much as $3.2 million.

Adding backup power supplies often requires big changes to electrical and HVAC systems, all of which need state and local permits. The process can take years, and current supply chain constraints and tariff-related delays could add to those challenges, Egel said.

“A number of facilities, especially those in urban areas, were not constructed with adequate space for generators of this size. In some instances, accommodating a unit comparable in size to a semitruck is not feasible,” Egel said.

Charlene Harrington, a professor and researcher at the University of California-San Francisco who studies nursing homes, said against stricter regulations and enforcement has succeeded largely because nursing home owners have been good at .

“When you have a governor who is running for president, they’re susceptible to tremendous influence,” Harrington said of Newsom, who is widely expected to launch . And nursing homes, she said, “have been very effective in arguing that they’re losing money.”

Nationally, efforts to more effectively regulate the nursing home industry or enforce tougher standards have often fallen flat, even as the quality of care in skilled nursing facilities has for years.

In April, a federal judge in Texas blocked a Biden administration rule to increase staffing at nursing homes, even though research has found low staffing to be at the root of many of the quality issues across such facilities. published in early May by Harrington and other researchers found that most facilities have nurse staffing levels “well below” the expected staffing based on resident needs and federal minimum staffing requirements.

“They’re jeopardizing the safety of their patients,” Harrington said.

While federal regulations require nursing homes to have emergency plans with options for backup power or evacuations, some states demand additional preparedness. After in an overheated nursing home after Hurricane Irma knocked out the power, Florida in 2018 enacted legislation requiring nursing homes and assisted living facilities to have a generator capable of keeping patient areas at 81 degrees Fahrenheit or lower for at least four days. most facilities were compliant by 2021.

assisted living facilities to maintain emergency generators that can run for 48 hours, and on-site. And this year, Texas lawmakers to require generators in nursing homes and assisted living facilities.

In California, it took groups representing about 400,000 nursing home residents several years to secure the rule for extended backup power, overcoming a veto by Newsom in 2020. “Put simply, any loss of electrical power puts nursing home residents in peril, since most are extraordinarily vulnerable, and many rely on electrical-powered life support systems,” state AARP director Nancy McPherson wrote in to the California Department of Public Health. “Unsafe temperatures, unrefrigerated medications, and medical devices without power can all have deadly consequences for nursing home residents.”

It’s unclear whether lawmakers will go along with Newsom’s request. State senators are advancing separate that would mandate 72 hours of backup power at assisted living facilities that are home to 16 or more residents. Such facilities are not considered health care operations and have different regulations in California.

Democratic Assembly member Jacqui Irwin, who authored the 96-hour law, expressed frustration with the governor for “attempting to bureaucratically veto” her legislation, noting that climate-related threats, such as power shutoffs, have only increased.

Irwin said Newsom’s budget proposal “for an indefinite suspension of the requirement abandons California seniors and those recuperating from an illness or surgery.”

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Amid Plummeting Diversity at Medical Schools, a Warning of DEI Crackdown’s ‘Chilling Effect’

Annie Sciacca — Thu, 20 Mar 2025 09:00:00 +0000

The Trump administration’s could exacerbate an unexpectedly steep drop in diversity among medical school students, even in states like California, where public universities have been navigating bans on affirmative action for decades. Education and health experts warn that, ultimately, this could harm patient care.

Since taking office, President Donald Trump has issued a handful of executive orders aimed at terminating all diversity, equity, and inclusion, or DEI, initiatives in federally funded programs. And in his , he described the Supreme Court’s 2023 decision banning the consideration of race in college and university admissions as “brave and very powerful.”

Last month, the Education Department’s Office for Civil Rights — which in mid-March — directed schools, including postsecondary institutions, to end race-based programs or risk losing federal funding. The cited the Supreme Court’s decision.

Paulette Granberry Russell, president and CEO of the National Association of Diversity Officers in Higher Education, said that “every utterance of ‘diversity’ is now being viewed as a violation or considered unlawful or illegal.” Her organization filed a lawsuit .

While California and eight other states — Arizona, Florida, Idaho, Michigan, Nebraska, New Hampshire, Oklahoma, and Washington — had already of varying degrees on race-based admissions policies well before the Supreme Court decision, schools bolstered diversity in their ranks with equity initiatives such as targeted .

But the court’s decision and the subsequent state-level backlash — 29 states have since introduced bills to curb diversity initiatives, according to data published by — have tamped down these efforts and led to the recent declines in diversity numbers, education experts said.

After the Supreme Court’s ruling, the numbers of Black and Hispanic medical school enrollees fell by double-digit percentages in the 2024-25 school year compared with the previous year, according to the . Black enrollees declined 11.6%, while the number of new students of Hispanic origin fell 10.8%. The decline in enrollment of American Indian or Alaska Native students was even more dramatic, at 22.1%. New Native Hawaiian or other Pacific Islander enrollment declined 4.3%.

“We knew this would happen,” said Norma Poll-Hunter, AAMC’s senior director of workforce diversity. “But it was double digits — much larger than what we anticipated.”

The fear among educators is the numbers will decline even more under the new administration.

At the end of February, the Education Department launched an encouraging people to “report illegal discriminatory practices at institutions of learning,” stating that students should have “learning free of divisive ideologies and indoctrination.” The agency later issued a “” document about its new policies, clarifying that it was acceptable to observe events like Black History Month but warning schools that they “must consider whether any school programming discourages members of all races from attending.”

“It definitely has a chilling effect,” Poll-Hunter said. “There is a lot of fear that could cause institutions to limit their efforts.”

Numerous requests for comment from medical schools about the impact of the anti-DEI actions went unreturned. University presidents are staying mum on the issue to protect their institutions, according to .

Utibe Essien, a physician and UCLA assistant professor, said he has heard from some students who fear they won’t be considered for admission under the new policies. Essien, who co-authored a study on the effect of on medical schools, also said students are worried medical schools will not be as supportive toward students of color as in the past.

“Both of these fears have the risk of limiting the options of schools folks apply to and potentially those who consider medicine as an option at all,” Essien said, adding that the “lawsuits around equity policies and just the climate of anti-diversity have brought institutions to this place where they feel uncomfortable.”

In early February, the Pacific Legal Foundation against the University of California-San Francisco’s Benioff Children’s Hospital Oakland over an internship program designed to introduce “underrepresented minority high school students to health professions.”

Attorney Andrew Quinio filed the suit, which argues that its plaintiff, a white teenager, was not accepted to the program after disclosing in an interview that she identified as white.

“From a legal standpoint, the issue that comes about from all this is: How do you choose diversity without running afoul of the Constitution?” Quinio said. “For those who want diversity as a goal, it cannot be a goal that is achieved with discrimination.”

UC Health spokesperson Heather Harper declined to comment on the suit on behalf of the hospital system.

Another lawsuit accuses the University of California of favoring Black and Latino students over Asian American and white applicants in its undergraduate admissions. Specifically, the complaint states that UC officials pushed campuses to use a “holistic” approach to admissions and “move away from objective criteria towards more subjective assessments of the overall appeal of individual candidates.”

The scrutiny of that approach to admissions could threaten diversity at the UC-Davis School of Medicine, which for years has employed a “race-neutral, holistic admissions model” that enrollment of Black, Latino, and Native American students.

“How do you define diversity? Does it now include the way we consider how someone’s lived experience may be influenced by how they grew up? The type of school, the income of their family? All of those are diversity,” said Granberry Russell, of the National Association of Diversity Officers in Higher Education. “What might they view as an unlawful proxy for diversity equity and inclusion? That’s what we’re confronted with.”

California Attorney General Rob Bonta, a Democrat, recently joined other state attorneys general urging that schools continue their DEI programs despite the federal messaging, saying that legal precedent allows for the activities. California is also among over its deep cuts to the Education Department.

If the recent decline in diversity among newly enrolled students holds or gets worse, it could have , academic experts said, pointing toward the vast racial disparities in health outcomes in the U.S., particularly for Black people.

A higher proportion of Black primary care doctors is associated with longer life expectancy and lower mortality rates among Black people, according to published by the JAMA Network.

Physicians of color are also more likely to build their careers in , studies have shown, which is increasingly important as the AAMC of up to 40,400 primary care doctors by 2036.

“The physician shortage persists, and it’s dire in rural communities,” Poll-Hunter said. “We know that diversity efforts are really about improving access for everyone. More diversity leads to greater access to care — everyone is benefiting from it.”

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California Hospitals Scramble on Earthquake Retrofits as State Limits Extensions

Annie Sciacca — Tue, 15 Oct 2024 09:00:00 +0000

More than half of the 410 hospitals in California have at least one building that likely wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.

Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Association that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural, or “distressed” hospitals to get an extension of up to three years.

“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which serves Northern California’s East Bay and is undertaking a $25 million retrofit of its hospital in Alameda, on an island beside Oakland.

The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.

The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.

Many more — 674 buildings, spread across 251 licensed hospitals — do not meet the second set of standards, which require hospital facilities to remain functional in the event of a major earthquake. That work is supposed to be done by 2030.

“The importance of it is hard to argue with,” said Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that damaged or destroyed multiple hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need at a time of emergency like that.”

The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of the three bills addressing the issue this year represents a partial victory for the industry.

Hospital administrators have long complained about the steep cost of seismic retrofits.

“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” wrote Carmela Coyle, president and CEO of the California Hospital Association, in a letter to Newsom before he vetoed the CHA bill. A paid for by the CHA pinned the price of meeting the 2030 standards at between $34 billion and $143 billion statewide.

Labor unions representing nurses and other medical workers, however, say the hospitals have had plenty of time to get their buildings into compliance, and that most have the money to do so.

“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Association, said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”

In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified, and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”

He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.

But he signed a third bill, which allows small, rural, and “critical access” hospitals, and some others, to apply for a three-year extension, and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.

The state designates 37 hospitals as providing “critical access,” while 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning they are funded by special government entities called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.

Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is very close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.

“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.

The Rand study estimated the average cost of a retrofit at per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.

Small and rural hospitals can get some aid from the state via grants financed by the California Electronic Cigarette Excise Tax, but HCAI spokesperson Andrew DiLuccia said it would yield just $2-3 million total annually. He added that the Small and Rural Hospital Relief Program has also received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.

Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”

Stebbins has had to help her district figure out a plan.

After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back .

The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled nursing facility. The construction work is set to be completed in 2027.

“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler, the Alameda Health System associate chief medical officer, said. “How do we make sure that they get what they need to stay open?”

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In California, Faceoff Between Major Insurer and Health System Shows Hazards of Consolidation

Annie Sciacca — Mon, 19 Feb 2024 10:00:00 +0000

For weeks, more than half a million Anthem Blue Cross enrollees who receive health care from the University of California were held in suspense. It wasn’t clear whether they would have to find new doctors or switch plans as the health system and one of its largest insurance partners struggled to reach agreement on a new contract.

UC Health accused Anthem of not negotiating in good faith, while Anthem leaders retorted that UC Health had demanded too much and rebuffed the insurer’s request for administrative efficiencies. In fact, roughly 8 million Anthem members in California were at risk of losing in-network access to UC Health’s vast network of prestigious hospitals and medical facilities, which could have left them with much higher out-of-pocket expenses. While not all patients were made aware of the situation, Anthem notified some enrollees they would be reassigned to new primary care doctors if no deal were reached.

But even as the parties announced an eleventh-hour agreement on Feb. 5, industry analysts say the conflict has become part of a trend in which patients are increasingly caught in the crossfire of contract disputes. Amid negotiations over rising labor and equipment costs, it’s often patients who are ultimately saddled with higher bills as the health industry continues to consolidate.

“This type of contract dispute is a routine feature of the health care system,” said Kristof Stremikis, director of market analysis and insight at the California Health Care Foundation. “At the same time, from a patient’s perspective, it’s an unfortunate feature of our health care system because it creates uncertainty and anxiety.” (California Healthline is an editorially independent service of the California Health Care Foundation.)

Stremikis noted that as mergers occur in the health industry, patients are left with fewer choices. Any time there are disputes, disruptions are felt more widely. And such fights rarely result in lower costs for consumers long-term across California.

A found widespread evidence that consolidation of health providers leads to higher health care prices for private insurance. The same brief from 2020 found some evidence suggesting that large, consolidated insurance companies are able to obtain lower prices from providers, but that has not necessarily led to lower premiums for patients. And a 2022 report from the found that health care costs have grown “at an unsustainable rate,” and noted that between 2010 and 2018 “health insurance premiums for job-based coverage increased more than twice the rate of growth for wages.” State regulators also found that health plans on prescription drugs in 2022 than in 2021.

In trying to slow growth, California in 2022 set up an , which has proposed a 3% spending growth target for the industry for 2025-2029. But enforcement will start in 2028 at the earliest, using spending data from 2026.

Cathy Jordan, 60, a social worker in Yuba City, California, has been a patient at UC Davis Health for two decades. Jordan was diagnosed at the end of 2021 with aggressive small cell carcinoma, a rare form of cancer. She has undergone surgery, chemotherapy, radiation, and other treatments since then, yet her cancer has returned twice.

“I don’t have the luxury of time — my cancer comes back fast,” Jordan said.

She is among the group of Anthem-insured patients at UC Health who were at risk of losing access to in-network care there, and when she got a notice from Anthem, she grew alarmed, she said.

Jordan’s oncologist, Rebecca Brooks, said in an interview prior to the agreement being reached that it would be “incredibly disruptive” for cancer patients to have to switch providers in the middle of their treatments.

“It’s a detriment to their care,” said Brooks, director of the gynecologic oncology division at UC Davis Health. “It’s going to disrupt treatment and cause worse outcomes.”

Jordan said she appreciates that UC Davis Health has a National Cancer Institute comprehensive cancer center designation; the only other cancer center of that caliber in Northern California not part of UC Health is at Stanford University, several hours away in Santa Clara County.

Jordan is among the Anthem-insured patients at UC Health who were at risk of losing access to in-network care there, and when she got a notice from Anthem, she grew alarmed. “I don’t have the luxury of time — my cancer comes back fast,” she said. (Anne Chadwick Williams for �鶹Ů�� Health News)

Jordan was worried that she and other UC Health patients would have to compete for treatment elsewhere. She was also uncomfortable with the idea of adjusting to a new setting and routine while undergoing intensive medical treatment.

“Someone needs to say, ‘We need to think about these patients.’ Someone needs to step up and say, ‘What’s going to be best for our patients?’” Jordan said. “This is my life.”

Stremikis said such concerns are ever more urgent as the health care industry consolidates. UC San Francisco recently announced it would in San Francisco, and it is joining Adventist Health in making a new effort to purchase a bankrupt . And UC Irvine recently in Southern California.

“There is consolidation vertically up and down the supply chain and horizontally,” he explained. “So when there are disputes between these large entities, it has a larger and larger impact because there are fewer choices for patients.”

While contract disputes between health care providers and insurers are nothing new, there is some evidence that they are increasing, at least in public view. FTI Consulting last year that found a steady increase in media coverage of rate negotiations between providers and insurers from 2022 to 2023. In addition to the fight with Anthem, UC Health narrowly avoided a break with Aetna last year by in April. And regional hospital systems, including and , have been at odds with Anthem within the last few months.

UC and Anthem have now agreed to extend the current contract to April 1 while terms of the new agreement are being finalized. UC Health spokesperson Heather Harper said the rate increases were below the inflation rate.

Anthem spokesperson Michael Bowman said the new contract would allow Anthem members to access care at UC Health for years to come.

“This underscores our mutual commitment to providing Anthem’s consumers and employers with access to high quality, affordable care at UC Health,” Bowman said in an email.

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California Moves Ahead of the FDA in Banning Common Candy Additives

Annie Sciacca — Fri, 20 Oct 2023 09:00:00 +0000

Halloween candy could be in for a California makeover.

Asserting that the Food and Drug Administration has not moved quickly enough on dangerous food additives, state lawmakers last month passed the California Food Safety Act, which bans four ingredients found in popular snacks and packaged foods — including candy corn and other Halloween treats.

Consumer health advocates hope the ban, signed into law by Democratic Gov. Gavin Newsom on Oct. 7 and set to take effect in 2027, will lead confectioners and food producers to modify their recipes for products sold both in California and elsewhere around the country.

The law prohibits the manufacture and distribution of , , , and , which are used in processed foods including variations of instant potatoes and store-brand sodas, as well as candies. The additives have been linked to increased risks of cancer and nervous system problems, according to the Environmental Working Group, which sponsored the legislation, and are already banned in many other countries.

Melanie Benesh, vice president of government affairs for the Environmental Working Group, celebrated the new law as “a very big deal” and the first of its type in the country.

Food manufacturers and their lobbyists opposed the legislation, rejecting the idea that the four additives are unhealthy and arguing that such assessments should be made by the FDA.

“We should rely on the scientific rigor of the FDA in terms of evaluating the safety of food ingredients and additives,” said Christopher Gindlesperger, a spokesperson for the National Confectioners Association.

But food safety advocates say the FDA has moved far too slowly in regulating food chemicals.

“It’s unacceptable that the U.S. is so far behind the rest of the world when it comes to food safety,” said state Assembly member Jesse Gabriel (D-Woodland Hills), who introduced the bill along with Assembly member Buffy Wicks (D-Oakland), in a statement.

sent to lawmakers from the sponsors of AB 418 this year noted that many new additives put in food products are not reviewed by the FDA before reaching the market. A provision in federal law called “generally recognized as safe” allows the industry to designate the chemicals as safe enough to include in food, even without notifying the agency.

FDA spokesperson Enrico Dinges, referencing the Federal Food, Drug, and Cosmetic Act, noted in an email that “food and color additives must be approved for their intended conditions of use, and safety information must be available to establish a reasonable certainty of no harm before they are used in products on the market.”

He added that the agency regularly reviews new data on food chemicals, and it is working on to ban the use of brominated vegetable oil — one of the ingredients included in the new California law — as a food ingredient. Dinges said it was “not uncommon for a substance to be approved in one jurisdiction but not in another.” He noted some color additives are authorized for use in Europe and elsewhere but not allowed in the U.S.

California’s initiative made headlines this year as a “Skittles ban” that would wipe popular candies off California shelves. But Gabriel and other proponents of the bill said the intention is simply to require modifications in the ingredients, as has already happened in Europe.

One additive included in an original version of the bill — titanium dioxide, which is in Skittles and other candy — was removed from those products before the bill reached its final version. It has been by the International Agency for Research on Cancer.

“I admire the California legislature for doing this,” said Joan Ifland, a researcher who studies food addiction and a fellow at the American College of Nutrition. She hopes state lawmakers go further in addressing food safety issues and the chemicals in processed food. “It should give courage to other legislators.”

Perhaps the most prominent ingredient on California’s banned list is red dye No. 3. It is allowed only in candied and cocktail cherries in the European Union but is widely used in the U.S.

A search of , an online database maintained by the Environmental Working Group, generated more than 3,000 products that contain the chemical. The list includes items like frosted pretzels and scores of brand-name candies such as and . It also includes items like fruit cocktail cups, protein drinks, and yogurts.

Peeps is already phasing out the ingredient — products will no longer contain red dye No. 3 after the 2024 Easter season, according to Keith Domalewski, director of marketing for its parent company, Just Born Quality Confections.

“Just Born has always evolved with new developments and consumer preferences,” Domalewski said in an emailed statement. “We have worked hard to develop new formulations to bring fans the colorful PEEPS they know and love.”

Pez representatives did not respond to a request for comment. The two major manufacturers of candy corn also did not comment.

The FDA banned some uses of the color additive , confirming it had been linked to increased risks of cancer, and prohibited its use in cosmetics and as a pigment in various foods. It said at the time it was taking steps to restrict the chemical — but never did.

Another of the newly banned ingredients, , has also been and is on California’s Proposition 65 list of ingredients that may pose increased cancer risks. It also has not been banned.

Food manufacturers and distribution groups did not indicate whether they would challenge California’s new law.

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California’s Medical Board Can’t Pay Its Bills, but Doctors Resist Proposed Fixes

Annie Sciacca — Fri, 25 Aug 2023 09:00:00 +0000

California doctors and state lawmakers are squaring off once again over the future of the Medical Board of California, which is responsible for licensing and disciplining doctors and has been criticized by patient advocates for years for being too lax.

A bill before the legislature would significantly increase the fees doctors pay to fund the medical board, which says it hasn’t had the budget to carry out its mission properly. It would also mandate new procedures for investigating complaints.

Patient advocates say the board, which oversees about 150,000 physicians and surgeons with active licenses in the state, is hamstrung by a lack of funding and clunky processes, and that its shortcomings pose a risk to the public by allowing bad doctors to continue practicing. The board opened only about 1,000 investigations out of nearly 10,000 complaints last year, according to its 2022 annual report.

But the California Medical Association, which represents physicians, is proposed increases in the fee, which was unchanged for more than a decade before being raised in 2021 after a contentious debate. Now lawmakers want to boost the license renewal fee to $1,289 every two years, up from $863 currently.

The doctors’ lobby largely defeated the 2021 efforts to strengthen the board, and critics say the group is trying to whittle away the board’s power by depriving it of funding.

The legislation, sponsored by Sen. Richard Roth, a Riverside Democrat, would also require board staff to interview patients or families before closing their complaints, create a unit to better facilitate communications, and improve efficiency by changing procedures and adjusting standards of evidence for investigations.

Another provision would allow patients and relatives to make a statement during the investigation about how a doctor’s negligence or misconduct affected them — similar to crime victims speaking during a sentencing hearing in criminal court.

The bill faces a pivotal vote in the state Assembly’s Appropriations Committee this month.

Most California licensing boards are funded through license fees. Currently, dentists pay $668 for a two-year license renewal, plus other permitting fees such as $325 for general anesthesia or $650 for oral surgery. Attorneys actively practicing in California pay $510 annually.

But the medical association insisted in a memo that it “cannot agree to a fee increase of nearly 50% that will primarily go toward building a multimillion-dollar reserve fund and future programs for the Medical Board.”

“If the bill is passed in its current form, it would have vast, negative impacts on the practice of medicine and health care delivery in California,” it added.

George Soares, a legislative advocate for the California Medical Association, told lawmakers last month that the association would be willing to accept a fee increase, but that $1,289 is too much — more than for state medical licenses. A July from the National Bureau of Economic Research found that physicians’ annual earnings average $350,000 across the U.S.

The medical board supports the bill and says a fee hike is needed to cover operations, repay millions of dollars in loans, and establish a three-month reserve. Over the past two years, the Department of Consumer Affairs, which is responsible for the operations of the medical board and other licensing boards, has had to backfill the board’s $79 million budget, using a total of $18 million in loans from Bureau of Automotive Repair license fees to cover the gap.

“The simple reality is that the board is not able to pay its bills,” a spokesperson for the medical board read from a joint statement from Randy Hawkins, the vice president of the board, and Richard Thorp, a former president of the California Medical Association and current member of the board, at a last month.

“We are physicians in private practice, and this fee increase will impact us personally, albeit at an increased cost of less than $20 per month,” the statement read. “We do not see this as a burden but rather as an investment into the organization that helps ensure that physicians have the confidence of the patients that we are privileged to treat.”

Roth points out that the medical board, which is composed of eight physicians and seven members of the public, has little control over staffing costs. Its 169 employees work for the state and are covered by labor agreements negotiated by statewide employee unions.

Consumer advocates say the opposition from the doctors’ lobby is part of a years-long effort to weaken the board and deprive it of adequate funding.

A report about the medical board’s operations conducted by a consulting firm that serves as the enforcement monitor for the board, Alexan RPM Inc., and recommended adopting automatic annual fee increases tied to the consumer price index, or something similar. Some lawmakers suggested the fees could be determined on a sliding scale based on doctors’ income.

Critics have complained for years that the medical board doesn’t hold doctors accountable often enough. Families that file complaints against doctors frequently go years without updates on the status of investigations, and often aren’t told why when their complaints are rejected.

“This is kind of the culmination of two things: patient advocacy trying to make changes and a few years of very recent, direct pushes by the legislature,” said Carmen Balber, the executive director of Consumer Watchdog, a consumer and patient advocacy organization.

The California Medical Association has already blunted some aspects of the bill, including securing the removal of a provision to add two more members of the public to the board, which would have made it a public-member majority instead of its current physician majority.

The association is also opposed to a provision currently in the bill that would lower the standard of proof for disciplining doctors in instances besides those in which they could lose their licenses.

Tracy Dominguez, a Bakersfield resident whose daughter, Demi, and grandson, Malakhi, died in 2019 from complications of severe preeclampsia, is among those advocating for reforms.

One of the physicians who treated Dominguez’s daughter prior to her death had already been accused by the medical board of gross negligence that led to the death of a young mother, according to . Advocates at Consumer Watchdog allege his negligence had death or permanent injury of other mothers and babies he treated, and that he was already banned from practicing in some hospitals at the time he treated Demi Dominguez but had been allowed to keep his license.

Tracy Dominguez said she hopes changing evidentiary standards and strengthening the medical board overall “will put dangerous doctors away.”

And a chance to provide a victim impact statement would be important for families hurt by medical neglect, she added. It would be “an opportunity for them to hear from the family, directly — to know that she was a person, not just a number.”

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California Debates Extending PTSD Coverage to More First Responders

Annie Sciacca — Tue, 09 May 2023 09:00:00 +0000

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

A paramedic for about 30 years, Susan Farren knew all was not well with first responders: Eight of her colleagues had died by suicide. Others had grappled with substance abuse or gone through painful divorces.

So, in 2018, Farren founded a nonprofit in Santa Rosa to train and support emergency personnel struggling with trauma and stress. Hundreds of firefighters, police officers, and other first responders have since availed themselves of the organization’s timely help.

“Nobody prepares you to walk into a house where four people have been murdered,” said Farren, executive director of

Firefighters, paramedics, and police often respond to the worst days of people’s lives — accidents, deaths, fires, and other distressing events. After the deadly mass shootings earlier this year in Monterey Park and Half Moon Bay, and countless others across the country, has grown.

But there is no national consensus on when and which emergency personnel should be provided workers’ compensation benefits.

“We wouldn’t think twice about taking care of a first responder who broke their leg, and we shouldn’t think twice about taking care of their mental health needs,” Karen Larsen, CEO of the Steinberg Institute, a nonprofit public policy institute, said in an email.

This year, there has been a push in California by first responders for laws that expand access to workers’ compensation for post-traumatic stress injuries among their ranks. But some business groups and local governments want to pump the breaks, citing worries about potential fraud or abuse of the workers’ compensation system.

The allegation that some people could take advantage of a more open workers’ compensation system should not deter California from providing immediate access to mental health treatment to those who need it, said Farren, who noted that many of the first responders she works with are denied workers’ compensation coverage or have to go through many steps to get it approved.

“That shouldn’t keep us from getting help to those who really need it. That help should be available often, and affordably, and it should be available immediately,” Farren said.

Perceptions about employers’ responsibility for alleviating work-related mental stress have changed over time, and that’s showing up in workers’ compensation. Each state has its own workers’ compensation laws, which provide benefits like disability pay and medical care to workers injured or sickened on the job.

More than half have enacted PTSD policies or policy changes since 2018, according to a by Optum, a company that creates workers’ compensation programs. Coverage varies widely for post-traumatic stress injuries, which can be triggered by a single traumatic event or continued exposure to high stress and traumatic events.

In 2019, Gov. Gavin Newsom signed legislation into law to give California firefighters and police officers a stronger chance at earning workers’ compensation. The bill, , authored by state Sen. Henry Stern (D-Calabasas) changed state law so that post-traumatic stress “injury,” such as PTSD, is legally presumed to be work-related for those first responders.

It was a small step by lawmakers in a state where recognition of work-related injuries for workers’ compensation has typically been limited to physical illnesses such as heart disease and cancer. Previously, psychiatric conditions were handled differently, with employers and insurance companies long contending that psychological injuries can have many sources and might be too easy to blame on work.

Researchers at the Rand Corp. suggested in a that further study is needed to evaluate the financial toll the 2019 law has had on employers — particularly counties and other municipalities that pay for police, firefighters, and other publicly employed first responders. Rand researchers estimated the added costs for local governments and the state to cover post-traumatic stress injuries could rise from $20 million to $116 million annually.

Firefighters and police in most cases now no longer have to prove that work was mostly responsible for their PTSD. But the law sunsets in 2025 and excludes many other first responders, including dispatchers, paramedics, and first responders at state hospitals.

This year, legislation by state Sen. John Laird (D-Santa Cruz), , co-sponsored by an advocacy group representing firefighters in the state — California Professional Firefighters — would extend PTSD workers’ compensation coverage until 2032 and open it up to state firefighters, additional law enforcement officers, public safety dispatchers, and other emergency response communication employees who work for public agencies. The Senate Labor, Public Employment and Retirement Committee unanimously approved the bill in April, and it is awaiting a vote by the Senate Appropriations Committee.

Business groups and local governments — many of which opposed the 2019 law — are lobbying against more expansion. In letters to lawmakers, groups including the California Chamber of Commerce, California Coalition on Workers’ Compensation, California Hospital Association, and California State Association of Counties warned that pending legislation could “open the door to abuse and fraud.”

“There is no evidence that workers are being inappropriately denied the care or benefits that they need,” Virginia Drake, a spokesperson for the California Coalition on Workers’ Compensation, told �鶹Ů�� Health News. The group represents employers, cities and counties, insurance brokers, and government agencies on issues of workers’ compensation.

Legislation that would extend benefits to more first responders would “put taxpayer funds at risk by tying the hands of public employers and forcing them to pay even the most questionable claims,” she added in a statement.

In addition, there does not seem to be consensus on which emergency personnel should get covered.

A measure by Assemblymember Freddie Rodriguez, a Democrat from Chino who worked as an emergency medical technician for three decades, has stalled. would expand workers’ compensation coverage to paramedics and emergency medical technicians, but it didn’t get a hearing in the Assembly. Unions representing paramedics and EMTs in California did not return messages seeking comment.

“It’s a very stressful job,” said Rodriguez, who told �鶹Ů�� Health News that two of his paramedic friends had died by suicide. “It affects people differently.”

Clearing a path to speedy mental health recovery, particularly after traumatic incidents, “should be automatic,” he added.

It’s unclear if Newsom will back Laird’s bill extending coverage for groups of emergency responders, amid a . A spokesperson for his office, Omar Rodriguez, said the governor typically does not comment on pending legislation and “will evaluate the bills on their own merits if they reach his desk.”

Last year, the Democratic governor , saying in a statement that it would be premature to shift coverage of PTSD before any studies had been conducted on how the current law has worked for those who are covered.

Broadening coverage, Newsom wrote, “could set a dangerous precedent that has the potential to destabilize the workers’ compensation system going forward.”

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Black Patients Dress Up and Modify Speech to Reduce Bias, California Survey Shows

Annie Sciacca — Fri, 10 Mar 2023 10:00:00 +0000

A young mother in California’s Antelope Valley bathes her children and dresses them in neat clothes, making sure they look their very best — at medical appointments. “I brush their teeth before they see the dentist. Just little things like that to protect myself from being treated unfairly,” she told researchers.

A 72-year-old in Los Angeles, mindful that he is a Black man, tries to put providers at ease around him. “My actions will probably be looked at and applied to the whole race, especially if my actions are negative,” he said. “And especially if they are perceived as aggressive.”

Many Black Californians report adjusting their appearance or behavior — even minimizing questions — all to reduce the chances of discrimination and bias in hospitals, clinics, and doctors’ offices. , 32% pay special attention to how they dress; 35% modify their speech or behavior to put doctors at ease. And 41% of Black patients signal to providers that they are educated, knowledgeable, and prepared.

The ubiquity of these behaviors is captured in a survey of 3,325 people as part of an October study titled “,” funded by the California Health Care Foundation. (KHN receives funding support from the California Health Care Foundation.) Part of its goal was to call attention to the effort Black patients must exert to get quality care from health providers.

“If you look at the frequency with which Black Californians are altering their speech and dress to go into a health care visit,” said Shakari Byerly, whose research firm, Evitarus, led the study, “that’s a signal that something needs to change.”

One-third of Black patients report bringing a companion into the exam room to observe and advocate for them. And, the study found, more than a quarter of Black Californians avoid medical care simply because they believe they will be treated unfairly.

“The system looks at us differently, not only in doctors’ offices,” said Dr. Michael LeNoir, who was not part of the survey.

LeNoir, an Oakland allergist and pediatrician who founded the African American Wellness Project nearly two decades ago to combat health disparities, found the responses unsurprising, given that many Black people have learned to make such adjustments routinely. “There is general discrimination,” he said, “so we all learn the role.”

There is ample evidence of racial inequality in health care. by the nonprofit Urban Institute published in 2021 found that Black patients are much more likely to suffer problems related to surgical procedures than white patients in the same hospital. published in November by the National Bureau of Economic Research found that Black mothers and babies had worse outcomes than other groups across many health measures. And published in January, led by Dana-Farber Cancer Institute investigators, found that older Black and Hispanic patients with advanced cancer are less likely to receive opioid medications for pain than white patients. (Hispanic people can be of any race or combination of races.)

Gigi Crowder, executive director of the Contra Costa County chapter of the National Alliance on Mental Illness, said she frequently sees delayed mental health diagnoses for Black patients.

“I hear so many stories about how long it takes for people to get their diagnoses,” Crowder said. “Many don’t get their diagnoses until six or seven years after the onset of their illness.”

Almost one-third of respondents in the California Health Care Foundation study — which looked only at Black Californians, not other ethnic or racial groups — reported having been treated poorly by a health care provider because of their race or ethnicity. One participant said her doctor advised her simply to exercise more and lose weight when she reported feeling short of breath. She eventually discovered she had anemia and needed two blood transfusions.

“I feel like Black voices aren’t as loud. They are not taken as seriously,” the woman told researchers. “In this case, I wasn’t listened to, and it ended up being a very serious, actually life-threatening problem.”

People KHN spoke with who weren’t part of the study described similar bad experiences.

Southern California resident Shaleta Smith, 44, went to the emergency room, bleeding, a week after giving birth to her third daughter. An ER doctor wanted to discharge her, but a diligent nurse called Smith’s obstetrician for a second opinion. It turned out to be a serious problem for which she needed a hysterectomy.

“I almost died,” Smith said.

Years later and in an unrelated experience, Smith said, her primary care doctor insisted her persistent loss of voice and recurring fever were symptoms of laryngitis. After she pleaded for a referral, a specialist diagnosed her with an autoimmune disorder.

Smith said it’s not clear to her whether bias was a factor in those interactions with doctors, but she strives to have her health concerns taken seriously. When Smith meets providers, she will slip in that she works in the medical field in administration.

Black patients also take on the additional legwork of finding doctors they think will be more responsive to them.

Ovester Armstrong Jr. lives in Tracy, in the Central Valley, but he’s willing to drive an hour to the Bay Area to seek out providers who may be more accustomed to treating Black and other minority patients.

When seeking medical care, Ovester Armstrong Jr. tries to find doctors accustomed to treating Black and other minority patients. A recent study found 1 in 3 Black Californians modify their speech or behavior to put doctors at ease. (Shelby Knowles for KHN)

“I have had experiences with doctors who are not experienced with care of different cultures — not aware of cultural differences or even the socialization of Black folks, the fact that our menus are different,” Armstrong said.

Once he gets there, he may still not find doctors who look like him. A found that the proportion of U.S. physicians who are Black is 5.4%, an increase of only 4 percentage points over the past 120 years.

While health advocates and experts acknowledge that Black patients should not have to take on the burden of minimizing poor health care, helping them be proactive is part of their strategy for improving Black health.

LeNoir’s African American Wellness Project arms patients with information so they can ask their doctors informed questions. And the California Black Women’s Health Project is hiring health “ambassadors” to help Black patients navigate the system, said Raena Granberry, senior manager of maternal and reproductive health for the organization.

Southern California resident Joyce Clarke, who is in her 70s, takes along written questions when she sees a doctor to make sure her concerns are taken seriously. “Health professionals are people first, so they come with their own biases, whether intentional or unintentional, and it keeps a Black person’s guard up,” Clarke said.

While the study shed light on how Black patients interact with medical professionals, Katherine Haynes, a senior program officer with the California Health Care Foundation, said further research could track whether patient experiences improve.

“The people who are providing care — the clinicians — they need timely feedback on who’s experiencing what,” she said.

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