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. related coverage from 2020Less-Lethal Weapons Blind, Maim and Kill. Victims Say Enough Is Enough.Read MorePolice 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. … I couldn’t believe that this was allowed to be [done to] civilians — students — 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 KFF 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 KFF 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 — including beanbags filled with metal pellets, sponge-tipped rounds, and projectiles commonly known as rubber bullets — 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 said in a post 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 KFF 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 and other law enforcement agencies 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, ‘Hey, are you OK?’” Fukushima said. “To the point of courage of these undergrads, he’s like, ‘Yeah, 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, eventually drawing thousands of supporters, 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 hired an independent policing consultant 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 — not just a visit to the emergency room — but actual hospitalization.” Police Tactics ‘Lawful 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 — including blinding and a broken jaw — from being shot with these projectiles, sometimes in apparent violations of police department policies, according to a joint investigation by KFF 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 KFF 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 — ‘lawful but awful’ — 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 KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. 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Ecstasy, “magic mushrooms” and other psychedelic drugs could soon be recognized as therapeutic in California — one of the latest states, and the biggest, to consider allowing their use as medicine. Legislation by state Sen. Scott Wiener (D) and Assembly member Marie Waldron (R) would allow the therapeutic use of psilocybin, mescaline, ecstasy and dimethyltryptamine — a chemical that occurs in the psychoactive ayahuasca plant mixture — in state-approved locations under the supervision of licensed individuals. It would also regulate the production, distribution, quality control and sale of those psychedelics. The bill is intended to get across the desk of Gov. Gavin Newsom, a Democrat who vetoed broader decriminalization legislation last year while calling psychedelics “an exciting frontier” and asking for “regulated treatment guidelines” in the next version. While most psychedelics are prohibited under federal law, research has shown them to be promising treatments for depression, anxiety, post-traumatic stress disorder and addiction. Several large cities including D.C., have effectively decriminalized their use, as has Colorado. Oregon, which previously decriminalized personal possession of all illegal drugs, including psychedelics, rolled back that policy but created a system to regulate the use of psilocybin mushrooms. Leanne Cavellini, 49, of Pleasanton, Calif., attended a psychedelic retreat in Mexico this year. She said the experience helped her overcome deep-rooted trauma. “The person I was before was a wound-up tight ball of rubber bands who kept everything in and felt a lot of fear and worry,” Cavellini said. “The person I am today is very free. I live in the present moment. I don’t live other people’s lives, and I don’t take on their emotions.” State regulation, though, doesn’t always mean easy access. Oregon permits consumption of psilocybin mushrooms only under the guidance of state-licensed facilitators in “psilocybin service centers.” Sessions can cost more than $2,500; they’re not covered by insurance. Colorado is building regulated “healing centers,” where people will be able to take psilocybin mushrooms and some other psychedelics under the supervision of licensed facilitators. In California, one obstacle is the state’s $45 billion budget deficit. Its elected leaders are already looking for programs to cut. One that doesn’t yet exist could be low-hanging fruit. Under the pending legislation, anyone hoping to be licensed to supervise people using psychedelics will need a professional health credential. Bills pending in several other states would ease access to psychedelics or relax current laws against them. Some first responder and veterans groups are among legalization’s biggest boosters, and there is significant public support. A survey out of the University of California at Berkeley last year showed 61 percent of registered voters in the United States support regulated therapeutic access to psychedelics — though nearly half of those respondents said such drugs were not “good for society.” Ken Finn, the former president of the American Board of Pain Medicine, said although the science around psychedelics is promising, the California legislation is premature “pending more robust and rigorous research to protect public safety.” This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact [email protected]. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/vZKLjh8 Check out http://plush-draw15.tumblr.com/ ROCHESTER, N.Y. — Jolynn Mungenast spends her days looking for ways to help people pay their hospital bills. Working out of a warehouse-like building in a scruffy corner of this former industrial town, Mungenast gently walks patients through health insurance options, financial aid, and payment plans. Most want to pay, said Mungenast, a financial counselor at Rochester Regional Health. Very often, they simply can’t. “They’re scared. They’re nervous. They’re upset,” said Mungenast, who on one recent call worked with an older patient to settle a $143 bill. “They do think ‘I don’t want this to affect my credit rating. I don’t want you to come take my house.’” At Rochester Regional Health, that won’t happen. The nonprofit system in upstate New York is one of only a few nationally that bar all aggressive collection activities. Patients who don’t pay won’t be taken to court. Their wages won’t be garnished. They won’t end up with liens on their homes or be denied care. And unpaid bills won’t sink their credit scores. American hospital officials often insist that lawsuits and other aggressive collections, though unsavory, are necessary to protect health systems’ finances and deter freeloading. But at Rochester Regional, ditching these collection tactics hasn’t hurt the bottom line, said Jennifer Eslinger, chief operating officer. The system has even been able to move staff out of its collections department as it spends less to go after patients who haven’t paid. Eslinger said there’s been another benefit to the change: rebuilding trust with patients. “We think and talk a lot and strategize a lot about where is the distrust in health care,” she said. “We have to remove that as a barrier to meaningful health care. We have to get the trust with the populations that we serve so that they can get the care that they need.” ‘Folks Cannot Afford This’ Rochester Regional, a large health system serving a wide swath of communities along the south shore of Lake Ontario, is big, with more than $3 billion in annual revenue. But in a place where once-mighty employers like Kodak and Xerox have withered, finances can be challenging. In 2022, Rochester Regional finished nearly $200 million in the red. Patients have their own challenges. Unable to afford their bills, many ended up in collections, or even on the receiving end of lawsuits. “We would go to court,” acknowledged Lisa Poworoznek, head of financial counseling at Rochester Regional. Then, before the pandemic, hospital leaders looked more closely at why patients weren’t paying. The barriers became clear, Poworoznek said: confusing insurance plans, high deductibles, and inadequate savings. “There are so many different situations that patients have,” she said. “It’s really just not as simple as demanding payment and then filing legal action.” Nationally, nearly half of adults are unable to cover a $500 medical bill without going into debt, a 2022 KFF poll found. At the same time, the average annual deductible for a single worker with job-based coverage now tops $1,500. Instead of chasing people who didn’t pay — a costly process that often yields meager returns — Rochester Regional resolved to find ways to get patients to settle bills before collections started. The health system undertook new efforts to enroll people in health insurance. New York has among the most robust safety-net systems in the country. Rochester Regional also bolstered its financial assistance program, making it easier for low-income patients to access free or discounted care. At many hospitals, applying for aid is complicated — long applications that demand extensive information about patients’ income and assets, including cars, retirement accounts, and property, KFF Health News has found. Patients applying for aid at Rochester Regional are asked to disclose only their income. Finally, the health system looked for ways to get more people on payment plans so they could pay off big bills over a year or two. Importantly, the payment plans are interest-free. That was a change. Rochester Regional, like some other major health systems across the country such as Atrium Health, used to rely on financing companies that charged interest, which could add thousands of dollars to patients’ debts. “Folks cannot afford this,” Poworoznek said. Ending ‘Extraordinary Collection Actions’ Working more closely with patients on their bills allowed Rochester Regional to stop taking them to court. The health system also stopped reporting people to credit bureaus, a practice many medical providers use that can depress consumers’ credit scores, making it harder to rent an apartment, get a car loan, or even get a job. In 2020, Rochester Regional adopted a written policy barring all aggressive collections by the system or its contracted collection agencies. That put Rochester Regional in select company. A 2022 KFF Health News investigation of billing practices at 528 hospitals around the country found just 19 that explicitly prohibit what are called extraordinary collection actions. Among them are leading academic medical centers, including UCLA and Stanford University, but also community hospitals such as El Camino Hospital in California’s Bay Area and St. Anthony Community Hospital outside New York City. Also barring extraordinary collection actions: the University of Vermont Medical Center; Ochsner Health, a large New Orleans-based nonprofit; and UPMC, a mammoth system based in Pittsburgh. Like Rochester Regional, UPMC officials said they were able to scrap aggressive collections by developing better systems that allow patients to pay off their bills. Elisabeth Benjamin, a vice president at the Community Service Society of New York, a nonprofit that has led efforts to restrict aggressive hospital collections, said there’s no reason more hospitals shouldn’t follow suit, particularly nonprofits that are expected to serve their communities in exchange for their tax-exempt status. “The value is to promote health, to care about a population, to promote health equity,” Benjamin said. “Suing people for medical debt or engaging in extraordinary collection actions is really anathema to all those values,” she said. “Forget about your ‘cancer-mobile’ or your child vaccination clinic.” Rochester Regional’s approach doesn’t eliminate medical debt, which burdens an estimated 100 million people in the U.S. And payment plans like those the system encourages can still mean big sacrifices for some families. But Benjamin applauded Rochester Regional’s ban on aggressive collections. “I give them big props,” she said. “It never should have been allowed.” New laws in New York now prohibit all medical bills from being reported to credit bureaus and restrict other collection tactics, such as wage garnishments. Many hospital finance officials nevertheless say they need the option to pursue patients who have the means to pay. “Maybe it’s on a very specific case where there is an issue with someone just not paying their bill,” said Richard Gundling, a senior vice president at the Healthcare Financial Management Association, a trade group. But at Rochester Regional’s finance offices, officials say they almost never find patients who just refuse to pay. More often, the problem is the bills are simply too big. “People just don’t have $5,000 to pay off that bill,” Poworoznek said. On her calls with patients, Mungenast tries to reassure the patients on the other end of the line. “Put yourself in their shoes,” she said. “How would it be if that was you receiving that?” About This Project“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America. The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels. The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher. Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/KlRcfSh Check out http://plush-draw15.tumblr.com/ PRESQUE ISLE, Maine — Outside the Mi’kmaq Nation’s health department sits a dome-shaped tent, built by hand from saplings and covered in black canvas. It’s one of several sweat lodges on the tribe’s land, but this one is dedicated to helping people recover from addiction. Up to 10 people enter the lodge at once. Fire-heated stones — called grandmothers and grandfathers, for the spirits they represent — are brought inside. Water is splashed on the stones, and the lodge fills with steam. It feels like a sauna, but hotter. The air is thicker, and it’s dark. People pray and sing songs. When they leave the lodge, it is said, they reemerge from the mother’s womb. Cleansed. Reborn. The experience can be “a vital tool” in healing, said Katie Espling, health director for the roughly 2,000-member tribe. She said patients in recovery have requested sweat lodges for years as a cultural element to complement the counseling and medications the tribe’s health department already provides. But insurance doesn’t cover sweat ceremonies, so, until now, the department couldn’t afford to provide them. In the past year, the Mi’kmaq Nation received more than $150,000 from settlements with companies that made or sold prescription painkillers and were accused of exacerbating the overdose crisis. A third of that money was spent on the sweat lodge. Health care companies are paying out more than $1.5 billion to hundreds of tribes over 15 years. This windfall is similar to settlements that many of the same companies are paying to state governments, which total about $50 billion. To some people, the lower payout for tribes corresponds to their smaller population. But some tribal citizens point out that the overdose crisis has had a disproportionate effect on their communities. Native Americans had the highest overdose death rates of any racial group each year from 2020 to 2022. And federal officials say those statistics were likely undercounted by about 34% because Native Americans’ race is often misclassified on death certificates. Still, many tribal leaders are grateful for the settlements and the unique way the money can be spent: Unlike the state payments, money sent to tribes can be used for traditional and cultural healing practices — anything from sweat lodges and smudging ceremonies to basketmaking and programs that teach tribal languages. “To have these dollars to do that, it’s really been a gift,” said Espling of the Mi'kmaq tribe. “This is going to absolutely be fundamental to our patients’ well-being” because connecting with their culture is “where they’ll really find the deepest healing.” Public health experts say the underlying cause of addiction in many tribal communities is intergenerational trauma, resulting from centuries of brutal treatment, including broken treaties, land theft, and a government-funded boarding school system that sought to erase the tribes’ languages and cultures. Along with a long-running lack of investment in the Indian Health Service, these factors have led to lower life expectancy and higher rates of addiction, suicide, and chronic diseases. Using settlement money to connect tribal citizens with their traditions and reinvigorate pride in their culture can be a powerful healing tool, said Andrea Medley, a researcher with the Johns Hopkins Center for Indigenous Health and a member of the Haida Nation. She helped create principles for how tribes can consider spending settlement money. Medley said that having respect for those traditional elements outlined explicitly in the settlements is “really groundbreaking.” ‘A Drop in the Bucket’ Of the 574 federally recognized tribes, more than 300 have received payments so far, totaling more than $371 million, according to Kevin Washburn, one of three court-appointed directors overseeing the tribal settlements. Although that sounds like a large sum, it pales in comparison with what the addiction crisis has cost tribes. There are also hundreds of tribes that are excluded from the payments because they aren’t federally recognized. “These abatement funds are like a drop in the bucket compared to what they’ve spent, compared to what they anticipate spending,” said Corey Hinton, a lawyer who represented several tribes in the opioid litigation and a citizen of the Passamaquoddy Tribe. “Abatement is a cheap term when we’re talking about a crisis that is still engulfing and devastating communities.” Even leaders of the Navajo Nation — the largest federally recognized tribe in the United States, which has received $63 million so far — said the settlements can’t match the magnitude of the crisis. “It’ll do a little dent, but it will only go so far,” said Kim Russell, executive director of the Navajo Department of Health. The Navajo Nation is trying to stretch the money by using it to improve its overall health system. Officials plan to use the payouts to hire more coding and billing employees for tribe-operated hospitals and clinics. Those workers would help ensure reimbursements keep flowing to the health systems and would help sustain and expand services, including addiction treatment and prevention, Russell said. Navajo leaders also want to hire more clinicians specializing in substance use treatment, as well as primary care doctors, nurses, and epidemiologists. “Building buildings is not what we want” from the opioid settlement funds, Russell said. “We’re nation-building.” High Stakes for Small Tribes Smaller nations like the Poarch Band of Creek Indians in southern Alabama are also strategizing to make settlement money go further. For the tribe of roughly 2,900 members, that has meant investing $500,000 — most of what it has received so far — into a statistical modeling platform that its creators say will simulate the opioid crisis, predict which programs will save the most lives, and help local officials decide the most effective use of future settlement cash. Some recovery advocates have questioned the model’s value, but the tribe’s vice chairman, Robert McGhee, said it would provide the data and evidence needed to choose among efforts competing for resources, such as recovery housing or peer support specialists. The tribe wants to do both, but realistically, it will have to prioritize. “If we can have this model and we put the necessary funds to it and have the support, it'll work for us,” McGhee said. “I just feel it in my gut.” The stakes are high. In smaller communities, each death affects the whole tribe, McGhee said. The loss of one leader marks decades of lost knowledge. The passing of a speaker means further erosion of the Native language. For Keesha Frye, who oversees the Poarch Band of Creek Indians’ tribal court and the sober living facility, using settlement money effectively is personal. “It means a lot to me to get this community well because this is where I live and this is where my family lives,” she said. Erik Lamoreau in Maine also brings personal ties to this work. More than a decade ago, he sold drugs on Mi’kmaq lands to support his own addiction. “I did harm in this community and it was really important for me to come back and try to right some of those wrongs,” Lamoreau said. Today, he works for the tribe as a peer recovery coordinator, a new role created with the opioid settlement funds. He uses his experience to connect with others and help them with recovery — whether that means giving someone a ride to court, working on their résumé, exercising together at the gym, or hosting a cribbage club, where people play the card game and socialize without alcohol or drugs. Beginning this month, Lamoreau’s work will also involve connecting clients who seek cultural elements of recovery to the new sweat lodge service — an effort he finds promising. “The more in tune you are with your culture — no matter what culture that is — it connects you to something bigger,” Lamoreau said. “And that’s really what we look at when we’re in recovery, when we talk about spiritual connection. It’s something bigger than you.” KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/gzoV9mA Check out http://plush-draw15.tumblr.com/ LAKE ELSINORE, Calif. — Yahushua Robinson was an energetic boy who jumped and danced his way through life. Then, a physical education teacher instructed the 12-year-old to run outside on a day when the temperature climbed to 107 degrees. “We lose loved ones all the time, but he was taken in a horrific way,” his mother, Janee Robinson, said from the family’s Inland Empire home, about 80 miles southeast of Los Angeles. “I would never want nobody to go through what I’m going through.” The day her son died, Robinson, who teaches phys ed, kept her elementary school students inside, and she had hoped her children’s teachers would do the same. The Riverside County Coroner’s Bureau ruled that Yahushua died on Aug. 29 of a heart defect, with heat and physical exertion as contributing factors. His death at Canyon Lake Middle School came on the second day of an excessive heat warning, when people were advised to avoid strenuous activities and limit their time outdoors. Yahushua’s family is supporting a bill in California that would require the state Department of Education to create guidelines that govern physical activity at public schools during extreme weather, including setting threshold temperatures for when it’s too hot or too cold for students to exercise or play sports outside. If the measure becomes law, the guidelines will have to be in place by Jan. 1, 2026. Many states have adopted protocols to protect student athletes from extreme heat during practices. But the California bill is broader and would require educators to consider all students throughout the school day and in any extreme weather, whether they’re doing jumping jacks in fourth period or playing tag during recess. It’s unclear if the bill will clear a critical committee vote scheduled for May 16. “Yahushua’s story, it’s very touching. It’s very moving. I think it could have been prevented had we had the right safeguards in place,” said state Sen. Melissa Hurtado (D-Bakersfield), one of the bill’s authors. “Climate change is impacting everyone, but it’s especially impacting vulnerable communities, especially our children.” Last year marked the planet’s warmest on record, and extreme weather is becoming more frequent and severe, according to the National Oceanic and Atmospheric Administration. Even though most heat deaths and illnesses are preventable, about 1,220 people in the United States are killed by extreme heat every year, according to the Centers for Disease Control and Prevention. Young children are especially susceptible to heat illness because their bodies have more trouble regulating temperature, and they rely on adults to protect them from overheating. A person can go from feeling dizzy or experiencing a headache to passing out, having a seizure, or going into a coma, said Chad Vercio, a physician and the division chief of general pediatrics at Loma Linda University Health. “It can be a really dangerous thing,” Vercio said of heat illness. “It is something that we should take seriously and figure out what we can do to avoid that.” It’s unclear how many children have died at school from heat exposure. Eric Robinson, 15, had been sitting in his sports medicine class learning about heatstroke when his sister arrived at his high school unexpectedly the day their brother died. “They said, ‘OK, go home, Eric. Go home early.’ I walked to the car and my sister’s crying. I couldn’t believe it,” he said. “I can’t believe that my little brother’s gone. That I won’t be able to see him again. And he’d always bugged me, and I would say, ‘Leave me alone.’” That morning, Eric had done Yahushua’s hair and loaned him his hat and chain necklace to wear to school. As temperatures climbed into the 90s that morning, a physical education teacher instructed Yahushua to run on the blacktop. His friends told the family that the sixth grader had repeatedly asked the teacher for water but was denied, his parents said. The school district has refused to release video footage to the family showing the moment Yahushua collapsed on the blacktop. He died later that day at the hospital. Melissa Valdez, a Lake Elsinore Unified School District spokesperson, did not respond to calls seeking comment. Schoolyards can reach dangerously high temperatures on hot days, with asphalt sizzling up to 145 degrees, according to findings by researchers at the UCLA Luskin Center for Innovation. Some school districts, such as San Diego Unified and Santa Ana Unified, have hot weather plans or guidelines that call for limiting physical activity and providing water to kids. But there are no statewide standards that K-12 schools must implement to protect students from heat illness. Under the bill, the California Department of Education must set temperature thresholds requiring schools to modify students’ physical activities during extreme weather, such as heat waves, wildfires, excessive rain, and flooding. Schools would also be required to come up with plans for alternative indoor activities, and staff must be trained to recognize and respond to weather-related distress. California has had heat rules on the books for outdoor workers since 2005, but it was a latecomer to protecting student athletes, according to the Korey Stringer Institute at the University of Connecticut, which is named after a Minnesota Vikings football player who died from heatstroke in 2001. By comparison, Florida, where Gov. Ron DeSantis, a Republican, this spring signed a law preventing cities and counties from creating their own heat protections for outdoor workers, has the best protections for student athletes, according to the institute. Douglas Casa, a professor of kinesiology and the chief executive officer of the institute, said state regulations can establish consistency about how to respond to heat distress and save lives. “The problem is that each high school doesn’t have a cardiologist and doesn’t have a thermal physiologist and doesn’t have a sickling expert,” Casa said of the medical specialties for heat illness. In 2022, California released an Extreme Action Heat Plan that recommended state agencies “explore implementation of indoor and outdoor heat exposure rules for schools,” but neither the administration of Gov. Gavin Newsom, a Democrat, nor lawmakers have adopted standards. Lawmakers last year failed to pass legislation that would have required schools to implement a heat plan and replace hot surfaces, such as cement and rubber, with lower-heat surfaces, such as grass and cool pavement. That bill, which drew opposition from school administrators, stalled in committee, in part over cost concerns. Naj Alikhan, a spokesperson for the Association of California School Administrators, said the new bill takes a different approach and would not require structural and physical changes to schools. The association has not taken a position on the measure, and no other organization has registered opposition. The Robinson family said children’s lives ought to outweigh any costs that might come with preparing schools to deal with the growing threat of extreme weather. Yahushua‘s death, they say, could save others. “I really miss him. I cry every day,” said Yahushua’s father, Eric Robinson. “There’s no one day that go by that I don’t cry about my boy.” This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/6WsFUMo Check out http://plush-draw15.tumblr.com/ Facility fees are charges tacked on for visiting a doctor’s office or even a telehealth visit. They’re becoming increasingly common and they can add hundreds of dollars to your bill. “An Arm and a Leg” host Dan Weissmann wants to know how often this happens, where, and how much it costs patients. If you’ve ever seen a charge for a facility fee on your medical bill — especially for a visit or service that didn’t take place in a hospital — “An Arm and a Leg” wants to hear from you.Click here to share your story. It may be featured on an upcoming episode. Dan Weissmann @danweissmann Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.CreditsEmily Pisacreta Producer Adam Raymonda Audio wizard Ellen Weiss Editor“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions. To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and the social platform X. And if you’ve got stories to tell about the health care system, the producers would love to hear from you. To hear all KFF Health News podcasts, click here. And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/P4msUZ1 Check out http://plush-draw15.tumblr.com/ Houston, Texas. – Los pacientes internados en el Hospital Metodista de Houston llevan adherido al pecho un dispositivo de monitoreo del tamaño de medio billete, desempeñando sin saberlo un papel en el uso cada vez más frecuente de la inteligencia artificial (IA) en la atención médica. Este delgado dispositivo, que funciona con baterías, se llama BioButton y registra los signos vitales de los pacientes, incluidas la temperatura, y las frecuencias cardíaca y respiratoria. Esos informes se envían —de manera inalámbrica— al personal de enfermería, que puede estar tanto en la sala de control del hospital, que funciona las 24 horas, como en sus propias casas. El software del dispositivo utiliza la IA para analizar la abrumadora cantidad de datos que registra, y también para detectar señales que indiquen que la salud del paciente está empeorando. Autoridades del hospital afirman que desde comenzaron a usarlo el año pasado, el BioButton ha mejorado la calidad de la atención y reducido la carga de trabajo de las enfermeras. “Como detectamos las cosas antes, a los pacientes les va mejor, ya que no tenemos que esperar a que el equipo de cabecera se dé cuenta si algo anda mal”, dijo Sarah Pletcher, vicepresidenta del sistema en Houston. “Sin embargo, algunas enfermeras temen que esta tecnología termine sustituyéndolas en lugar de respaldar su trabajo, lo que podría perjudicar a los enfermos. El Hospital Metodista de Houston, uno de los muchos hospitales estadounidenses que emplean el BioButton, es el primero en utilizar este dispositivo para monitorear a todos sus pacientes excepto los que están en cuidados intensivos”, explicó Pletcher. “Existe una publicidad engañosa y exagerada que afirma que estos dispositivos proporcionan cuidados a gran escala con menores costos laborales”, afirmó Michelle Mahon, enfermera titulada y directora adjunta de National Nurses United, el mayor sindicato del personal de enfermería del país. “Esta tendencia nos parece preocupante”, añadió. La implementación del BioButton es uno de los ejemplos más recientes del modo en que los hospitales utilizan la tecnología con el fin, por un lado, de optimizar la eficiencia y, por el otro, de hacer frente a la escasez de enfermeras, un problema que se ha agudizado con el tiempo. Sin embargo, esa transición ha generado otras preocupaciones, entre ellas el uso de IA para operar el dispositivo. Las encuestas muestran que el público desconfía de que los proveedores de salud dependan de la IA para atender a los pacientes. En diciembre de 2022, la Administración de Alimentos y Medicamentos (FDA) autorizó el uso del BioButton en pacientes adultos siempre que no estuvieran en terapia intensiva. Es una de las muchas herramientas de IA que ahora se usan en los hospitales para resolver un gran número de tareas, como por ejemplo interpretar los resultados de diagnósticos por imagen. En 2023, el presidente Joe Biden le encargó al Departamento de Salud y Servicios Humanos (HHS) la formulación de un plan para regular el uso hospitalario de la IA que incluyera la recopilación de informes de pacientes perjudicados por su uso. James Mault es el director general de BioIntelliSense, la empresa que desarrolló el BioButton. Desde su sede en Golden, Colorado, Mault afirma que este dispositivo supone un enorme avance si se lo compara con el trabajo tradicional de las enfermeras, que iban varias veces al día a las habitaciones para monitorear los signos vitales de los pacientes. “Con la IA hemos pasado de preguntarnos ‘¿por qué este paciente empeoró repentinamente?’ a decir ‘podemos prevenir la crisis antes de que se produzca e intervenir adecuadamente’”, afirma Mault. El BioButton se pega a la piel mediante un adhesivo, es resistente al agua y su batería tiene una vida útil de hasta 30 días. La empresa asegura que el pequeño dispositivo, que permite que los profesionales detecten rápidamente el deterioro de la salud a partir del registro de más de un millar de mediciones diarias por persona, se ha utilizado en más de 80,000 pacientes hospitalizados en todo el país durante el último año. Los hospitales le pagan a BioIntelliSense una cuota anual por los dispositivos y el software. Las autoridades del Hospital Metodista de Houston no quisieron revelar cuánto paga la institución por esta tecnología, aunque Pletcher dijo que la suma equivale a menos de una taza de café al día por paciente. Para un sistema hospitalario que atiende a miles de personas simultáneamente —el Metodista, en sus ocho hospitales del área de Houston, tiene 2,653 camas fuera de la UCI—, esa inversión podría traducirse en millones de dólares al año. Sin embargo, los directivos del hospital aseguraron que no hubo ningún cambio en la dotación del personal de enfermería por la implementación del BioButton ni tienen previsto que lo vaya a haber. Una mañana reciente unas, 15 enfermeras y técnicos en uniforme estaban sentados en el centro de control de monitoreo virtual del hospital frente a grandes monitores. Allí veían el estado de salud de cientos de pacientes. Una marca roja junto al nombre de uno de esos pacientes indicaba que el software de IA había detectado una tendencia fuera de lo normal. Los profesionales pudieron, entonces, hacer clic en el historial médico de ese paciente y comprobar cómo habían sido sus signos vitales a lo largo del tiempo así como otros antecedentes médicos. Estas “enfermeras virtuales”, por así decirlo, pudieron ponerse en contacto con las enfermeras de planta por teléfono o por correo electrónico, e incluso hacer una videollamada directamente a la habitación del paciente. Nutanben Gandhi, una técnica que esa mañana vigilaba a 446 pacientes en su monitor, dijo que cuando recibe una alerta consulta el historial médico de esa persona para ver si la anomalía puede explicarse fácilmente por su situación de salud o si es preciso que se ponga en contacto con las enfermeras de planta que la atienden en la sala. En muchas ocasiones, el llamado de atención puede ignorarse. Pero identificar signos de deterioro de la salud puede ser difícil, afirma Steve Klahn, director clínico de Medicina Virtual del Metodista de Houston. “Estamos buscando una aguja en un pajar”, explica. Donald Eustes, de 65 años, ingresó al hospital en marzo para someterse a un tratamiento contra el cáncer de próstata pero allí le detectaron un accidente cerebrovascular. Está contento de llevar el BioButton. “Nunca se sabe lo que nos puede pasar, y tener un conjunto de ojos extra observándonos es algo bueno”, reflexionó desde la cama del hospital. Después que le explicaron que el dispositivo utiliza IA, este hombre de Montgomery, Texas, dijo que no tiene ningún problema en que esta tecnología ayude a su equipo médico. “Parece un buen uso de la inteligencia artificial”, opinó. Tanto los pacientes como el personal de enfermería se benefician de un monitoreo a distancia como el que realiza el BioButton, aseguró Pletcher. También contó que el hospital ha colocado pequeñas cámaras y micrófonos en el interior de todas las habitaciones, lo que habilita a las enfermeras del centro de monitoreo a comunicarse con los pacientes y colaborar en ciertas tareas como las admisiones y las instrucciones de alta. “Los pacientes pueden incluir a sus familiares en las llamadas a distancia con el personal de enfermería o el equipo médico”, agregó. La tecnología virtual libera a los enfermeros de guardia de modo que puedan prestar una ayuda más directa, como colocar una vía intravenosa, explicó Pletcher. Con el BioButton, las enfermeras pueden espaciar el control de los signos vitales y realizarlo cada ocho horas en lugar de cada cuatro, como lo hacían habitualmente, explicó. Pletcher sostiene que el dispositivo reduce el estrés que genera en las enfermeras el monitoreo de los pacientes y permite que algunas trabajen con horarios más flexibles porque la atención virtual también puede hacerse desde sus propias casas. En última instancia, esto ayuda a retener al personal de enfermería, no lo ahuyenta, dijo. Sheeba Roy, jefa de enfermería del Metodista de Houston, dijo que, sin embargo, a algunos miembros del personal de enfermería los ponía nerviosos depender del dispositivo y no comprobar ellos mismos los signos vitales de los pacientes con tanta frecuencia. Pero las pruebas han demostrado que el dispositivo proporciona información precisa. “Cuando lo pusimos en marcha, al personal le encantó”, afirma Roy. Serena Bumpus, directora ejecutiva de la Asociación de Enfermeras de Texas, dijo que su preocupación ante cualquier innovación tecnológica es que pueda ser más gravosa para las enfermeras y quitarles tiempo con los pacientes. “Tenemos que estar muy atentos para asegurarnos de que no nos estamos apoyando en esta tecnología para sustituir la capacidad de las enfermeras de pensar críticamente, de evaluar a los pacientes y para que puedan corroborar que lo que este dispositivo está informando es lo correcto”, advirtió Bumpus. Este año, el Hospital Metodista de Houston tiene previsto enviar a los pacientes a su casa con el BioButton para que el hospital pueda efectuar un mejor seguimiento de su evolución en las semanas posteriores al alta, medir su calidad de sueño y comprobar la estabilidad con la que se mueven y caminan. “No vamos a necesitar menos enfermeras en la atención sanitaria, pero nuestros recursos son limitados y debemos utilizarlos de la forma más inteligente posible”, dijo Pletcher. “Si tenemos en cuenta la demanda proyectada y los recursos con los que realmente contamos, ya sabemos que no serán suficientes para satisfacerla, así que todo lo que podamos hacer para devolverles tiempo a las enfermeras es beneficioso”, concluyó. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/nqa1JCS Check out http://plush-draw15.tumblr.com/ La esposa de Bill Thompson nunca lo había visto sonreír con confianza. Durante los primeros 20 años de su relación, una infección en la boca le había ido robando los dientes, uno a uno. “¡No tenía dientes para sonreír!”, dijo el hombre de 53 años de Independence, Missouri. Thompson dijo que durante años lidió con punzantes dolores de muelas y una hinchazón en la cara, también muy dolorosa, producto de abscesos, mientras trabajaba como cocinero en Burger King. Necesitaba desesperadamente ir al dentista, pero dijo que no podía permitirse tomar tiempo libre sin pago. Missouri es uno de los muchos estados que no requieren que los empleadores proporcionen licencia por enfermedad paga. Entonces, Thompson se tragaba un Tylenol y soportaba el dolor mientras trabajaba sobre la parrilla caliente. “O vamos a trabajar y tenemos un cheque de pago”, dijo Thompson. “O cuidamos de nosotros mismos. No podemos cuidar de nosotros mismos porque, bueno, estamos atrapados en este círculo vicioso”. En una nación que estuvo fuertemente dividida sobre los mandatos de salud del gobierno durante la pandemia de covid-19, el público se está sintiendo cómodo con la idea de reglas gubernamentales que proporcionen licencia por enfermedad remunerada. Antes de la pandemia, 10 estados y el Distrito de Columbia tenían leyes que requerían que los empleadores proporcionaran licencia por enfermedad paga. Desde entonces, Colorado, Nueva York, Nuevo México, Illinois y Minnesota han aprobado leyes que ofrecen algún tipo de tiempo libre por enfermedad remunerado. Oregon y California ampliaron las leyes de licencia paga que ya estaban vigentes. En Missouri, Alaska y Nebraska, defensores están presionando para llevar el tema a votación este otoño. Estados Unidos es uno de los nueve países que no garantizan licencia por enfermedad paga, según datos compilados por el World Policy Analysis Center. En respuesta a la pandemia, el Congreso aprobó la Emergency Paid Sick Leave y el Emergency Family and Medical Leave Act. Estas medidas temporales permitieron a los empleados tomar hasta dos semanas de licencia paga si la enfermedad estaba relacionada con covid y su atención. Pero las disposiciones expiraron en 2021. “Cuando golpeó la pandemia, finalmente vimos una voluntad política real para resolver el problema de no tener licencia por enfermedad paga federal”, dijo la economista Hilary Wething. Wething fue co-autora de un informe reciente del Economic Policy Institute sobre el estado de la licencia por enfermedad en el país. Descubrió que más de la mitad, el 61%, de los trabajadores peor pagos no pueden tomarse este tipo de licencia. “Me sorprendió mucho lo rápido que la pérdida de salario, debido a que estás enfermo, puede traducirse en recortes inmediatos y devastadores para el presupuesto familiar”, dijo. Wething señaló que la pérdida de salarios incluso por uno o dos días puede equivaler a un mes de gasolina que un trabajador necesitaría para llegar a su trabajo, o la elección entre pagar una factura de electricidad o comprar alimentos. Agregó que presentarse al trabajo enfermo representa un riesgo tanto para los compañeros como para los clientes. Los empleos mal remunerados que a menudo no tienen licencia por enfermedad paga, como cajeros, cosmetólogas, asistentes de salud en el hogar y trabajadores de comida rápida, implican muchas interacciones cara a cara. “Así que la licencia por enfermedad paga se trata tanto de proteger la salud pública de una comunidad como de proporcionar a los trabajadores la seguridad económica que necesitan desesperadamente cuando deben tomar tiempo libre del trabajo”, dijo. La National Federation Of Independent Business se ha opuesto a las reglas de licencia por enfermedad obligatoria a nivel estatal, argumentando que los lugares de trabajo deberían tener la flexibilidad para resolver el tema con sus empleados cuando se enferman. El grupo dijo que el costo de pagar a los trabajadores por tiempo libre, el papeleo adicional y la productividad perdida son una carga para los pequeños empleadores. Según un informe del National Bureau of Economic Research, una vez que estas disposiciones entran en vigencia, los empleados toman, en promedio, dos días más de enfermedad al año comparado con antes de que entrara en vigor la ley. Las reglas de tiempo libre pago de Illinois entraron en vigencia este año. Lauren Pattan es co-propietaria de Old Bakery Beer Co. allí. Antes de este año, la cervecería artesanal no ofrecía tiempo libre remunerado para sus empleados por hora. Pattan dijo que apoya la nueva ley de Illinois, pero tiene que ver cómo pagarla. “Realmente intentamos ser respetuosos con nuestros empleados y ser un buen lugar para trabajar, y al mismo tiempo nos preocupa no poder permitirnos ciertas cosas”, dijo. Eso podría significar que los clientes tengan que pagar más para cubrir el costo, agregó Pattan. En cuanto a Bill Thompson, escribió una columna de opinión para el periódico Kansas City Star sobre sus problemas dentales. “A pesar de trabajar casi 40 horas a la semana, muchos de mis compañeros no tienen hogar”, escribió. “Sin seguro, ninguno de nosotros puede pagar a un médico o un dentista”. Ese artículo generó atención local y, en 2018, un dentista de su comunidad donó su tiempo y trabajo para quitarle los dientes restantes a Thompson y reemplazarlos con dentaduras postizas. Esto permitió que su boca se recuperara de las infecciones con las que había estado lidiando durante años. Hoy, Thompson tiene una nueva sonrisa y un trabajo, con licencia por enfermedad paga, en el servicio de alimentos en un hotel. En su tiempo libre, ha estado recopilando firmas para presentar una iniciativa en la boleta electoral de noviembre que garantizaría al menos cinco días de licencia por enfermedad paga al año para los trabajadores de Missouri. Los organizadores de la petición dijeron que tienen suficientes firmas para llevarlo ante los votantes. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/iXEoeQO Check out http://plush-draw15.tumblr.com/ Millions of people were surprised to find themselves booted from Medicaid over the past year after pandemic-era protections expired that had prevented states from terminating their coverage. Turns out, millions of them were also unaware they had been covered by the government program. Nearly 1 in 3 people enrolled in Medicaid in 2022 — or 26 million people — didn’t know it, according to a study by Harvard and New York University researchers published in Health Affairs this month. The report estimated that of those who didn’t know they were on Medicaid, about 3 million thought they were uninsured. They almost certainly had coverage, though, because the federal government from March 2020 to April 2023 prohibited states from dropping anyone from Medicaid rolls in exchange for billions of dollars in pandemic relief money. “What this means is people could have been accessing health-care services and probably did not because they thought they were uninsured,” said Jennifer Tolbert, deputy director of the KFF Program on Medicaid & Uninsured. “People not understanding that they have Medicaid is not a good thing.” This lack of awareness has implications for efforts to predict how much the nation’s uninsured rate has changed as a result of the Medicaid “unwinding” — the process that began last year in which states redetermine whether people enrolled in the program since the pandemic unfolded remain eligible. States have dropped about 22 million people from Medicaid in the past year, often for procedural reasons like failing to return paperwork. A KFF survey in April found about 1 in 4 adults who were disenrolled from Medicaid a year ago remained uninsured. One group enjoys some upside from Americans’ ignorance about their insurance coverage: the companies that administer Medicaid for most states, including UnitedHealthcare and Centene. States pay them a monthly fee for every person enrolled in their plans. But if people don’t know they’re insured, they’re less likely to seek health services — which means higher profits for the companies. “Insurers reaped windfalls from this reality,” said Brian Blase, president of the Paragon Health Institute and a former health policy adviser to President Donald Trump. “People who are enrolled but don’t know they are enrolled receive no benefit from the program.” In March 2022, the Centers for Medicare & Medicaid Services reported that about 88 million people had Medicaid coverage. But census survey data found about 62 million people self-reported Medicaid coverage — an undercount of 26.4 million, the study said. Several factors explain why enrollees may not realize they’re on Medicaid. They don’t pay monthly premiums, so the cost of the coverage can be invisible. Because it’s administered by private insurers, many Medicaid recipients may believe they have commercial coverage. And states often market their Medicaid programs with a consumer-friendly name, like Husky Health in Connecticut or SoonerCare in Oklahoma. “Medicaid having different names should not lead people to think they are uninsured,” said Benjamin Sommers, a health economist at Harvard who was one of the study’s authors. This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact [email protected]. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/xTlLJFR Check out http://plush-draw15.tumblr.com/ James Lemons, de 39 años, quiere que le extraigan la bala de su muslo para poder volver a trabajar. Sarai Holguín, de 71 años y originaria de México, ha aceptado la bala alojada cerca de su rodilla como su “compa”, es decir, una amiga cercana. A Mireya Nelson, de 15, la alcanzó una bala que atravesó su mandíbula y le rompió el hombro, donde quedaron fragmentos. Por ahora vivirá con ellos, mientras los médicos monitorean los niveles de plomo en su sangre por al menos dos años. A casi tres meses del tiroteo en el desfile del Super Bowl de los Kansas City Chiefs, que dejó al menos 24 personas heridas, recuperarse de esas heridas es algo profundamente personal e incluye una sorprendente área gris de la medicina: si las balas deberían o no extraerse. El protocolo médico no ofrece una respuesta clara. Una encuesta de 2016 entre cirujanos reveló que solo cerca del 15% de los encuestados trabajaban en instalaciones médicas que tenían normas sobre la extracción de balas. Los médicos en Estados Unidos a menudo dejan las balas enterradas profundamente en el cuerpo de una persona, al menos al principio, para no causar más trauma. Pero a medida que la violencia armada surge como una epidemia de salud pública, algunos investigadores se preguntan si esa práctica es la mejor. Algunos de los heridos, como James Lemons, quedan en una situación precaria. “Si hay una manera de sacarla y se saca de forma segura, sáquenla fuera de la persona”, dijo Lemons. “Hagan que esa persona se sienta más segura consigo misma. Y que no tengas que estar caminando con ese recuerdo dentro de tí”. Lemons, Holguín y Nelson están sobrellevando las cosas de manera muy diferente. El dolor se convirtió en un problema Tres días después de que los Chiefs ganaran el Super Bowl, Lemons condujo las 37 millas desde Harrisonville, Missouri, hasta el centro de Kansas City para celebrar la victoria. Lemons, quien trabaja en un depósito, llevaba a su hija de 5 años, Kensley, en sus hombros cuando sintió una bala entrar en la parte posterior de su muslo derecho. Los disparos se desataron en un área abarrotada de fans, dijeron más tarde los fiscales, después de una “confrontación verbal” entre dos grupos. Los detectives encontraron “múltiples cartuchos de bala calibre 9 mm y .40” en el lugar. Lemons dijo que entendió inmediatamente lo que estaba sucediendo. “Conozco mi ciudad. No estamos lanzando fuegos artificiales”, dijo. Mientras se tiraban al suelo, Lemons protegió el rostro de Kensley para que no golpeara sobre el cemento. Su primer pensamiento fue llevar a su familia —su esposa, Brandie; su hija de 17 años, Kallie; y su hijo de 10 años, Jaxson— a un lugar seguro. “Me dispararon. Pero no te preocupes”, recordó Lemons que le dijo a Brandie. “Tenemos que irnos”. Llevó a Kensley en sus hombros mientras la familia caminaba una milla hasta su auto. Al principio su pierna sangraba a través de sus pantalones, pero después paró, dijo. Ardía de dolor. Brandie insistió en llevarlo al hospital, pero el tráfico estaba estancado, así que encendió las luces de emergencia y condujo en la dirección opuesta. Lemons recordó que ella dijo: “’Te estoy llevando al hospital. Estoy cansada de que la gente se interponga en mi camino'”. “Nunca había visto a mi esposa así. La miré y pensé, ‘esto es algo sexy'”. Contó que le sonrió a su esposa y aplaudió, a lo que ella respondió: “¿Por qué estás sonriendo? Acaban de dispararte”. Se mantuvo en silenciosa admiración hasta que los detuvo un sheriff, que llamó a una ambulancia, recordó Lemons. Lo llevaron a la sala de emergencias de University Health, que ese día admitió a 12 pacientes del rally, incluidos ocho con heridas de bala. Las placas mostraron que la bala apenas había esquivado una arteria, dijo Lemons. Los médicos limpiaron la herida, pusieron su pierna en un aparato ortopédico y le dijeron que regresara en una semana. La bala todavía estaba en su pierna. “Me sentí un poco desconcertado, pero pensé, ‘Está bien, lo que sea, saldré de aquí'”, recordó Lemons. Cuando regresó, los médicos le quitaron el aparato ortopédico pero le explicaron que a menudo dejan balas y fragmentos en el cuerpo, a menos que se vuelvan demasiado dolorosos. “Entiendo, pero no me gusta eso”, dijo Lemons. “¿Por qué no la sacarías si pudieras?” Leslie Carto, vocera de University Health, dijo que el hospital no puede comentar sobre la atención de pacientes debido a las leyes federales de privacidad. Los cirujanos generalmente extraen las balas cuando las encuentran durante la cirugía o cuando están en lugares peligrosos, como en el canal espinal, o a punto de dañar un órgano, explicó Brendan Campbell, cirujano pediátrico del Connecticut Children’s. Campbell también preside el Comité de Prevención y Control de Lesiones del Comité de Trauma del Colegio Americano de Cirujanos, que trabaja en la prevención de lesiones por armas de fuego. LJ Punch, cirujano entrenado en trauma y fundador de la Bullet Related Injury Clinic en St. Louis, dijo que los orígenes de la atención del trauma también ayudan a explicar por qué las balas generalmente no se extraen. “La atención del trauma es medicina de guerra”, dijo Punch. “Está preparada para estar lista en cualquier momento, todos los días, para salvar una vida. No está equipada para cuidar la curación que se necesita después”. En la encuesta a los cirujanos, las razones más comunes dadas para extraer una bala fueron el dolor, una bala palpable alojada cerca de la piel o una infección. Mucho menos comunes fueron la intoxicación por plomo y las preocupaciones de salud mental como el trastorno de estrés postraumático y la ansiedad. Los cirujanos dijeron que lo que querían los pacientes también impactaba en sus decisiones. Lemons quería que le quitaran la bala. El dolor en su pierna se irradiaba desde su muslo, lo que le dificultaba moverse durante más de una hora o dos. Era imposible trabajar en el depósito. “Tengo que levantar 100 libras cada noche”, recordó Lemons que le dijo a sus médicos. “Tengo que levantar a mi hijo. No puedo trabajar así”. Ha perdido sus ingresos y su seguro de salud. Otro racha de mala suerte: el dueño de la casa que alquilaban decidió venderla poco después del desfile, y tuvieron que encontrar un nuevo lugar para vivir. La casa actual es más pequeña, pero era importante mantener a los niños en el mismo distrito escolar con sus amigos, dijo Lemons en una entrevista en el dormitorio rosa de Kensley, el lugar más tranquilo para hablar. Han pedido dinero prestado y recaudaron $6,500 en GoFundMe para ayudar con el depósito y las reparaciones del automóvil, pero el tiroteo del desfile ha dejado a la familia en un profundo pozo financiero. Sin seguro, Lemons temía no poder pagar para que le extrajeran la bala. Luego se enteró que su cirugía sería pagada por donaciones. Programó una cita en un hospital al norte de la ciudad, donde un cirujano tomó medidas en su radiografía y le explicó el procedimiento. “Necesito que estés involucrado tanto como yo voy a estar involucrado”, recordó que le dijeron, “porque —adivina qué— esta no es mi pierna”. La cirugía está programada para este mes. “Nos hicimos amigas” Sarai Holguín no es gran fanática de los Chiefs, pero aceptó ir al rally en Union Station para mostrarle a su amiga el mejor lugar para ver a los jugadores en el escenario. Era un día inusualmente cálido, y estaban paradas cerca de una entrada donde había muchos policías. Había papás con bebés en cochecitos, los niños jugaban al fútbol americano y Holguín se sentía segura. Un poco antes de las 2 pm, escuchó lo que pensó que eran fuegos artificiales. La gente comenzó a correr lejos del escenario. Se dio vuelta, tratando de encontrar a su amiga, pero se sintió mareada. No se dio cuenta que le habían disparado. Tres personas rápidamente la ayudaron a tirarse al suelo, y un extraño se quitó la camisa e hizo un torniquete en su pierna izquierda. Holguín, originaria de Puebla, México, ciudadana estadounidense desde 2018, nunca había visto tanto caos, tantos paramédicos trabajando bajo tanta presión. Fueron “héroes anónimos”, dijo. Los vio atendiendo a Lisa López-Galván, una conocida DJ de 43 años y dos hijos. López-Galván murió en el lugar, y fue la única víctima mortal. A Holguín la llevaron a University Health, a unos cinco minutos de Union Station. Allí, la operaron, pero dejaron la bala en su pierna. Holguín se despertó en medio de más caos. Había perdido su bolso y su teléfono celular, así que no pudo llamar a César, su esposo. La internaron en el hospital bajo un alias, una práctica común en los centros médicos para comenzar a atender al paciente de inmediato. Su esposo e hija no la encontraron hasta cerca de las 10 pm, unas ocho horas después de que le dispararan. “Ha sido un gran trauma para mí”, dijo Holguín a través de un intérprete. “Estaba herida y en el hospital sin haber hecho nada malo. [El rally] era un momento para jugar, relajarse, estar juntos”. Holguín estuvo una semana internada, e inmediatamente tuvo dos cirugías ambulatorias más para eliminar el tejido muerto alrededor de la herida. Usó un dispositivo especial durante varias semanas y tuvo citas médicas cada dos días. Campbell, el cirujano de trauma, dijo que esos dispositivos, llamados “de cierre asistido por vacío” son comunes cuando las balas dañan tejidos que no se pueden reconstruir fácilmente en la cirugía. (Ayudan a acelerar el proceso de cierre de la herida) “No son solo las lesiones físicas”, dijo Campbell. “Muchas veces son las lesiones emocionales, psicológicas, que muchos de estos pacientes también experimentan”. La bala sigue cerca de la rodilla de Holguín. “La tendré por el resto de mi vida”, dijo, agregando que ella y la bala se han convertido en “compas”, amigas cercanas. “Nos hicimos amigas para que ella no me haga ningún otro daño”, dijo Holguín sonriendo. Punch, de la Bullet Related Injury Clinic en St. Louis, dijo que algunas personas como Holguín pueden tener la fortaleza mental para vivir con una bala en el cuerpo. “Si puedes crear una historia sobre lo que significa que esa bala esté en tu cuerpo, eso te da poder; te empodera”, dijo Punch. La vida de Holguín cambió en un instante: está usando un andador para moverse. Su pie, dijo, actúa “como si hubiera tenido un derrame cerebral”, se queda colgando y es difícil mover los dedos de los pies. La consecuencia más frustrante es que no puede viajar para ver a su padre de 102 años, que está en México. Lo ve en video a través de su teléfono, pero eso no ofrece mucho consuelo, dijo, y pensar en él la hace llorar. En el hospital le dijeron que sus facturas médicas serían cubiertas, pero luego muchas de ellas llegaron por correo. Intentó obtener ayuda para las víctimas del estado de Missouri, pero le costo entender todos los formularios que tenía porque estaban en inglés. Solo alquilar el dispositivo de cierre asistido por vacío costaba $800 al mes. Finalmente escuchó que el Consulado de México en Kansas City podía ayudar, y el cónsul la remitió a la Oficina del Fiscal del condado de Jackson, donde se registró como víctima oficial. Ahora todas sus facturas están siendo pagadas, dijo. Holguín no buscará tratamiento de salud mental, ya que cree que uno debe aprender a vivir con una situación determinada o se convertirá en una carga. “He procesado este nuevo capítulo en mi vida”, dijo Holguín. “Nunca me he rendido y seguiré adelante con la ayuda de Dios”. “Vi sangre en mis manos” Mireya Nelson llegó tarde al desfile. Su madre, Erika, le dijo que se fuera temprano, por el tráfico y el millón de personas que se esperaba en el centro de Kansas City, pero ella y sus amigos adolescentes ignoraron el consejo. Los Nelson viven en Belton, Missouri, aproximadamente a media hora al sur de la ciudad. Mireya quería sostener el trofeo del Super Bowl. Cuando ella y sus tres amigos llegaron, el desfile que había pasado por el centro ya había terminado y había comenzado el rally en Union Station. Estaban atrapados entre la multitud y se aburrieron rápido, dijo Mireya. Mireya y una de sus amigas intentaron llamar al conductor de su grupo para irse, pero no tenían señal en el celular, por la gran multitud. En medio del caos de personas y ruido, Mireya de repente se desplomó. “Vi sangre en mis manos. Así que supe que me habían disparado. Sí, y simplemente me arrastré hacia un árbol”, dijo Mireya. “En realidad, al principio no sabía dónde me habían disparado. Solo ví sangre en mis manos”. La bala rozó la barbilla de Mireya, atravesó su mandíbula, le rompió el hombro y salió por su brazo. Quedaron fragmentos de bala en su hombro. Los médicos decidieron dejarlos porque la joven ya había sufrido mucho daño. Por ahora, la madre de Mireya apoya esa decisión, señalando que eran solo “fragmentos”. “Creo que si no la van a dañar el resto de su vida”, dijo Erika, “no quiero que siga volviendo al hospital y teniendo cirugías. Eso es más trauma para ella y más tiempo de recuperación, más terapia física y cosas así”. Punch dijo que los fragmentos de bala, especialmente los que son solo superficiales, a menudo se abren paso como astillas, aunque a los pacientes no siempre se les dice eso. Además, agregó, las lesiones causadas por las balas se extienden más allá de aquellos con tejido dañado a las personas a su alrededor, como Erika. Pidió un enfoque holístico para recuperarse de todo el trauma. “Cuando las personas permanecen en su trauma, ese trauma puede cambiarlas para toda la vida”, dijo Punch. Mireya será sometida a pruebas de niveles de plomo en su sangre durante al menos los próximos dos años. Ahora sus niveles están bien, dijeron los médicos a la familia, pero si empeoran, necesitará cirugía para remover los fragmentos, dijo su madre. Campbell, el cirujano pediátrico, dijo que el plomo es particularmente preocupante para los niños pequeños, cuyos cerebros en desarrollo los hacen especialmente vulnerables a sus efectos perjudiciales. Incluso una pequeña cantidad de plomo —3.5 microgramos por decilitro— es suficiente para informar a las autoridades de salud estatales, según los Centros para el Control y Prevención de Enfermedades (CDC). Mireya habla sobre adolescentes lindos, pero todavía usa pijamas de Cookie Monster. Parece confundida por los tiroteos, por toda la atención en casa, en la escuela, de los periodistas. Cuando le preguntaron cómo se siente sobre los fragmentos en su brazo, dijo: “Realmente no me importan”. Después de su estadía en el hospital, Mireya tomó antibióticos durante 10 días porque los médicos temían que hubieran bacterias en la herida. Ha tenido terapia física, pero es doloroso hacer los ejercicios. Tiene una cicatriz en la barbilla. “Una muesca”, dijo, que es “irregular”. “Dijeron que tuvo suerte porque si no hubiera girado la cabeza de cierta manera, podría haber muerto”, dijo Erika. Mireya enfrenta una evaluación psiquiátrica y sesiones de terapia, aunque no le gusta hablar de sus sentimientos. Hasta ahora, el seguro de Erika está pagando las facturas médicas, aunque espera obtener algo de ayuda del fondo #KCStrong de United Way, que recaudó casi $1.9 millones, o de una organización de fe llamada Unite KC. Erika no quiere limosnas. Tiene un trabajo en atención médica y acaba de tener un ascenso. La bala ha cambiado la vida de la familia de muchas maneras. Ahora forma parte de sus charlas. Hablan sobre cómo desearían saber qué tipo de munición era, o cómo se veía. “Como si quisiera quedarme con la bala que atravesó mi brazo”, dijo Mireya. “Quiero saber qué tipo de bala era”. Eso provocó un suspiro de su mamá, quien dijo que su hija había visto demasiados episodios de “Forensic Files”. Erika se culpa por la herida, porque no pudo proteger a su hija en el desfile. “Me duele mucho porque me siento mal, porque ella me suplicó que dejara el trabajo y no fui allí porque cuando tienes un puesto nuevo, no puedes simplemente irte del trabajo”, dijo Erika. “Porque yo hubiera recibido la bala. Porque haría cualquier cosa. Es lo que hace una mamá”. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/fzSYZBr Check out http://plush-draw15.tumblr.com/ |