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LA County Care Court aims to help those on streets with mental illness

Thursday, November 30, 2023

LOS ANGELES (KABC) — Los Angeles County has about 75,000 people living on the streets. Officials estimate about 10% suffer schizophrenia or other disorders.

“There are too many people with severe mental illness who are living on the streets,” LA County Supervisor Janice Hahn says. “We’ve all seen them and so far, we’ve been unable to reach them.”

Los Angeles County officials on Thursday announced a new program called Care Court to help people receive treatment and services.

“We are really committed to helping people get the support they need to improve their mental health and well-being. We are here to change the trajectory of people’s lives,” says Dr. Lisa Wong from the Los Angeles County Department of Mental Health.

With this program a family member or someone else can file a petition asking to determine if someone qualifies.

A judge can then order a care plan for the person.

Samantha Jessner, presiding judge for the Superior Court of Los Angeles County, says “This new tool provides an alternative to the way in which most individuals enter our county’s mental health system, which is usually through the criminal justice system.”

“Initially, LA County wasn’t going to have this program until next year. But we are ground zero for this problem. And so, we moved our start date up an entire year,” adds Hahn.

Not everyone likes this program. The Western Center on Law & Poverty sued to stop the Care law, saying it forces treatment on people.

In an article it claimed, “The law paves the way to eventually institutionalize people who are unhoused and have schizophrenia and other psychotic disorders.”

Ricardo García, the Los Angeles County public defender says, “To those who are concerned that Care court will lead to forced treatments or detention, I want to emphasize participation in Care Court is absolutely voluntary.”

The program officially begins Friday and until then authorities say they’re not sure how many people would qualify for Care Court.

Black Midwifery in the US

Since the inception of the United States, midwifery has been the most customary practice for pregnancy care and childbirth. Today, the primary care for pregnant people in most developed European countries is facilitated by midwives. However, in the United States a divide began to take root in the 1800’s, when white male physicians began to explore childbirth with greater interest. Their approach was based on a patriarchal and colonial framework that was highly experimental and racist, often times using enslaved African to test explicit drug therapies, shock treatments, and surgeries without any anesthesia.

Prior to the creation of formalized medical education in obstetrics and gynecology, midwives were the sole experts in birth work and medicine relied heavily on Native American and African American knowledge of plants and indigenous healing modalities. For millennia, birth work was considered a female occupation or “woman’s work” (Hoch-Smith and Spring, 1978; Leavitt, 1983; Rooks, 1997; Donegan, 1978; Litoff, 1990). The midwifery model of education was a indigenous model of apprenticeship under more experienced midwives that were often grandmothers who also learned from their grandmothers. In the United States midwifery was largely practiced by enslaved Africans who were responsible for women’s healthcare of all enslaved women on the plantation as well as the white women who owned them. A large part of midwifery apprenticeship on the plantation included various forms of training such as herbalism, procedures for dealing with birth complications, perinatal care, and serving as traditional healing.

Once the field of medicine became “professionalized” and legitimized by the legal system with the invention of the American Board of Obstetrics and Gynecology in 1927, physicians sought to dominate the field of birth work as its primary practitioners. Their claim to jurisdiction spurred racist propaganda campaigns depicting Black midwives as caricatures falsely accusing midwives of being “incompetent”, “witches”, “unclean”, “savages”, and “untrustworthy”. These physicians also lured white women to trust them because they offered “innovative” pain relief options such as opioid tampons, and mercury. In addition to the propaganda, because pregnancy began to be viewed as a pathological condition beginning in the late 1800s and continuing into the 1900s, physicians claimed that only legally trained individuals could “treat” this “condition”. Such assertions/claims served as manipulative tools that “pushed the scales” in favor of physician-assisted births versus granny midwife assisted births.

The public perception of midwives began to shift as the midwives who had for centuries in the Americas served as the primary maternal and infant healthcare providers were essentially deemed illegitimate. These smear campaigns were supported by the white male physicians who were founders and members of State Boards of Health which controlled who was able to care for and treat women in childbirth. By the 1900s white male physicians attended approximately half of births, despite having little to no training in obstetrics.

In rural America, however, Black midwives continued to attend births especially for Black folks who lived in the segregated south and had no access to hospitals in their communities. In the Southern states, Black midwives, sometimes called “granny” midwives, attended up to 75% of births until the 1940’s.

Racist laws, educational restrictions, and campaigns against midwifery care led to the dismantling of the practice especially for Black women, for example:

  • The 1910 Flexner Report recommended hospital deliveries and the abolition of midwifery. The study has since been recognized for its racist, sexist, and classist approach to medical education.
  • “Twilight sleep” was introduced in 1914, an amnesiac given to women by white physicians preventing any memories of giving birth.
  • In 1915, Dr. Joseph DeLee – a prominent obstetrician – called pregnancy and childbirth “dangerous” and “evil.” Dr. DeLee promoted the use of forceps, sedatives, ether, and other interventions that needed hospital-level care. He argued that midwives were incompetent.
  • The Department of Indian Affairs passed legislation that moved births from the home to the hospital.
  • The Shepphard-Tower Infancy and Protection Act became a federal law in 1921. It encouraged states to develop their own maternal and child health legislation. Before these changes, lay midwives practiced mostly without restrictions. The new laws severely reduced their practice in many states. For example, Alabama began requiring all midwives to obtain a license, then later required nurse-midwives to practice only in hospitals. These changes prevented 150 “granny midwives” from practicing across the state practically overnight.
  • Public health nurse Mary Breckenridge founded Frontier Nursing Service (FNS) in rural Kentucky in 1925 which led to the more formalized field of nurse-midwifery also developed at this time. Breckenridge’s racist rhetoric impacted Black midwives’ entry into the nurse midwifery route though Breckenridge has been for “creating a pathway for midwifery education and certification.”

The formalization of education and certification ultimately delegitimized apprentice-trained midwives in every community. Today, less than 5% of midwives in the United States are people of color. Disparities in maternal morbidity and mortality rates are striking; Black mothers are 2-3 times more likely to die in childbirth than white mothers. This impact reflects the powers and forces that disconnected midwives from their communities.

Black Midwives that Birthed Communities

Mary Coley was born in Baker County, Georgia. She began training as a midwife under the tutelage of Onnie Lee Logan. She became an advocate for the health of Georgia’s black population and was known for her willingness to work with women regardless of race in a time of segregation. It is estimated that she delivered over 3,000 babies in her career.

Ms. Arilla Smiley was trained by the local Health Department in Brunswick Georgia and apprenticed with her mother-in-law. She received her license to perform midwifery in 1963 and retired in 1987. During her career as a midwife, Ms. Smiley delivered over 1,000 babies in Mitchell County.

Maude Callen was a nurse-midwife in the South Carolina Low country for over 60 years. Her work was brought to national attention in W. Eugene Smith’s photo essay, “Nurse Midwife,” published in Life on December 3, 1951.

Margaret Charles Smith delivered more than 3,000 babies. In 1949, she became one of the first official midwives in Green County, Alabama, and she was still practicing in 1976 when the state passed a law outlawing traditional midwifery. In the 1990s, she cowrote a book about her career, Listen to Me Good: The Life Story of an Alabama Midwife, and in 2010 she was inducted into the Alabama Women’s Hall of Fame.

Bibliography
Abbott, Andrew. 1988 The System of Professions. Chicago: University of Chicago Press.
Donnegan, Jane B. 1978 Women and Men Midwives: Medicine, Morality, and Misogyny in Early America. Westport: Greenwood Press.
Fraser, Gertrude Jacinta. 1998 African American Midwifery in the South: Dialogues of Birth, Race, and Memory. Cambridge: Harvard University Press.
Hoch-Smith, Judith and Anita Spring. 1978 Women in Ritual and Symbolic Roles. New York: Plenum Press.
Leavitt, Judith Walzer. 1987 “The Growth of Medical Authority: Technology and Morals in Turn-of-the-Century Obstetrics.” Medical Anthropology Quarterly 1(3). September. 230-255.
Leavitt, Judith Walzer. 1983 “Science Enters the Birthing Room: Obstetrics in America Since the Eighteenth Century.” The Journal of American History. 70(2). 281-304.
Litoff, Judy Barrett. 1996 “Forgotten Women: American Midwives at the Turn of the Twentieth Century.” Pp. 425-441 in Childbirth: Changing Ideas and Practices in Britain and America 1600 to the Present, edited by Phillip K. Wilson, Ann Dally, and Charles R. King. New York: Garland Publishing.
Pringle, Rosemary 1998 Sex and Medicine: Gender, Power, and Authority in the Medical Profession. Cambridge: Cambridge University Press.
Radcliffe, Walter. 1989 Milestones in Midwifery and the Secret Instrument: The Birth of the Midwifery Forceps. San Francisco: Norman Publishing.
Rooks, Judith Pence. 1985 Midwifery and Childbirth in America. Philadelphia: Temple University Press.

Making Food Prescriptions a Reality in California

If you are a Type 1 diabetic there are two constants in your life: the rising cost of insulin or the constant pain of the pricking needle. Now, imagine your doctor offered a new alternative to help manage your glucose.

What if your doctor could prescribe food tailored to your specific nutritional needs?

Unbeknownst to many, such a program has been in the works for the past five years. Food prescription pilots outside of the state have been around for decades. Around 2018 California officially began its food as medicine services. By early 2022, the California Department of Health Care Services (DHCS) began a 5-year initiative to reform Medi-Cal, called CalAIM.

CalAIM is attempting to address the root causes and complex health needs in various communities across the state. Beginning in 2022 the DHCS began to offer 14 community support services that health plans can opt-in to, they provide an alternative to higher-cost medical services. Designed to address people’s health-related social needs, some of these community supports include navigation services for housing and sobering centers. By the end of 2022, all 58 counties in California offered at least two community services,  while 16 counties offered at least 10, and 3 counties (Sacramento, Riverside, and San Diego County) offered all 14 community support services.

The second most popular service among all counties is the Medically Supportive Food & Nutrition (MSFN) support. The spectrum of medically supportive food and nutrition interventions includes: medically tailored meals, medically supportive meals, food pharmacies, medically tailored groceries, medically supportive groceries, produce prescriptions and nutrition supports when paired with food provision. Different counties have different approaches to where and how food is received. Whatever the approach, around 26,000 Medi-Cal members have used this community support.

These amazing food and nutrition supports have been proven to be successful at helping people to treat, manage, or even prevent chronic health conditions as seen in pilots and studies not only across California but also nationally. These programs are an especially critical tool towards achieving health equity goals since BIPOC communities are disproportionately impacted by health issues and poverty. A recent study shows that Black Californians are nearly twice as likely to be diagnosed with diabetes than white Californians and more than 10% more likely to be diagnosed with high blood pressure.

Western Center’s own Whitney Francis shares her experiences on the frontlines of this work, “Having previously worked in food pharmacies, I’ve seen first-hand how our patients were empowered to manage their health through accessing fresh produce weekly, especially for patients who struggled with issues such as food and housing insecurity.”

The time is now to make Medically Supportive Food and Nutrition (MSFN) accessible to more Californians. We need to be scaling this CalAIM support up; this means investing in outreach and education to make providers and patients aware of this community support and how to access it, assisting food/nutrition providers in establishing contracts with health plans, and establishing Medically Supportive Food and Nutrition as a permanent part of Medi-Cal.

Last year, Assemblymember Mia Bonta from Oakland introduced AB 1644, a bill that would transition medically supportive food and nutrition services a from an optional service under a time-limited waiver to a permanently covered benefit under Medi-Cal. While the bill did not get past the Appropriations Committee, the Medically Supportive Food & Nutrition coalition, co-led by SPUR and the Food as Medicine Collaborative who co-sponsored AB 1644, are preparing to reintroduce a similar bill, AB 1975. One of the major updates to the bill this year is more robust language incentivizing sourcing food from small and medium-sized farms, minority-owned farms, and farms using organic, regenerative, and other climate-smart practices – if passed, this would be a big win for the health of Californians, the planet, and our local economies.

California needs this — make no mistake this is an opportunity to invest in the long-term health of Californians. The benefits of food as low-cost medicine far outweigh the immediate costs it is said to incur for our state.

Whitney Francis agrees, she says, “these kinds of health interventions help to bridge the siloes between healthcare and social and economic factors that impact one’s health. That’s why I’m excited to support advocacy efforts to expand access to these services under Medi-Cal.”

I agree with my colleague, 2024 should be the year we make medically supportive foods and nutrition a more accessible reality.

There is no other time than now to take bold steps and get AB 1975 across the finish line and make an impact on Black and Latinx lives and offer food as medicine.

To stay updated on legislative advocacy for AB 1975, you can visit MSFNCA.org/contact and sign up for the Medically Supportive Food & Nutrition coalition updates.

Settlement Finalized in Katie A. vs. Los Angeles County Mental Health Lawsuit

After more than 20 years of litigation, the U.S. District Court for the Central District of California, Western Division, has given final approval to a settlement in the longstanding case Katie A. v. Los Angeles County. The Court’s action ends a federal class action lawsuit that, over time, led to significantly improved mental health services for children and young adults in foster care or who face imminent risk of placement in foster care. 

Filed in 2002, the suit alleged the county and state agencies failed to provide legally mandated health care services to youth in its custody. The lack of mental health services harmed foster youth by increasing the likelihood they would be removed from their homes.  Removals compound trauma for foster youth, making the lack of appropriate care even harder for children already struggling with mental illness.

“In the beginning of this lawsuit, we saw many youth have multiple moves due to behaviors that weren’t being addressed with treatment, and they were losing important connections to family and community,” said Antionette Dozier, one of Western Center’s lead attorneys on the case. 

While the County has instituted numerous new systems as a result of the lawsuit, perhaps most noteworthy is the now-standard practice for youth to receive intensive home-based mental health services that aim to keep youth with severe mental health needs in a homelike setting. Previously, they were more likely to have been  hospitalized or sent to a group home.

The County first settled the lawsuit in 2003 and agreed to provide mental health services, in addition to a long monitoring process. Plaintiffs filed a successful motion in 2009 to enforce the original settlement provisions.

Eventually, the plaintiffs reached separate settlement agreements with both the state and LA County in the case.

Co-counsel include: Disability Rights California, Bazelon Center for Mental Health, National Center for Youth Law, Public Counsel.

 

‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States

In California, staffing shortages at county agencies that administer Medi-Cal, the state’s Medicaid program, are making it more difficult for people to renew their coverage.

In Missouri and Florida, callers waited on hold for more than two hours on hotlines to renew their Medicaid coverage.

In Tennessee, the parents of a disabled man who had been on Medicaid for three decades fought with the state this summer to keep him enrolled as he lay dying from pneumonia in a hospital.

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Children’s Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients’ eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove they’re still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

“It’s not just bad, but worse than people can imagine,” said Camille Richoux, health policy director for the nonprofit Arkansas Advocates for Children and Families. “This unwinding has not been about determining who is eligible by all possible means, but how we can kick people off by all possible means.”

To be sure, some of the Medicaid recipients who signed on to the program when the U.S. unemployment rate soared amid covid-19 lockdowns have since gotten health insurance through new jobs as unemployment dropped back to pre-pandemic lows.

And some of the disenrolled are signing up for Affordable Care Act marketplace plans. Centene CEO Sarah London, for example, told investors on Oct. 24 that the health care giant expected as many as 2.4 million of its 15 million Medicaid managed care members to lose coverage from the unwinding, but more than 1 million customers had joined its exchange plans since the same time last year.

Still, it’s anyone’s guess how many former Medicaid beneficiaries remain uninsured. States don’t track what happens to everyone after they’re disenrolled. And the final tallies likely won’t be known until 2025, after the unwinding finishes by next summer and federal officials survey Americans’ insurance status.

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Western Center Roundup – August 2023


Commemorating the 60th Anniversary of the March on Washington, Black August, and Black Philanthropy Month

This month, we commemorated the 60th anniversary of the March on Washington, led by Rev. Dr. Martin Luther King Jr. and other giants of the civil rights movement. The march and King’s remarks that day are lodged in Americans’ collective memory as a turning point in the struggle for civil rights. Last Saturday, more than half a century later, a multiracial coalition of thousands of people gathered once again on the steps of the Lincoln Memorial to demand social, racial, and economic justice and decry the people and systems that are trying to undo the progress we’ve made over the past 60 years. We recognize that all of our struggles are interconnected, and that liberation requires all of us to play a role in fighting oppression. Black August is a commemoration of the fallen freedom fighters of the Black Liberation Movement, a call for the release of political prisoners, a condemnation of the conditions in prisons, and a continued fight for Black liberation. This month is also Black Philanthropy Month, founded by Dr. Jackie Bouvier Copeland in 2011, as a global celebration and intentional campaign to elevate giving and funding equity. The theme of this year is “Love in Action,” inspired by the writings of bell hooks on love as a driver of true social change. She wrote, “But love is really more of an interactive process. It’s about what we do, not just what we feel. It’s a verb, not a noun.” Our development team continues to intentionally uplift the practice of putting love into action by applying community-centric fundraising principles in their work with the support and guidance of our philanthropy consultant, April Walker from Philanthropy for the People



New Settlement: Affirming Access to Charity Care

Earlier this month, we announced our landmark settlement in a charity care case against Santa Clara Valley Healthcare with co-counsel Consumer Law Center, Inc., addressing the county’s failure to adequately inform patients with low and no incomes of the hospital’s charity care and discount payment policies. As a result, the County has updated their notices on how patients can qualify for free and discounted payments and expanded the number of languages notices are available in. An estimated 43,000 former patients of Santa Clara Valley Healthcare have received notice of possible billing corrections and refunds. “Medical debt, particularly hospital debt, burdens many Californians and forces them to forgo medically necessary care and other life necessities. We hope this lawsuit will give thousands of Santa Clara residents some financial relief,” said Helen Tran, Senior Attorney with the Western Center on Law and Poverty.

News coverage of the settlement can be viewed in Kaiser Health News and KTVU.

 

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9/19: Pasa La Voz and Meet the Advocates – Medi-Cal Renewals

For this next Meet the Advocates, we’re excited to partner with the Latino Coalition for a Healthy California. Their “Pasa La Voz” project aims to spread awareness and education about health, and to provide community resources to Latinx families and individuals in a culturally and community-informed manner. On Tuesday, September 19th from 12:00 PM to 1:00 PM, join Western Center senior attorneys David Kane and Helen Tran and Ana Tutila, a Promotora in Orange County with the Latino Coalition for a Healthy California as they discuss the importance of Medi-Cal renewals for California’s health and racial equity goals – and the current challenges facing those renewing their coverage. Millions of Californians who depend on Medi-Cal are going through the renewal process for the first time since before the start of the pandemic. We’ll be diving into the work advocates and community-based organizations are doing to support people enrolled in Medi-Cal to keep their coverage, highlighting on-the-ground challenges enrollees are facing, and discussing the policy changes needed to improve this process.

RSVP


Santa Clara Valley Healthcare病人可寻求医疗费用减免

此前,圣塔克拉拉谷医疗保健公司(Santa Clara Valley Healthcare)被指控向贫困患者收取本应免费获得的医疗费用的违规操作。该县昨天表示,已开始通知本应有资格享受 “慈善护理”(charity care,为低收入人群提供的减费或免费医疗服务)的病人。那些在未来几周内提出申请的人,其未付的医院账单将作废,或收到邮寄的退款支票。
对于参与此案的西部法律与贫困中心(Western Center on Law and Poverty)资深律师海伦-陈(Helen Tran)等病人权益倡导者来说,此次和解是一次重大胜利。
她说:”这向全州的医院发出了一个非常重要的信息–他们应该认真履行慈善医疗义务。”
加州的所有急症护理医院都必须为收入低于一定标准(目前为联邦贫困线的 400%)的无保险者和部分有保险者提供慈善护理。即个人年收入约为 58000 元,四口之家年收入约为 120000 元,均符合要求。此外,还必须用患者的母语向他们介绍慈善医疗的选择。

About 43K California patients are receiving refunds and billing corrections

Approximately 43,000 former patients of Santa Clara Valley Healthcare, serving Santa Clara County in California, will soon receive notice of possible billing corrections and refunds.

The increased patient outreach efforts are part of the settlement of a lawsuit that alleged the county did not adequately inform three former patients about its previous hospital charity care and discount payment policies after they incurred bills ranging from $8,000 to $35,000 between 2013 and 2017. The bills were sent to collections, according to Santa Clara County.

At the time of their hospitalization, one petitioner was uninsured who was a single mother of two children and a full-time student; another was uninsured and spoke primarily Spanish; and the third was unemployed and unhoused.

WHAT’S THE IMPACT

As part of the settlement, the county will provide an opportunity for patients whose bills were sent to collections between October 28, 2018, and December 31, 2021, to have their bills re-reviewed for full or partial discounts.

People who receive this notice will have 65 days to complete and return a form indicating their interest to apply. They’ll then have an additional 150 days to complete their application by submitting documents to verify their information.

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Santa Clara Valley Healthcare patients can seek debt relief

Tens of thousands of people treated at Santa Clara County-owned hospitals may now qualify to have their medical debt erased.

This comes in the wake of a June lawsuit settlement that accused Santa Clara Valley Healthcare of charging needy patients for care they should have received for free.

The county said yesterday it has begun notifying patients who should have been eligible for “charity care,” reduced-cost or free medical services for low-income people. Those who apply in the next several weeks could see their outstanding hospital bills voided, have court judgements corrected and even receive refund checks in the mail.

The settlement is a major win for patient advocates like Helen Tran, a senior attorney with the Western Center on Law and Poverty who worked on the case.

“It sends a really important message to hospitals statewide—that they should take their charity care obligations seriously,” she told San José Spotlight. “The county has done so.”

All acute care hospitals in California must offer charity care to anyone uninsured, and many people with insurance, who earn below a certain threshold—currently 400% of the federal poverty level. That’s about $58,000 annually for an individual and $120,000 for a family of four. Patients must also be told about charity care options in their native language.

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Getting Answers: Santa Clara Refunds

If you are a former patient at Santa Clara Valley Medical Center, you may be owed some cash. The hospital has started notifying more than 40,000 former patients about refunds due to incorrect billing. It is part of a settlement involving patients who were sent to collections for charges that they never should have been asked to pay. Joining us live now to discuss the settlement is Helen Tran, senior attorney with Western Center on Law and Poverty, which filed the suit back in 2019.

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