Tag Archives: hospital

Map of the Day: Access to Good Primary Care in America

Mother Jones

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I’m playing around with GeoFRED again while we all wait for the next three or four shoes to drop on the Jeff Sessions show. Here’s an interesting map: the rate of preventable hospital admissions. This is based on the number of hospital admissions for “ambulatory care sensitive conditions,” such as diabetes, asthma, and hypertension, which normally doesn’t require hospitalization if patients are being treated by good primary care doctors. Essentially, then, this map shows the places where good primary care isn’t widely available or isn’t doing its job.

What makes it interesting is that it doesn’t map all that closely to poverty. From Kentucky down to Louisiana, you have lots of counties with high poverty and a poor access to good primary care. But north of that you have the same thing even though poverty is relatively low. Out west, you have the opposite: a fair amount of poverty, but pretty good access to primary care. So what’s going on?

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Map of the Day: Access to Good Primary Care in America

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8 People Who Owe Their Lives to Obamacare

Mother Jones

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President Donald Trump has vowed to dismantle the Affordable Care Act (ACA)â&#128;&#138;—â&#128;&#138;a move that could leave some 30 million Americans without health insurance. ACA literally sustains millions of livesâ&#128;&#138;. Without the health insurance it provides, many people wouldn’t have access to medicine and procedures that they need to survive. When we asked people on Twitter and through healthcare advocacy organizations to share their stories of how ACA keeps them alive, we were overwhelmed with responses. We heard from people waiting for organ transplants, from cancer survivors, from people with debilitating mental illness, and more. They told us about the toll that disease has taken on their lives: Before the ACA, some were forced to skip treatments because of the price; others couldn’t get insurance at all because they were already sick. Here are a few of their stories.

Claudette Williams

Claudette Williams, 58, Orlando, Florida: I lost my job in 2005. After that I decided to purchase a policy. I found them online. They had a gentleman come to my house, and we talked about my blood pressure medications. The insurance was almost twice what they had quoted me because of the medication, and also because of my condition. I eventually couldn’t afford it any more. I was uninsured, except for one year when I qualified for Medicaid. I ended up in the emergency room on a few occasions for heart trouble. I also developed diabetes. I couldn’t afford to have regular mammograms. In 2014 I signed up for Obamacare. I was diagnosed with breast cancer in September of last year. The lumpectomy alone was billed at $40,000. I have four more chemo sessions to go, and after that, I have to do radiation. Luckily my cancer is only a stage one, so my prognosis is pretty good. But it is really scary thinking about my insurance being taken away. This is a fight for my life.

Charis Hill

Charis Hill, 30, California: When I was 25, in 2012, I had a series of unexplained and undiagnosable respiratory challenges that felt like the flu or bronchitis or pneumonia. Doctors just couldn’t figure out what was wrong with me. My condition got worse and worse. I visited urgent care a few times. I thought I was having a heart attack once. They tried to blame it on anxiety.

Eventually reached out to my dad, who was estranged from me. I knew that he had a severe health condition. The first words out of his mouth were, it sounds like you have what I have, which is ankylosing spondylitis (AS). I knew that I would need health insurance to be treated. But if I were to get a diagnosis before getting health insurance, I would have the preexisting condition working against me. So I got the cheapest plan that existed. I wasn’t getting all the tests done or getting all the treatments. Then, ten months later, the ACA was implemented, and because of my income, I was eligible for a subsidy to purchase health insurance on the exchange in California. I got a better plan for less than I was paying before, which meant that I could access more treatment and not skip medication.

I have infusions of a drug every eight weeks. I have to go to an infusion center for 2.5 hours. There’s no generic. There’s no way to get those treatments unless I have insurance. They slow down the progression of my disease. I also take anti-inflammatory medications orally. AS is a severe inflammatory condition. It primarily affects the spine. It causes a lot of pain and fatigue from the body trying to fight that inflammation. I’m permanently disabled. I was a college athlete, and now I’m not even able to run. I use a wheelchair sometimes. As hard as I fight to be healthy, I’m never going to be healthy, and I’m always going to have to rely on the medical system to keep me alive.

John Weiler, 27, Oakland, California: I got HIV when I was 19. When I was in college, I was on my parents health insurance, so when I started meds when I was 21, I took it for granted that I was going to have insurance that would cover it, because it was so easy. When I went to grad school, I naively accepted a position without asking any questions about how the insurance was structured. When you do a science PhD, it’s typical for the school to pay your tuition, pay your health insurance premium, and give you a stipend. In my program, the stipend is about $30,000 a year. So when I enrolled and started to look at my insurance situation, I realized the policy offered to students provided up to $10,000 worth of prescription coverage per academic year, and that was it. But in 2013, the student government got together and petitioned the university to change across the UC system. The students basically said, ‘We don’t care if our insurance premiums are higher, we don’t want these things that the ACA offers to not be part of the insurance plan for the school.’

I was on a med cocktail called Complera, and that one was $22,000 a year. HIV meds are super expensive. I switched to a different medication since then, called Stribild, and I don’t know exactly what it is this year, but if I remember correctly, that one was closer to $27,000 a year.

I’m about to graduate and find a job, and, let’s say worst case scenario, first Congressional session they manage to totally gut the ACA and revert to how things were before. If that were to happen and I were to get a job, it would be totally legal for an employer to be like, ‘Hey, yeah, we’re not covering this.’ I’d be looking at close to $35,000 a year in medical expenses just for maintenance, let alone if I got sick.

Ruth Linehan

Ruth Linehan, 26, Portland, Oregon: I graduated college in May 2012. I was 22. About a month later, I started an internship as a software developer at a Portland startup. Thanks to ACA I was on my parents’ insurance. After four months I was offered a full time job, but the insurance didn’t start until 6 weeks after my first day as an employee. On my first day I was diagnosed with Burkitt’s Lymphoma. I looked like I was 7 months pregnant. I started chemo the day after I was hospitalized. This is an incredibly fast-growing cancer. I was in the hospital for seven weeks. I received about four rounds of chemo. After four months I was declared in remission. I continue to be in remission. The hospital bills were about half a million dollars. I only had to pay about $10,000 because I was on my parents’ insurance.

If I lose my job and the cancer comes back, what am I going to do? I worry about illness down the road. I’ve had cancer at a very young age and a lot of very harsh chemo. I worry that I won’t be able to get affordable insurance, or get insurance at all.

Larry Sterlingshires, 35, Tennessee: I have a condition called hidradenitis surruptiva—look it up, do not look at pictures, because it’s not a good time—it’s a chronic skin condition that’s ultimately debilitating. As it progresses, it causes tissue degradation on the skin layer that doesn’t heal, like normal wounds do. Sometimes it creates lesions that don’t heal for a year and half. It’s debilitating because it’s painful—the tissue underneath is exposed without that protective layer, so it bleeds regularly. You have to keep everything patched and bandaged, and it easily gets infected. But because of the ACA, I can have medication that can’t completely undo the symptoms, but it seems to have halted its progression, and even promoted some healing. Complications related to the tissue damage and infections can be fatal.

The medications I’m on right now, in addition to just my normal medications for diabetes and hypertension, will help me survive longer. This lets me afford something called Claravis, and another medication called Humira. Humira runs approximately $7300 a month, and the Claravis is about $4000 a month. Those basically keep me functional without being completely disabled. That’s no exaggeration. If you check the disability schedule, it’s so painful and considered debilitating enough that you can qualify for full disability with it. The Affordable Care Act covers all of that medication in full. I come from poverty, I’m just now getting used to having insurance for the first time in my adult life, and now that seems like it might evaporate.

Debbie Lynn Smith, 59, Las Vegas, Nevada: I was a TV writer and producer. In 2000 I was diagnosed with bronchiolitis obliterans. It’s also called popcorn lung. I got it from buttered popcorn. When you work in TV, you work 15 hour days. They provide snacks and things. Microwave popcorn is one of the things they give you. I ate a lot of it. It just so happened that I was susceptible to this disease.

I was in remission for 16 years, but I was living with 50 percent of my lung capacity. I couldn’t do TV anymore, couldn’t put in those long hours. I really had a hard time working and being reliable because I would get sick. So I couldn’t get insurance through work. I had insurance through the high-risk California program and I was paying $2,000 a month for that. My husband was on it, too, he had prostate cancer. We moved to Nevada. When the ACA came around we were ecstatic. We were both out of work at the time, so we went on ACA.

This year, in April, my disease came out of remission. I am now down to 30 percent of my lung capacity and waiting for a lung transplant. So you can imagine the fear I have—being so close to getting a transplantthat they might repeal the ACA right away, and I will no longer have access to insurance, and I won’t be able to get my transplant. I am extremely stressed. I was so stressed before the election that I could not take anything else. I was working for Hillary and I ended up in the hospital.

Michele Munro

Michele Munro, 64, Southern California: I was first diagnosed with breast cancer in 1997. I was 44. I was a single mom with two boys. I had Kaiser insurance. It wasn’t a bad cancer, and we caught it early. Then seven years later I was diagnosed with a different type of breast cancer. That was 2004. I also had a hip replacement. The Kaiser premium doubled, so I went without insurance for the first time in years. I was working as a freelancer, and insurers told me I was uninsurable. In 2011, ACA started to kick in. It was not allowing insurance companies to consider preexisting conditions. I applied and was accepted into Aetna. The first thing I did was go for a mammogram, and, sure enough, I had a triplenegative tumor. Very aggressive. It was small and early, so we caught it just in time. I had a double mastectomy and chemotherapy and breast reconstruction, all covered through ACA. I went into the hospital seven times total for infections. The billing was $900,000. Aetna settled and paid out $180,000.

I’m feeling really good right now because December was the fifth anniversary of being cancer-free. I exercise a lot. I’m doing everything I can on my end. But there is only so much you can do. I’m scared for myself, and also for my children. My parents had to claim bankruptcy for health insurance reasons. They were not covered for a medical emergency.

Suzanna Moore, 29, Fairfield, Iowa: When I was a baby, I had a stroke. I recovered well, but I would always have issues afterward. Throughout my childhood, it always a concern if I would have proper health care. I grew up in a pretty poor family in New England. With Obamacare, I went to an orthopedist for the first time in forever and got a prescription for orthotics to alleviate chronic pain in my knees and ankles on one side, because my right side was affected more from the stroke than my left side. The pain built up for a while, but basically throughout my twenties, I was never able to get it addressed, because I was living on my own in Tennessee and was unable to focus any money toward my personal health care.

I also had a meniscus tear during that time. Had I had surgery on that on my own, it would have been like $15,000 or more. With Obamacare, we still had to prioritize, but we didn’t go in debt over it.

My husband has a rare condition called achalasia, which means the muscles in his throat stopped working the way they were supposed to, so he had trouble swallowing and eating. He had to force food down his esophagus with air and water. After a while, it got so painful that he was eating less and he was losing weight rapidly. It was hindering his quality of life, and, left untreated, it could contribute to throat cancer. So he had to have surgery about eight months after I had my knee surgery. We were able to afford all of it. We wouldn’t have been able to do that without Obamacare.

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8 People Who Owe Their Lives to Obamacare

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This Superbug Is Resistant to All Antibiotics—and Has Killed Its First American Victim

Mother Jones

For a while now, the specter of “pan-resistant” pathogens—superbugs so super that they can withstand all available antibiotics—have haunted US and global public health authorities. This week, we got news of one showing up in the United States.

An elderly Nevada woman died in September after being infected by a strain of Klebsiella pneumoniae that was “resistant to all available antimicrobial drugs,” the Centers for Disease Control and Prevention revealed in a Friday note.

For Americans, the good news is that she probably didn’t contract her fatal infection here. She had been on an “extended trip” to India, CDC reports, where she had been hospitalized several times for a broken femur (thigh bone). Since she had a history of foreign hospitalizations, the US hospital in Nevada where she died sent a sample of Enterobacteriaceae for extensive CDC testing, as the CDC recommends in such cases. The result: The bug showed resistance to no fewer than 26 antibiotics. The fact that other patients admitted to the Nevada hospital tested negative for the same strain suggests the patient picked it up in India.

But that should be cold comfort. Bacteria don’t respect borders—they travel rapidly, not just in people and products, but also in wild birds. As Sarah Zhang recently put it in The Atlantic:

Over and over, scientists have identified genes conferring resistance to a class of antibiotics, only to find the gene had circled the globe. Another recent example is ndm-1, a gene found in 2009 that confers resistance to class of antibiotics called carbapenems. “It’s very rare to catch something at the very beginning,” says Alexander Kallen, a medical epidemiologist with the Centers for Disease Control and Prevention. Looking for resistance is a constant game of catch-up. You don’t notice anything until there is something to notice; by the time there is something to notice, something bad has already happened.

Too often, though, media reports about antibiotic resistance neglect to mention a key driver: modern meat production. The unraveling of antibiotics as a tool to fight infections is intimately related to the way we have raised animals for decades, dosing them with antibiotics to make animals gain weight faster and avoid infections despite in tight, unsanitary conditions. Overuse in human medicine also drives the problem, but nearly 80 percent of the antibiotics used in the United States flow into livestock farms.

The CDC, the World Health Organization, the UK government, and other public health authorities warn that overuse of drugs in meat farming are a key generator of antibiotic-resistant pathogens, which cause 90,000 US deaths annually, while also racking up $55 billion in costs and causing 8 million additional days that people spend in the hospital, according to the National Institute of Allergy and Infectious Diseases.

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This Superbug Is Resistant to All Antibiotics—and Has Killed Its First American Victim

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This Woman’s Attempted Coat-Hanger Abortion Landed Her in Jail for a Year. Now She Faces New Charges.

Mother Jones

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The charges against Anna Yocca, a 32-year-old Tennessee woman who used a coat hanger in an attempt to terminate her pregnancy last year, have varied since she was first jailed in December 2015. The initial charge was attempted first-degree murder, which was downgraded last spring to aggravated assault.

But on November 12, three new charges were filed by a Rutherford County grand jury: aggravated assault with a weapon, attempted procurement of a miscarriage, and attempted criminal abortion. The new charges will replace the aggravated assault charge brought last spring.

In September 2015, Yocca attempted to self-induce abortion with a coat hanger in her bathtub in Murfreesboro, Tennessee, when she was 24 weeks pregnant. When she began to bleed uncontrollably, her boyfriend drove her to the hospital. Physicians delivered a 1.5-pound boy who had severe medical problems resulting from the premature delivery and the attempted termination of her pregnancy.

At her public defense attorney’s request, Yocca underwent a mental evaluation to establish competency to stand trial, and the evaluation found that “there is no indication that Ms. Yocca failed to have sufficient reality contact in regard to the nature and wrongfulness of her accused behavior.”

Last month, Yocca’s attorney filed a motion to dismiss the case, arguing that bringing her to trial “makes every pregnant woman vulnerable to arrest and prosecution if she is perceived to have caused or even risked harm to a human embryo or fetus…and that the prosecution is absurd, illogical, and unconstitutional.”

Tennessee has some of the most restrictive abortion laws in the country, and state legislators have been vocal about their plans to propose more. In 2014, an amendment to the state constitution clarified that it would not protect a woman’s right to an abortion and prohibited public funding for abortion—despite that fact that state and federal dollars cannot legally be used to fund abortion. The average cost of an abortion in the state has been calculated to be $475 to $680. Clinics in Tennessee don’t perform abortions after about 17 weeks.The 2014 amendment was one of the most expensive ballot measures in the state’s history, and it also gave state lawmakers more power to restrict abortion access.

The state Legislature enacted an additional law implementing a 48-hour waiting period in May 2015. The state also passed a “fetal homicide law” in 2014, which meant prosecutors could charge women for any behavior, such as taking drugs, that might harm or kill a fetus. The law expired in July.

There are some ongoing legal efforts to roll back these measures. The Center for Reproductive Rights filed a federal lawsuit in June 2015 to challenge three Tennessee laws—one that required abortion clinics to meet the standards of an ambulatory surgical center, one that required abortion providers to have admitting privileges at nearby hospitals, and the 48-hour waiting period. A federal judge blocked the ambulatory surgical center law after CRR filed its lawsuit last year.

“The cumulative effect of these restrictions is to make it very difficult for women in these parts of the state to access abortion and to create huge delays in women’s abortion care,” Stephanie Toti, senior legal counsel for CRR said. “It is a lesson that we have learned all around the world that when women don’t have adequate access to safe abortion care, they turn to other means.”

Yocca’s new court date to face these charges is November 28.

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This Woman’s Attempted Coat-Hanger Abortion Landed Her in Jail for a Year. Now She Faces New Charges.

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This Salvadoran Woman Served 4 Years for Having a Miscarriage

Mother Jones

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Maria Teresa Rivera didn’t realize she was pregnant in 2011 when she went into early labor. The 28-year-old factory worker in El Salvador, who already had one son, started bleeding heavily late one night, so her family called an ambulance to drive her to the hospital. The next day, Rivera was taken to jail.

Her crime? Having a miscarriage.

Rivera is one of a number of women in El Salvador incarcerated not for abortion, which is illegal, but as a result of miscarriages. An abortion rights group in the area has identified 17 people convicted of homicide, with sentences upward of 40 years, after facing obstetric emergencies such as miscarriage or stillbirth.

After serving four of her 40-year prison sentence for aggravated homicide, Rivera’s conviction was overturned by a judge and she walked free this spring. But the prosecution appealed her release, and this week a three-judge panel will decide whether to hold a new hearing or throw out the charges for good.

Only six countries in the world, including El Salvador, ban abortion in all cases, even when the pregnancy is the result of rape or threatens the life of the mother. Nicaragua, Chile, the Dominican Republic, the Vatican city-state, and Malta are the only other places with similar prohibitions. In January, El Salvador’s deputy health minister told women to avoid getting pregnant for two years because of worries over the effects of Zika virus.

“A woman who procures herself an abortion is running a very high risk,” Carmen Barroso, the former regional director of the International Planned Parenthood Federation in the Western Hemisphere, told Mother Jones. “She’ll run the risk to her life because she’ll have to have an unsafe abortion because they are so limited in availability. It is tragic.”

The ban in El Salvador got international attention in 2013, when the country’s highest court rejected the abortion request of a young woman, known only as Beatriz, with a potentially life-threatening pregnancy, ruling the “rights of the mother cannot be privileged over those” of the fetus. The fetus suffered from anencephaly, a severe congenital disorder where the fetus’ brain and skull stop growing, giving it little chance of surviving outside the womb. The woman survived after getting a controversial caesarian section.

Despite the ban, more than 19,000 illegal abortions were reported in El Salvador between 2005 and 2008, according to the Ministry of Health’s Information, Monitoring, and Evaluation Unit, an estimate that advocates say is low. Nearly a third of abortions performed were on adolescents, who make up a large percent of the region’s unplanned pregnancies. According to the World Health Organization, 9 percent of maternal deaths in Central America are the result of illegal abortions.

As a result of the criminalization, women in El Salvador frequently face legal scrutiny for abortion-related crimes. According to research done by a Salvadoran advocacy group, between 2000 and 2011 about 130 women were criminally prosecuted for ending their pregnancies. That number doesn’t include cases where the allegations were dropped or cases involving minors, whose records are sealed. Almost 50 women were convicted of either illegal abortion or different degrees of homicide, which carries a sentence of up to 50 years.

Then there are the cases of the 17 women who are part of “Las 17,” as they’re known, who are all, like Rivera, young, impoverished, and accused of losing their pregnancies on purpose. Guadalupe Vasquez, a housekeeper, was only 17 years old when she became pregnant from rape. She decided to keep the baby but lost it during labor. After her employer sent her to the hospital, she was reported to the police and eventually sentenced to 30 years behind bars.

Many of the women, including Rivera, were reported to the police by medical staff at the hospital. In some cases, neighbors or friends called law enforcement.

“I felt the need to go to the bathroom, I pushed, and it was the baby that came out into the latrine,” Rivera said in a video from prison. She passed out from loss of blood and was in the hospital when she woke up. “Then they took me to this place,” she said.

Rivera was convicted “despite the complete lack of evidence of any wrongdoing,” according to an analysis of Las 17 cases by a Salvadoran lawyer and a Harvard sociologist. The analysis also concluded that Salvadoran courts systematically discriminated against the women by aggressively pursuing “the mother’s prosecution instead of pursuing the truth.”

“In stark contrast to the courts’ findings, our analysis concludes that the legal and medical facts in the majority of these cases correspond with medical emergency—not with homicide,” they wrote.

Rivera successfully appealed her conviction and has spent the last two months walking free.

“What worries me is leaving my son alone again,” Rivera, who grew up in orphanages, told Rewire after being released in May. “I was forced to abandon him for four and a half years, and he suffered greatly during that time.”

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This Salvadoran Woman Served 4 Years for Having a Miscarriage

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Homeless People Are Older and Sicker Than Ever Before. Here’s One Way to Help.

Mother Jones

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“Everything,” Tom Wesley answers when I ask what’s ailing him. Diabetes. Multiple heart attacks. Chronic liver failure. “They’ve told me I’m dying.”

Wesley, a towering man in a salmon-colored corduroy shirt buttoned just at the top, is only 54. But for most of his adult life, he lived on the streets. He refused to stay in shelters because he didn’t like the structure; he says he also spent a significant time behind bars for heroin possession. “You could say I was using heroin,” Wesley says with a smirk. “But I don’t know who was using who—it sure used me up.”

This article is part of the SF Homeless Project, a collaboration between nearly 70 media organizations to explore the state of homelessness in San Francisco and potential solutions.

He quit a few years ago—after losing two wives to overdoses. Around that time Wesley’s health problems started getting worse. Last year, a terrible pain in his abdomen brought him to San Francisco General Hospital, where he says he was admitted, via the emergency room, seven times in a matter of three months. At that point he was already used to the ER, having relied on it instead of primary care. “I wasn’t one for doctors,” he says.

Wesley’s experience isn’t unique. Sixty-six percent of the country’s chronically homeless people—those who have a disabling condition and who’ve been homeless for a year or more (or four times in three years)—are living on the streets. Chronically homeless adults have high rates of mental illness, substance use, and incarceration. They tend to be sicker than both housed people and other homeless people. And they’re less likely to use primary or specialty care to address their medical needs. Many make up the group of “super-utilizers“: patients who rack up huge medical costs from recurring yet preventable ER and hospital visits.

According to one estimate from the National Health Care for the Homeless Council, more than 80 percent of all homeless people have at least one chronic health condition. More than half have a mental illness. They are frequently the victims of violent crimes, and they’re more susceptible to traumatic injuries like assault and robbery. Their living conditions also make them more likely to have skin conditions and respiratory infections.

Perhaps it’s no wonder, then, that people experiencing homelessness have a life expectancy of between 42 and 52 years, compared with 78 for the general population. A recent study by Margot Kushel, a professor of medicine at the University of California-San Francisco, found that homeless people in their 50s develop geriatric conditions such as incontinence, failing eyesight, and cognitive impairment that are typical of people 20 years older. “When you see a homeless person in their 50s,” Kushel says, “you should imagine a 75-year-old.”

Kushel is also one of the founders of the San Francisco Medical Respite Program, a long-term medical shelter located on the edge of the city’s Tenderloin neighborhood that gives homeless people like Tom Wesley a place to recuperate after being in the hospital. With the homeless population in San Francisco and the rest of the country getting older—the number of homeless people age 60 or older in San Francisco increased 30 percent from 2007 to the 2014-15 fiscal year, and an estimated 31 percent of homeless people in the United States were older than 50 in 2014, a 20 percent increase from 2007—Respite and programs like it are seeing more people who are managing both chronic diseases and short-term illnesses. “We now have a group of homeless people that have more complex and co-occurring medical needs than ever before,” Kushel says.

For those homeless people who live on the streets or in a shelter—most of which are only open overnight—getting discharged from the hospital often means losing their meds, struggling to clean their wounds, or failing to make the specialist appointment across town. Others will get even sicker. Some will go back to the emergency room and start the process all over again.

“If you’re experiencing homelessness,” says Michelle Schneidermann, the medical director at Respite, “you’re thinking about where you’re going to get your next meal and how you’re going to keep yourself safe, not where you’re going to refrigerate your meds or make your next appointment.”

As a result, homeless people visit the hospital at rates up to 12 times higher than low-income people with housing. A 2007 study in Boston found that the majority of high emergency room users were homeless, according to the NHCHC. At one hospital, 16 homeless patients visited the ER a combined 400 times in one year. Hospital readmissions for homeless people are “strikingly high“; one study found that more than half of the homeless people it followed after discharge were readmitted to inpatient care within 30 days. Another recently published study found that homeless people had a 30-day readmission rate of 22 percent, compared with a rate of just 7 percent for housed people with the same health concern. And once in the hospital, homeless patients stay nearly twice as long as housed people.

This reliance on emergency medical services is extremely costly to San Francisco, which spends more on health care than on any other type of homeless service. According to the San Francisco Chronicle, the city spends $241 million annually on homeless services, including an average of $87,480 in medical costs per year for each of the sickest people on the streets, compared with $17,353 a year for each person in supportive housing. Another estimate, from 2004, places the cost of hospital care for the city’s homeless people at more than $2,000 per person per day, by far the priciest service. “People who are homeless use the most expensive parts of the health care system,” says Schneidermann, who notes that SF General discharges an average of 130 homeless people each month.

This is despite the fact that, in a city like San Francisco, health insurance and access to outpatient primary care clinics are relatively accessible, thanks mostly to Medicaid expansion. “Access to insurance is not the biggest problem” Kushel says. “Their chaos of life prevents even those with insurance from getting care.” Indeed, evidence shows that even with access to primary care and specialty doctors, homeless people still use emergency services at rates higher than everyone else. In one study based out of Canada, where health coverage is universal, people experiencing homelessness still had longer inpatient stays and cost the hospital more than housed patients.

“Appointment-based care is difficult for all of us, let alone someone who is homeless,” Schneidermann says. “That’s where medical respite comes in.”

The first medical respite programs for the homeless were founded in Boston and Washington, DC, in 1985, but the model gained currency in 2006, when an elderly woman in a hospital gown and slippers was spotted wandering on Los Angeles’ Skid Row. The woman, a homeless 63-year-old with dementia, had been released from a nearby Kaiser hospital, which was later sued by the city and forced to establish new discharge rules. At least four other hospitals were caught “patient dumping,” including once incident when a paraplegic man was dropped on Skid Row and was later seen dragging himself, along with a torn colostomy bag, down the street.

There are now nearly 80 homeless medical respite programs, more than twice as many as in 2006. San Francisco’s Respite was founded in 2007 by the city’s Department of Public Health to address the acute medical needs (think broken bone or stab wound) of homeless patients who’ve ended up in General’s inpatient care via the emergency room. But beyond that, it might just offer an emergency room alternative to reach the city’s sickest, most vulnerable homeless population.

With only 45 beds and a waitlist at least equal that, Respite prioritizes people who are both the sickest and also the highest users of the ER. More than a quarter of Respite clients have seven or more chronic illnesses, and the average stay is five weeks, a figure that has risen as the client population has aged. (The longest stay was almost eight months.)

A 2006 study that compared homeless people who’d gotten into respite programs with those who hadn’t found that the respite group had fewer ER visits the following year. Among those admitted to the hospital following an emergency visit, the respite group stayed an average of three days, compared with eight days for the nonrespite group. A 2009 study found that discharging homeless people from the hospital to respite was associated with a 50 percent reduction in their likelihood of readmission in the next three months.

The dining area at the San Francisco Medical Respite Program Mark Murrmann/Mother Jones

Still, despite evidence that medical respite programs reach the health system’s super-utilizers, only 10 respite centers nationwide are covered through Medicaid or Medicare. Instead, most programs rely on funding from hospitals, donations, or state and local governments.

And so Respite has its limitations. A quarter of its clients go straight from the program into permanent housing or long-term residential treatment. Another 50 percent are discharged back to a shelter with a case manager. The last quarter return to the streets.

The first time Tom Wesley was admitted to Respite, he was discharged to a single-room-occupancy hotel. He promptly ditched that setup, traveled to Cincinnati to see his children, and then returned to San Francisco’s streets. Shortly afterward, he was back in the hospital and then Respite, where he was diagnosed with chronic liver failure and moved into what he calls a glorified nursing home—a permanent supportive housing apartment just blocks away. Feeling like he’d tied up loose ends, he decided to stay.

When I meet Wesley in Respite’s foyer, in front of the room that houses the few dozen beds where the men stay, he’s been out for a few months already. He’s wearing a Golden State Warriors cap, and his eyes are blood red. We take the elevator up and walk to the facility’s small meeting space, past the dining room where patients receive three meals a day and the single-person rooms where women stay.

He grabs a seat with his back facing the bright light coming through a window. As he tells me about his connection to Respite, Wesley’s legs bounce up and down. “If there were more programs like this,” he says, “people wouldn’t be dying on the streets every day.”

Mark Murrmann/Mother Jones

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Homeless People Are Older and Sicker Than Ever Before. Here’s One Way to Help.

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Here’s Why Oral Rape is Not Rape in Oklahoma

Mother Jones

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In Oklahoma, it’s legal to have oral sex with someone who’s completely unconscious, the state’s highest criminal court has ruled.

In a unanimous decision, the Oklahoma Court of Criminal Appeals found that a teenage boy was not guilty of forcible sodomy after having oral sex with a teenage girl who was so intoxicated after a night of drinking that she had to be carried to his car. “Forcible Sodomy cannot occur where a victim is so intoxicated as to be completely unconscious at the time of the sexual act of oral copulation,” the judges ruled on March 24. The decision was reported by the Guardian on Wednesday.

Local prosecutors were shocked, saying the court’s ruling perpetuated victim-blaming and antiquated ideas about rape. Benjamin Fu, assistant district attorney in Tulsa County, described the decision as “insane,” “dangerous,” and “offensive.”

But some legal experts note that Oklahoma’s forcible sodomy law only prohibits oral sex with someone who’s unable to provide consent because of mental illness or mental disability, not because of intoxication or unconsciousness. Therefore, they say, the court’s ruling was appropriate. The state has a separate rape law that protects victims who are too drunk to consent, but only in cases of vaginal or anal penetration, not oral sex. “We will not, in order to justify prosecution of a person for an offense, enlarge a statute beyond the fair meaning of its language,” the appeals court wrote.

The incident occurred in 2014 after the two high school students had been drinking and smoking marijuana with friends at a Tulsa park. The boy, who was 17 years old at the time, gave the 16-year-old girl a ride home; blood tests later showed her blood-alcohol level was .341, indicative of severe alcohol poisoning, Oklahoma Watch reported, citing court records. She was unconscious when he dropped her off at her grandmother’s house and taken to the hospital, where she woke up in the middle of an examination for sexual assault. The boy’s DNA was detected around her mouth. He claimed she had consented to have oral sex, but she says she can’t remember anything after leaving the park, the Guardian reports.

Sexual battery might have been a more appropriate charge than rape or forcible sodomy, Shannon McMurray, an attorney for the defendant, told Oklahoma Watch. She added, however, that it would be difficult to show there had been no consent, since the girl could not recall what happened after leaving the park.

The court’s decision was an “unpublished opinion,” meaning it can’t be cited as legal precedent. But according to Fu, other defendants are asserting the same interpretation of Oklahoma law in a bid to avoid charges in similar cases.

“This is a call for the legislature to change the statute, which is entirely out of step with what other states have done in this area and what Oklahoma should do,” Michelle Anderson, the dean of the CUNY School of Law, told the Guardian. “It creates a huge loophole for sexual abuse that makes no sense.”

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Here’s Why Oral Rape is Not Rape in Oklahoma

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The Green Gold in Your Wedding Dress

Keeping your wedding dress forever might seem like a good idea the day after your wedding when you’re still euphoric after your wonderful event. But within a few years or maybe even a few weeks, you may be wondering just what you’re going to do with a big white gown that needs to be kept in an airtight plastic bag for the rest of its life.

Are you going to move itaround from place to place, then cram it into the back of a closet somewhere? Or maybe stuff it into a trunk in the attic where you’ll forget all about it? Or pay to store it at a facility that will keep it pristine until maybe a daughter or niece or godchild gets engaged?

Why not take amore eco-friendlyapproach, one that may generate a little cash for you, too?

Enjoy your dress, then find a way to repurpose it sooner rather than later.

Here’s how:

Turn it into a cocktail dress:Depending on the style of your dress, you should be able to shorten it or dye it. There are many tailors who could do the job so well for you, you’d never be able to tell that the garment originally was a wedding gown. Some dry cleaning facilities will dye fabrics if you prefer to have a dress that’s a color other than white. Take a look at 11 different wedding dress transformations Cosmopolitan featured recently.

Re-use the material:If your dress has a long train for a big flowing skirt, that material could pretty easily be converted into a shawl or shoulder wrap, a short jacket for evening wear or even fancy napkins and a tablecloth. Check out the free skirt sewing patterns on So-Sew-Easy.com. If you’d rather not sew something yourself, have a tailor do it for you. It’s pretty straightforward to convert fabric into a shawl or wrap, but Prom DIY puts up the instructions on YouTubehere.

Donate it:Search “donate wedding dress + your locale” and you’ll find women’s shelters and organizations that help girls who need prom dresses. You can also donate your dress to Fairy Tale Brides, a non-profit that re-sells the dresses at reasonable prices, then donate their profits to charities that include St. Judes children’s Research Hospital, Suited for Change and the Kids Network. You can download a donation form on their website here.

Rent it:You can rent a gown to wear or you can rent out your own gown. A surprising number of online companies make this process easy, from Rent the Runway to Borrowing Magnoliato Pre-Owned Wedding Dresses.

Sell it:Many of the online companies mentioned above will buy your wedding gown from you and relieve you of all responsibility to ever have to take care of it again. Given the care with which most gowns are made, they should be able to stand up to at least ten weddingsso why not let them? Of course, you can also put your dress on EBay or Craig’s List, sell it at a local consignment shop, or let your Facebook community know it’s for sale. Agree on a price you think is fair, then enjoy the pictures and the memories, as well as the thought that someone else is extending the life of your lovely gown.

Related
10 Easy Ways to Make Your Wedding More Eco-Friendly
25 DIY Wedding Ideas

Disclaimer: The views expressed above are solely those of the author and may not reflect those of Care2, Inc., its employees or advertisers.

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The Green Gold in Your Wedding Dress

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Shooting in Rural Washington Leaves 5 Dead, Including Gunman

Mother Jones

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A gunman shot and killed four people at a house in rural western Washington state on Friday before he turned the gun on himself, Mason County officials have confirmed.

The incident in Belfair, Washington, started Friday morning, when authorities received a call from a man who said he had shot four people. A SWAT team responded to the house, where authorities attempted to negotiate with the suspected gunman for several hours.

Mason County Sheriff Casey Salisbury told reporters that the gunman stepped out of the house and shot himself in front of deputies. “It’s a terrible tragedy,” Salisbury told the Seattle Times.

According to the Associated Press, a girl who survived has been taken to the hospital for an evaluation.

This is a breaking news post. We will update as more information becomes available.

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Shooting in Rural Washington Leaves 5 Dead, Including Gunman

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Always Bring a Nuke to a Knife Fight

Mother Jones

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Yesterday Donald Trump finally went ballistic over Ted Cruz’s attacks against him. After listing half a dozen alleged lies, he made this threat:

One of the ways I can fight back is to bring a lawsuit against him relative to the fact that he was born in Canada and therefore cannot be President. If he doesn’t take down his false ads and retract his lies, I will do so immediately.

The great thing about this is that Trump doesn’t even bother pretending that he wants to sue Cruz because he truly believes Cruz isn’t a natural-born citizen. He just flat-out admits that he plans to do it purely as revenge for Cruz being mean to him. The Golden Rule here is simple: “They pull a knife, you pull a gun. He sends one of yours to the hospital, you send one of his to the morgue.”

This appears to be a considerable source of Trump’s appeal. His supporters don’t care much about actual political positions; they care about having a mean SOB in office. They probably like Trump more because he’s going after Cruz out of anger rather than as a matter of principle.

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Always Bring a Nuke to a Knife Fight

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