HealthyCal.org

By Matt Perry, California Health Report

Grandma just sent her first email. Tonight, she’ll log in to see the latest pictures of her grandkids. And her doctors and children can monitor her health from around the world at any time.

Armed with mounting research linking social isolation to illness, technology firms are marketing electronic solutions aimed at older adults in senior living facilities with two goals: network them socially, and monitor their health continuously.

This new electronic wave – loosely termed eCare – is speeding electronic adoption by older adults with a robust set of features that integrate social interaction with health monitoring.

Socially, it means linking older adults online. They can now surf the internet via larger graphics, record oral histories, stay abreast of community events, join online communities, or email and video chat with friends worldwide.

Healthwise, seniors are reminded to take medications, visit the doctor, and check blood pressure or glucose levels. Daily results are recorded online where doctors, family members and caregivers can track them. For some adults it can mean video conferences with distant health specialists. Doctors then get a fuller health picture instead of seeing patients every few months when they might miss key health events.

While the solutions are digital, for older adults and their caregivers the benefits are intensely personal.

“It’s providing care like we used to do, when we lived next door to one another.” says Harry Bailes, CEO of Family Health Network.

The company, headquartered in North Carolina’s Research Triangle Park, is one of a growing number of firms in a nascent but growing industry. As they jostle for market share, each tout unique features. For Bailes, though, it means solving a single problem for older adults:

“Do I really matter to people any more?”

The health impacts of solitude are well documented. Depressed individuals are four times more likely to develop heart disease. And death rates are consistently higher for those who are single, divorced, or widowed.

Jeff Pepper’s family history is typical of many executives in this industry.

Pepper created his firm Touchtown after his father entered a retirement home and was suddenly cut off from friends, hobbies, and familiar activities. Pepper immediately noticed a significant deterioration in health.

Pepper’s goal: “To bring older people back into touch with the activities, people, situations that they really care about.”

The flagship product for the Pittsburgh-based Touchtown is a complete television station for residential facilities. Now with more than 1,200 users after 13 years, program content is split between local senior facilities and their regional headquarters.

Losing a sense of purpose is even more acute for men who “have a tough time getting engaged with the superficial activities of senior living,” says Pepper. “What people really crave is not entertainment, but involvement.”

“The elderly have no problem with technology,” says Kian Saneii, CEO of San Diego-based Independa, which delivers its eCare solutions on several devices. “They have a problem with poor design.”

Saneii trumpets his company’s two products, saying they need no previous computer knowledge. Seniors who are completely computer illiterate can receive reminders about medication, appointments, and birthdays by phone.

Older adult residents can also place a simple phone call to record and archive their life histories.

Independa then centralizes all data on its servers for easy distribution to cell phones, computers, tablets, or even specialized TV sets.

“Your medication reminder pops right up on top of your programming,” says Saneii.

Care Innovations, a well-heeled joint venture between Intel and General Electric that launched its Connect portal in the spring of 2011, sees itself at a distinct market advantage because of its robust healthcare planning, collaboration, and documentation tools.

“Most technologies want to stay away from health, because it has (further) implications to it,” says Jim Pursley, general manager for Independent Living at the Roseville-based firm.

Some companies target just one area: social networking and entertainment or – like Care Innovations – health.

“Unless you solve all those problems together you are still spinning your wheels,” says Saneii.

Experts unanimously agree that eCare technologies have a surprising health benefit: they bring older adults squarely into the digital age.

Adult caregivers frequently have the same observation about seniors who send their first email: “They haven’t seen someone so animated or alive for a long time,” says Bailes.

Saneii describes another advantage of health monitoring using technology: it removes the burden of medical hassling from the shoulders of family members.

“If I only didn’t have to ask my dad about his health I’d have a much better phone conversation,” says Saneii.

While more older adults are going online every day, their experiences with new eCare systems aren’t always smooth.

“It really needs a hell of a lot of improvement if they’re ever going to have any use of it,” says John Fraser, 88, former head of legislative affairs for Pacific Gas & Electric and a resident of the Eskaton Carmichael adult living facility outside Sacramento. “It’s kind of like a kindergarten toy almost. It just seems like whoever put that thing together was on a different planet than I’m on.”

Betty McNairy, who uses Family Health Network’s Connected for Life at Well Spring Retirement Community in Greensboro, North Carolina, likes having pre-written email templates to speed her responses.

She also likes sharing her medical information with concerned family members and attaching 30-second voice files to her emails.

“It’s amazing what you can say in 30 seconds if you plan it well,” says McNairy, 83, a former first grade teacher.

But McNairy hasn’t yet been able to use other features of the system.

“I don’t think I’m quite ready to grade it yet,” says McNairy, echoing a common sentiment. “I don’t think we realized we were quite so close to the cutting edge when we got it.”

One area of potential growth is that eCare technology can differentiate adult care facilities looking for a marketing advantage in a competitive market.

Although most counties in Californian expect their populations over 60 to double in the next 10 years, stark economic realities and dwindling retirement savings mean senior living facilities will be fighting for clients.

Adults are also staying healthier longer and are determined to stay at home as long as possible. Pepper says most Baby Boomers won’t even consider senior living until their 70s or 80s.

Pepper said his TV station became more attractive to adult living facilities when it doubled as a marketing tool.

“We found pretty quickly it was much more valuable to our customers if we could deliver this on their website for prospective customers.”

In California, eCare systems are only slowly working their way into the senior care market – both senior living facilities and home eldercare.

AgeTech California surveyed senior care providers around the state and found that only 13.5% used some sort of social connection technology – from the simplicity of Skype to full-blown social networking hubs.

Just 3% of adult care providers were planning to adopt the technology in the coming year, according to the firm’s 2011 Provider Technology Survey.

Although nearly 20% of providers wanted to learn more, over half reported not using the technology at all – or planning to.

Still, developers are looking hungrily at the untapped market – both nationally and abroad – according to AgeTech California’s executive director Scott Peifer.

“There is tremendous growth potential in the next five years.”

By Herbert A. Sample

As California’s population continues to age, state officials are urging residents to do something human beings frequently find agonizing: Plan for that time in their twilight years when they may need assistance getting out of bed, visiting the bathroom and dressing themselves.

That’s the impetus behind the five-month-old website www.RUReadyCA.org, which is managed by the California Partnership for Long-Term Care, a joint venture of the state Department of Health Care Services and a trio of insurance companies that sell long-term care policies in the state.

The department had long published a website on long-term care coverage for insurance agents and consumers. But the newer site is aimed just at consumers in hopes that many more will realize — even in a time of tight household budgets — that they should spend money now to handle medical expenses that may not arise for 10, 20 or more years, if ever.

“It’s been a challenge to really get the word out and make sure that (Californians) understand all of the complexities of long-term care,” said Brenda Bufford, the partnership’s chief.

Long-term care insurance helps defray the cost of in-home support services and nursing home care, which are not generally covered by regular medical policies and only in limited ways by Medicare. Medicaid (or Medi-Cal, as it’s known in California) typically covers nursing home bills, but usually requires beneficiaries to first exhaust most of their financial assets.

Still, long-term care frequently remains off the radar screen of most adults because of its cost, in many cases above $100 a month, and because it’s unlikely to be needed in the near future.

Enter RUReadyCA.org. The result of focus groups and other consumer research, and accompanied by pictures of smiling or pensive 50-somethings, the website describes long-term care insurance, what services it generally covers, how much it costs, and where it can be purchased. It offers videos of Californians discussing various aspects of long-term care. And it includes calculators that estimate insurance premiums and how much money a consumer would need to stash away, in lieu of buying insurance, to help cover long-term care expenses in the distant future. (The answer: A lot.)

“We never want to think about the possibility that we’ll one day need help with getting dressed, eating or bathing,” the site declares. “But when daily activities become difficult and you or a loved one need long-term care because of a chronic physical condition such as arthritis or Parkinson’s disease, or a degenerative mental disease such as Alzheimer’s, who will pay for this care?”

In somewhat obscure fashion, the site also describes consumer-friendly features of long-term care policies that only companies enrolled in the California partnership can offer.

For example, partnership policies must allow for a 5 percent increase in benefits, compounded annually, to compensate for what officials expect will be 5 percent annual growth in long-term care costs. (Over the last three decades, such expenses have risen between 5 and 6 percent a year, Bufford said.)

Thus, a partnership policy that would pay out $260 a day when first purchased in 2012 will provide $690 a day in benefits 20 years later, according to the state. A non-partnership policy without inflation protection might continue to pay $260 a day after two decades.

Partnership policies also require a third party unaffiliated with the insurance carrier to assess policyholders seeking benefits, as well as their plan of care. The insurer is required to follow the evaluation’s conclusions, though it can seek a second opinion from another independent party.

“Asset protection” is an exclusive feature of partnership policies: Each dollar the policy pays out in lifetime benefits entitles the policyholder to hold onto a dollar of his or her assets when later seeking Medi-Cal coverage. In other words, if a partnership policy caps lifetime benefits at $200,000, and a policyholder exhausts that coverage and then applies for coverage through Medi-Cal, $200,000 in assets are shielded from Medi-Cal’s standard eligibility requirement that almost all assets be liquidated first.

“That’s kind of what distinguishes the partnership policies from other policies,” said Brian Millsap, vice president of product management for long-term care with Bankers Life and Casualty, a unit of CNO Financial Group. “It makes sense to have the policy available for (customers) that gives them…that Medicaid asset protection on the back end rather than only offering ones that don’t have that feature.”

Partnership companies must win approval for rate hikes – which are capped at 40 percent — from both the state Department of Insurance and the partnership office. If approved, the increase must be spread equally over three years. On the other hand, partnership policies tend to be more expensive than non-partnership versions, Bufford said.

Only three firms — Bankers Life, Genworth Financial, and New York Life Insurance – and CalPERS currently offer partnership policies in California. John Hancock expects to “soon” restart selling policies in California, a spokeswoman said.

More than a dozen other insurers offer stand-alone, non-partnership policies in the state, according to Dave Althausen of the insurance department. Currently, close to 660,000 long-term care policies are in force in California, he added.

That number should be much higher, say long-term care advocates. They point to sobering facts: Life expectancy is growing, and the number of California residents age 85 and older — those who are most likely to need extended care at home or in nursing homes — is likely to more than double by the year 2030, when the bulk of baby boomers will reach advanced age, according to the California Health Foundation.

And the cost of long-term care is unlikely to recede. According to the partnership website, the average daily private pay rate for nursing facility care in Los Angeles County currently is $206. In San Diego, it’s $240; San Francisco, $272; Sacramento, $232; and in Fresno, $213.

Long-term care advocates said the website should help jump-start conversations among more Californians about planning for their future care needs. Sean Coffey, a policy specialist at the National Center on Caregiving in San Francisco, said the site’s tips on buying long-term care insurance were helpful, though it lacked definitions of such bureaucratese as “average daily benefit.”

He also pointed out an irony: The website states that the majority of long-term care is provided by relatives, and provides a link to 11 Caregiver Resource Centers, which assist those who provide care to family members. However, as Coffey noted, Gov. Jerry Brown’s proposed 2012-13 budget would eliminate funding for the caregiver centers and make big cuts in the In-Home Supportive Services program, which would impact 254,000 recipients whose household tasks are frequently handled by family members.

Herbert A. Sample is a freelance writer based in Los Angeles. He can be reached at hasample@mac.com.

This article was updated to correct the first name of Brenda Bufford.

By Callie Shanafelt

Seventy-five-year-old Leigh Weimers realized his left arm wasn’t working when he tried to pull his Costco card out of his back pocket. Luckily, he also had another card that helped him understand what was happening to him – one from the Stroke Awareness Foundation that he picked up at a Rotary Club meeting. Weimers realized his numb arm was a sign of a stroke, so he asked his wife to take him to the hospital.

The moment he walked into the Kaiser Permanente Santa Clara Medical Center and said he was having a stroke, the staff scanned his brain. They quickly realized Weimers was right. A pool of blood was building up in his head. They immediately started treatment.

Now, less than a year later, Weimers is completely recovered with no debilitating effects from the stroke.

In large part, his happy ending is due to the fact that he had his stroke in Santa Clara County-–the first in California to coordinate their stroke identification and treatment efforts.

Stroke is the leading cause of long-term disability in California and the third leading cause of death. Many gains have been made in the treatment of strokes in the past decade, with new methods of treatment and identification. But in order for treatment to save lives and prevent disability, it is crucial that patients get to a stroke center within three hours.

“Time is brain,” said Dr. Lilly Chaput of the California Department of Public Health (CDPH).

In order to improve stroke survival and lessen brain damage, CDPH is coordinating an effort to standardize stroke treatment in all 32 Emergency Medical Services (EMS) regions.

The first step towards a better stroke treatment system is to get hospitals stroke certified. This means that they have 24/7 access to some kind of imaging system like a CT scan or MRI to identify if a patient is having a stroke and what kind.

A stroke means your brain isn’t getting enough blood. For most strokes (87%) this happens when there is a clot in an artery (ischemic stroke). The less common type of stroke (hemorrhagic) happens when a blood vessel ruptures in your brain- as happened to Leigh Weimers.

A new drug called tissue plasminogen activator, or tPA, was released in the 1990s. If delivered within three hours of an ischemic stroke, tPA can bust a blood clot without invasive surgery, according to the FDA. Some hospitals have found that the drug can still be effective within a four-hour window.

“There is a new reason why you should call 911,” said Dr. Chaput.

She says it is always best to take an ambulance to the hospital when having a stroke. Treatment starts immediately, and first responders, who know which facilities are stroke certified, notify the hospital to prepare their imaging equipment.

Hospitals must also have treatments like tPA and specialists available in order to qualify as stroke centers. The first five Californian hospitals were stroke certified in Santa Clara County in 2004. Now 11 of California’s 32 EMS districts have stroke systems in place.

One of the challenges to improving state-wide stroke treatment is the difficulty for rural areas to meet the standards to become stroke certified, Dr. Lilly Chaput says. Many hospitals don’t have 24-hour access to a CT scanner, MRI or tPA.

CDPH is trying to help some of these districts to set up “telestroke” systems where they can connect a patient with a specialist via phone or video chat to determine the best treatment.

The other major challenge in rural areas is getting patients to a certified center within the three-hour time window. Chaput hopes that having statewide regulations will give the facilities helpful tools and guidelines.

Contra Costa was the most recent county to develop a stroke system, which went into affect January 2. Now seven of the nine hospitals in the county are stroke certified.

“We’re very lucky compared to other communities,” said Pat Frost, Director of Emergency Medical Services for Contra Costa Health Services. “We have hospitals in all of our regions so no patient is not near a stroke receiving center.”

Frost says it was easier for the county to coordinate a stroke system because they had already implemented a coordinated high-risk heart attack system. A primary delay for other EMS districts’ stroke systems, Chaput says, is that they are implementing a heart attack system first.

But the biggest challenge seems to be public awareness of stroke symptoms. “Nobody thinks it’s going to be them,” says Sherry Houston, Executive Director of the Stroke Awareness Foundation. But one in four people will suffer a stroke in their lifetime.

So the Stroke Awareness Foundation recently put forty thousand advertisements on buses in Santa Clara County to promote the ACT F.A.S.T (Face, Arm, Speech, Time) stroke identification system.

“If you’re the one having a stroke and your brain is under attack, how capable are you of diagnosing it?” Houston asks. “It’s people around you most likely that will notice.”

If you are the person assessing a friend or loved one’s stroke symptoms, first assess their face by asking them to smile. If one side of their face drops they may be having a stroke. Then ask them to raise their arms, if one drifts downwards they may be having a stroke. Then test their speech by asking them to repeat a sentence – if their speech is slurred they may be having a stroke. If they show any of these symptoms, call 911 and ask to be taken to a stroke center.

People are more likely to go to a hospital when having a heart attack than a stroke because of the crushing chest pains. “Stroke symptoms can be more mild and people think they should just lay down,” said Chaput.

If patients are treated within the three–hour window there is a good chance they won’t suffer any long-term disability, as was the case for Leigh Weimers.

With minimal physical therapy, such as practicing dealing cards and balancing, Weimers is back to normal. After semi-retiring from a career writing for the San Jose Mercury News, he is back to writing for various online publications. When he realized that he was ten years older then the first of the baby boomers he started his blog: Boomerometer, a barometer for Baby Boomers entering their golden years.

“I’ve even been able to go back to Costco,” Weimers says.

By Callie Shanafelt

Sen. Mark Leno is trying to get 20 of his fellow California state senators to vote in favor of his single-payer healthcare legislation this week.

The proposed law, dubbed the “Medicare for All” bill, doesn’t look likely to pass.

Yet the introduction of the bill raises an interesting question: why push for radical changes to insurance and healthcare so soon after President Obama signed historic reforms into law in March of 2010?

The Affordable Care Act, the federal healthcare reform bill passed in 2010, falls short of the universal coverage advocated by Leno’s proposed legislation. Despite reform efforts, one in five people in California currently uninsured will remain without coverage, according to reports from the non-partisan California Budget Project.

“The federal reforms will still leave 3 million Californians without healthcare coverage,” Leno said. The “Medicare for All” bill is named after the federal government’s single payer plan for elderly Americans, Medicare.

Leno’s legislation would replace private insurance companies with a newly created California Healthcare Agency. The new state agency would manage the $200 billion supporters say is already spent on healthcare by employers, individuals and the state each year.

Every California resident would be enrolled automatically in the program regardless of citizenship or income.

Current healthcare providers would continue to provide care, and Californians could choose their doctor and plan, but insurance companies would no longer manage the healthcare system under Leno’s proposal.

“The federal law goes a long way to expanding coverage and making coverage more secure for those who have it, but it is different than a more universal proposal,” said Anthony Wright, executive director of health care consumer advocacy group Health Access.

Instead of a universal plan, under current reform law, coverage will be extended to four out of five uninsured people in California with three key changes: helping people with preexisting conditions afford insurance, increasing the number of people eligible for Medicaid, and establishing health insurance exchanges designed to make it easier for people to shop for and buy insurance.

More than seven million Californians are uninsured today.

Between 200,000 and 300,000 of them will qualify for coverage from the California Pre-Existing Condition Plan, according a report from the California Budget Project.

Help for people with pre-existing conditions was one of the first benefits to take effect as part of federal healthcare reform. Relatively few people in California have used the benefit so far. As of December 2011, about 6,000 Californians have signed up for the pre-existing condition plan.

Other changes are rolling out in California ahead of federal healthcare reform, including an expansion of Medicaid benefits to childless adults who earn slightly more than the federal poverty line. Medicaid is the government insurance program that has traditionally insured the poorest Americans. The federal government is providing matching funds for this expansion of the Medicaid program, called MediCal in California.

“We think this has the potential to improve the lives of Californians,” said Jean Ross, executive director of the California Budget Project. More than 220,000 Californians have signed up for the Low Income Health Program since November of 2010. More that 42 percent of currently uninsured Californians will qualify for coverage under MediCal by 2014.

Many of the remaining uninsured Californians will have access to insurance through the Health Insurance Exchange, which goes into effect in January 2014. The exchange will offer subsidized health care options to individuals and employees from small businesses. By pooling a large number of consumers, the state should be able to reduce overhead costs and offer plans with more comprehensive care than currently available to those who qualify for the exchange.

When Congress was negotiating the Affordable Care Act, the creation of a public health insurance option was one of the biggest points of contention. Ultimately, the legislation did not create a federal public health plan.

In California, however, most large counties with public hospitals have had a public health plan for more than a decade, available to low-income residents.

California counties are currently developing the health plans that will be part of the health insurance exchange in 2014, and some are considering including public plans on their exchange. Orange County has already considered and rejected the possibility of allowing uninsured people to buy coverage under public plans initially designed to help the indigent.

Help for people with limited incomes was built into federal reform: about one quarter of currently uninsured people will qualify for tax breaks to help subsidize the cost of insurance purchased on exchanges.

Some small business will get a tax break too, to encourage them to offer employee benefits, rather than shifting the burden of health insurance payments to workers. By 2014 tax credits will cover up to half of their contribution to employee health care through the exchange.

Businesses with more than 50 employees that don’t offer health benefits or offer inadequate health benefits will be fined if any of their employees seek coverage through the exchange.

Despite such tax benefits and safeguards, reform will not result in insurance coverage for all Californians. Such gaps in healthcare may have a direct impact on individual and public health, according to Anthony Wright.

People without insurance have worse health, he noted. “They live sicker. They die younger. They’re one emergency away from financial run.”

When consumers aren’t able to pay their bills it raises the cost for others, Wright added, and when patients don’t seek preventative or early treatment, they need more expensive care.

More than 15 percent of currently uninsured Californians will remain without health insurance because of their citizenship status.

Whether or not eligible people and businesses will take advantage of the reforms remains unclear.

According to the 2011 California Health Benefits Employer Survey conducted by the California Healthcare Foundation, only 21 percent of small firms have even tried to learn if they qualify for health care tax subsidies. Among those that did, only 46 percent said they are planning on taking advantage of the tax credit offered in 2010 and 2011.

The legislation mandates that every individual in the country get health insurance or face a fine, but the fine is likely to cost less than insurance, so some will remain uninsured and simply pay the fine, according to the CBP analysis.

The new system is potentially confusing, and it will take time for Californians to understand. “How do you reach every Californian and let them know what their options are?” Ross said.

Under Leno’s proposal, all Californians, including undocumented immigrants, would automatically have health insurance.

Similar bills passed in California in 2007 and 2008 but were vetoed by then Governor Schwarzenegger.

Leno’s bill is currently two votes shy of what it needs to pass the Senate by January 31, when the legislation would be put on hold for another year.

By Robin Urevich, California Health Report

A ruling is expected in the coming weeks in a first-of-its kind-legal battle over methyl iodide, one of the most controversial pesticides in use in California.

Attorneys for Earthjustice, an environmental law firm, filed court papers describing the state Department of Pesticide Regulation’s approval of methyl iodide in December 2010 as “irresponsible and illegal”.

“Breathing even small amounts causes slurred speech, vomiting, fetal miscarriage, and permanent damage to the lungs, liver, kidneys, and central nervous system. Direct skin exposure causes burns. And methyl iodide causes cancer…” they wrote.

The attorneys representing Pesticide Action Network North America, the United Farm Workers union, and similar groups are asking Alameda County Superior Court Judge Frank Roesch to roll back the state’s decision and make methyl iodide illegal in California.

They say the state violated key environmental laws in approving the chemical.

If the courts agree, pesticide regulation in the state could become tougher and more transparent.

“Legal challenges like this are extremely rare,” said Californians for Pesticide Reform Co-Director Tracey Brieger, adding that with more than 1,000 pesticides in use in the state, it’s difficult to target them individually.

“Methyl iodide is an exception because it’s so dangerous and the science is so strong that it was very important to us to have it never be registered,” Brieger said.

But some California growers feel equally strongly that they need methyl iodide to replace methyl bromide, a soil fumigant that will be banned under international treaty by 2015, because it depletes the earth’s ozone layer.

Soil fumigants like methyl bromide and methyl iodide are among the most toxic of pesticides, but many farmers consider them essential because they clear the soil of pests before strawberries, tomatoes, and many other crops are planted.

State officials have defended the methyl iodide decision, saying it came only after an exhaustive eight-year long approval process.

Former DPR Director Mary Ann Warmerdam called methyl iodide “the most evaluated pesticide in the department’s history” and insisted it could be used safely with strict mitigation measures.

But Earthjustice attorney Greg Loarie said Warmerdam, now an executive in regulatory affairs at the Clorox Company, mishandled the evaluation: She allowed herself to be swayed by methyl iodide maker Arysta Lifescience when she approved the chemical for use at 100 times the levels her own staff recommended, and flouted sound scientific practice in doing so, Loarie argued. And, according to Loarie, Warmerdam failed to explain to the public how and why she overruled her staff’s recommendations.

“As my sixth grade teacher might say, the director didn’t show her work,” Loarie said in a Jan. 12 court hearing.

Still, Loarie contended his strongest argument against DPR was that the agency violated the California Environmental Quality Act, which requires state and local governments to identify and reduce harm to the environment, and discuss alternatives before moving forward on a project.

DPR’s public report is just seven pages long with only a single paragraph on alternatives, Loarie noted. In it, the agency says that a full alternatives analysis is beyond the scope of the pesticide registration process.

“If the violation seems extremely clear cut, it is,” Loarie told the judge.

Roesch, the judge in the case, seized on the CEQA argument and wouldn’t let go, boxing Deputy Attorney General Cecilia Dennis into a corner in this exchange:

Roesch: Tell me where in the record I’d find environmental impacts if the decision was not to register.

Dennis: I can’t point to any place specific. The entire discussion goes to whether the pesticide should or shouldn’t be registered.

Roesch: CEQA says the specific alternative of no project should be evaluated along with its impact. I need to know where that is. I have to tell you that if you have not done that, this is a granted petition (for the pesticide’s opponents). I don’t know how you can say you are CEQA compliant if you didn’t do that.

Dennis: You have to read between the lines.

Roesch: Where?

Roesch ended his questioning with a second warning that the state would lose if it couldn’t show that it had considered alternatives to methyl iodide registration.

But attorney Stanley Landfair, who represents methyl iodide maker Arysta Lifescience North America, argued that DPR, as a state certified regulatory agency, correctly followed its own rules in registering the chemical. He contended those rules trump CEQA.

As the hearing ended, Roesch agreed to consider additional briefs on the CEQA issue before ruling.

Both Landfair and an Arysta spokesman declined to comment on the case.

Roesch can uphold methyl iodide’s registration, cancel or suspend it, or craft another remedy somewhere in between.

Farmers and agriculture trade groups are keeping a close watch on the case, even though methyl iodide use in the state has been sparse. Only six California growers have used it to date.

Some say they fear protests or lawsuits, and await the judge’s ruling before trying it.

The Fresno-based Nisei Farmer’s League, and several nursery growers unsuccessfully petitioned last spring to present their own pro-methyl iodide arguments as interveners in the case. Roesch denied their request, and an appeals court backed him up.

“If any fumigant has to go through this type of hell, we won’t have any fumigants,” said Manuel Cunha, president of the Nisei Farmer’s League.

“You talk about a state that will have dead trees and insects…If you don’t have these tools, how do we combat these horrible diseases?”

Still these arguments, and the debate over health and safety will remain in the background as the judge considers whether DPR is exempt from CEQA.

Experts say they doubt that it is.

“CEQA is over and above other laws,” said Richard Drury, an attorney who often represents environmentalists in court. “The same argument [DPR makes] has been spun out a bunch of different times…Every time, the judge says you have to do CEQA, too,” Drury said.

Just because state agencies, like DPR, have their own regulatory programs doesn’t mean they don’t have to fulfill CEQA requirements, said Maureen Gorsen, a Sacramento attorney who headed the Department of Toxic Substances Control under Gov. Arnold Schwarzenegger.

Regulatory agencies must hash out the environmental pros and cons and alternatives to their proposed projects in so-called functional equivalent documents, Gorsen said.

“The air board functional equivalent documents? They’re huge. The energy commission’s? They’re huge,” Gorsen said

Roesch, the first judge in California to rule on whether new pesticides must go through a CEQA-like evaluation, is experienced in the field, Drury said.

“He’s done a ton of CEQA cases. He’s one of the smarter judges in the state.”

At the Jan 12 hearing, Roesch remarked that he probably won’t have the last word on the methyl iodide matter, as 98 percent of such cases are appealed.

Loarie said he and his clients would consult on any appeals decision. Cal EPA spokeswoman Deborah Hoffman said in an email that her agency and the attorney general’s office would be involved with DPR in making such a call.

Despite lobbying by environmentalists, Gov. Jerry Brown has kept mum on methyl iodide since last March when he told a reporter for the Ventura County Star that he’d take a fresh look at the question. He has not yet appointed a new DPR director to replace Warmerdam, a move that observers say is a first step toward any administration action on methyl iodide.

Still, state officials appear to have noted public concern about methyl iodide. This year’s prosposed DPR budget includes a new $700,000 fund to study alternatives to chemical fumigants. The money does not come from the state general fund.

Texas health officials linked several mercury poisoning cases to Crema Aguamary, a cosmetic produced in Mexico.

By Ngoc Nguyen, New America Media

SAN FRANCISCO — There could be a dark side to skin-lightening creams often found in stores that cater to ethnic communities.

Starting next week, California health officials will collect and test a sampling of skin-lightening products in the Bay Area for possible mercury contamination. Health officials launched the investigation in response to a spate of mercury poisoning cases linked to the tainted face creams that are made outside the United States.

A handful of cases emerged in the mid ‘90s, but it was a 2010 case involving a 39-year-old Latina and her family in Alameda County that spurred the state to action.

Coordinators of a health study found the East Bay resident with dangerously-high mercury levels, and notified state health officials.

An investigation traced the source of her mercury poisoning to an unlabeled jar of face cream, which relatives from Virginia had brought back from Mexico and given to her.

State health officials, working with their Virginia counterparts, identified in total 22 people who were exposed to mercury through similar face creams, including extended family and friends. The case was highlighted last week in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR).

“This is one of the first investigations of the problem within California,” said Dr. Rapali Das, chief of the Environmental Health Investigations Branch of the state Department of Public Health and co-author of the MMWR report. “Why [we’re focusing] attention on the issue now — these cases have come to our attention here, we think it’s enough of a problem to address it.”

Last year, the state documented a dozen cases of mercury poisoning from tainted skin lighteners, Das says, and have anecdotal reports of at least another four cases.
Health problems from mercury exposure include “mental and neurological” symptoms, according to Dr. Mark Miller, director of the Pediatric Environmental Health Specialty Unit at UCSF and co-author of the MMWR report, which noted that some of those who were exposed to mercury experienced “numbness, tingling, dizziness, forgetfulness, headaches, and depression.” Encountering high enough levels or chronic exposure can also harm the kidneys, Miller says.

The people profiled in the MMWR report said they used the face cream for “skin-lightening, fading freckles, and treating acne.” Mercury, a metal, is a highly effective skin lightener, because it blocks melanin, which gives hair and skin pigmentation.

“It’s effective. It’s just dangerous for you,” said Miller, adding that the FDA does not allow any mercury in products sold in the United States. He said all the products with dangerous mercury levels are here “illegally.”

Nationwide, state health departments are coming across scores of cases of mercury poisoning through skin-lightening products brought into the country from someplace else. Health officials in Texas, New York, and Minnesota have recently carried out investigations of skin-lighteners, and alerted the public about possible mercury contamination.

In 2010, the Chicago Tribune carried out an investigation of skin-lighteners sold in local stores and on the Internet, and found that out of 50 face creams, six contained “mercury levels banned by federal law.” The six products were made in “Lebanon, China, India, Pakistan and Taiwan.”

California health officials will begin to collect and test a sampling of skin-lightening products from store shelves in San Francisco, Oakland, and San Jose, said Lori Copan with the state health department. She says they will target ethnic stories and swap meets, catering to three “priority groups,” including Chinese, Filipino, and Latino.

In the cases documented last year by California health officials, most involved products that were brought into the state through people’s “personal luggage,” Copan said. The extended family profiled in the MMWR report brought the skin-lightening cream back from Mexico, while two other households bought them in local stores. The products were also made in Mexico.

Copan says the state health department issued alerts about mercury-laced skin-lighteners in 2010, and will be working with a statewide network of “promotoras” — peer health educators — to get information into hard-to-reach communities.

“It is very important. Ladies using the cream not only put it in her face, but using in [sic] her whole body,” said Vicky Avila, health educator with Vision y Compromiso in Redwood City, Calif. “They put the cream on babies…it’s a big problem for them.”

The case that prompted California health officials to issue a health alert in 2010 involved unlabeled products in white jars. Other state health departments have issued alerts about products made in Mexico with dangerous levels of mercury, including Crema de Belleza–Manning and Crema AguaMary.

Last year, researchers from UC Berkeley and UCSF, conducting a health study in collaboration with state health officials, found a Latina in San Francisco with high mercury levels, the source of which was eventually traced to her face cream. In that case, the cream was a U.S. brand name product that was purchased and likely adulterated in Mexico.

“It is not likely that U.S. brand name products for skin lightening would contain mercury. Though there is no real oversight by FDA,” Copan said, adding that any skin-lightening product purchased abroad could be tainted.

California’s health department advised consumers to avoid buying products that list “mercury,” “mercurio,” or “calomel” (mercurous chloride) on the label as well as unlabeled beauty products.

Health worker Avila says many of the women she sees prefer to buy products they are familiar with from their home countries, especially new immigrants who want to feel connected to their “roots” and culture.

Avila says the women load up on products when they travel to Tijuana or they may shop for them at local Latino stores in California. Often times, the products may not be displayed on shelves, but carried in a backroom, so they must ask for them specifically.

“Women don’t like to talk about it,” Avila said. “They don’t like to say where they bought it.”

By Heather Gilligan, California Health Report

Joe Alfano got married twice in four years – to the same person. He met his husband Frank Capley at the San Francisco pride parade twelve years ago. “We locked eyes from across the crowd,” Alfano recalled. He gestured to Capley to come over to him, but let Capley coax him over instead. “We’ve been pretty much inseparable ever since,” he said.

They first married in 2004, during the short window when Gavin Newsom, then mayor of San Francisco, issued licenses to same-sex couples. Those unions were ruled illegal, so when the state Supreme Court gave marriage the green light in 2008, Alfano and Capley made another trip to the altar. The couple, who also changed their last names to Capley-Alfano, are one of the about 18,000 same-sex couples that remain legally married in the state.

Recent studies suggest that men like Joe Capley-Alfano can expect good and bad health effects from the historic legislation that’s shaped their lives in recent years, and the lives of gays and lesbians across the state and the country.

Marriage, for instance, has always been good for the health of straight men in heterosexual relationships. Now it seems that marriage may be good for the health of married gay men too, according to a Feb. 2012 study in the American Journal of Public Health.

Gay and bisexual men in Massachusetts needed less healthcare the year after same-sex marriage became legal there, according to the study of slightly more than 1,200 men. Medical and mental health care visits dropped more than 13 percent between 2002 and 2003, when the marriage law passed. This decrease bucked a statewide trend towards increasing use of healthcare.

Gay and bisexual men in the study generally needed less medical help for illnesses like hypertension and depression, said lead author Mark Hatzenbuehler.

“Disorders associated with stress went down,” Hatzenbuehler said, “and we know from previous studies that these are the policies that this group finds stressful.”

The health benefits of marriage even extended to gay and bisexual men who were not in relationships, he noted.

That finding is consistent with Hatzenbuehler’s earlier study, published in the American Journal of Public Health in 2010, which suggested that anti-gay legislation hurts the mental health of gay people generally, and not just the health of people who want to marry but cannot. Psychiatric disorders were much higher among gay people in states that passed bans on same-sex marriage in 2004 and 2005: mood disorders were more than 36 percent higher and generalized anxiety disorders almost 250 percent higher compared to gay people in states that did not pass bans.

Recent research indicates that 20 percent of gays and lesbians in California have mental health needs – a rate that is twice the state’s average, according to a Nov. 2011 study from the UCLA Center for Health Policy Research.

That difference is likely because gay people still find themselves rejected by family and the larger culture, an experience straight people don’t typically have, according to David Grant, the study’s lead author.

Marriage lends a legitimacy to same-sex relationships that helps ease the sting of past discrimination, Joe Capley-Alfano says.

“Both Frank and I were raised in an atmosphere and a culture, in a time that reinforced for us since we were children, that gay relationships don’t matter,” Capley-Alfano said, “that gays were unlovable, and that we were not capable of love.”

Marriage changed that for Capley-Alfano. The significance of their relationship suddenly became understandable to their parents, their families and to the culture at large. It also gave Capley-Alfano a sense of stability and permanence he never even knew he was missing.

“We were able to see our relationship and the future in a way that we had never imagined it before,” Capley-Alfano said. “As a result of the marriage, now there were some certains. We had each other’s backs. Through sickness and health, for richer and poorer. That made a huge difference for my mental health.”

But problems related to their status as a same-sex couple remained after the marriage, and they directly impacted Capley-Alfano’s health.

Capley-Alfano, disabled from a car accident 20 years ago, works part-time and as a contractor. He has no employer-provided health insurance and could not afford private insurance because of his preexisting condition. The state of California recognizes Capley-Alfano’s 2008 marriage, so his husband’s income disqualifies him for state assistance. Frank Capley-Alfano works as an elevator mechanic in a federally unionized job – and his benefits did not extend to his husband.

They fought for an extension of benefits, and eventually they won. Joe Capley-Alfano was insured as of Jan. 2010. But the wait took its toll. “I lived with excruciating pain and physical limitations,” he said. “It was completely preventable.”

Capley-Alfano’s difficulties affect a significant proportion of gay and lesbian people in California. Partnered lesbians and gay men are twice as likely to be uninsured as married straight people in California, according to a 2010 article in the journal Health Affairs. That lack of insurance hurts their access to healthcare and consequently their health, researchers say.

Capley-Alfano said his health improved dramatically after he had insurance. Doctors took simple steps to decrease his pain and extend the life of the titanium knee and hip. He got steroid injections, orthopedic inserts and physical therapy.

The treatment is improving his ability to walk, which had been deteriorating, he said. But the mental distress of those uninsured years still haunts him, and he does not expect it to ease anytime soon.

“I could see the hypocrisy of the situation,” Capley-Alfano said. “There is an immense amount of frustration, anger and hurt. To a certain extent, that will always be there. It will always be in the back of my head, that maybe my hip wouldn’t hurt today if situations in society were different.”

Heather Gilligan is a correspondent for the California Health Report at www.healthycal.org

Note: This article has been corrected. An earlier version of the article referred to the Capley-Alfanos as Joe Alfano and Frank Capley.

A majority of California adults would be willing to pay higher taxes to preserve current levels of spending on health and social services, according to a new, independent poll released Tuesday.

The survey by the Public Policy Institute of California found that 57 percent of Californians would be willing to pay higher taxes to support the safety net, the same number who said they would support higher taxes to keep current spending levels for higher education. Even more — 72 percent — said they would pay higher taxes to support K-12 education. Just 13 percent support higher levies for the prison system.

The same poll found broad support for Gov. Jerry Brown’s proposal to raise income and sales taxes to help balance the budget.

While 74 percent said they support raising taxes on the wealthy and just 29 percent say they would back an increase in the sales tax, Brown’s proposal, which combines the two ideas, drew the support of 72 percent of all adults and 68 percent of likely voters. Another 31 percent of likely voters say they oppose the plan.

Voters were also opposed to the cuts Brown has proposed in his budget or suggested might be necessary if voters fail to pass the tax increase in November.

Only 24 percent of likely voters said they would support the cuts to schools that Brown has threatened to implement, the equivalent of cutting three weeks off the school year.

And 44 percent said they favored cuts to welfare, child care and Medi-Cal, which Brown says will be necessary even if the voters agree to raise taxes.

But Mark Baldasssare, president and CEO of the PPIC, said Brown might still have an uphill battle passing his plan because voters still believe that government can be cut further, and very few support raising the sales tax.

“The challenge the governor faces with his tax initiative is that one generally popular tax increase—raising personal income taxes on the wealthy—is paired with one generally unpopular one—raising the state sales tax,” Baldassare said.

To see the full poll, go here.