HealthyCal.org

By Helen Afrasiabi
California Health Report

Mike Kelly opens his medical marijuana dispensary each morning not truly knowing if it will be his last day of business. Kelly, owner of Aloha Community Collective in Santa Ana, provides medical marijuana to patients presenting doctors’ recommendations for conditions ranging from insomnia to cancer.

Though Santa Ana initiated its ban on medical marijuana dispensaries almost five years ago, only recently have code enforcement officers decided to crack down on these operations. Sixty-five dispensaries have been closed by code enforcement in Santa Ana since 2007, according to Jose Gonzalez, public information officer for the City of Santa Ana. Kelly said he wouldn’t be surprised if his was the next to get a random visit from officers presenting a warrant.

Kandice Hawes, Director of the Orange County chapter of NORML- the nonprofit organization supporting medical marijuana legal reform- has not been able to identify the specific reason or pattern associated with the closures.

“It’s sporadic,” Hawes said.

Those approached have been given reasons including operating without a business license and being too close to schools or other dispensaries, according to Hawes. Many have been in business for years, and some only open a few months.

According to the city of Santa Ana’s Department of Planning, the ban on storefront dispensary operations-also referred to as collectives- is tied to the fundamental safety and well being of the residents and business community. Storefront dispensaries may induce local dealers to entice patients with lower prices, driving customers away from neighboring businesses. Dispensaries have sold to undercover police without the proper documentation.

Hawes, along with dispensary owners and patients, has decried the city’s position on dispensaries. “The fact is if they close those locations those younger people don’t have any problem finding it, it’s the older patients who truly need it that will get hurt,” Hawes said.

As both a medical marijuana patient and advocate since 2008, Marla James, 51, has heard every argument against storefront collectives a dozen times. She believes the city is doing medical marijuana patients a disservice.

In the last thirteen years, James said, she was struck twice with necrotizing fasciitis – also known as flesh-eating bacteria – and had partial leg amputation resulting from her diabetes. She also suffers from rheumatoid arthritis, she said. She said her conditions left her permanently wheelchair bound and on a litany of prescription drugs. Four years ago, she realized that she was not able to function without opiate painkillers Oxycontin and intravenous Hydrocodone. The addiction left her with little mental awareness and deprived of the ability to do routine tasks such as drive. James has since gotten on medical marijuana, which she says has left her free of pain, alert and functional.

If dispensaries disappear the only choice she’ll have is to buy off of the street, and that is hardly a viable option, she says. For one thing, she is confident in the quality of the the marijuana she gets from a dispensary because she knows the marijuana sold there has been grown under specific conditions and tested for substances such as mold.

“That is why it is important to keep it off the street,” James said. “How do we know what dealers will be selling us?” James is also afraid of the covert nature of buying off the street.

Like James, patient Robin Bollay would be in the same boat if the city rid itself of all dispensaries. She says the only choice it would leave her is to buy from street dealers or go back to medication, and that is not an option. Bollay has huge misgivings about hitting the streets for her marijuana.

“Its sneaky. It’s not like I’m a patient going buy medication, its like I’m pounding the pavement for illicit drugs,” Bollay said.

Born asthmatic and unresponsive to bronchodilators, Bollay had been on steroids since the age of two, and developed Addison’s disease at age 16. According to Bollay, 51, medical marijuana has made her a walking miracle by relieving her of the pain of her illnesses.

Despite California laws, purchasing or dispensing marijuana are in violation of federal regulations, notes Drug Enforcement Agency spokesman Jeffrey Scott. No state law can override or encourage citizens to override the federal law, Scott added.

“Individuals who use dispensaries as a shield for persistent criminal activity are of interest to us,” Scott said. “We have targeted those dispensaries where we believe activities are more indicative of criminal behavior than medical.”

According to Orange County medical marijuana attorney Anthony Curiale, there are two unresolved issues at the heart of the problem.

The first echoes the assertion made by Scott, the lack of a universal law with regard to marijuana users.

“California says if you use with a doctor’s recommendation, you won’t go to jail, but we can’t prevent the feds from enforcing federal law. If they want to, they can come in and prosecute,” Curiale said.

And so it unfolds on a case-by-case basis, Curiale said.

Although dispensaries within hospitals, hospice facilities and other medical environments won’t be touched, according to the city, Curiale says the other problem is the absence of a precise definition of a dispensary.

“There is no legal definition of the term dispensary anywhere. It’s whatever cities decide it is,” he said. He explains further that Santa Ana defines a dispensary as any location that makes marijuana available to two or more patients, emphasizing that the definition focuses on distribution and not sale.

“It’s a very important concept because under these circumstances it’s not just limited to storefronts anymore,” Curiale said.

Dispensary owner Kelly says Aloha isn’t just about paying the bills; its about the people he helps emotionally as well as physically.

Most new patients who walk through his doors ultimately end up becoming his friends.

“We have so many chemo patients and they [city] don’t get to meet these people,” Kelly said.

Bollay acknowledges the city’s concerns about dispensaries are not completely unfounded, but says a solution is within reach.

“There are a few very non-compliant dispensaries that sell ridiculous amounts of marijuana really cheap, and I’m for those ones being closed” Bollay said. “But the Santa Ana police should be able to do their job. We have enough of a police force to go around and keep these guys under control.”

A food store established in the early days of the epidemic continues to help people with AIDS

By Brenda Duran
California Health Report

When the country was facing the growing AIDS epidemic three decades ago, members of Christ Chapel Church of Long Beach found that local residents afflicted with the disease were struggling. Too often, people living with AIDS at the beginning of the epidemic lacked basic necessities like food.

During the Thanksgiving holiday in 1985, church members including Margo Martinez decided to lend a helping hand by assembling food baskets and distributing them to AIDS patients in the church. The gesture was so well received that the church assembled weekly food baskets. The non-profit AIDS Food Store grew from those efforts.

“There were a lot of people that were disabled and unable to work, they were going hungry,” said Martinez, now interim director of the AIDS Food Store. “It didn’t take long to recognize there was a huge need, so we stepped up to help as much as we could.”

It didn’t take long for word to spread about the AIDS Food Store through a steady stream of referrals from local health and social service agencies.

Today, the AIDS Food Store continues to serve as a safety net for people with limited incomes.

Most of the clients are living off of Supplemental Security Income checks. Often, they are estranged from their families and friends. The store is the only support for some, Martinez said.

The organization determines who qualifies for free food delivery service after they can prove their HIV-positive status through their medical records and that they are living on less than $1,500 a month.

In the early 1980s, there were a high number of infected residents in Long Beach that mirrored the rest of the state, but with widespread HIV testing, the numbers have trended down, according to the California Department of Public Health.

Last year, the Department of Health and Human Services for the city of Long Beach found approximately 6,151 people are living with AIDS in the city of Long Beach.

In 2006, the department began tracking the number of people who were testing positive for HIV. Since the tracking began, the number of new HIV-positive cases reported in the city has been 1,435, according to the department’s HIV Epidemiology Report.

At one point, the AIDS Food Store served more than 200 people a month. Today, the center serves 60 to 70 on the first and fourth Saturday of the month with the help of numerous volunteers.

“All of the volunteers have their hearts in wanting to do this work,” said Martinez. “Like myself, a lot of these volunteers find their lives have been blessed by being of service to those in need.”

In addition to dedicated volunteers, the AIDS Food Store also receives support from numerous other local organizations.

Porter Gilberg, administrative director for The Center, a resource center for the Long Beach gay and lesbian community, said they often refer both volunteers and clients to the center. The Center also hosts food receptacle bins for drop-off donations.

“The AIDS Food Store is not only great for those who go hungry and don’t have enough to eat, it is also great for those who have been dealing with the astronomical medical costs that are associated with being diagnosed with HIV,” said Gilberg.

Ismael Morales, director of health services for The Center, estimates the annual cost of medical care for an HIV patient typically ranges from $30,000 to $50,000 a year.

“Organizations like the AIDS Food Store are vital when you see these numbers because they truly are a safety net for these people,” said Gilberg.

On a recent Saturday morning, more than 20 volunteers convened at the AIDS Food Store to distribute a variety of items, including fresh produce and fruit, perishable items such as yogurt, meat and frozen soups.

Local volunteer Larry Cruz said giving back through the AIDS Food Store is rewarding in more ways than one.

“I like the mission they have here, how dignified and respectful it is and what it offers to the clients,” said Cruz. “It’s fun and you see results of your help right away.”

Last month, the AIDS Food Store received a $5,000 donation from the AIDS Assistance Thrift Store with the AIDS Assistance Foundation Inc. The funds will be used to fill the gaps that the organization still has, from providing toiletries to emergency food for clients.

Since the organization does not receive any government funding, it relies heavily on agencies, foundations, groups, churches and individuals to assist them with ongoing donations of food and supplies.

For the past two decades, this support has remained steady and has allowed the organization to have a solid presence in the city with no end in sight, said Martinez.

“Often times I hear from our clients that they wouldn’t know what to do if we weren’t here,” said Martinez. “I always tell them we will be here until there is a cure, until there is no longer a need.”

New benefits depends on continuation of federal healthcare reform

By Mary Flynn,
California Health Report

While the heated national debate about healthcare reform continues, many health communities in California are quietly making changes to prepare for the Affordable Care Act’s implementation. Federal funding is available to help community clinics transition towards what they will resemble in 2014.

One important change that’s taking place: community clinic are moving towards becoming ‘medical homes,’ or centers of care. That means qualifying low-income patients have access to primary care, pharmacy services, or specialty care (by referral). And especially exciting to health specialists is the new availability of mental health and substance abuse services, which are being included at clinics for the first time.

“For years, we separated out those conditions as if they were somehow different from a heart condition or an ulcer or if you have diabetes,” said Leslie Tremaine, the Mental Health Director for Santa Cruz County. “But in fact, what we know is that mind and body are completely connected; “health” needs to incorporate all of those needs.”

Mental health issues affect a significant number of people. According to a 2009 report, an estimated 45 million adults suffer from sort of mental illness each year, including issues with depression or anxiety, but of that population, only approximately 38% of them receive any sort of treatment for mental illness.

In Santa Cruz, behavioral health specialists are now able to seeing patients at community clinics. “Our staff are going to those sites and integrating what we do with what you go to the doctor for,” Tremaine said.

During a check-up, the primary care doctors conducts an assessment that indicates whether a patient is suffering from a mental health issue or has a substance abuse problem. If it appears the patient has a problem, they can seek treatment inside their own clinic.

“The provider can walk down the hall to office and introduce the patient to that clinician right there,” said Lynn Harrison, a Behavioral Health Program Manager. She said it is called a ‘warm handoff,’ and when this introduction happens, it significantly increases the chance the patient will continue to seek care.

Harrison explained that the county does not have enough specialists to staff each of the four clinics full-time, but they try to do a warm handoff as much as possible.

In the past, a patient would have to request an appointment with a mental health or substance abuse specialist for a different date and place. Leslie Tremaine said that simply locating behavioral health clinicians in the same building makes a difference in whether a patient will continue to seek treatment.

“For a lot of people just getting to another place is too confusing or too hard to do, and maybe they’re embarrassed about the idea of having a mental health problem so going to see a ‘shrink’ is something they wouldn’t do,” she said, “But they’d see somebody right inside their own health provider’s office.”

Additionally, unless the person was severely mentally ill, or required psychiatric observation or medication, the cost of the care would not be covered. So those suffering from mild to moderate mental conditions, such as depression or anxiety, would be less likely to receive care.

“We can see people who would otherwise not have been seen or not have met the system of care,” Harrison said.

In the past behavioral health had been largely excluded from patient care, but for Tremaine and other mental health care workers, the future of healthcare reform appears much brighter. “What we’re excited about is that healthcare reform is based on the notion that mental health and substance abuse are part of the whole picture of health,” Tremaine said.

In January of this year, four clinics in Santa Cruz County – MediCruz North County Clinic, MediCruz South County Clinic, Salud Para La Gente, and Santa Cruz Women’s Health Center – began offering a pilot public health program, called Medicruz Advantage, that expanded Medicaid eligibility.

Medi-Cruz is the name given Santa Cruz County’s Medicaid program (while Medi-Cal is the name of California’s Medicaid program). This program, whatever the name, provides necessary health care services for low-income individuals with specific diseases such as breast cancer or HIV/AIDS.

Medi-Cruz Advantage is an expansion of Medi-Cruz where patients no longer need to have a specific condition to receive care. As long as an applicant meets the eligibility requirements – resident of the county, is a legal resident, and has an income at or below 100% of the federal poverty level – they can qualify for comprehensive care.

Leslie Goodfriend, the MediCruz Advantage Manager for Santa Cruz County Health Services Agency, said that before under MediCruz, someone with a specific medical need could apply for care from the county and potentially receive care for specific services related to their condition for a few months.

“It’s what we consider ‘band-aid’ care,” she said.

“The intention behind the medical home is that people can see a doctor, not just when they’re at death’s door or when they have an acute situation, “ she said. The medical home provides patients not only with preventative wellness care, but a primary care person to contact if they have a question or an issue, rather than crowd inside emergency rooms.

”These folks did not have that before,” she said, “and they would certainly not get mental health or substance abuse services.”

The Medicruz Advantage program is not the only one of its kind. In other counties in California, it is called the Low Income Health Program (LIHP), a pilot program between now and 2014 that gives counties an opportunity to see how healthcare reform might work for them.

Fourteen counties have been authorized their own version of the LIHP in California, while another 13 are pending. Eligibility for the program varies from one county to the next, but each is part of the Affordable Care Act’s “bridge to reform” that provides heath coverage to low-income legal residents of California.

Through the program, the federal government matches what the county spends on healthcare. “Where we [the county] paid 100% of the cost before, we’d now only pay 50% and get federal reimbursement for the cost,” Tremaine said.

“The feds have made it financially advantageous to participate in the program and that helped us bring some staff on to do this,” she said.

However, whether healthcare reform will continue, and its corresponding flow of federal funding, depends largely on what the Supreme Court decides. Tremaine said that although they will continue to work towards integrating behavioral health with clinical care, access and comprehensive coverage would be hindered by the loss of federal support.

“The whole community benefits when we all have access to health care, and that health care includes mental health and substance abuse,” she said. “Healthy people make healthy communities.”

South Los Angeles twenty years after the riots

By Robert Fulton
California Health Report

On April 29, 1992, Cary Earle worked on his yet-unopened restaurant on Crenshaw Boulevard in the South Los Angeles neighborhood of the same name. Cary and his brother Duane had operated hot dog carts in L.A. for nearly a decade, and after years of work were able to establish a permanent location where they could serve hot dogs, burgers and fries.

Because the new Earlez Grille had yet to open, there was little of value on site. No cash, no equipment. Just Cary Earle and some cohorts working to get the restaurant ready for its upcoming opening.

That opening would be delayed.

Los Angeles exploded that day, following the acquittal of four white police officers charged in the beating of African American motorist Rodney King.

This month marks the 20th anniversary of the 1992 Los Angeles Riots. And according to residents and community leaders in South Los Angeles, too little has changed over the past two decades.

Like many around the region and the nation, Cary watched the violence unfold on television.

“The air became a little thick,” Earle said. “You felt a little tension.”

A few doors down from the restaurant, a liquor store went up in flames. Then a stationary store. Earle called the Los Angeles Fire Department, but emergency calls stretched the fire department thin, as looters and arsonists set hundreds of fires during the six days of unrest.

Cary and his crew sprayed down the building with a water hose. The structure caught fire, but the fire department arrived and suppressed the flames. Earlez suffered significant damage, but the restaurant was saved and opened a few months later.

“It only takes one person,” said Earle, now 49, sitting in the most recent iteration of Earlez Grille, at the corner of Crenshaw Boulevard and Exposition Drive. “It was a chain reaction. Most of the people that started the problems were not people from the community. Most of these people were passing through. There’s a lot of good people that live down here. In between those knuckleheads, there’s a lot of good people.”

On March 3, 1991, George Holliday filmed members of the Los Angeles police department beating Rodney King on the side of the road following a traffic stop. The Los Angeles District Attorney charged Stacey Koon, Laurence Powell, Timothy Wind and Theodore Briseno with assault, and a jury in Simi Valley acquitted the four officers.

The unrest that followed resulted in 53 deaths, hundreds more injured and an estimated one billion dollars in damage. The riots originated in South L.A., but the unrest soon spread to other parts of the city and region. Mayor Tom Bradley imposed a curfew, and the National Guard was called in. The mayor did not lift the curfew until May 4.

“It was the most unjustifiable thing you can ever see,” Earle said. “You’re burning your own neighborhood.”

Discussing the events of 1992 can lead to a semantics debate. The word “riot” is common. Some prefer “uprising,” “rebellion” or “civil unrest.”

Reverend Cecil “Chip” Murray prefers the latter, but also applies “explosion,” citing the Langston Hughes poem “A Dream Deferred”:

“What happens to a dream deferred?/Does it dry up/like a raisin in the sun?/Or fester like a sore–/And then run?/Does it stink like rotten meat?/Or crust and sugar over–/like a syrupy sweet?/Maybe it just sags/like a heavy load/Or does it explode?”

“I certainly am not offended by the use of the other terms, but I think the civil unrest explains more completely a dream that exploded,” Murray said.

Rev. Murray was the pastor at the First African Methodist Episcopal Church in South Los Angeles for 27 years, and is now the John R. Tansey Chair of Christian Ethics in the USC School of Religion. He is also the Chairman of USC’s recently opened Cecil Murray Center for Community Engagement, which works to empower the undeserved community through job placement, mentoring, reentry programs for released prisoners, housing and more.

As pastor at FAME, Rev. Murray worked to keep the peace in 1992. He still sees many of the same inequities in the area, including poverty, lack of jobs, under performing schools, and a biased penal system.

“If history does in fact repeat itself, the only fix must be to change our way of operation,” said Murray, 82, sitting in the center that bares his name, located a few blocks east of the USC campus, tucked up against the 110 Freeway. “To keep on doing the same old thing in the same old way and to expect different results, I think that’s the definition they say of insanity.”

According to the website city-data.com, the poverty rate in zip codes in South Los Angeles is greater than 30 percent. That rate is 15.1 in the nation and 19.5 in Los Angeles as a whole, according to the U.S. Census Bureau.

The life expectancy in the Florence-Graham neighborhood east of the 110 is 76.7 years, according to the Los Angeles County Department of Health. The county average is 80.3, and according to the Centers of Disease Control, the national average is 77.9.

John Griffith, PhD., cites a need for access to housing and jobs in South L.A. Dr. Griffith is the president and CEO of Kedren Community Health Center, which provides mental health services to the community, as well as a Head Start program.

“I think there’s been significant improvement, but still a lot that needs to be done,” Griffith said.

Dr. Matt Harris, the executive Director at Project Impact, which works with at-risk youth, wants to see more emphasis on addressing the causes for unrest and inequality in South L.A., instead of only treating the symptoms.

“The inequalities do exist and they will continue to exist until we have come together with a much more comprehensive plan that reflects a research, that reflects our ability to understand what we’ve been affected by, and that we have appropriated the right type of resources and skill sets to deal with those issues,” Harris said.

Rev. Murray said he’s seen positives in South L.A., from financial investment in the area to a change in the mentality of law enforcement.

Murray Center executive director Reverend Mark Whitlock does not believe another uprising is likely to occur. He cites more African American elected leaders, and points out the peaceful protests surrounding the still evolving Trayvon Martin shooting in Florida.

“We probably won’t see anything like we saw back in 1992,” Rev. Whitlock said. “There’s still a group of young people that are more prone to violence than not. But if we look at things in comparison to 1992, no, it’s not going to burn.”

The corner of Florence and Normandie is ground zero of the unrest. This is where rioters pulled Reginald Denny from his truck and beat him.

Just a couple of blocks west from that infamous intersection sits S.C.O.P.E. (Strategic Concepts in Organizing and Policy Education), a grassroots social justice organization serving South L.A.

“Poverty in South Los Angeles is South Los Angeles,” said S.C.O.P.E. organizer Clementina Lopez. “We don’t have access to good paying jobs. Buildings were burned down and empty lots exist there to this day.”

On April 29, 1992, Lopez was at her home with her 10-year-old son at the corner of Adams and Vermont, just north of the University of Southern California. She saw fires burning in her neighborhood, and people with weapons on the roof of a nearby liquor store defending the property.

Out of the 1992 unrest rose Action for Grassroots Empowerment and Neighborhood Development Alternatives (AGENDA). Lopez joined AGENDA in 1997, and the organization later changed to S.C.O.P.E to better reflect its mission.

While Lopez still sees inequality in South Los Angeles, she believes the work done by S.C.O.P.E. and others as the key to moving forward.

“Folks are looking for real change, and we’re hearing that from the residents when we speak to them,” said Lopez, who has lived in the neighborhood for 30 years. “We have hope, and the hope for change is very much alive.”

One example of change in South L.A. is the addition of the Expo Line. After several delays, the light rail line that connects downtown Los Angeles to points west and runs along the northern portion of South L.A., will open on April 28. One day before the 20th anniversary. Earlez Grille sits next to one of the line’s stops.

Earle, for one, sees the path to change and improvement in South L.A. through engagement.

“What I tell a lot of young kids, if you’re not happy with the way things are going, you have to join,” he said. “You have to make change from within.”

“You can’t make change by going out and burning and looting and rioting,” he added.