Starting June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.
If that sounds simple, it won’t be.
California’s End of Life Option Act creates a long list of administrative hurdles that both patients and their doctors must clear.
For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).
Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.
“This will not be an on-demand service,” says Sarah Hooper, executive director of the UCSF / UC Hastings Consortium on Law, Science and Health Policy.
“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.”
California will be the fifth state to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group Compassion & Choices.
Rather than list every requirement, I’m going describe a few potential challenges you might face if you or a loved one is considering asking for these medications — from doctors who are unwilling to write prescriptions to the cost of the medications themselves.
Let’s start with the doctors.
This law is voluntary “every step of the way,” says Democratic state Sen. Bill Monning, co-author of the law.
That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.
Nothing requires patients to take the drugs once they have obtained a prescription.
Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to data compiled by the Oregon Public Health Division.
“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’” Monning says.
But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.
“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.
For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.
If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.
But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.
Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the Alliance of Catholic Health Care.
Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”
If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.
Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.
In Oregon, Washington and Montana — states where aid-in-dying is legal — some health plans cover the cost and some don’t, he says. He expects the same to occur in California.
Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the California Association of Health Plans.
If you have questions about coverage, she suggests you contact your insurer directly.
Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.
If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.
If you need more step-by-step guidance about the law, tap into these resources:
- Compassion & Choices has online guides for consumers and doctors at www.EndOfLifeOption.org. You can also call the group’s help line at 800-893-4548.
- The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a helpful fact sheet at http://bit.ly/248Z2l6.
- The California Medical Association, which represents doctors, has a detailed, 14-page document at www.cmanet.org/endoflife. You’ll need to register on the site to read the document.
- Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: www.mbc.ca.gov.
This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. Kaiser Health News is national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.
A new app has the potential of broadening the use of a prescription drug that can prevent HIV infection among those at high risk.
But some HIV/AIDS activists are raising concerns because the app allows people to order prescriptions online for pre-exposure prophylaxis, commonly known as PrEP, without direct contact with a doctor.
PrEP can reduce the risk of HIV infection by 90 percent. It’s recommended by the U.S. Centers for Disease Control and Prevention for people at high risk, including sexually active gay men and people with infected sex partners.
Earlier this year, Nurx, a company headquartered in the San Francisco area, announced it would add PrEP to the prescriptions available to users of its innovative app.
The service currently has limited reach, delivering prescribed oral contraceptives to customers in California and New York. On its website, Nurx promotes its services: “If you have health insurance, Nurx is free. If you pay cash, you can get birth control from $15 per month.
“Whether you are currently on the pill or new to birth control, Nurx is for you. We always ship you three months of birth control, for your convenience.”
Most recently, Nurx announced the availability of PrEP “right from the app with our clinical team. No need to go into the doctor’s office, or to the pharmacy.”
Customers would apply online with Nurx and receive a prescription after completing a health survey and undergoing lab tests that show normal kidney function and no HIV infection.
Some public health officials see services like Nurx as a new way to help lower new HIV infection rates, especially in areas that lack HIV/AIDS services or where such services are overburdened.
However, others, such as activists with the California-based AIDS Healthcare Foundation, are concerned.
“While the goal to improve access to effective HIV prevention tools is admirable, removing any or all direct contact with a physician or medical provider is not,” said Michael Weinstein, president of AHF. The organization has taken a position against widespread deployment of PrEP as a communitywide public health strategy. In 2014, Weinstein referred to Truvada, the anti-viral medication used for PrEP as a “party drug.”
AHF does support the use of PrEP on a case-by-case basis that’s decided between a medical provider and patient.
Weinstein said STD rates are skyrocketing, particularly among young people using hookup apps like Grindr and Tinder.
“We challenge the wisdom and ethics of an app that allows people to order a drug to prevent HIV as readily as ordering pizza,” he said. “PrEP is not simply a pill taken in isolation: It is a four-part HIV prevention strategy that can be highly effective, but one that offers no protection against any other STDs. Eliminating primary contact with the physician or medical provider from this equation is really a disservice to the patient.”
PrEP as a prevention strategy includes the use of Gilead Sciences’ medication Truvada to prevent HIV infection in non-infected individuals.
Truvada was first approved for treatment of HIV/AIDS patients in August 2004. The FDA approved use of Truvada as PrEP in July 2012.
Guidelines issued by the FDA for PrEP include:
• An initial baseline negative HIV test.
• Daily adherence to the Truvada medication.
• Ongoing periodic HIV testing to ensure the individual on PrEP remains HIV-negative.
• Continued use of other prevention methods, such as condoms.
In Wisconsin, a key resource for information and access to PrEP is the AIDS Resource Center of Wisconsin, which announced expanded access to health care services across the state on World AIDS Day in December 2015. ARCW is online at arcw.org. — L.N.
Learn more about Nurx.
About 9.3 percent of Hispanic children in Wisconsin in 2014 were uninsured, leaving nearly 14,000 kids without coverage according to a new report from Georgetown Center for Children and Families and the National Council of La Raza.
This is comparable to the national uninsured rate for Hispanic children, which reached a historic low of 9.7 percent.
However, the findings also show that Wisconsin has stagnated in making progress.
“While Wisconsin is on par with the national average, it did not reduce its rate of uninsured Hispanic children in 2014. There are still steps the state can take to move forward and be more of a leader in coverage,” said Sonya Schwartz, a research fellow at the Georgetown University Center.
The report highlights health inequities for Hispanic children when compared to all children. The uninsured rate for Wisconsin’s Hispanic children was more than double the percentage of all children in the state who were uninsured — 4.4 percent.
“We’re eager to move the needle in 2016, so Wisconsin can truly be a leader when it comes to health coverage for all our communities,” stated Sashikala Gregory, health care policy analyst for the Wisconsin Council on Children and Families.
In particular, the council urged state lawmakers to accept federal funding for Medicaid expansion, which would make health care more affordable for adults. When parents have access to health coverage, their children are also more likely to be covered.
“Every single child, no matter their background, deserves access to high-quality, affordable health care,” said Gregory. “Accepting federal Medicaid dollars helps all Wisconsinites, including Hispanic families. It’s time we close the health coverage gap and help kids get the health coverage that gives them a better chance to succeed in school and in life.”
Dr. Dee Thornell bought the first heated surgery table in the state of Alaska — for animals. But as a veterinarian with an animal hospital in Fairbanks, she doesn’t always get to use that table. She’s just as likely to be flying to some remote location, performing surgery using a church pew, pool table or truck bed.
Thornell also is the first veterinarian from Alaska with a reality television show. Animal Planet’s Dr. Dee, Alaska Vet, debuted on Nov. 7 at 7 p.m. CST.
Some of the show is filmed in the wild. The rest comes from her practice — which she calls Animal House. It includes a large, modern animal hospital, a Montessori dog training school, a laundry, groomer, retail store and the latest addition, a crematorium.
She likes her job, from the dogs, cats, moose, beavers, woodchucks and other animals she cares for, to the people.
“The people are helpful, friendly and outgoing. There is not a single soul who would not stop to help you. It’s a big little city,” she said.
It’s also a cold place in winter, with an average low in January of minus 17 degrees. Throw a cup of coffee in the air and it might freeze, she says. She wants her 15 employees to be happy at work, so she makes sure there is warmth and laughter on the job.
In the first episode, viewers traveled with Thornell as she did welfare checks on a black bear and a team of sled dogs, castrated a group of piglets and untangled a reindeer’s antler growth. Trying to save a horse injured in an expedition was her biggest challenge, partly because of the weather and partly because it is a good friend’s beloved pet.
Thornell set up the Golden Heart Pet Assistance League so remote villagers can get help paying for treatment for domestic and farm animals. She also uses the charity to do as much spay and neuter work in outlying areas as possible. And she conducts a two-week class every year to introduce 10 high school juniors and seniors to the world of veterinary medicine.
As a grade-schooler in Michigan, Thornell wrote a report on Alaska and fell in love with the state. She and her husband, Ken Rodriguez, met in 2005. “His dream was to fly and I was building a house. He helped me build the house and I helped him learn to fly,” she said. Now he works for the state of Alaska as a pilot and they share a house and barn with three dogs, three cats, two Friesian horses, one donkey named Gus and several pet chickens.
“I’ve been going to her for 35 years. She’s a wonderful lady, a good vet and she cares deeply for you and your animals,” said Cindy Reason, who has two blue heelers (Australian cattle dogs), Dottie and Missy. Reason invited all her friends and relatives to a viewing party the night the first episode aired.
Reason said Thornell has been by her side during her toughest moments over the last three decades — including helping her through the loss of several dogs.
“When you have to make the hard decision to put your babies down, that’s extreme. Dr. Dee has the compassion that helps you through that. She’s just fantastic support for you during that time,” she said.
Thornell says she’s been told: “You are not Dr. Doo-little, you are Dr. Do-a-lot.”
But she says life only makes sense if “you close your eyes for the last time, and there are no ‘what ifs.’”
Professors at the University of Michigan predict there will be resignations if state lawmakers ban health insurance for domestic partners of public employees.
At least seven have signed a letter asking Gov. Rick Snyder not to sign House Bill 4770 into law if it is passed by the Senate. A university official, meanwhile, said the benefits are important for recruiting and keeping top faculty.
Andries Coetzee, who moved to Ann Arbor from South Africa 10 years ago, told AnnArbor.com that Michigan is “moving in the opposite direction” of other states. The linguistics professor said he’s already looking for a new job.
“I question my decision to come to Michigan,” said Coetzee, who turned down an offer at the same time from New York University.
“I chose Michigan because it just seemed better. But now New York just made same-sex marriage legal and now in Michigan they want people like my partner to not get treated.”
Coetzee said health insurance has helped his seven-year partner, Gary Woodall, whose cancer is in remission.
Rep. Dave Agema, R-Grandville, said taxpayers shouldn’t pay for the benefits, whether domestic partners are same sex or male and female.
“Providing benefits in this way is not the role of the state, especially when tax dollars are in short supply and there are critical programs being affected by the decrease in revenue,” Agema said.
He did not, however, call for the repeal of benefits for married couples to save money.
The university is concerned about eliminating benefits.
“We’re in competition on a lot of levels. This would be an added competitive disadvantage,” said Cynthia Wilbanks, U-M’s vice president of government relations.
U-M Latin professor Sara Ahbel-Rappe predicts an exodus of professors if the bill becomes law.
“It’s a total slap in the face. It tells me that I don’t deserve the same consideration” as married heterosexual couples, Ahbel-Rappe said.
Critics of the legislation believe the University of Michigan, Michigan State University and Wayne State University still might be able to offer benefits because the schools are run by elected, independent boards.
Radio host Linda Harvey of Mission America went on an anti-gay rant during her “Christian” radio show yesterday, warning parents to keep their children away from LGBT healthcare professionals. Her implication was that exposing young kids to LGBT people in a medical setting could turn them gay.
Harvey acknowledged that LGBT healthcare professionals “can be certainly competent workers,” but she expressed concerns that “their involvement with your child during a hospital stay is sure to be an influence … they are tacking on to their workplace identity one that is highly offensive to many people and can be erroneously influential to children who won’t, or shouldn’t, see the whole picture of how this behavior really manifests itself.”
“(Let’s) say your 11-year-old has broken her leg rather badly and needs to be in the hospital a few days, which would you prefer: a nurse who’s proud of her lesbianism, who has rainbow identifiers on her work clothing, or a nurse who does not?” Harvey asked listeners.
Harvey indicated that it was OK to allow openly gay or lesbian doctors and nurses to treat children under emergency circumstances. But otherwise she advised parents to “write a letter that you file with your pediatrician that should your child ever be hospitalized, you do not want your child to be treated or cared for” by an out gay person.
Republicans who control the Michigan House of Representatives passed legislation on Sept. 15 to prohibit public employees from sharing their health benefits with their domestic partners.
The 64-44 to vote was mostly along party lines. The measure goes next to the Republican-led Senate, where it’s also expected to pass.
The Associated Press reports that it’s unclear how much impact the legislation would have if it became law. It’s written to apply to “all public employers to the greatest extent consistent with constitutionally allocated powers.”
Democrats who opposed the legislation say it is unconstitutional and would be challenged in court. They say public universities have the constitutional authority to determine their own policies, and that the Michigan Civil Service Commission has the power to make decisions about what kinds of benefits are offered to many state employees.
The civil service commission voted early this year to allow domestic partner benefits for some state employees starting in October. Republicans tried to overturn the decision but couldn’t get the two-thirds majority vote needed in the House.
– From staff and wire reports
By a vote of 10 to 6, the Appleton Common Council approved a measure extending healthcare and related employment benefits to the registered domestic partners of city workers on Sept. 7.
The move makes the city a more competitive recruiter, said Mayor Tim Hanna.
“We do want to be able to attract good, talented employees and retain good, talented employees and level the playing field in terms of access to benefits,” Hanna told council members.
The decision also marks an important victory for fairness, said Fair Wisconsin executive director Katie Belanger. “Appleton’s vision for creating an inclusive and welcoming workplace makes them a leader in our efforts to build a more fair and just state for all Wisconsinites,” Belanger said.
Belanger singled out Hanna, Alds. Teege Mettille, Christoph Wahl and Kole Oswald, as well as Appleton human resources director Sandy Neisen, for praise.
The benefit expansion was opposed by aldermen who said the estimated $100,000 price tag is too high.
The addition of domestic partner benefits in Appleton was part of a larger plan to standardize benefit packages for non-union employees after a state law adopted earlier this year eliminated most collective bargaining rights for state unions.
Appleton’s extension of domestic partnership benefits comes after Milwaukee County passed a similar law this summer. The state of Wisconsin, the city of Milwaukee, Marquette University, Kimberly-Clark, Aurora Health Care and MillerCoors are among the state’s many major employers also offering the benefits.
– Louis Weisberg
What a difference a year makes.
Last year I was at our state Capitol watching former Gov. Jim Doyle sign the Healthy Youth Act, a long-overdue law ensuring that Wisconsin youth get accurate and age-appropriate information in Wisconsin sex education classrooms.
Fast forward to today, when we are facing serious attacks on access to healthcare at the state and federal level.
At the state level, I join with the chorus of tens of thousands of Wisconsinites outraged at the overreach of conservative politicians working to advance an extreme agenda in a Trojan horse barreling through a purported state of fiscal emergency.
Gov. Scott Walker, who has been a staunch opponent of reproductive healthcare his entire political career, now wants his unelected political appointees to be able to make drastic changes to Wisconsin’s successful BadgerCare Family Planning program through the so-called Budget Repair Bill, which is a power grab unlike anything we have seen before.
And in his budget proposal, Walker completely eliminates the state’s only dedicated family-planning funding stream, while pushing to allow insurance plans to exclude prescription birth control in drug plans.
The budget also gives the state Department of Health and Human Services the power to make men ineligible for reproductive healthcare under Medicaid, which currently covers HIV and other STD testing and treatment, cancer screenings and contraceptive counseling.
While all eyes are on the deep cuts for Wisconsin workers, children and families in Walker’s budget proposal, an all-out war on women is also being waged in Congress. Five of Wisconsin’s eight U.S. representatives voted to prohibit Planned Parenthood health centers from receiving any federal funds for the basic preventive healthcare we provide to millions of patients throughout the country, including more than 73,000 un- and under-insured Wisconsinites, more than 31,000 of whom seek care at our Milwaukee health centers.
One in five women has relied on Planned Parenthood for basic women’s healthcare at some point in their lives, and 60 percent of our patients consider us to be their only healthcare provider.
These same representatives also voted to eliminate Title X, America’s decades-old family planning program. We appreciate our Reps. Gwen Moore, Ron Kind and Tammy Baldwin for recognizing that, at $317 million, less than 0.1 percent of the federal budget, Title X is a small price to pay for more than 4 million lifesaving cancer screenings and over 6 million STD tests, including a million HIV tests, for women who otherwise would have nowhere to turn.
None of these funds pays for abortions.
It’s no understatement to say that the state and federal attacks mean we’re in the midst of the most aggressive political assault on women’s health in history. And while this plays out, women’s lives hang in the balance.
Take, for instance, this story: In the wake of the U.S. House vote to eliminate Title X and defund Planned Parenthood, Judy X called me and told me something remarkable: “Honestly, if it wasn’t for Planned Parenthood and Title X funding, I wouldn’t be here today.”
In the early 1990s, Judy was a divorced single mother in her mid-30s going to school and working hard to make ends meet as she raised her daughter in Waukesha. Every year, she came to Planned Parenthood for her annual exam.
One year, out of the blue, a routine pap test came back very abnormal. Planned Parenthood’s nurse referred Judy to an ob/gyn who diagnosed her with a rare form of cervical cancer. The doctor told Judy that if she had skipped her regular check-up that year, the cancer would have been very advanced by the time she showed symptoms.
Judy credits Planned Parenthood with saving her life.
In attacking Planned Parenthood, politicians who want to overturn Roe v. Wade are undermining the organization that does more than any other to prevent unintended pregnancy. In eliminating funding for reproductive healthcare, politicians are taking away the preventive healthcare currently available to 73,000 un- and under-insured Wisconsinites seeking care at Planned Parenthood of Wisconsin.
This reckless political assault needs to end.