latimes--2020-12-09--With 'a lot to lose,' dialysis firms spend big, become California power players

The nation ’ s dialysis industry has poured $ 233 million into California campaigns over the past four years , establishing its leading companies as a formidable political force eager to protect their bottom line and influence state policy .
Most of the money the industry spent from Jan. 1 , 2017 , through Nov. 30 , 2020 , funded the defeat of two union-backed ballot measures that would have regulated dialysis clinics — and eaten into their profits .
But the companies and their trade association also stepped up their offense , dedicating about $ 16.4 million to lobbying @ @ @ @ @ @ @ , a California Healthline analysis of state campaign finance records shows .
Nearly every member of the legislature , Democratic Gov .
Gavin Newsom and his predecessor , former Gov .
Jerry Brown , the Democratic and Republican parties , and dozens of political campaigns — including some local school board and city council races — received a contribution from a dialysis company .
“ These are very large , very profitable companies , ” said Mark Stephens , founder of Prima Health Analytics , a health economics research and consulting firm .
@ @ @ @ @ @ @ .
The fear would be that if some of this stuff passed in California , the union would certainly try to get similar measures on the ballot or in the legislatures in other states .
The stakes are higher than just California for them.
” California has about 600 dialysis clinics , which are visited by an estimated 80,000 patients each month , typically three times a week .
At the clinics , patients are hooked up to machines that filter toxins and remove excess fluid from their blood because their kidneys can @ @ @ @ @ @ @ , which covers most dialysis patients , pays a base rate of $ 239.33 for each dialysis treatment .
DaVita and Fresenius Medical Care North America are the largest dialysis providers in the state and country , operating roughly 80 % of clinics nationwide .
Last year , DaVita reported $ 811 million in net income , on revenue of $ 11.4 billion .
Fresenius posted $ 2 billion in operating income on revenue of $ 13.6 billion .
DaVita was responsible for about $ 143 million — or more than three-fifths — @ @ @ @ @ @ @ four years , and Fresenius gave about $ 68 million .
Until four years ago , the dialysis industry ’ s political spending was relatively modest compared with that of the hospital , physician and other health care associations so well known in Sacramento .
In those days , dialysis lobbyists focused on regulatory issues and health care reimbursement rates , and companies gave minimal campaign contributions .
The industry ’ s transformation into one of the biggest spenders in California politics began in 2017 , the first of four years in which @ @ @ @ @ @ @ In 2017 , a Democratic lawmaker introduced a bill that would have set strict staff ratios at dialysis clinics .
The bill , SB-349 , which failed , had faced opposition from the California Hospital Association , the California Chamber of Commerce and the dialysis industry .
The SEIU-United Healthcare Workers West union ( SEIU-UHW ) followed the next year with Proposition 8 , a ballot initiative that would have capped industry profits .
DaVita and Fresenius were forced to defend their huge profits and allegations of subpar patient care , turning the @ @ @ @ @ @ @ politics .
The industry spent $ 111 million to successfully defeat the measure , breaking the record for spending by one side on an initiative .
“ I think it ’ s very natural for these private chains to spend millions to make billions of profits , ” said Ryan McDevitt , associate professor of economics at Duke University .
“ They ’ re lobbying to protect their profits.
” Last year , the industry fought AB-290 , a bill that aimed to stop a billing practice dialysis companies use to get higher @ @ @ @ @ @ @ But the legislature wasn ’ t swayed , and Newsom signed the bill into law , which is now tied up in federal court .
And this year , the industry spent $ 105 million to block Proposition 23 , which would have required every clinic have a physician on-site and institute other patient safety protocols .
Kent Thiry , the former chairman and CEO of DaVita , said the industry had no choice but to spend heavily to defeat the ballot measures , which he said would have increased costs and harmed @ @ @ @ @ @ @ that , you have to use some of your money to defend yourself , your patients and your teammates , ” Thiry said in an interview with KHN , which publishes California Healthline .
“ It forces companies to allocate precious resources to do something that never should have been brought up to start with.
” In an emailed statement , DaVita said it would continue to work to “ educate lawmakers and defend against policy measures that are harmful to our patients.
” Fresenius also defended its advocacy , saying the company @ @ @ @ @ @ @ intent on abusing the political system .
The company will “ continue to support legislation that improves access to quality care and improves patient outcomes , ” said David Puffer , a company spokesperson .
By comparison , SEIU-UHW , which sponsored the ballot measures , spent about $ 25 million to advocate for the initiatives , and $ 7.8 million on lobbying and political contributions .
The union lobbies lawmakers on a wide array of health care issues “ They ’ ve got tons of money .
We understand that , ” @ @ @ @ @ @ @ s president .
“ We ’ ve seen them spend a quarter of a billion dollars in a very short period of time .
I hope they ’ re prepared to spend another quarter of a billion dollars , because we ’ re not going to go away until there ’ s legitimate common sense reforms to this industry.
” While most of dialysis companies ’ political spending in California has been used to defeat ballot measures , several of the largest companies also dedicated about $ 16.4 million to lobbying and political @ @ @ @ @ @ @ The companies and their trade association , the California Dialysis Council , put almost three-fourths of that — nearly $ 12 million — into hiring veteran lobbyists to advocate for dialysis companies when lawmakers consider legislation that could affect the industry .
For instance , when Newsom took office in 2019 , both DaVita and Fresenius added Axiom Advisors to their lobbying teams , paying it $ 737,500 since then .
One of the firm ’ s partners is Newsom ’ s longtime friend Jason Kinney , whose close relationship with the governor @ @ @ @ @ @ @ dinner fiasco .
Newsom came under intense criticism for attending the early November dinner at the exclusive restaurant , held to celebrate Kinney ’ s birthday , because he and his administration were asking Californians not to gather .
The industry has also given at least $ 4.6 million in contributions to political candidates and committees , both directly and to entities on behalf of a lawmaker or candidate .
All but five state senators and Assembly members who served during the 2019-20 legislative session received a direct contribution from at least one @ @ @ @ @ @ @ Council .
Most of the donations to individuals went to state lawmakers , but DaVita dipped into local races , too .
For instance , it contributed $ 10,000 to a Glendale city council candidate in February , $ 7,700 to an El Monte school board candidate in October and $ 3,500 to a Signal Hill city council candidate last year .
Dialysis companies also gave to the state Democratic and Republican parties .
“ They ’ re spreading it out .
They ’ re doing the full gambit , ” said Bob @ @ @ @ @ @ @ California Fair Political Practices Commission , which enforces state political campaign and lobbying laws .
State law limits how much a company or person can give to a political candidate in an election , but there are legal loopholes that allow individuals and corporate interests to give more .
The dialysis industry has taken advantage of them .
Under state campaign finance rules , lawmakers can accept only $ 4,700 from any one person or company per election .
But some lawmakers operate “ ballot measure committees ” so they can accept unlimited @ @ @ @ @ @ @ advocate for a ballot measure , but lawmakers often use them to pay for political consultants and marketing , and to contribute to state and local initiatives they support .
Candidates can also get unlimited help from donors who independently pay for campaign costs , such as mailings and digital campaign ads .
For instance , DaVita chipped in $ 93,505 to help pay for a direct mail campaign on behalf of state Sen. Steve Glazer ( D-Orinda ) in this year ’ s primary election .
Glazer also received $ 55,600 from @ @ @ @ @ @ @ Council in contributions to himself and his ballot committee , Citizens for a Better California .
In some cases , lawmakers such as Glazer who netted some of the biggest contributions from dialysis companies voted with the industry .
That was the case last year when the legislature approved AB-290 , the bill limiting the dialysis billing practice .
Glazer voted no , as did Assembly member Adam Gray ( D-Merced ) , whose Valley Solutions ballot measure committee had received $ 112,500 from DaVita and Fresenius since 2017 .
Gray also received @ @ @ @ @ @ @ , DaVita and U.S. Renal Care .
Gray issued a statement saying campaign contributions play “ zero role ” in how he represents his district .
Glazer did not respond to a request for comment .
Assembly member Reggie Jones-Sawyer ’ s 84-year-old mother is on dialysis .
The Los Angeles Democrat and SEIU-UHW member has called for improved staffing ratios at dialysis clinics and has voted repeatedly to regulate them .
DaVita wrote a $ 249,000 check in October to a political committee supporting Jones-Sawyer ’ s opponent , Efren Martinez , @ @ @ @ @ @ @ considered more friendly .
DaVita followed up with a $ 15,000 check the week before the election .
Jones-Sawyer , who won the race , said he ’ s frustrated dialysis companies aren ’ t willing to make changes to improve patient safety on their own , saying it would cost them far less than the nearly quarter-billion dollars they have spent on political contributions .
So for now , he said , he will continue to push to improve conditions at dialysis clinics from the Capitol , despite the industry ’ s @ @ @ @ @ @ @ dialysis is saying , ‘ Look , we can be the 800-pound gorilla now , ’ ” Sawyer said .
“ It ’ s not just influence for a day ; it ’ s longevity.
” Rae Ellen Bichell and Elizabeth Lucas of KHN contributed to this report , which was produced by KHN ( Kaiser Health News ) .
KHN publishes California Healthline , an editorially independent service of the California Health Care Foundation .
KHN is not affiliated with Kaiser Permanente .
Among the ways dialysis companies exert influence on the @ @ @ @ @ @ @ campaigns ; hiring lobbyists ; and paying for advertising and marketing on behalf of candidates .
• Opposition to ballot measures : Using the California secretary of state ’ s website , California Healthline downloaded the contributions made by DaVita , Fresenius Medical Care North America , U.S. Renal Care , Satellite Healthcare , Dialysis Clinic Inc. and American Renal Management to the campaign committees formed to defeat Propositions 8 and 23 .
This includes some non-monetary contributions .
• Lobbying : We created a spreadsheet of expenses reported on lobbying disclosure forms @ @ @ @ @ @ @ state ’ s website , by DaVita , Fresenius , U.S. Renal Care , Satellite Healthcare and the California Dialysis Council .
We found details about how much the industry paid lobbying firms , what agencies it lobbied and which bills it tracked .
• Political contributions : DaVita , Fresenius , U.S. Renal Care and the California Dialysis Council made direct contributions to more than 100 candidates , which we compiled from the secretary of state ’ s website .
DaVita and Fresenius made other contributions , often large , to Democratic @ @ @ @ @ @ @ committees led by lawmakers .
The two companies also made contributions known as “ independent expenditures ” that benefited candidates ’ campaigns and “ behested payments , ” which are donations to nonprofit organizations and charities in lawmakers ’ names .
Behested payments are disclosed on the California Fair Political Practices Commission website .
• The SEIU-United Health Care West union uses two political committees for its giving .
Its PAC contributes mostly to lawmakers and county and state Democratic parties while its Issues Committee gives to local hospital ballot measures .
We @ @ @ @ @ @ @ ballot measures for this story , but we did include contributions made by the Issues Committee to the California Democratic Party , which helps state lawmakers .

Giraldo Garcia, left, waits for dialysis to start as patient care technician Leodegario Ventura prepares him for the process in this 2014 file photo at a DaVita Dialysis Center in Inglewood.
The nation’s dialysis industry has poured $233 million into California campaigns over the past four years, establishing its leading companies as a formidable political force eager to protect their bottom line and influence state policy.
Most of the money the industry spent from Jan. 1, 2017, through Nov. 30, 2020, funded the defeat of two union-backed ballot measures that would have regulated dialysis clinics — and eaten into their profits. But the companies and their trade association also stepped up their offense, dedicating about $16.4 million to lobbying and political contributions during the same period, a California Healthline analysis of state campaign finance records shows.
For the record: An earlier version of this story misidentified Brad Puffer, spokesman for Fresenius Medical Care North America.
Nearly every member of the legislature, Democratic Gov. Gavin Newsom and his predecessor, former Gov. Jerry Brown, the Democratic and Republican parties, and dozens of political campaigns — including some local school board and city council races — received a contribution from a dialysis company.
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“These are very large, very profitable companies,” said Mark Stephens, founder of Prima Health Analytics, a health economics research and consulting firm. “They have a lot to lose. The fear would be that if some of this stuff passed in California, the union would certainly try to get similar measures on the ballot or in the legislatures in other states. The stakes are higher than just California for them.”
Staking ground in Sacramento
California has about 600 dialysis clinics, which are visited by an estimated 80,000 patients each month, typically three times a week. At the clinics, patients are hooked up to machines that filter toxins and remove excess fluid from their blood because their kidneys can no longer do the job.
Medicare, which covers most dialysis patients, pays a base rate of $239.33 for each dialysis treatment.
DaVita and Fresenius Medical Care North America are the largest dialysis providers in the state and country, operating roughly 80% of clinics nationwide. Last year, DaVita reported $811 million in net income, on revenue of $11.4 billion. Fresenius posted $2 billion in operating income on revenue of $13.6 billion.
DaVita was responsible for about $143 million — or more than three-fifths — of the political spending in the past four years, and Fresenius gave about $68 million.
Until four years ago, the dialysis industry’s political spending was relatively modest compared with that of the hospital, physician and other health care associations so well known in Sacramento. In those days, dialysis lobbyists focused on regulatory issues and health care reimbursement rates, and companies gave minimal campaign contributions.
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The industry’s transformation into one of the biggest spenders in California politics began in 2017, the first of four years in which it faced ballot or legislative threats. In 2017, a Democratic lawmaker introduced a bill that would have set strict staff ratios at dialysis clinics. The bill, SB-349, which failed, had faced opposition from the California Hospital Association, the California Chamber of Commerce and the dialysis industry.
The SEIU-United Healthcare Workers West union (SEIU-UHW) followed the next year with Proposition 8, a ballot initiative that would have capped industry profits.
DaVita and Fresenius were forced to defend their huge profits and allegations of subpar patient care, turning the competitors into allies — at least in politics.
The industry spent $111 million to successfully defeat the measure, breaking the record for spending by one side on an initiative.
“I think it’s very natural for these private chains to spend millions to make billions of profits,” said Ryan McDevitt, associate professor of economics at Duke University. “They’re lobbying to protect their profits.”
Last year, the industry fought AB-290, a bill that aimed to stop a billing practice dialysis companies use to get higher insurance reimbursements for some low-income patients. But the legislature wasn’t swayed, and Newsom signed the bill into law, which is now tied up in federal court.
And this year, the industry spent $105 million to block Proposition 23, which would have required every clinic have a physician on-site and institute other patient safety protocols.
Kent Thiry, the former chairman and CEO of DaVita, said the industry had no choice but to spend heavily to defeat the ballot measures, which he said would have increased costs and harmed patient care.
“When someone does that, you have to use some of your money to defend yourself, your patients and your teammates,” Thiry said in an interview with KHN, which publishes California Healthline. “It forces companies to allocate precious resources to do something that never should have been brought up to start with.”
In an emailed statement, DaVita said it would continue to work to “educate lawmakers and defend against policy measures that are harmful to our patients.” Fresenius also defended its advocacy, saying the company needs to protect itself against special interests intent on abusing the political system. The company will “continue to support legislation that improves access to quality care and improves patient outcomes,” said Brad Puffer, a company spokesperson.
By comparison, SEIU-UHW, which sponsored the ballot measures, spent about $25 million to advocate for the initiatives, and $7.8 million on lobbying and political contributions. The union lobbies lawmakers on a wide array of health care issues
“They’ve got tons of money. We understand that,” said Dave Regan, the union’s president. “We’ve seen them spend a quarter of a billion dollars in a very short period of time. I hope they’re prepared to spend another quarter of a billion dollars, because we’re not going to go away until there’s legitimate common sense reforms to this industry.”
From defense to offense
While most of dialysis companies’ political spending in California has been used to defeat ballot measures, several of the largest companies also dedicated about $16.4 million to lobbying and political contributions over the past four years.
The companies and their trade association, the California Dialysis Council, put almost three-fourths of that — nearly $12 million — into hiring veteran lobbyists to advocate for dialysis companies when lawmakers consider legislation that could affect the industry.
For instance, when Newsom took office in 2019, both DaVita and Fresenius added Axiom Advisors to their lobbying teams, paying it $737,500 since then. One of the firm’s partners is Newsom’s longtime friend Jason Kinney, whose close relationship with the governor was highlighted by the recent French Laundry dinner fiasco. Newsom came under intense criticism for attending the early November dinner at the exclusive restaurant, held to celebrate Kinney’s birthday, because he and his administration were asking Californians not to gather.
The industry has also given at least $4.6 million in contributions to political candidates and committees, both directly and to entities on behalf of a lawmaker or candidate.
All but five state senators and Assembly members who served during the 2019-20 legislative session received a direct contribution from at least one of the companies or the California Dialysis Council.
Most of the donations to individuals went to state lawmakers, but DaVita dipped into local races, too. For instance, it contributed $10,000 to a Glendale city council candidate in February, $7,700 to an El Monte school board candidate in October and $3,500 to a Signal Hill city council candidate last year.
Dialysis companies also gave to the state Democratic and Republican parties.
“They’re spreading it out. They’re doing the full gambit,” said Bob Stern, former general counsel for the California Fair Political Practices Commission, which enforces state political campaign and lobbying laws.
Legal loopholes
State law limits how much a company or person can give to a political candidate in an election, but there are legal loopholes that allow individuals and corporate interests to give more. The dialysis industry has taken advantage of them.
Under state campaign finance rules, lawmakers can accept only $4,700 from any one person or company per election.
But some lawmakers operate “ballot measure committees” so they can accept unlimited contributions. These committees are supposed to advocate for a ballot measure, but lawmakers often use them to pay for political consultants and marketing, and to contribute to state and local initiatives they support. Candidates can also get unlimited help from donors who independently pay for campaign costs, such as mailings and digital campaign ads.
For instance, DaVita chipped in $93,505 to help pay for a direct mail campaign on behalf of state Sen. Steve Glazer (D-Orinda) in this year’s primary election. Glazer also received $55,600 from DaVita, Fresenius and the California Dialysis Council in contributions to himself and his ballot committee, Citizens for a Better California.
In some cases, lawmakers such as Glazer who netted some of the biggest contributions from dialysis companies voted with the industry. That was the case last year when the legislature approved AB-290, the bill limiting the dialysis billing practice.
Glazer voted no, as did Assemblyman Adam Gray (D-Merced), whose Valley Solutions ballot measure committee had received $112,500 from DaVita and Fresenius since 2017. Gray also received $36,900 in direct contributions from Fresenius, DaVita and U.S. Renal Care.
Gray issued a statement saying campaign contributions play “zero role” in how he represents his district. Glazer did not respond to a request for comment.
Targeting legislative adversaries
Assemblyman Reggie Jones-Sawyer’s 84-year-old mother is on dialysis. The Los Angeles Democrat and SEIU-UHW member has called for improved staffing ratios at dialysis clinics and has voted repeatedly to regulate them.
DaVita wrote a $249,000 check in October to a political committee supporting Jones-Sawyer’s opponent, Efren Martinez, another Democrat, but one the industry considered more friendly. DaVita followed up with a $15,000 check the week before the election.
Jones-Sawyer, who won the race, said he’s frustrated dialysis companies aren’t willing to make changes to improve patient safety on their own, saying it would cost them far less than the nearly quarter-billion dollars they have spent on political contributions. So for now, he said, he will continue to push to improve conditions at dialysis clinics from the Capitol, despite the industry’s growing political clout.
“I think dialysis is saying, ‘Look, we can be the 800-pound gorilla now,’” Sawyer said. “It’s not just influence for a day; it’s longevity.”
Young writes for Kaiser Health News. Rae Ellen Bichell and Elizabeth Lucas of KHN contributed to this report. KHN publishes California Healthline, an editorially independent service of the California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.
METHODOLOGY
How California Healthline compiled data about dialysis companies’ political spending:
Among the ways dialysis companies exert influence on the political process is by contributing money to campaigns; hiring lobbyists; and paying for advertising and marketing on behalf of candidates.


latimes--2020-12-09--Hospital ICUs full in Silicon Valley, Central Valley as California braces for more

From Silicon Valley to Fresno , hospital intensive care units began reaching capacity Tuesday as California continued to set new records for coronavirus cases that officials fear will get worse in the coming days .
The high transmission rates come after weeks of warnings that hospitals could be overwhelmed as serious coronavirus cases spike to unprecedented levels .
Officials warn the ICUs that filled up could be just the beginning .
The situation elsewhere in the state was somewhat better but still critical .
Capacity remained at about 10 % in Southern California , 24 % in the Bay Area @ @ @ @ @ @ @ but less than 6 % in the Central Valley .
Meanwhile , the state hit grim new milestones .
California surpassed 20,000 deaths and Los Angeles County surpassed 8,000 deaths .
California reported 35,400 new coronavirus cases on Tuesday , according to a Times county-by-county tally , and more than 219 deaths — both records for a single day .
The latest tally means an average of 135 Californians have died each day over the past week — a number not seen since August — and nearly 25,000 people tested positive for the @ @ @ @ @ @ @ twice as bad as the peak of the summer surge .
About 1 in 8 of those testing positive are expected to need hospital care in the coming weeks as the virus further replicates in their bodies , causing illnesses like pneumonia and shortness of breath , and in severe situations , respiratory failure and failure of multiple organs .
Officials expect cases and hospitalizations to keep rising as more people who got sick during Thanksgiving show symptoms .
They urged residents to follow new stay-at-home rules in effect for 84 % of @ @ @ @ @ @ @ said marked the best hope for bending the curve .
“ Our message is : As much as you can , stay at home , ” Dr. Mark Ghaly , California ’ s health and human services secretary , said Tuesday .
“ We know that it works .
We know that we can bring our transmission rates down.
” At least three counties in the San Joaquin Valley have reached 0 % capacity in their hospitals ’ intensive care units , making the state ’ s agricultural hub the first area in @ @ @ @ @ @ @ a population of almost 1 million people , Fresno County faces a potentially dire situation , overshadowing its smaller neighbors Madera County , to the north , and Kings County , to the south .
“ All the things that you ’ re hearing about how impacted our hospitals are , about how dire this situation with our ICUs is : it ’ s absolutely true , ” said Dr. Rais Vohra , Fresno County Department of Public Health ’ s interim health officer .
“ That really is the reason that we @ @ @ @ @ @ @ as possible , at least for the next few weeks , until we get this surge under control , as we try to work through the hospitalizations that are just coming in so quickly and try to provide the best care.
” ICU beds come with specially trained healthcare professionals and high-tech equipment that can mean the difference between life and death for very sick patients .
They are especially critical for patients with severe cases of COVID-19 , who may require ventilators and round-the-clock care .
Vohra emphasized that the 0 % @ @ @ @ @ @ @ ” — the number changes as patients shift to higher or lower levels of care .
With ICU capacity depleted , patients with serious COVID-19 cases may take up open beds in the emergency department , said Fresno County emergency medical services director Dan Daniel J. Lynch .
He said the county expects to activate an alternate care site for overflow patients at the Porterville Developmental Center on Monday .
The facility , which can hold 123 people , would begin with 20 to 25 patients while waiting for ICU staffing to ramp @ @ @ @ @ @ @ at hospitals in the San Joaquin Valley during a Tuesday news conference , Ghaly said it has been getting more difficult to secure additional staffing when counties call for help .
“ We ’ re fulfilling what we can .
But it is getting harder .
We know that staff is our main scarce resource , ” Ghaly said .
“ Our requests , both across the state and the nation , are hard to fulfill because of what ’ s happening across America with COVID.
” Nonetheless , with the extreme shortage @ @ @ @ @ @ @ Valley , the region is a priority for additional staffing requests , Ghaly said .
The ICU shortage was a devastating blow for California ’ s 10th most populous county , after almost 10 months battling the contagion .
Miguel Arias , president of the Fresno City Council , said he and his colleagues have been working furiously to avoid reaching this point .
They have fined businesses that violate health orders , distributed protective equipment and sanitizers and asked people to wear masks and maintain social distance .
“ Even with all @ @ @ @ @ @ @ point where , Monday , we officially reached that epicenter that we ’ ve all been trying to avoid , ” Arias said in an interview Tuesday .
In Santa Clara County , the situation at hospitals was also deteriorating .
On Tuesday , Santa Clara County was down to only 31 available intensive care unit beds — just 9.5 % of its capacity — to serve Northern California ’ s most populous county , home to nearly 2 million people .
“ It is the worst we have seen , and it @ @ @ @ @ @ @ said Dr. Ahmad Kamal , Santa Clara County director of health preparedness .
“ Hospitals are nearing capacity , our staffing is stretched thin — not just in our county , but throughout the state and throughout the nation.
” Hospitals have started to cancel scheduled surgeries to create more capacity for the sickest patients .
By noon Tuesday , there were more than 400 coronavirus-positive patients in Santa Clara County ’ s hospitals , including 12 children .
There were fewer than 100 before election day , Nov. 3 .
“ We @ @ @ @ @ @ @ , ” Kamal said .
“ We have more than doubled our ICU census in the last two weeks .
Our system can not withstand another doubling.
” Even more alarming than the hospitalized patient total is how fast ICU beds are filling .
“ Much more concerning than the low vacancy is the rate at which we are filling .
As of today , 8 out of 10 hospitals have fewer than five ICU beds remaining , with some having zero , ” Kamal said .
Officials may seek to open up @ @ @ @ @ @ @ up to 36 sub-acute patients and ask patients to collect their own specimen samples to free up clinical staff .
Santa Clara County is also looking for additional staff from the state or National Guard , although state officials have warned that the supply of extra medical staff is limited .
The new stay-at-home order imposed this week requires affected communities to limit most retail capacity to 20 % and to close hair salons , nail salons , public outdoor playgrounds , card rooms , museums , zoos , aquariums and wineries .
@ @ @ @ @ @ @ or delivery as indoor and outdoor dining are banned .
The new order has prompted a backlash from some merchants , including restaurant owners who say the suspension of outdoor dining in L.A. County in unfair and could destroy their businesses .
In a decision announced Tuesday , a judge curtailed an outdoor dining ban issued by Los Angeles County officials , even as a state order that superseded the county order will keep the restriction in place past Christmas .
Regardless of the state ’ s order , if L.A. County wants @ @ @ @ @ @ @ county public health officials must conduct a risk-benefit analysis to show the measure is warranted , L.A. Superior Court Judge James Chalfant said in his decision .
The state ’ s targeted stay-at-home order , which rolled out across most of California late Sunday , prevents outdoor restaurant dining until the critical shortage of ICU beds improves .
The county should not be allowed to keep its own shutdown order indefinitely , the judge added .
The ruling arrives nearly a week after Chalfant ordered the county to that went into effect Nov. @ @ @ @ @ @ @ to last only three weeks , but the county later made the restrictions indefinite , the judge said .
Lin reported from San Francisco , and Pinho , Seidman and Money from Southern California .

Faith E. Pinho, Rong-Gong Lin II, Lila Seidman, Luke Money

Mario Flores views the body of his godfather, Felipe Juarez, at a funeral service held in August in East Los Angeles. Juarez died of COVID-19.
From Silicon Valley to Fresno, hospital intensive care units began reaching capacity Tuesday as California continued to set new records for coronavirus cases that officials fear will get worse in the coming days.
The high transmission rates come after weeks of warnings that hospitals could be overwhelmed as serious coronavirus cases spike to unprecedented levels. Officials warn the ICUs that filled up could be just the beginning.
The situation elsewhere in the state was somewhat better but still critical. Capacity remained at about 10% in Southern California, 24% in the Bay Area, 19% in the Sacramento region but less than 6% in the Central Valley.
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Meanwhile, the state hit grim new milestones. California surpassed 20,000 deaths and Los Angeles County surpassed 8,000 deaths. California reported 35,400 new coronavirus cases on Tuesday, according to a Times county-by-county tally, and 219 deaths — both records for a single day. The latest tally means an average of 135 Californians have died each day over the past week — a number not seen since August — and nearly 25,000 people tested positive for the virus daily, a figure more than twice as bad as the peak of the summer surge.
About 1 in 8 of those testing positive are expected to need hospital care in the coming weeks as the virus further replicates in their bodies, causing illnesses like pneumonia and shortness of breath, and in severe situations, respiratory failure and failure of multiple organs.
Officials expect cases and hospitalizations to keep rising as more people who got sick during Thanksgiving show symptoms. They urged residents to follow new stay-at-home rules in effect for 84% of California’s residents, which officials said marked the best hope for bending the curve.
“Our message is: As much as you can, stay at home,” Dr. Mark Ghaly, California’s health and human services secretary, said Tuesday. “We know that it works. We know that we can bring our transmission rates down.”
At least three counties in the San Joaquin Valley have reached 0% capacity in their hospitals’ intensive care units, making the state’s agricultural hub the first area in California to become maxed out.
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With a population of almost 1 million people, Fresno County faces a potentially dire situation, overshadowing its smaller neighbors Madera County, to the north, and Kings County, to the south.
“All the things that you’re hearing about how impacted our hospitals are, about how dire this situation with our ICUs is: it’s absolutely true,” said Dr. Rais Vohra, Fresno County Department of Public Health’s interim health officer. “That really is the reason that we want everyone to stay home as much as possible, at least for the next few weeks, until we get this surge under control, as we try to work through the hospitalizations that are just coming in so quickly and try to provide the best care.”
ICU beds come with specially trained healthcare professionals and high-tech equipment that can mean the difference between life and death for very sick patients. They are especially critical for patients with severe cases of COVID-19, who may require ventilators and round-the-clock care.
Vohra emphasized that the 0% capacity is a “snapshot in time” — the number changes as patients shift to higher or lower levels of care.
With ICU capacity depleted, patients with serious COVID-19 cases may take up open beds in the emergency department, said Fresno County emergency medical services director Dan Daniel J. Lynch. He said the county expects to activate an alternate care site for overflow patients at the Porterville Developmental Center on Monday. The facility, which can hold 123 people, would begin with 20 to 25 patients while waiting for ICU staffing to ramp up.
When asked about staffing shortages at hospitals in the San Joaquin Valley during a Tuesday news conference, Ghaly said it has been getting more difficult to secure additional staffing when counties call for help.
“We’re fulfilling what we can. But it is getting harder. We know that staff is our main scarce resource,” Ghaly said. “Our requests, both across the state and the nation, are hard to fulfill because of what’s happening across America with COVID.”
Nonetheless, with the extreme shortage of ICU staff in the San Joaquin Valley, the region is a priority for additional staffing requests, Ghaly said.
The ICU shortage was a devastating blow for California’s 10th most populous county, after almost 10 months battling the contagion. Miguel Arias, president of the Fresno City Council, said he and his colleagues have been working furiously to avoid reaching this point. They have fined businesses that violate health orders, distributed protective equipment and sanitizers and asked people to wear masks and maintain social distance.
“Even with all that, we have come to a point where, Monday, we officially reached that epicenter that we’ve all been trying to avoid,” Arias said in an interview Tuesday.
In Santa Clara County, the situation at hospitals was also deteriorating. On Tuesday, Santa Clara County was down to only 31 available intensive care unit beds — just 9.5% of its capacity — to serve Northern California’s most populous county, home to nearly 2 million people.
“It is the worst we have seen, and it’s continuing to worsen,” said Dr. Ahmad Kamal, Santa Clara County director of health preparedness. “Hospitals are nearing capacity, our staffing is stretched thin — not just in our county, but throughout the state and throughout the nation.”
Hospitals have started to cancel scheduled surgeries to create more capacity for the sickest patients. By noon Tuesday, there were more than 400 coronavirus-positive patients in Santa Clara County’s hospitals, including 12 children.
There were fewer than 100 before election day, Nov. 3.
“We are continuing to see a massive increase,” Kamal said. “We have more than doubled our ICU census in the last two weeks. Our system cannot withstand another doubling.”
Even more alarming than the hospitalized patient total is how fast ICU beds are filling. “Much more concerning than the low vacancy is the rate at which we are filling. As of today, 8 out of 10 hospitals have fewer than five ICU beds remaining, with some having zero,” Kamal said.
Officials may seek to open up beds at DePaul Health Center to treat up to 36 sub-acute patients and ask patients to collect their own specimen samples to free up clinical staff. Santa Clara County is also looking for additional staff from the state or National Guard, although state officials have warned that the supply of extra medical staff is limited.
The new stay-at-home order imposed this week requires affected communities to limit most retail capacity to 20% and to close hair salons, nail salons, public outdoor playgrounds, card rooms, museums, zoos, aquariums and wineries. Restaurants are able to offer only takeout or delivery as indoor and outdoor dining are banned.
The new order has prompted a backlash from some merchants, including restaurant owners who say the suspension of outdoor dining in L.A. County in unfair and could destroy their businesses.
In a decision announced Tuesday, a judge curtailed an outdoor dining ban issued by Los Angeles County officials, even as a state order that superseded the county order will keep the restriction in place past Christmas.
Regardless of the state’s order, if L.A. County wants to defend its outdoor dining ban, county public health officials must conduct a risk-benefit analysis to show the measure is warranted, L.A. Superior Court Judge James Chalfant said in his decision.
The state’s targeted stay-at-home order, which rolled out across most of California late Sunday, prevents outdoor restaurant dining until the critical shortage of ICU beds improves. The county should not be allowed to keep its own shutdown order indefinitely, the judge added.
The ruling arrives nearly a week after Chalfant ordered the county to provide scientific evidence justifying the ban that went into effect Nov. 25. The initial ban was scheduled to last only three weeks, but the county later made the restrictions indefinite, the judge said.
Lin reported from San Francisco, and Pinho, Seidman and Money from Southern California.


latimes--2020-12-09--Three daughters mourn fathers in a sisterhood of grief

Her voice flittered from the screen , filling her father ’ s New York City hospital room .
From a couch in her home office in Los Angeles ’ Mar Vista neighborhood , Carolyn Freyer-Jones watched through her laptop as a ventilator forced air into his lungs .
She knew he didn ’ t want to linger — he had made that clear during end-of-life conversations .
I love you , she told him , over and over .
Thank you , and I love you .
“ Don ’ t hang around for us , Dad , ” she @ @ @ @ @ @ @ to go on your birthday , you can go.
” Later that afternoon — nine days after testing positive — her father , Hugh Freyer , a retired banker from the Bronx who for years committed himself fiercely to his sobriety , died on his 86th birthday .
Eight days later , Serena Dobbie , a 37-year-old real estate agent , stood near her own father ’ s hospital bed in Upland , Calif. , crying behind two masks and searching for words to say goodbye .
A month later , Dolly Spadaro @ @ @ @ @ @ @ ’ s Jet Propulsion Laboratory in La Cañada Flintridge , rushed to LAX and sobbed through both legs of her flight to Lebanon , where she ’ d sit down with her mother and break the news of her father ’ s passing .
The three daughters — strangers who crossed paths in a private Facebook group for people who ’ ve lost loved ones to COVID-19 — are now part of a sisterhood of communal grief .
Started in April by two women whose fathers died of the virus , the group @ @ @ @ @ @ @ politics ” and “ science-based posting only ” — now has 3,700 members across the globe who share photos , send one another encouraging notes and commiserate over how much they ’ re dreading their first holidays without their loved ones .
At least once a day , Freyer-Jones scrolls the page and leaves a variation of the same message on a new post : “ I ’ m so sorry that you ’ re here .
You ’ re not alone.
” As thousands of people have privately grieved deaths , illnesses @ @ @ @ @ @ @ sudden recession while in isolation , many have turned to social media for support , solace and answers .
Facebook alone hosts dozens of groups for COVID-19 “ long-haulers , ” who swap information about their lasting symptoms .
More formal avenues of support have also cropped up during the pandemic .
Therapists across the country host COVID-19-related support groups by phone and video conference .
In Los Angeles , Kaiser Permanente started bereavement groups , conducted weekly by phone in English , Spanish and Armenian .
The scope of collective grief and @ @ @ @ @ @ @ said Deborah Serani , and adjunct professor at Adelphi University in New York .
And the next several weeks could be especially hard for many families , she said , adding that it ’ s important to find ways to incorporate memories of loved ones into holiday rituals and traditions .
“ It ’ s a way to say , ‘ What would my Dad wish we could do ?
’ ” she said .
For Freyer-Jones , who works as a life and business coach , one of those new rituals is @ @ @ @ @ @ @ started urging people to set aside 60 seconds a week to think about someone affected by the coronavirus — perhaps a sick friend , a family in mourning or someone who has lost income or educational opportunities .
She views it as a time to slow down — a grounding moment amid the magnitude of our suffering .
On a recent morning , while broadcasting live from her Instagram account , @ thefridayminute , Freyer-Jones — donning a black baseball cap , one of more than 200 from her father ’ s collection @ @ @ @ @ @ @ of meditation .
She said she thinks often of other grieving families whose stories she has learned — the other devastated daughters who had far fewer years with their own fathers .
Women like Dobbie , who watched on a Thursday in July as her 61-year-old father , Eddie Fierro , walked slowly from her childhood home in Rancho Cucamonga , struggling to breathe .
It wasn ’ t safe to share a car , she knew , so he drove himself ; she followed behind , watching as a hospital employee pushed @ @ @ @ @ @ @ wheelchair .
“ I never , ever , ever , ever would have thought he wasn ’ t coming out , ” she said .
At first , he had enough energy to text Dobbie and her younger sister , Lauren Andrews , photos of himself wearing a mask in his hospital room , but soon doctors were mentioning remdesivir and convalescent plasma .
He responded well to the plasma treatment , Dobbie said , and she was able to talk to him on the phone .
I feel like I could walk @ @ @ @ @ @ @ told her .
A day later , he went into cardiac arrest ; five days later , he died .
In an instant , Dobbie and her sister , both in their mid-30s , had lost their father and become caregivers for their mother , who has late-stage Alzheimer ’ s disease .
The sisters wrapped up pending jobs from their father ’ s custom cabinet company — S & L Design , for their initials — and immediately began clearing out their childhood home , knowing they ’ d soon need to @ @ @ @ @ @ @ the cost of caring for their mother in a skilled nursing facility .
Sometimes relatives dropped off food outside the door , but other than their husbands , no one could come in to help .
They knew how contagious this virus is — it had also sickened and hospitalized their mother , their uncle , their grandfather and their grandmother .
Dobbie ’ s days blurred with tears and calls from the Internal Revenue Service .
On Halloween , she saw people on social media posing in spiky red orb costumes .
@ @ @ @ @ @ @ wear masks — calling the coronavirus a hoax .
It felt as if the only people who truly understood her — who knew how triggering it could be to hear a sneeze followed by a joke about “ the ’ rona ” — were the other members of the Facebook group , which she had stumbled upon months earlier while searching for events memorializing the dead .
She hasn ’ t yet shared her own story with the group , Dobbie said , but she comments on as many posts as she can @ @ @ @ @ @ @ lifelong Dodgers fan , died July 22 , hours before the delayed season opener .
During the bottom of the eighth inning , when a single aluminum balloon floated onto the field , she wondered if it was him sending a sign .
A few weeks later , while driving to an anniversary dinner with her husband , another aluminum balloon floated overhead .
This time , she knew .
She has found some peace , Dobbie said , in knowing that her father never lived a day without his beloved wife and @ @ @ @ @ @ @ her condition , she will never fully know a day without him .
From scrolling the Facebook group , Dobbie knew that many daughters were simultaneously grieving their fathers and comforting their mothers .
One of those was Spadaro , the NASA employee , who emigrated 12 years ago from Beirut to Los Angeles .
She was at work one afternoon in August when she peeked down at her phone and saw that her brother was calling .
Her heart sank .
Several days earlier , her 65-year-old father , living in Beirut @ @ @ @ @ @ @ and started to sweat though the night .
Farid Dahdal tried to nurse his symptoms at home , thinking it best to avoid hospitals , many of which had been damaged by the massive explosion in the Mediterranean port city earlier that month .
When he finally went to the hospital , his blood oxygen level had dropped to 93 % , but he was told he could still manage at home .
He returned to the hospital the next day and was admitted , even as doctors assured him that his vitals @ @ @ @ @ @ @ breathing became increasingly labored ; he was put on a ventilator and the next day went into cardiac arrest .
Doctors tried for 40 minutes to revive him .
Spadaro ’ s cousin , a doctor in Lebanon , broke the news to her brother , who then called her .
Their mother , who was quarantining alone after testing positive herself , was unaware , and the siblings couldn ’ t bear to tell her by phone .
What if she fainted ?
And local relatives couldn ’ t visit her at @ @ @ @ @ @ @ and her two brothers frantically booked plane tickets and took coronavirus tests , knowing they ’ d need negative results to be let into Lebanon .
If our mother calls , they begged the hospital , please say our father isn ’ t doing well but remains in critical condition .
When they arrived at their family home in gloves and robes and masks , they sat down and gave their mother the news .
She sobbed , but Spadaro couldn ’ t risk giving her a hug .
Spadaro will return to @ @ @ @ @ @ @ that the home will feel achingly empty .
Dad won ’ t be there cuddling his cat or playing the piano or accordion .
Even the thought of putting up a tree makes her feel nervous .
Her parents had paid off their home earlier this year , and her father ’ s dream of retiring in the U.S. had seemed like more than a distant hope .
Maybe , Spadaro remembers thinking , we ’ ll all finally be in the same place .
“ COVID robbed me of my dreams , @ @ @ @ @ @ @ ’ t dream right now.
” She finds deep comfort and validation in the Facebook group .
Sure , many people survive the virus , but the group reminds her that there are many others whose recently healthy loved ones did not .
It was deeply therapeutic to receive so much encouragement after sharing her story , she said , and these days , she has a little more energy to encourage others , as well .
The only other thing buoying her spirit now , she said , is her faith — @ @ @ @ @ @ @ and heaven awaits .
Sometimes sadness hits like a wave , and she repeats a verse from Corinthians 2 like a mantra : We are afflicted in every way , but not crushed ; perplexed , but not driven to despair .

Carolyn Freyer-Jones, who lost her father to COVID-19, started the movement the Friday Minute, in which she encourages people to set aside 60 seconds each week to focus their thoughts on a person or group suffering from the impacts of the pandemic.
Her voice flittered from the screen, filling her father’s New York City hospital room.
From a couch in her home office in Los Angeles’ Mar Vista neighborhood, Carolyn Freyer-Jones watched through her laptop as a ventilator forced air into his lungs. She knew he didn’t want to linger — he had made that clear during end-of-life conversations. I love you, she told him, over and over. Thank you, and I love you.
“Don’t hang around for us, Dad,” she assured him. “If you want to go on your birthday, you can go.”
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Later that afternoon — nine days after testing positive — her father, Hugh Freyer, a retired banker from the Bronx who for years committed himself fiercely to his sobriety, died on his 86th birthday.
Eight days later, Serena Dobbie, a 37-year-old real estate agent, stood near her own father’s hospital bed in Upland, Calif., crying behind two masks and searching for words to say goodbye. A month later, Dolly Spadaro, a 38-year-old resource analyst at NASA’s Jet Propulsion Laboratory in La Cañada Flintridge, rushed to LAX and sobbed through both legs of her flight to Lebanon, where she’d sit down with her mother and break the news of her father’s passing.
The three daughters — strangers who crossed paths in a private Facebook group for people who’ve lost loved ones to COVID-19 — are now part of a sisterhood of communal grief.
Started in April by two women whose fathers died of the virus, the group — whose ground rules include “no politics” and “science-based posting only” — now has 3,700 members across the globe who share photos, send one another encouraging notes and commiserate over how much they’re dreading their first holidays without their loved ones.
At least once a day, Freyer-Jones scrolls the page and leaves a variation of the same message on a new post: “I’m so sorry that you’re here. You’re not alone.”
As thousands of people have privately grieved deaths, illnesses and the stresses of living through a sudden recession while in isolation, many have turned to social media for support, solace and answers. Facebook alone hosts dozens of groups for COVID-19 “long-haulers,” who swap information about their lasting symptoms.
More formal avenues of support have also cropped up during the pandemic. Therapists across the country host COVID-19-related support groups by phone and video conference. In Los Angeles, Kaiser Permanente started bereavement groups, conducted weekly by phone in English, Spanish and Armenian.
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Serena Dobbie, 37, lost her father, Eddie Fierro, 61, to COVID-19 in July. At one point, five of her relatives were hospitalized with the disease. (Gina Ferazzi / Los Angeles Times)
The scope of collective grief and isolation is unparalleled in recent history, said Deborah Serani, a psychologist and adjunct professor at Adelphi University in New York. And the next several weeks could be especially hard for many families, she said, adding that it’s important to find ways to incorporate memories of loved ones into holiday rituals and traditions.
“It’s a way to say, ‘What would my Dad wish we could do?’” she said.
For Freyer-Jones, who works as a life and business coach, one of those new rituals is the Friday Minute, a movement she started urging people to set aside 60 seconds a week to think about someone affected by the coronavirus — perhaps a sick friend, a family in mourning or someone who has lost income or educational opportunities.
Carolyn Freyer-Jones, a life and business coach, helps followers meditate via her movement the Friday Minute. (Wally Skalij / Los Angeles Times)
She views it as a time to slow down — a grounding moment amid the magnitude of our suffering.
On a recent morning, while broadcasting live from her Instagram account, @thefridayminute, Freyer-Jones — donning a black baseball cap, one of more than 200 from her father’s collection — led her followers through 60 seconds of meditation. She said she thinks often of other grieving families whose stories she has learned — the other devastated daughters who had far fewer years with their own fathers.
Women like Dobbie, who watched on a Thursday in July as her 61-year-old father, Eddie Fierro, walked slowly from her childhood home in Rancho Cucamonga, struggling to breathe.
It wasn’t safe to share a car, she knew, so he drove himself; she followed behind, watching as a hospital employee pushed him into the emergency room in a wheelchair.
“I never, ever, ever, ever would have thought he wasn’t coming out,” she said.
At first, he had enough energy to text Dobbie and her younger sister, Lauren Andrews, photos of himself wearing a mask in his hospital room, but soon doctors were mentioning remdesivir and convalescent plasma. He responded well to the plasma treatment, Dobbie said, and she was able to talk to him on the phone. I feel like I could walk out of the hospital today, he told her.
A day later, he went into cardiac arrest; five days later, he died.
In an instant, Dobbie and her sister, both in their mid-30s, had lost their father and become caregivers for their mother, who has late-stage Alzheimer’s disease. The sisters wrapped up pending jobs from their father’s custom cabinet company — S&L Design, for their initials — and immediately began clearing out their childhood home, knowing they’d soon need to put it on the market to cover the cost of caring for their mother in a skilled nursing facility.
After their father died, Serena Dobbie and her sister began preparing for the sale of their childhood home to cover the cost of their mother’s care in a skilled nursing facility. (Gina Ferazzi / Los Angeles Times)
Sometimes relatives dropped off food outside the door, but other than their husbands, no one could come in to help. They knew how contagious this virus is — it had also sickened and hospitalized their mother, their uncle, their grandfather and their grandmother.
Dobbie’s days blurred with tears and calls from the Internal Revenue Service. On Halloween, she saw people on social media posing in spiky red orb costumes. Some of her close friends refused to wear masks — calling the coronavirus a hoax.
It felt as if the only people who truly understood her — who knew how triggering it could be to hear a sneeze followed by a joke about “the ’rona” — were the other members of the Facebook group, which she had stumbled upon months earlier while searching for events memorializing the dead. She hasn’t yet shared her own story with the group, Dobbie said, but she comments on as many posts as she can.
Dobbie’s father, a lifelong Dodgers fan, died July 22, hours before the delayed season opener. During the bottom of the eighth inning, when a single aluminum balloon floated onto the field, she wondered if it was him sending a sign. A few weeks later, while driving to an anniversary dinner with her husband, another aluminum balloon floated overhead. This time, she knew.
After his death from COVID-19, Eddie Fierro’s grieving daughters set his photo near the head of the table during their Thanksgiving meal. (Gina Ferazzi / Los Angeles Times)
She has found some peace, Dobbie said, in knowing that her father never lived a day without his beloved wife and that, because of the severity of her condition, she will never fully know a day without him. From scrolling the Facebook group, Dobbie knew that many daughters were simultaneously grieving their fathers and comforting their mothers.
One of those was Spadaro, the NASA employee, who emigrated 12 years ago from Beirut to Los Angeles. She was at work one afternoon in August when she peeked down at her phone and saw that her brother was calling. Her heart sank.
Several days earlier, her 65-year-old father, living in Beirut, had lost his sense of smell and started to sweat though the night. Farid Dahdal tried to nurse his symptoms at home, thinking it best to avoid hospitals, many of which had been damaged by the massive explosion in the Mediterranean port city earlier that month.
When he finally went to the hospital, his blood oxygen level had dropped to 93%, but he was told he could still manage at home. He returned to the hospital the next day and was admitted, even as doctors assured him that his vitals and prognosis looked good. But his breathing became increasingly labored; he was put on a ventilator and the next day went into cardiac arrest. Doctors tried for 40 minutes to revive him.
Column One A showcase for compelling storytelling from the Los Angeles Times. More stories
Spadaro’s cousin, a doctor in Lebanon, broke the news to her brother, who then called her. Their mother, who was quarantining alone after testing positive herself, was unaware, and the siblings couldn’t bear to tell her by phone. What if she fainted? And local relatives couldn’t visit her at home, risking infecting themselves.
Spadaro and her two brothers frantically booked plane tickets and took coronavirus tests, knowing they’d need negative results to be let into Lebanon. If our mother calls, they begged the hospital, please say our father isn’t doing well but remains in critical condition.
When they arrived at their family home in gloves and robes and masks, they sat down and gave their mother the news. She sobbed, but Spadaro couldn’t risk giving her a hug.
Spadaro will return to Beirut at Christmastime, but she worries that the home will feel achingly empty. Dad won’t be there cuddling his cat or playing the piano or accordion. Even the thought of putting up a tree makes her feel nervous.
Her parents had paid off their home earlier this year, and her father’s dream of retiring in the U.S. had seemed like more than a distant hope. Maybe, Spadaro remembers thinking, we’ll all finally be in the same place.
“COVID robbed me of my dreams,” she said. “I can’t dream right now.”
She finds deep comfort and validation in the Facebook group. Sure, many people survive the virus, but the group reminds her that there are many others whose recently healthy loved ones did not. It was deeply therapeutic to receive so much encouragement after sharing her story, she said, and these days, she has a little more energy to encourage others, as well.
The only other thing buoying her spirit now, she said, is her faith — her confidence that this is temporary, and heaven awaits. Sometimes sadness hits like a wave, and she repeats a verse from Corinthians 2 like a mantra: We are afflicted in every way, but not crushed; perplexed, but not driven to despair.


latimes--2020-12-09--Dying Californians suffer harm and neglect from an industry meant to comfort them

Nicolas Tuparan was eating breakfast at a Pasadena nursing home when he suddenly gasped for air .
“ Your father choked on eggs and oatmeal , ” a nurse with Vitas Hospice Services would later tell Tuparan ’ s daughter , according to his family ’ s lawsuit .
“ He was very demanding and keep on telling me : feed me , feed me !
So I kept on feeding him.
” The nurse said she did not perform CPR because it was against Vitas policy , even though Tuparan had explicitly requested lifesaving measures in the event of @ @ @ @ @ @ @ .
Vitas attorneys did not respond to messages seeking comment .
Deprived of oxygen , Tuparan suffered severe brain damage , underwent a tracheostomy and intubation and was put on a ventilator .
He died two months later .
“ We have had a lot of anger and pain because my father did not die naturally , ” his daughter , Lori Tuparan , said of the February 2016 ordeal .
“ They robbed him away from us.
” Nicolas Tuparan ’ s experience is the antithesis of the compassionate , comforting care @ @ @ @ @ @ @ But it is hardly unique among a group of patients who are often bedbound , cognitively impaired and heavily dependent on caregivers who sometimes fail them , with devastating results .
At a time when the U.S. population is aging and the hospice industry is booming , a Times investigation found hundreds of instances in which California patients were harmed , neglected or put at serious risk , their mistreatment sometimes exacerbated by serious gaps in government oversight .
Quality-of-care failures ran the gamut from mismanaged medications to neglected wounds that became infested @ @ @ @ @ @ @ aides repeatedly missed appointments or slept on the job as patients lay writhing in pain .
But even when regulators identified such failures , hospices were rarely penalized , according to a review of lawsuits , Medicare data and state licensing and inspection records spanning a decade .
Violations that led to severe infections or death were addressed with little more than a promise by hospices to do better .
Hospices are regulated far less rigorously than other healthcare providers .
While nursing homes and hospitals are subject to a range of potential @ @ @ @ @ @ @ regulations do not provide for those penalties .
At the federal level , regulators rarely impose their only available sanction : cutting off Medicare funding and booting bad actors from the program .
From 2014 to 2017 , only 19 hospices were terminated — fewer than one half of 1 % of the 4,000-plus providers then operating nationwide , according to the Government Accountability Office .
Until 2015 , Medicare mandated hospices to be inspected only once every six years .
That time frame has been shortened to once every three years , @ @ @ @ @ @ @ required annually for nursing homes .
“ Really , the enforcement is still pathetic , ” said Charlene Harrington , a UC San Francisco nursing professor emeritus who formerly worked for the California Department of Public Health , which regulates hospices in the state .
“ If you are only visiting every three years , you are not catching everything , ” she said .
“ There ’ s no penalty , so why stop doing it ?
You know they ’ re not coming back to check on you for three years @ @ @ @ @ @ @ are the problems more acute than in California , where the number of hospices quadrupled over the last decade as end-of-life care has become a multibillion-dollar business dominated by profit-driven operators .
Los Angeles County alone saw a sixfold increase in hospices , according to a Times analysis of federal healthcare data .
States license and inspect hospices for the federal government , but providers may opt to choose their own overseers by hiring accreditation agencies that have the authority to “ deem ” them to be in compliance with federal standards .
@ @ @ @ @ @ @ are less transparent than others because they are not subject to inspection and recertification by state regulators , and accreditation organization inspection reports by law are not made public .
More than 80 % of California hospices choose accreditation , compared to about half nationwide .
Relying on accreditation organizations to inspect large numbers of hospices that pay them creates a conflict of interest and diminishes accountability , said Michael Connors , a patient care advocate with California Advocates for Nursing Home Reform .
“ Hospices are so poorly regulated in California , @ @ @ @ @ @ @ that a lot of companies are trying to cash in , ” Connors said .
“ There is no meaningful regulatory oversight whatsoever in California.
” In a written response to questions about its oversight of hospices , the California Department of Public Health told The Times that it “ enforces both federal and state requirements as described in state and federal law.
” Asked if it favored having the authority to impose fines or other penalties , the agency said , “ we decline to respond to hypothetical questions.
” The Centers @ @ @ @ @ @ @ to respond to specific questions but defended its oversight of hospices , citing its use of data analysis , medical review and investigations .
“ Ensuring patient safety and access to quality care at hospice and all certified care facilities is paramount to CMS ’ work , ” it said in a statement to The Times .
“ The agency takes the oversight role of the Medicare hospice program seriously and is aggressively focused on reducing and eliminating fraud , waste , and abuse.
” Since the outbreak of COVID-19 earlier this year @ @ @ @ @ @ @ .
In March , Medicare suspended requirements for most hospice inspections , limiting investigations to complaints and only the most serious incidents , such as those involving abuse and infection .
Mark Smith , a spokesman for the state public health agency , said it has suspended some regulatory requirements but is following Medicare guidelines and an executive order by Gov .
Gavin Newsom , which require it to act on “ allegations of the most serious violations impacting health and safety.
” Long before the pandemic , serious patient-care flaws had surfaced @ @ @ @ @ @ @ A July 2019 analysis by the U.S. Department of Health and Human Services Office of Inspector General found that 94 % of California ’ s hospices had at least one serious deficiency from 2012 to 2016 .
The nationwide rate was 80 % .
In a 2016 sampling by the inspector general , 313 hospices surveyed nationwide qualified as “ poor performers ” by having at least one serious deficiency or substantiated severe complaint .
California led the country with 45 .
The Times ’ analysis of federal data shows that California also @ @ @ @ @ @ @ most-serious violations , with 420 since 2008 — four times as many as states such as Texas and Georgia , which also have large numbers of hospices .
Los Angeles County accounted for 43 % of those , racking up 179 .
The most common serious violations include missed nursing visits , state records show .
An Alzheimer ’ s patient living in a senior community in Riverside was scheduled for visits by a Vitas hospice nurse every Monday , Wednesday and Friday .
The nurse failed to show for a 10-day stretch @ @ @ @ @ @ @ s open sore to fester .
“ This agency failure resulted in Resident 1 not receiving adequate wound care and developing maggots … in a foot wound , requiring admission to the acute care hospital , ” a state report said .
In a similar scenario , 11 missed nursing visits over two months left a patient at Innerjoy Hospice in Simi Valley hospitalized with a serious foot wound .
Even when appointments are kept , there is no guarantee of quality care .
In one San Diego case , Vitas sent a @ @ @ @ @ @ @ patient overnight and keep him comfortable .
Twice during the night , the man ’ s family member was awakened by his loud moaning in pain , according to a state inspection report .
Both times , she found the aide asleep and wearing earphones at the anguished man ’ s side .
The October 2015 incident led to a neglect finding by state investigators , who also found that the aide falsified records to hide that he had given medication to the patient several times even though he was not authorized to @ @ @ @ @ @ @ counseled and no longer works for Vitas , ” the company said in a corrective action plan that included re-educating employees about work rules and practices .
Another aide , working in 2015 for Hospice Spectrum Inland Empire in Rancho Cucamonga , triggered a finding by state inspectors of “ immediate jeopardy ” — a situation in which patients are at serious risk .
The aide told state inspectors that twice a week she had been refilling a patient ’ s pill box , checking her blood-sugar level with a glucometer and giving @ @ @ @ @ @ @ ” — all tasks for which the aide was unqualified .
“ This failure had the potential to adversely affect the patient ’ s health and safety , ” an inspection report said , noting that the home health aide was terminated .
Although hospices are required to submit corrective action plans to address violations , the plans do little to prevent recurrences , according to the Health and Human Services inspector general .
“ The plan is designed to address a specific circumstance ; it is not designed to resolve the underlying @ @ @ @ @ @ @ and may continue to cause harm to other beneficiaries , ” the federal watchdog said in a report issued last year .
The inspector general recommended that the federal Centers for Medicare and Medicaid Services , or CMS , seek authority to impose fines and deny payments for care , as it does with problematic nursing homes and home health agencies .
“ We urge CMS to extend these protections to hospice beneficiaries , ” the inspector general said .
“ These beneficiaries are especially vulnerable and should be protected from harm.
” @ @ @ @ @ @ @ fines are for improperly disclosing patient information , often through lost or stolen records .
Since 2014 , California has cited about a dozen such breaches .
Exacerbating lax enforcement is a lack of transparency in reporting problems .
Licensing and inspection reports compiled by the state — sanitized of key information , such as the names of hospice employees and doctors — are available to the public and include details of violations and corrective action plans .
But inspection reports written by the accreditation agencies that oversee the vast majority of California @ @ @ @ @ @ @ least two legislative efforts to address shortcomings had stalled in Congress in the past year , including a bipartisan bill introduced in February by U.S. Reps. Jimmy Panetta ( D-Carmel ) and Tom Reed ( R-N.Y. ) .
The bill would expand available penalties to include fines of up to $ 10,000 a day and suspension of Medicare payments .
It also would require Medicare to post inspection results online .
The bill cleared the House Ways and Means Committee but had been derailed by the pandemic , according to a Panetta spokesperson @ @ @ @ @ @ @ into another Medicare-related bill , the BENES Act , which was approved by the House .
The act now will move to the Senate for consideration .
Absent major changes in the system , consumers shopping for a hospice in their neighborhood might never know about serious problems uncovered by state and federal regulators .
Take , for example , Senior Hospice Care Inc. in Burbank .
The company was cited in August 2018 after a patient suffered extreme pain for two days “ without any relief ” before he died .
State @ @ @ @ @ @ @ to show the patient ’ s family how to safely give him morphine to alleviate his discomfort from kidney cancer , according to inspection records .
“ I did not give it to him even though he was in pain .
I was waiting for the nurse to come and show me how , ” a family member told a state surveyor .
Regulators flagged it as an “ immediate jeopardy ” situation .
A representative for Senior Hospice Care did not respond to requests for comment .
With some digging , details @ @ @ @ @ @ @ on an online database of complaint investigations compiled by the Centers for Medicare and Medicaid Services .
But there is no information about it on the Medicare compare website , which CMS promotes as a tool for consumers to gauge the quality and safety of hospices across the country .
In general , the site provides scant details about complaints , inspections or specific problems identified by regulators .
Details about the 2018 violation are also nowhere to be found on Cal Health Find , the state database of healthcare facilities where consumers @ @ @ @ @ @ @ It is all very hard for the consumer to figure out , ” said Harrington , the UCSF nursing professor emeritus .
Harrington tried to remedy the situation with CalQualityCare.org , a joint project of UCSF and the California Health Care Foundation that rated hospices and other facilities and provided additional information to help consumers pick good providers and avoid bad ones .
The website was supported by the foundation for more than a decade but was taken down after it lost its funding in 2016 .
A subsequent bid to secure state @ @ @ @ @ @ @ she hopes to find another revenue source and revive the website .
With little public information available to guide their choices , families seeking hospice care for their loved ones are left to their own devices .
A stroke left Joan Price severely disabled , paralyzed and unable to speak , eat , drink , dress or wash on her own .
The octogenarian lived with her daughter for seven years before signing up for services with Roze Room Hospice of the Valley in April 2016 and moving to an assisted-living facility the @ @ @ @ @ @ @ filed by the daughter , Jennifer Price .
Soon after , during a visit at the assisted-living facility , Jennifer noticed that her mother ’ s left leg was swollen and asked a hospice nurse to assess it .
The nurse refused , the lawsuit alleged , insisting that the swelling and associated pain were due to arthritis .
“ Your mother is fine , ” the nurse said , according to the complaint .
Price , a Simi Valley music store owner , was skeptical and took her mother home .
While @ @ @ @ @ @ @ that her left leg had ballooned to twice the size of her right one .
She called Roze Room to send a nurse .
After waiting in vain for 18 hours , she took her mother to the hospital and learned that her left femur was fractured .
Joan Price spent a week in the hospital for her broken leg .
Her daughter sued the hospice , the assisted-living home and a skilled nursing facility for elder abuse , neglect and wrongful death after Price died in June 2017 .
All denied wrongdoing @ @ @ @ @ @ @ Roze Room Hospice with the state public health department , which substantiated the allegations and approved the provider ’ s corrective action plan for improving communications and coordination of services .
Jennifer Price , who reached a confidential settlement last December , declined to comment for this article .
Attorneys for Roze Room did not respond to requests for comment .
Three years after the death of Peter Craig on Oct. 24 , 2017 , his sisters Joyce Craig and Ellie Craig Goldstein are haunted by the memory of his final hours .
@ @ @ @ @ @ @ accounting firm partner who was in the end stages of cancer , had signed up with Providence TrinityCare Hospice just a few days before he died .
His family needed someone “ to be there to help us get through this at the end , ” Joyce Craig said .
Hospice representatives enrolled Craig and gave his family a “ comfort kit ” with the narcotic painkiller morphine , and left a flier with a number to call when his condition deteriorated .
The hospice also promised to send someone to stay at @ @ @ @ @ @ @ the sisters said .
The day before Craig died , his family started phoning the agency whenever his condition changed significantly , Joyce said , but calls went unanswered or were not returned .
On her brother ’ s final day , she said , a hospice nurse visited his home and consulted briefly with the family but had to leave for another appointment .
Instead of spending their brother ’ s final hours comforting him , Joyce said , she and Ellie were in the kitchen , repeatedly calling the hospice for @ @ @ @ @ @ @ in the next room .
“ How did it ever happen that I was the one who had to give him his last morphine before he died , because they didn ’ t come ?
” Ellie said .
“ It ’ s a nightmare.
” Providence TrinityCare executive director Shayna Stiles said in a statement that the nonprofit hospice “ is committed to caring for terminally ill patients and supporting families during a sacred time in their lives , ” but that it can not comment on Craig ’ s care because @ @ @ @ @ @ @ the utmost compassion for Peter Craig ’ s family and their loss , ” it read in part .
In an earlier note added to Craig ’ s bereavement file in response to his family ’ s complaint , the hospice said there had been “ miscommunication or a misunderstanding that ’ 24 hours around the clock care at the end of life ’ meant we would be physically in the home.
” But the note acknowledged the hospice might have better served the family .
“ Overall , they felt unprepared and @ @ @ @ @ @ @ ” the note read .
“ We agreed to take this information back and speak to staff about their experience to improve services.
” By then it was too late for Peter Craig and his sisters , who felt they had let him down .
“ Hospice sold us on the promise of their medical professionals being in the room , competent and capable of administering pain meds when his death came , ” Joyce said .
“ Well , the time came but hospice did not .
”

A well-worn office building on Victory Boulevard in Van Nuys is home to more than a dozen hospice providers. Los Angeles County hospices have multiplied sixfold in the last decade and now account for more than half of the state’s roughly 1,200 Medicare-certified providers.
Nicolas Tuparan was eating breakfast at a Pasadena nursing home when he suddenly gasped for air.
“Your father choked on eggs and oatmeal,” a nurse with Vitas Hospice Services would later tell Tuparan’s daughter, according to his family’s lawsuit. “He was very demanding and keep on telling me: feed me, feed me! So I kept on feeding him.”
Tuparan, 88, stopped breathing and fell into a coma.
The nurse said she did not perform CPR because it was against Vitas policy, even though Tuparan had explicitly requested lifesaving measures in the event of a medical emergency, the complaint alleged. Vitas attorneys did not respond to messages seeking comment.
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Deprived of oxygen, Tuparan suffered severe brain damage, underwent a tracheostomy and intubation and was put on a ventilator. He died two months later.
“We have had a lot of anger and pain because my father did not die naturally,” his daughter, Lori Tuparan, said of the February 2016 ordeal. “They robbed him away from us.”
Nicolas Tuparan’s experience is the antithesis of the compassionate, comforting care that hospices promise the terminally ill.
But it is hardly unique among a group of patients who are often bedbound, cognitively impaired and heavily dependent on caregivers who sometimes fail them, with devastating results.
Nicolas Tuparan, right, died two months after he choked, stopped breathing and fell into a coma while in hospice. (Tuparan family)
At a time when the U.S. population is aging and the hospice industry is booming, a Times investigation found hundreds of instances in which California patients were harmed, neglected or put at serious risk, their mistreatment sometimes exacerbated by serious gaps in government oversight.
Quality-of-care failures ran the gamut from mismanaged medications to neglected wounds that became infested with maggots. Nurses and home health aides repeatedly missed appointments or slept on the job as patients lay writhing in pain.
But even when regulators identified such failures, hospices were rarely penalized, according to a review of lawsuits, Medicare data and state licensing and inspection records spanning a decade. Violations that led to severe infections or death were addressed with little more than a promise by hospices to do better.
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Hospices are regulated far less rigorously than other healthcare providers. While nursing homes and hospitals are subject to a range of potential fines and civil enforcement actions, hospice regulations do not provide for those penalties.
At the federal level, regulators rarely impose their only available sanction: cutting off Medicare funding and booting bad actors from the program. From 2014 to 2017, only 19 hospices were terminated — fewer than one half of 1% of the 4,000-plus providers then operating nationwide, according to the Government Accountability Office.
‘Hospices are so poorly regulated in California, and Medicare dollars are so lucrative, that a lot of companies are trying to cash in.’ — Michael Connors, a patient care advocate with California Advocates for Nursing Home Reform
Until 2015, Medicare mandated hospices to be inspected only once every six years. That time frame has been shortened to once every three years, but inspections remain less frequent than those required annually for nursing homes.
“Really, the enforcement is still pathetic,” said Charlene Harrington, a UC San Francisco nursing professor emeritus who formerly worked for the California Department of Public Health, which regulates hospices in the state.
“If you are only visiting every three years, you are not catching everything,” she said. “There’s no penalty, so why stop doing it? You know they’re not coming back to check on you for three years. It’s ludicrous.”
Nowhere are the problems more acute than in California, where the number of hospices quadrupled over the last decade as end-of-life care became a multibillion-dollar business dominated by profit-driven operators. Los Angeles County alone saw a sixfold increase in hospices, according to a Times analysis of federal healthcare data.
States license and inspect hospices for the federal government, but providers may opt to choose their own overseers by hiring accreditation agencies that have the authority to “deem” them to be in compliance with federal standards.
Deemed hospices face less government scrutiny and are less transparent than others because they are not subject to inspection and recertification by state regulators, and accreditation organization inspection reports by law are not made public.
More than 80% of California hospices choose accreditation, compared with about half nationwide.
Relying on accreditation organizations to inspect large numbers of hospices that pay them creates a conflict of interest and diminishes accountability, said Michael Connors, a patient-care advocate with California Advocates for Nursing Home Reform.
“Hospices are so poorly regulated in California, and Medicare dollars are so lucrative, that a lot of companies are trying to cash in,” Connors said. “There is no meaningful regulatory oversight whatsoever in California.”
In a written response to questions about its oversight of hospices, the California Department of Public Health told The Times that it “enforces both federal and state requirements as described in state and federal law.” Asked if it favored having the authority to impose fines or other penalties, the agency said, “we decline to respond to hypothetical questions.”
The Centers for Medicare and Medicaid Services also declined to respond to specific questions but defended its oversight of hospices, citing its use of data analysis, medical review and investigations.
“Ensuring patient safety and access to quality care at hospice and all certified care facilities is paramount to CMS’ work,” it said in a statement to The Times. “The agency takes the oversight role of the Medicare hospice program seriously and is aggressively focused on reducing and eliminating fraud, waste, and abuse.”
Since the outbreak of COVID-19 earlier this year, there has been even less oversight.
In March, Medicare suspended requirements for most hospice inspections, limiting investigations to complaints and only the most serious incidents, such as those involving abuse and infection.
Mark Smith, a spokesman for the state public health agency, said it has suspended some regulatory requirements but is following Medicare guidelines and an executive order by Gov. Gavin Newsom, which require it to act on “allegations of the most serious violations impacting health and safety.”
Long before the pandemic, serious patient-care flaws had surfaced in California’s hospice system.
A July 2019 analysis by the U.S. Department of Health and Human Services Office of Inspector General found that 94% of California’s hospices had at least one serious deficiency from 2012 to 2016. The nationwide rate was 80%.
In a 2016 sampling by the inspector general, 313 hospices surveyed nationwide qualified as “poor performers” by having at least one serious deficiency or substantiated severe complaint. California led the country with 45.
The Times’ analysis of federal data shows that California also had the largest raw number of the most-serious violations, with 420 since 2008 — four times as many as states such as Texas and Georgia, which also have large numbers of hospices. Los Angeles County accounted for 43% of those, racking up 179.
Hospice care businesses with printed and hand-lettered signs along a stretch of Victory Boulevard. (Kim Christensen / Los Angeles Times)
The most common serious violations include missed nursing visits, state records show.
An Alzheimer’s patient living in a senior community in Riverside was scheduled for visits by a Vitas hospice nurse every Monday, Wednesday and Friday. The nurse failed to show for a 10-day stretch in 2016, allowing the patient’s open sore to fester.
“This agency failure resulted in Resident 1 not receiving adequate wound care and developing maggots … in a foot wound, requiring admission to the acute care hospital,” a state report said.
In a similar scenario, 11 missed nursing visits over two months left a patient at Innerjoy Hospice in Simi Valley hospitalized with a serious foot wound.
Even when appointments are kept, there is no guarantee of quality care.
In one San Diego case, Vitas sent a home health aide to monitor a cancer patient overnight and keep him comfortable. Twice during the night, the man’s family member was awakened by his loud moaning in pain, according to a state inspection report. Both times, she found the aide asleep and wearing earphones at the anguished man’s side.
The October 2015 incident led to a neglect finding by state investigators, who also found that the aide falsified records to hide that he had given medication to the patient several times even though he was not authorized to do so.
The aide “was counseled and no longer works for Vitas,” the company said in a corrective action plan that included re-educating employees about work rules and practices.
Another aide, working in 2015 for Hospice Spectrum Inland Empire in Rancho Cucamonga, triggered a finding by state inspectors of “immediate jeopardy” — a situation in which patients are at serious risk.
The aide told state inspectors that twice a week she had been refilling a patient’s pill box, checking her blood-sugar level with a glucometer and giving her insulin shots “in the stomach” — all tasks for which the aide was unqualified.
“This failure had the potential to adversely affect the patient’s health and safety,” an inspection report said, noting that the home health aide was terminated.
Although hospices are required to submit corrective action plans to address violations, the plans do little to prevent recurrences, according to the Health and Human Services inspector general.
“The plan is designed to address a specific circumstance; it is not designed to resolve the underlying issues that gave root to the deficiencies and may continue to cause harm to other beneficiaries,” the federal watchdog said in a report issued last year.
The inspector general recommended that the federal Centers for Medicare and Medicaid Services, or CMS, seek authority to impose fines and deny payments for care, as it does with problematic nursing homes and home health agencies.
“We urge CMS to extend these protections to hospice beneficiaries,” the inspector general said. “These beneficiaries are especially vulnerable and should be protected from harm.”
At the state level, the only fines are for improperly disclosing patient information, often through lost or stolen records. Since 2014, California has cited about a dozen such breaches.
Lax enforcement is exacerbated by a lack of transparency in reporting problems.
Licensing and inspection reports compiled by the state — sanitized of key information, such as the names of hospice employees and doctors — are available to the public and include details of violations and corrective action plans.
But inspection reports written by the accreditation agencies that oversee the vast majority of California hospices are not publicly disclosed.
At least two legislative efforts to address shortcomings had stalled in Congress in the past year, including a bipartisan bill introduced in February by U.S. Reps. Jimmy Panetta (D-Carmel Valley Village) and Tom Reed (R-N.Y.).
The bill would expand available penalties to include fines of up to $10,000 a day and suspension of Medicare payments. It also would require Medicare to post inspection results online.
The bill cleared the House Ways and Means Committee but had been derailed by the pandemic, according to a Panetta spokesperson. On Tuesday, it was incorporated into another Medicare-related bill, the BENES Act, which was approved by the House. The act now will move to the Senate for consideration.
Charlene Harrington, a UC San Francisco nursing professor emeritus who formerly worked for the California Department of Public Health, says the enforcement of hospices “is still pathetic.” (Paul Kitagaki Jr. / Sacramento Bee)
Absent major changes in the system, consumers shopping for a hospice in their neighborhood might never know about serious problems uncovered by state and federal regulators.
Take, for example, Senior Hospice Care Inc. in Burbank.
The company was cited in August 2018 after a patient suffered extreme pain for two days “without any relief” before he died. State inspectors found that a hospice nurse failed to show the patient’s family how to safely give him morphine to alleviate his discomfort from kidney cancer, according to inspection records.
“I did not give it to him even though he was in pain. I was waiting for the nurse to come and show me how,” a family member told a state surveyor.
Regulators flagged it as an “immediate jeopardy” situation.
A representative for Senior Hospice Care did not respond to requests for comment.
With some digging, details of the 2018 incident can be found on an online database of complaint investigations compiled by the Centers for Medicare and Medicaid Services.
But there is no information about it on the Medicare compare website, which CMS promotes as a tool for consumers to gauge the quality and safety of hospices across the country. In general, the site provides scant details about complaints, inspections or specific problems identified by regulators.
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Details about the 2018 violation are also nowhere to be found on Cal Health Find, the state database of healthcare facilities where consumers can search hospices by name.
“It is all very hard for the consumer to figure out,” said Harrington, the UCSF nursing professor emeritus.
Harrington tried to remedy the situation with CalQualityCare.org, a joint project of UCSF and the California Health Care Foundation that rated hospices and other facilities and provided additional information to help consumers pick good providers and avoid bad ones.
The website was supported by the foundation for more than a decade but was taken down after it lost its funding in 2016. A subsequent bid to secure state funding was unsuccessful, but Harrington said she hopes to find another revenue source and revive the website.
With little public information available to guide their choices, families seeking hospice care for their loved ones are left to their own devices.
A stroke left Joan Price severely disabled, paralyzed and unable to speak, eat, drink, dress or wash on her own.
The octogenarian lived with her daughter for seven years before signing up for services with Roze Room Hospice of the Valley in April 2016 and moving to an assisted living facility the next month, according to a lawsuit filed by the daughter, Jennifer Price.
Soon after, during a visit at the assisted living facility, Jennifer noticed that her mother’s left leg was swollen and asked a hospice nurse to assess it. The nurse refused, the lawsuit alleged, insisting that the swelling and associated pain were due to arthritis.
“Your mother is fine,” the nurse said, according to the complaint.
Price, a Simi Valley music store owner, was skeptical and took her mother home. While undressing her for bed, she discovered that her left leg had ballooned to twice the size of her right one.
She called Roze Room to send a nurse. After waiting in vain for 18 hours, she took her mother to the hospital and learned that her left femur was fractured.
Joan Price spent a week in the hospital for her broken leg.
Her daughter sued the hospice, the assisted living home and a skilled nursing facility for elder abuse, neglect and wrongful death after Price died in June 2017. All denied wrongdoing.
She also filed a complaint against Roze Room Hospice with the state public health department, which substantiated the allegations and approved the provider’s corrective action plan for improving communications and coordination of services.
Jennifer Price, who reached a confidential settlement last December, declined to comment for this article. Attorneys for Roze Room did not respond to requests for comment.
Peter Craig and his sister, Ellie Craig Goldstein. Three years after his death in 2017, Ellie and her sister Joyce Craig are haunted by the memory of his final hours. (Family photo)
Three years after the death of Peter Craig on Oct. 24, 2017, his sisters Joyce Craig and Ellie Craig Goldstein are haunted by the memory of his final hours.
Craig, 74, a widower and accounting-firm partner who was in the end stages of cancer, had signed up with Providence TrinityCare Hospice just a few days before he died. His family needed someone “to be there to help us get through this at the end,” Joyce Craig said.
Hospice representatives enrolled Craig and gave his family a “comfort kit” with the narcotic painkiller morphine, and left a flier with a number to call when his condition deteriorated. The hospice also promised to send someone to stay at his side as he neared death, the sisters said.
The day before Craig died, his family started phoning the agency whenever his condition changed significantly, Joyce said, but calls went unanswered or were not returned.
On her brother’s final day, she said, a hospice nurse visited his home and consulted briefly with the family but had to leave for another appointment.
Instead of spending their brother’s final hours comforting him, Joyce said, she and Ellie were in the kitchen, repeatedly calling the hospice for help, as he thrashed in pain in the next room.
“How did it ever happen that I was the one who had to give him his last morphine before he died, because they didn’t come?” Ellie said. “It’s a nightmare.”
Providence TrinityCare executive director Shayna Stiles said in a statement that the nonprofit hospice “is committed to caring for terminally ill patients and supporting families during a sacred time in their lives,” but that it cannot comment on Craig’s care because of privacy laws.
“We have the utmost compassion for Peter Craig’s family and their loss,” it read in part.
In an earlier note added to Craig’s bereavement file in response to his family’s complaint, the hospice said there had been “miscommunication or a misunderstanding that ‘24 hours around the clock care at the end of life’ meant we would be physically in the home.”
But the note acknowledged the hospice might have better served the family.
“Overall, they felt unprepared and unsupported for Peter’s death,” the note read. “We agreed to take this information back and speak to staff about their experience to improve services.”
By then it was too late for Peter Craig and his sisters, who felt they had let him down.
“Hospice sold us on the promise of their medical professionals being in the room, competent and capable of administering pain meds when his death came,” Joyce said. “Well, the time came but hospice did not.”