Tag Archives: Los Angeles

Hepatitis A Outbreak Expands Throughout Southern California

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

In mid-September 2017, HEAL Blog wrote about the extreme measures taken by San Diego County and city to combat a severe outbreak of Hepatitis A (HAV) among the county’s homeless, indigent, and illicit drug user populations (Hopkins, 2017). At that time, the HAV outbreak consisted of 421 confirmed cases, 292 hospitalizations, and 16 deaths. That initial outbreak, which began in November 2016, has continued to grow with 481 confirmed cases, 337 hospitalizations, and 17 deaths (Sisson, 2017). The outbreak is also spreading.

Both Santa Cruz and Los Angeles Counties have begun seeing outbreaks of HAV related to the initial outbreak in San Diego County, with 68 confirmed cases in Santa Cruz County (Health Services Agency, 2017) and 12 confirmed cases in Los Angeles County, 9 of which required hospitalization (Acute Communicable Disease Control, 2017). These cases do not include all of the reported HAV cases; only those connected to the San Diego outbreak. These cases are primary among the same populations in these counties as they were in San Diego County – homeless, indigent, and illicit drug users.

Hepatitis A Facts

Photo Source: MedChitChat.com

According to Kaiser Health News writer, Stephanie O’Neill, poor access to restrooms and sinks in homeless encampments is largely to blame for these outbreaks (O’Neill, 2017). San Diego County responded to their outbreak by installing 40 portable hand-washing stations throughout the downtown areas hardest hit by the outbreak, leaving public restrooms open overnight, and power-washing heavily soiled sections of downtown sidewalks and streets with a bleach solution in an effort to stop the spread of the virus (O’Neill).

Southern California’s HAV outbreak is being described as “unprecedented” and “the largest outbreak in the U.S. that is not related to a contaminated food product” since the U.S. first introduced a vaccine for hepatitis A in 1995 (O’Neill). This trend is unlikely to be restricted to Southern California. According to the National Law Center on Homelessness and Poverty (NLCHP), “Despite a lack of affordable housing and shelter space, many cities have chosen to criminally or civilly punish people living on the street for doing what any human being must do to survive” (NLCHP, n.d.). Additionally, the NLCHP notes that, since 2006, bans on camping city-wide have increased by 69%, bans on sleeping in public have increased by 31%, bans on sitting or lying down in public have increased 52%, bans on loitering, loafing, and vagrancy have increased 88%, and bans on living in vehicles have increased 143% (NLCHP). Furthermore, most cities in the U.S. close public restrooms at dusk, leaving homeless people with nowhere to relieve themselves.

While the intention of these bans is to move cities’ homeless populations out of the line of sight and create “safer” public spaces for homed populations, the real-life effect has resulted in creating conditions ripe for the spread of diseases like HAV. People who lack access to restroom and handwashing facilities are forced to relieve themselves in the open, creating biohazardous waste and fostering the spread of HAV to potentially anyone who comes in contact with their refuse.

It is also likely that, as more cities are hit with HAV outbreaks related to homelessness and illicit drug use, responses will vary between highly effective public health responses like those put in place by San Diego County, and highly ineffective criminalization responses that end up creating worse circumstances than they purport to fix.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Pre-Requisite Treatment Standards Still Abound

By: Marcus J. Hopkins, Blogger

Remember that time when county health officials refused medical treatment coverage to people living with HIV if they were drug users and openly admitted it in a radio interview? Yeah…me, either. This was, however, the case on August 24th, 2016, when Dr. Hal Lee, Los Angeles County Health Services’ Chief Medical Officer and liver specialist, freely admitted to the practice with the following statement:

It’s our obligation to offer treatment in a manner that’s rational and logical. We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now. We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs (Plevin, 2016).

This policy is in direct conflict with the Medi-Cal – California’s Medicaid program – Treatment Policy for the Management of Chronic Hepatitis C, a set of guidelines that went into effect on July 1st, 2015, well over a year prior to the date of this interview (State of California, 2015). What makes Yee’s statement ironic is that Medi-Cal is very likely the agency that would be paying for the services that his office is failing to provide.

In this interview, the reporter states that Yee has developed a checklist of criteria to determine if patients are eligible for treatment – one that apparently disregards the very specific checklist put forth by the State of California. One of the criteria requires patients to be free of drug use for six months prior to receiving Hepatitis C medications.

To bring this further into focus, Health Services, which provides health care for about a half-million low-income Los Angelinos, has approved treatment for only 160 people, as of the beginning of August. By comparison, San Francisco Health Network, which serves only 65,000 people overall, treated 631 people by late June 2016. This is a stark difference in treatment approaches, and speaks, I believe, to the social and socioeconomic stratification that exists in Los Angeles County.

My own experiences with L.A. County’s Health Department left much to be desired. As someone who has relocated to several states and been the beneficiary of their respective health agencies, my experiences within L.A.’s low-income health care programs presented a stark and sad reflection of how L.A. treats its residents who don’t reside in the best zip codes.

Hospitals were run essentially like prisons, with barred windows, numerous metal detectors, and employees who behaved more like judgmental prison workers, rather than health care professionals. Facilities were overcrowded, parking was nearly impossible to find, and locations were so far-flung that taking public transportation to them would take hours. After enduring hours-long commutes on the 5 and 405 freeways just to get to an appointment, I finally gave up on the County program and switched my treatment facility to the AIDS Healthcare Foundation in Van Nuys.

Just beyond the Sepulveda Pass in “The Valley” (San Fernando, that is), this facility that catered to low-income patients was in the right zip code. Though small, it was rarely crowded, focused solely on patients with HIV, and the employees treated everyone, regardless of their mental or physical state, without judgment. There were no metal detectors or barred windows; just good healthcare providers.

Dr. Hal Lee

Photo Source: L.A. Care Consult

What makes me sad about the interview with Dr. Yee is the following quote:

If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment. I know that if you come talk to me in one year, in five years, in ten years, you’re going to see these numbers climb, because we’ve put in infrastructure that I know allows us to provide the kind of care that other counties can’t even begin to think about.

Make no mistake – Yee’s approach to treatment is not only outside of California’s long-established treatment guidelines, they are also part of a greater issue: the belief that not everyone is deserving of treatment; that some patients are just “better” than others; that one’s station in life makes them more deserving of quality healthcare.

This interview with not just a county healthcare employee, but the Chief Medical Officer, is a sad reminder of how some doctors fail to live up to their obligations to their patients in a nation where healthcare is not considered a human right. Opponents of Universal/Single-Payer Healthcare love to bandy about the boogieman of “Death Panels,” failing to see that those types of panels already exist, right here in our United States.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

References:

 

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