Angels to open 2024 schedule in Baltimore

• July 13, 2023

After opening their season in Oakland in five of the previous seven years, the Angels will begin the 2024 season with a series in Baltimore against the Orioles, per the Thursday release of next year’s schedule.

The Angels play three games in Baltimore from March 28-31, with an off day March 29, followed by a three-game series in Miami. The Angels open their home schedule April 5 with a series against the Boston Red Sox.

The Freeway Series will include two games at Dodger Stadium on June 21-22 and two at Angel Stadium on Sept. 3-4.

The interleague schedule is reversed from this year, with the Angels hosting all of the National League teams they played on the road in 2023.

pic.twitter.com/bVdczboELr

— Jeff Fletcher (@JeffFletcherOCR) July 13, 2023

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​ Orange County Register 

How the hold on the Marine leader’s confirmation impacts Camp Pendleton

• July 13, 2023

A recent move by a Republican senator to hold up the confirmation of the Marines’ top leader not only impacts that office but a whole host of other officers and their families who, during the summer months, report to new commands at bases across the nation and overseas.

At Camp Pendleton, for example, the top general to lead the Corps’ largest and most significant warfighting command, the 1st Marine Expeditionary Force, is unable to take over his command of at least 48,000 Marines and their units.

At present, the command — critical to the nation’s defense and presently focused on strategy and deterrence of aggression in the Indo-Pacific — is led by Lt. Gen. George Smith, who is set to retire in August. Lt. Gen. Michael Cederholm will replace him, but he cannot move himself or his family to Southern California because he also has not been confirmed by the U.S. Senate.

In addition to Cederholm, the holdup in the U.S. Senate means other general officers and their families are unable to move to their new posts, meaning they’re facing delays in getting children enrolled in schools, dealing with base housing wait times and spouses are hindered from seeking employment.

If Cederholm, who presently serves at the Pentagon, is not confirmed in time, Brig. Gen. Robert Fulford, the acting deputy commanding general of the IMEF, would then take over the role. That leaves the command and its many units in the hands of a one-star general rather than a three-star general.

“These holds limit the Marine Corps’ ability to make sure the right person is at the right place at the right time in order to ensure operational readiness and strategic success,” said Maj. Josh Larson, a spokesperson for the assistant commandant.

Locally, that means at least 30 officers and their families are impacted “at a time when the Marine Corps is modernizing to defend the nation against the pacing challenge of the People’s Republic of China and the acute threat of Russia,” Larson said.

Democratic Rep. John Garamendi, who serves on the Armed Services Committee, called the holdup a “threat to national security,” noting it impacts not only top leadership positions but the entire chain of command.

“It’s not just the 200 officers requiring Senate confirmation; it’s everyone below that that’s affected,” said Garamendi.

Typically at this time of year, the U.S. Senate confirms general and flag officers as well as service chiefs if their four-year term is up.

Gen. David Berger — who led the Marines for four years and focused on the Corps’ modernization by strengthening its amphibious capabilities and developing a closer relationship with its sister service, the U.S. Navy — relinquished his duties on Monday, July 10. Berger, who was the IMEF commanding general at Camp Pendleton from 2014-16, ended a career of 42 years.

Commandant of the Marine Corps Gen. David H. Berger stands with Assistant Commandant of the Marine Corps Gen. Eric M. Smith during Berger’s relinquishment of command ceremony at Marine Barracks Washington, D.C., July 10, 2023. (DoD photo by U.S. Navy Petty Officer 1st Class Alexander Kubitza)

Though Assistant Commandant Gen. Eric Smith was recently nominated to replace Berger, he can’t officially step into the office and can only lead the Marines in an “acting capacity.”

Sen. Tommy Tuberville, R-Alabama, has stalled all nominations for senior military jobs because he disagrees with Defense Secretary Lloyd Austin’s decision to have the Defense Department pay for travel when a service member has to go out of state for abortion services or other reproductive health care.

In a message to Marines on Tuesday, Smith, a highly decorated infantry officer who once led the 1st Marine Division at Camp Pendleton, said he would perform the duties of the office of the commandant until the Senate has confirmed the 39th commandant — but in doing so, he must do his own job and that of the commandant at the same time.

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Federal law, said Marine spokesperson Maj. Jim Stenger, dictates that an assistant commandmant performs the duties of the commandant until a successor is appointed during vacancies. But that person cannot do anything that would presume confirmation, Stenger said.

Garamendi said that, in essence, will handicap Smith in major decisions because “the acting commandant does not have the full power of the commandant.”

“If, for example, there’s a decision to close the West Gate at Camp Pendleton,” Garamendi said, “the person who is to assume the commandant after confirmation will be reluctant to make the decision because this decision might upset one of the 100 senators. Key decisions that need to be made could be delayed.”

“Sen. Tuberville’s irresponsible blockade of high-level nominations, including the commandant of the Marine Corps, is having a direct adverse effect on our service members and their families aboard Camp Pendleton and will directly impact retention and readiness,” said Rep. Mike Levin, D-San Juan Capistrano. “Our military needs strong leaders, and his nonsensical objection to judicious confirmations is preventing our Armed Forces from operating at its full potential.”

Tuberville has maintained the hold does not impact “people who actually fight” and called on the Pentagon to suspend the abortion policy memo.

In the meantime, Smith said the Marines’ mission remains the same as it was under Berger: to “modernize our Corps to be most ready to fight and defeat a peer adversary.”

“We’re privileged to wear this uniform and call ourselves Marines,” he said. “We need ironclad discipline, adherence to high standards of conducting and warfighting excellence. Our conduct in and out of uniform will be beyond reproach; anything less is contrary to our ethos.”

The Associated Press contributed to this report.

​ Orange County Register 

27 new eats and drinks coming to San Fransokyo Square — What Disneyland chefs are cooking up

• July 13, 2023

“Big Hero 6”-themed eats and drinks will begin rolling out next week in San Fransokyo Square as Disneyland continues the transformation of the Pacific Wharf dining area into a tribute to the Disney computer-animated superhero film.

Disneyland chefs will introduce more than two dozen new menu items at Lucky Fortune Cookery (July 19), Cocina Cucamonga Mexican Grill (July 26), Rita’s Turbine Blenders (July 26), Aunt Cass Cafe (Mid-August) and Port of San Fransokyo Cerveceria (Mid-August) as part of the thematic makeover of the Disney California Adventure food court.

Concept art of the San Fransokyo Square makeover coming to Disney California Adventure. (Disney)

SEE ALSO: Disneyland sells out of Oogie Boogie Bash tickets in 12 hours after ‘nightmare’ sales launch

San Fransokyo served as the central location in the 2014 Disney animated film, drawing upon inspirations from both cities to create the fictional metropolis.

Reimagining the Pacific Wharf food court — which remained largely unchanged since DCA opened in 2001 — is intended to infuse the land with more Disney storytelling and characters.

The transformation that is expected to continue through mid-August will require Walt Disney Imagineering to turn the Monterey Bay-themed land into an architectural cross between the San Francisco Bay and Tokyo Bay areas.

SEE ALSO: These 12 Disneyland ride vehicles could fetch $750,000 at auction

Let’s take a closer look at the 27 new food and beverage items coming to San Fransokyo Square at Disney California Adventure.

The Karaage-inspired Crispy Chicken Sandwich coming to the Lucky Fortune Cookery in San Fransokyo Square at Disney California Adventure. (Disney)

Lucky Fortune Cookery

Available starting July 19

Karaage-inspired Crispy Chicken Sandwich with slaw, and Togarashi mayonnaise on a potato bun served with garlic chips
Beef Birria Ramen with consomme, served with house-made birria, soft boiled egg, Monterey Jack, cilantro, roasted corn, onions and radish
Yaki Udon with mushrooms, sugar snap peas, roasted red peppers, bok choy, dark soy saunce and hoisin sauce
Yaki Udon with Karaage-inspired Chicken, mushrooms, sugar snap peas, roasted red peppers, bok choy, dark soy sauce and hoisin sauce

The Baymax Macaron coming to the Lucky Fortune Cookery in San Fransokyo Square at Disney California Adventure. (Disney)

Baymax Macaron filled with chocolate-hazelnut spread and buttercream
Yaki Udon kids meal with mushrooms, sugar snap peas, bok choy, dark soy sauce and hoisin sauce
Lychee unsweetened black tea with lychee syrup and lychee coconut jelly
Strawberry Lychee Cocktail with vodka, lychee liqueur, premium strawberry syrup, fresh lemon juice and sliced strawberry garnish

SEE ALSO: She picks through Disneyland trash with one goal: Zero waste by 2030

The Curry Beef bread bowl coming to the Aunt Cass Cafe in San Fransokyo Square at Disney California Adventure. (Disney)

Aunt Cass Cafe

Formerly Pacific Wharf CafeAvailable by mid-August

Curry Beef with carrots, potatoes and onions cooked in classic curry topped with rice, pickled ginger and green onions served in a Boudin sourdough bread bowl
San Fransokyo Clam Chowder with bacon, potatoes and a hint of white miso served in a Boudin sourdough bread bowl
Soba Noodle Salad with tofu, cabbage, edamame, carrots, roasted corn, scallions and cilantro topped with crispy shallots and sesame ginger dressing
Shrimp Katsu Sandwich with a panko-breaded shrimp patty on a potato bun with cabbage slaw, spicy mayo and katsu sauce served with garlic chips
Steamed Rice

The Soba Noodle Salad coming to the Aunt Cass Cafe in San Fransokyo Square at Disney California Adventure. (Disney)

Honey Lemonade with yuzu puree, passion fruit and strawberry popping spheres
Caramel Cream Mudslide Cold Brew topped with house-made sea salt caramel whipped cream
Peach Soju Citrus Cocktail with peach-flavored soju
Japanese-style Fluffy Cheesecake

The Turbine Twirler coming to the Rita’s Turbine Blenders in San Fransokyo Square at Disney California Adventure. (Disney)

Rita’s Turbine Blenders

Formerly Rita’s Baja BlendersAvailable starting July 26

Turbine Twirler with choice of frozen wild cherry, frozen lemon-lime, frozen strawberry or frozen blue raspberry slushie topped with peach gummy ring
Rita’s Lemon-Lime Margarita with strawberry cream-covered cocoa biscuit stick
Rita’s Grand Lemon-Lime Margarita with a splash of liqueur and strawberry cream-covered cocoa biscuit stick
Rita’s Strawberry Margarita with strawberry cream-covered cocoa biscuit stick
Rita’s Grand Strawberry Margarita with a splash of liqueur and strawberry cream-covered cocoa biscuit stick

The San Fransokyo-style Street Corn coming to the Cocina Cucamonga Mexican Grill in San Fransokyo Square at Disney California Adventure. (Disney)

Cocina Cucamonga Mexican Grill

Available starting July 26

San Fransokyo-style Street Corn with Togarashi mayonnaise, queso fresco, furikake and bonito flakes served with wheat chicharrones
Melon Cocktail with tequila, melon liqueur, fresh lemon juice and orgeat topped with a cherry

The Garlic Pinwheel Chips Mix coming to the Cocina Cucamonga Mexican Grill in San Fransokyo Square at Disney California Adventure. (Disney)

Port of San Fransokyo Cerveceria

Formerly Pacific Wharf Distribution Co. beer truckAvailable by mid-August

Garlic Pinwheel Chips Mix
Karl Strauss Endless Summer Hard Seltzer with Mandarin Orange and Dragon Fruit
Karl Strauss Moment of Zen Japanese rice lager

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​ Orange County Register 

Ask the Pediatrician: When a pet dies, how do I help my child cope?

• July 13, 2023

How your child reacts to your pet’s death will depend on their age and developmental level. When children display emotions like sadness, it’s important to validate them.

During my own childhood, I remember when a pet died, my well-meaning mother told me I shouldn’t dwell on being sad. It’s natural to want to protect your child from unpleasant emotions. But letting children experience them helps them build coping skills for the future.

Here’s what you can do to help your child deal with the loss of a pet.

Explain your own sadness.

If your emotion isn’t obvious, this may confuse your child. It’s OK to let them see you cry. Keep in mind, though, that not all children — whatever their age — express their grief through sadness. Anger is also a common way to express grief. Understanding this is important so you can help them learn to work through it.

Remember, grief-related emotions can come and go, sometimes without warning. It may take longer than you thought for your child to get through this period. Be sure to let your pediatrician know if your child is having more serious symptoms such as sleep disturbances, anxiety or depression.

Be prepared for questions.

Children may ask about death and what happens after we die. While the specifics of your answer will depend on your family’s beliefs, this is a sign your child wants to talk about it. If they don’t bring up questions, especially when you’ve given them opportunities, it’s possible your child might not want to discuss it. Follow their lead.

Create some type of small memorial or ritual.

This can really help your child with the process of saying goodbye after the loss of a pet. The memorial could involve scattering ashes, creating a memorial collage or planting a tree in the pet’s memory. Your child might find this uncomfortable, so try suggesting it gently and follow their wishes.

How to talk with your child about a pet’s death: advice by age

What your child understands about death will depend on their age. Here’s what you can expect, along with age-appropriate books to help your child understand and cope with losing your family’s pet.

Toddlers

Toddlers have a difficult time understanding death. They might ask over and over where the pet is. They may even seem unconcerned by your pet’s death. Don’t be worried about this — they’re not being insensitive or uncaring. At this stage, they simply don’t understand the meaning of death.

Recommended reading for toddlers:

— “Something Very Sad Happened: A Toddler’s Guide to Understanding Death” by Bonnie Zucker

— “Bear Island” by Matthew Cordell

— “Up in Heaven” by Emma Chichester Clark

Preschoolers

Like toddlers, younger preschoolers may have difficulty with the concept of death. Older preschoolers may start to have a deeper understanding.

Recommended reading for preschoolers:

— “Goodbye Mousie” by Robie H. Harris

— “The Forever Dog” by Bill Cochran

— “The Old Dog” by Charlotte Zolotow

— “Goodbye, Brecken” by David Lupton

— “Alfie and the Birthday Surprise” by Shirley Hughes

— “The Goodbye Book” by Todd Parr

Grade schoolers

At this age, kids are much more able to understand death. If your pet is going to die soon due to old age or illness, this is a good age to prepare your child ahead of time. (See “Parent FAQs about the loss of a family pet,” below, for more information.)

Recommended reading for grade schoolers:

— “Love That Dog: A Novel” by Sharon Creech

— “Grandmother Bryant’s Pocket” by Jacqueline Briggs Martin

— “Kate, the Ghost Dog: Coping With the Death of a Pet” by Wayne L. Wilson

— “Memories of You” by Erainna Winnett

— “Jasper’s Day” by Marjorie Blain Parker

— “The Tenth Good Thing About Barney” by Judith Viorst

Teens

Most teenagers are able to understand abstract concepts like death. Be prepared, though — as with anything, their reaction to grief can span the range of human emotions.

Books on grief and loss for teens tend to be less focused on pets, but they often discuss death in general. Teens’ different tastes in types of books — for instance, preferring fiction to nonfiction, or realism to fantasy — can make general reading recommendations challenging too.

Here are some recommendations for nonfiction books about grief. These might also help you understand how to best help your grieving teen.

Recommended reading for teens:

— “The Grieving Teen: A Guide for Teenagers and Their Friends” by Helen Fitzgerald

— “Healing Your Grieving Heart for Teens” by Alan D. Wolfelt

— “Saying Goodbye When You Don’t Want To” by Martha Bolton

— “Straight Talk About Death for Teenagers” by Earl Grollman

More information is available at HealthyChildren.org.

—

ABOUT THE WRITER:

Dipesh Navsaria, MPH, MSLIS, MD, FAAP, is Chair of the American Academy of Pediatrics Council on Early Childhood. He is a professor of Pediatrics and of Human Development & Family Studies at the School of Medicine & Public Health and the School of Human Ecology, at the University of Wisconsin–Madison. He has practiced primary care pediatrics in a variety of settings and is the founding medical director of Reach Out and Read Wisconsin and was appointed by the White House to the National Museum and Library Services Board. Dr. Navsaria regularly writes op-eds on health-related topics; participates in radio and television interviews; hosts two podcasts, and frequently speaks locally, regionally, and nationally on early brain and child development, early literacy, and advocacy to a broad variety of audiences. Follow him on Twitter @navsaria, Facebook, and visit his website.

©2023 Tribune Content Agency, LLC.

​ Orange County Register 

First over-the-counter birth control pill gets FDA approval

• July 13, 2023

By Matthew Perrone | The Associated Press

U.S. officials have approved the first over-the-counter birth control pill, which will let American women and girls buy contraceptive medication from the same aisle as aspirin and eyedrops.

The Food and Drug Administration said Thursday it cleared Perrigo’s once-a-day Opill to be sold without a prescription, making it the first such medication to be moved out from behind the pharmacy counter. The company won’t start shipping the pill until early next year, and there will be no age restrictions on sales.

Hormone-based pills have long been the most common form of birth control in the U.S., used by tens of millions of women since the 1960s. Until now, all of them required a prescription.

SEE MORE: Morning after pill company increases access, supply

Medical societies and women’s health groups have pushed for wider access, noting that an estimated 45% of the 6 million annual pregnancies in the U.S. are unintended. Teens and girls, women of color and those with low incomes report greater hurdles in getting prescriptions and picking them up.

Some of the challenges can include paying for a doctor’s visit, getting time off from work and finding child care.

“This is really a transformation in access to contraceptive care,” said Kelly Blanchard, president of Ibis Reproductive Health, a nonprofit that supported the approval. “Hopefully this will help people overcome those barriers that exist now.”

Ireland-based Perrigo did not announce a price. Over-the-counter medicines are generally much cheaper than prescriptions, but they typically aren’t covered by insurance.

READ MORE: Adderall’s disappearing act leaves millions without treatment

Forcing insurers to cover over-the-counter birth control would require a regulatory change by the federal government, which women’s advocates are urging the Biden administration to implement.

Many common medications have made the switch to non-prescription status in recent decades, including drugs for pain, heartburn and allergies. Birth control pills are available without a prescription across much of South America, Asia and Africa.

Perrigo submitted years of research to FDA to show that women could understand and follow instructions for using the pill. Thursday’s approval came despite some concerns by FDA scientists about the company’s results, including whether women with certain underlying medical conditions would understand they shouldn’t take the drug.

FDA’s action only applies to Opill. It’s in an older class of contraceptives, sometimes called minipills, that contain a single synthetic hormone and generally carry fewer side effects than more popular combination hormone pills.

But women’s health advocates hope the decision will pave the way for more over-the-counter birth control options and, eventually, for abortion pills to do the same.

That said, FDA’s decision has no relation to the ongoing court battles over the abortion pill mifepristone. The studies in Perrigo’s FDA application began years before the Supreme Court’s reversal of Roe v. Wade, which has upended abortion access across the U.S.

With some states curtailing women’s reproductive rights, the FDA has faced pressure from Democratic politicians, health advocates and medical professionals to ease access to birth control. The American Medical Association and the leading professional society for obstetricians and gynecologists backed Opill’s application for over-the-counter status.

An outside panel of FDA advisers unanimously voted in favor of the switch at a hearing in May where dozens of public speakers called for Opill’s approval.

Dyvia Huitron was among those who presented, explaining how she has been unable to get prescription birth control more than three years after becoming sexually active. The 19-year-old University of Alabama student said she still isn’t comfortable getting a prescription because the school’s health system reports medical exams and medications to parents.

“My parents did not let me go on the pill,” Huitron said in a recent interview. “There was just a lot of cultural stigma around being sexually active before you’re married.”

While she uses other forms of contraception, “I would have much preferred to have birth control and use these additional methods to ensure that I was being as safe as possible.”

Huitron spoke on behalf of Advocates for Youth, one of the dozens of groups that have pushed to make prescription contraceptives more accessible.

The groups helped fund some of the studies submitted for Opill and they encouraged HRA Pharma, later acquired by Perrigo, to file its application with the FDA.

Advocates were particularly interested in Opill because it raised fewer safety concerns. The pill was first approved in the U.S. five decades ago but hasn’t been marketed here since 2005.

“It’s been around a long time and we have a large amount of data supporting that this pill is safe and effective for over-the-counter use,” said Blanchard, of Ibsis Reproductive Health.

Newer birth control pills typically combine two hormones, estrogen and progestin, which can help make periods lighter and more regular. But their use carries a heightened risk of blood clots and they shouldn’t be used by women at risk for heart problems, such as those who smoke and are over 35.

Opill has only progestin, which prevents pregnancy by blocking sperm from reaching the cervix. It must be taken around the same time daily to be most effective.

In its internal review published in May, the FDA noted that some women in Perrigo’s study had trouble understanding the drug’s labeling information. In particular, the instructions warn that women with a history of breast cancer should not take the pill because it could spur tumor growth. And women who have unusual vaginal bleeding are instructed to talk to a doctor first, because it could indicate a medical problem.

Common side effects of the pill include bleeding, headaches, dizziness, nausea and cramps, according to the FDA. The label also cautions that certain drugs can interfere with Opill’s effectiveness, including medications for seizures, HIV and hypertension.

Perrigo executives said the company will spend the rest of the year manufacturing the pill and its packaging so it can be available in stores early next year.

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​ Orange County Register 

L.A.’s new homeless solution clears camps but struggles to house people

• July 13, 2023

Tents, makeshift shacks and broken-down RVs crowded both sidewalks under a U.S. Highway 101 overpass in Hollywood seven months ago.

More than two-dozen people lived in the squalid encampment, feet from cars flying past. Neighbors and nearby businesses fumed, saying they and their customers felt unsafe.

On a Wednesday afternoon last month, all traces of the tents – and the people who lived in them – were gone. The sidewalks were spotless, without even a speck of trash.

What happened?

The site was part of a Los Angeles homeless program called Inside Safe – Mayor Karen Bass’ answer to the city’s staggering homelessness crisis. Under the new initiative, outreach workers move from encampment to encampment, offering everyone at each targeted camp a hotel room. From there, the goal is to move everyone quickly from the hotel into permanent housing.

There’s a lot riding on its success at a local, state and even national level. Bass has all but staked her tenure as mayor on fighting Los Angeles’ homelessness crisis. And President Joe Biden’s administration picked L.A. as one of six places to focus its homelessness efforts.

Inside Safe already has been a godsend for people like Tim and Sandy, who live in a condo about two blocks from the overpass and are relieved to see the now-spotless sidewalks.

“It’s absolutely wonderful,” said Tim, who declined to provide his last name to protect his privacy. “I just hope it stays that way.”

Inside Safe has clear advantages over previous efforts to make a dent in L.A.’s homeless crisis. It removes the sprawling encampments that, as the city’s most visible symptom of homelessness, spark never-ending complaints. Advocates say it’s much easier to find long-term housing for people in hotel rooms than for people still in tents. Hotel rooms provide a safe place where residents can heal from the trauma of the street, get their documents in order and relearn how to live indoors. And it means their case workers don’t have to trek all over the city looking for them.

But while Inside Safe has succeeded in putting a temporary roof over the heads of many of Los Angeles’ most vulnerable residents, the program has obvious shortcomings. Now in its seventh month, Inside Safe has moved very few people from hotels into permanent housing – and the city is struggling to produce data on the program’s impact. Access to much-needed services, such as mental and physical health care, have been lacking. And renting the hotel rooms is far too expensive for Los Angeles to keep it up indefinitely, leading some activists to worry participants may end up back on the street when the funding runs out.

A homeless encampment in Los Angeles on June 20, 2023. Photo by Julie A Hotz for CalMatters

The 101 overpass at Cahuenga Boulevard, cleared in December, was the first Inside Safe operation. Since then, the city has completed close to two-dozen – moving 1,373 people into hotels as of earlier this month. But only about 77 of those people – less than 6% – have moved from the hotels into permanent housing, frustrating officials as the number of unhoused people in the city continues to skyrocket.

“We have a real problem if the folks aren’t getting housed,” Councilman Bob Blumenfield, vice chair of the Housing and Homelessness Committee, said during a recent meeting.

Inside Safe was a major piece of the newly elected Bass’ campaign for mayor. And it has the potential to serve as a model for other cities throughout California. She has outsized influence beyond Los Angeles as chair of the U.S. Conference of Mayors’ homelessness task force. And, home to more than 46,000 unhoused people per the city’s recently released point-in-time count, L.A. is the epicenter of California’s homelessness crisis, accounting for about a quarter of the state’s homeless population.

“It was not acceptable to me to say, you know what, we’re not going to get people off the streets until we have figured out all of the issues,” Bass said in a phone interview. “As we have found problems, we are aggressively moving to address them.”

Despite concerns about the low number of people housed through the program, the City Council allocated $250 million to continue and expand Inside Safe over the next year. Los Angeles County is also launching a copycat program.

Bass agreed the Inside Safe data is “extremely disappointing.”

“Make no mistake — We are not satisfied with the amount of people in housing,” she said in an emailed statement.

Bass blames the issue partly on bureaucracy. People have to jump through a series of hurdles to prove they qualify for subsidized housing, including obtaining the right form of identification. She says she’s attempting to streamline the process. The city’s lack of affordable housing is another major factor. But 3,200 new units are expected to open this year thanks to Proposition HHH (the $1.2 billion housing bond L.A. voters passed in 2016), according to Va Lecia Adams Kellum, CEO of the Los Angeles Homeless Services Authority.

Pete Wales, outside his temporary hotel housing, in Los Angeles on June 20, 2023. Photo by Julie A Hotz for CalMatters

Pete Wales, 65, is one of the few Inside Safe participants who found permanent housing. But Wales already was working with a nonprofit on getting into housing before he moved into one of the program’s hotels in February.

At the time he was interviewed by a reporter late last month, Wales was preparing to move into a subsidized studio apartment in a new building near Echo Park.

“I consider myself lucky,” he said.

Gaps in Los Angeles homeless services

For many people who spent years on the street, simply getting a roof over their head is far from enough – they may need additional support including counseling, medical care, job training or help getting a new ID. Access to those services has been lacking in the motels, according to Inside Safe participants, outreach workers and even the mayor herself.

“That is a major concern of mine,” said Bass, who says the service providers simply don’t have the capacity to meet everyone’s needs. She wants to bring in doctors, nurses, dentists and social workers in-training from local universities to help fill the gap.

Shayne Smith, outside her temporary hotel housing, in Los Angeles on June 20, 2023. Photo by Julie A Hotz for CalMatters

When Shayne Smith, 53, got into an Inside Safe hotel after seven years on the street, she thought it was a dream.

“It feels really good,” she said. “I can take a shower. I can sleep. I have electricity. I have hot water.”

Smith, a former interior designer, ended up homeless after a devastating seizure put her in a coma and caused her to lose her income. She had to relearn how to do basic tasks like reading and speaking. During her time on the street, Smith said she was the victim of multiple sexual and physical assaults. One beating knocked the veneers off her teeth, leaving her with what she has today – worn down stumps of teeth with exposed nerves and receding gums that have resulted in abscesses and infections.

She has received two 10-minute counseling sessions and a prescription for Zoloft since arriving at the hotel. But she says she needs ongoing, in-depth mental health treatment and medical care for her teeth, and she’s not getting either.

“I’m still not getting treatment and I have massive headaches every day so bad that I feel like I’m going to throw up,” she said. “I can’t eat. I’ve lost a lot of weight. I’m in pain. Really bad pain all the time.”

Kris Rehl, an organizer with outreach group L.A. Street Care who works with Smith and others at that motel, said Smith isn’t the only one whose needs aren’t being met. Another guest at the hotel has a hernia so severe that she’s forced to use a wheelchair, Rehl said.

“The thing that really just destroys me is I will talk to people every week, like Shayne, who says ‘I’m in chronic pain,’” Rehl said. “Or people who are like I have debilitating panic attacks or debilitating depression or PTSD or some sort of urgent medical issue.”

Cost is another worry. The city is leasing rooms in about three-dozen motels, paying between $100 and $125 a night, per room. So far, Inside Safe has burned through nearly $40 million, city staff said during a committee meeting earlier this month. To make the program more affordable, the city is trying to buy some of the hotels. The mayor’s office said it is close to purchasing one 300-room motel, which would drop the nightly cost of sheltering people in those rooms from $135 down to $50, said Mercedes Márquez, the mayor’s chief of housing and homelessness solutions.

L.A. homeless encampment returns

Inside Safe has had mixed success when it comes to its goal of completely eliminating the encampments it targets. The city attempted to close a camp earlier this year at North Spring and Arcadia streets, two blocks from City Hall. On a recent afternoon, about 15 tents still dotted the sidewalks around that intersection.

Bass said that was one of a small number of Inside Safe sites the city wasn’t able to completely clear because some people at the encampment declined a hotel room . She suspects heavy drug use in the area is a factor – one woman overdosed during that Inside Safe operation, and a medic had to administer the overdose reversing drug Narcan four times to bring her back.

Skid Row, the infamous center of Los Angeles’ homeless community, is another area where any progress Inside Safe made is scarcely visible. The program moved 175 people from encampments in that neighborhood into hotel rooms, but it barely made a dent. The streets remain lined with tents and make-shift camps, where as many as 2,000 people are estimated to live.

But for those living and working near the U.S. 101 overpass that was the site of the city’s first Inside Safe operation, the difference is night and day.

For more than five years, passersby were forced to walk in the road to get around the encampment taking up the sidewalk, said Glenn Burroughs, who owns a gym called Sweat Equity Fitness down the street. Sometimes, people pitched tents right outside the gym’s door and it took months for the city to remove them, he said.

“I know I lost a lot of customers,” Burroughs said. “People would tell me all the time that they saw the gym and it had good reviews but they didn’t feel comfortable or safe parking their car or being in that neighborhood.”

Now, Burroughs is in “complete shock” that the sidewalks have remained so clean after the Inside Safe operation.

“It’s been extremely nice,” he said.

Homeless man returns to streets

But it hasn’t been a success story for everyone. About a block from the overpass, one small green and silver tent sits alone on the sidewalk. Inside, a 47-year-old man who goes by Selene, was reading an X-Men comic book on a recent afternoon. He had been part of the Inside Safe operation, and moved from the encampment into a hotel in December.

His reprieve from living outdoors lasted only about six months.

After getting into a disagreement with the hotel manager over his malfunctioning keycard, Selene kicked in the door to his room so he could get inside. As a result, he said, he was told to move out.

Now, he’s back on the street. After dropping him from the hotel, outreach workers gave him a tent and drove him back to the overpass, he said. After he pitched his tent, police quickly came and told him he could no longer camp there. So he moved a block down the road.

A location where unhoused folks receive temporary housing, in hopes of eventually being transferred to permanent housing, in Los Angeles on June 20, 2023. Photo by Julie A Hotz for CalMatters

After living on the street for nearly three decades, Selene has multiple mental health symptoms, including anger issues and anxiety attacks that make his whole body shake. He said he could have used counseling, but never got it while in the hotel. It’s possible that could have prevented the outburst that got him kicked out, he said.

The situation makes him feel useless and worthless, like “a waste of space and a waste of time.” Still, he insists he deserves a chance. “I’m a good person,” he said, a tear running down his cheek.

Despite stories like Selene’s, Inside Safe seems like a “really promising model,” said Nichole Fiore, who studies homeless encampments and solutions as a principal associate with research firm Abt Associates. People are much more willing to move from encampments into hotels than into traditional shelters, she said, as hotels offer a private space with a locking door and the ability to bring more possessions.

But people have so many needs beyond the simple solution of a temporary hotel room – including mental and physical health care and other services, as well as permanent housing.

“Inside Safe has a hard job,” said Lauren Dunton, another associate at Abt. “It’s a very hard thing. It’s not simple.”

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​ Orange County Register 

Secret Service: No DNA, fingerprints from found cocaine

• July 13, 2023

By Colleen Long and Michael Balsamo | Associated Press

WASHINGTON — No fingerprints or DNA turned up on the baggie of cocaine found in a lobby at the White House last week despite a sophisticated FBI crime lab analysis, and surveillance footage of the area didn’t identify a suspect, according to a summary of the Secret Service investigation obtained by The Associated Press. There are no leads on who brought the drugs into the building.

U.S. Secret Service agents found the white powder during a routine White House sweep on July 2, in a heavily trafficked West Wing lobby where staff go in and out, and tour groups gather to drop their phones and other belongings.

“Without physical evidence, the investigation will not be able to single out a person of interest from the hundreds of individuals who passed through the vestibule where the cocaine was discovered,” Secret Service officials said in the summary.

It’s most likely the bag was left behind by one of the hundreds of visitors who traveled in and out of the building over the weekend, according to a person familiar with the investigation who was not authorized to talk about an ongoing probe and spoke to The Associated Press on condition of anonymity.

The presence of cocaine at the White House prompted a flurry of criticism and questions from Republicans, who received a closed briefing Thursday on the results of the investigation.

“There is no equal justice,” House Speaker Kevin McCarthy said Thursday. “Anything revolving around ‘Biden, Inc.’ gets treated different than any other American and that’s got to stop.”

White House press secretary Karine Jean-Pierre said President Joe Biden believed it was “incredibly important” for the Secret Service to get to the bottom of how the drugs ended up in the White House. The Secret Service is responsible for securing the White House and led the investigation.

Biden wasn’t there at the time of the discovery. He was at Camp David with members of his family for the holiday weekend.

The complex was briefly evacuated as a precaution when the white powder was found. The fire department was called in to test the substance on the spot to determine whether it was hazardous, and the initial test came back negative for a biohazard but positive for cocaine.

The bag was sent for a secondary, more sensitive lab analysis. Homeland Security’s National Biodefense Analysis and Countermeasures Center analyzed the item for any biothreats. Tests conducted at the facility came back negative.

The cocaine and packaging underwent further forensics testing, including advanced fingerprint and DNA work at the FBI’s crime laboratory, according to the summary. The FBI also did chemical testing.

Meanwhile, Secret Service investigators put together a list of several hundred individuals who may have accessed the area where the drugs were found. Anyone who comes through the White House must give identifying information and pass through security before entering.

But the lab results didn’t turn up latent fingerprints or DNA, so agents can’t compare anything to the possible suspect pool. White House staff are fingerprinted; participants in tour groups are not.

Video of the West Executive street lobby entrance did not identify the person or provide any solid investigative leads, the Secret Service said.

The lobby is open to staff-led tours of the West Wing, which are scheduled for nonworking hours on the weekends and evenings. Those tours are invitation-only and led by White House staff for friends, family and other guests. Most staffers who work in the complex can request an evening or weekend tour slot, but there is often a long wait list. There were tours on the day, a Sunday, the drugs were found, as well as on the two preceding days.

The Situation Room, located in the West Wing, where staffers would also drop their phones before entering, has been undergoing construction work and was not in use at the time the baggie was found, national security adviser Jake Sullivan said last week.

Associated Press writer Kevin Freking contributed to this report.

​ Orange County Register 

Patients squeezed in fight over who gets to bill for pricey infusion drugs

• July 13, 2023

Samantha Liss | (TNS) KFF Health News

Health insurers and medical providers are battling over who should supply high-cost infusion drugs for patients, with the tussle over profits now spilling into statehouses across the country.

The issue is that some insurers are bypassing hospital pharmacies and physician offices and instead sending more complex drugs through third-party pharmacies. Those pharmacies then send the medications directly to the medical provider or facility for outpatient infusing, which is called “white bagging,” or, more rarely, to patients, in what is called “brown bagging.” That shifts who gets to buy and bill for these complex medications, including pricey chemotherapy drugs.

Insurers say the policies are needed because hospital markups are too high. But hospitals argue that adding an intermediary results in unnecessary risks and delays, and they say some insurers have their own or affiliated pharmacy companies, creating financial motives for controlling the source of the medications. The patients, meanwhile, are left to deal with the red tape.

Paula Bruton Shepard in Bolivar, Missouri, is among those caught in the middle. Flares of lupus, an autoimmune disease, rob Shepard of her mobility by attacking her joints. She relies on monthly infusions to treat her symptoms. But at times, she said, her treatments were delayed due to UnitedHealthcare’s white bagging infusion policy. And interruptions to her treatments exacerbated her symptoms.

“I once had to use a toilet lift and it was kind of demoralizing to say, ‘I’m a 50-year-old woman and I have to use a toilet lift,’” Shepard said of the medication delays.

This is a tug of war over profits between insurers and medical providers, said Ge Bai, a professor of accounting and health policy at Johns Hopkins University. While insurers claim the arrangement reduces costs, she said, that doesn’t mean insurers pass along savings to patients.

“I don’t think we should have more sympathy toward one party or the other,” Bai said. “Nobody is better than the other. They’re all trying to make money.”

The savings from white bagging can be significant for expensive infusion drugs, according to a report from the Massachusetts Health Policy Commission. For example, Remicade, used to treat a variety of inflammatory diseases, including Crohn’s, cost on average $1,106 per unit in 2015 under hospitals’ traditional buy-and-bill system, the commission found in its review of state claims data. That same drug cost an average of $975 per unit under white bagging, a 12% savings.

But the report also found patients, on average, faced higher cost sharing — what they are responsible for paying — for Remicade and other drugs when white bagging was used. While some patients had only modest increases to their costs under the policy, such as $12 more for a medication, the review found it could mean much greater cost sharing for some patients, such as those on Medicare.

At Citizens Memorial Hospital in rural Bolivar, more than 1 in 4 patients who receive regular infusions are being forced to use an outside pharmacy, said Mariah Hollabaugh, the hospital’s pharmacy director. Shepard was among them.

Even if the hospital has the exact drug on the shelf, patients must wait for a separate shipment, Hollabaugh said, potentially interrupting care. Their shipped drugs may sometimes be unusable when the doctor needs to change the dosage. Or the medicine comes in a nondescript package that doesn’t get immediately flagged for the pharmacy, potentially subjecting the drugs to damaging temperature fluctuations. For patients, that can mean delays in care.

“They’re in pain, they’re uncomfortable,” Hollabaugh said. “They may be having symptoms that don’t allow them to go to work.”

Siteman Cancer Center, led by physicians from Washington University School of Medicine in St. Louis, has confronted the same issue. But the cancer center’s size has helped it largely avoid such insurer policies.

John DiPersio, a Siteman oncologist and researcher who led the university’s oncology division for more than two decades, said Siteman reluctantly allows white bagging for simple injectables but refuses to accept it for complicated chemotherapies. It does not accept brown bagging. Occasionally, he said, that means turning patients away.

“You’re talking about cancer patients that are getting life-threatening treatments,” DiPersio said, referring to the dangers of chemo drugs, which he said can be fatal if used improperly. “It doesn’t make any sense to me. It’s all stupid. It’s all lunacy.”

At least 21 states, including Missouri, introduced some form of white or brown bagging legislation during the most recent legislative session, according to the American Society of Health-System Pharmacists. And in the past two years, the trade group said, at least 13 states have already enacted restrictions on white bagging, including Arkansas, Louisiana, and Virginia.

ASHP has created model legislation to limit insurers from requiring the practices as a condition of coverage.

“This is a major issue,” said Tom Kraus, a vice president at the trade group. “We see this as central to our ability to coordinate patient care.”

At the heart of the tension is an often-litigated federal program that allows certain hospitals and the clinics they own to purchase drugs at deep discounts. The 340B program, named for a section of the law that created it, allows hospitals to buy certain drugs for much less — sometimes for a total cost of a single penny — than what they are later paid for those drugs. Hospitals are not required to pass along 340B savings to patients.

The program was intended to help hospitals spread scarce resources further to treat patients in poor and vulnerable communities, but it has morphed into a means of enriching hospitals and their affiliated clinics, researchers said in a 2014 Health Affairs report. Hollabaugh said many rural facilities such as Citizens rely on the revenue generated from the 340B drugs to subsidize infusions that have no profit margin.

The number of participating hospitals and their affiliated outpatient clinics has increased significantly since the 340B program was created in 1992. More than 2,600 of the nation’s roughly 6,100 hospitals were participating in the 340B program as of January 2023. That gives them access to discounts that can knock off as much as 50% of a drug’s cost, according to the Health Resources & Services Administration, which oversees the program.

The insurance industry argues that hospital markups, especially when made on top of those discounts, have gotten out of control.

“The fact is, people got greedy,” Shannon Cooper, a lobbyist for Blue Cross and Blue Shield of Kansas City, said during a Missouri state Senate hearing in March.

Markups are not unique to 340B hospitals, said Sean Dickson, who helps lead pharmaceutical policy for AHIP, a trade group formerly known as America’s Health Insurance Plans. The markups thrusted on commercial plans are “widely out of line” with what Medicare will pay, he said, and that is driving up costs without providing additional value.

Legislation that targets white bagging hinders an insurer’s ability to rein in such costs, Dickson said, especially when an area lacks competition.

“What we’re really trying to focus on here is putting pressure on those markups that are not related to cost or safety,” Dickson said.

Anthem Blue Cross and Blue Shield lobbyist David Smith testified during the March hearing in Missouri that even the idea of white bagging elicited a quick response and that almost every major hospital system in the state said they would drop their prices and come back to the negotiation table.

For now, Citizens Memorial Hospital and other Missouri medical facilities will have to continue to tango with the insurers: Legislation to limit white and brown bagging did not pass during the Missouri General Assembly’s recent session.

Shepard, though, won’t need such legislation.

UnitedHealthcare had been sending her lupus infusion through other pharmacies on and off since 2021, unwilling to cover the drugs if they came from Citizens’ in-house pharmacy. Shepard had to authorize each shipment before it was sent. If she missed the monthly call, she said, it was a “bureaucratic mess” trying to get the medication shipped.

“We are driving unnecessary costs out of the health care system to help make care more affordable, while also maintaining drug safety, effectiveness and quality of care,” UnitedHealthcare spokesperson Tony Marusic wrote.

But after KFF Health News inquired about Shepard’s case, Marusic said UnitedHealthcare stopped white bagging Shepard’s medication to “prevent potential delays in shipping.” And during her latest infusion in June, her hospital was again able to supply Shepard’s medication directly.

“I’m just so relieved,” Shepard said. “I don’t have to take phone calls. I don’t have to reply to emails. I just show up.”

___

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

​ Orange County Register