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Fri11152019

Last updateTue, 18 Sep 2018 1pm

Elizabeth Brown’s bedroom holds a trove of evidence of her fight to save herself.

Preserved among Twilight novels, posters of Korean pop singers and cameras she used for her budding journalism career are clues about the Santa Rosa teenager’s agonizing struggle with the mental illness that claimed her life last year.

Next to her bed sits the lavender candle she lit to soothe herself. On her desk are the bunny slippers she wore when she was too depressed and anxious to leave the house. Taped to the wall are two plastic hospital bracelets from separate psychiatric admissions in 2017.

Underneath them hang four sticky notes, on which she had printed:

“channel all the anger, sadness, hurt into this one thing”

“you can have control”

“you can be beautiful”

“this pain is good.”

The cutting, the suffocating despair, the suicidal thoughts—those details live in the journal she hid behind a password on her laptop.

“She really tried hard,” says her mother, Seong Brown. “She believed in the medical system to help her.

“But they failed at every turn.”


Around California, people with mental illness—and their family members—talk about pleading with insurance providers for treatment.

Their stories share an underlying premise: Despite policy advances in the last two decades intended to compel insurers to provide equivalent levels of care for physical and mental illnesses, the reality on the ground still looks very different.

A poll released in January by the California Health Care Foundation and the Kaiser Family Foundation found that more than half of those surveyed thought their communities lacked adequate mental-health-care providers, and that most people with mental health conditions are unable to get needed services.

The state Department of Managed Health Care has cited health plans dozens of times in the past decade—penalizing them millions of dollars—for mental-health-related violations.

And earlier this month, a federal judge in Northern California ruled that United Behavioral Healthcare had wrongly restricted treatment for patients with mental-health and substance-abuse disorders in order to cut costs, in violation of federal law.

Not all problems with access to mental health care are illegal, but some almost certainly are, said David Lloyd, policy adviser at The Kennedy Forum, a nonprofit mental health advocacy organization founded by former congressman Patrick Kennedy.

“There’s a lot of evidence that discrimination by plans is happening,” he said.

Experts say mental health has been underfunded historically, in part because of prejudice against people with mental illness and substance abuse disorders.


California enacted a law requiring health plans to provide coverage for the diagnosis and treatment of severe mental illnesses in 1999.

A decade later, in a major victory for mental-health advocates, the state passed a law requiring health plans that offered mental health coverage to provide the same level of care they gave on the medical/surgical side. The law was strengthened again in 2010 when the Affordable Care Act listed mental health as an essential benefit that insurers were required to provide.

Insurers say they’re doing their best to comply with these laws but face a shortage of mental-health providers. Plans are working closely with state regulators and using a variety of methods, including virtual appointments, to meet these “serious challenges,” said Mary Ellen Grant, spokeswoman for the California Association of Health Plans, a trade group that represents insurers.

Most plans no longer limit the number of visits to a mental-health provider, nor do they charge higher co-pays or deductibles. But that hasn’t made access to mental and physical health care equivalent, said Lloyd of The Kennedy Forum.

The primary challenges for patients now exist in areas harder to track and quantify, including pre-authorization requirements and determinations of what is “medically necessary,” he said.

Parity laws are often so complex that it can be hard for people to know whether the barriers they face are actually illegal or just feel unfair, said Jennifer Mathis, policy director at the Bazelon Center for Mental Health Law in Washington, D.C.

“Most people aren’t able to figure this out,” Mathis said.

All many people know is that their loved one desperately needs help—and isn’t getting it.


In early January 2019, on the first anniversary of the day that Elizabeth Brown took the action that eventually ended her life, her parents, Seong and David, sat at the kitchen table in the immaculate Santa Rosa home that Seong, an architect, designed.

Seong retrieved an email from her husband’s colleague detailing cancer treatment his wife received from Kaiser Permanente. While Elizabeth descended into mental illness, their friend’s wife was treated by a team of oncologists, nurses, counselors, social workers and outside specialists.

“This is what she got,” Seong said. “And she’s still here.”

Citing federal privacy laws, Kaiser declined to comment on Elizabeth’s care. In a written statement, the company said, “This is a heartbreaking story, and our condolences go out to the Brown Family and her loved ones. While we can’t speak to any individual case out of respect for the privacy of those involved, the loss of any person greatly saddens every physician, therapist and nurse involved in that patient’s care. We review each case extensively and when opportunities to improve are discovered, we share that knowledge with our care teams.”

Elizabeth was a top student, her parents said. She earned a black belt in karate, played piano and was a violinist in the San Francisco Symphony Youth Orchestra.

After sophomore year, she applied to Bard College at Simon’s Rock in Massachusetts and started there before her 16th birthday. She made the dean’s list.

She also started having panic attacks. In May 2016, after her second year at Bard, she asked to see a therapist.

“Something’s not right, Mom,” Seong said she told her.

A few days later, Elizabeth first met with a Kaiser psychologist in Santa Rosa, beginning a treatment odyssey chronicled in 3,000 pages of medical records provided by her parents. The psychologist described “depression, self-criticism and self-destructive behaviors,” suggesting a self-forgiveness audio program and discussing cognitive behavioral therapy strategies.

As the months passed, Seong and David Brown grew increasingly concerned. Their daughter would head off to college, only to land in a hospital or threaten to kill herself and return home to California.

The family was dissatisfied with the frequency of sessions available through Kaiser. They were referred to an outside contractor, records show, but grew frustrated waiting to hear back. They eventually began paying $160 a session so she could see an outside therapist once or twice a week.

On Jan. 18, 2017, records show, Elizabeth tore up her parents’ house, searching for pills to swallow to kill herself. She found herself holding a kitchen knife and, frightened, called police. They took her to the hospital. Two days later, she was screened for an intensive outpatient treatment program offered through Kaiser.

“Patient’s mother is very worried that Patient will kill herself and requested a higher level of care,” the provider Elizabeth met with wrote in her notes.

Elizabeth agreed to try the Kaiser program—group therapy a few hours a day, several times a week, for two weeks. She was taking several medications, but they didn’t seem to be working, her parents said.

A letter she wrote herself during that time offers a window into her mindset.

“The depression drops you into a deep pit, leaving you to claw at the edges in an attempt to pull yourself out,” she wrote. “But there are people, resources, pieces of hope that will drop you a ladder—I promise. Even though you scream, and it seems like no one hears you, you will learn to help yourself. … You can rely on yourself; you are your own saving grace. Because in the end, you won’t be saved by IOP or medications or therapy—you will be saved by you.”

Around that time, records show, her Kaiser psychiatrist diagnosed her with bipolar disorder. Over the next few months, he changed her medications regularly and offered words of encouragement via email.

But a few weeks later, she was struggling again.


In 2013, the state Department of Managed Health Care levied a $4 million fine—one of the largest in its history—against Kaiser for deficiencies in providing timely access to mental health care and for violations of state parity law related to mental health education materials.

In an interview, Department Director Shelley Rouillard said Kaiser “actually is doing very well” at meeting the settlement agreement’s benchmarks.

In December, Democratic state Sen. Jim Beall of San Jose introduced legislation to require plans to report to the state annually on parity compliance—and for the state to make those reports accessible to the public.

That same month, Kaiser mental-health workers went on strike for five days to protest long patient wait times. Striking providers described not using the restroom all day and working through lunch, afraid that any call they don’t answer will leave a patient to suffer.

“The HMO is not going to go to oncology and say, ‘Our next available opening is in six weeks, so that’s what’s available,” said Kenneth Rogers, a psychologist with Kaiser in Elk Grove who serves as a shop steward for the union.

People on both sides of the debate agree that mental health workforce shortages are a big piece of the problem.

Kaiser has hired 30 percent more therapists since 2015, and pays the state’s highest rates, said Dr. Linda Kim, chair of regional mental health and addiction medicine and recovery services for Kaiser Northern California.

“I truly believe no other organization is doing more than what we are doing, in terms of aggressively hiring and in terms of truly innovating and finding new models of care that are evidence-based,” she said.

Professional associations representing psychiatrists and social workers say they often don’t want to work with insurers at all, citing low reimbursements and onerous administrative burdens.

One study found that only 55 percent of psychiatrists accept insurance, compared to an average for all health care professionals of 89 percent.

Sheree Lowe, vice president of behavioral health for the California Hospital Association, said health plans often require reauthorization every five days for hospitalized patients receiving mental-health or substance-abuse treatment—even for evidence-based care that routinely takes much longer. In some cases, clinicians have to wait up to two hours on hold in order to get that authorization, she said.

“That doesn’t happen if you go in with a fractured hip or with pneumonia,” she said.


Elizabeth returned to college in Massachusetts in the fall of 2017. She was quickly hospitalized twice. Doctors there diagnosed her with borderline personality disorder, her parents said, which was subsequently added to her Kaiser medical record.

That October, as the deadly Tubbs Fire moved closer to the hills around the home Elizabeth’s mother had designed, she hosed down her roof and bargained with God: “Take my house. Bring my child back.”

The house was spared. Elizabeth got sicker. Desperate, her parents made plans to send her to a residential treatment program in January 2018. It would cost $45,000 out-of-pocket.

On Dec. 4, 2017, Elizabeth emailed her Kaiser psychiatrist. “There is a lot to cover since we last met,” she said.

“It’s a 30 min visit to remind you and my part at this time is to refill your meds in the transition to your more intensive treatment,” he responded, according to Elizabeth’s medical record.

That afternoon, Seong sent the psychiatrist an email: “This is very critical and important for Elizabeth’s well-being because of her acute symptoms. She will be home more than a month and she needs an intensive outpatient therapy that is more than once a week.”

He responded that he understood, and that Elizabeth could return to the Intensive Outpatient Program or try to see a new therapist through an outside contractor. “That is the options I have available,” he wrote.

Seong developed a protocol when she was away from Elizabeth. She’d check in via text. If no response came within 15 minutes, she would call twice. If there was no answer, she’d race home.

On Jan. 10, 2018, Seong felt hopeful. Elizabeth texted that she was drinking coffee and reading a book. They made plans to buy new glasses frames after Seong came home from work.

In between texts to her mother, her parents said, Elizabeth also sent one to a friend. Its message, in essence: Send the police to collect my body. I don’t want my parents to find me.

This is an abridged version of the full story, which is available here at CALmatters.org—a nonprofit, nonpartisan media venture explaining California’s policies and politics. The coverage is funded by a grant from the California Health Care Foundation. Consumers experiencing access issues, or other issues with their health plans, can reach the state’s Department of Managed Health Care Help Center at 1-888-466-2219 or www.HealthHelp.ca.gov. If you or someone you know is having thoughts of suicide, there is help available. Call the National Suicide Prevention Lifeline 1-800-273-8255 (TALK) for resources and support.

Published in Features

If Jerry Brown could write the script in which he exits the political stage while still in the spotlight, he could do no better than what’s teed up for him later this week: presiding over the Global Climate Action Summit with a few hundred of his closest fellow leaders in the fight against global warming.

The San Francisco event is a hybrid of various high-level international meetings in which political figures discuss what can be done to address climate change, sign declarations, adjourn and then meet again later, somewhere else.

This summit, which Brown is co-hosting with former New York Mayor Michael Bloomberg and a bevy of international officials, aims to advance that staid model by including a broad group of “non-state actors”—mayors, governors and leaders representing regions rather than entire countries.

Brown’s extensive networking will come into play, as will two organizations he helped found. One is the Under2 Coalition, a group of more than 200 governments vowing to prevent global temperatures from rising more than two degrees Celsius.

A second grew out of his partnership with Bloomberg: America’s Pledge, a mix of states, cities and businesses that vow to adhere to the emission reductions set out in the Paris agreement.

Perhaps most intriguing is the inclusion of business in the proceedings. Large industries are sometimes shunned as the root of the climate-change problem and not seen as entities offering solutions. Brown’s idea is to invite companies to the table, take advantage of whatever solutions they offer, and then ask them to commit to specific goals for reducing greenhouse gases.

Whether and how such promises come to fruition, and whether any other meaningful actions come out of the summit, are the questions that typically bedevil these talk-heavy, photo-opportunity events.

“It could be a lot of pomp and not much action, but there could also be a lot of good things coming out of it,” said Sean Hecht, co-executive director of UCLA’s Emmett Institute on Climate Change and the Environment.

“If your metric for success is how confident are we that this will help us turn the corner—there’s certainly reason for pessimism. On the other hand, you have to keep trying,” Hecht said. “It’s possible that there will be some moment that the corner gets turned.”

Among the invitees are the heavy-hitters of the climate change world: former Vice President Al Gore; Patricia Espinosa, executive secretary of the U.N. Framework Convention on Climate Change; primatologist Jane Goodall; and prominent climate scientists and researchers. And, this being California, a sprinkling of activist movie stars and other celebrities will be on hand, including actors Alec Baldwin and Harrison Ford, and musician Dave Matthews.

But with business leaders front and center, the summit affords companies a chance to brag about their green credentials. As unusual as that opportunity may be at climate conferences, it’s not uncommon in California.

 In fact, much of the state’s conservation achievements have been driven by business advocacy, according to David Vogel, a retired business and political science professor at the University of California, Berkeley. His book, California Greenin’: How the Golden State Became an Environmental Leader, which was published in May, traces the influence of private enterprise in forging environmental and conservation policies.

“The state has carved out a leadership role on climate issues, but influential business leaders have historically supported much of that,” Vogel said, citing steamship companies’ having lobbied for Yosemite to become a national park, in part so they could gain the lucrative trade in ferrying visitors to California.

“Business has certainly awakened to self-interest around climate,” said Kathy Gerwig, vice president of employee safety, health and wellness, and environmental stewardship officer, at Kaiser Permanente, a health-care giant.

Kaiser donated $1 million to help fund the summit, as did the Schwab Charitable Trust, according to filings with the state. The William and Flora Hewlett Foundation gave $1.25 million. Other sponsors contributed as well.

Kaiser set a goal to reduce carbon emissions 30 percent across the company by 2020, which was achieved three years early, she said. Climate change affects the health-care business—both its care facilities and its patients, she added.

“There are business risks associated with climate change—infrastructure where facilities are located, and storm damage. Those are real costs,” Gerwig said, referring to extreme weather and rising seas. “And the number, variety and severity of some of the health impacts of climate change are what’s front and center for our mind, that’s our business.”

She cited heat-related illness and the poor air quality that often plagues poorer neighborhoods.

Among the themes to be addressed in panels and seminars at the summit are inclusive economic growth, sustainable communities, and land and ocean stewardship. Some events are open to the public; others are not.

In keeping with the inclusive approach, there will be hundreds of side events, exhibits and tours in addition to the main speakers and panels. There will be much emphasis on environmental justice—how climate change can disproportionately harm low-income communities, many of which are near industrial sites that foul air and water.

The summit is expected to be accompanied by demonstrators—but they, too, are welcomed by at least some participants. A march is planned for the weekend before the conference, with another on its opening day. Greenpeace has docked its ship Arctic Sunrise, which will carry a banner calling for immediate action on climate change.

“I love the collaborative nature of this summit,” Gerwig said. “I don’t care what anybody’s motivation is for action on climate. … Come to the table.”

The official portions of the summit run Wednesday, Sept. 12, through Friday, Sept. 14, at the George R. Moscone Convention Center. Affiliated events will take place all week around the Bay Area.

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Environment

Linda is my wife, my best friend. She’s the daughter of Annette, who had been battling cancer for years.

Fifteen months prior to this August 2016 morning, Annette, then 93, had come to live out her last days with us in our Palm Desert home. Now, Linda stood at the foot of her mother’s bed and spoke softly to our cat, who had stretched herself out across Annette’s lower legs.

“Lola, honey, come on now,” Linda cajoled. “You have to get up, sweetie. Mom-mom’s no longer here. She’s gone now.”

Lola stayed put with her chin on her crossed front paws. It seemed that nothing or no one could disturb this quiet, calm and peaceful scene.

Thanks to California’s End of Life Option Act, Annette had just left behind the painful captivity of the cancer that had progressively destroyed her quality of life.


This peaceful day came after one of the most trying 15 months of our lives.

“Mom was diagnosed as having six months or less to live, and was in hospice care when she came to stay with us,” Linda recalled. “At this point, she never had a day when she felt well. So, when the End of Life Option became legal in California,” on June 9, 2016, after being signed into law by Gov. Jerry Brown in October 2015, “she decided that she wanted to participate in it. I went online and did a lot of research.”

Linda quickly learned the process was not going to be easy.

“What I found was that none of the hospitals out here (in the Coachella Valley) were participating in providing their patients with the support to obtain the life-ending prescriptions,” Linda said. “And that meant that none of the doctors out here, as far as I knew, were participating.”

Linda has directed information-research departments for major media and advertising companies—so her online search skills are well-honed, to say the least. However, she could find no local leads for resources to contact on her mom’s behalf.

“Actually, that isn’t uncommon, because doctors don’t want to advertise that they participate in this program,” Linda said. “I had been in contact with people in Oregon and other states where (medical aid in dying) had been legal for a while. That’s where I started to see what had come before: Doctors don’t want to be seen as ‘Dr. Kevorkians’ or doctors of death, so there are no lists. Even in places where it has been legal for 18 years, there’s no list for doctors who are participating. You have to talk to your own doctor.

“During my research, though, I came upon the organization Compassion and Choices, and I contacted them,” Linda said. “I asked if they had any contacts in California who could help us access this option, and they said that the only thing they knew was that Kaiser Permanente was participating—which meant, to me, our only recourse was Kaiser.”


Amy Thoma, the director of public affairs for Kaiser Permanente, recently talked to me about Kaiser’s participation.

“We allow our physicians to participate in California’s End of Life Option Act,” Thoma said. “Physician participation is not mandatory. Also, we allow it in other regions such as Washington and Oregon, where it’s been an option for a while now. We encourage our patients to have thoughtful discussions with their loved ones, family and friends, as well as their health-care providers, about their end-of-life wishes so that they can have whatever dignified ending they choose.”

I asked what Kaiser does to “market” the fact that it allows patients and their doctors to participate in the End of Life Option Act.

“Health plans in general are not allowed to market the End of Life Option Act in California,” Thoma said. “It’s prohibited by (the End of Life Option) law, so we do not market it to our patients at all.”

Thoma referred me to Compassion and Choices for a broader discussion about medical-provider systems in California and their participation in the End of Life Option Act. Therefore, I reached out to Matt Whitaker, the newly appointed California state director for Compassion and Choices. We asked him whether the lack of support by the medical industry in our area was atypical.

“I would say that the Coachella Valley is pretty unique in the way that there is really no access to medical providers supporting the End of Life Option Act program,” Whitaker said. “In most of the population centers across California, you have the few religiously affiliated hospitals and organizations that made the decision not to participate, but you don’t see the majority of health systems choosing not to participate.”

In particular, he focused on the fact that Eisenhower Medical Center, one of the major health-care providers in our valley, has chosen not to offer End of Life Option services—nor is Eisenhower permitting any associated doctors to participate.

“They are not religiously affiliated,” Whitaker said. “We know from our work in the community that they have a large number of doctors who want to participate and who were super-upset when the decision not to do so came down, because there wasn’t much stakeholder engagement at all prior to making that decision.”


Last summer, Linda began taking steps for Annette to move from her existing insurance plan and health-care network to the Kaiser Permanente universe.

“Mom had Medicare insurance, so what we needed to do was change her supplemental insurance to Kaiser,” Linda said. “Fortunately, if you are on Medicare, Kaiser offers open enrollment at any time, all year. … But before we joined Kaiser, I called them, and we went over everything. They told me that (providing End of Life services in California) was new to them, and that they were hiring an end-of-life coordinator for Riverside County who would take us through the entire process. So we cancelled Mom’s supplemental policy in the middle of the month, and by the first of the next month, she was on Kaiser. She got a senior (citizen) insurance plan that had no monthly fee to be paid.”

It became very obvious, very quickly, that the Riverside County end-of-life coordinator’s support was an invaluable resource provided by Kaiser. The two of them worked as a team on Annette’s behalf in the weeks ahead.

“Once I got in contact with the new and extremely helpful coordinator, she reviewed for me the criteria necessary for a terminally ill patient to qualify for the End of Life Option in California,” Linda said. “You have to prove that you are a resident of California; you need to have a diagnosis of six months or less to live; you have to demonstrate that you are in your right mind and not suffering from depression; and you must be able to self-administer the prescribed medications. Also, you must be able to confirm, both in writing and orally, that you are personally in agreement with the decision to follow this end-of-life course of action.”

The California law also stipulates that two doctors must be involved in the process of granting permission to obtain the life-ending medications.

“The coordinator told me that there would be a first-opinion doctor who Mom would see initially, and who would then evaluate her again at least 15 days following that initial in-person appointment,” Linda said. “During that interim period, she would have to visit another doctor in person for a second opinion.”

Because Kaiser’s operations in support of the End of Life Option Act in California were just beginning, there were no existing relationships with doctors in their network who had elected to participate in the program. Originally, the coordinator was able to find doctors—but they were hours away from Palm Desert. “I told her that Mom was in no shape to make those trips,” Linda said. “I explained to her that we weren’t in a rush, but that we needed to find doctors close to our home in Palm Desert.

“She found us the first-opinion doctor at the Kaiser Indio facility, and the second doctor was in Palm Springs.”

At this point, Annette was given a form that she had to complete in preparation for her initial doctor visit, and appointments were made for the first two doctor visits.

“When we saw the first doctor, it was not a long trip to Indio, and the visit was rather short,” Linda said. “(My mom) gave him the completed form, and he reviewed her medical history. Then he interviewed Mom to make sure that this was her choice, and that it wasn’t a case of anyone trying to talk her into it. He asked why she wanted to pursue this end-of-life option. She told him that she suffered from two types of cancer and never had a day when she felt well.

“Less than a week later, we had an appointment to see the second-opinion doctor in the Palm Springs Kaiser office. He asked her another bunch of questions: When was she diagnosed? What illness did she have? Was she in pain? He talked to her about other things to confirm that she was coherent and in her right mind, and that it was her choice to do this. Also, he asked if she was capable of self-administering the drugs.

“Finally, Annette had her return consultation with the first-opinion doctor. Shortly thereafter, he was able to prescribe the necessary medications.”

The cost of these medications to the patient can vary, depending on the type of insurance; in fact, the drugs can be quite expensive. However, Kaiser may be able to help a patient find financial aid if he or she can prove financial hardship.

At this stage, the coordinator made an appointment for Linda to meet with a Kaiser pharmacist manager for the drugs to be delivered into the possession of either the patient or his/her representative, and to review—in detail—the procedure for administering the drugs.

“In our case, I met him at the Moreno Valley Kaiser facility,” Linda said. “He explained that there would be three separate drugs to be ingested to complete the end-of-life protocol, and he described in great detail the procedure for taking them to ensure the intended result.”

Everything was ready for Annette to make a final decision. The process—from the time she joined Kaiser to the time when we received the life-ending drugs—took no longer than 60 days.

“It’s important to note that the patient can change his or her mind at any time during this process,” Linda said. “Even if they have obtained the prescribed medications, they can change their mind. It seems that only approximately 30 percent of the people who receive the medications actually follow through and take them. … A lot of people change their mind.

“It gives you the option to control your own passing, and that is a wonderful thing.”


Dr. Wayne McKinny is a retired pediatrician and a resident of Desert Hot Springs. He’s also a hospice patient, diagnosed with terminal bladder cancer.

In the last six months, he has written two opinion pieces published in the local press. Both decried the refusal of our valley’s three major hospitals—Eisenhower Medical Center, Desert Regional Medical Center and John F. Kennedy Memorial Hospital—to participate in or allow any of their associated doctors to participate in End of Life Option medical support. He is currently working with Compassion and Choices on their efforts to get these large medical organizations to support the law—and their patients’ desires.

“Having this right available is emotional insurance for a dying patient,” Dr. McKinny told the Independent. “They know they have it, and that they won’t have any problem, and they can use it. Likewise, it’s emotional insurance for a person who does not choose this option initially, because they know that if they change their mind, they would be able to get the option somewhat easily.”

How can terminally ill and despairing patients in our valley get access to the right to choose the circumstances of their passing?

“The choices that have been made by Coachella Valley health-care systems are not reflective of the attitude of the people in the community,” said Whitaker, of Compassion and Choices. “That’s what we’re really trying to make sure those hospitals there know. Hospitals and health systems are a community resource like libraries, churches or community centers. They exist to serve their communities. For example, during the (statewide) campaign to get the End of Life Option Act passed into law, there was a huge amount of support out of the Coachella Valley. There were a lot of people who did organizing and advocacy to make the option available, and so I think that’s where a lot of the current community disappointment comes from. There’s this population there that clearly wants this option, but the bulk of the apparatus (of medical providers) that is there to serve the community isn’t doing it.

Whitaker said his organization has had several hundred people call Eisenhower Medical Center to voice their disappointment.

“We’ve tried to approach the issue with as much civility as possible, but it’s gotten to the point where people who are interested in pushing back should go to our website and sign up to volunteer and add their name to our list,” he said. “We will be holding rallies and community meetings. We have an organizer in Southern California, and the Coachella Valley is an area with a big bull’s-eye on it for him, because we need to get people out and empowered and making some noise about this issue.”


Neither Linda nor I will ever forget that August day when Annette, who had been sick and in pain for so long, chose to end her life

“On the morning that Mom chose to follow through on her decision, we sat her on the edge of her own bed in her own room,” Linda said. “We followed carefully the process the pharmacist had described. The first drug she took was an anti-nausea medication to ease the ingestion of the other drugs in the quantities prescribed. Then, about 45 minutes later, the second drug was taken; it was a beta-blocker intended to slow down the heart rate. Then about another 15 minutes later, Mom took a large dose of Seconal, which would cause death. We had opened up 90 capsules and mixed their contents into one half-cup of applesauce, which she ate. (It could be mixed into juice or other items that the pharmacist approves.) The pharmacist had emphasized that Mom had to follow the procedure closely, and that there was a certain timeframe in which the drugs had to be completely consumed to avoid any mishaps.

“After she finished taking the last of the Seconal, we helped her lie down on the bed and made her comfortable. I had an aide, who Mom had grown close to, helping me that morning, and it was a very good idea to have her there. It’s good to have someone there with you for support.

“Very quickly, like after 30 seconds, Mom closed her eyes and drifted into a peaceful sleep. Her breathing was a little labored, but that was pretty much normal for her at that point. And then in about 20 minutes, with no gasping for breath or anything, she just stopped breathing. And it was so peaceful. It was really incredibly peaceful. She had her favorite cat with her, and it was just a beautiful death. She wanted it to be very quiet. We had put her in very comfortable clothes, and it was very beautiful.

“It’s the way we all should die.”

To enroll in a Kaiser Permanente health plan and/or to receive information about their End of Life Option services, call 800-464-4000. For more information about the End of Life Option Act, visit www.compassionandchoices.org/california.

Published in Features