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Here’s how much fruit juice children should drink, according to new guidelines

Next time you're grocery shopping for your kids, think twice before adding a carton of fruit juice to your basket. The American Academy of Pediatrics has updated its guidelines on all juices, advising parents to pull back on how much they serve their little ones.

» Related: What Atlanta dietitians feed their kids 

Previous recommendations said parents should wait to give their babies juice until after six months, but its latest update is suggesting that they wait one year. 

In fact, infants should only be fed breast milk or infant formula for the first six months. After six months, moms and dads can then introduce fruit to their diet, but not fruit juice. 

>> Read more trending news

“Parents may perceive fruit juice as healthy, but it is not a good substitute for fresh fruit and just packs in more sugar and calories,” said Melvin B. Heyman, MD, FAAP, co-author of the statement. “Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1.”

» Related: Should we slap a tax on sugary drinks? 

Scientists laid out instructions for older children, too. Toddlers who are ages 1 to 4 should only have one cup of fruit a day. Four ounces of that can come from 100 percent fruit juice, but it should be pasteurized and not labeled “drink,” “beverage” or cocktail.” 

For children ages 4 to 6, fruit juice intake shouldn't exceed four to six ounces a day. 

The amount increases just slightly for children ages 7 to 18. They can have up to two and a half cups of fruit servings, but only eight ounces of it should be juice. 

At least 5 contract botulism, potentially fatal poisoning, from gas station nachos

Multiple Californians have contracted botulism, a rare and potentially deadly poisoning after eating nachos purchased at a local gas station. 

>> Read more trending news

According to CBS News, Lavinia Kelly, a mother of three, was one of at least five people hospitalized when she contracted botulism after consuming contaminated nacho cheese from a gas station in Northern California last month. 

Kelly called her sister for help when she noticed something was wrong.

“My phone rings, and I pick up the phone, and it’s her. And she can’t articulate a word,” said Kelly’s sister, Theresa Kelly. “And she’s basically saying, ‘Sister, I need you here now.’”

Lavinia Kelly could barely breathe or open her eyes. 

“Nausea, vomiting, diarrhea. But then symptoms that start are typically in the face with neurologic manifestations, so difficulty swallowing, difficulty speaking. Maybe one eyelid is dragging,” Dr. Sean Townsend at California Pacific Medical Center in San Francisco said of botulism symptoms, WABC reported. Blurry vision and slurred speech are also symptoms.

“It’s really scary. And to think if her and my mother had eaten there,” Theresa Kelly said, according to KTXL. “My mom’s older. If my mom had eaten there, I don’t know if we would have lost both of them.”

According to CBS News, Lavinia Kelly purchased Doritos at Valley Oak Food and Fuel in Walnut Grove, California, on April 21. She drizzled the chips with cheese sauce before consuming them.

Botulism, caused by a toxin found in bacterial spores, can cause paralysis in its worst cases. Between 5 and 10 percent of botulism cases are fatal, according to the World Health Organization.

Lavinia Kelly is now in intensive care. She has been in the ICU with minimal function for three weeks, CBS News reported. According to WABC, she cannot open her her eyes and has no motor functions.

Her family says she’s expected to recover. They plan to take legal action against the gas station, CBS News reported.

“Somebody needs to be accountable. Somebody needs to pay attention to what the heck they’re ... doing, you know? It’s crazy,” Dawn Kelly, Lavinia Kelly’s mother, said, according to KTXL.

The Valley Oak Food and Fuel gas station stopped selling food and drinks May 5 after the county Department of Environmental Management temporarily revoked its permit, The Sacramento Bee reported. 

Hand injuries involving avocados prompt medical group's call for safety labels

Some avocado lovers are seeing red instead of green and yellow when they slice into the fruit, and the rising number of hand injuries is a concern to physicians.

According to The Times, the British Association of Plastic, Reconstructive and Aesthetic Surgeons wants to see safety labels put on the fruit, in response to a growing number of hand injuries related to avocado preparation that surgeons have seen in UK emergency rooms. The Times reported that some of the injuries involved serious nerve and tendon damage and required surgery.

>> Read more trending news 

The California Avocado Commission also reports seeing a fair share of hand injuries. A hashtag, #avocadohand, is documenting the trend on Twitter. The commission has posted safety tips for consumers on how to properly slice and dice avocados. 

Removing the large avocado seed in the middle of the fruit is a common source of injury. Experts recommend removing it with a spoon, and never poking or prodding it with a knife.

4 ways to protect yourself from wildfire smoke

Health officials in Florida are urging residents to take precautions to protect themselves from smoke being produced by the West Mims wildfire.

The West Mims fire is 12 percent contained. It has burned more than 144,000 acres, officials said at a Thursday morning news conference.>> Read more trending stories

Smoke was so bad in Duval on Thursday that school officials canceled all outdoor and after-school activities.

SOUTH GEORGIA WILDFIRE COVERAGE

>>WSB: 100,000-acre fire in wildlife refuge forces evacuations in Georgia

>>AJC: South Georgia wildfire picks up steam

The Florida Department of Health in Duval County wants people to take precautions when in areas affected heavily by smoke.

Officials said the smoke can cause scratchy throats or irritated eyes and noses. Smoke can also worsen asthma and other chronic lung or heart conditions.

Health officials said people can protect their families in several ways:

  • Avoid prolonged outdoor activities in areas heavily affected by smoke. This is especially important for children and people with pre-existing medical conditions.
  • Stay indoors and run your air conditioner. Keep the fresh air intake closed and the filter clean to prevent bringing additional smoke inside. For best results, run the air conditioning with recirculated air.
  • Help keep particle levels lower inside. When smoke levels are high, try to avoid using anything that burns, such as wood fireplaces, gas logs, gas stoves and candles. Do not vacuum, which stirs up particles already inside your home. Do not smoke.
  • Follow your doctor’s advice about taking medicines and following your asthma management plan if you have asthma or other lung diseases. Call your doctor if your symptoms worsen. Pay attention to local air quality reports (www.airnow.gov), news coverage or health warnings related to smoke.

Study: Young children using handheld devices could have speech delays

Children between the ages of 6 months and 2 years are more likely to experience speech delays if they use handheld devices like smartphones, tablets and electronic games, according to a study released Thursday.

>> Read more trending news 

The study was presented at the 2017 Pediatric Academic Societies Meeting in San Francisco, CNN reported.

"I believe it's the first study to examine mobile media device and communication delay in children," Catherine Birken, the study's senior investigator and a pediatrician and scientist at the Hospital for Sick Children in Toronto, told CNN. "It's the first time that we've sort of shone a light on this potential issue, but I think the results need to be tempered (because) it's really a first look."

The study involved nearly 900 children. Parents reported the amount of time their children spent using the screens at age 18 months. Researchers then used an infant toddler checklist to assess the children’s language development, CNN reported. The checklist included whether a child uses sounds or words to get attention, and how many words the child uses.

Twenty percent of the children spent an average of 28 minutes a day using screens, according to the study. Every 30-minute increase in daily screen time was linked to a 49 percent increased risk of what the researchers call expressive speech delay, which is using sounds and words, CNN reported. The study did not find any link between use of a handheld device and other areas of communication, such as gestures, body language and social interaction.

Birken said more research is needed to determine what content the children are viewing, and also whether they are using the devices with a parent or caregiver present, CNN reported.

"I think in order to actually develop the evidence to inform parents and clinicians about what to recommend, we need more definitive research," Birken said. "You need trials. You need good evidence, at least longitudinal studies, but this, at least, this finding is identifying an association and it does support the current recommendation" from the American Academy of Pediatrics.

That group recommends no screens at all, other than video-chatting with family, for children younger than 18 months, CNN reported.

For kids between the ages of 18 to 24 months, the American Academy of Pediatrics recommends that parents choose high-quality programming and watch it with their children to help them understand what exactly they are seeing.

Nearly 40 percent of children under age 2 have used a mobile device, an increase of 10 percent in 2011, according to a 2013 study by Common Sense Media.

What is tetralogy of Fallot – the disorder Jimmy Kimmel's son has?

On Monday, late-night talk show host Jimmy Kimmel told viewers in an emotional monologue that his newborn son had been diagnosed with a heart defect and underwent open heart surgery.

Kimmel said his son Billy, born on April 21, was discovered to have a disorder called tetralogy of Fallot (teh-TRAL-uh-jee of fuh-LOW), a congenital (meaning present at birth) disorder where the wall that separates the two sides of the heart is missing. 

Kimmel said his son had surgery last Monday and is now home recovering. 

Here’s a look at tetralogy of Fallot and pulmonary atresia, the other problem Kimmel said his son is suffering from.

What was Kimmel’s son diagnosed with?The disorder is called tetralogy of Fallot. It is a rare condition – only about 5 children out of 10,000 are diagnosed with it each year.

What is it?The disorder happens because of a structural problem with the heart. Tetralogy of Fallot is caused by a combination of four heart defects that are present at birth.

What are the defects?

According to the Centers for Disease and Control, the defects are:

1. A hole in the wall between the two lower chamber – or ventricles – of the heart. This condition also is called a ventricular septal defect.

2. A narrowing of the pulmonary valve and main pulmonary artery. This condition also is called pulmonary stenosis.

3. The aortic valves, which opens to the aorta, is enlarged and seems to open from both ventricles, rather than from the left ventricle only.

4. The muscular wall of the lower right chamber of the heart (right ventricle) is thicker than normal. This also is called ventricular hypertrophy.

What happens because of the problems?

The structure of the heart is affected and the defects cause blood that is oxygen-poor – meaning it has gone through the body and is being pumped back to the heart for recirculation – to be incorrectly routed through the body. Oxygen-poor blood is usually moved to the lungs to be infused with oxygen then routed through the heart to the brain and other organs. 

With tetralogy of Fallot, the blood mixes in the heart, sending the oxygen-poor blood throughout the body. Because the blood does not have enough oxygen, it leaves a baby’s skin with a blue tinge.

What is the treatment?

Surgery is needed soon after birth. During the surgery, doctors widen or replace the pulmonary valve and place a patch over the ventricular septal defect to close the hole between the two lower chambers of the heart. 

The surgery is incredibly delicate. Dr. Jennifer Ashton on “Good Morning America” Tuesday, offered this perspective on the complicated nature of the surgery: Try to imagine operating on an organ the size of a walnut with veins the diameter of angel-hair pasta.

Is it always diagnosed at birth?

No, not always, but usually. Sometimes it is diagnosed when the baby is still in the womb. Sometimes it is not diagnosed until later in life.

What about the other problem Kimmel mentioned – pulmonary atresia?

Pulmonary atresia (PULL-mun-airy ah-TREE-sha) is a birth defect of the pulmonary valve. That valve controls the blood flow from the right lower chamber of the heart into the blood vessel that carries blood from the heart to the lungs. Pulmonary atresia means that no pulmonary valve ever formed in the baby’s heart.

What caused these problems?

The cause of the defects is not known. Some are caused by gene or chromosome changes, some by something the mother and baby are exposed to – environmental factors or food, drinks or medication the mother uses. 

What is the prognosis? Can children with this lead normal lives?

The baby needs surgery not long after birth to repair the problem if possible. When the defects are caught early and the child is treated, most lead fairly normal lives. Usually, three surgeries are required to fix the defects. 

(Sources: Centers for Disease and Control, Mayo Clinic;

University of California San Francisco)

 

Running Short On Time, Covered California And Insurers Seek Obamacare Answers From GOP

With a deadline looming, California’s health exchange and a major insurer pressed Republican leaders in Washington to clear up confusion over their commitment to key provisions of the Affordable Care Act.

Health insurers participating in the Covered California exchange for individuals and families must submit initial rates for 2018 on Monday. Peter Lee, the exchange’s executive director, warned in a conference call Thursday that rates could jump by more than 40 percent if the Trump administration and Republican-led Congress walk away from crucial elements of the health law.

In the meantime, House Republicans are looking to revive their Obamacare replacement bill and rally more support among moderate lawmakers in hopes of holding a vote soon.

In addition to Covered California, the chief executive of Molina Healthcare, a Long Beach-based insurer, implored Congress and the Trump administration on Thursday to act quickly to stabilize the exchange markets.

At issue are the continued federal funding of subsidies that reduce low-income consumers’ deductibles and copays and the enforcement of the individual mandate to purchase health coverage or pay a penalty.

Premiums in Covered California plans could increase by 42 percent, on average, if those subsidies aren’t funded and the mandate isn’t enforced, according to an analysis released Thursday by the exchange. Covered California has about 1.3 million customers.

Lee said it is imperative for leaders in Washington to clear up the uncertainty to avoid damaging insurance markets nationwide and hurting consumers. He said statements this week by the Trump administration that it would continue funding the cost-sharing subsidies haven’t specifically addressed whether that applies to all of 2017 or 2018.

“Health plans need to know now what are the rules of the road,” Lee said. “Insurers are considering their participation in the face of unprecedented uncertainty.”

Much of the debate this week in Washington has centered on House Republicans amending their Obamacare replacement bill, the American Health Care Act. But Lee said addressing the current market rules should be a priority ahead of crafting broader legislation.

Lee declined to comment on the latest legislative proposal from House Republicans, but he noted it still faces a long road ahead in Congress before it would win approval. “Health plans need to submit bids for today’s reality. Policymakers need to address that reality,” Lee said.

In a letter to House Speaker Paul Ryan and other congressional leaders, Molina Healthcare CEO J. Mario Molina said the cost-sharing reduction subsidies are essential for making coverage affordable for many consumers. Those subsidies cover out-of-pocket costs for exchange customers with incomes below 250 percent of the federal poverty level. They are separate from the tax credits that subsidize premium costs.

Without that federal funding, Molina wrote, “we will have no choice but to send a notice of default informing the government that we are dropping our contracts for their failure to pay premiums and seek to withdraw from the marketplace immediately.”

Molina said his company currently serves more than 1 million people through insurance exchanges in California and several other states. Molina had nearly 69,000 enrollees in Covered California as of December, state data show.

Anthem, California’s largest for-profit health insurer and a key player on exchanges nationally, issued a similar warning this week. During an earnings conference call on Wednesday, Anthem CEO Joseph Swedish said the insurer may exit some state exchanges or resubmit for higher rates if the fate of the cost-sharing subsidies isn’t resolved by early June.

Anthem has more than 310,000 customers in the California exchange, or nearly 25 percent of the market. Rival Blue Shield of California is the leader in state enrollment with 389,480, or 31 percent market share.

Republican leaders in Congress say they will address these concerns and move quickly to aid consumers by replacing the ACA with a plan that will reduce premiums and expand options for coverage.

The health law “is collapsing,” Ryan said at a news conference Thursday. “The American health care system in the individual market is in peril right now. We have a moral obligation to prevent people from getting hurt, to stop the damage from being continued.”

Many conservative Republicans oppose the Trump administration’s decision to continue to pay the cost-sharing subsidies, calling the subsidies unconstitutional because they lack congressional approval. House Republicans successfully sued to block the payments, but a judge put the ruling on hold while the Obama administration appealed the case. It’s not yet clear how President Donald Trump will handle that appeal.

Amid this political uncertainty, California Insurance Commissioner Dave Jones told insurers this week they could submit two sets of rate filings on Monday for their exchange business. One filing would reflect continued funding of cost-sharing subsidies and enforcement of the individual mandate. A separate filing could assume the opposite.

“In light of all the actions taken by the Trump administration and House leadership to undermine the ACA, I expect that health insurers will consider filing significant rate increases for 2018,” Jones wrote in a bulletin to insurers this week.

For 2017, rates in Covered California rose by 13.2 percent, on average, statewide. The state exchange is one of the few that actively negotiates rates with insurers. Premiums for the next year usually are announced in July.

‘Center Of Excellence’ Designation Doesn’t Rule Out Complications Of Bariatric Surgery

Getting bariatric surgery at a “center of excellence” doesn’t mean that patients can be assured that they will avoid serious complications from the weight-loss procedure at the facility, according to a recent study.

Even though facilities that have been accredited as centers of excellence must all meet minimum standards, including performing at least 125 bariatric surgeries annually, the risk of serious problems varied widely among centers, the study found.

“To become accredited, there’s no measure of outcomes, it’s just a process list,” said Dr. Andrew Ibrahim, a research fellow at the University of Michigan Institute for Healthcare Policy and Innovation and the study’s lead author. In addition to minimum case volumes, accredited centers have to have special surgical equipment to handle overweight patients, such as bariatric operating tables and longer laparoscopic instruments.

Insurers typically restrict coverage of bariatric surgery to procedures performed at accredited facilities, however, and nearly 90 percent of bariatric surgeries are performed at a center of excellence.

Bariatric surgery is used to treat people who are severely obese and have not had success with other weight-loss programs. Surgeons use a variety of methods to make the stomach smaller so that less food can be consumed easily.

For this study, researchers analyzed claims data of more than 145,000 patients at 165 bariatric surgery centers of excellence in 12 states from 2010 to 2013. Nationally, the rate of serious complications following surgery — heart attack, kidney failure or blood transfusion, for example — varied widely among the centers, from 0.6 percent at the low end to 10.3 percent at the high end. The rate varied widely within states as well. Nearly 1 in 3 lower-performing hospitals had a higher-performing hospital in the same service area, the study found.

Bariatric surgery has come a long way from the early days when some low-volume centers experienced 30-day mortality rates approaching 10 percent, according to Ibrahim. In this study, 72 patients died in the hospital following surgery — a rate of less than 1 percent among study participants.

However, while accreditation has had an effect on quality and safety, “at the moment, just going to a center that is accredited does not ensure uniform high-quality care for a patient,” Ibrahim said.

The degree of technical skill of the surgeon performing the procedure may affect post-operative outcomes, the study found, as may the degree to which centers follow accepted best practices for bariatric patient care. Neither of those variables is captured in this study.

The organization that accredits bariatric surgery hospitals collects data from hospitals about serious complications, but the data aren’t publicly available, according to the study. So there’s no way for patients to use the data to learn which bariatric center of excellence in their area has the lowest serious complication rates. “Not yet,” Ibrahim said.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Try This At Home: Program Brings Drug Addiction Treatment To Patients

[audio mp3="https://kaiserhealthnews.files.wordpress.com/2017/04/20170417_atc_home-based_drug_treatment_program_costs_less_and_works.mp3"][/audio]Can’t see the audio player? Click here to download.

Hannah Berkowitz is 20 years old. When she was a senior in high school, her life flew off the rails.

She was abusing drugs. She was suicidal. She moved into a therapeutic boarding school to get sober, but she could stay sober only while she was on campus during the week.

“I’d come home and try to stay sober really hard — really, really hard,” said Berkowitz, who had trouble staying away from old friends and bad habits. “Sometimes I’d make it through the weekend, and sometimes I just couldn’t make it. It was white-knuckling it, just holding on.”

The transition back home always triggered a relapse for Berkowitz.

“I thought it was just my fault and there was no hope,” she said.

But Berkowitz did have luck. She had private health insurance and lived in Connecticut, where a startup company, Aware Recovery Care, had begun treating clients in the very environment where Hannah struggled to stay sober: her home.

A Chronic Disease Approach

Treating addiction is a growing business, and some treatments, especially inpatient care, can run tens of thousands of dollars. For many people, the help is only temporary. The National Institutes of Health estimates that 40 to 60 percent of people addicted to drugs relapse. But there is a way to help some people pay less for better results, said Matt Eacott, vice president of Aware Recovery Care.

“Ninety-nine percent of the industry really treats addiction as an acute problem — like a rash on your arm that you rub lotion on and you’re done,” he said.

Rather than a bad rash, Aware treats addiction as a chronic illness that doesn’t disappear just because symptoms are under control — a cost-effective way of treating addiction, Eacott said.

Aware comes into clients’ homes and connects them with a nurse, a primary care doctor, a therapist, peer support, 12-step meetings and a case manager. Clients hooked on opioids can get medication-assisted treatment. They can also submit to urine screening and GPS tracking, if that helps them stick with the program.

Hannah’s mother, Lois Berkowitz, said the program is intense at first. But as Hannah built coping skills, the supports faded into the background.

“It’s not like they’re doing the work for the addict,” said Lois Berkowitz. “They’re just basically taking them by the hand and saying, ‘Here are the places you need to go that will help you. And I’m going to go with you to start so it doesn’t feel that uncomfortable. And then we’re going to let you fly.'”

Before they fly, Aware clients have a pretty long runway. The treatment lasts a full year.

The Numbers

Aware has now expanded from its base in Connecticut into New Hampshire. The program is expensive: $38,000 a year. As of now, it’s available only to private-pay clients and people insured through Anthem health insurance in New Hampshire and Connecticut.

Anthem became the first insurer to pay Aware, because the treatment is based on hard science that’s yielding solid results for clients, said Dr. Steven Korn, Anthem’s behavioral health medical director. Science and results are rare in addiction treatment, he said.

“There are old, old notions that have hung pretty tough,” said Korn. “When I was young, when I was in training and as soon as substance abuse was mentioned, the response of physicians was, ‘Well, go to AA. That’s not our problem. We don’t treat that.'”

For a year of treatment, Anthem said, it’s paying Aware about the same as the cost of a month or two of inpatient treatment. Anthem also says 72 percent of Aware clients are either sober at the end of one year or still in active treatment.

That’s about twice the sobriety rate of people who check in to a facility for a month and then get no follow-up care, said Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine.

Treating addiction at home makes sense because it’s the exact place where people learned their bad habits, Gitlow said.

“It’s all based on this concept that addiction is not about the substance use but is about what led to the substance use in the first place. And you can’t really get there without getting to know the patient,” he added.

Aware said it’s in negotiations with four more major insurers. It aims to have a couple of hundred clients in New Hampshire by the end of the year.

This story is part of a partnership that includes NHPR, NPR and Kaiser Health News.

California Proposes Stringent Cap On Toxic Chemical In Drinking Water

California regulators are proposing a strict limit on a toxic man-made chemical that has contaminated water supplies throughout the state, particularly in its vast agricultural heartland.

California would be only the second state, after Hawaii, to establish a threshold for the former pesticide ingredient and industrial solvent known as TCP (1,2,3-trichloropropane) in drinking water. The chemical compound, identified in California as a human carcinogen, is no longer in wide use but has leached over the years into many wells and reservoirs.

The problem extends well beyond California and Hawaii, environmental advocates say, but the chemical is not regulated by the federal government. Citing federal data, the Environmental Working Group, a Washington, D.C.-based advocacy organization, says the chemical also has been detected in water supplies of a dozen other states, including New York, Pennsylvania and New Jersey, as well as Puerto Rico.

Once TCP gets into the groundwater, it “persists for centuries,” according to the EWG’s April report.

The California State Water Resources Control Board’s proposal would set the maximum allowable amount of TCP in public tap water at five parts per trillion — the lowest level that existing filtration systems can reliably detect and far lower than Hawaii’s.

It “is a top priority for the state water board,” said board spokesman Andrew DiLuccia.

TCP taints water systems serving nearly a million people from Sacramento to San Diego, according to the state water board. The compound is present at levels above the proposed limit in 562 wells, reservoirs and other sources belonging to 94 public water systems, according to 2016 data. Those numbers do not include private wells.

In California, the contamination exists in many urban areas, including in Los Angeles, San Bernardino and San Mateo counties. Though the source in those more populated regions is not known, the pollution is believed to come from industrial and hazardous waste sites.

“Los Angeles has quite a bit of contamination,” said Andria Ventura, toxics program manager for the environmental advocacy group Clean Water Action. “It’s hard for water providers to pinpoint where it came from.”

But California’s most serious and widespread TCP contamination is in the agricultural counties of the Central Valley, where the chemical was an ingredient in soil fumigants sold by the Shell Oil and Dow Chemical companies from at least the 1950s into the 1980s.

During that period, farmers who grew potatoes, sugar beets and other vegetables used the fumigants to kill tiny, soil-dwelling worms called nematodes. Dozens of municipalities and public water suppliers across the state have filed lawsuits against Shell and Dow, alleging that the companies knew — or should have known — that the TCP in their soil-fumigating pesticides would migrate into groundwater and pose a serious health hazard.

Shell and Dow have denied wrongdoing. Shell quit selling its product, known as D-D, in the mid-1980s. About the same time, Dow opted to reformulate its fumigant, known as Telone, after which TCP declined to “generally undetectable” levels, according to company spokesman Jarrod Erpelding. He declined to comment further, citing pending litigation.

Shell sent an email response: “The former Shell agricultural product, last manufactured more than 30 years ago, contained trace amounts of 1,2,3 trichloropropane (TCP). It was used to control microscopic worms that attacked crops causing millions of dollars a year of crop loss for farmers, and was approved for use by the U.S. government and the State of California.”

Environmental advocates say the adoption of a regulatory limit for TCP is a crucial step to help cash-strapped, rural water districts pay for the cleanup of their drinking water.

“It allows the districts when they go into court to be very specific and say to the judge, ‘We’re going to need exactly this amount of money to purchase this kind of system to meet the state standards,’” said Bill Walker, managing editor at the Environmental Working Group and co-author of its report on the role of Shell and Dow in California’s TCP drinking water problem.

“It doesn’t guarantee they’ll win,” he said, “but it increases their leverage.”

At a public hearing on April 19, water board members heard testimony and received written comments on the proposed limit. Now the board is reviewing the input it received and will likely vote on the plan by summer, DiLuccia said.

The regulation would require water utilities to test their supplies for TCP and remove it from any public drinking water source that exceeded the threshold, starting in 2018.

The proposed limit is more stringent than Hawaii’s because it is as close as California could get to meeting its stated “public health goal” for TCP set in 2009, officials say.

Though it is difficult to know how long the California cleanup might take, the cost of TCP testing and subsequent cleanup could reach nearly $500 million over 20 years, according to one water board estimate.

TCP contamination “disproportionately impacts poor communities and communities of color,” said Jenny Rempel, of Community Water Center, a Visalia, Calif.-based advocacy group. “This is a problem where the cost should not be borne by taxpayers.”

Todd E. Robins, a San Francisco attorney who is representing more than two dozen of the water suppliers that are suing Shell and Dow, argues that the companies included TCP in their worm-killing pesticides to get rid of the compound without having to pay for proper disposal. It was a byproduct of unrelated manufacturing processes and, according to the suits, played no role in killing the plant-damaging worms.

“The TCP that we find today in groundwater is the result of past use of soil fumigants that contained TCP as an unnecessary ingredient,” Robins said. “Instead of paying for disposal costs, they started getting farmers to pay for them.”

“The saddest part of the story,” Robins added, “is that the … actual active ingredient breaks down in the soil after a matter of days and has rarely been detected in anyone’s groundwater.”

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One of the lawsuits filed by Robins, on behalf of the Del Rey Community Service District in Fresno County, says the companies knew they could remove or reduce the amount of TCP in their pesticides without compromising its effectiveness but failed to do so.

The complaint calls TCP a “hazardous waste” — a byproduct created in the manufacturing of a different chemical, allyl chloride, that Shell and Dow used to make plastics and other commercial products.

An internal Shell memo uncovered in Robins’ litigation cites $3.2 million in savings from “cost avoidance for disposal” related to the allyl chloride operations. The memo is dated Jan. 20, 1983 — a year before the company stopped producing the TCP-laced pesticide.

In addition to the pending cases, which also name distributors and marketers as defendants, Robins said he has settled eight cases against both Shell and Dow since 2010. He said he cannot disclose the amounts because of confidentiality agreements.

Last December, in a case tried by a different lawyer, a Fresno Superior Court jury awarded the city of Clovis $22 million against Shell to clean up its TCP-tainted drinking water.

In 2010, in a case brought by the city of Redlands, Shell won. The company argued that a nearby aerospace plant was the source of the toxin. Moreover, the wells in question were used for irrigation, and the jury didn’t believe they’d ever be used for drinking water.

As the lawsuits proceed, some California residents do what they can to protest the toxic chemicals in their water supply. Bartolo Chavez, 57, took time off his job in a juice packing house to testify at the recent hearing in Sacramento.

“We talk about the contaminants and the danger,” said Chavez, who has lived for 21 years in the Central Valley town of Arvin, Calif. “And [that] we’re exposed.”

He said he gets tokens from the water district to get free filtered water — not just because of TCP but because of other contaminants as well, such as arsenic and chromium-6.

“But the tokens aren’t enough,” Chavez said, speaking through a Spanish-language interpreter. “So in addition, we buy bottled water at Costco.”

Chavez and his wife, a hotel worker, pay about $50 a month for that water — a price they say they can ill afford. But leaving Arvin isn’t an option either, Chavez said.

“I have thought about moving, but it’s not so easy to find work in other places, especially when you’re older,” he said. “Our house is almost paid off, and to move would be to start over again, so it’s almost impossible.”

California Healthline Managing Editor Bernard Wolfson contributed to this report.  This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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