After taking some flack for uploading a photo to Facebook depicting what appears to be a deceptive marketing practice to gather referendum signatures I took a road trip to visit the petition gatherers and hear what they had to say.

The two I met were from Sacramento and hired by a Sacramento company called American Petition Consultants.

The guys are paid a buck each for signatures on two state measures and $2 a pop for the marijuana ordinance referendum.

The referendum effort is being sponsored by the newly formed “Community Alliance to Ban Illegal Cannabis Cultivation.”

The group includes some of the folks who were involved in last year's failed Measure D marijuana initiative.

The name “Community Alliance to Ban Illegal Cannabis Cultivation” raises the question, how can you ban something that's already illegal?

I met with one signature gatherer who was working the door at Walmart; the other had set up shop outside of Safeway in Lakeport.

The Safeway guy said he's collecting around 300 to 500 signatures a day on three petitions combined, so he's making a pretty decent wage. I imagine there are plenty of local folk who would leap at the opportunity to make that kind of money.

Unfortunately, both were utterly uninformed about the new county ordinance; one admitted that he didn't know the specifics while the other explained that I could have six plants on an acre and 24 on 20 acres. Neither seemed aware of the option to grow indoors.

The guy who admitted he didn't really know much about it explained that the referendum was to protect mom and pop businesses from corporate takeover. He said this was to let the voters decide. So I asked him if he'd ever heard of our Measure D. Nope.

Measure D was a grower-sponsored initiative put to the voters in June 2012. It went down to defeat by a two-to-one margin.

All in all, the petition gatherers were very pleasant, though totally ill informed about the place where they are working.

While I was kicking it with one of the guys, a couple signing the petition explained to me that part of the ordinance was to charge fees for plants and require “RFID” – radio frequency identification – tags so officials could drive through neighborhoods and check on compliance with some kind of radio receiver.

In addition to that paranoid departure from reality they also apparently thought Measure D won and had been altered by the Board of Supervisors after passing. I asked if they paid attention to local news and both those local people said no.

To satisfy my curiosity I'd looked up the petition for the advertised children's hospital funding on the Secretary of State website and learned that's not what the ballot measure really is.

The fabled “Children’s Hospital” ballot initiative is actually an initiative to change legislative rules to require a two-thirds vote in the Legislature when they want to amend existing laws that impose fees on hospitals. It also directs the fees collected to pay hospitals for uncompensated care for the uninsured of any age, even children.

To my surprise the text of the initiative has no Children’s Hospitals mentioned at all. Nice try, but no cigar.

The third petition being offered for signature is to require drug and alcohol testing for doctors and for those test results to be reported to the California Medical Board. Positive tests would require suspension of the doctor and disciplinary action if the doctor was impaired while on duty.

John Jensen is co-founder of Lake County News. He lives in Lucerne, Calif.

California’s aging water infrastructure is insufficient for our present and future needs. Unfortunately, the current Bay Delta Conservation Plan (BDCP) and its two massive tunnels is a destructive $25 billion boondoggle that won't solve the problem.

California can solve its water needs and end the water wars that pit north vs. south and water exporters vs. environmentalists – but not with the BDCP.

California needs a comprehensive water plan that generates new water and is focused on six priorities:

1) New water storage infrastructure,

2) Water conservation,

3) Water recycling,

4) Fixing the Delta with levee improvements, habitat restoration, and a right sized conveyance,

5) A science-driven process,

6) The protection of existing water rights.

If the BDCP moves forward, two tunnels will be constructed near Sacramento with the capacity to move 15,000 cubic feet per second (cfs).

To accommodate this massive plumbing project, we would sacrifice prime agricultural land, destroy legacy Delta communities, and potentially suck our Delta dry.

At a minimum cost of $24.5 billion, it’s extraordinarily expensive for California taxpayers and water ratepayers.

Delta farmers, fishermen and recreation businesses would see their livelihoods destroyed to benefit powerful corporate agribusinesses operating on desert lands in part of the San Joaquin Valley.

We need to develop surface and underground water storage systems. Sites Reservoir north of Sacramento could be built and Los Vaqueros reservoir could be expanded at an estimated cost of $4.8 billion creating the capacity to store 1.9 million acre feet of water and providing up to 700,000 acre feet of water to use each year.

The San Louis dam could be repaired and expanded as could Shasta Dam. New reservoirs could be built at Los Banos Grandes and other off stream sites throughout the Central Valley. The underground aquifers of the Central Valley offer enormous storage when used in a conjunctive management system.

The quickest and cheapest new water source is conservation. The California Department of Water Resources estimates that robust conservation efforts in urban water use could save 1 million acre feet of water each year by investing $530 million.

In addition to urban conservation, we must also look to agricultural water users to conserve water. California’s $40 billion agricultural economy needs a sustainable water supply and the technology already exists to conserve 3 million acre feet of water each year at a cost of $1.2 billion over 10 years.

Each year, 3.5 million acre feet of treated water is dumped into the Pacific Ocean by cities in the Los Angeles Basin. How foolish to pump water 500 miles, clean it, use it once, clean it to a higher standard than the day it arrives, and dump it in the ocean. One million acre feet could be recycled and stored in the underground aquifers in Southern California at a cost of $1.3 billion. Similar projects must be done in Northern California. Desalination of ocean water can also add to our supplies.

With adequate investment and implementation, urban and agriculture conservation, recycling programs and new storage could create approximately 5.7 million acre feet of new water to use each year at a projected cost of $7.8 billion.

Any plan that doesn’t include levee improvements in the Delta is a plan awaiting disaster. The BDCP will spend $25 billion, but not one dime to secure the Delta levee system that is necessary for delivering half of the anticipated water supply. How foolish and short sighted. The key Delta levees could be secured at an estimated cost of $1 billion.

The BDCP skips all of these important sources of increased water supply. It's a $25 billion boondoggle that won’t create a single drop of new water for California.

The BDCP plan for habitat restoration is well intentioned, but too extensive and expensive. The plan calls for as much as 145,000 acres of valuable Delta farm land to be converted to wildlife habitat. Every scientific study done thus far doubts the potential of this $10 billion proposal to restore and maintain the endangered fish in the Delta, yet the BDCP moves forward as if money is no problem.

After investing in conservation, recycling, storage and Delta levees and carefully monitoring their progress, it might be necessary to construct a much smaller Delta water delivery facility.

A 3,000 cubic feet per second facility could operate year round delivering 2 million acre feet water to the pumps in Tracy and on to the south.

Instead of destroying heritage communities and Delta farm land, this facility could use the existing 25 mile long Sacramento Deep Water Shipping Channel for water deliveries to a short 12 mile pipe connected to existing channels leading to the Tracy pumps. This could save billions of dollars while preserving the economy and communities of the Delta.

Providing a foundation for these projects is the protection of existing water rights. If we are going to build any project, these rights must be honored.

Stop the $25 billion BDCP boondoggle and use that money on water conservation, recycling, storage, fixing the Delta, a balanced habitat program, and a small Delta facility.

California could create up to 5.7 million acre feet of new water at half the cost of the $25 billion tunnel plan, solve its water crisis, and avoid a fruitless time consuming water war. Only by embracing a comprehensive plan can we avoid this gridlock.

It’s time to move forward and ensure a reliable water supply for the entire state.

Congressman Garamendi represents Northern California’s 3rd Congressional District, which includes part of Lake County. He served as a state senator, lieutenant governor, insurance commissioner and as President Bill Clinton’s deputy interior secretary.

At holiday time, many people who are dealing with loss are caught in a dilemma between the need to grieve and the pressure to get into the spirit of the season.

Holidays or not, it is important for people who feel grief to find ways to take care of themselves.

Here are 10 tips for hope for the holidays from Hospice Services of Lake County.

– Plan ahead as to where and how you will spend your time during the holidays. Let yourself scale back on activities if you want to.

– Select a candle in your loved one’s favorite color and scent. Place it in a special area of your home and light it at a significant time throughout the holidays, signifying the light of the love that lives on in your heart.

– Give yourself permission to express your feelings. If you feel an urge to cry, let the tears flow. Tears are healing.

– Write an “unsent letter” to your loved one expressing what you are honestly feeling toward him or her in the moment. After you compose the letter, you may decide to place it in a book, album or drawer in your home, leave it at a memorial site, throw it away, or even burn it and let the ashes symbolically rise.

– When you are especially missing your love one, call family members or dear friends and share your feelings. If they knew him or her, consider asking them to share some memories of times they shared with your loved one.

– If you live within driving distance of the cemetery, decorate the memorial site with a holiday theme.

– Play music that is comforting and meaningful to you. Take a few moments to close your eyes and feel the music within the center of your being.

– Give money you would have spent for gifts for your absent loved one to a charity in your loved one’s name.

– Read a book or article on grief. Some suggestions are “Don’t Take My Grief Away From Me” by Doug Manning; “The Comfort Book For Those Who Mourn,” compiled by Anna Trimiew; and “A grief Observed” by C.S. Lewis.

– Remember that the anticipation of holidays without your loved one is often harder than the actual holidays themselves.

The public is invited to attend an open supportive discussion entitled Hope for the Holidays, including a DVD and light refreshments, on Tuesday, Dec. 10, 1:30 p.m. to 3 p.m., at the following locations: Lakeport – 1605 S. Main St.; Lower Lake – 162 Second St. at the Lower Lake Community United Methodist Church reception hall.

For more information call 707-263-6222.

Linda Laing, MFT, is director of Bereavement Services for Hospice Services of Lake County, Calif.

Sometimes it happens suddenly or seemingly overnight. We are all going about our business and then we get sick or have an accident.

Our health and independence – what we once took for granted – can be taken away from us in a heart beat. Illness and/or aging seem to sneak up on most of us when we are busy living life. It doesn’t make it any easier when we see it coming, such as when we or a loved is diagnosed with a serious health condition that doesn’t have a cure.

November is National Family Caregiver Month and this year’s theme is “Family Caregivers – Now More Than Ever!”

Each year, more and more Americans are caring for a loved one with a disability, chronic condition, or the frailties of old age.

There are as many as 90 million family care providers in the United States today, and it’s not just the elderly who need caregiving – the number of parents caring for children with special needs is increasing, too, due to the rise in cases of many childhood conditions.

We are all members of an aging society. Whether an older person becomes confused or physically frail, or an otherwise healthy disabled person begins to face health issues that are associated with aging, there is a common theme: How do I keep doing what I want to do and how I want to do it, for as long as I am able?

Those needing assistance need to be part of the decision-making process. When this isn’t completely possible, it is critical that family members and friends take the time to understand and discuss a person’s expectations for care and support so their choices and wishes can be respected and honored.

This conversation also serves to help determine what is needed in a care provider, and helps care providers know what is to be expected.

Know community resources

The Area Agency on Aging of Lake and Mendocino counties provides guidance and support for older adults and care providers striving to maintain healthy and independent lives in Lake and Mendocino Counties.

Its Information and Assistance Program helps seniors and care providers locate the best resources for their unique situations.

Be a knowledgeable care provider – attend a care provider training

The In-Home Supportive Services Public Authority offers care provider training courses throughout the year in Lake County for those caring for In-Home Supportive Services recipients.

The feedback on these classes is always positive. Folks walk away from the training with increased confidence as well as relief, knowing that they will be of better service to the person who needs their help.

Use the registry to find help

A list of available care providers can be mailed, emailed or faxed upon request to In-Home Supportive Services recipients.

Screen your care providers

Although care providers on the registry have been screened and have completed required training, it is important to do a thorough interview.

Asking the following questions can help select the right care provider:

• What experience do you have as a care provider?
• Do you have any specialized training?
• Do you have any physical limitations?
• Would you be willing to take me to appointments? If he/she is going to be providing transportation, ask to see his/her driver license and auto insurance.
• Would you cook according to my needs?
• Do you have any problems with the days or hours that I need you?
• If you don’t smoke, do you mind being around someone who smokes?
• Do you use drugs or alcohol?

If you have special needs, ask the applicant how they would handle your specific needs.

If you have animals, ask if they have any allergies to them.

Ask if they have gone through the provider enrollment process, including being fingerprinted.

Give them a chance to ask you questions about the job and the services that you need.

Pace yourself – family caregiver support program

Family care providers need a break now and then as well as those receiving care from family care providers.

The Family Caregiver Support Program offers respite grants to unpaid care providers to allow them to get a break from their regular caregiving responsibilities.

So remember to acknowledge and celebrate someone you know who is caring for a loved one to reinforce this year’s theme: “Family Caregivers, Now More Than Ever!”

For information about In-Home Supportive Services and the Public Authority Registry, please call 707-995-4680.

For information about the Area Agency on Aging’s Information & Assistance and Family Caregiver Support Programs, call 707-262-4517.

Todd Metcalf is the Adult Services Program manager at Department of Social Services serving Lake County, Calif.

Some people may not realize it, but there are actually two ways to get Medicare benefits.

The best-known way is Original Medicare. With Original Medicare, you can choose any doctor, hospital, or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly.

The other way is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies approved by Medicare. If you’re in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.

If you go outside the network, you may have to pay more.

On the other hand, Medicare Advantage companies may offer some coverage – such as dental, hearing, vision, and wellness programs – that Original Medicare doesn’t.

Most people with Original Medicare pay a monthly premium. If you’re in Medicare Advantage, you sometimes pay an additional monthly premium to the private insurance company that covers you.

With Original Medicare, you must pay deductibles, co-pays, and coinsurance.

To cover these “gaps” in Medicare, some people buy a type of supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of the covered costs, and then your Medigap policy pays its share.

Medigap policies also are sold through private companies. All plans offer the same basic benefits but some offer additional benefits. The costs vary between insurance companies – and often cost is the only difference between policies. Some Medigap policies also offer benefits that Original Medicare doesn’t, such as medical care when you travel outside the United States.

Original Medicare generally doesn’t cover prescription drugs. If you want drug coverage, you can get it through Medicare Part D. Part D policies are sold through private companies approved by Medicare. You have to pay an additional monthly premium for Part D.

About 75 percent of Medicare beneficiaries choose Original Medicare, with the rest getting coverage through Medicare Advantage.

Medicare Advantage companies must cover all of the services that Original Medicare covers, except hospice care and some care in qualifying clinical research studies. (Original Medicare covers hospice and qualifying clinical research care even if you’re in a Medicare Advantage plan.)

In all types of Medicare Advantage plans, you’re covered for emergency and urgent care. Most Medicare Advantage plans also include prescription drug coverage.

But the plans can charge different out-of-pocket amounts and they have different rules for how you get service.

For example, you may need a referral to see a specialist. And you may need to stay in their provider network, unless you’re willing to pay more to go outside the network.

You should always check with the plan before you get a service to find out whether it’s covered and what your costs may be. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

How can you decide whether Original Medicare or Medicare Advantage is better for you?

There’s a more detailed explanation of the differences between Original Medicare and Medicare Advantage in the “Medicare & You” handbook. An updated version of “Medicare & You” is mailed to all Medicare beneficiaries every fall.

You can also find “Medicare & You” on our Web site, www.Medicare.gov .

If you have any questions, you can always call Medicare’s toll-free number, 1-800-MEDICARE (1-800-633-4227).

David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories.

As you probably know, Sutter Lakeside Hospital became a Critical Access Hospital (CAH) back in 2008. What you may not know is why – or what that designation means.

In 2007 and 2008, we were struggling financially and we were considering several options: We could reduce services, we could close programs or we could consider becoming a Critical Access Hospital.

Under the direction of our volunteer board of directors, and with the blessing of our medical staff, we decided to apply for Critical Access Hospital status.

The federal CAH program is designed to provide additional financial support for small rural hospitals.

This option is offered to small rural hospitals of 25 beds or fewer to ensure that critical health care services remain available locally.

Our Critical Access designation allows us to receive significantly higher reimbursement from Medicare for inpatient and outpatient procedures as compared to non-Critical Access hospitals.

Since 2008, Sutter Lakeside Hospital has received more than $16 million in additional Medicare reimbursement due to our critical access status.

Some of you may remember when Lakeside Community Hospital had more than 50 beds. On average, we had between 27 and 30 patients in beds each night since the inception of the hospital in the mid-1940s.

We decided that a 25 bed-count required by the CAH guidelines would be manageable – and we were right.

Part of the reason that 25 beds continues to work for us is that medicine is changing and evolving.

Procedures, such as hysterectomies, that once required a week-long inpatient stay, can now be done safely and effectively as outpatient procedures.

Major abdominal surgeries are being replaced with laparoscopic procedures using video technology, which greatly reduces procedure recovery times.

In addition, hospitals continue to work with our community partners to get patients home sooner with the care they need, whether that is homecare, equipment to help care for patients at home (like walkers and hospital beds), support from hospice, or placement in skilled nursing facilities.

As medicine continues to evolve, the move to more outpatient and home-based care will gain momentum.

This is an exciting time to be a part of health care and witness the change in how we deliver care to the people who need it.

I hear comments from the community about the use of helicopter transfers from our Emergency Department.

The overwhelming reason why we transfer patients out of the area is so that the patient may receive a higher level of care.

This means that the patient being seen in our Emergency Department has a medical condition that needs treatment by a specialist, such as an open heart surgeon, a stroke specialist for brain surgeries or the patient requires a procedure like microscopic hand surgery.

Lake County’s population of 65,000 residents is too small for those high-level specialists to make a living.

For example, a cardiac open heart program needs to do about 300 to 500 procedures a year to ensure the staff and providers working in the program maintain their skills.

The old adage “practice makes perfect” is as true in medicine as it is anywhere else. To do 300 open heart procedures a year requires a population base of about 400,000 people – or six times the number of residents in Lake County.

We have been pleased with the results of becoming a Critical Access Hospital. With the transition to CAH status, we have been able to continue offering our community excellent medical care close to home, and that’s crucial to all of us who live and work in Lake County.

If you have any questions about our CAH status, please write to me at This email address is being protected from spambots. You need JavaScript enabled to view it. .

Siri Nelson is chief administrative officer of Sutter Lakeside Hospital in Lakeport, Calif.