Science

She’s Trying to Stay Ahead of Alzheimer’s, in a Race to the Death

Published

1 year ago

February 16, 2025

She’s Trying to Stay Ahead of Alzheimer’s, in a Race to the Death

Soon, Irene Mekel will need to pick the day she dies.

She’s not in any hurry: She quite likes her life, in a trim, airy house in Castricum, a Dutch village by the sea. She has flowers growing in her back garden, and there is a street market nearby where vendors greet villagers by name. But if her life is going to end the way she wants, she will have to pick a date, sooner than she might like.

“It’s a tragedy,” she said.

Ms. Mekel, 82, has Alzheimer’s disease. It was diagnosed a year ago. She knows her cognitive function is slowly declining, and she knows what is coming. She spent years working as a nurse, and she cared for her sister, who had vascular dementia. For now, she is managing, with help from her three children and a big screen in the corner of the living room that they update remotely to remind her of the date and any appointments.

In the not-so-distant future, it will no longer be safe for her to stay at home alone. She had a bad fall and broke her elbow in August. She does not feel she can live with her children, who are busy with careers and children of their own. She is determined that she will never move to a nursing home, which she considers an intolerable loss of dignity. As a Dutch citizen, she is entitled by law to request that a doctor help her end her life when she reaches a point of unbearable suffering. And so she has applied for a medically assisted death.

In 2023, shortly before her diagnosis, Ms. Mekel joined a workshop organized by the Dutch Association for Voluntary End of Life. There, she learned how to draft an advance request document that would lay out her wishes, including the conditions under which she would request what is called euthanasia in the Netherlands. She decided it would be when she could not recognize her children and grandchildren, hold a conversation or live in her own home.

But when Ms. Mekel’s family doctor read the advance directive, she said that while she supported euthanasia, she could not provide it. She will not do it for someone who has by definition lost the capacity to consent.

A rapidly growing number of countries around the world, from Ecuador to Germany, are legalizing medical assistance in dying. But in most of those countries, the procedure is available only to people with terminal illness.

The Netherlands is one of just four countries (plus the Canadian province of Quebec) that permit medically assisted death by advance request for people with dementia. But the idea is gaining support in other countries, as populations age and medical interventions mean more people live long enough to experience cognitive decline.

The Dutch public strongly supports the right to an assisted death for people with dementia. Yet most Dutch doctors refuse to provide it. They find that the moral burden of ending the life of someone who no longer has the cognitive capacity to confirm their wishes is too weighty to bear.

Ms. Mekel’s doctor referred her to the Euthanasia Expertise Center, in The Hague, an organization that trains doctors and nurses to provide euthanasia within the parameters of Dutch law and connects patients with a medical team that will investigate a request and provide assisted death to eligible patients in cases where their own doctors won’t. But even these doctors are reluctant to act after a person has lost mental capacity.

Last year, a doctor and a nurse from the center came every three months to meet with Ms. Mekel over tea. Ostensibly, they came to discuss her wishes for the end of her life. But Ms. Mekel knew they were really monitoring how quickly her mental faculties had declined. It might seem like a tea party, she said, “but I see them watching me.”

Dr. Bert Keizer is alert for a very particular moment: It is known as “five to 12” — five minutes to midnight. Doctors, patients and their caregivers engage in a delicate negotiation to time death for the last moment before a person loses that capacity to clearly state a rational wish to die. He will fulfill Ms. Mekel’s request to end her life only while she still is fully aware of what she is asking.

They must act before dementia has tricked her, as it has so many of his other patients, into thinking her mind is just fine.

“This balance is something so hard to discover,” he said, “because you as a doctor and she as your patient, neither of you quite knows what the prognosis is, how things will develop — and so the harrowing aspect of this whole thing is looking for the right time for the horrible thing.”

Ms. Mekel finds this negotiation deeply frustrating: The process does not allow for the idea that simply having to accept care can be considered a form of suffering, that worrying about what lies ahead is suffering, that loss of dignity is suffering. Whose assessment should carry more weight, she asks: current Irene Mekel, who sees loss of autonomy as unbearable, or future Irene, with advanced dementia, who is no longer unhappy, or can no longer convey that she’s unhappy, if someone must feed and dress her.

More than 500,000 of the 18 million people in the Netherlands have advance request documents like hers on file with their family doctors, explicitly laying out their wishes for physician-assisted death should they decline cognitively to a point they identify as intolerable. Most assume that an advance request will allow them to progress into dementia and have their spouses, children or caregivers choose the moment when their lives should end.

Yet of the 9,000 physician-assisted deaths in the Netherlands each year, just six or seven are for people who have lost mental capacity. The overwhelming majority are for people with terminal illnesses, mostly cancer, with a smaller number for people who have other nonterminal conditions that cause acute suffering — such as neurodegenerative disease or intractable depression.

Physicians, who were the primary drivers of the creation of the Dutch assisted dying law — not Parliament, or a constitutional court case, as in most other countries where the procedure is legal — have strong views about what they will and will not do. “Five to 12” is the pragmatic compromise that has emerged in the 23 years since the criminal code was amended to permit physicians to end lives in situations of “unbearable and irremediable suffering.”

A Shock

Ms. Mekel, petite and brisk, had suspected for some time before she received a diagnosis that she had Alzheimer’s. There were small, disquieting signs, and then one big one, when she took a taxi home one day and could not recognize a single house on the street where she had lived for 45 years, could not identify her own front door.

At that point, she knew it was time to start making plans.

She and her best friend, Jean, talked often about how they dreaded the idea of a nursing home, of needing someone to dress them, get them out of bed in the morning, of having their worlds shrink to a sunroom at the end of a ward.

“When you lose your own will, and you are no longer independent — for me, that’s my nightmare,” she said. “I would kill myself, I think.”

She knows how cognition can slip away almost imperceptibly, like mist over a garden on a spring morning. But the news that she would need to ask Dr. Keizer to end her life before such losses happened came as a shock.

Her distress at the accelerated timeline is not an uncommon response.

Dr. Pieter Stigter, a geriatric specialist who works in nursing homes and also as a consultant for the Expertise Center, must frequently explain to startled patients that their carefully drawn-up advance directives are basically meaningless.

“The first thing I tell them is, ‘I’m sorry, that’s not going to happen,’” he said. “Assisted dying while mentally incompetent, it’s not going to happen. So now we’re going to talk about how we’re going to avoid getting there.”

Patients who have cared for their own parents with dementia may specify in their advance directive that they do not wish to reach the point of being bedridden, incontinent or unable to feed themselves. “But still then, if someone is accepting it, patiently smiling, it’s going to be very hard to be convinced in that moment that even though someone described it in an earlier stage, that in that moment it is unbearable suffering,” Dr. Stigter said.

The first line people write in a directive is always, “‘If I get to the point I do not recognize my children,’” he said. “But what is recognition? Is it knowing someone’s name, or is it having a big smile when someone enters your room?”

Five-to-12 makes the burden being placed on physicians morally tolerable.

“As a doctor, you are the one who has to do it,” said Dr. Stigter, a warm and wiry 44-year-old. “I’m the one doing it. It has to feel good for me.”

Conversations about advance requests for assisted death in the Netherlands are shadowed by what many people who work in this field refer to, with a wince, as “the coffee case.”

In 2016, a doctor who provided an assisted death to a 74-year-old woman with dementia was charged with violating the euthanasia law. The woman had written an advance directive four years earlier, saying she wished to die before she needed to enter a care home. On the day her family chose, her doctor gave her a sedative in coffee, and then injected a stronger dose. But during the administration of the medication that would stop her heart, the woman awoke and resisted. Her husband and children had to hold her down so the doctor could complete the procedure.

The doctor was acquitted in 2019. The judge said the patient’s advance request was sufficient basis for the doctor to act. But the public recoil at the idea of the woman’s family holding her down while she died redoubled the determination of Dutch doctors to avoid such a situation.

A Day Too Late

Dr. Stigter never takes on a case assuming he will provide an assisted death. Cognitive decline is a fluid thing, he said, and so is a person’s sense of what is tolerable.

“The goal is an outcome that reflects what the patient wants — that can evolve all the time,” he said. “Someone can say, ‘I want euthanasia in the future’, but actually when the moment is there, it’s different.”

Dr. Stigter found himself explaining this to Henk Zuidema a few years ago. Mr. Zuidema, a tile setter, had early-onset Alzheimer’s at 57. He was told he would no longer be permitted to drive, and so he would have to stop working and give up his main hobby, driving a vintage motocross bike with friends.

A gruff, stoic family man, Mr. Zuidema was appalled at the idea of no longer providing for his wife or caring for his family, and he told them he would seek a medically assisted death before the disease left him totally dependent.

His own family doctor was not willing to help him die, nor was anyone in her practice, and so his daughter Froukje Zuidema found the Expertise Center. Dr. Stigter was assigned to his case and began driving 30 minutes from his office in the city of Groningen every month to visit Mr. Zuidema at his home in the farming village of Boelenslaan.

“Pieter was very clear: ‘You have to tell me when,’” Ms. Zuidema said. “And that was very hard, because Dad had to make the decision.”

When he grasped that the disease might impair his judgment, and thus cause him to overestimate his mental competence, Mr. Zuidema quickly settled on a plan to die within months. His family was shocked, but for him the trade-off was clear: “Better a year too early than a day too late,” he would say.

Dr. Stigter pushed Mr. Zuidema to define what, exactly, his suffering would be. “He would say, ‘Why is it so bad to get old like that?’” Ms. Zuidema recalled. “‘Why is it so bad to go to a nursing home?’” She said the doctor would tell her father, “ ‘Your idea of suffering is not the same as mine, so help me understand why this is suffering, for you.’ “

Her reticent father struggled to explain, and finally put it in a letter: “I don’t want to lose my role as a husband and a father, I do not want to be unable to help people any longer … Suffering would be if I could no longer be alone with my grandchildren because people did not trust me any longer: even this thought makes me crazy … Do not be misled by a moment in which I look happy but instead look back at this moment when I am with my wife and children.’”

The progress of dementia is unpredictable, and Mr. Zuidema did not experience a rapid decline. In the end, Dr. Stigter visited each month for a year and a half, and the two men developed a relationship of trust, Ms. Zuidema said.

Dr. Stigter provided a medically assisted death in September 2022. Mr. Zuidema, then 59, was in a camp bed near the living room window, his wife and children at his side. His daughter said she sees Dr. Stigter “as a real hero.” She has no doubt her father would have died by suicide even sooner, had he not been confident he could receive an assisted death from his doctor.

Still, she is wistful about the time they didn’t have. If the advance directive had worked as defined in the law — if there had been no fear of missing the moment — her father might have had more months, more time sitting on the vast green lawn between their houses and watching his grandchildren kick a soccer ball, more time with his dog at his feet, more time sitting on a riverbank with his grandson and a lazy fishing line in the water.

“He would have stayed longer,” Ms. Zuidema said.

Her sense that her father’s death was rushed does not outweigh her gratitude that he had the death he wanted. And her feeling is widely shared among families, according to research by Dr. Agnes van der Heide, a professor of end-of-life care and decision making at Erasmus Medical College, University Medical Center Rotterdam.

“The large majority of the Dutch population feel safe in the hands of the doctor, with regards to euthanasia, and they very much appreciate that the doctor has a significant role there and independently judges whether or not they think that ending of life is justifiable,” she said.

For five to 12 to work, doctors should know their patients well and have time to track changes in their cognition. As the public health system in the Netherlands is increasingly strained, and short of family practitioners, that model of care is becoming less common.

Ms. Mekel’s physician, Dr. Keizer, said his lengthy visits to patients were possible only because he is mostly retired and not in a hurry. (In addition to his half-time practice, he writes regular op-eds for Dutch newspapers and comments on high-profile cases. He is a bit of an assisted-dying celebrity, and, Ms. Mekel confided, the other older women at the right-to-die workshops were envious when they learned that he had been assigned as her physician.)

Now that he is clear on her wishes, the tea parties are paused; he will resume the visits when her children tell him there has been a significant change in her awareness or ability to function — when they feel that five to 12 is close.

An Intolerable Price

Ms. Mekel is haunted by what happened to her best friend, Jean, who, she said, “missed the moment” for an assisted death.

Although Jean was determined to avoid moving to a nursing home, she lived in one for eight years. Ms. Mekel visited her there until Jean became unable to carry on a conversation. Ms. Mekel continued to call her and sent emails that Jean’s children read to her. Jean died in the nursing home in July, at 87.

Jean is the reason Ms. Mekel is willing to plan her death for sooner than she might like.

Yet Jean’s son, Jos Van Ommeren, is not sure that Ms. Mekel understands her friend’s fate correctly. He agrees that his mother dreaded the nursing home, but once she got there, she had some good years, he said. She was a voracious reader and devoured a book from the residence library each day. She had loved sunbathing all her life, and the staff made sure she could sit in the sun and read for hours.

Most of the last years were good years, Mr. Van Ommeren said, and to have those, it was worth the price of giving up the assisted death she had requested.

For Ms. Mekel, that price is intolerable.

Her youngest son, Melchior, asked her gently, not long ago, if a nursing home might be OK, if by the time she got there she wasn’t so aware of her lost independence.

Ms. Mekel shot him a look of affectionate disgust.

“No,” she said. “No. It wouldn’t.”

Veerle Schyns contributed reporting from Amsterdam.

Audio produced by Tally Abecassis.

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Science

A virus without a vaccine or treatment is hitting California. What you need to know

Published

8 hours ago

March 4, 2026

Press Room

A virus without a vaccine or treatment is hitting California. What you need to know

A respiratory virus that doesn’t have a vaccine or a specific treatment regimen is spreading in some parts of California — but there’s no need to sound the alarm just yet, public health officials say.

A majority of Northern California communities have seen high concentrations of human metapneumovirus, or HMPV, detected in their wastewater, according to data from the WastewaterScan Dashboard, a public database that monitors sewage to track the presence of infectious diseases.

A Los Angeles Times data analysis found the communities of Merced in the San Joaquin Valley, and Novato and Sunnyvale in the San Francisco Bay Area have seen increases in HMPV levels in their wastewater between mid-December and the end of February.

HMPV has also been detected in L.A. County, though at levels considered low to moderate at this point, data show.

While HMPV may not necessarily ring a bell, it isn’t a new virus. Its typical pattern of seasonal spread was upended by the COVID-19 pandemic, and its resurgence could signal a return to a more typical pre-coronavirus respiratory disease landscape.

Here’s what you need to know.

What is HMPV?

HMPV was first detected in 2001, according to the U.S. Centers for Disease Control and Prevention. It’s transmitted by close contact with someone who is infected or by touching a contaminated surface, said Dr. Neha Nanda, chief of infectious diseases and hospital epidemiologist for Keck Medicine of USC.

Like other respiratory illnesses, such as influenza, HMPV spreads and is more durable in colder temperatures, infectious-disease experts say.

Human metapneumovirus cases commonly start showing up in January before peaking in March or April and then tailing off in June, said Dr. Jessica August, chief of infectious diseases at Kaiser Permanente Santa Rosa.

However, as was the case with many respiratory viruses, COVID disrupted that seasonal trend.

Why are we talking about HMPV now?

Before the pandemic hit in 2020, Americans were regularly exposed to seasonal viruses like HMPV and developed a degree of natural immunity, August said.

That protection waned during the pandemic, as people stayed home or kept their distance from others. So when people resumed normal activities, they were more vulnerable to the virus. Unlike other viruses, there isn’t a vaccine for human metapneumovirus.

“That’s why after the pandemic we saw record-breaking childhood viral illnesses because we lacked the usual immunity that we had, just from lack of exposure,” August said. “All of that also led to longer viral seasons, more severe illness. But all of these things have settled down in many respects.”

In 2024, the national test positivity for HMPV peaked at 11.7% at the end of March, according to the National Respiratory and Enteric Virus Surveillance System. The following year’s peak was 7.15% in late April.

So far this year, the highest test positivity rate documented was 6.1%, reported on Feb. 21 — the most recent date for which complete data are available.

While the seasonal spread of viruses like HMPV is nothing new, people became more aware of infectious diseases and how to prevent them during the pandemic, and they’ve remained part of the public consciousness in the years since, August and Nanda said.

What are the symptoms of HMPV?

Most people won’t go to the doctor if they have HMPV because it typically causes mild, cold-like symptoms that include cough, fever, nasal congestion and sore throat.

HMPV infection can progress to:

An asthma attack and reactive airway disease (wheezing and difficulty breathing)
Middle ear infections behind the ear drum
Croup, also known as “barking” cough — an infection of the vocal cords, windpipe and sometimes the larger airways in the lungs
Bronchitis
Fever

Anyone can contract human metapneumovirus, but those who are immunocompromised or have other underlying medical conditions are at particular risk of developing severe disease — including pneumonia. Young children and older adults are also considered higher-risk groups, Nanda said.

What is the treatment for HMPV?

There is no specified treatment protocol or antiviral medication for HMPV. However, it’s common for an infection to clear up on its own and treatment is mostly geared toward soothing symptoms, according to the American Lung Assn.

A doctor will likely send you home and tell you to rest and drink plenty of fluids, Nanda said.

If symptoms worsen, experts say you should contact your healthcare provider.

How to avoid contracting HMPV

Infectious-disease experts said the best way to avoid contracting HMPV is similar to preventing other respiratory illnesses.

The American Lung Assn.’s recommendations include:

Wash your hands often with soap and water. If that’s not available, clean your hands with an alcohol-based hand sanitizer.
Clean frequently touched surfaces.
Crack open a window to improve air flow in crowded spaces.
Avoid being around sick people if you can.
Avoid touching your eyes, nose and mouth.

Assistant data and graphics editor Vanessa Martínez contributed to this report.

Science

After rash of overdose deaths, L.A. banned sales of kratom. Some say they lost lifeline for pain and opioid withdrawal

Published

20 hours ago

March 4, 2026

Press Room

After rash of overdose deaths, L.A. banned sales of kratom. Some say they lost lifeline for pain and opioid withdrawal

Nearly four months ago, Los Angeles County banned the sale of kratom, as well as 7-OH, the synthetic version of the alkaloid that is its active ingredient. The idea was to put an end to what at the time seemed like a rash of overdose deaths related to the drug.

It’s too soon to tell whether kratom-related deaths have dissipated as a result — or, really, whether there was ever actually an epidemic to begin with. But many L.A. residents had become reliant on kratom as something of a panacea for debilitating pain and opioid withdrawal symptoms, and the new rules have made it harder for them to find what they say has been a lifesaving drug.

Robert Wallace started using kratom a few years ago for his knees. For decades he had been in pain, which he says stems from his days as a physical education teacher for the Glendale Unified School District between 1989 and 1998, when he and his students primarily exercised on asphalt.

In 2004, he had arthroscopic surgery on his right knee, followed by varicose vein surgery on both legs. Over the next couple of decades, he saw pain-management specialists regularly. But the primary outcome was a growing dependence on opioid-based painkillers. “I found myself seeking doctors who would prescribe it,” he said.

He leaned on opioids when he could get them and alcohol when he couldn’t, resulting in a strain on his marriage.

When Wallace was scheduled for his first knee replacement in 2021 (he had his other knee replaced a few years later), his brother recommended he take kratom for the post-surgery pain.

It seemed to work: Wallace said he takes a quarter of a teaspoon of powdered kratom twice a day, and it lets him take charge of managing his pain without prescription painkillers and eases harsh opiate-withdrawal symptoms.

He’s one of many Angelenos frustrated by recent efforts by the county health department to limit access to the drug. “Kratom has impacted my life in only positive ways,” Wallace told The Times.

For now, Wallace is still able to get his kratom powder, called Red Bali, by ordering from a company in Florida.

However, advocates say that the county crackdown on kratom could significantly affect the ability of many Angelenos to access what they say is an affordable, safer alternative to prescription painkillers.

Kratom comes from the leaves of a tree native to Southeast Asia called Mitragyna speciosa. It has been used for hundreds of years to treat chronic pain, coughing and diarrhea as well as to boost energy — in low doses, kratom appears to act as a stimulant, though in higher doses, it can have effects more like opioids.

Though advocates note that kratom has been used in the U.S. for more than 50 years for all sorts of health applications, there is limited research that suggests kratom could have therapeutic value, and there is no scientific consensus.

Then there’s 7-OH, or 7-Hydroxymitragynine, a synthetic alkaloid derived from kratom that has similar effects and has been on the U.S. market for only about three years. However, because of its ability to bind to opioid receptors in the body, it has a higher potential for abuse than kratom.

Public health officials and advocates are divided on kratom. Some say it should be heavily regulated — and 7-OH banned altogether — while others say both should be accessible, as long as there are age limitations and proper labeling, such as with alcohol or cannabis.

In the U.S., kratom and 7-OH can be found in all sorts of forms, including powder, capsules and liquids — though it depends on exactly where you are in the country. Though the Food and Drug Administration has recommended that 7-OH be included as a Schedule 1 controlled substance under the Controlled Substances Act, that hasn’t been made official. And the plant itself remains unscheduled on the federal level.

That has left states, counties and cities to decide how to regulate the substances.

California failed to approve an Assembly bill in 2024 that would have required kratom products to be registered with the state, have labeling and warnings, and be prohibited from being sold to anyone younger than 21.

It would also have banned products containing synthetic versions of kratom alkaloids. The state Legislature is now considering another bill that basically does the same without banning 7-OH — while also limiting the amount of synthetic alkaloids in kratom and 7-OH products sold in the state.

“Until kratom and its pharmacologically active key ingredients mitragynine and 7-OH are approved for use, they will remain classified as adulterants in drugs, dietary supplements and foods,” a California Department of Public Health spokesperson previously told The Times.

On Tuesday, California Gov. Gavin Newsom announced that the state’s efforts to crack down on kratom products has resulted in the removal of more than 3,300 kratom and 7-OH products from retail stores. According to a news release from the governor’s office, there has been a 95% compliance rate from businesses in removing the products.

(Los Angeles Times photo illustration; source photos by Getty Images)

Newsom has equated these actions to the state’s efforts in 2024 to quash the sale of hemp products containing cannabinoids such as THC. Under emergency state regulations two years ago, California banned these specific hemp products and agents with the state Department of Alcoholic Beverage Control seized thousands of products statewide.

Since the beginning of 2026, there have been no reported violations of the ban on sales of such products.

“We’ve shown with illegal hemp products that when the state sets clear expectations and partners with businesses, compliance follows,” Newsom said in a statement. “This effort builds on that model — education first, enforcement where necessary — to protect Californians.”

Despite the state’s actions, the Los Angeles County Board of Supervisors is still considering whether to regulate kratom, or ban it altogether.

The county Public Health Department’s decision to ban the sale of kratom didn’t come out of nowhere. As Maral Farsi, deputy director of the California Department of Public Health, noted during a Feb. 18 state Senate hearing, the agency “identified 362 kratom-related overdose deaths in California between 2019 and 2023, with a steady increase from 38 in 2019 up to 92 in 2023.”

However, some experts say those numbers aren’t as clear-cut as they seem.

For example, a Los Angeles Times investigation found that in a number of recent L.A. County deaths that were initially thought to be caused by kratom or 7-OH, there wasn’t enough evidence to say those drugs alone caused the deaths; it might be the case that the danger is in mixing them with other substances.

Meanwhile, the actual application of this new policy seems to be piecemeal at best.

The county Public Health Department told The Times it conducted 2,696 kratom-related inspections between Nov. 10 and Jan. 27, and found 352 locations selling kratom products. The health department said the majority stopped selling kratom after those inspections; there were nine locations that ignored the warnings, and in those cases, inspectors impounded their kratom products.

But the reality is that people who need kratom will buy it on the black market, drive far enough so they get to where it’s sold legally or, like Wallace, order it online from a different state.

For now, retailers who sell kratom products are simply carrying on until they’re investigated by county health inspectors.

Ari Agalopol, a decorated pianist and piano teacher, saw her performances and classes abruptly come to a halt in 2012 after a car accident resulted in severe spinal and knee injuries.

“I tried my best to do traditional acupuncture, physical therapy and hydrocortisone shots in my spine and everything,” she said. “Finally, after nothing was working, I relegated myself to being a pain-management patient.”

She was prescribed oxycodone, and while on the medication, battled depression, anhedonia and suicidal ideation. She felt as though she were in a fog when taking oxycodone, and when it ran out, ”the pain would rear its ugly head.” Agalopol struggled to get out of bed daily and could manage teaching only five students a week.

Then, looking for alternatives to opioids, she found a Reddit thread in which people were talking up the benefits of kratom.

“I was kind of hesitant at first because there’re so many horror stories about 7-OH, but then I researched and I realized that the natural plant is not the same as 7-OH,” she said.

She went to a local shop, Authentic Kratom in Woodland Hills, and spoke to a sales associate who helped her decide which of the 47 strains of kratom it sold would best suit her needs.

Agalopol currently takes a 75-milligram dose of mitragynine, the primary alkaloid in kratom, when necessary. It has enabled her to get back to where she was before her injury: teaching 40 students a week and performing every weekend.

Agalopol believes the county hasn’t done its homework on kratom. “They’re just taking these actions because of public pressure, and public pressure is happening because of ignorance,” she said.

During the course of reporting this story, Authentic Kratom has shut down its three locations; it’s unclear if the closures are temporary. The owner of the business declined to comment on the matter.

When she heard the news of the recent closures, Agalopol was seething. She told The Times she has enough capsules of kratom for now, but when she runs out, her option will have to be Tylenol and ibuprofen, “which will slowly kill my liver.”

“Prohibition is not a public health strategy,” said Jackie Subeck, executive director of 7-Hope Alliance, a nonprofit that promotes safe and responsible access to 7-OH for consumers, at the Feb. 18 Senate hearing. “[It’s] only going to make things worse, likely resulting in an entirely new health crisis for Californians.”

Science

There were 13 full-service public health clinics in L.A. County. Now there are 6

Published

1 day ago

March 3, 2026

Press Room

There were 13 full-service public health clinics in L.A. County. Now there are 6

Because of budget cuts, the Los Angeles County Department of Public Health has ended clinical services at seven of its public health clinic sites.

As of Feb. 27, the county is no longer providing services such as vaccinations, sexually transmitted infection testing and treatment, or tuberculosis diagnosis and specialty TB care at the affected locations, according to county officials and a department fact sheet.

The sites losing clinical services are Antelope Valley in Lancaster; the Center for Community Health (Leavy) in San Pedro, Curtis R. Tucker in Inglewood, Hollywood-Wilshire, Pomona, Dr. Ruth Temple in South Los Angeles, and Torrance. Services will continue to be provided by the six remaining public health clinics, and through nearby community clinics.

The changes are the result of about $50 million in funding losses, according to official county statements.

“That pushed us to make the very difficult decision to end clinical services at seven of our sites,” said Dr. Anish Mahajan, chief deputy director of the L.A. County Department of Public Health.

Mahajan said the department selected clinics with relatively lower patient volumes. Over the last month, he said, the department has sent letters to patients about the changes, and referred them to unaffected county clinics, nearby federally qualified health centers or other community providers. According to Mahajan, for tuberculosis patients, particularly those requiring directly observed therapy, public health nurses will continue visiting patients.

Public health clinics form part of the county’s healthcare safety net, serving low-income residents and those with limited access to care. Officials said that about half of the patients the county currently sees across its clinics are uninsured.

Mahajan noted that the clinics were established decades ago, before the Affordable Care Act expanded Medi-Cal coverage and increased the number of federally qualified health centers. He said that as more residents gained access to primary care, utilization at some county-run clinics declined.

“Now that we have a more sophisticated safety net, people often have another place to go for their full range of care,” he said.

Still, the closures have unsettled providers who work closely with local vulnerable populations.

“I hate to see any services that serve our at-risk and homeless community shut down,” said Mark Hood, chief executive of Union Rescue Mission in downtown Los Angeles. “There’s so much need out there, so it always is going to create hardship for the people that actually need the help the most.”

Union Rescue Mission does not receive government funding for its healthcare services, Hood said. The mission’s clinics are open not only to shelter guests, up to 1,000 people nightly, but also to people living on the streets who walk in seeking care.

Its dental clinic alone sees nearly 9,000 patients a year, Hood said.

“We haven’t seen it yet, but I expect in the coming days and weeks we’ll see more people coming through our doors looking for help,” he said. “They’re going to have to find help somewhere.” Hood said women experiencing homelessness are especially vulnerable when preventive care, including sexual and reproductive health services, becomes harder to access.

County officials said staffing impacts so far have been managed through reassignment rather than layoffs. Roughly 200 to 300 positions across the department have been eliminated amid funding cuts, officials said, though many were vacant. About 120 employees whose positions were affected have been reassigned; according to Mahajan, no one has been laid off.

The clinic closures come amid broader fiscal uncertainty. Mahajan said that due to the Trump administration’s “Big Beautiful Bill,” Los Angeles County could lose $2.4 billion over the next several years. That funding, he said, supports clinics, hospitals and community clinic partners now absorbing patients who previously went to the clinics that closed on Feb. 27.

In response, the L.A. County Board of Supervisors has backed a proposed half-cent sales tax measure that would generate hundreds of millions of dollars annually for healthcare and public health services. Voters are expected to consider the measure in June.