Naheed Mangi, 70, was convicted earlier this year of intentional damage to a protected computer. Prosecutors say that after being fired, she changed the database by replacing patient information with gibberish and childish insults like, “doctor too stupid.”

While the incident happened in 2013, Mangi wasn’t indicted until 2018, and wasn’t convicted until a jury trial last February, records show. Prosecutors asked for a 10-month sentence to be split between jail and house arrest, but instead Senior U.S. District Judge Edward J. Davila sentenced Mangi to probation.

Her attorney argued in court that no time in custody was a just outcome.

“Notably, for the seven years since her arrest, Ms. Mangi has complied with her conditions of release. She is 70 years old and has lived at the same address for the past 28 years,” a defense sentencing memo says. “Ms. Mangi is currently unemployed, living a solitary life on her social security and savings.”

Mangi must pay $10,520.69 in restitution, court records show.

Mangi was working on a Stanford University study, sponsored by Genentech, testing a new, experimental pharmaceutical treatment for breast cancer. Prosecutors argued her actions betrayed the trust of patients who agreed to participate in the study, and that it was motivated by Mangi’s hurt feelings from being fired.

More than 17 million Californians have health insurance through their job, according to a survey released in November by the health information group KFF. The average cost of premium payments for an employee’s family plan rose 24% to $28,400 a year, the survey found. Meanwhile, the national inflation rate was 12%, and wages grew by 14%, KFF wrote.

Health insurance premiums have risen year after year for decades. But costs spiked after the start of the COVID-19 pandemic, driven by industry consolidation, increasing use of Ozempic and similar weight-loss drugs and other factors, according to KFF. Together, these forces are putting pressure on families and businesses, while some major health insurance providers in California continue to post profits.

“People are paying more and more, it’s taking up more and more of their family budgets, and they’re getting less,” said Miranda Dietz, who leads UC Berkeley Labor Center’s health program.

Along with rising premiums, more California employees also face increasing out-of-pocket costs. Workers bear indirect costs, too, Dietz said. As businesses spend more on health plans, they spend less on wages and other benefits, she said. She cited a study that concluded the average family with employer-sponsored health insurance would have earned nearly $9,000 more in 2019 if the cost of care hadn’t increased disproportionately since the late 1980s.

Under the Affordable Care Act, businesses with at least 50 full-time equivalent employees must offer health insurance coverage that meets affordability and care requirements, or face fines. Workers and businesses split the cost, and in practice, businesses shoulder most of the burden: employers pay about three-quarters of a family plan premium, on average, and about 85% of single plans, according to KFF.

At the independent bookstore Booksmith in San Francisco’s storied Haight-Ashbury neighborhood, owner Christin Evans said four of her employees qualify for health benefits. She said she covers the full cost of her workers’ Kaiser Permanente care — one of her “top expenses” of doing business.

Her costs are rising, she said, by about 17% — to $3,250 each month in 2026 from $2,776 in 2025. Last year, premiums rose 7.5%, she said.

“Many small business owners will likely decide to cut benefit offerings and reduce wages,” said Bianca Blomquist, director of the advocacy group Small Business Majority California, in an email. “While some entrepreneurs may even close up shop and go work for someone else, mainly so they can access quality health insurance.”

Faced with high health insurance costs, owners could be unable to make other investments in their businesses, she said.

Matthew Rae, associate director of KFF’s health care marketplace program, led the California survey. Between January and July 2025, KFF oversaw interviews with 460 employee benefit managers at companies based in California or with workers here.

In an interview, Rae pinned part of the cost spike on the pandemic, which officially ended in May 2023. During the worst days of the pandemic, in 2020 and 2021, insurance costs grew slowly as patients delayed serious care, he said.

Then “pent-up” need for care arrived, inflation nationally drove up prices and health care workers fought for better pay and benefits, Rae said.

In California, Gov. Gavin Newsom signed a law in 2023 setting separate minimum wages for health care employees, which reached $24 per hour at hospitals with 10,000 or more full-time employees this year. (The state’s general minimum wage is $16.50 per hour.)

Meanwhile, more Californians began using expensive GLP-1s such as Ozempic or Wegovy to manage diabetes and lose weight, Rae said. The hospital industry became more consolidated nationally, he said, which contributes to rising costs by reducing competition. More than 400 hospital and health system mergers were announced from 2018 to 2023, KFF said.

Meanwhile, some of California’s biggest insurers are posting profits.

An analysis by the Center for Media and Democracy, a Wisconsin-based nonprofit watchdog, found Kaiser Permanente put $27 billion into reserves in the last four years. The Oakland-based health giant reports several billion dollars of profit each quarter. Elevance Health, the publicly-traded parent company of Anthem Blue Cross, reported $1.2 billion in profit in the third quarter of 2025, up from $1 billion the year prior, the Wall Street Journal reported.

While health plan premiums rose for workers and employers over the past three years, the quality of the insurance declined. The KFF survey found that 75% of workers now have a deductible, up from 68% three years ago.

According to the UC Berkeley Labor Center, less than half of Californians in the private sector had a deductible 20 years ago. Rae said that it can strain workers and their families.

“There’s a lot of worry about the affordability of plans for even people who are working,” or who have a family member who is, Rae said. “You’re pushing people past their assets, because the deductibles are too high.”

At the same time, changes are happening outside of the employer-based health insurance market. The new KFF data arrived in November as public health experts and patients began to brace for a big shake-up in the individual health insurance market: the expiration of Affordable Care Act tax credits that have benefited enrollees since 2021. In California, monthly premiums for those plans will double on average, according to Covered California, the state’s Affordable Care Act marketplace.

Self-employed freelancers and contractors, in particular, can expect major price spikes when the credits expire at the end of December. But small business owners and their workers make up half of all Affordable Care Act enrollees nationally, said Blomquist, of the small business advocacy group.

Starting Jan. 1, a new law will take effect requiring most tortillas and corn masa products sold in the state to contain folic acid, a vitamin that’s important to infant health.

Latinas in California are far less likely than other women to get enough folic acid early in pregnancy — a gap that can lead to life-altering birth defects.

RELATED: New California law requires some ultraprocessed foods to be removed from school lunches

State data show that, between 2017 and 2019 – the latest years for which state data is available – about 28% of Latinas reported taking folic acid the month before becoming pregnant. White women took the vitamin at a higher rate, with 46% of them reporting consuming folic acid,  according to the California Department of Public Health.

This puts Latinas at higher risk of having a baby born with neural tube defects — defects of the brain and spinal cord. Some examples of that are conditions like spina bifida and anencephaly.

Research has shown that folic acid can reduce birth defects by up to 70%. That’s why it’s found in prenatal vitamins. But because women may not find out they are pregnant until weeks or months after, public health has long recommended that folic acid also be added to staple foods.

In 1998, the U.S. required manufacturers to fortify certain grain products with folic acid, such as pasta, rice, and cereals, to help women of reproductive age get the necessary amounts. Since that rule took effect, the rate of babies born with neural tube defects dropped by about a third, according to the Centers for Disease Control and Prevention.

But even with the addition to these foods, birth defect rates among babies born to Latinas have been consistently higher. In search of a more culturally appropriate addition, in 2016, the federal government allowed makers of corn masa to add folic acid to their foods – but didn’t require it.

Joaquin Arambula, a Democrat from Fresno, who authored the law said leaving folic acid out of corn masa products, used in many Latino staple foods, was a “real oversight.”

Now, with the implementation of Assembly Bill 1830, California is the first state to require folic acid in corn masa products. The law requires manufacturers that do business in the state to add 0.7 milligrams of folic acid to every pound of flour and to list the addition in their nutrition labels. The law makes exemptions for small batch producers like restaurants and markets that might make their own tortillas from scratch.

Months after California’s law was signed, Alabama passed its own version. Its law goes into effect in June 2026.

Some large manufacturers have already been adding folic acid to their products for years. Gruma, the parent company of Mission Foods, said it started fortifying its foods back in 2016, when the federal government first allowed it. A company spokesperson said Gruma “has a longstanding commitment to supporting legislative fortification initiatives” and supports the new laws in California and Alabama.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

WASHINGTON (AP) — It’s not unusual for a 20-something to text Mom in a panic from the doctor’s office, seeking help answering a question. And patients of any age can struggle to recall all their medicines — or forget to mention a concern.

Getting the most out of a doctor’s visit requires some advance preparation. Even the professionals plan ahead.

“It is really hard — even for me as a doctor going to see my own family doctor — to remember the things that I wanted to bring up,” said Dr. Sarah Nosal, president of the American Academy of Family Physicians. “The worst is when you’ve had that moment with your doctor” only to recall another problem after walking out, she said. “You’ve lost that time.”

Her top tip: Bring a list of symptoms and questions to show at the start of the visit. The first item should be your top concern, but seeing the full list helps your doctor prioritize what’s most medically urgent.

“I’m actually going to be able to see, is there a red flag?” explained Nosal, who has some advice about prepping for a typical primary care visit.

Your primary care doctor monitors your overall health

Some illnesses require specialists like a cardiologist or rheumatologist. But regardless of your age or how healthy you are, research has long shown that a relationship with a primary care provider is important for overall health. It might be a family physician like Nosal, who cares for all ages, or an internist. Some patients choose gynecologists, geriatricians, or have a primary care team that includes nurse practitioners or physician assistants.

Primary care is more than preventive checkups to help avoid illness, such as vaccinations, cancer screenings or health advice. It also includes detecting and treating common problems like high blood pressure, and helping to find and coordinate specialty care.

“That ongoing relationship also helps me know your ‘normal,’” Nosal explained. “If something’s different or changes or you feel off, when you tell me that information and I also have known you over time, we can really figure out together what’s going on.”

Quiz your family before the appointment

Young adults navigating health care on their own for the first time may need help filling out forms with their personal medical history. Have you ever had general anesthesia? Is your tetanus shot up to date?

If you still have access to the patient portal at your former pediatrician’s office, you can see records of vaccinations and prior illnesses, or you may have to request them or quiz parents.

For all ages, family medical history is critical — and needs regular updating. Ask what diseases your close relatives have had and how they fared. For example, if Type 2 diabetes runs in the family, or Grandma had a stroke, or someone had cancer at a young age, that information could help tailor your preventive care, Nosal said.

Fill out your paperwork ahead of the visit

Filling out paperwork from home makes it easier to check medicine bottles for the name and dose. Include both prescription and over-the-counter medicines, pills or creams — and don’t forget vitamins and supplements.

Why are the latter important? Some can interact with prescription medicines. Nosal cited some patients whose longtime treatments quit working after they started taking turmeric, a spice also sold as a supplement.

Also before your visit, check if the doctor received records of recent lab tests, hospitalizations or visits to other health providers, since electronic medical records aren’t always automatically shared.

Keep a running list of questions before a doctor visit

Some symptoms are bad enough to prompt an urgent visit. But if you’ve got a checkup coming, whether it’s routine or to follow up on health problems, start a list of questions in advance.

Notice a pain when you move a certain way? Or chatting with a friend who just got a colonoscopy and wonder if you’re due? Pop those on your list right away, before you forget — and be specific in describing symptoms.

Nosal keeps a running list on her phone and, ahead of visits with her own doctor, sends it as a heads-up through her patient portal. Patients also can include their list on visit check-in forms.

The idea is to address the most urgent questions first, rather than patients running out of time before raising a key concern. Nosal said questions about mental or sexual health and wellness especially tend to come up at the last minute.

Whatever the medium, “please bring that list,” she said. “That’s the most critical of all pieces.”

It’s OK to ask again

People may know to ask questions about treatments, such as how well they work and what side effects to expect. But it’s also important to understand why a doctor makes a particular diagnosis or, conversely, isn’t as worried about a symptom as you might be.

Don’t hesitate to say, “Explain to me what else could be going on,” Nosal advised. “What would be the next step? How would you evaluate that for me, to know if it’s this or that?”

Most health advocacy groups also advise bringing along a friend or relative, especially if you have serious or multiple health problems. They can help ask questions and take notes.

“Whether you are 20 or you are 85, you will not remember everything from your medical visit,” Nosal said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The union representing 31,000 Kaiser workers statewide — including about 2,000 rehab therapists, physician assistants, nurse anesthetists and others in Northern California — is seeking a new contract with better pay and working conditions. Workers walked off the job in October for a five-day strike, after their contract expired.

Talks between United Nurses Associations of California/Union of Health Care Professionals and the Oakland-based health care giant have broken down amid sharply different accounts of why negotiations stalled. 

The union says Kaiser officials unlawfully walked away from negotiations. Kaiser did pause the talks, Elissa Harrington, a spokesperson for Kaiser in the East Bay, confirmed in an email. She said the decision came after an unnamed labor leader went outside formal bargaining channels and threatened to release what Kaiser described as damaging information about the company if an agreement was not reached. Harrington said the union “has refused to share the information it claims to have.”

“This was received as a clear threat to coerce the national bargaining agreement between Kaiser Permanente and the [alliance of health care unions],” Harrington said, referring to the group that negotiates on behalf of UNAC/UHCP and other unions.

Anjetta Thackeray, a spokesperson for the union, flatly denied Kaiser’s account.

“That claim is incorrect, and Kaiser is aware it’s incorrect,” Thackeray said in an email. “There was no blackmail or threat. We’d rather stay focused on what matters: getting to a contract that invests properly in patient care.”

With talks at an impasse, Harrington said Kaiser officials believe the union is planning a new strike. Harrington said Kaiser officials were shown a text circulating among some employees that read: “The goal is to get Kaiser confused so they don’t know how to staff the hospital.”

Asked whether union members planned to walk off the job again, Thackeray said: “As of today, UNAC/UHCP has not served Kaiser with a required 10-day notice to strike,” referencing a requirement of the National Labor Relations Act.

Repeated strikes have worked for Kaiser workers in recent history. In 2023, CalMatters reported that other Kaiser employees won steep raises after walking off the job twice in 12 months.

Two months after the major strike in Oakland, Santa Clara and elsewhere on the West Coast, both the union and Kaiser appear to be offering the same pay proposals that were on the table in October. Kaiser management is still offering a 21.5% wage increase over four years, while the union continues to seek a 25% raise over the same period.

While that gap may appear small, the competing proposals are “billions, not millions” of dollars apart, said John August, who led a coalition of Kaiser Permanente unions from 2006 to 2013 and now heads a Cornell University conflict resolution institute.

Kaiser tends to pay workers better than its competitors, August said, but it is not immune to the understaffing and pay pressures that have characterized U.S.  hospitals for decades. The COVID-19 pandemic “ripped the Band-Aid off,” he said, accelerating burnout and departures across the health care workforce.

Kaiser’s proposal would add nearly $2 billion in payroll costs, Harrington said. The union’s proposal would add “another $1 billion in costs over four years, putting affordable health care at risk,” she said.

Union officials counter that Kaiser, the country’s largest private nonprofit health care organization, can afford the increases.

Kaiser Permanente and its affiliated nonprofit, Risant Health, reported $2.6 billion in profits in the third quarter of 2025, following $3.3 billion the previous quarter. The union cites an analysis by the Center for Media and Democracy, a Wisconsin-based nonprofit watchdog, which found that Kaiser holds more than $67 billion in reserves — up $27 billion from four years ago — and spent $72 million on senior executive compensation in 2023.

“They’re not exactly going through tough times,” Joe Guzynski, the union’s executive director and lead negotiator, wrote in a message to members. “All this, while our own members — the people making these profits possible — had to live on salaries that don’t keep pace with the rising cost of living.”

Guzynski and rank-and-file union members say they need significant raises to keep pace with inflation since 2021, along with an expanded pension eligibility, stronger retirement protections and increase staffing levels they say are necessary to safely care for patients.

LOS GATOS — Like many retirement communities, The Terraces serves as a tranquil refuge for a nucleus of older people who no longer can travel to faraway places or engage in bold adventures.

But they can still be thrust back to their days of wanderlust and thrill-seeking whenever caretakers at the community in Los Gatos, California, schedule a date for residents — many of whom are in their 80s and 90s — to take turns donning virtual reality headsets.

Within a matter of minutes, the headsets can transport them to Europe, immerse them in the ocean depths or send them soaring on breathtaking hang-gliding expeditions while they sit by each other. The selection of VR programming was curated by Rendever, a company that has turned a sometimes isolating form of technology into a catalyst for better cognition and social connections in 800 retirement communities in the United States and Canada.

A group of The Terraces residents who participated in a VR session earlier this year found themselves paddling their arms alongside their chairs as they swam with a pod of dolphins while watching one of Rendever’s 3D programs. “We got to go underwater and didn’t even have to hold our breath!” exclaimed 81-year-old Ginny Baird following the virtual submersion.

During a session featuring a virtual ride in a hot-air balloon, one resident gasped, “Oh my God!” Another shuddered, “It’s hard to watch!”

The Rendever technology can also be used to virtually take older adults back to the places where they grew up as children. For some, it will be the first time they’ve seen their hometowns in decades.

A virtual trip to her childhood neighborhood in New York City’s Queens borough helped sell Sue Livingstone, 84, on the merits of the VR technology even though she still is able to get out more often than many residents of The Terraces, which is located in Silicon Valley about 55 miles south of San Francisco.

“It isn’t just about being able to see it again, it’s about all the memories that it brings back,” Livingstone said. “There are a few people living here who never really leave their comfort zones. But if you could entice them to come down to try out a headset, they might find that they really enjoy it.”

Adrian Marshall, The Terraces’ community life director, said that once word about a VR experience spreads from one resident to another, more of the uninitiated typically become curious enough to try it out — even if it means missing out on playing Mexican Train, a dominoes-like board game that’s popular in the community.

“It turns into a conversation starter for them. It really does connect people,” Marshall said of Rendever’s VR programming. “It helps create a human bridge that makes them realize they share certain similarities and interests. It turns the artificial world into reality.”

Rendever, a privately owned company based in Somerville, Massachusetts, hopes to build upon its senior living platform with a recent grant from the National Institutes of Health that will provide nearly $4.5 million to study ways to reduce social isolation among seniors living at home and their caregivers.

Some studies have found VR programming presented in a limited viewing format can help older people maintain and improve cognitive functions, burnish memories and foster social connections with their families and fellow residents of care facilities. Experts say the technology may be useful as an addition to and not a replacement for other activities.

“There is always a risk of too much screen time,” Katherine “Kate” Dupuis, a neuropsychologist and professor who studies aging issues at Sheridan College in Canada, said. “But if you use it cautiously, with meaning and purpose, it can be very helpful. It can be an opportunity for the elderly to engage with someone and share a sense of wonder.”

VR headsets may be an easier way for older people to interact with technology instead of fumbling around with a smartphone or another device that requires navigating buttons or other mechanisms, said Pallabi Bhowmick, a researcher at the University of Illinois Urbana-Champaign who is examining the use of VR with older adults.

“The stereotypes that older adults aren’t willing to try new technology needs to change because they are willing and want to adapt to technologies that are meaningful to them,” Bhowmick said. “Besides helping them to relieve stress, be entertained and connect with other people, there is an intergenerational aspect that might help them build their relationships with younger people who find out they use VR and say, ‘Grandpa is cool!’”

Rendever CEO Kyle Rand’s interest in helping his own grandmother deal with the emotional and mental challenges of aging pushed him down a path that led him to cofound the company in 2016 after studying neuroengineering at Duke University.

“What really fascinates me about humans is just how much our brain depends on social connection and how much we learn from others,” Rand said. “A group of elderly residents who don’t really know each other that well can come together, spend 30 minutes in a VR experience together and then find themselves sitting down to have lunch together while continuing a conversation about the experience.”

It’s a large enough market that another VR specialist, Dallas-based Mynd Immersive, competes against Rendever with services tailored for senior living communities.

Besides helping create social connections, the VR programming from both Rendever and Mynd has been employed as a possible tool for potentially slowing down the deleterious effects of dementia. That’s how another Silicon Valley retirement village, the Forum, sometimes uses the technology.

Bob Rogallo, a Forum resident with dementia that has rendered him speechless, seemed to be enjoying taking a virtual hike through Glacier National Park in Montana as he nodded and smiled while celebrating his 83rd birthday with his wife of 61 years.

Sallie Rogallo, who doesn’t have dementia, said the experience brought back fond memories of the couple’s visits to the same park during the more than 30 years they spent cruising around the U.S. in their recreational vehicle.

“It made me wish I was 30 years younger so I could do it again,” she said of the virtual visit to Glacier. “This lets you get out of the same environment and either go to a new place or visit places where you have been.”

In another session at the Forum, 93-year-old Almut Schultz laughed with delight while viewing a virtual classical music performance at the Red Rocks Amphitheatre in Colorado and later seemed to want to play with a puppy frolicking around in her VR headset.

“That was quite a session we had there,” Schultz said with a big grin after she took off her headset and returned to reality.

“I feel like I’ve lived too many lifetimes in this one lifetime,” Punjwani said.

The San Jose couple’s life together was thrown into chaos in February with a heartbreaking diagnosis: their 5-year-old son, Jayaan, had brain cancer. His parents had sensed that something was off last winter, when Jayaan’s writing skills nosedived at preschool and he mysteriously lost balance on the left side of his body.

What followed were months and months of anxious days and long nights at clinics and hospitals as Jayaan, tough as nails, soldiered through his treatment plan: brain surgery and chemotherapy, plus a whirlwind of appointments for occupational therapy, physical therapy, blood tests and MRIs.

Through the ups and downs, though, the couple weren’t alone. Staff from Jacob’s Heart, a nonprofit based in Watsonville serving families in Silicon Valley and the Central Coast who have a child with cancer, stepped in to help them weather the ordeal.

After a hospital social worker pointed them to the nonprofit, the family said, Jacob’s Heart provided a slew of resources with all the care and attention of a family member. The nonprofit has paid for their energy bills at home, plus their groceries and gas. Nasta is the family’s sole breadwinner at the moment as Punjwani practically lives at Lucile Packard Children’s Hospital at Stanford with Jayaan.

When the hospital discharged Jayaan earlier this year, Jacob’s Heart staff visited and played with him, bringing some of his favorite toys, like Mickey Mouse and Bluey.

The nonprofit also dispatched van drivers to whisk them from their home to medical appointments, as early as 6 a.m. or as late as 10 p.m. – and in emergencies, such as a day this fall when Jayaan became unresponsive and landed in the pediatric intensive care unit for a month

“They’re such an amazing team,” Nasta said. “We honestly could not do it without them.”

The nonprofit’s services are exhaustive: transportation to medical appointments, therapy and emotional support, parent support groups and grocery deliveries for families with immunocompromised children. The organization helps pay for funeral and memorial expenses. Specialized staffers known as family support specialists are liaisons with the families and connect them with whatever they might need.

All free of charge, no questions asked.

Most of Jacob’s Heart clients live around Monterey Bay, plus clusters in the Salinas Valley and the southern tip of the Bay Area. Many are Latino and lower-income. On a giant map in the nonprofit’s Watsonville resource center, hundreds of pins mark the homes of families who have, at some point, accepted help in the 27 years since Jacob’s Heart launched.

Jayaan’s family is one of two dozen in Santa Clara County whom the nonprofit is now serving after expanding into the county this summer. Jacob’s Heart is seeking $40,000 to further its expansion into Silicon Valley and continue its core services in Santa Cruz County. With that funding, the nonprofit said, staff could support at least 50 families in Santa Cruz and Santa Clara counties.

The nonprofit is named for Jacob Judd. As a child in the 1990s, Judd was diagnosed with cancer and given a 5% survival rate. He beat the odds. Now, he’s in his 30s.

Other children were less fortunate. Hanging on the wall next to Judd’s portrait in the nonprofit’s Watsonville resource center are photos of two kids who did not survive: Maddy, who inspired the nonprofit’s arts programs, and Augustin, whom Jacob’s Heart helped send to Mexico to be with his family. On a foggy day in late October, staff had erected a Dia de los Muertos altar where dozens of families offered ofrendas to their loved ones.

Eli Garnica, manager of development and communications at Jacob’s Heart, said people often offer sympathy when she tells them what she does, and the work can be emotionally taxing. But it’s fulfilling, she said – even “joyous” to watch families build community and work together.

“We get to play a role in their journey and their life,” Garnica said.

The nonprofit’s home base in Watsonville is as far from a gloomy clinic or social services office as you can imagine.

The vibrant space is replete with children’s toys, house plants, therapists offices, a community kitchen, a food pantry and a free clothing store. Staff host volunteer events and “art from the heart workshops,” where kids learn to express themselves artistically. And in the summer, Stanford hospital nurses volunteer at the nonprofit’s three-day summer camp.

Even after months of treatment that would strain the toughest adult, Jayaan is still “a really happy kid,” Nasta said. On Halloween, he and Punjwani sat in a courtyard at the Stanford children’s hospital. They had recently heard good news: after weeks in the pediatric intensive care unit, Jayaan was heading back to the oncology wing.  Hopefully, after finishing another course of chemo and then rehabilitation, Jayaan could get back to the things he loves most.

That day was a good one, Punjwani said, “because Jayaan is having a good day.”

ABOUT WISH BOOK
Wish Book is a 501(c)(3) nonprofit organization operated by The Mercury News. Since 1983, Wish Book has been producing series of stories during the holiday season that highlight the wishes of those in need and invite readers to help fulfill them.

WISH
Donations to Jacob’s Heart Children Cancer Support Services will help the nonprofit provide clients with transportation to treatment and medical appointments, nutritious food, and crisis support, in addition to helping with expenses related to the safety and care of the child with cancer. Goal: $40,000.

HOW TO GIVE
Donate at wishbook.mercurynews.com/donate or mail in this form.

ONLINE EXTRA
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NEW YORK (AP) — A coalition of 19 states and the District of Columbia on Tuesday sued the U.S. Department of Health and Human Services, its secretary, Robert F. Kennedy Jr., and its inspector general over a declaration that could complicate access to gender-affirming care for young people.

The declaration issued last Thursday called treatments like puberty blockers, hormone therapy and surgeries unsafe and ineffective for children and adolescents experiencing gender dysphoria, or the distress when someone’s gender expression doesn’t match their sex assigned at birth. It also warned doctors that they could be excluded from federal health programs like Medicare and Medicaid if they provide those types of care.

RELATED: Federal judge finds parents have right to receive gender information

The declaration came as HHS also announced proposed rules meant to further curtail gender-affirming care for young people, although the lawsuit doesn’t address those as they are not final.

Tuesday’s lawsuit, filed in U.S. District Court in Eugene, Oregon, alleges that the declaration is inaccurate and unlawful and asks the court to block its enforcement. It’s the latest in a series of clashes between an administration that’s cracking down on transgender health care for children, arguing it can be harmful to them, and advocates who say the care is medically necessary and shouldn’t be inhibited.

“Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices,” New York Attorney General Letitia James, who led the lawsuit, said in a statement Tuesday.

The lawsuit alleges that HHS’s declaration seeks to coerce providers to stop providing gender-affirming care and circumvent legal requirements for policy changes. It says federal law requires the public to be given notice and an opportunity to comment before substantively changing health policy — neither of which, the suit says, was done before the declaration was issued.

A spokesperson for HHS declined to comment.

HHS’s declaration based its conclusions on a peer-reviewed report that the department conducted earlier this year that urged greater reliance on behavioral therapy rather than broad gender-affirming care for youths with gender dysphoria.

The report questioned standards for the treatment of transgender youth issued by the World Professional Association for Transgender Health and raised concerns that adolescents may be too young to give consent to life-changing treatments that could result in future infertility.

Major medical groups and those who treat transgender young people have sharply criticized the report as inaccurate, and most major U.S. medical organizations, including the American Medical Association, continue to oppose restrictions on transgender care and services for young people.

The declaration was announced as part of a multifaceted effort to limit gender-affirming health care for children and teenagers — and built on other Trump administration efforts to target the rights of transgender people nationwide.

HHS on Thursday also unveiled two proposed federal rules — one to cut off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children, and another to prohibit federal Medicaid dollars from being used for such procedures.

The proposals are not yet final or legally binding and must go through a lengthy rulemaking process and public comment before becoming permanent. But they will nonetheless likely further discourage health care providers from offering gender-affirming care to children.

Several major medical providers already have pulled back on gender-affirming care for young patients since Trump returned to office — even in states where the care is legal and protected by state law.

Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have adopted laws restricting or banning the care. The Supreme Court’s recent decision upholding Tennessee’s ban means most other state laws are likely to remain in place.

Joining James in Tuesday’s lawsuit were Democratic attorneys general from California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Wisconsin, Washington and the District of Columbia. Pennsylvania’s Democratic governor also joined.