March 5, 2023 - PBS News Weekend full episode

JOHN YANG: Tonight on "PBS News Weekend," a historic global deal to protect marine life on the high seas is reached in dramatic down to the wire negotiations at the United Nations.

Then, an insurance change where a type of breast reconstruction is leaving patients and doctors concerned about future access.

WOMAN: We need more people on board about this.

This is very, very important, because this is going to change people body images, JOHN YANG: And our Hidden History series continues with the story of the first Hispanic woman in space.

(BREAK) JOHN YANG: Good evening, I'm John Yang.

Delegates at the United Nations have agreed on a historic international treaty to protect biodiversity in the ocean.

It's been years in the making and only made it over the finish line after a marathon 36-hour negotiating session that ended late last night.

Even for people who don't live near it, the ocean is central to life on Earth.

It covers more than 70 percent of the Earth's surface, is home to tens of thousands of fish species, provides oxygen for the planet and provides the livelihood for billions of people.

But only 1.2 percent of the ocean has any legal protection, leaving the high seas lawless and ripe for exploitation.

Overfishing threatens biodiversity.

Another threat, the oceans rising temperatures caused in part by climate change, and the manmade scourge of plastic pollution poses an ever growing problem.

Late last month as the United Nations kicked off a fifth round of negotiations to establish a treaty to protect more of the ocean.

The cause gained some starpower.

JANE FONDA, Actor and Activist: We depend on the ocean.

Even dogs don't poop in their kennel because they know that the kennel provides security and a home for them.

We're pooping in our kennel.

We're supposed to be so smart.

We're destroying things we don't even understand.

JOHN YANG: The outcome is critical to reaching another UN goal protecting 30 percent of the ocean by 2030.

Over the past two weeks, delegates from 193 countries met to try to hammer out the final details of a treaty.

Among the goals creating a legal framework to establish a network of high sea marine protected areas, creating rules for exploitation of resources and confronting the issue of overfishing.

RANA LEE, UN Ambassador for Oceans and Law of the Sea Issues: The ship has reached the shore.

JOHN YANG: Late last night after 36 straight hours of negotiations with the United Nations, the president of the conference announced the historic agreement.

Earlier I spoke with Liz Karan, who was at the UN for those negotiations as head of the Pew Charitable Trusts efforts to protect ocean Life on the high seas.

I asked her about the final push to get the deal done.

LIZ KARAN, The Pew Charitable Trusts: It was truly incredible.

The negotiations started even before the official starting time of 10 a.m. on Friday morning and went all through the night into the next morning and didn't conclude almost 10 p.m. the next day.

So, you know, it's not unusual for negotiations this kind to go into a little bit of overtime but this was really an incredible situation where I think because of the complexity of package, issues being dealt with, and negotiators really needed that extra time to push it over the finish line.

JOHN YANG: Given the complexity, given how long this has been in the works, and how long these final round of talks were, how much of the significance of this agreement is in the details of the provisions?

And how much is it the fact that it exists, that countries were able to come to an agreement at all?

LIZ KARAN: Given where the situation in the world today, I think that it's historic that we are able to have a multilateral agreement of this scale that covers to the high seas, which covers two thirds of the world's ocean.

It is also an incredibly detailed agreement sets out a legal framework for establishing high seas, marine protected areas and other airbase management tools, sets out standards and a consistent process to evaluate environmental impacts of new activities in the high seas.

And it also sets out financial benefit sharing for derived from marine genetic resources.

And a very important element is ensures capacity building and the transfer of marine technology to ensure the equitable and effective implementation of this agreement.

JOHN YANG: What were the final hurdles are some of the toughest hurdles to clear before the agreement was reached?

LIZ KARAN: I think two key issues one is around that financial benefit sharing of the marine genetic resources, it really is an unprecedented provision, and basically ensures that benefits are derived from the global commons are shared, even by shared globally.

So what that means is that developing countries can also benefit from them, and that those benefits will be in turn used for conservation and sustainable use of the reign of violence.

JOHN YANG: So it sounds like it's some of the same splits that we've seen in climate change talks between the rich industrial nations and the poor nations who feel that they're being asked to pay for what the rich industrial nations have created.

But now, they're looking to get the benefits.

Is that right?

LIZ KARAN: That's true.

Yes, I think financial benefit sharing is an important issue.

It really isn't an issue of equity and allowing for the effective implementation of the agreement.

The agreement will, as I mentioned, set out a process for the establishment of large scale marine protected areas in the high seas.

And that is really important to protect areas, they're going to be key for biodiversity, especially in a changing climate.

JOHN YANG: Now, this still has to be ratified by many of the signatory nations.

Is that right?

LIZ KARAN: It does.

Actually what occurred last night is that the president of the conference, finalize the text that will then be going for technical review and translation into all six UN official languages, which time countries will come back and officially adopted in the near future.

JOHN YANG: And what's next?

I mean, I know that the UN would like to have rules governing 30 percent of the oceans by 2030.

Does this help that?

LIZ KARAN: Absolutely.

The high seas make up two thirds of the world's oceans.

It's over half of the surface area of the planet.

They play a very important role in ensuring the implementation of the 30 by 30 target.

Actually, without this treaty, it can be very hard to meet that target.

JOHN YANG: Liz Karan of the Pew Charitable Trusts.

Thank you very much.

LIZ KARAN: Thank you, John.

JOHN YANG: Person, President Biden went to Selma, Alabama to mark the 58th anniversary of Bloody Sunday.

That's when hundreds of protesters were violently attacked by police during a voting rights march.

Today, the President used the occasion to highlight the Democrats push to update the 1965 Voting Rights Act.

JOE BIDEN, U.S. President: Selma is a reckoning the right to vote, the right to vote to have your vote counted as the threshold of democracy and liberty.

With it, anything's possible without it.

Without that right, nothing is possible.

JOHN YANG: President Biden has pushed for two voting rights bills while in office including one name for the late Congressman John Lewis of Georgia, who was badly beaten of the Edmund Pettus Bridge in 1965.

Former Maryland Governor Larry Hogan ended speculation today saying he will not run for the 2024 Republican presidential nomination.

Hogan is a moderate Republican who served two terms and heavily Democratic Maryland.

He's also a longtime and vocal critic of Donald Trump.

Hogan says he wants to avoid a crowded Republican field that could help the former president win the nomination.

And Bangladesh, the Rohingya refugee camp erupted in flames today.

UN and local officials said no one was killed but the thousands are homeless.

More than a million Muslim Rohingya refugees have fled from Myanmar to Bangladesh over the past several decades to escape persecution.

And a trailblazing advocate for disability rights has died.

Judy Heumann's lifelong activism fought discrimination and prejudice against people with disabilities.

Her work led to major legislation including the Americans with Disabilities Act.

She was featured in the 2020 prize winning documentary Crip Camp, and was once a special adviser to President Barack Obama on International Disability Rights.

In 2021, she spoke to the NewsHour about her work.

JUDY HEUMANN, Disability Rights Activist: I think having a disability really has allowed me to do and get in touch with so many things and opportunities that otherwise would not have happened.

People look at us as the label of our disability.

And it is a part of who we are.

But it is not who we are.

JOHN YANG: Judy Huemann was 75 years old.

Still to come on "PBS News Weekend," fear that an insurance change will limit access to a type of breast reconstruction surgery and the story of NASA's first Hispanic female astronaut.

(BREAK) JOHN YANG: Health insurance companies are changing the way they reimburse doctors for performing a complicated type of breast reconstruction surgery.

Doctors and patients fear the changes will make the procedure inaccessible to all but the wealthiest.

Eli Rogin's report is part of our ongoing series unequal treatment, looking at inequities in the health care for women.

ELI ROGIN: The surgery is known as DIEP flap reconstruction.

It uses a person's own blood vessels fat and skin to reconstruct the breast.

Older, less complex reconstruction methods use abdominal muscles, but they often lead to complications like hernias, and muscle weakness.

Since 2006, doctors have built insurance companies for DIEP flap reconstruction using a unique four digit code.

But now that code is sunsetting over the next two years.

Instead, DIEP flap surgeries will be built with a different code that also includes those older, less complex procedures, which are also cheaper to perform.

Doctors and patients worry that this will lead to insurance companies only reimbursing the value of the older, less complex procedures and that doctors might not be able to perform DIEP flap surgery unless patients pay out of pocket.

We spoke to some women who have received or are hoping to receive this surgery.

DIANE HEDITSIAN, Diagnosed with Breast Cancer: I'm Diane Heditsian and I'm 68 years old, I was diagnosed with breast cancer and I had three different lumps.

KATE GETZ, Diagnosed with Breast Cancer: My name is Kate Getz and I am 30 years old.

I was diagnosed in January of 2023 with breast cancer.

LATISHIA WHEATON, Diagnosed with Breast Cancer: My name is Latishia Wheaton.

I'm 50 years old.

I was diagnosed with triple negative breast cancer on March 11, 2020.

I had to do like 16 rounds of chemo.

JENNI OSIER, Prophylactic Mastectomy Patient: My name is Jenni Osier and I am 46 years old.

I had a prophylactic mastectomy due to genetic mutation and family history.

I had originally planned to go with implants, but my body rejected the tissue expanders.

So deepest my only option now for reconstruction.

JESSICA HEZKIAH: My name is Jessica Hezekiah.

I am 37 years old.

My surgeon recommended that DIEP flat over having an implant because of radiation having 33 treatments probably would not support the implant.

WAI-CHOO FINCH: My name is Wai-Choo Finch and I'm 65 years old.

It just looked like natural breast so it makes it easier for you to move forward.

LATISHIA WHEATON: I'm just amazed how good of a job that my breasts you cannot really tell I had reconstruction surgery.

DIANE HEDITSIAN: I was extremely happy with the results.

I just felt whole again.

JESSICA HEZKIAH: Going through chemo and going through radiation you don't look at yourself.

You're bystandard you don't know that person because you get put through.

Chemo radiation you become a number in a clinic, but to have your surgeon make subtle changes and have your insurance cover that for you.

Now I look at myself and I'm who I am before I had all my treatments done.

DIANE HEDITSIAN: I see taking away the insurance code for this particular kind of surgery as an access issue.

If we don't win our fight to get this reversed.

It's going to end up that the DIEP flap and other flap surgeries are just not available to underserved women.

LATISHIA WHEATON: We need more people on board about this.

This is very, very important because this is going to change people body images.

KATE GETZ: It is 2023.

We have made surgical advances.

We are doing better and healthcare, you know than we ever have been.

And women should be seeing the benefits of that.

ALI ROGIN: Joining me now is Dr. Elizabeth Potter.

She is a plastic surgeon who specializes in breast reconstruction, and is a co-founder of the Community Breast Reconstruction Alliance, an advocacy group dedicated to preserving access to DIEP flap reconstruction.

And a note some of the women we just heard from are her patients.

Dr. Potter, thank you so much for joining us.

You are one of a relatively small handful of doctors who perform this type of procedure, and to give people a sense of where DIEP flap surgery fits into the broader breast reconstruction landscape.

DIEP flap reconstruction constituted 17 percent of reconstructive surgeries in 2020.

Can you explain what goes into this surgery?

DR. ELISABETH POTTER, Breast Reconstruction Surgeon: DIEP flap surgery is really the culmination of many years of surgical refinement and a technique that we as reconstructive surgeons, used to transfer a woman's own tissue to her chest to create a natural breast.

During a DIEP flap surgery, I remove skin and fat and blood vessels, no muscle from the abdomen area that's similar to the area that might be removed during a tummy tuck procedure.

But instead of discarding that, we are able to carefully connect blood vessels in the chest so that that breast is then living on the chest, we can then mold that into the shape that's most natural for the patient.

And then the patient moves forward with a breast that is there for their lifetime, very different from an implant.

ALI ROGIN: And why would somebody choose this surgery over a breast implant?

ELISABETH POTTER: You know, patient choice is critical here.

So, someone might just prefer to not have a foreign body.

There are a lot of issues that have come up around implant safety over the last several years.

The more we know, the more patients are informed about risks regarding implants.

There's cancers associated with implants and other complications.

There's also the fact that implants are not lifetime devices and have to be maintained and potentially replaced several times over a patient's lifetime.

Importantly, there is a real clinical reason why many women need to have natural tissue reconstruction.

And that's radiation.

So radiation is an important part of the treatment for breast cancer.

And for women who have to have radiation, an implant is a less safe option.

So for women with a more advanced cancer, with a younger age of diagnosis, or a more aggressive type, who might need to have radiation.

This is really the gold standard of reconstruction.

ALI ROGIN: Doctor, access to this kind of surgery is already very limited.

Lots of insurance plans don't cover it.

So how would these coding changes affect the access that already exists?

ALISABETH POTTER: So actually, under the Women's Health and Cancer Rights Act of 1998, access to reconstruction is really should be guaranteed least coverages, although it's difficult to talk about money in cancer, and especially to talk about payments for physicians.

This is about patience.

If we decrease the payment to surgeons, then quietly those procedures go away.

And the woman who finds herself needing to find a surgeon or a procedure will find that it doesn't exist in her community.

ALI ROGIN: And stakeholders like insurance companies and the federal government, they say that this change was always supposed to happen that the unique code that previously was used for the surgery was always meant to be temporary.

And that this change means that it's just a more mainstream surgery and can be identified using one of these existing codes.

How do you respond to that?

ELISABETH POTTER: I think that that's a really important point to make.

This is not the time to be taking this code way.

Patient outcomes weren't considered in removal of this code.

And despite the fact that insurance companies could plan to change codes over time, we weren't allowed to have a discussion about patient impact and the implementation of this change.

So absolutely.

Can we work together to work over time if codes need to be changed or addressed?

Yes, but a drastic change in coverage.

A drastic change in access is what's happening now and that's not OK. ALI ROGIN: So who has the power to change this?

ELISABETH POTTER: The Centers for Medicaid and Medicare have the ability to restore these codes and they honestly have the power to do that pretty quickly.

We're seeing right now that patients are being asked to pay cash for the surgeries and facing decreased access in their communities.

ALI ROGIN: And Dr. Potter there's a much broader conversation have -- being had right now about women's health access who gets to make these decisions is this surgery and the changes to the way it's dealt with administratively?

Is that part of that larger conversation?

ELISABETH POTTER: Absolutely it is.

This effort really highlights so many problems that we're facing in healthcare.

Right now we need for women to have access to care that is best for them from the patient perspective.

To me, that's the most important thing that we're seeing.

We need to pivot away from just the dollars and cents of insurance companies and surgeons, and we need to look at patient outcomes and what patients need.

ALI ROGIN: Dr. Elisabeth Potter, a breast reconstruction specialist and the co-founder of the Community Breast Reconstruction Alliance.

Thank you so much for your time.

ELISABETH POTTER: Thank you, Ali.

JOHN YANG: We asked the Centers for Medicare and Medicaid Services about the change.

Official said phasing in the new code allows more than two years for providers and payers to adjust.

And that will give doctors and insurers ample time to consult with the American Medical Association which administers the code.

March is Women's History Month.

So over the next few weeks, we're highlighting stories of women whose accomplishments have often not gotten widespread recognition.

MAN: Hello, Ellen.

ELLEN OCHOA, NASA Astronaut: Hello there.

I'm up here taking pictures to support the experiment.

JOHN YANG: Ellen Ochoa was the first Hispanic woman in space.

She logged nearly 1,000 hours in space over the course of four missions between 1999 and 2002.

MAN: Astronaut Ellen Ochoa is maneuvering the robotic arm into a position where it will be for the start of the spacewalk.

JOHN YANG: And engineer she directed her fellow astronauts on spacewalks from the International Space Station.

Ochoa went on to become the first Hispanic person to be head of the Johnson Space Center.

ELLEN OCHOA: This is a really exciting and important mission for us.

We will in the future be putting our astronauts on board and we're testing some of the highest risks.

JOHN YANG: Today she's an advocate for STEM education and has written a bilingual children's book, We Are All Scientists.

Now online and Instagram story on Americans living with diabetes and the price of insulin.

You can find this and other stories on our Instagram at nstagram.com/newshour.

And that is "PBS News Weekend" for this Sunday.

I'm John Yang.

For all of my colleagues, thanks for joining us.

Have a good week.