Brian Krans, Author at Â鶹ŮÓÅ Health News Tue, 27 Sep 2022 22:54:52 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.5 /wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=32 Brian Krans, Author at Â鶹ŮÓÅ Health News 32 32 161476233 Judges Try To Balance Legal Rights And Courtroom Health /news/judges-try-to-balance-legal-rights-and-courtroom-health/ Thu, 04 Jun 2020 09:01:17 +0000 https://khn.org/?p=1112456&preview=true&preview_id=1112456 It’s tough getting people to report for jury duty in normal times. It’s even harder during a pandemic.

The kidnapping and rape trial of Kenneth Weathersby Jr. opened Feb. 24 in Vallejo, California, but three weeks later two jurors refused to show up after the state ordered people to stay home. Then the state’s chief justice stopped jury trials for 60 days, later into June.

Eventually, Solano County Superior Court Judge Robert Bowers had had enough.

At 10:24 a.m. on May 20, Bowers called the jurors who were left ― 11, and an alternate ― into Courtroom 101. Bailiffs offered each of the six men and six women a squirt of hand sanitizer before showing them to their seats. Four were led into the jury box, the rest to the gallery, with yellow tape covering groups of three seats to enforce social distancing.

“Citizens have a right to trials,” the tall, furrow-browed Bowers told the jurors, pulling down his blue mask to speak. “We have to find a way going forward.”

Solano was the first California county to resume a jury trial. Three others — Contra Costa, Santa Clara and Monterey — have notified Chief Justice Tani Cantil-Sakauye that they are resuming trials in the coming weeks, despite rising COVID-19 infection rates in the state.

In reopening, judges are trying to balance the constitutional rights of the accused to a speedy trial against the safety of jurors, bailiffs, clerks, attorneys, court reporters and others who work in their courthouses.

But courtrooms can be snug. Jury rooms almost always are. It will be very hard for people to keep the recommended distance, even as they abstain from the usual buttonholing, emoting and hugging in courthouse hallways.

Judges are conferring with health departments to limit the risks. Some courts, but not all, are requiring masks. Some are checking people’s temperatures before allowing them to enter the courthouse. Others may install plexiglass or plastic barriers.

Gone, for now at least, are the days when jury duty began with scores of prospective jurors packed into halls and waiting rooms. Courthouses in Contra Costa and Monterey are staggering the times and days of the week when potential jurors report, and calling only 50 people at a time to prevent large groups from gathering. Some are adding temperature checks to their usual security screenings.

“If they have a temperature over 100, they won’t be allowed in,” said Barry Baskin, presiding judge for Contra Costa County.

All the courts resuming trials say they’ll allow people to delay jury duty if they have concerns about the coronavirus. “We’re doing everything we can for their protection,” Baskin said.

Forty-eight states and territories — all except Illinois, Nebraska, Nevada, Ohio, South Dakota, Texas, American Samoa and the U.S. Virgin Islands — have restricted jury trials, according to the . So far, 14 states have reported coordinated statewide plans to reopen. California isn’t one of them.

At the federal level, decisions to resume jury trials are made on a district-by-district basis. All federal courts moved hearings to on April 8.

Health concerns and the legal rights of the accused are bound to be in conflict sooner or later in every jurisdiction.

Under the U.S. Constitution’s Sixth Amendment, defendants have a right to confront their accusers in a speedy public trial by a jury of their peers. In , trial is supposed to start within 60 days of arraignment for a felony case and within 45 days for a misdemeanor. The chief justice’s order can provide relief from those deadlines on a in the interest of public safety.

Still, some counties are reluctant and want Cantil-Sakauye to delay trials into July. The chief justice’s ruling allows courts to reopen earlier if they can do so “in compliance with applicable health and safety laws, regulations, and orders, including through the use of remote technology, when appropriate.”

“The further we get away from the height of the pandemic, the more likely people are to show up,” said Alameda County District Attorney Nancy O’Malley, president of the California District Attorneys Association.

“We are still hoping and pressing that people will respond,” said Chris Ruhl, court executive officer for Monterey County. “Jurors are real heroes in these times.”

While health officials recommend masks to prevent the spread of the coronavirus, testifying while wearing one may violate the Sixth Amendment, which allows a defendant to literally face their accuser, Baskin said.

The U.S. Supreme Court determined in in 1988 that witnesses can’t testify behind curtains or other visual obstructions. In the current pandemic, the ruled in April that witnesses must lower or remove their masks when testifying.

Courts are looking to erect plexiglass barriers around witness stands, or have attorneys and witnesses wear clear plastic face shields, so everyone in the courtroom can see and hear what is said.

But mandates for such measures will come on a county-by-county basis. That frustrates Oscar Bobrow, chief deputy public defender in Solano County and the president of the California Public Defenders Association. He wants a consistent state policy and notes that Ohio released a to resuming jury trials after consulting with people from across that state’s legal community.

Bobrow worries that fear of infection will result in juries with fewer African Americans and Hispanics, two groups that have suffered the brunt of the pandemic. People over 60 might also be reluctant to appear; some counties would exclude them from jury service, according to guidelines posted on various websites.

“The whole process is going to be slowed down, if it’s done right,” he said.

If courthouses don’t do enough to protect jurors from the virus, the panels may be unable to concentrate on testimony. “You’ll be more worried about someone sneezing than what’s being said to you,” Bobrow said.

When Weathersby’s trial resumed May 20, fewer than 25 people sat in the courtroom, which has a new maximum capacity of 53. Yellow tape over seats assured they sat at least 6 feet apart.

Masks were “strongly recommended” but not required — and four jurors declined the ones offered by bailiffs.

“We have a balance of personal freedoms and human protections,” Bowers told the jurors. “This is the new norm. This is what jury trials will look like in the future.”

The jury found Weathersby guilty on 10 counts, including forcible rape and kidnapping to commit rape. He faces multiple life terms at sentencing, scheduled for July 14.

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San Francisco Quick To Fight COVID-19, Slow To Help Homeless /news/san-francisco-quick-to-fight-covid-19-slow-to-help-homeless/ Tue, 21 Apr 2020 09:00:20 +0000 https://khn.org/?p=1087782&preview=true&preview_id=1087782 San Francisco Mayor London Breed has won for taking drastic early measures against COVID-19 that seem to have spared San Francisco the catastrophic fate of New York and other cities.

But she hesitated over what to do with the city’s estimated 8,000 homeless people during the pandemic — until the issue came back to bite her.

A COVID-19 outbreak at the city’s largest homeless shelter had sickened at least 105 people by Friday, about a tenth of the entire San Francisco caseload. It led the city — which had planned to pack the homeless into the Moscone Center, the city’s gigantic convention hall, and other big venues — to suddenly switch directions.

While only 123 homeless people had been housed in six hotels as of April 3, last week the city said it had moved 447 people from shelters into some of the 2,082 rooms it had rented. That included all 340 residents of , the shelter run by the St. Vincent de Paul Society where the outbreak happened.

“It’s really a massive undertaking that has the city’s entire focus now,” said Abigail Stewart-Kahn, the city’s director of the department of homelessness and assistive housing.

Meanwhile, the Board of Supervisors — San Francisco’s city council — on Tuesday unanimously passed an emergency ordinance requiring the city to rent 8,250 hotel rooms by April 26 for homeless people, discharged COVID-19 patients and exposed front-line workers.

The board, as well as advocates for the poor and health care workers in San Francisco, had for weeks lashed out at Breed for her approach to the homeless, saying it epitomized the city’s disgraceful handling of its most vulnerable population.

The pandemic has exposed San Francisco’s “deep disregard for the humanity of our unhoused people,” said Dr. Rupa Marya, an internist at UC-San Francisco Medical Center. “COVID-19 is exposing the fracture lines of our society and bringing to the forefront who we don’t care about.”

While negotiating room rates with hotel and motel owners for more rooms, San Francisco opted first to put only homeless people with confirmed COVID-19 infections into hotels, while preparing mass shelters for others living on the streets.

Breed declared a state of emergency on Feb. 25, nine days before the city reported its first confirmed case of COVID-19, and took center stage as six Bay Area counties issued stay-at-home orders for all residents on March 16.

But the mayor resisted using her authority to provide hotel rooms for the homeless, citing logistical difficulties. Staff and resources were needed to ensure “chaos” didn’t overtake the hotels, she said.

“I know that people are asking: Why don’t we just open the doors and let everyone who is homeless have access to a hotel room? I wish it were that easy,” Breed said at a news briefing.

Some progressives took matters into their own hands, moving people out of shelters and into hotels despite the city government’s reluctance. City Supervisor Dean Preston put up $10,000 of his own money to help reserve at least 30 rooms at the near City Hall.

On April 4, another supervisor, Matt Haney, led a guerrilla action with six staff members and about 25 guests from , one of the city’s oldest shelters. The residents put their belongings on moving carts and pushed them to a nearby vacant hotel.

Hospitality House prioritized those age 60 or older or those suffering from underlying health conditions. They made sure those people could care for themselves in a hotel room, said its executive director, Joe Wilson.

“People are loving having their own bed, their own private bathroom,” Wilson said a few days later. “We’re urging the city to really step up and accelerate its actions.”

“Our position all along has been to get people into private rooms,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness in San Francisco. “Why not do it early? The city is paying for the rooms.”

City officials estimate that renting 8,250 rooms will cost $58.6 million a month, including food and security. Up to $40 million of that could be reimbursed by the state.

On April 3, Gov. Gavin Newsom announced Project Roomkey, a statewide initiative that aimed to open up 15,000 hotel rooms to the state’s homeless population, with a 75% reimbursement rate from the federal government.

Around that time, Los Angeles — home to the state’s largest concentration of homeless, about 58,000 people — began moving people into hotel rooms, pulling them out of shelters, hospitals and access centers, or off the streets. But Los Angeles has also moved slowly.

The goal was to house homeless people in 15,000 hotel rooms, said Heidi Marston, interim executive director of Los Angeles’ Homeless Services Authority, but as of Friday only 629 had moved in.

“It gives them an opportunity to rest and recover,” Marston said. “It’s a good opportunity for us to engage with folks without the stress of having to live on the streets. We’re committed to not going back to where we were.”

Unlike San Francisco, Los Angeles hasn’t had a large outbreak at a homeless shelter, though authorities reported last Monday that staying in shelters in L.A. County have tested positive for the virus.

In San Francisco, the city originally looked into large venues that could be used to “thin out” the shelters. A plan to house 400 people at the Moscone Center was scrapped after a publication for the homeless, , showed the plans involved putting mats on concrete floors divided by masking tape.

The city has repeatedly cited logistical concerns in moving people into hotels, while saying that many living on the street preferred to stay there.

“We don’t want to be renting 3,000 rooms that sit empty for a couple weeks, but we want to be flexible enough to be able to manage the medical surge, as well as manage the need for our vulnerable populations, both in our shelters and on our streets, as well as in our single-room occupancy hotels,” said Trent Rohr, director of San Francisco’s Human Services Agency.

Advocates for the homeless said the Multi-Service Center South outbreak could be repeated unless hotel rooms are quickly made available.

“It’s very scary to think about what’s going to happen with them and very painful to know this could have been prevented,” Dr. Juliana Morris, a primary care physician at UCSF who works with patients at shelters, said at a virtual news conference.

“While Mayor Breed should be commended for her acting so rapidly to protect so many people in San Francisco, who got left behind were our unhoused,” Marya said.

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Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer /news/patients-caught-in-crossfire-between-giant-hospital-chain-large-insurer/ Thu, 06 Feb 2020 10:00:54 +0000 https://khn.org/?p=1048982&preview=true&preview_id=1048982 After Zoe Friedland became pregnant with her first child, she was picky about choosing a doctor to guide her through delivery.

“With so many unpredictable things that can happen with a pregnancy, I wanted someone I could trust,” Friedland said. That person also had to be in the health insurance network of Cigna, the insurer that covers Friedland through her husband’s employer.

Friedland found an OB-GYN she liked, who told her that she delivered only at Sequoia Hospital in Redwood City, California, a part of San Francisco-based . Friedland and her husband, Bert Kaufman, live in Menlo Park, about 5 miles from the hospital, so that was not a problem for them — until Dec. 12.

That’s the day Friedland and Kaufman received a letter from Cigna informing them their care at Sequoia might not be covered after Jan. 1. The insurance company had not signed a contract for 2020 with the hospital operator, which meant Sequoia and many other Dignity medical facilities around the state would no longer be in Cigna’s network in the new year.

Suddenly, it looked as if having their first baby at Sequoia could cost Friedland and Kaufman tens of thousands of dollars.

“I was honestly shocked that this could even happen because it hadn’t entered my mind as a possibility,” Friedland said.

She and her husband are among an estimated 16,600 people caught in a financial dispute between two gigantic health care companies. Cigna is one of the largest health insurance companies in the nation, and Dignity Health has 31 hospitals in California, as well as seven in Arizona and three in Nevada. The contract fight affects Dignity’s California and Nevada hospitals, but not the ones in Arizona.

“The problem is price,” Cigna said in a statement just before the old contract expired on Dec. 31. “Dignity thinks that Cigna customers should pay substantially more than what is normal in the region, and we think that’s just wrong.”

Tammy Wilcox, a senior vice president at Dignity, said, “At a time when many nonprofit community hospitals are struggling, Cigna is making billions of dollars in profits each year. Yet Cigna is demanding that it pay local hospitals even less.”

In 2018, the most recent full year for which earnings data is available, Cigna generated on revenue of approximately $48 billion. Dignity Health reported on revenue of $14.2 billion in its 2018 fiscal year.

It’s possible Cigna and Dignity can still reach an agreement. Both sides said they will keep trying, though no talks are scheduled.

Disagreements between insurers and health systems that leave patients stranded are a in U.S. health care. , a professor of health economics at the University of Southern California, said such disputes, which are disruptive to consumers, are often settled.

Melnick believes Dignity is using an “all or nothing” strategy in contract negotiations, meaning either all its facilities are in the insurer’s network or none are.

“This allows them to increase their market power to get higher prices, which is not necessarily good for consumers,” Melnick said.

Dignity replied in an emailed statement: “We do not require payers to contract with all or none of Dignity Health’s providers. We do try to make sure patients have access to the full range of Dignity Health services and facilities in each of our communities.”

Dignity faces a number of legal and financial challenges while it works to implement a February 2019 merger with Englewood, Colorado-based Catholic Health Initiatives that created one of the nation’s largest Catholic hospital systems — known as Health.

California Attorney General Xavier Becerra approved the deal with , including that Dignity’s California hospitals spend $10 million in the first three years on services for people experiencing homelessness and offer free care to more low-income patients.

The requirement to treat more poor patients at no charge followed a period, from 2011 to 2016, in which Dignity’s while its net income was $3.2 billion.

Last October, CommonSpirit announced an operating loss of on revenue of nearly $29 billion for the 2019 fiscal year, its first annual financial statement after the merger took effect. Much of the loss was due to merger-related costs and special charges.

The same month, Dignity completed a five-year “corporate integrity agreement” with the U.S. Office of the Inspector General following an into how it billed the government for hospital inpatient stays. Dignity said it “fully complied” with the agreement.

Dignity is also defending itself in a alleging that it bills uninsured patients at grossly inflated rates even though it claims to provide “affordable” care at “the lowest possible cost.”

More recently, an appeals court judge — often a lot higher than state-set rates — for treating enrollees of Medi-Cal health plan at its Northridge Hospital Medical Center.

Dignity disagreed with the court’s ruling in that case, saying that although the Northridge facility did not have a contract with L.A. Care, many of the health plan’s enrollees who initially sought emergency treatment there stayed in the hospital for additional care after they had been stabilized. The hospital “seeks appropriate reimbursement for providing this care,” Dignity said.

If Dignity does not reach an agreement with Cigna, its hospitals, outpatient surgery centers and medical groups in most of California will soon be out-of-network for many Cigna enrollees. In-network coverage for Open Access (OAP) and Preferred Provider (PPO) ended Feb. 1, and for HMO patients it is set to end April 1.

Peter Welch, president and general manager for Cigna in Northern California and the Pacific Northwest, said Cigna can provide “adequate access” to other hospitals and doctors.

Certain Cigna enrollees can apply to continue visiting Dignity facilities and doctors under law, enacted in 2014. Eligible enrollees include patients with chronic conditions, those already scheduled for pre-authorized services, people in need of emergency care and pregnant women in their third trimester.

Friedland and Kaufman applied, hoping she would be able to continue seeing her Dignity-affiliated OB-GYN at in-network rates.

On Jan. 22, less than a month from Friedland’s Feb. 15 due date, they received written confirmation that their request had been approved. They wouldn’t have to shop for a new doctor or face stiff medical bills after all.

Early Tuesday evening, Friedland gave birth to a baby girl, Eliza, who entered the world 11 days earlier than expected, weighing in at 7 pounds, 3 ounces.

“While the ordeal was stressful, and the communication fraught, we were happy to receive confirmation of continuity of care and that it ended in the best possible way — with the birth of our healthy baby daughter with the provider where we established care,” Kaufman said. “For the sake of those caught in the middle and now having to start relationships with new health care providers, we hope the two sides can come to an agreement.”

This story was produced by , which publishes , an editorially independent service of the .

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San Francisco Hopes To Improve Care For People With Mental Illness Living On Streets /news/san-francisco-hopes-to-improve-care-for-people-with-mental-illness-living-on-streets/ Fri, 13 Dec 2019 10:00:33 +0000 https://khn.org/?p=1030275&preview=true&preview_id=1030275 San Francisco has promised to tackle her city’s homelessness crisis, a vexing situation involving drug abuse and mental illness that is compounded by the city’s high housing costs. Breed has asked Dr. Anton Nigusse Bland, most recently the medical director for psychiatric emergency services at Zuckerberg San Francisco General Hospital, to help solve the problem.

In March, she appointed him to the newly created position of director of mental health reform. His main is to help the city improve its mental health and addiction treatment for people experiencing homelessness.

“I had the opportunity being there on the front lines, providing services directly to clients, to better understand and appreciate when a person has that combination of homelessness, mental illness and substance abuse,” said Nigusse Bland. He has in several Bay Area county mental health systems, first as an integrated care psychiatrist with Alameda Health System, then as chief of psychiatry for Contra Costa County.

The mayor backed a new state law, , which establishes pilot programs to expand the use of conservatorship — a controversial practice that allows the city to take people with mental illness or substance abuse issues off the streets without their consent and put them into treatment.

To identify the people most in need of services, city employees used data on the 18,000 residents in need of immediate shelter. They identified about 3,700 who were experiencing what Nigusse Bland calls the “trifecta” of homelessness, mental illness and substance use. Many of them have repeatedly visited ERs or been jailed multiple times in the past year.

Of those 3,700 people, 237 were identified as immediate priorities. Nigusse Bland said the key is coordinating care to get them into housing and services they may not know are available.

San Francisco is the only jurisdiction so far to create such a conservatorship pilot program, though the law also allows Los Angeles and San Diego counties to do so.

San Francisco officials also recently on how to allocate mental health funding for those with the most urgent needs. Their plan includes a 24-hour service center and an outreach team.

Nigusse Bland sat down last month with California Healthline at the San Francisco Department of Public Health in the city’s Civic Center, which has long been a hub of homelessness and , to talk about the daunting task facing him. His comments have been edited for space and clarity.

Q: What were some of your first steps when you took this job?

We had a couple of challenges ahead of us, one of which was being clear about who is affected by homelessness, mental illness and substance abuse and finding the root cause of why they’re having this experience right now. In this population, care coordination works, and you have to be very thoughtful about deploying evidence-based practices to get those services to those individuals.

One of the overwhelming assumptions about this group of individuals is that they’re all getting high on crystal meth, but we were surprised to learn that 95% of these people have an alcohol-related problem. The good thing is that there are many things we can do about alcohol.

Q: What services will be available to the 237 people you identified as having the most urgent needs?

Those individuals will receive an advanced care coordination team coupled with street responders, mental health specialists, a psychiatrist, and caseworkers who are actively reaching out to these people in the community.

If they are found in an emergency setting, we will go to that setting and help navigate them to a safe place, which might be a substance use treatment program, a mental health residential program or directly into housing.

Q: Allowing city officials to hold people against their will is controversial. What do you think about using conservatorship to treat people with mental illness or substance abuse disorders?

We have to be very thoughtful in the balance between autonomy and restoring a person’s dignity and health. It’s inhumane to allow someone to suffer on the streets with serious mental illness and substance abuse when there are alternatives available to them. In many of those cases, those individuals who are so severely affected may not even understand what’s happening to them at that moment. They’re struggling.

Through conservatorship, we have an opportunity to help restore that person’s capacity. I see it as an opportunity. In some cases, it can be the right thing to do to help that person get back on track.

Q: How will you get people the services they need given historically limited funding?

Our mayor has made a significant investment by adding over 200 new behavioral health beds into our pipeline with plans to add over 800 new beds.

We have commitments to increase the number of our intensive case managers, especially in mental health services for individuals with complex mental health and substance abuse issues.  We’ve made a commitment to reduce intensive case managers’ workloads to be able to meet the needs of these clients.

We want to make sure the ones most severely affected are getting into housing and get the support to stay in housing.

Q: How will you gauge success?

We should see changes in people experiencing homelessness, the amount of time they spend in jail and the emergency room, and their engagement in some kind of meaningful activity.

There are a couple of things that I think are going to make an impact, one of which is our Drug Sobering Center for those suffering the consequences of methamphetamine use. If someone appears confused, is having difficulty keeping their clothes on or yelling at someone, there’s a safe place that’s not jail, that’s not the emergency room, where they can recover and get counseling. And, if they’re ready, they can go into a treatment program as a next step.

That person doesn’t have to spend another night on the street and has the opportunity to get into services rather than having a jail record. And there’s the indirect impact of our emergency departments likely experiencing less crowding.

Q: What else should people know about this work?

of those 3,700 individuals in that trifecta are black and/or African American, a group that represents only 5% of San Francisco’s population, so they are disproportionately represented in the most vulnerable among us. We want to see an equitable San Francisco so everyone has a fair shot at wellness and recovery.

Sometimes that first opportunity isn’t successful and you might have to engage again to get that person on the right track, but what we know is that with every opportunity, they can make progress. It might be incremental, and it’s on their own timeline, but they can get better.

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California’s Working Mothers Get Stronger Support For Workplace Lactation /news/californias-working-mothers-get-stronger-support-for-workplace-lactation/ Tue, 26 Nov 2019 10:00:56 +0000 https://khn.org/?p=1024065&preview=true&preview_id=1024065 Katie Woody’s firstborn, Oliver, struggled from birth to latch onto her breast, so she had little choice but to pump her milk and feed it to him from a bottle.

After a three-month maternity leave, Woody returned to her job as a sous-chef for a meal delivery service in Los Angeles, expecting to have access to the sole office in the rented building to pump her breast milk — an agreement she had made with the building manager. But a male shift supervisor who occupied the office would not let her use it.

Instead, she pumped in her car, covering the windows as best she could. “But the stress of the situation was too much,” she said, so she stopped giving her son breast milk a few months after her return to work. That upset her, because Oliver, now 2, had health problems, and she wanted to give him the best nutrition possible.

The recommends children be exclusively breastfed for the first six months of their lives. But, as in Woody’s case, many mothers return to work well before that and often have trouble finding a suitable place to pump and store their breast milk.

A law signed last month by Gov. Gavin Newsom, which takes effect Jan. 1, seeks to rectify that problem. It requires that working mothers be given a more dignified space to pump and proper equipment for storing the milk.

Authored by Sen. Scott Wiener (D-San Francisco), requires employers to provide mothers a secure and private space close to their workstation with a chair and a table or shelf to hold their pumping equipment, as well as access to electricity. Running water and a refrigerator or cooler for their milk must be located close to their workstations.

“Too many new mothers are unable to express milk at work or are forced to do so in a restroom or other unsuitable space,” Wiener said in a statement. The lack of a proper lactation space, research shows, is particularly pronounced among lower-income workers and women of color.

The new law requires employers to notify employees of their right to pump their breast milk at work, including the time and space provided for it — and it mandates that any violations of those rights be communicated to the

The Affordable Care Act requires employers across the U.S. to give women time and a space — other than a bathroom — to pump their breast milk. But it does not mandate specifics.

SB-142 is not Wiener’s first attempt to beef up workplace lactation requirements in California. Last year, he authored a similar bill, but . Brown did sign , which lacked the specific requirements contained in the Wiener bill.

In 2017, San Francisco passed a first-in-the-nation , to which SB-142 bears a close resemblance.

, executive director of Breastfeed LA — one of many breastfeeding rights groups that supported the new state law — said it provides “minimum standards” for safe and clean lactation spaces across California. That’s important, she said, because employers around the state have varying ideas about what such spaces should look like.

Failure to conform to the new specifications will open employers to fines and further liability, Palmer said, adding: “The law that protects a woman from retaliation is extremely important.”

One Friday this month, Palmer said, she fielded complaints from women who had been harassed about their pumping breaks. One was fired, and another quit her job.

On the other hand, Palmer said, many employers are empathetic and want to accommodate new mothers — but limited space can make it hard for small businesses operating on thin margins to do so.

The new law exempts businesses with fewer than 50 employees that can prove accommodating lactating mothers would create an undue hardship.

One solution for employers with limited space is free-standing, portable lactation rooms. Palmer cited the case of a fieldworker whose employers provided her a pod, with portable electricity, manufactured by , a Burlington, Vt., company that designs lactation spaces for airports and workplaces.

Sascha Mayer, Mamava’s CEO, said she came up with the idea for her company while working as an executive in a design studio. She said she was able to have privacy simply by closing the door to her office, “but so many women I’ve met don’t have that privilege.”

Lactation laws vary around the country, but even with minimum federal standards, Mayer said, “millions of employers are probably out of compliance.”

Opponents of the new California law — including statewide associations representing retailers, restaurants and health care providers — argued before its passage that it would be “quite burdensome for employers” and expose them to “potential litigation traps.” They said already had required costly changes regarding lactation.

Proponents of the new law cite from the U.S. Breastfeeding Committee showing that more than half of mothers return to the workforce before their children are 1 year old. In California, half of mothers work during pregnancy, and most of them say they plan to return to work while they are still breastfeeding, according to the state’s Ìý(°ä¹ó±á).

And barriers at work, the proponents say, can cause those women to stop breastfeeding before their child is 6 months old.

from the California Department of Public Health shows a large disparity in access to breastfeeding support among California’s working mothers, breaking down along racial, ethnic and economic lines.

Wealthier white women reported receiving the most lactation support from their employers, while black and Latina mothers reported the least support. And women at or below the poverty line were far less likely than others to work for employers who accommodated their lactation needs.

Still, the CFH reports that since 2011 the percentage of all women who reported receiving workplace breastfeeding support increased from just over half to two-thirds.

Carissa Rosenthal, 32, recently returned to her job in public relations after giving birth to a baby boy 3½ months ago.

Her co-working office in San Diego has a “mothers’ lounge” with a door that locks, a comfortable chair, a shelf, a lamp, a fridge and a sink down the hall in the kitchen, she said.

“It’s definitely a perk and a selling point for a shared office,” Rosenthal said over the phone while pumping in the room one recent Thursday afternoon. “I definitely feel it’s an important thing for it to be comfortable, and not just stuffed into a janitor’s closet.”

Woody, who is pregnant again, said she wasn’t aware of the new requirements under SB-142, but the potential lactation accommodations in her new workplace seem a little better than at the last one.

“There’s a changing room, so I’ll probably be able to pump in there,” she said.

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