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California Lawmakers Seek Protections for Patients in ICE Custody

Claudia Boyd-Barrett — Wed, 22 Apr 2026 12:40:00 +0000

California lawmakers alarmed by the treatment of people brought to hospitals by federal immigration agents want to strengthen protections for detained patients receiving care at medical facilities, including by making it easier for their families and attorneys to find them.

Two bills moving through the state Senate seek to prevent immigration enforcement officers from isolating patients from their loved ones and interfering with their ability to get legal help. Analyses for both bills cite reporting by �鶹Ů�� Health News that found family members and attorneys have faced extreme difficulty locating and supporting patients hospitalized while in immigration custody.

�鶹Ů�� Health News found that some hospitals have facilitated patient isolation through what are known as blackout policies, which can include registering people under pseudonyms, withholding their names from the hospital directory, and preventing staff from contacting patients’ relatives to let them know their location and condition.

A bill by Democratic state Sen. Caroline Menjivar of the San Fernando Valley, , would largely prohibit the use of blackout policies for patients in immigration custody and ensure they retain the right to have their families and others notified of their whereabouts and condition. Blackout policies would be allowed when the health care provider determines the patient is a credible risk to themself or others and the risk is documented in the patient’s medical record. Patients would also be allowed to receive visitors.

It seeks to address reports of Immigration and Customs Enforcement agents guarding patients in their hospital rooms while they undergo medical exams or talk with doctors, interfering with medical decisions, and pushing for patients to be discharged prematurely to detention facilities ill-equipped to provide follow-up care.

“These are actions that have no place in health care, and it is a clear violation of the patients’ rights,” Menjivar said.

Under Menjivar’s proposal, agents would not be allowed into the rooms of patients they bring in for care unless they can show legal authorization to be there. If agents remain in the room, staff would be required to ask them to leave during medical exams and patient care discussions. If agents refuse, health care facility staff would need to document it.

, authored by state Sen. Susan Rubio, a Democrat from the San Gabriel Valley, would require health care providers to inform staff and relevant volunteers to respond when patients want their families to know where they are, and to post a notice at facility entrances with information about visitation and access policies. The law already says patients can agree to have loved ones notified they’re in the hospital, and Rubio’s bill seeks to make sure staff and others know they can do that for patients in immigration custody.

The federal Department of Homeland Security, which oversees immigration enforcement, did not respond to a request for comment.

Both bills were passed by the Senate Health and Judiciary committees along party lines and will be heard next by the Senate Appropriations Committee.

More than 20 immigrant rights advocates and health care workers voiced support for strengthened protections for patients at a hearing last week.

“This state must do everything in its power to protect against these abuses and ensure detainees have the right to contact their loved ones when they are hospitalized and in critical conditions,” said Hector Pereyra, political manager with the Inland Coalition for Immigrant Justice.

However, representatives from the California Hospital Association and California Medical Association told lawmakers last week they had concerns that directing health care workers to document agents’ badge numbers and ask them to leave patients’ rooms could create conflict and pose a safety risk.

“While we understand that this is an important issue, we want to ensure the bill strikes the right balance and does not create conflicting or unclear obligations for hospitals and their staff and clinicians, particularly in real-time interactions with federal officers,” said Vanessa Gonzalez, a vice president of state advocacy for the hospital association.

�鶹Ů�� Health News reported that one man, 43-year-old Julio César Peña, was held at a hospital in Victorville for almost two weeks before his attorney and family found out where he was. Peña, who had terminal kidney disease, was shackled to his hospital bed, guarded by immigration agents, and told he wasn’t allowed to disclose his location, according to his wife. He then suffered a seizure that left him intubated and unconscious, but no one notified his family. Peña died Feb. 25, less than two months after he was released to go home.

Advocates for immigrants and health care workers, as well as lawmakers, fear similar incidents are happening around the state.

Menjivar said her bill “seeks to close the gap between existing law and practice by empowering health care provider entities with the tools to uphold the privacy, health, and visitation rights of a patient brought in under immigration custody.”

SB 915 would prohibit hospitals and clinics from allowing immigration officers to make medical decisions for the patient or provide interpretation. Health care facilities would be required to document and verify, “to the extent possible,” the identities of immigration officers; provide patients access to communication tools; and inform patients of their rights. They would also need to complete discharge planning that includes attempts to coordinate with any receiving facility, such as a detention center, to ensure patients receive follow-up care.

The bills come on the heels of legislation passed last year that sought to limit immigration enforcement at health care facilities, including by prohibiting medical establishments from allowing federal agents without a valid search warrant or court order into private areas. However, that bill did not address situations in which patients are already in immigration custody.

“ICE has instilled fear in our hospitals and has kept us from doing our job,” said SatKartar Khalsa, an emergency medicine resident at a safety net hospital in San Francisco who has treated detained patients and testified in support of SB 915. “This has all led to worse care for our patients and has added another layer of fear among health care workers.”

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Affirmative Action Critics Refuse To Back Down in Fight Over Medical Bias Training

Ronnie Cohen — Thu, 11 Sep 2025 09:00:00 +0000

Critics of affirmative action have launched a long-shot appeal aimed at stopping California from requiring training on unconscious bias in every continuing medical education class.

A July ruling by a three-judge panel of the 9th U.S. Circuit Court of Appeals upheld California’s right to mandate that every course doctors take to remain licensed must address how bias contributes to poorer health outcomes for racial and ethnic minorities. The ruling against the nonprofit and Los Angeles ophthalmologist Azadeh Khatibi amounts to a victory for California as it fights the Trump administration and right-leaning advocacy and legal groups’ attacks on perceived “wokeness.”

In August, the Pacific Legal Foundation, which represents Do No Harm and Khatibi, asked that a panel of 11 appellate judges reconsider what attorney Caleb Trotter characterized as a “very clearly wrong” decision. Trotter, a senior attorney for the Pacific Legal Foundation, expects the court’s response in October. If the appeal fails, he said, his firm would likely appeal to the U.S. Supreme Court. At stake, legal scholars say, is the latitude of states to prescribe educational content, including health equity training, for licensed professionals.

“The general recent tenor of the Supreme Court’s First Amendment jurisprudence has been very speech protective, so that we would like our odds with, of course, the understanding that any attempt to get the Supreme Court to take your case is a long shot,” Trotter said.

Erwin Chemerinsky, dean of the University of California-Berkeley law school, described the chances of the Supreme Court taking the case as “very unlikely” and the appellate ruling as “clearly correct” in affirming the state’s authority to impose course requirements.

California began requiring implicit-bias training for physicians in 2022. From 2019 through July 2022, enacted legislation mandating the training. California is the only state that requires it to be included in every course involving direct patient care.

In enacting the law, the legislature found that bias contributed to health care disparities and persisted regardless of other factors influencing care. Black women, for example, are often prescribed less pain medication than white women with the same complaints and are as white women to die of pregnancy-related causes.

Bias does influence clinical care and contribute to health care disparities, a concluded. Implicit-bias training, however, might have no impact and might even worsen care, the report noted.

and Khatibi alleged that violated their First Amendment rights. Khatibi acknowledges that unconscious bias might prejudice how clinicians treat patients. But the Los Angeles ophthalmologist does not believe she should be forced to carve out time to talk about it in a class she might teach on, for example, ocular tumors.

“The government is mandating doctors endorse a specific ideology or priority instead of science,” she said. “I believe government should not mandate or compel the speech of doctors.”

The three-judge appellate panel disagreed. No one is forcing Khatibi to teach state-accredited continuing education, the panel wrote in its a lower court’s decision that the state had the right to mandate the training. The judges found that the curriculum requirement constitutes government speech and, therefore, is not subject to free-speech protections.

The does not dispute the state’s authority to require physicians to learn about unconscious prejudices. Instead, it argues the state has no right to demand that all teachers discuss bias in every continuing medical education class. California physicians must take at least 50 hours of continuing education every two years. Private institutions offer the courses, and physicians generally teach them.

Rep. Sydney Kamlager-Dove (D-Calif.), who wrote the bill when she was a member of the state Assembly, defended it. “By connecting every provider to consistent and evolving training, we can help close these gaps and provide more equitable care,” she said.

The Medical Board of California declined to comment.

Ashutosh Bhagwat, a UC Davis School of Law distinguished professor, said the state has a right to require implicit-bias training, although he disagrees that the training constitutes government speech. He sees it as private, but not compelled, speech because Khatibi and other instructors need only include a discussion of implicit bias if they want their classes to qualify for state licensing credit.

He likened the requirement to that of an accredited private school having to teach math. “Doesn’t matter if you don’t want to teach math. Doesn’t matter if you don’t believe in math,” he said. “You have to teach math.”

Bhagwat sees Khatibi’s case as “very weak.” But he said he could not predict anything the Supreme Court, with its six-justice conservative majority, might do.

“If Khatibi wins in the Supreme Court, or at any level, then chaos reigns because now every single requirement in any licensure that says you must teach this to qualify for continuing education is up for grabs,” he said.

Trotter fears the opposite outcome. If allowed to stand, the implicit-bias training mandate could be extended to continuing education for 50 trades and professions in California alone, he said. “Then all kinds of governments based on all kinds of views can start requiring private speakers to say all kinds of things that, depending on where you are, are going to be controversial in all different kinds of ways,” he said.

While Khatibi’s lawsuit and others like it have had little success in the courts, said Joan Williams, a distinguished professor emerita at UC Law-San Francisco, they have chilled the creation of laws deemed “woke” or those favoring diversity, equity, and inclusion, known as DEI.

“There’s been this huge attack on DEI, and it’s been extraordinarily effective in creating regulatory risk such that people are apprehensive and self-editing because they don’t want to put a target on their backs,” said Williams, who directs the .

Still, some supporters of bias training say California could refine its approach. Cristina Gonzalez, an internist and a New York University Grossman School of Medicine professor, designs and evaluates interventions to help recognize, prevent, and repair clinicians’ prejudices. She described implicit-bias training as “a science” and California’s approach as misguided because it requires all instructors, regardless of their knowledge of implicit bias, to teach the material.

Finger-wagging and blaming in implicit-bias training can lead doctors to become defensive and avoid patients, but done correctly, by experts, it does work, Gonzalez said. “The messaging has to be, ‘You’re not a bad person,’” she said.

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In a Nation Growing Hostile Toward Drugs and Homelessness, Los Angeles Tries Leniency

Angela Hart — Tue, 08 Jul 2025 09:00:00 +0000

LOS ANGELES — Inside a bright new building in the heart of Skid Row, homeless people hung out in a canopy-covered courtyard — some waiting to take a shower, do laundry, or get medication for addiction treatment. Others relaxed on shaded grass and charged their phones as an intake line for housing grew more crowded.

The Skid Row Care Campus officially opened this spring with ample offerings for people living on the streets of this historically downtrodden neighborhood. Pop-up fruit stands and tent encampments lined the sidewalks, as well as dealers peddling meth and fentanyl in open-air drug markets. Some people, sick or strung out, were passed out on sidewalks as pedestrians strolled by on a recent afternoon.

For those working toward sobriety, clinicians are on site to offer mental health and addiction treatment. Skid Row’s first methadone clinic is set to open here this year. For those not ready to quit drugs or alcohol, the campus provides clean syringes to more safely shoot up, glass pipes for smoking drugs, naloxone to prevent overdoses, and drug test strips to detect fentanyl contamination, among other supplies.

As many Americans have grown increasingly intolerant of street homelessness, cities and states have returned to tough-on-crime approaches that penalize people for living outside and for substance use disorders. But the Skid Row facility shows Los Angeles County leaders’ embrace of the principle of harm reduction, a range of more lenient strategies that can include helping people more safely use drugs, as they contend with a homeless population estimated — among of any county in the nation. the approach can help individuals enter treatment, gain sobriety, and end their homelessness, while addiction experts and county health officials note it has the added benefit of improving public health.

“We get a really bad rap for this, but this is the safest way to use drugs,” said Darren Willett, director of the Center for Harm Reduction on the new Skid Row Care Campus. “It’s an overdose prevention strategy, and it prevents the spread of infectious disease.”

Despite in overdose deaths, drug and alcohol use continues to be the among homeless people in the county. Living on the streets or in sordid encampments, homeless people saddle the health care system with high costs from uncompensated care, emergency room trips, inpatient hospitalizations, and, for many of them, their deaths. Harm reduction, its advocates say, allows homeless people the opportunity to obtain jobs, taxpayer-subsidized housing, health care, and other social services without being forced to give up drugs. Yet it’s hotly debated.

Politicians around the country, including in California, are reluctant to adopt harm reduction techniques, such as needle exchanges or supervised places to use drugs, in part because they can be seen by the public as condoning illicit behavior. Although Democrats are more supportive than Republicans, this year found lukewarm support across the political spectrum for such interventions.

Los Angeles is defying President Donald Trump’s agenda as he advocates for forced mental health and addiction treatment for homeless people — and locking up those who refuse. The city has also been the scene of large protests against Trump’s immigration crackdown, which the president has fought by deploying National Guard troops and Marines.

Trump’s on homelessness and substance use disorder came during his campaign, when he attacked people who use drugs as criminals and said that homeless people “have no right to turn every park and sidewalk into a place for them to squat and do drugs.” Health and Human Services Secretary Robert F. Kennedy Jr. reinforced Trump’s focus on treatment.

“Secretary Kennedy stands with President Trump in prioritizing recovery-focused solutions to address addiction and homelessness,” said agency spokesperson Vianca Rodriguez Feliciano. “HHS remains focused on helping individuals recover, communities heal, and help make our cities clean, safe, and healthy once again.”

A led by Margot Kushel, a professor of medicine at the University of California-San Francisco, this year found that nearly half of California’s homeless population had a complex behavioral health need, defined as regular drug use, heavy drinking, hallucinations, or a recent psychiatric hospitalization.

The chaos of living outside, she said — marked by violence, sexual assault, sleeplessness, and lack of housing and health care — can make it nearly impossible to get sober.

Skid Row Care Campus

The new care campus is funded by about $26 million a year in local, state, and federal homelessness and health care money, and initial construction was completed by a Skid Row landlord, Matt Lee, who made site improvements on his own, according to Anna Gorman, chief operating officer for community programs at the Los Angeles County Department of Health Services. Operators say the campus should be able to withstand potential federal spending cuts because it is funded through a variety of sources.

Glass front doors lead to an atrium inside the yellow-and-orange complex. It was designed with input from homeless people, who advised the county not just on the layout but also on the services offered on-site. There are 22 recovery beds and 48 additional beds for mostly older homeless people, arts and wellness programs, a food pantry, and pet care. Even bunnies and snakes are allowed.

The new Skid Row Care Campus offers homeless people health care and a place to rest, charge their phones, grab some food, or even get connected with housing. (Angela Hart/�鶹Ů�� Health News)

John Wright, who goes by the nickname “Slim,” works as a harm reduction specialist at the new Skid Row Care Campus, a center that provides both harm reduction services and treatment for mental illness and substance use disorder. (Angela Hart/�鶹Ů�� Health News)

John Wright, 65, who goes by the nickname Slim, mingled with homeless visitors one afternoon in May, asking them what they needed to be safe and comfortable.

“Everyone thinks we’re criminals, like we’re out robbing everyone, but we aren’t,” said Wright, who is employed as a harm reduction specialist on the campus and is trying, at his own pace, to stop using fentanyl. “I’m homeless and I’m a drug addict, but I’m on methadone now so I’m working on it,” he said.

Nearby on Skid Row, Anthony Willis rested in his wheelchair while taking a toke from a crack pipe. He’d just learned about the new care campus, he said, explaining that he was homeless for roughly 20 years before getting into a taxpayer-subsidized apartment on Skid Row. He spends most of his days and nights on the streets, using drugs and alcohol.

The drugs, he said, help him stay awake so he can provide companionship and sometimes physical protection for homeless friends who don’t have housing. “It’s tough sometimes living down here; it’s pretty much why I keep relapsing,” said Willis, who at age 62 has asthma and arthritic knees. “But it’s also my community.”

Willis said the care campus could be a place to help him kick drugs, but he wasn’t sure he was ready.

Research shows harm reduction helps prevent death and can build long-term recovery for people who use substances, said Brian Hurley, an addiction psychiatrist and the medical director for the Bureau of Substance Abuse Prevention and Control at the Los Angeles County Department of Public Health. The techniques allow health care providers and social service workers to meet people when they’re ready to stop using drugs or enter treatment.

“Recovery is a learning activity, and the reality is relapse is part of recovery,” he said. “People go back and forth and sometimes get triggered or haven’t figured out how to cope with a stressor.”

Swaying Public Opinion

Under harm reduction principles, officials acknowledge that people will use drugs. Funded by taxpayers, the government provides services to use safely, rather than forcing people to quit or requiring abstinence in exchange for government-subsidized housing and treatment programs.

Los Angeles County is spending to , while also launching a multiyear “” campaign to build public support, fight stigma, and encourage people to use services and seek treatment. Officials have hired a nonprofit, , to conduct the campaign including social media advertising and billboards to promote the expansion of both treatment and harm reduction services for people who use drugs.

The organization led a national and is working on overdose prevention and public health campaigns in using roughly $70 million donated by Michael Bloomberg, the former mayor of New York.

“We don’t believe people should die just because they use drugs, so we’re going to provide support any way that we can,” said Shoshanna Scholar, director of harm reduction at the Los Angeles County Department of Health Services. “Eventually, some people may come in for treatment but what we really want is to prevent overdose and save lives.”

Los Angeles also finds itself at odds with California’s Democratic governor. Newsom has spearheaded stricter laws targeting homelessness and addiction and has backed treatment requirements for people with mental illness or who use drugs. Last year, California voters , which allows felony charges for some drug crimes, requires courts to warn people they could be charged with murder for selling or providing illegal drugs that kill someone, and makes it easier to order treatment for people who use drugs.

Even San Francisco approved a measure last year that requires welfare recipients to participate in treatment to continue receiving cash aid. Mayor Daniel Lurie recently ordered city officials to stop handing out free drug supplies, including , and instead to require participation in drug treatment to receive services. Lurie signed a recovery-first ordinance, which prioritizes “” from substance use, and the city is also while funding new sober-living sites and treatment centers for people recovering from addiction.

Cindy Ashley hugs her companion dog on an afternoon in late May. She lost her housing due to the hospitalization and was homeless. (Angela Hart/�鶹Ů�� Health News)

On Skid Row, Ashley recovers from surgery on her hand and arm. (Angela Hart/�鶹Ů�� Health News)

‘Harm Encouragement’

State Sen. Roger Niello, a Republican who represents conservative suburbs outside Sacramento, says the state needs to improve the lives of homeless people through stricter drug policies. He argues that providing drug supplies or offering housing without a mandate to enter treatment enables homeless people to remain on the streets.

Proposition 36, he said, needs to be implemented forcefully, and homeless people should be required to enter treatment in exchange for housing.

“I think of it as tough love,” Niello said. “What Los Angeles is doing, I would call it harm encouragement. They’re encouraging harm by continuing to feed a habit that is, quite frankly, killing people.”

Keith Humphreys, who worked in the George W. Bush and Barack Obama administrations and practices across the nation, said that communities should find a balance between leniency and law enforcement.

“Parents need to be able to walk their kids to the park without being traumatized. You should be able to own a business without being robbed,” he said. “Harm reduction and treatment both have a place, and we also need prevention and a focus on public safety.”

Just outside the Skid Row Care Campus, Cindy Ashley organized her belongings in a cart after recently leaving a local hospital ER for a deep skin infection on her hand and arm caused by shooting heroin. She also regularly smokes crack, she said.

She was frantically searching for a home so she could heal from two surgeries for the infection. She learned about the new care campus and rushed over to get her name on the waiting list for housing.

“I’m not going to make it out here,” she said, in tears.

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California’s Much-Touted IVF Law May Be Delayed Until 2026, Leaving Many in the Lurch

Sarah Kwon — Wed, 25 Jun 2025 09:00:00 +0000

California lawmakers are poised to delay the state’s much-ballyhooed new law mandating in vitro fertilization insurance coverage for millions, set to take effect July 1. Gov. Gavin Newsom has to push the implementation date to January 2026, leaving patients, insurers, and employers in limbo.

The law, , requires state-regulated health plans offered by large employers to cover infertility diagnosis and treatment, including IVF. will qualify for coverage under the law. Advocates have praised the law as “,” especially in making and aspiring single parents eligible, though cost concerns .

People who had been planning fertility care based on the original timeline are now “left in a holding pattern facing more uncertainty, financial strain, and emotional distress,” Alise Powell, a director at Resolve: The National Infertility Association, said in a statement.

During IVF, a patient’s eggs are retrieved, combined with sperm in a lab, and then transferred to a person’s uterus. A single cycle can , out of reach for many. The California law requires insurers to cover up to three egg retrievals and an unlimited number of embryo transfers.

Not everyone’s coverage would be affected by the delay. Even if the law took effect July 1, it wouldn’t require IVF coverage to start until the month an employer’s contract renews with its insurer. Rachel Arrezola, a spokesperson for the California Department of Managed Health Care, said most of the employers subject to the law renew their contracts in January, so their employees would not be affected by a delay.

She declined to provide data on the percentage of eligible contracts that renew in July or later, which would mean those enrollees wouldn’t get IVF coverage until at least a full year from now, in July 2026 or later.

The proposed new implementation date comes amid heightened national attention on fertility coverage. California is now with an IVF mandate, and in February, President Donald Trump seeking policy recommendations to expand IVF access.

It’s the second time Newsom has asked lawmakers to delay the law. When the Democratic governor signed the bill in September, he asked the legislature to consider delaying implementation by six months. The reason, Newsom said then, was to allow time to reconcile differences between the bill and a by state regulators to include IVF and other fertility services as an essential health benefit, which would require the marketplace and other individual and small-group plans to provide the coverage.

Newsom spokesperson Elana Ross said the state needs more time to provide guidance to insurers on specific services not addressed in the law to ensure adequate and uniform coverage. Arrezola said embryo storage and donor eggs and sperm were examples of services requiring more guidance.

State Sen. Caroline Menjivar, a Democrat who authored the original IVF mandate, acknowledged a delay could frustrate people yearning to expand their families, but requested patience “a little longer so we can roll this out right.”

Sean Tipton, a lobbyist for the American Society for Reproductive Medicine, contended that the few remaining questions on the mandate did not warrant a long delay.

Lawmakers to advance the delay to a vote by both houses of the legislature, likely before the end of June. If a delay is approved and signed by the governor, the law would immediately be paused. If this does not happen before July 1, Arrezola said, the Department of Managed Health Care would enforce the mandate as it exists. All plans were required to submit compliance filings to the agency by March. Arrezola was unable to explain what would happen to IVF patients whose coverage had already begun if the delay passes after July 1.

The California Association of Health Plans, which opposed the mandate, declined to comment on where implementation efforts stand, although the group agrees that insurers need more guidance, spokesperson Mary Ellen Grant said.

Kaiser Permanente, the state’s largest insurer, has already sent employers information they can provide to their employees about the new benefit, company spokesperson Kathleen Chambers said. She added that eligible members whose plans renew on or after July 1 would have IVF coverage if implementation of the law is not delayed.

Employers and some fertility care providers appear to be grappling over the uncertainty of the law’s start date. Amy Donovan, a lawyer at insurance brokerage and consulting firm Keenan & Associates, said the firm has fielded many questions from employers about the possibility of delay. Reproductive Science Center and Shady Grove Fertility, major clinics serving different areas of California, posted on their websites that the IVF mandate had been delayed until January 2026, which is not yet the case. They did not respond to requests for comment.

Some infertility patients confused over whether and when they will be covered have run out of patience. Ana Rios and her wife, who live in the Central Valley, had been trying to have a baby for six years, dipping into savings for each failed treatment. Although she was “freaking thrilled” to learn about the new law last fall, Rios could not get clarity from her employer or health plan on whether she was eligible for the coverage and when it would go into effect, she said. The couple decided to go to Mexico to pursue cheaper treatment options.

“You think you finally have a helping hand,” Rios said of learning about the law and then, later, the requested delay. “You reach out, and they take it back.”

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This Bill Aims To Help Firefighters With Cancer. Getting It Passed Is Just the Beginning.

Mark Kreidler — Wed, 09 Apr 2025 09:00:00 +0000

As firefighters battled the catastrophic blazes in Los Angeles County in January, California’s U.S. senators, Adam Schiff and Alex Padilla, signed onto legislation with a simple aim: Provide federal assistance to first responders diagnosed with service-related cancer.

The is considered crucial by its supporters, with climate change fueling an and firefighting by the World Health Organization. Firefighters have a of dying from cancer than the general population, according to a 2024 study, and the disease was of career firefighter line-of-duty deaths from 2002 to 2019.

The Los Angeles wildfires brought the fear generated by these statistics into bold relief. As homes, businesses, and cars — and the products within them — were incinerated, gases, chemicals, asbestos, and were released into the air, often settling into soil and dust. First responders working at close range, often without , were at higher risk of developing adverse health conditions.

Just days after the fires were contained, researchers tested who had come from Northern California to help battle the flames and found dangerously elevated levels of lead and mercury in their blood.

“Firefighters and first responders put their lives on the line without a second thought to protect California communities from the devastating Southern California fires,” Padilla said in a statement. “When they sacrifice their lives or face severe disabilities due to service-related cancers, we have a shared duty to help get their families back on their feet.”

But while the Honoring Our Fallen Heroes Act has bipartisan support, it still faces a rough road politically, and those who’ve spent years dealing with similar government-run programs warn of major implementation issues should the measure become law.

The Senate Judiciary Committee passed a similar bill in 2024, but the measure didn’t advance to a vote on the floor. And with legislators pondering potentially massive federal budget cuts, its fate in Congress this year is far from clear. What is clear is that, for legislation tying benefits to service-related health conditions, the devil is in the details.

“Getting the piece of legislation passed is not as hard as guarding it,” said John Feal, who was injured at the 9/11 ground zero site while working as a demolition supervisor. He has since become a fierce advocate for first responders and military veterans.

“You will watch the legislation mature, as more and more people who need the assistance come forward,” Feal said. At that point, he added, the program’s capacity to grow — and to successfully process the applications of those who’ve come forward for help — may become a challenge.

That, Feal said, is what happened with the various government programs created after the 9/11 attacks to provide monetary compensation and health care to injured first responders, including some later diagnosed with cancer. Both the and the encountered substantial funding issues and were beset by logistical failures.

The structure of the Honoring Our Fallen Heroes Act, sponsored by Sen. Amy Klobuchar (D-Minn.), might allow it to sidestep some funding pitfalls. Rather than create a new benefit program, the bill would grant firefighters who have non-9/11 cancer-related conditions access to the long-standing , which provides monetary death, disability, and education benefits to line-of-duty responders and surviving family members.

Death benefits in such programs are considered and are funded regardless of congressional budget decisions. Funding for disability and education benefits, however, depends on annual appropriations.

Even with full funding, the legislation could face implementation problems similar to those plaguing the 9/11 programs, including complex eligibility criteria, difficulty documenting that illnesses are service-related, and — more recently — long waits to enroll amid .

Attorney Michael Barasch represented the late New York police detective James Zadroga, who developed pulmonary fibrosis from toxic exposure at the World Trade Center site and for whom the is named. Barasch, who still represents 9/11 victims and lobbies Congress for program improvements and funding, said the Honoring Our Fallen Heroes Act should streamline the process for first responders to document that their cancers are related to fighting wildfires.

“In my experience representing more than 40,000 members of the 9/11 community, any similar program should have a clear set of standards to determine eligibility,” Barasch told �鶹Ů�� Health News. “Needless complexity creates a serious risk that responders who should have been eligible might not have access to benefits.”

Feal added that lawmakers should be ready to bolster funding to adequately staff the Public Safety Officers’ Benefits Program if it adds to the conditions currently covered, noting that the 9/11 programs have swelled as more and more first responders have presented service-related conditions.

“There were 75,000 people in the program in 2015. There’s now close to 140,000,” Feal said. “There’s a backlog on enrollment into the WTC program because they’re understaffed, and there’s also a backlog on getting your illnesses certified so you can get compensated.”

As the Public Safety Officers’ Benefits Program is currently implemented, firefighters and other first responders are eligible for support for physical injuries they incur in the line of duty or for deaths from duty-related heart attacks, strokes, mental health conditions, and 9/11-related illnesses. The bill would add provisions for those who die or become permanently disabled from other service-related cancers.

has already been launched to track the short- and long-term health impacts of the Los Angeles wildfires. “This was an environmental and health disaster that will unfold over decades,” Kari Nadeau, a professor at Harvard’s T.H. Chan School of Public Health, said in announcing the study.

Firefighters who battled the massive 2018 Camp Fire in Northern California, meanwhile, have been found to of carcinogens and other toxic substances in their blood than the general population, according to a study commissioned by the San Francisco Firefighters Cancer Prevention Foundation.

The Honoring Our Fallen Heroes Act was first introduced in 2023 and reintroduced on Jan. 23 of this year, with Klobuchar referencing the California wildfires in her . The Congressional Budget Office estimated last year that the bill would cost about $250 million annually from 2024 to 2034; it has not weighed in since the measure was reintroduced.

“Cancer’s grip on the fire service is undeniable,” said Edward Kelly, president of the International Association of Fire Fighters. “When a firefighter dies from occupational cancer, we owe it to them to ensure their families get the line-of-duty death benefits they are owed.”

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Law and Order or Bystander Safety? Police Chases Spotlight California’s Competing Priorities

Don Thompson — Tue, 04 Mar 2025 10:00:00 +0000

SACRAMENTO, Calif. — California Gov. Gavin Newsom is pressuring Oakland to expand its police department’s ability to chase suspects, referencing the public’s desire for a crackdown on crime. He said that voters had recently taken more tough-on-crime positions and “expressed in pretty clear terms they want change.”

Weeks later, a in San Francisco ended with the suspect’s vehicle crashing and sending six people, including a child, to the hospital.

The February crash was a reminder of how dangerous high-speed pursuits can be to the public. At least 30% of police vehicle chases include collisions, and up to nearly one-fifth bring injuries or deaths, according to research cited in a .

But balancing the public appetite for tougher law enforcement with the risks to public health these chases pose is challenging, and as cities nationwide wrestle with what trade-offs they’re willing to accept on either side, experts worry that lives are at risk.

Geoffrey Alpert, an authority on police pursuits, helped craft Oakland’s policy, which allows chases only if police believe a suspect has a gun or committed certain violent crimes. He thinks loosening guidelines would be a menace to public health.

“If you reverse and start chasing for these minor offenses, you’re signing death warrants. It’s extremely dangerous. That’s the reason why people went away from chasing everyone until the wheels fell off,” said Alpert, a criminology professor at the University of South Carolina.

Alpert said there is no convincing evidence that chases deter people from fleeing or lower crime rates. “This is a political decision; it’s not scientific,” he said of the Democratic governor’s drive to loosen these regulations.

The push toward more restrictive chase policies comes as has raised the public health alarm, leading to more local policies focused on road safety. New York City, for example, recently banned chasing drivers for traffic violations and other low-level offenses, reserving vehicle pursuits for suspected felonies or violent misdemeanors. Police Commissioner Jessica Tisch said such pursuits “can be both potentially dangerous and unnecessary.”

Similarly, Houston limited pursuits in 2023 after the Houston Chronicle reported on an increase in .

The Police Executive Research Forum, a national think tank on policing standards, recommended in 2023 that pursuits be allowed only when there has been a violent crime and the suspect is an imminent violent threat.

“You can get a suspect another day, but you can’t get a life back,” wrote Chuck Wexler, the group’s executive director.

Nearly 12,000 police pursuits were , the most recent data available. More than 400 bystanders were injured because of those chases. Of the 34 people who died, five were uninvolved bystanders.

Nationwide, more than 500 people died because of police pursuits in 2020, the first year of the covid pandemic, up from closer to 400 people a year from 2016 to 2019, according to federal data.

But federal statistics understate the danger.

The San Francisco Chronicle found that hundreds of people killed in chases from 2017 through 2021 in federal databases, increasing the number to more than 3,000 people over five years.

Alexis Piquero, a criminologist and previous director of the federal Bureau of Justice Statistics, said high-stakes trade-offs are involved in creating chase policies.

He said that while police chases are “dangerous because they are usually at high speeds or there’s a lot of people around,” he would allow police to chase someone fleeing a traffic stop or a shoplifter fleeing a store.

“If we loosen it to create more things that police can pursue, you also increase the likelihood that bad things could happen,” Piquero said. “What’s the risk-reward calculation that someone is willing to deal with?”

After three people were killed in two years in Oakland as a result of collisions during pursuits, the in December 2022, adding a speed limit on chases. Pursuits dropped from 130 that year to 38 in the first seven months of 2024. The number of captured suspects and recovered firearms fell, too. But while there were no further deaths, the number of injuries to both suspects and bystanders remained static as of July.

By contrast, the California Highway Patrol last year was involved in more than 500 pursuits in Oakland, . They resulted in 155 felony arrests, according to the CHP. Beauchamp did not mention that they also led to 62 collisions, 19 of them involving injuries — a dozen of those to uninvolved third parties, the CHP said in response to an inquiry from �鶹Ů�� Health News.

“Police pursuits are dangerous, and we recognize that. That is why we need active supervision and active management during police pursuits,” he said. “But let me be clear: When a criminal flees from the police, it is the community that is suffering, and it is the criminal that is putting people in jeopardy.”

In late January, President Donald Trump Washington, D.C., police officers sentenced to prison for their role in a fatal police chase that killed a 20-year-old on a moped. “They arrested the two officers and put them in jail for going after a criminal,” Trump said in announcing clemency for the officers.

Support for law and order has been gaining ground in progressive parts of the nation. New Jersey in 2022 in response to a surge in car thefts. Washington state lawmakers last year allowed police to pursue of violating the law, instead of only those suspected of specific crimes. Milwaukee loosened its policies and in accidents and injuries.

Kristie Priano was 15 when she died in 2002 in Chico from injuries sustained when her family’s car was hit during a police chase. They had been on their way to her high school basketball game. (Candy Priano)

Even San Francisco shares that sentiment. Less than a year before the February police chase that sent several bystanders to the hospital, voters changed the city’s pursuit policy to allow police to chase committed or is likely to commit a felony or violent misdemeanor.

But for Mark Priano and his family, the drive to change these policies is personal. He had no idea that police in Chico were chasing a teenage driver joyriding with two friends in her mother’s car that dark night in January 2002. The Prianos were headed with their 15-year-old daughter, Kristie, to her high school basketball game.

“We got T-boned. Never saw it coming,” Priano said. “They blew right through the fifth stop sign and she ran right into us going close to 60 miles an hour.”

Kristie died.

Her parents twice tried unsuccessfully to change California law to limit pursuits to when an “,” an effort known as , and started an who have lost loved ones to police chases.

Kristie’s father is still frustrated that the safeguards proposed in their daughter’s name never became law.

“To this day,” Priano said, “pursuits continue to kill innocent victims.”

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Deny and Delay? California Seeks Penalties for Insurers That Repeatedly Get It Wrong

Christine Mai-Duc — Tue, 18 Feb 2025 23:05:00 +0000

When Colleen Henderson’s 3-year-old daughter complained of pain while using the bathroom, doctors brushed it off as a urinary tract infection or constipation, common maladies in the potty-training years.

After being told her health insurance wouldn’t cover an ultrasound, Henderson charged the $6,000 procedure to her credit card. Then came the news: There was a grapefruit-sized tumor in her toddler’s bladder.

That was in 2009. The next five years, Henderson said, became a protracted battle against her insurer, UnitedHealthcare, over paying for the specialists who finally diagnosed and treated her daughter’s rare condition, . She appealed uncovered hospital stays, surgeries, and medication to the insurer and state regulators, to no avail. The family racked up more than $1 million in medical debt, she said, because the insurer told her treatments recommended by doctors were unnecessary. The family declared bankruptcy.

“If I had not fought tooth and nail every step of the way, my daughter would be dead,” said Henderson, of Auburn, California, whose daughter eventually recovered and is now a thriving 20-year-old junior at Oregon State University. “You pay a lot of money to have health insurance, and you hope that your health insurance has your well-being at the forefront, but that’s not happening at all.”

While insurance denials are , show few Americans them. Unlike in Henderson’s case, various analyses have found that many who escalate complaints to successfully get . Consumer advocates and policymakers say that’s a clear sign insurance companies routinely deny care they shouldn’t. Now a proposal in the California Legislature seeks to penalize insurers who repeatedly make the wrong call.

While the measure, , would cover only about a third of insured Californians whose health plans are regulated by the state, experts say it could be one of the boldest attempts in the nation to rein in health insurer denials — before and after care is given. And California could become one of only a handful of states that require insurers to disclose denial rates and reasoning, statistics the industry often considers proprietary information.

The measure also seeks to force insurers to be more judicious with denials and would fine them up to $1 million per case if more than half of appeals filed with regulators are overturned in a year.

In 2023, , about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer’s initial denial being reversed.

“When you have health insurance, you should have confidence that it’s going to cover your health care needs,” said Sen. Scott Wiener, the San Francisco Democrat who introduced the bill. “They can just delay, deny, obstruct, and, in many cases, avoid having to cover medically necessary care, and it’s unacceptable.”

A spokesperson for the California Association of Health Plans declined to comment, saying the group was still reviewing the bill language. Gov. Gavin Newsom’s spokesperson Elana Ross said his office generally does not comment on pending legislation.

Concerned about spiraling consumer health costs, state lawmakers across the nation have increasingly looked for ways to verify that insurers are paying claims fairly.

In 2024, 17 states legislation dealing with prior authorization of care by private insurers, according to the National Conference of State Legislatures. Connecticut, which has one of the most robust denial rate disclosure laws, publishes an detailing the number and percentage of claims each insurer has denied, as well as the share that ends up getting reversed. Oregon published similar information , when state disclosure requirements lapsed.

In California, there’s no way to know how often insurers deny care, which health experts say is especially troubling as mental health care is reaching among children and young adults. According to Keith Humphreys, a health policy professor at Stanford University, it’s easier to deny mental health care because a diagnosis of, say, depression can be more subjective than that of a broken limb or cancer.

“We think it’s unacceptable that the state has absolutely no idea how big of a problem this is,” said Lishaun Francis, senior director of behavioral health for the advocacy group Children Now, a sponsor of the bill.

Under Wiener’s proposal, private insurers regulated by the Department of Managed Health Care and the Department of Insurance would be required to submit detailed data about denials and appeals. They would also need to explain those denials and report the outcomes of the appeals.

For appeals that make it to the state’s independent medical review process, known as IMR, insurers whose denials are overturned more than half the time would face staggering penalties. The first case that brings a company above the 50% threshold would trigger a fine of $50,000, with a penalty ranging from $100,000 to $400,000 for a second. Each one after that would cost $1 million.

If passed, the measure would cover roughly 12.8 million Californians on private insurance. It would not apply to patients on Medi-Cal, the state’s Medicaid program, or Medicare, and it would exclude self-insured plans offered by large employers, which are regulated by the U.S. Department of Labor and cover roughly 5.6 million Californians.

The phrase “deny and delay” continues to reverberate across the health care industry after the of UnitedHealthcare CEO Brian Thompson. A by NORC at the University of Chicago released shortly after the brazen attack revealed that 7 in 10 people said they believed denials for health coverage and profits by health insurance companies bore a great deal or a moderate amount of responsibility for Thompson’s death.

Following Thompson’s death, UnitedHealthcare said in statements that had been circulated about the way the company treats claims and that insurers, which are highly regulated, “typically have .”

Wiener called Thompson’s killing a “cold-blooded assassination” but said his bill grew out of a that failed last year aimed at improving mental health coverage for children and adults under age 26. But he acknowledged the nation’s reaction to the killing underscores the long-simmering anger many Americans feel about health insurers’ practices and the urgent need for reform.

Humphreys, the Stanford professor, said the U.S. health system creates strong financial incentives for insurers to deny care. And, he added, state and federal penalties are paltry enough to be written off as a cost of doing business.

“The more care they deny, the more money they make,” he said.

Increasingly, large employers are starting to include language in contracts with claim administrators that would penalize them for approving too many or too few claims, said Shawn Gremminger, president of the National Alliance of Healthcare Purchaser Coalitions.

Gremminger represents mostly large employers who fund their own insurance, are federally regulated, and would be excluded from Wiener’s bill. But even for such so-called self-funded plans, it can be nearly impossible to determine denial rates for the insurance companies hired simply to administer claims, he said.

While it could be too late for many families, Sandra Maturino, of Rialto, said she hopes lawmakers tackle insurance denials so other Californians can avoid the saga she endured to get her niece treatment.

She adopted the girl, now 13, after her sister died. Her niece had long struggled with self-harm and violent behavior, but when therapists recommended inpatient psychiatric care, her insurer, Anthem Blue Cross, would cover it for only 30 days.

For more than a year, Maturino said, her niece cycled in and out of facilities and counseling because her insurance wouldn’t cover a long-term stay. Doctors tested a laundry list of prescription drugs and doses. None of it worked.

Anthem declined a request for comment.

Eventually, Maturino got her niece into a residential program in Utah, paid for by the adoption agency, where she was diagnosed with bipolar disorder and has been undergoing treatment for a year.

Maturino said she didn’t have the energy to appeal to Anthem. “I wasn’t going to wait around for the insurance to kill her, or for her to hurt somebody,” Maturino said.

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Health Care Is Newsom’s Biggest Unfinished Project. Trump Complicates That Task.

Angela Hart — Tue, 07 Jan 2025 10:00:00 +0000

SACRAMENTO, Calif. — Six years after he entered office vowing to be California’s “,” Democrat Gavin Newsom has steered tens of billions in public funding to safety net services for the state’s neediest residents while engineering rules to make health care more accessible and affordable for all Californians.

More than a million California residents living in the U.S. without authorization now qualify for Medi-Cal, the state’s version of Medicaid, making California among the first states to regardless of their immigration status. The state is experimenting with Medicaid money to pay for social services such as housing and food assistance, especially for those living on the streets or with chronic diseases. And the state is forcing the health care industry to while imposing on doctors, hospitals, and insurers to provide better-quality, more accessible care.

However, Newsom has so far failed to fully deliver on his most sweeping health care policies — and many changes are not yet visible to the public: Health care costs continue , homelessness , and many Californians still struggle to get basic medical care.

Now, some of Newsom’s signature health initiatives, which could shape his profile on the national stage, are in peril as Donald Trump returns to the White House. According to national health policy experts, California stands to lose billions of dollars in health care funding should the Trump administration alter Medicaid programs is likely. Such a move could force the state to dramatically slash benefits or eligibility.

And although allowing immigrants without legal status to enroll in free health care has been funded with state money, it makes California a political target.

“That is fuel to feed the Republican MAGA argument that we are taking tax dollars from good Americans and providing health care to immigrants,” said Mark Peterson, a health care expert at UCLA, referring to the “Make America Great Again” movement.

Newsom declined an interview with �鶹Ů�� Health News. In a statement, he acknowledged that many of his initiatives are works in progress. But although he will attempt to work with Trump, the governor vowed to protect his health care agenda in his final two years in office.

“We are approaching the incoming administration with an open hand, not a closed fist,” Newsom said. “It is a top priority of my administration to ensure that quality health care is available and affordable for all Californians.”

Mark Ghaly, a former Health and Human Services secretary under Newsom, said transforming the way health care is paid for and delivered can be bumpy. “We didn’t do it perfectly,” Ghaly said. “Implementation is always messy in a state of 40 million people.”

Ahead of Trump’s Jan. 20 inauguration, Newsom has to challenge Trump on reproductive health care, disaster relief, and other services. His request is pending in the state’s Democratic-controlled legislature.

Here are the major initiatives that will shape Newsom’s health care legacy:

Medicaid

Potential federal cuts loom large in America’s most populous state. Of the whopping annually on health care and social services, nearly $116 billion flows from the federal government. Most of that goes to Medicaid, which covers more than . GOP leaders in Washington have floated ideas to , which could slash benefits or cut enrollment.

In addition, California’s expansion of Medi-Cal to immigrants without legal status is projected to cost the state roughly $6.4 billion for the fiscal year ending June 30. Newsom suggested in early December that the state would continue to fund the immigrant health care expansion in the upcoming budget year but whether he would preserve the coverage in future years.

Advocacy groups are readying to defend those benefits should Trump target California over the issue. “We want to continue to protect access to care and not see a rollback,” said Amanda McAllister-Wallner, interim executive director of Health Access California.

Generic Drugs

Citing the high cost of prescription drugs, plowed into his plan to produce generic insulin for California and to produce a range of generic drugs. Three years later, California has done neither. Newsom did, however, in April to purchase in bulk the opioid reversal drug naloxone, which the state made available to schools, health clinics, and other institutions at .

“It’s certainly disappointing that there isn’t much more progress on it,” said former state Sen. Richard Pan, who authored the .

On generic insulin, Newsom acknowledged “that it’s taken longer than we hoped to get insulin on the market, but we remain committed to delivering $30 insulin available to all who need it as soon as we can.”

Abortion

The governor helped lead the successful 2022 campaign to in the state constitution. He signed laws to ensure abortions and miscarriages and to allow to perform abortions in California; built a stockpile of when mifepristone faced a national ban; and set aside who can’t afford abortion care to access it.

Newsom, who has made reproductive rights a central tenet of his political agenda, also and traversed the country attacking Trump and other Republicans in red states who have rolled back abortion access.

After Trump won the election, Newsom called a special legislative session to ready for potential legal battles with the federal government. He told �鶹Ů�� Health News the state is preparing “in every possible way to protect the rights guaranteed in California’s Constitution and ensure bodily autonomy for all those in our state.”

Rising Health Care Costs

In 2022, Newsom created the to set limits on health care spending and impose penalties on industry payers and providers that fail to meet targets. By 2029, California will cap annual price increases for health insurers, doctors, and hospitals at 3%.

While Trump has voiced concern about the steady rise of health care costs nationally — and the quality of health care Americans are receiving — his ideas have focused on deregulation and , which experts say could cost and increase patient health care spending. California could potentially lose federal subsidies that have helped for most of the roughly people who buy their health coverage from Covered California, the state’s ACA marketplace, which would increase patient out-of-pocket costs.

The state could use money it raises from on the uninsured, which Newsom adopted after the Obamacare individual mandate was zeroed out by Congress in 2017. Those state revenues are projected to be , according to the state Department of Finance. That’s a fraction of the federal health insurance subsidies California receives — roughly .

Health and Homelessness

Under Newsom, California has on tackling homelessness, yet the crisis has worsened under his watch.

From 2019, when Newsom took office, to 2023, homelessness jumped 20% to , despite his funneling more than $20 billion into trying to get people off the streets, including converting hotels and motels into . He has also plowed roughly $12 billion into CalAIM, an to , including rental and eviction assistance.

A last year found the state isn’t doing a good job of tracking the effectiveness of taxpayer money. CalAIM isn’t serving as many Californians as expected and patients face difficulty receiving from health insurers.

“The homelessness crisis on our streets is unacceptable,” Newsom acknowledged. “But we are starting to see progress.”

Experts expect the Trump administration to reverse liberal policies that have allowed Medicaid money to be used for health care experiments through waivers . Notably, Trump has attacked Newsom for his handling of the homelessness crisis and has vowed to more forcefully . California’s CalAIM waiver ends at the end of 2026.

Instead of expanding housing and food assistance, for instance, the state could instead see federal moves to end CalAIM benefits and make .

Mental Health and Substance Use

Newsom has launched the most extensive overhaul of California’s behavioral health system in decades, directing billions in state funding toward a new network of treatment facilities and prevention programs.

Two of his most controversial signature initiatives, and , infuse money into treatment and housing for Californians with behavioral health conditions, especially homeless people living in crisis. And CARE Court allows judges to compel treatment for those suffering from debilitating mental illness and substance use.

Both have been hamstrung by funding challenges, rely on counties for implementation, and could take years to produce noticeable results. Whereas Newsom has sought to expand community-based treatment, Trump has promised a return to institutionalization and suggested homeless people and those with severe behavioral health conditions be moved to “.”

Newsom said he hopes his “innovative” approaches will transform behavioral health care with “a laser focus on people with the most serious illness and substance use disorders.”

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California Hospitals Scramble on Earthquake Retrofits as State Limits Extensions

Annie Sciacca — Tue, 15 Oct 2024 09:00:00 +0000

More than half of the 410 hospitals in California have at least one building that likely wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.

Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Association that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural, or “distressed” hospitals to get an extension of up to three years.

“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which serves Northern California’s East Bay and is undertaking a $25 million retrofit of its hospital in Alameda, on an island beside Oakland.

The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.

The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.

Many more — 674 buildings, spread across 251 licensed hospitals — do not meet the second set of standards, which require hospital facilities to remain functional in the event of a major earthquake. That work is supposed to be done by 2030.

“The importance of it is hard to argue with,” said Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that damaged or destroyed multiple hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need at a time of emergency like that.”

The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of the three bills addressing the issue this year represents a partial victory for the industry.

Hospital administrators have long complained about the steep cost of seismic retrofits.

“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” wrote Carmela Coyle, president and CEO of the California Hospital Association, in a letter to Newsom before he vetoed the CHA bill. A paid for by the CHA pinned the price of meeting the 2030 standards at between $34 billion and $143 billion statewide.

Labor unions representing nurses and other medical workers, however, say the hospitals have had plenty of time to get their buildings into compliance, and that most have the money to do so.

“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Association, said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”

In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified, and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”

He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.

But he signed a third bill, which allows small, rural, and “critical access” hospitals, and some others, to apply for a three-year extension, and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.

The state designates 37 hospitals as providing “critical access,” while 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning they are funded by special government entities called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.

Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is very close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.

“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.

The Rand study estimated the average cost of a retrofit at per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.

Small and rural hospitals can get some aid from the state via grants financed by the California Electronic Cigarette Excise Tax, but HCAI spokesperson Andrew DiLuccia said it would yield just $2-3 million total annually. He added that the Small and Rural Hospital Relief Program has also received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.

Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”

Stebbins has had to help her district figure out a plan.

After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back .

The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled nursing facility. The construction work is set to be completed in 2027.

“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler, the Alameda Health System associate chief medical officer, said. “How do we make sure that they get what they need to stay open?”

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California Bill Would Require State Review of Private Equity Deals in Health Care

Bernard J. Wolfson — Tue, 13 Aug 2024 09:00:00 +0000

A bill pending in California’s legislature to ratchet up oversight of private equity investments in health care is receiving enthusiastic backing from consumer advocates, labor unions, and the California Medical Association, but drawing heavy fire from hospitals concerned about losing a potential funding source.

The legislation, sponsored by Attorney General Rob Bonta, private equity groups and hedge funds to notify his office of planned purchases of many types of health care businesses and obtain its consent. It also reinforces state laws that bar nonphysicians from directly employing doctors or directing their activities, which is a primary reason for the doctor association’s support.

Private equity firms raise money from institutional investors such as pension funds and typically acquire companies they believe can be run more profitably. Then they look to boost earnings and sell the assets for multiples of what they paid for them.

That can be good for future retirees and sometimes for mismanaged companies that need a capital infusion and a new direction. But critics say the profit-first approach isn’t good for health care. Private equity deals in the sector are coming under increased scrutiny around the country amid mounting evidence that they often lead to higher prices, lower-quality care, and reduced access to core health services.

Opponents of the bill, led by the state’s hospital association, the California Chamber of Commerce, and a national private equity advocacy group, say it would discourage much-needed investment. The hospital industry has already persuaded lawmakers to exempt sales of for-profit hospitals from the proposed law.

“We preferred not to make that amendment,” Bonta said in an interview. “But we still have a strong bill that provides very important protections.”

The legislation would still apply to a broad swath of medical businesses, including clinics, physician groups, nursing homes, testing labs, and outpatient facilities, among others. Nonprofit hospital deals are already subject to the attorney general’s review.

A final vote on the bill could come this month if a state Senate committee moves it forward.

Nationally, private equity investors on health care acquisitions in the past decade, according to a report by The Commonwealth Fund. Physician practices have been especially attractive to them, with transactions in a decade and often leading to significant price increases. Other types of outpatient services, as well as clinics, have also been targets.

In California, the value of private equity health care deals from 2005 to 2021, from less than $1 billion to $20 billion, according to the California Health Care Foundation. Private equity firms are tracking the pending legislation closely but so far haven’t slowed investment in California, according to a from the research firm PitchBook.

Multiple studies, as well as a series of reports by �鶹Ů�� Health News, have documented some of the difficulties created by private equity in health care.

in the Journal of the American Medical Association showed a larger likelihood of adverse events such as patient infections and falls at private equity hospitals compared with others. Analysts say more research is needed on how patient care is being affected but that the impact on cost is clear.

“We can be almost certain that after a private equity acquisition, we’re going to be paying more for the same thing or for something that’s gotten worse,” said Kristof Stremikis, director of Market Analysis and Insight at the California Health Care Foundation.

Most private equity deals in health care are below the $119.5 million threshold that triggers a federal regulators, so they often slide under the government radar. The Federal Trade Commission is stepping up scrutiny, and a private equity-backed anesthesia group for anticompetitive practices in Texas.

Lawmakers in several other states, including Connecticut, Minnesota, and Massachusetts, have proposed legislation that would subject private equity deals to greater transparency.

Not all private equity firms are bad operators, said Assembly member Jim Wood, a Democrat from Healdsburg, but review is essential: “If you are a good entity, you shouldn’t fear this.”

The bill would require the attorney general to examine proposed transactions to determine their impact on the quality and accessibility of care, as well as on regional competition and prices.

Critics note that private equity deals are often financed with debt that is then owed by the acquired company. In many cases, private equity groups to generate immediate returns for investors and the new owners of the property then charge the acquired company rent.

That was a factor in the financial collapse of Steward Health Care, a multistate hospital system that was owned by the private equity firm Cerberus Capital Management from 2010 to 2020, by the Private Equity Stakeholder Project, a nonprofit that supports the California bill. Steward filed for Chapter 11 bankruptcy in May. “Almost all of the most distressed US healthcare companies are owned by private equity firms,” by the group.

Opponents of the legislation argue it would dampen much-needed investment in an industry with soaring operating costs. “Our concern is that it will cut off funding that can improve health care,” said Ned Wigglesworth, a spokesperson for , a coalition of groups fighting the legislation. The prospect of having to submit to a lengthy review by the attorney general, he said, would create “a chilling effect on private funders.”

Proponents of private equity investment point to what they say are notable successes in California health care.

Children’s Choice Dental Care, for example, said in a letter to state senators that it logs over 227,000 dental visits annually, mostly with children on Medi-Cal, the health insurance program for low-income Californians. “We have been able to expand to 25 locations, because we have been able to access capital from a private equity firm,” the group wrote.

Ivy Fertility, with clinics in California and eight other states, said in a letter to state senators that private investment has expanded its ability to provide fertility treatments at a time when demand for them is increasing.

Researchers note that private equity investors are hardly alone when it comes to health care profiteering, which extends even to nonprofits. , a major nonprofit hospital chain, for example, in a by then-Attorney General Xavier Becerra, for unfair contracting and pricing.

“It’s helpful to look at ownership classes like private equity, but at the end of the day we should look at behavior, and anyone can do the things that private equity firms do,” said Christopher Cai, a physician and health policy researcher at Harvard Medical School. He added, though, that private equity investors are “more likely to engage in financially risky or purely profit-driven behavior.”

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California Lawmakers Seek Protections for Patients in ICE Custody

Khnerich — Wed, 22 Apr 2026 12:40:00 +0000

“These are actions that have no place in health care, and it is a clear violation of the patients’ rights,” Menjivar said.

The federal Department of Homeland Security, which oversees immigration enforcement, did not respond to a request for comment.

Both bills were passed by the Senate Health and Judiciary committees along party lines and will be heard next by the Senate Appropriations Committee.

More than 20 immigrant rights advocates and health care workers voiced support for strengthened protections for patients at a hearing last week.

Advocates for immigrants and health care workers, as well as lawmakers, fear similar incidents are happening around the state.

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Affirmative Action Critics Refuse To Back Down in Fight Over Medical Bias Training

Khnkit — Thu, 11 Sep 2025 09:00:00 +0000

Critics of affirmative action have launched a long-shot appeal aimed at stopping California from requiring training on unconscious bias in every continuing medical education class.

Bias does influence clinical care and contribute to health care disparities, a concluded. Implicit-bias training, however, might have no impact and might even worsen care, the report noted.

“The government is mandating doctors endorse a specific ideology or priority instead of science,” she said. “I believe government should not mandate or compel the speech of doctors.”

The Medical Board of California declined to comment.

Bhagwat sees Khatibi’s case as “very weak.” But he said he could not predict anything the Supreme Court, with its six-justice conservative majority, might do.

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In a Nation Growing Hostile Toward Drugs and Homelessness, Los Angeles Tries Leniency

Khnangelah — Tue, 08 Jul 2025 09:00:00 +0000

The chaos of living outside, she said — marked by violence, sexual assault, sleeplessness, and lack of housing and health care — can make it nearly impossible to get sober.

Skid Row Care Campus

The new Skid Row Care Campus offers homeless people health care and a place to rest, charge their phones, grab some food, or even get connected with housing. (Angela Hart/�鶹Ů�� Health News)

John Wright, 65, who goes by the nickname Slim, mingled with homeless visitors one afternoon in May, asking them what they needed to be safe and comfortable.

Willis said the care campus could be a place to help him kick drugs, but he wasn’t sure he was ready.

Swaying Public Opinion

The organization led a national and is working on overdose prevention and public health campaigns in using roughly $70 million donated by Michael Bloomberg, the former mayor of New York.

Cindy Ashley hugs her companion dog on an afternoon in late May. She lost her housing due to the hospitalization and was homeless. (Angela Hart/�鶹Ů�� Health News)

On Skid Row, Ashley recovers from surgery on her hand and arm. (Angela Hart/�鶹Ů�� Health News)

‘Harm Encouragement’

Proposition 36, he said, needs to be implemented forcefully, and homeless people should be required to enter treatment in exchange for housing.

Keith Humphreys, who worked in the George W. Bush and Barack Obama administrations and practices across the nation, said that communities should find a balance between leniency and law enforcement.

She was frantically searching for a home so she could heal from two surgeries for the infection. She learned about the new care campus and rushed over to get her name on the waiting list for housing.

“I’m not going to make it out here,” she said, in tears.

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California’s Much-Touted IVF Law May Be Delayed Until 2026, Leaving Many in the Lurch

Lynne Shallcross — Wed, 25 Jun 2025 09:00:00 +0000

Sean Tipton, a lobbyist for the American Society for Reproductive Medicine, contended that the few remaining questions on the mandate did not warrant a long delay.

“You think you finally have a helping hand,” Rios said of learning about the law and then, later, the requested delay. “You reach out, and they take it back.”

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This Bill Aims To Help Firefighters With Cancer. Getting It Passed Is Just the Beginning.

Khnkytjaw — Wed, 09 Apr 2025 09:00:00 +0000

Just days after the fires were contained, researchers tested who had come from Northern California to help battle the flames and found dangerously elevated levels of lead and mercury in their blood.

Death benefits in such programs are considered and are funded regardless of congressional budget decisions. Funding for disability and education benefits, however, depends on annual appropriations.

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Law and Order or Bystander Safety? Police Chases Spotlight California’s Competing Priorities

Khnkytjaw — Tue, 04 Mar 2025 10:00:00 +0000

Weeks later, a in San Francisco ended with the suspect’s vehicle crashing and sending six people, including a child, to the hospital.

Similarly, Houston limited pursuits in 2023 after the Houston Chronicle reported on an increase in .

“You can get a suspect another day, but you can’t get a life back,” wrote Chuck Wexler, the group’s executive director.

Nearly 12,000 police pursuits were , the most recent data available. More than 400 bystanders were injured because of those chases. Of the 34 people who died, five were uninvolved bystanders.

Nationwide, more than 500 people died because of police pursuits in 2020, the first year of the covid pandemic, up from closer to 400 people a year from 2016 to 2019, according to federal data.

But federal statistics understate the danger.

The San Francisco Chronicle found that hundreds of people killed in chases from 2017 through 2021 in federal databases, increasing the number to more than 3,000 people over five years.

Alexis Piquero, a criminologist and previous director of the federal Bureau of Justice Statistics, said high-stakes trade-offs are involved in creating chase policies.

“We got T-boned. Never saw it coming,” Priano said. “They blew right through the fifth stop sign and she ran right into us going close to 60 miles an hour.”

Kristie died.

Her parents twice tried unsuccessfully to change California law to limit pursuits to when an “,” an effort known as , and started an who have lost loved ones to police chases.

Kristie’s father is still frustrated that the safeguards proposed in their daughter’s name never became law.

“To this day,” Priano said, “pursuits continue to kill innocent victims.”

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Deny and Delay? California Seeks Penalties for Insurers That Repeatedly Get It Wrong

KhnoonaZ — Tue, 18 Feb 2025 23:05:00 +0000

The measure also seeks to force insurers to be more judicious with denials and would fine them up to $1 million per case if more than half of appeals filed with regulators are overturned in a year.

In 2023, , about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer’s initial denial being reversed.

Concerned about spiraling consumer health costs, state lawmakers across the nation have increasingly looked for ways to verify that insurers are paying claims fairly.

“The more care they deny, the more money they make,” he said.

Anthem declined a request for comment.

Eventually, Maturino got her niece into a residential program in Utah, paid for by the adoption agency, where she was diagnosed with bipolar disorder and has been undergoing treatment for a year.

Maturino said she didn’t have the energy to appeal to Anthem. “I wasn’t going to wait around for the insurance to kill her, or for her to hurt somebody,” Maturino said.

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Health Care Is Newsom’s Biggest Unfinished Project. Trump Complicates That Task.

Khnangelah — Tue, 07 Jan 2025 10:00:00 +0000

And although allowing immigrants without legal status to enroll in free health care has been funded with state money, it makes California a political target.

Here are the major initiatives that will shape Newsom’s health care legacy:

Medicaid

Generic Drugs

“It’s certainly disappointing that there isn’t much more progress on it,” said former state Sen. Richard Pan, who authored the .

Abortion

Rising Health Care Costs

Health and Homelessness

Under Newsom, California has on tackling homelessness, yet the crisis has worsened under his watch.

“The homelessness crisis on our streets is unacceptable,” Newsom acknowledged. “But we are starting to see progress.”

Instead of expanding housing and food assistance, for instance, the state could instead see federal moves to end CalAIM benefits and make .

Mental Health and Substance Use

Newsom said he hopes his “innovative” approaches will transform behavioral health care with “a laser focus on people with the most serious illness and substance use disorders.”

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California Hospitals Scramble on Earthquake Retrofits as State Limits Extensions

Khnkytjaw — Tue, 15 Oct 2024 09:00:00 +0000

Hospital administrators have long complained about the steep cost of seismic retrofits.

Labor unions representing nurses and other medical workers, however, say the hospitals have had plenty of time to get their buildings into compliance, and that most have the money to do so.

He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.

“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.

The Rand study estimated the average cost of a retrofit at per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.

Stebbins has had to help her district figure out a plan.

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California Bill Would Require State Review of Private Equity Deals in Health Care

Khnkytjaw — Tue, 13 Aug 2024 09:00:00 +0000