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Pressure Mounts on How Police Handle Mental-Health Crises

Published July 20, 2020 on Capitol Weekly.

 

Calls to ‘defund’ police gain traction, as protesters — and public officials — contend that money would be better spent if clinicians, social workers responded to mental-health 911 calls. Police say many such programs already exist, and that they need more staff and funding.  (First of two parts. Part 2 can be seen here.)

On the afternoon of May 8, 2017, the family of 32-year-old Mikel McIntyre called 911 for help in dealing with his increasingly erratic and threatening behavior. The former high school and college athlete, who lived in Antioch and had briefly played baseball in the minor leagues, had been showing signs of serious mental illness, and his mother was concerned. She hoped a visit with family in Sacramento might help.

The first call, shortly after 3 p.m., indicated a possible mental-health crisis: McIntyre had locked himself in a vehicle and was being “slightly combative,” but the firefighters who responded decided he was not a threat. When family members called again to say McIntyre was becoming increasingly volatile, Sacramento County sheriff’s deputies responded at 3:32 p.m., and they determined McIntyre’s behavior did not meet the criteria for him to be detained on a 72-hour mental-health hold, as a danger to himself or others. The deputies suggested he leave the house, which he did.

McIntyre fled on foot toward the Zinfandel Drive onramp to westbound Highway 50, then on the freeway shoulder.

Later that same day, at 6:47 p.m., McIntyre was observed hitting and choking his mother in her car outside a Ross store in Rancho Cordova, near a busy intersection at Zinfandel Drive and Highway 50. Several witnesses called 911, and deputies again responded.

This time, the confrontation rapidly escalated.

McIntyre walked across the parking lot, ignoring deputies.  There was a scuffle, and a deputy fell while attempting to detain McIntyre, who threw a large rock, hitting the deputy in the head. Dazed and bleeding from a head wound, the deputy fired two shots, but missed, as McIntyre fled on foot toward the Zinfandel Drive onramp to westbound Highway 50, then on the freeway shoulder. Officers from several agencies quickly swarmed the area.

At one point, McIntyre threw another, smaller rock from the piles of river rock near the freeway, that hit a sheriff’s deputy and a canine.  According to a highly critical Sacramento County Inspector General’s report on the incident, three deputies fired a total of 28 rounds at McIntyre as he fled the scene, running alongside the busy freeway during rush hour. He was hit by seven bullets in his torso and limbs, six of them in his back.

The scene along Highway 50 in Rancho Cordova where deputies shot and killed Mikel McIntyre on May 8, 2017. Three years after McIntyre’s death, Sheriff Scott Jones released videos and documents related to the case. (Photo: Sacramento County Sheriff’s Department)

Several rounds were found embedded in the roadway, and Inspector General Rick Braziel, a former Sacramento police chief who consults for law enforcement agencies throughout the U.S., said vehicles were passing on the freeway as shots were being fired.

“There are instances where the number of rounds fired at McIntyre were excessive, unnecessary and put the community at risk,” Braziel concluded in the detailed, 27-page report. The report infuriated Sacramento County Sheriff Scott Jones, who barred him from further investigation and issued a statement describing the findings of Braziel, a highly regarded former police chief, as “a lay opinion.” The county board of supervisors took no action to prevent Braziel’s precipitous firing, despite intense public pressure and demonstrations.

McIntyre was not armed and Braziel concluded “escape was unlikely,” and that officers had options other than lethal force to detain him.

“There were adequate resources on the ground with three officers on foot, six officers driving marked vehicles, and a canine, for a total of nine law enforcement officers, to isolate and contain McIntyre without firing additional shots,” Braziel wrote. There was also a sheriff’s helicopter and a CHP aircraft hovering over the scene.

Mikel McIntyre (Screen capture, Fox40 News)

The graphic videos of the pursuit are difficult to watch. They show McIntyre, who was Black, running alongside the freeway, pursued by multiple police vehicles and officers. The canine, which bit him, and several officers can be seen descending on McIntyre as he drops to the ground.  He was transported to UCD Medical Center, where he died shortly afterward.  In a detailed, May 28 Sacramento Bee account following release of the sheriff’s report and videos, a sheriff’s photo of the aftermath at the scene shows a pool of blood where McIntyre’s body had been, a pair of sneakers nearby.

“He did nothing but run for his life,” his mother Brigette McIntyre told reporters. “His death was senseless.” Sacramento District Attorney Anne Marie Schubert ruled the shooting justified.

McIntyre’s family sued, and the county settled for $1.725 million earlier this year, while not admitting fault. Despite a new state law requiring law enforcement agencies to release reports and videos of incidents that result in death or serious injury, Jones had refused to release the McIntyre reports or video, saying the case occurred before the law became effective in January 2019. The CHP released a redacted video, but the sheriff’s video was only released by Jones this past May, after the Sacramento Bee and the Los Angeles Times went to court, and more than three years after McIntyre’s death.

One in four
According to a 2015 study, “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters,” by the nationally recognized Treatment Advocacy Center, “the risk of being killed during a police incident” is 16 times greater for people with untreated mental illness. “By all accounts – official and unofficial – a minimum of 1 in 4 fatal police encounters ends the life of an individual with severe mental illness.”

“We would never send a social worker to a bank robbery. Why would we send a police officer to a mental-health emergency?” — Maggie Meritt

The McIntyre case – and many like it, frequently involving the deaths of Black men at the hands of police — have become flashpoints in growing calls for major changes in police use of force and in the way law enforcement responds to mental-health crises. Black Lives Matter protesters and civil-liberties groups, including the American Civil Liberties Union, are calling for “defunding” the police, slashing police budgets to fund more social services and redirecting mental-health calls to social workers and clinicians better qualified to help.

“We would never send a social worker to a bank robbery,” says Maggie Merritt, executive director of the nonprofit Steinberg Institute in Sacramento, which was founded by former state Senate Leader Darrell Steinberg, now Sacramento’s mayor, to advocate for improved mental-health policy and programs. “Why would we send a police officer to a mental-health emergency?”

But Merritt and other mental-health policy experts caution against removing police officers entirely from the equation.

“There is a need for somebody in the process of responding to a call to do a threat analysis and public-safety assessment,” says Randall Hagar, legislative advocate for the California Psychiatric Association. “There is no doubt that we need a lot more clinicians on the street responding to crises that are derived from a person’s mental illness, but sometimes a clinician needs backup” by law enforcement, especially in incidents where a weapon is involved. “There always has to be a determination of whether a public-safety issue is involved.”

Hagar and others want more training for police and 911 dispatchers on how to respond to mental-health crises, perhaps with a clinician involved in screening the calls. A former president of the Sacramento chapter of the National Alliance on Mental Illness (NAMI), which advocates for families, Hagar said he once surveyed his members and found that more than half had experienced “some sort of law enforcement in the last year, and those were not always happy situations.”

Many law enforcement and mental-health professionals argue that existing programs already use clinicians and counselors who work with officers to respond to mental-health calls, often de-escalating potentially volatile situations. They emphasize that follow-up contact is essential to avoid future crises, and that the presence of mental-health professionals frees up officers to focus on violent, serious crimes, saving limited public funds by preventing incarceration, hospitalization and homelessness.

In reality, the 5150 statute is widely regarded as ineffective and outdated.

“Officers didn’t sign up to be social workers, or to determine people’s mental-health status,” says veteran San Diego police officer Brian Marvel, president of the influential Peace Officers Research Association of California (PORAC). For many years, Marvel worked as an officer in the San Diego Police Department’s Psychiatric Emergency Response Team (PERT), in which officers are paired with mental-health professionals to respond to and follow up on mental-health emergencies. “I’ve long been an advocate of sending mental-health calls to others first – let the people who are skilled in this area handle these calls,” he said.

“I don’t think we have to re-invent the wheel in California,” he adds. “It’s a matter of evaluating what the best program would be. But it’s really incumbent on elected officials to be sure it’s adequately funded. Elected officials have set up law enforcement to fail, because they’ve failed to properly fund services for homelessness and mental health.”

Officers are required to respond to so-called “5150” calls, a reference to the state Welfare and Institutions Code that sets criteria for detaining someone for 72 hours who is deemed “a danger to self or others.” In reality, the statute, which is widely regarded as ineffective and outdated, too often means an individual who is detained under a 5150 goes to an already overburdened hospital emergency room. There, an officer must stay with the patient, who frequently is released without treatment, medication, or a referral to overwhelmed mental-health programs and largely nonexistent housing. It’s an expensive, time-consuming and frustrating process for all concerned.

The SMART unit also has 60 clinicians, whose salaries are paid through the county’s Department of Mental Health with some funding from the state Mental Health Services Act.

“I’m very limited in what I can do in a 5150,” says Marvel. But when clinicians are involved in the response at the outset, as in San Diego’s PERT program, “that literally opens up all of the services available in the county.”

The Los Angeles Police Department, which has 9,000 sworn officers and 3,000 civilian employees,  has long had a mental-health unit that pairs officers in civilian clothes (a uniform of tan khaki’s and a black polo with the LAPD insignia, designed in consultation with NAMI) and clinicians – social workers and psychologists – to respond to mental-health calls.

Headed for the past five years by Lt. Brian Bixler, who was a youth pastor before he became a cop, the SMART (Systemwide Mental Assessment Response Team) unit currently includes 68 officers and 18 supervisors, also sworn officers, some with advanced degrees in social work and psychology, and 60 clinicians, whose salaries are paid through the county’s Department of Mental Health with some funding from the state Mental Health Services Act.

“We run it like a patrol division,” Bixler said, “with four shifts” around the clock. Like San Diego’s PERT program, they also partner with community programs that provide mental-health treatment and suicide prevention.

Depending on the time of the call and its location, regular patrol officers may be the first responders to a mental-health call, Bixler said, with SMART teams either joining them at the scene or following up soon afterward. Bixler has long believed “there’s gotta be a better way” for police to respond to mental-health crises, and current calls for major change “may be the impetus to do that.”

“I’m asked if we want more police officers (in the SMART program),” he adds, “and I say I’d rather have more clinicians [who can intervene] before someone gets to the point where they call 911. My whole goal is to work us out of a job.”

Some local agencies send mental-health and other “non-criminal” calls directly to community mental-health programs.

In Sacramento County, the Division of Behavioral Services has a Community Support Team – which includes licensed mental-health clinicians and peer-support specialists (lay counselors with personal experience) — who provide phone and community-based assistance, connecting people with mental-health and housing programs. Using state Mental Health Services Act funds, the county also has six Mobile Crisis Support Teams, consisting of licensed mental-health clinicians who work with local law enforcement to respond to calls and help de-escalate mental-health emergencies.

Mobile crisis teams expand
The Mobile Crisis teams, which the county is expanding to 11 teams, each include a senior mental health counselor paired with an officer or deputy, as well as a “peer navigator” (a lay counselor with personal experience) who helps to ensure connections with ongoing services.  As in other agencies throughout the state, staffing and funding are inadequate, and mental-health clinicians are spread thin in a large county with multiple police and fire agencies asking for help.

There are other, similar programs around the country, in which police collaborate with mental-health professionals on crisis calls. Some local agencies send mental-health and other “non-criminal” calls directly to community mental-health programs, with police backup if necessary.

Many point to the 30-year-old CAHOOTS (Crisis Assistance Helping Out on the Streets) program in Eugene, Ore., a collaboration between the police department and a 50-year-old community program, the White Bird Clinic, in which non-emergency and 911 calls that do not involve an extreme threat of violence or bodily harm are routed to a medical-crisis team (usually a nurse or EMT and a mental-health professional) trained in de-escalating mental-health crises and connecting individuals with services.

Myriad proposals have been made in cities and counties throughout California and the U.S. in the wake of massive national protests against historic police mistreatment.

As a result of national protests, the CAHOOTS program is getting a lot of press in recent weeks. According to a “Media Guide” on the White Bird Clinic website, CAHOOTS teams responded to 24,000 calls in 2019, about 20 percent of total non-emergency and 911 calls, and only 150 required police backup. The program is estimated to save the city about $8.5 million annually in public safety costs, plus some $14 million in ambulance trips and ER costs.

The coronavirus epidemic in many ways has served to shine a bright light on the historic lack of coordination between police and mental-health professionals, with growing national demands for changes in how police respond, particularly to calls involving people of color.

“When we have a loud response from a diverse community, there is this opportunity for looking at different ways of doing things,” says Jennifer Reiman, a licensed clinical social worker who is Sacramento County’s Mental Health Program Coordinator for the Community Support Team and Mobile Crisis programs. “Providing a spectrum of response is really important.”

Myriad proposals have been made in cities and counties throughout California and the U.S. in the wake of massive national protests against historic police mistreatment – and many deaths – of Black citizens, especially Black men and boys who are arrested and incarcerated at numbers far disproportionate to their numbers in the general population.

Some proposed changes involve nomenclature as well as pandemic-driven cuts and redirecting police spending. The Davis City Council is considering a proposal to rename the Police Department, calling it the Department of Public Safety. In Minneapolis, where the gruesome death of George Floyd under a policeman’s knee spurred national protests, the City Council has proposed the creation of a Department of Public Safety and Violence Prevention.

“We must reduce our reliance just on caging people.” — Supervisor Sheila Kuehl

New York’s City Council recently voted to shift $1 billion from policing to education and social services in the coming year. In Los Angeles, the City Council cut the LAPD budget by $150 million, ostensibly redirecting more funds to social services. The LA County Board of Supervisors proposed cuts of $162 million to the 2020-21 Sheriff’s budget, also with an eye to redirecting services from incarceration to treatment.

And LA Supervisors are revisiting plans to close the dangerous, cramped Men’s Central Jail, to focus more on diverting the huge percentage of mentally-ill inmates in the system into treatment and diversion programs. LA County’s jail system, overseen by the Sheriff’s Department, is often referred to as the largest mental-health facility in the world.

“We must reduce our reliance just on caging people,” said Supervisor Sheila Kuehl, a former state legislator, public-interest attorney and law professor. The once-controversial proposed closure of the 57-year-old Men’s Central Jail is no longer a “revolutionary concept,” she added, but rather “simply logical, fiscally prudent and another opportunity for community healing.”

In Sacramento, Mayor Steinberg, who has long advocated for more funding and resources for mentally ill Californians and their families, last month proposed hiring an Inspector General to provide oversight and investigation of Sacramento police, as well as a plan for “triaging” 911 calls from individuals and families in mental-health crises. The plan would shift police funding to create a new unit comprised of mental-health professionals who would respond to calls involving mental-health emergencies, homelessness and other “non-criminal,” non-violent issues.

“We are the 24/7 crisis call line,” she said. “You call, we come, regardless of the level of crisis the individual may be in.” — Bridgett Dean

“We’ve been hearing calls for ‘de-funding’ the police,” Steinberg said in a press release, “but I think it’s more productive to talk about the function of the police and let the money follow the function.”

Sacramento Police Chief Daniel Hahn recently hired a licensed clinical social worker, Bridgette Dean, to oversee a Mental Health Unit in the Police Department. Dean, who has worked in law enforcement for the past decade, filled a similar role in the Roseville Police Department when Hahn was chief there. She is one of the few – possibly the only — social-services administrators in Northern California with direct authority over police officers whose primary focus is on mental-health calls.

Dean heads a team of five officers with intensive training in how to deal with mental-health crises, as well as a homeless outreach team. They work with patrol officers to assess mental-health emergencies and help people in crisis get services. “We’re not going in to do an enforcement model,” she said, “We want to close the gap, get the services they need.” She stresses the importance of training for officers and dispatchers, who are “trained and experienced in listening to key words to understand that it’s a mental-health call.”

“We are the 24/7 crisis call line,” she said. “You call, we come, regardless of the level of crisis the individual may be in. If it’s a priority call – ‘I’m going to kill myself’—we go right now. If it’s not an emergency crisis on the patrol side, they will refer the call to the mental-health unit for follow-up.”

‘Major Issues’ at state level
Collaboration is the key to the success of programs like Dean’s, and state support.

“We have some major issues we have to resolve at the state level,” she said, including reforms in an outdated, ineffective system created with the closures of state mental hospitals in the 1960s and 70s, which resulted in strict legal protections for the rights of the mentally ill. But those changes assumed that a robust system of “community care” would replace the hospitals – which never happened, leaving thousands of mentally ill Californians homeless and untreated, shuttling among hospital emergency rooms, jails and prisons, at tremendous public expense and incalculable human suffering.

“The structure we have in place is so antiquated,” Dean said, referring to the 1967 Lanterman Petris Short Act that drastically altered California’s system of mental-health care and has never been substantively changed or updated. And the ambitious proposals currently advanced throughout the country to reorganize and/or defund the police often fail to recognize the reality of services on the ground.

“All of this is good talk. . .until we realize we have 50 detox beds in Sacramento city and county,” and extremely limited numbers of beds for psychiatric patients in crisis, much less for those needing long-term care. “When we talk about the need to get somebody off the streets, we’re not able to do that because of the lack of beds.”

TOMORROW: Solutions emerge in national push for major changes in how police respond to mental-health crises (Second of two parts)

Editor’s Note: Sigrid Bathen is a longtime Sacramento journalist and former Sacramento Bee reporter who has covered mental-health and related issues for several publications for more than 40 years. She has taught journalism and communications at Sacramento State since 1988. She has written for Capitol Weekly since 2005, on a variety of subjects, including education and health care. To see two of Bathen’s recent pieces in Capitol Weekly on mental health issues, click here and here.

Stronger ‘Laura’s law’ wins Assembly approval

 

Legislation to strengthen California’s 2002 “Laura’s Law,” which gives family members a legal tool to get treatment for their severely mentally ill relatives, has been approved 77-0 by the state Assembly, despite opposition from some California counties, behavioral health directors and a labor union representing employees in local mental-health programs.

The Assembly’s approval on Wednesday for the bill, AB 1976 by Assemblywoman Susan Eggman, D-Stockton, would also make “Laura’s Law” permanent, ending the sunset provision which required “reauthorization hearings” every five years. The measure was sent to the Senate.

The action comes nearly two decades after contentious hearings on the original law, by then-Assemblywoman Helen Thomson, D-Davis, which had intense opposition from disability rights groups and county mental health directors.

Some counties are balking at a key provision of the Eggman bill that would require them to publicly explain — in writing — why they are “opting out” of participation in the program, which has had considerable success in reducing hospitalizations, homelessness and incarceration in the 20 counties where it has been adopted.  Under current law, county participation is voluntary.

The bill earlier sailed through two major Assembly committees, despite opposition, and was unanimously approved in recent weeks by the Assembly Health Committee (15-0) and Appropriations Committee (18-0).

Laura’s Law is named for 19-year-old Laura Wilcox, who was a college student working in a Nevada County mental-health clinic during her winter break in 2001, when she was shot and killed by a severely mentally ill man who went on a shooting rampage that killed three and injured three others.

“Now is a good time. We are passing things we’ve never passed before.” — Susan Eggman

“This bill would bring it full circle,” said Laura’s mother, Amanda Wilcox, who with her husband Nick became tireless legislative advocates for mental-health and gun-control legislation in California.

A similar bill to strengthen Laura’s Law, also by Eggman, failed in 2015, but she is optimistic about the current legislation. Likening the mental-health crisis playing out in plain view throughout California to “a wildfire in our streets,” she said there is growing support for major policy improvements in the state’s historically fractured mental-health care system, brought into even sharper relief by a global pandemic — as thousands of mentally ill Californians cycle in and out of emergency rooms and jails, or wander the streets.

“How is that dignity for anybody?” said Eggman, a former social worker and Sacramento State professor, in an interview with Capitol Weekly. “The human rights and public-health crisis is not fair to families, and I think it has become a stark reality for everybody. Now is a good time. We are passing things we’ve never passed before.”

In a May 29 letter to Assembly Appropriations Chair Lorena Gonzalez, the California State Association of Counties and the County Behavioral Health Directors Association, said they were not opposed to making the nearly 20-year-old “Laura’s Law” permanent, eliminating the five-year sunset provision that has dogged the law since its inception. A subsequent letter June 8 from the behavioral health directors and the Service Employees International Union said they “regretfully” oppose the bill because it “would place a virtual mandate on counties to participate [in Laura’s Law],” and would “increase staff workload.”

The sweeping, bipartisan vote in the Assembly – with one abstention, by Assemblyman Ash Kalra, D-San Jose – clearly sent a message to the counties that Laura’s Law is here to stay in California.

“At the end of the day, the opposition was not compelling,” said Randall Hagar, longtime legislative advocate for the California Psychiatric Association, which supports the bill, along with the California Medical Association and the California Hospital Association.

The 20 counties that have “opted in” to start Laura’s Law programs account for an estimated 70% to 80%  of the state’s population, but some county mental health directors and employees continue to oppose the bill’s requirement that counties choosing to “opt out” of the program must state their reasons in writing after public discussion.

“The notion that [the law] interferes with the counties is bogus.” — Judge Thomas Anderson

They also dislike adding judges to the list of individuals – which currently includes family members, health-care professionals and law enforcement – who can ask the local mental-health director to file a civil court petition for treatment under Laura’s Law, which in many cases is voluntary and does not require judicial intervention. And advocates point to statistics that show the law saves court costs by reducing incarceration and preventing costly conservatorships and criminal interventions.

Farah McDaid Ting, health policy representative for CSAC, argued that the existing “opt-in” provision of the original law, constitutes a public declaration.

“The ‘opt-in’ process is on the record,” she said. “The county has to budget for it, and the board [of supervisors] has to do this in public session.” While ‘Laura’s Law’ has proven to save money in reduced hospitalizations, incarceration and homelessness — and is partially supported by state funding from the Mental Health Services Act, the “millionaire’s tax” passed by voters as Prop. 63 in 2004 — there is no state budget appropriation in the original law, or the current bill. Counties argue there are “up-front” costs to establish such programs, and have long been opposed to any perceived “mandate.”

“The notion that [the law] interferes with the counties is bogus,” says Nevada County Superior Court Judge Thomas Anderson, a former public defender who was the defense attorney for Laura’s killer, has long supported Laura’s Law and helped start Mental Health Courts in Nevada County, one of the first counties in California to adopt the law. “And they’re wasting money by not having these services.”

“We always listen to the concerns of opponents or other members,” he said, “but we think [Laura’s Law] has proven to be effective.” — David Stammerjohan

Hagar says some counties that have chosen not to adopt “Laura’s Law” programs – including Sacramento County, which is surrounded by other counties with successful programs —  have done so quietly and behind the scenes, with little or no public discussion. “All we’re asking is that the counties have a public dialogue, put it on the record, explain their reasons for ‘opting out’,” he said. “It’s not a mandate.”

In the lead-up to the floor vote, David Stammerjohan, Eggman’s chief of staff, said the the “opt-out” requirements would remain in the bill, despite opposition from the counties. “We always listen to the concerns of opponents or other members,” he said, “but we think [Laura’s Law] has proven to be effective. Let’s have the counties actually have a conversation [about opting out], examine it from a public perspective, and then make a decision.”

As Assisted Outpatient Treatment (AOT or Laura’s Law in California) has gained supporters throughout the country – and shown widespread success in providing needed treatment, reducing hospitalizations, homelessness and incarceration, with significant cost savings – it nonetheless remains a little-known option for families of the mentally ill, who are often desperate to get treatment for family members but are generally barred from helping, even to warn of potentially volatile behavior, although they often are expected to serve as de facto caretakers.

Before Laura’s Law, the only real resource for families under existing law was the so-called “5150,”  a reference to that section of the state Welfare and Institutions Code governing 72-hour mental-health holds for someone deemed a danger to “self or others.” But invoking that provision involves law enforcement and usually means that an individual is soon released back to the streets, long before being stabilized on medication, or getting any treatment at all. Often, they return to families ill-equipped to help them, with sometimes tragic results.

Following their daughter’s tragic death, Laura’s parents, Amanda and Nick Wilcox, were determined to see legislation passed in California to give families options to get mentally ill relatives into treatment.

The valedictorian of her high school class, Laura Wilcox was a college sophomore on Jan. 10, 2001, working in a Nevada County mental health clinic during her winter break from Haverford College in Pennsylvania, when she was killed by a delusional clinic patient whose family had repeatedly tried to alert local mental-health authorities about his rapidly deteriorating condition – but they had refused to listen.

Scott Thorpe, then 40, a former school custodian, showed up at the clinic for an 11:30 a.m. appointment, and opened fire with a 9 mm semiautomatic handgun, killing Laura and a caregiver who had brought another patient to an appointment, and causing serious injury to two other clinic employees. He then drove to a nearby restaurant – which he thought was poisoning him – and killed the assistant manager, severely wounding a cook who tried to flee.

Thorpe’s brother, Kent, then a Sacramento Police sergeant and hostage negotiator, and his wife Sharon, had repeatedly attempted to alert clinic therapists about Scott’s increasingly alarming behavior, to no avail. “They wouldn’t listen,” said Kent Thorpe, who ultimately helped convince his brother to surrender peacefully later that day.

Scott remains in Napa State Hospital for the criminally insane, where he was sent after pleading Not Guilty by Reason of Insanity in Nevada County Superior Court.

“Some of those early hearings were uncomfortable. We were personally accused of  being ‘violence mongers’ and ‘spreading stigma.’” — Nick Wilcox

Following their daughter’s tragic death, Laura’s parents, Amanda and Nick Wilcox, were determined to see legislation passed in California to give families options to get mentally ill relatives into treatment. The resulting “Laura’s Law” has since been adopted by 20 of California’s 58 counties, including several of the state’s largest counties. But it has always been a voluntary process for California counties to “opt in” to start the Assisted Outpatient Treatment (AOT) programs that have been widely adopted in various forms, with considerable success, in 46 states throughout the U.S.

It was based on a similar law in New York, “Kendra’s Law,” passed in 1999, following the horrific death of 32-year-old Kendra Webdale, who was pushed in front of a subway train by a deranged man who had been hospitalized at least a dozen times, including six weeks before Kendra’s death. Unlike California, the New York Legislature made the law mandatory throughout the state, with state funding and stunning results.

In California, the path to adopting “Laura’s Law” was arduous at best, although it was strongly supported by the families of the mentally ill – including Scott Thorpe’s – and by victims, like Amanda and Nick Wilcox. Counties balked – many still do — at what they saw as an additional burden on already overwhelmed local mental-health systems.

Disability rights activists opposed the law, saying it infringed on the rights of the mentally ill to refuse treatment, and held noisy demonstrations on the Capitol lawn and in hearings on the original bill, many wearing yellow t-shirts with the triangular symbol for concentration-camp inmates deemed “mentally defective.” Then-Assemblywoman Thomson, a former psychiatric nurse who is the author of the original law, was heckled and called “Nurse Ratched,” after the abusive nurse in Ken Kesey’s “One Flew over the Cuckoo’s Nest,” about a fictional psychiatric hospital.

“Some of those early hearings were uncomfortable,” recalls Nick Wilcox, then an environmental scientist for the state Water Resources Control Board. “We were personally accused of  being ‘violence mongers’ and ‘spreading stigma’.  The first time I testified in 2001, I told the Assembly Judiciary Committee that I believe in civil rights. But when your civil rights interfere with someone’s right to live, it’s gone too far. Laura had a right to live.”

Now experienced legislative advocates, responsible for helping to pass dozens of bills on mental-health and gun-control issues in California, the Wilcox’ are optimistic about the current bill. “Bills grow legs,” Nick Wilcox said, “and this has very sturdy legs.”

Editor’s Note: UPDATES earlier and RECASTS lead with Assembly approval, EDITS throughout to conform. Sigrid Bathen is a veteran Sacramento journalist and former Sacramento Bee reporter who has covered mental-health and related issues for several publications, for more than 40 years. She has taught journalism and communications at Sacramento State since 1988. She has written for Capitol Weekly since 2005, on a variety of subjects, including education and health care. 

Mental health care: From the snake pit to the streets

Published January 28, 2020 on Capitol Weekly.

“California began emptying its mental hospitals 30 years ago (in 1967), when community based care was touted as the more humane alternative. As thousands of homeless mentally ill wander city streets, or end up in jail or prison, policy-makers wonder: Where is this ‘community care’, and isn’t there a better way?” – California Journal, 1997

“There are a lot of pieces to this puzzle, and we need to look at it as a whole – courts, prisons, police, state hospitals, community programs – and re-engineer a system that works better.” Randall Hagar, California Psychiatric Association, Capitol Weekly, 2011

“The State of California is treating homelessness as a real emergency – because it is one.” Gov. Gavin Newsom, State Budget Preview, Jan. 8, 2020

The modern history of mental-health care in California begins more than half a century ago with passage of the landmark 1967 Lanterman-Petris-Short Act, an ambitious — but ultimately disastrous —  overhaul of a draconian “system” of hoary old mental hospitals throughout California.

Most of the hospitals were closed, but the “community care” that was to take their place never materialized. Laws were changed to prevent forced institutionalization, and increasing numbers of mentally ill Californians wandered the streets, or languished in jails and prisons. Skyrocketing housing costs forced more people out of their homes, and California now leads the nation in the number of homeless people on its streets.

Residents – “inmates” was a more apt term – shuffled around in grimy “day rooms,” watched TV, or were confined to bleak dorms with few programs.

As Gov. Gavin Newsom, with great fanfare and reams of statistics, launches his ambitious $1.4 billion budget plan targeting mental illness and homelessness, there is both hope and a question: Will it really mean lasting change?

The odds are not good.

First, some history.

For decades, thousands of mentally ill and developmentally disabled residents were confined in chronically overcrowded, understaffed facilities  that often looked more like prisons than hospitals, where powerful antipsychotics were routinely dispensed, to “keep them quiet.” Residents – “inmates” was a more apt term – shuffled around in grimy “day rooms,” watched TV, or were confined to bleak dorms with few programs, little therapy, poor supervision, and hardly any future.

They were frequently confined against their will. The hospitals could be dangerous places, where hundreds of people, including mentally ill and developmentally disabled children and teens (the accepted term then was “mentally retarded”), were injured or died under questionable circumstances, prompting highly critical media coverage. Finally, sweeping state investigations were launched in the late 1970s into dozens of “suspicious deaths” in state hospitals going back years.

Some major staffing changes were made, but few, if any, criminal charges were filed.

“The state hospitals went from 35,000 to 5,000, and the community was expected to deal with it, without the expertise or the resources.” — Dr. Stephen Mayberg

As the hospitals closed during the Reagan administration, and into the first Jerry Brown term, only a few remained, primarily to house those deemed criminally insane by the courts.

For the legions of discharged residents without families willing or able to help or house them, the streets – and jails and prisons – of California cities ultimately became the default “homes” for thousands of mentally ill Californians.

The “community care” touted by the Lanterman reforms was largely nonexistent, and new laws limited institutionalizing or forcing people into treatment against their will. 

“The state hospitals went from 35,000 to 5,000, and the community was expected to deal with it, without the expertise or the resources,” Dr. Stephen Mayberg, who then headed the state Department of Mental Health, told a California Journal reporter in 1997.  “It was a recipe for problems, and we’ve spent a long time trying to dig ourselves out of that hole.”

Yet that “hole” Mayberg described in 1997 only seems to get deeper, despite multi-billion-dollar infusions of taxpayer funds, myriad executive and legislative fixes, critical state audits and frequent reorganizations — including the breakup of the massive state Health Department in the 1970s and, decades later, eliminating the state Mental Health Department in 2011.  As oversight responsibilities were spread among several state agencies, the “problem” has worsened exponentially, complicated by the lack of affordable housing and the Byzantine bureaucracy of “community care.”

More than 150,000 Californians are homeless (many of them mentally ill), according to recent federal estimates. Homeless “counts” are constantly changing, notoriously unreliable, and the numbers likely are much higher. In Los Angeles County alone, recent estimates place the number of homeless people at 60,000. A recent poll by the Public Policy Institute of California ranked homelessness as the No. 1 priority for immediate state action.

Under tremendous pressure to take sweeping action, Newsom earlier this month unveiled one of the most ambitious state reorganizations yet, committing more than $1 billion in state funding and prioritizing homelessness and mental health in his 2020-21 state budget proposal, which includes a $750,000 fund “to get individuals off the streets and into supportive services quickly.”

“Californians are demanding that all levels of government. . .do more to get people off the streets and into services, whether that’s housing, mental health services, substance abuse treatment or all of the above.” — Gavin Newsom

Released Jan. 10 in an unprecedented three-hour briefing that featured the governor alone, Newsom cited reams of statistics and budget figures, displaying a rare command of the mind-numbing details typical of a new state budget, as reporters’ eyes glazed and policy-makers watched, astonished.

“In more than 20 years of working in and around state government, we’ve never had a governor who was such a champion of mental health issues, and as knowledgeable about even the minutiae of mental health policy,” said Sacramento Mayor Darrell Steinberg, a veteran champion of mental-health reforms. Steinberg, the former leader of the state Senate, authored major legislation, including the 2004 Mental Health Services Act.

Passed by voters as Proposition 63, which boosted taxes on those with $1 million or more in taxable income, the so-called “millionaire’s tax” has raised billions for mental health programs, while at the same time homelessness has become the scourge – and the shame – of California. The state has more homeless people roaming its streets, living in cars, languishing in jails and prisons than any other state, at tremendous public cost and personal pain.

“Californians are demanding that all levels of government. . .do more to get people off the streets and into services, whether that’s housing, mental health services, substance abuse treatment or all of the above,” Newsom said in his Jan. 8 budget preview. “That’s why we’re using every tool in the toolbox – from proposing a massive new infusion of state dollars in the budget that goes directly to homeless individuals’ emergency housing and treatment programs, to building short-term emergency housing on vacant state-owned land.”

The budget proposal must now wend its way through the Legislature, emerging in the spring and with final approval in June. “It’s heartening,” Steinberg said of Newsom’s proposals to radically restructure – and prioritize – California’s historically fraught, extremely complex system of mental-health care, “and will surely help our state improve the lives of people suffering from mental illness.”

Steinberg co-chairs, with Los Angeles County Supervisor Mark Ridley-Thomas, the governor’s Council on Regional Homeless Advisors, which on Jan. 13 issued an “interim report” generally praising the governor’s proposals, while also urging more focus on the prevention of homelessness.

“Prevention should focus particularly on the growing number of Californians becoming homeless due to economic displacement,” the council recommended, “as well as those discharging from our institutional settings into homelessness.”

“We were disappointed that the governor did not include a proposal to create a certification program for Peer Support Specialists in the budget proposal.” — Steinberg Institute

The advisory council, which includes local and state officials and advocates, urged the governor to “create a single point of authority for homelessness in California” – a “high-level” official and team “to coordinate housing, health and human services and other state responsibilities relating to homelessness,” answering directly to the governor.

Despite campaign  promises that he would appoint a “homelessness czar,” no such appointment has yet been made. When reporters again raised questions about the position during the budget briefing, Newsom rather testily responded that he is the homelessness czar.

In a separate statement issued shortly after the governor’s Jan. 10 budget briefing by the Steinberg Institute on mental health policy, the former Senate leader generally praised Newsom’s proposals.

But Steinberg, who founded the institute, also criticized the governor’s veto last year of a bill widely supported by mental-health advocacy groups to fund a  program of “Peer Support Specialists” – people with personal and family experience in mental health issues – to help the mentally ill get access to critical services.

The measure has passed the state Legislature unanimously three times, and last year Newsom told advocates that “he wanted the process to be handled through the 2020 budget.”

Thus far, that hasn’t happened.

“We were disappointed that the governor did not include a proposal to create a certification program for Peer Support Specialists in the budget proposal,” the institute said, adding that, “We will take him up on his offer to work with us on this important issue and are determined to add this program to the budget.”

The ‘invisible’ families bearing the brunt of care
Limited peer-support programs have long been used successfully in local programs. They can cost far less than other staffing and support services for mentally ill individuals and their families, who bear the brunt of care for mentally ill relatives with little government support or even consultation.

“We knew the conversations were happening, and we tried to get involved.” — Jessica Cruz

Failure to include peer-support funding in the budget (a cost which the Steinberg Institute says is “modest”) highlights a historic policy misstep in efforts to restructure and improve the state’s convoluted and poorly monitored mental-health bureaucracy – failing to include the mentally ill and their families in policy discussions.

Families and many clinicians, social workers and administrators who work in well-regarded local programs, have long said that ignoring, or giving short shrift to, families in policy and budget discussions often torpedoes effective restructuring of the fractured system, with its long history of massive reorganizations, huge infusions of taxpayer funds – and limited accountability.

“We are going to advocate very heavily for family and consumer representatives” to be included in the budget discussions, said Jessica Cruz, California CEO of the influential National Alliance on Mental Illness (NAMI), which provides advocacy and support for families of people living with mental illness, who say they were not actively consulted in the run-up to the budget proposal.

“We knew the conversations were happening, and we tried to get involved,” Cruz said, attending several informational and “stakeholder” meetings and hearings. At one legislative hearing, she said dozens of mental-health advocates, including family members, were present, saying, “Hey, slow down, let us be part of the conversation.”

The governor’s veto of the peer-support legislation – and his failure to include it in the budget proposal – especially troubles family members.

She said families are often “the hidden, invisible population,” providing the bulk of housing and care for their mentally ill family members, with little support – or even acknowledgement — from public agencies. “When we don’t provide treatment for loved ones, everybody suffers. God forbid something happens to their family.”

She said that concern is particularly acute for aging family members caring for mentally ill relatives, often their adult children. “Many of our members are this invisible population that nobody sees or talks about,” Cruz added. “The family voice is so important, as 99 percent of the time we’re the caretakers, the ones providing housing, treatment, transportation.”

The governor’s veto of the peer-support legislation – and his failure to include it in the budget proposal – especially troubles family members.

“Peer support is huge for families,” Cruz said.  Individuals with “lived experience” as someone living with mental illness or as a family member “can help families navigate through difficult times. We are not trained professionals – we are experts in our own experience. We have to be taken seriously, thoughtfully and strategically as a part of these conversations.”

Kaino Hopper is an artist and former college art teacher – and a longtime Sacramento NAMI volunteer who leads family support groups. Her severely mentally ill adult daughter lives at home with her parents, who are in their 60s, when she is not hospitalized or temporarily institutionalized (there are few long-term, or even adequate short-term, facilities for the mentally ill). “We work 24/7 with no breaks,” Hopper said.

Under current law – which many experts say is an over-reaction to past, forced institutionalization — mentally ill people in crisis can only be detained on a 72-hour “5150” hold.

After horrific media accounts of mentally ill patients being discharged to the street, often with disastrous consequences, recent legislation now prohibits health-care facilities from discharging mentally ill patients without housing, which usually comes down to “a bed” that is often hard to find. Addressing the closure of many so-called “board and care” homes for the mentally ill in California cities because the state reimbursement rates are too low – particularly in urban areas where housing costs have skyrocketed — is part of the governor’s budget proposal, but with few details.

“When the person is released from a hospital, we [family members] become ‘the bed’,” Hopper said. “We need help at that point. . .There are ‘stepdown services’ (post-discharge services) after acute care, but they’re few and far between. It’s hard to get on the list.”

Under current law – which many experts say is an over-reaction to past, forced institutionalization — mentally ill people in crisis can only be detained on a 72-hour “5150” hold, a reference to a provision in state law affecting individuals deemed a threat to themselves or others.

Too often, that has meant languishing on a gurney in an overcrowded hospital emergency room. 

Exhausted family members often step in, with devastating results. When they try to get help, restrictive confidentiality laws routinely prevent consultation with families of adult relatives.

“It’s an impossible situation for families,” Hopper said. “The way the system is set up right now, our family members will receive more services” if they refuse to “house” their mentally ill relatives. “It’s emotional blackmail, and families find ourselves in the crosshairs.  We want to be part of the recovery process, but we are not allowed to be part of that process, although we are pressured to provide housing, with no support. Our homes become burnout zones.” Many parents work, many others are single parents, and there are frequently other children in the home. “Families could do more if we had a way to call for help in the home,” says Hopper.   

An explosive state audit in 2017 found that California counties were often “hoarding” millions in MHSA funds ($126 million in Sacramento County alone).

Cruz praised the governor for “prioritizing mental health and homelessness,” but cautioned against “lumping all people with mental illness together as homeless,” although mental health and substance abuse “are a big piece” of the puzzle.

Cruz and other mental-health advocates are also concerned about tapping into funds raised by the landmark 2004 Mental Health Services Act, from which money already has been diverted by California’s Proposition 2, a legislative measure passed by voters in 2018 to use MHSA funds for housing.  “We have to be extremely careful how we use MHSA funds,” Cruz said.

While vague on the details, Newsom’s budget recommended revisions to both Lanterman-Petris-Short and the MHSA, which the Steinberg Institute supported in concept, saying the MHSA funding should focus more on “the soaring number of people with serious mental illness who are also grappling with homelessness or have been involved in the criminal justice system, as well as the rising number of at-risk children and youth who are coping with mental illness.”

And there is widespread agreement that more accountability and state oversight are essential to tracking both funding and progress.

An explosive state audit in 2017 found that California counties were often “hoarding” millions in MHSA funds ($126 million in Sacramento County alone), and the flow of funding has subsequently, though inconsistently, increased from the counties to expand local programs.

Newsom’s budget urges better accountability. His advisory council recommends legal remedies, including sanctioning local governments that fail to move quickly to meet state benchmarks. Many critics and advocates blame the lack of oversight on the 2011 elimination of the state Mental Health Department, during the administration of Gov. Jerry Brown – a reorganization which dispersed the responsibility for monitoring mental health programs and spending among multiple state agencies, making accountability difficult

“We really need to synchronize mental-health services with housing and shelter services.” —  Steve Watters

The governor’s advisory council is adamant that a cabinet-level appointee – a “single point of authority” (e.g., a “homeless czar”) — be named by and report directly to the governor.

‘Shelter’ vs. ‘Housing’
Advocates also emphasize the distinction between “shelter” and “housing,” and Newsom attempts to address both in his budget proposal.

Short-term shelter – like the 100 travel trailers from the “state fleet” and an unspecified number of “complementary modular tent structures” that Newsom proposes be deployed throughout the state – are by definition not permanent housing, which takes much longer to realize and is much more expensive.

Many local agencies and nonprofits around the state work to provide permanent housing, and many others are focused on temporary shelter. Both, however, emphasize the importance of “wraparound services” for residents facing myriad physical, mental-health, social-services and substance-abuse issues.

“We really need to synchronize mental-health services with housing and shelter services,” says Steve Watters, a longtime CEO of Sacramento-area nonprofits (Safeground Sacramento and, more recently, First Step) that provide shelter, housing and other services for the homeless, many of whom are mentally ill.

“It should be easy, but it isn’t. . .Affordable, permanent housing takes a long time to develop. We’re trying to develop interim housing, a form of shelter, and wraparound services. We can’t wait for affordable housing. Our clients can’t wait,” he said.

The specter of epic tensions between the Newsom and Trump administrations also haunts the governor’s ambitious plans to tackle homelessness and mental illness in California.

On Jan. 1, First Step opened an 80-bed shelter on North A Street in Sacramento, funded through the county, and is working with the Sacramento Housing and Redevelopment Agency and the Sacramento City Council to establish “villages” of tiny homes, sleeping cabins — collaborating with other organizations to provide medical and other services.

“It’s much easier to engage clients [in services],” he says, “when you know where they are.”

State and federal funds are often distributed by the cities and counties, and navigating the funding maze can be an exercise in frustration even for the most experienced nonprofit administrators. 

“The city and county have funds coming from the state, with some requirements, and then the city and county decide how to spend the money,” Watters says. “There needs to be more involvement from the service providers [at the local level]. We actively campaign for solutions that involve sheltering and services that can be helpful – intensive case management for each individual, tied in with collaborators on the medical side for mental health counseling and primary care. . .But it’s difficult to navigate the system.”

The specter of epic tensions between the Newsom and Trump administrations also haunts the governor’s ambitious plans to tackle homelessness and mental illness in California, as federal funding is a key element, particularly in Newsom’s lofty plan to “transform Medi-Cal.”

“That three-hour press conference is one-way, directional. The only way you get to a solution is through communication, negotiation.” — Barbara O’Connor

The Los Angeles Times recently revealed that Los Angeles Mayor Eric Garcetti has been quietly negotiating with federal officials for funding to address the especially visible and acute homeless crisis in L.A. The efforts initially appeared to be bearing fruit, until the Trump administration placed myriad, but vague, “conditions” on actual funding, which included more involvement by law enforcement and reducing regulations on housing construction. Those conditions appear to have stymied the negotiations.

“But at least they’re communicating,” says Barbara O’Connor, a longtime political adviser and commentator and former communications professor at Sacramento State University.

“These are all great ideas,” O’Connor says of Newsom’s proposals, “but the coordination is lacking, with so much money and nobody to really run it. [Newsom] is not interactive, too much into one-way communication. That three-hour press conference is one-way, directional. The only way you get to a solution is through communication, negotiation. And there must be a project manager, which is true of any project — someone must be fully in charge of it. The homeless problem is not one solution for all. Modesto is not L.A., and the governor hasn’t even talked about federal money. The fact he hates Trump is not an excuse.”

Increasingly criticized for “big ideas,” and few actual accomplishments in his first year in office, the governor’s current proposals have enormous consequences for Newsom’s political future. O’Connor points to recent columns by influential L.A. Times political columnist George Skelton, who has both chastised the governor (for too many big ideas, too few actual accomplishments) and cautioned him (the current budget proposal initially appeared to be more focused on a few key issues, but the three-hour budget “briefing” should have been condensed to 30 minutes max.).

On the day after a preview of the 2020 budget, Skelton quoted two political veterans about prospects for Newsom’s second year:

From Republican political lawyer Steve Merksamer, who was chief of staff to Gov. George Deukmejian: “This governor made more promises than any governor I’ve seen. . .This is not a criticism, but it’s the time to put up or shut up. Taking on issues other people haven’t is fine, but that’s not the question. It’s taking them on and solving them. It’s time to fish or cut bait. It’s the second year.”

From Democratic political consultant Steve Maviglio, who was communications director for Gov. Gray Davis (like Newsom, Davis was a former college baseball player): “When you swing at a lot of pitches, you hit a lot of foul balls. He should focus on hitting a few out of the park.”

Advocates for the homeless mentally ill, meanwhile, always hoping for more state funding, are hesitant to publicly criticize public agencies.

Daniel Zingale, a top political adviser to two previous governors and former senior vice president of the California Endowment, reportedly has worn many hats in the Newsom administration, although his title was director of strategic communication and public engagement. He announced his retirement last week, but said he would stay on through Newsom’s State of the State message next month and may continue in an advisory capacity.

In his previous, equally high-profile jobs, Zingale was accessible, often quoted in news accounts, though less so during the first year of the Newsom administration.

Earlier this month, Zingale spoke to Skelton about the 2020 budget – and, perhaps, attempt some damage control over all of those reports of unfocused governing. He told Skelton that Newsom would be focused this year on three priorities: homelessness, health-care affordability and wildfires.

And then, a day later, Newsom delivered that marathon, one-man, three-hour budget “briefing,” showing a remarkable command of governmental minutiae, going well beyond his three “priorities” into the wonky details of the vast state bureaucracy. Not a good sign for actually accomplishing those priorities.

Advocates for the homeless mentally ill, meanwhile, always hoping for more state funding, are hesitant to publicly criticize public agencies and elected officials who help pay for their programs, although many are distressed by what O’Connor called Newsom’s “one-way communication.”

So they are waiting in the wings, hoping for the best, focused on keeping their clientele off the streets, connected with services.

“If you’re going to navigate the system and put things in place to help people,” says First Step’s Watters, “you can’t stand on the corner all the time with a bullhorn.”

Ed’s Note: 
Sigrid Bathen is a Sacramento journalist who teaches at California State University, Sacramento. She has written about mental-health issues for more than 40 years. Her investigative reporting has appeared in many publications, including the Sacramento Bee and the California Journal.  She has received several major awards, including a Pulitzer Prize nomination and recognition from the state and national mental health associations. Bathen has written about mental health, education, health care and state government for Capitol Weekly since 2005.

Sacramento State News

Professional Activities, April-June 2019

Sigrid Bathen, Communication Studies, was the guest speaker for the California Writers Club (Sacramento area chapter) on March 1, speaking on the topic, “Magazine Writing: Then and Now, Print to Digital,” describing her experiences “then and now” as a longtime journalist who has been a writer and editor for many local and state newspapers, magazines and other media, both print and online, including the Sacramento Bee, the Los Angeles TimesCalifornia JournalCapitol WeeklySacramento MagazineCalifornia Lawyer, the American Lawyer Newspapers GroupComstock’sMagazine,California MedicineMagazine, the Sacramento Business Journal, the California Health Care Foundation, and many others . She also recently completed a major oral-history project – a 90-minute video interview with legendary former lobbyist Clay Jackson, who for many years was one of the most prominent, highest paid lobbyists in California, and later served more than five years in federal prison following a massive “ Capitol Sting” investigation of political corruption in which many legislators, staffers, and one lobbyist were convicted on federal corruption charges. The oral-history series is funded by the Institute of Museum and Library Services through the California State Library, and is posted on the Capitol Weekly website http://capitolweekly.net/oral-history-project-clay-jackson/  Jackson had declined all interviews since his release from prison in 1999, and he was last interviewed by Bathen in prison in 1995, for a lengthy article published in the California Journal, a magazine about state politics and government where she was senior editor. That article received a first-place award for “enterprise reporting” from the Society of Professional Journalists, Central California chapter, and is linked in the oral history. https://secureservercdn.net/45.40.151.233/9c5.6e2.myftpupload.com/wp-content/uploads/2016/01/Clay-Jackson-1.pdf And Bathen recently wrote an in-depth article for the California Health Care Foundation, which publishes a variety of online health-care media, about the accomplishments of the late Herrmann Spetzler, who for decades directed (and vastly expanded) the “Open Door” health-care clinics in rural Humboldt and Del Norte Counties, which have become a national model for effective rural health care https://www.chcf.org/blog/herrmann-spetzler-visionary-rural-clinics/  The article was recently cited by the foundation as one of its “top ten” 2018 blogs.  Bathen has been an adjunct professor of Journalism and Communications at Sacramento State since 1988, and was also communications director for three state agencies.

Herrmann Spetzler Remembered as “Visionary” Who Developed California Rural Clinics

The CHCF Blog

Herrmann Spetzler

Herrmann Spetzler built a small clinic in a remote corner of California into the region’s primary care anchor. Photo courtesy of Open Door Community Health Centers

May 01, 2018

by Sigrid Bathen

In 1977, idealistic young people were moving to California’s strikingly beautiful but impoverished Humboldt County to escape urban congestion and do good works. One of them was Herrmann Spetzler, who came to the tiny city of Arcata to run a small counterculture health clinic called Open Door. Spetzler, a tall, bearded man with a German accent, wanted a safe, uncomplicated place that would suit a young family just starting out. He got that — and then he stayed for 40 years to pursue his vision of a health care system accessible to everyone regardless of income. Because of Spetzler’s leadership, thousands of people of all income levels in California’s rural northwest region receive medical care in an expanded network of modern facilities.

On March 12, Spetzler died suddenly at age 70, shocking the sprawling community that coalesced around his charismatic personality and irresistible vision. Colleagues and friends say Spetzler’s reach extended far beyond California’s North Coast, although he often described himself in meetings and speeches as “Herrmann Spetzler, RURAL,” to underscore his commitment to providing health care in remote locales.

“He had an amazing ability to build coalitions among the huge diversity and types of clinics,” said former state Senator Wes Chesbro of Arcata, Spetzler’s friend and supporter. “He built a broad political base.” The longtime CEO of Shasta Community Health Center, Dean Germano, who attended many conferences with Spetzler, said he “was often the smartest guy in the room.”

Modeled on a free clinic in San Francisco’s Haight-Ashbury neighborhood, Open Door began in 1971. “It became a clinic serving the broader low-income community in Humboldt County, then became the default clinic system for all citizens as mainstream primary care [physician] practices began to disappear,” Chesbro said. Today, experts say it is a national model for primary care.

Dramatic Expansion

Herrmann and Cheyenne Spetzler
Herrmann and Cheyenne Spetzler. Photo courtesy of the Spetzler family.

Spetzler and his wife, Open Door Chief Operating Officer Cheyenne Spetzler, are widely credited with expanding one tiny Open Door clinic into a string of 12 clinics and three mobile vans. Altogether, they provide a broad range of health services to an economically diverse and growing patient base in Humboldt and Del Norte Counties.

“Herrmann was the visionary, while Cheyenne provided the pragmatic assistance needed to implement those visions,” Chesbro said, “and they built a structure that would continue to grow.”

Chesbro was one of many elected officials who spoke to an overflow crowd of more than 500 at a memorial service for Spetzler in Arcata on April 2. The turnout was testament to the political reach of Spetzler’s collaborations and connections with other clinic directors, associations, and local, state, and federal lawmakers.

“He was a larger-than-life character,” said Bobbie Wunsch, a health care management consultant and longtime friend. “He was the kind of person that when you walked into a room, he lit up, he wanted to greet you personally, and he always asked about you. . . . He was a real conceptual thinker, always thinking about the next challenge.”

Spetzler was deeply committed to the health care safety net for low-income residents and co-founded or led multiple local, state, and national associations focused on rural health and primary care services. California State University in 2014 presented him with an honorary doctorate “in recognition of his enduring and extraordinary impact on North Coast rural health care.” He added that to a bachelor’s degree in geography from California State University, Los Angeles, and a master’s in education from Humboldt State University.

Dr. Bill Hunter had been practicing medicine on the North Coast for 20 years when Spetzler recruited him to become Open Door’s medical director in 1998. The two were kindred souls committed to providing quality health care to those who had none.

Primary Care for All

“Herrmann was such a strong leader, a great boss, great instincts about people and how they worked together, a really strong intuitive sense, and a tireless advocate for the particular needs of rural primary care,” Hunter said. As technology advanced, he said, Spetzler was “a really strong proponent of telemedicine, which is very important in rural areas.”

Archetectural rendering of clinic
The Fortuna Community Health Center now under construction. Rendering and design by Julian Berg of Arcata.

Spetzler pioneered a telehealth center, partnering with UC Davis Medical Center and specialists in big cities to link remote areas with specialty services that weren’t available in the region. Open Door deployed mobile vans for dental and medical care to remote sites in Humboldt and Del Norte Counties.

“Although it’s breathtakingly beautiful, there is also devastating poverty,” Hunter said.  According to 2015 US Census data, 21% of Humboldt and Del Norte residents live in poverty. “We started out taking care of so many marginalized people, and now we have become a big part of the primary care network in Northern California.”

Whenever the subject of retirement came up, Spetzler would avoid commitments, Germano said. Spetzler said he planned to retire after “one more project,” or that he had to “close the loop on this . . .”

After Spetzler’s death, Cheyenne Spetzler was named interim director of Open Door. “I’ve put my life into this organization,” she said. “I want to be sure we have a soft landing.” She is focused on completing current projects, including a 32,000-square-foot “state-of-the-art” clinic under construction in Fortuna, about 30 miles south of Arcata, and the accreditation of a residency program in rural health care for family practice physicians. Open Door already has residency programs for nurse practitioners and dentists.

“Herrmann’s vision is in good hands,” said US Representative Jared Huffman, D-San Rafael.

A Family of Immigrants From Germany

Herrmann was born in Nuremberg, Germany, in 1948, emigrating to the US when he was seven years old with his mother and four siblings to join their father, an engineer and watchmaker credited with inventing the self-winding wristwatch. His father had come to the US a year earlier. “It was a big deal,” Cheyenne said. “How do you take six kids away from their grandparents? And they don’t speak the language.”

But the family thrived in America, with all the Spetzler siblings earning advanced degrees (including two PhDs and two MDs). His four brothers and a sister live all over the US, and the extended family is close, with large reunions every two years. “Each sibling sets aside 1.5% of their gross annual income to pay for all the children, grandchildren, and their families to come to the reunions,” said Cheyenne. “That was Herrmann’s idea.”

The Spetzlers settled in Illinois. After he graduated from high school, Herrmann Spetzler moved to Southern California for college. Cheyenne was the divorced single mom of a toddler son working as a waitress at an Italian restaurant in Pasadena when she met her future husband. Herrmann, a Cal State LA student, was working in the seismology lab at the California Institute of Technology. “One of my jobs [at the restaurant] was to check the IDs of students,” she says. “I ‘carded’ him, and he was insulted. He made such a big fuss about it.”

After they married in 1973, they lived in Orange County in an apartment with Cheyenne’s 4-year-old son Gary from her previous marriage (who was adopted by Herrmann), and she was pregnant with their daughter Maria, now a physician assistant at Open Door.

Herrmann was hired by Orange County as assistant director of county mental health services and briefly served as interim director before he became executive director of the Sierra Council on Alcoholism and Alcohol Abuse in South Lake Tahoe.

The Green Hills of Arcata

The couple chose to move to Arcata partly because “it looked like southern Germany,” Herrmann’s birthplace, Cheyenne said. “When we first came [to Arcata], the hills were green, with patches of woods. . . . It was nostalgic, rural, and had a university.” Their third child, Gabriel, was born in Arcata.

Spetzler Family in 1977
Herrmann and Cheyenne Spetzler with their children Gary and Maria in Arcata in 1977. Photo courtesy of Cheyenne Spetzler

Spetzler was severely dyslexic, and his wife helped him with his college papers. “I think it is why he was so good at verbally communicating,” she said. “As technology improved, he could listen to everything. He listened to hundreds of audio books a year. He listened to the news in German so he could communicate with family in Germany.”

Spetzler extolled the natural beauty of the region to recruit highly qualified professionals to work at Open Door while also offering clinical support and training. He helped create and sustain the Clinic Leadership Institute, which provides training and mentoring for emerging health care professionals.

“He believed very deeply in fostering leaders in community health,” said Carlina Hansen, who for 17 years was executive director of the San Francisco Women’s Community Clinic. Hansen recently joined the California Health Care Foundation as a senior program officer working to improve access to care for the state’s low-income residents. “I first met him because I was an early participant in the Clinic Leadership Institute,” Hansen said. “He was a standout presence — a man of strong opinions, game-changing ideas, and a big, big heart. He’s done so much to develop leaders in community clinics.”

Herrmann created a unique and enduring template for rural health clinics, Hansen said. “The community clinic movement has always been extremely important in California, and rural clinics have their own unique challenges,” she said. “There can be a scarcity of providers and great distances to cover. Open Door is a real lifeline, often the only source of care, and very well-respected for the high-quality, comprehensive care that they deliver.”

Spetzler’s unexpected death leaves a huge void in the leadership of California clinics, especially in rural areas. But the structure he left in place will endure, said many clinic administrators, clinicians, and government officials. “My perception is that they are fully prepared to [carry] on,” said Chesbro.

“Herrmann directly or indirectly impacted the lives of tens of thousands of people,” he said. “One could only hope to have so much impact in one lifetime.”Related Tags: CHCF Goal: Improving Access to Coverage and CareCommunity Health CentersCommunity-Based CareFederally Qualified Health CentersProvidersTelehealthThe CHCF BlogSigrid Bathen

Sigrid Bathen is a Sacramento-based journalist whose award-winning health care coverage has appeared in many publications. She was a Sacramento Bee reporter for 13 years; a senior editor at the California Journal, a magazine about state government and politics; and communications director for three state agencies. She has been an adjunct professor of journalism and communications at California State University, Sacramento, since 1988. She can be reached at sigridbathen@gmail.com.

Clay Jackson, Sacramento Lobbyist

Clay Jackson, right, with his attorney, Donald Heller, in 1994 outside the federal courthouse in Sacramento. (Photo: Rich Pedroncelli/Associated Press)

Clay Jackson was once the most powerful lobbyist in Sacramento, representing the insurance industry and overseeing hundreds of thousands of dollars in campaign donations to politicians. His firm billed $2 million annually. But Jackson, along with 11 others, was caught in the FBI’s undercover corruption investigation of the state Capitol and wound up going to federal prison. The probe came to light in August 1988 following the FBI’s nighttime raid on the Capitol. The fallout of that investigation, one of the darkest episodes in the Capitol’s history, continued for years.

Here we present a two-part interview with Clay Jackson, once one of Sacramento’s most powerful lobbyists until he was convicted of federal political corruption charges and served more than five years in prison. He was interviewed by Sigrid Bathen, a journalist and lecturer at California State University, Sacramento

Clay Jackson, Part 1: Holding off the Future from Capitol Weekly on Vimeo.

Full transcript of Holding off the Future here

Clay Jackson, Part II: The Fall and After from Capitol Weekly on Vimeo.

Full transcript of After the Fall here.

For more information:

Sigrid Bathen’s 1995 interview, “Clay Jackson in Prison,” originally published in California Journal, is here.

Mario Gutierrez: Improving Access for All, “Giving Voice to the Voiceless”

The CHCF Blog

Mario Gutierrez: Improving Access for All, “Giving Voice to the Voiceless”

September 07, 2017

by Sigrid Bathen

Debra Johnson vividly recalls the day she met her future husband, Mario Gutierrez. She was a young physician interviewing for a position in an Indian health clinic in Mendocino County, and he was working for the California Rural Indian Health Board. It was 1982.

“I was invited to go to a community meeting, and there were several different tribes represented. The clinic was in trouble,” she said. “Mario was the only person I knew, and he signaled me to sit next to him. The meeting was getting more rancorous, more heated. People were calling people out. I sincerely thought it was going to come to blows in the parking lot. He turned to me and said, ‘I think I’ve had enough.’ And he went to the podium and said the tribes were going to have to come together and see this as a common good, and that the government was trying to keep them apart so they would remain as an underclass. After 30 minutes, he had them setting up a new board of directors and making a mission statement. I was just astounded. He could talk to a room full of people and make everyone feel important — and steer the ship in the direction it was meant to go. I thought, ‘This is a man I really need to get to know.'”

Mario Gutierrez

Gutierrez, a trailblazer who devoted his career to improving the health of people marginalized by disparities in California’s health care system, died on August 16 in Sacramento after complications from surgery. He was 68. Renowned in California as a pioneer in bringing health care to the rural poor, he gained national recognition for supporting telehealth programs to reach that goal.

For the past six years, Gutierrez was executive director of the Center for Connected Health Policy (CCHP), a program of the Public Health Institute, and a leader in the developing field of telemedicine. He was instrumental in the passage of California’s Telehealth Advancement Act of 2011. The following year, Gutierrez helped CCHP win a contract from the US Health Resources and Services Administration to serve as the federally designated National Telehealth Policy Resource Center. He also worked on a groundbreaking two-year pilot project for CCHP that linked 43 safety-net clinics across California with medical specialists at the five University of California medical schools. Before joining CCHP in 2010, Gutierrez served as director of strategic programs and director of rural health strategies at The California Endowment, a longtime supporter of telehealth.

 

Gutierrez saw telemedicine as “a way to enfranchise rural Americans and those with chronic conditions for whom access to care was difficult and costly. . . . He saw telemedicine as the great equalizer.”

Throughout his career, Gutierrez was heralded for bringing disparate communities together for a common purpose. “He was always really interested in helping those people who didn’t have a voice,” Johnson said. “Native Americans. AIDS patients when they were ostracized. Agricultural workers. He worked with communities of poverty that were rich in culture and banded together to improve public health through education and public development.”

Gutierrez saw telemedicine as a “way to enfranchise rural Americans and those with chronic conditions for whom access to care was difficult and costly,” she said. “He really thought that was the wave of the future for the poor. He saw telemedicine as the great equalizer.”

He was the first Latino to receive the prestigious Terrance Keenan National Leadership Award in Health Philanthropy in 2007, and he served on multiple health care boards and advisory panels.

Clinics Endure and Thrive

Longtime friend Jim Crouch, who succeeded Gutierrez as executive director of the California Rural Indian Health Board in 1987, said Gutierrez’s efforts were always based in “community organizing, facilitating, very much a community-focused public health approach to wellness — making things happen by making state law and policy.” He said Gutierrez’s lasting contribution was the “permanence of the structure” of the Indian Health Board, including clinics “from Bishop to Crescent City,” first created in the 1970s. “He created the structure, providing technical assistance, policy development, and advocacy,” Crouch said, enabling the clinics to endure and thrive.

Richard Figueroa, director of prevention for The California Endowment, said Gutierrez “lived the work.” He had a “real knack for connecting people who ordinarily wouldn’t connect — communities, funding sources — to collaboratively work on issues facing agricultural and rural communities,” Figueroa said. “He would always make the connections. It’s such a loss.”

When Gutierrez worked at the Sierra Health Foundation with Chet Hewitt, now its CEO, Gutierrez “was the ultimate bridge-builder, bringing together people with different perspectives and backgrounds without compromising populations that are too often marginalized,” Hewitt said. “He had a very rich history and extraordinary accomplishments in rural health, and was one of the first to focus on health in the Central and San Joaquin Valleys.”

Dr. Tom Nesbitt, associate vice-chancellor for Strategic Technologies and Alliances at UC Davis Health, shared Gutierrez’s interest in health disparities and telemedicine’s potential to ease them. “It was really never about the technology for Mario,” he said. “It was about the ability of technology to address health disparities — trying to remove barriers, reduce injustice and disparities, bring people together to create policy. He made everyone feel valuable — people in government, rural health, Native Americans, farmworker organizations. Everybody knew and trusted him as someone who was working for their benefit rather than his own.”

Moving Expertise Where It’s Needed

Nesbitt worked with Gutierrez in securing Sierra Health Foundation funding for telemedicine programs in the early 1990s. “It was slow going, difficult to get traction,” he recalls. “Now, as people talk about problems with access and geographic health care disparities, telemedicine is seen as a tool to move expertise where it’s needed.”

Gutierrez was a key participant in regular meetings of the 14 national and regional telehealth resource centers in the National Consortium of Telehealth Resource Centers. Deborah Peters, co-program director of the Pacific Basin Telehealth Resource Center, based at the University of Hawaii-Manoa, said Gutierrez was adept at “smoothing out the edges, without acrimony” to form an umbrella organization for the centers, which are in various stages of telehealth development. “Our situation is very different from California, or the Northwest,” she said, “with different infrastructure, varying levels of adoption [of telemedicine]. He had a vision for us. I can’t imagine what it will be like without him at our next meeting in October.”

The son of Cuban immigrants, Gutierrez grew up in Miami. He earned his bachelor’s degree at the University of Miami and a master’s in public health at UC Berkeley. His Cuban roots were strong, and he made frequent trips to Cuba with his wife, a plastic surgeon, as she performed reconstructive surgeries for international medical missions in developing countries. They developed programs to teach Cuban physicians new techniques. During his training, he took classmates to Cuba, gravitating to the health needs of residents, becoming close friends with the director of a pediatric hospital. Johnson said he was “perfectly bilingual” and enjoyed sharing his culture with family, friends, and colleagues.

“I was a great fan of his paella,” said Hewitt. “He was truly a Renaissance man, loved art, loved service, and had a deep devotion to the poor and disadvantaged. He lived a full life, cut too short, but his passion, his work left benefits for so many communities.”

In addition to his wife, Debra Johnson, Gutierrez is survived by their two children, Gabi and Pablo, and his brother, John Gutierrez. http://www.chcf.org/articles/2017/09/remembering-mario-gutierrez

Related: The CHCF Blog, Medi-Cal & Public Coverage, Telemedicine & Technology

About Sigrid

Sigrid Bathen is a Sacramento-based journalist whose award-winning health care coverage has appeared in many publications. She was a Sacramento Bee reporter for 13 years; a senior editor at the California Journal, a magazine about state government and politics; and communications director for three state agencies. She has been an adjunct professor of journalism and communications at California State University, Sacramento, since 1988. For more information, see www.sigridbathen.com.

LAO in retrospect: A conversation with Elizabeth Hill

Legislative snalyst Elizabeth Hill discusses her office's review of Gov. Arnold Schwarzenegger's revised 2007-08 state budget during a news conference in Sacramento, Calif., Tuesday, May 15, 2007. Hill said the governor's budget plan, released Monday, overstates California's reserve by 75 percent. (AP Photo/Rich Pedroncelli)

Legislative Analyst Elizabeth Hill discusses her office’s review of Gov. Arnold Schwarzenegger’s revised 2007-08 state budget during a news conference in Sacramento, Calif., Tuesday, May 15, 2007. Hill said the governor’s budget plan, released Monday, overstates California’s reserve by 75 percent. (AP Photo/Rich Pedroncelli)

Published April 25, 2016 on Capitol Weekly.

Elizabeth Hill became the first woman to head the California Legislative Analyst’s Office in 1986 when she was eight months’ pregnant with her second child. For 22 years, she held one of the most important positions in state government — advising the 120-member Legislature during fractious times and sometimes clashing over policy recommendations in an increasingly partisan environment beset by the passage of term limits, deep budget cuts, and recession.

Through it all, she quietly maintained a reputation as a no-nonsense, nonpartisan, data-driven, objective analyst of legislation, the state budget, and a growing number of ballot initiatives. She testified in countless hearings, was peppered with questions from legislators, state agency heads — even governors — and was always open with the news media, always on the record.

Nonpartisanship has been a hallmark of the office since it was created in 1941.

Sometimes the disagreements would devolve into invective, but Hill never wavered from her even, fact-based analysis, acknowledging that her job sometimes made her unpopular. “It comes with the territory,” she once told a reporter. At one point, she managed this mammoth, sometimes thankless responsibility with a staff of only 43.

Yet restrictions on budget and staff did not limit her ability to shape public policy, and in 2015, because of her influence on the state’s political and public developments, she was asked by the Center for California Studies at California State University, Sacramento, to be the subject of a detailed oral history (PDF)for the California State Archives.

Liz-Hill-290-WHill joined the LAO as a program analyst in 1976, following a steady climb from humble roots in the Central Valley city of Modesto, where she was born and raised. She earned degrees from Stanford and the University of California, Berkeley; served as a Fulbright Scholar in Sweden; and had stints with several state and local agencies. Four years after she was appointed to the top job, voters passed Proposition 140, the term-limits initiative that also cut legislative budgets and slashed the analyst’s office by 60%.

“It had a seismic effect on the office,” said Dan Carson, a former San Diego Union-Tribune Capitol bureau reporter who left journalism and joined the analyst’s office in 1995 — and stayed for 17 years. “But we found ways to develop new roles that were in keeping with the resources we had. And Liz pushed us forward on computer technology.”

“Everyone in that office is dedicated to the ethic of nonpartisanship,” former Republican Assembly member Roger Niello of Fair Oaks said when Hill retired, “because Liz has developed it that way.”

Despite the cuts, Carson and others said, Hill was personally and deeply involved in day-to-day decisions, while emphasizing a collaborative approach. “Any significant fiscal issue — she personally read and edited it, as the last line of defense for us,” he said. “She was very cognizant. She didn’t phone it in.”

Her employer was the Legislature — all 120 members — and she was widely viewed on both sides of the aisle as even-handed, thoroughly prepared, and a straight shooter. “She’s a solid shot with absolute, impeccable integrity. Couldn’t be any better,” John Vasconcellos, a powerful Santa Clara Democrat in the state senate, told a reporter when Hill announced her retirement in 2008. (Vasconcellos died in 2014.)

“Everyone in that office is dedicated to the ethic of nonpartisanship,” former Republican Assembly member Roger Niello of Fair Oaks said when Hill retired, “because Liz has developed it that way.”

Echoing other legislators, Denise Ducheny, a Democratic senator from San Diego at the time, said Hill’s departure “will leave a huge hole.” During legislative ceremonies after she announced her retirement, the San Francisco Chronicle reported how “evidence of her legacy rippled through the standing ovations from both sides of the aisle.”

With characteristic humility, Hill says nonpartisanship has been a hallmark of the office since it was created in 1941. From its inception, the analyst maintains credibility through nonpartisanship, she said, “providing untainted advice that is objective,” giving lawmakers the tools to make decisions about programs and policy.

When Hill left government, she said she initially spent time “decompressing,” traveling with her husband, Larry, who retired as director of cooperative education at California State University, Sacramento. She also wanted to spend more time with their two children, Erik, 34, and Kristina, 29, and two grandchildren. Today, at 66, Hill continues to focus on public policy issues in retirement, mainly health care and higher education.

In a wide-ranging April 4 interview for the California Health Care Foundation at her home in Sacramento, Hill spoke with veteran Sacramento journalist Sigrid Bathen about her path to becoming one of the most trusted and sought-after public policy experts in the state, and about how solid policy analysis can influence future decisions. Her recall for complex details, dates, and names is precise, razor-sharp — a quality often lauded by legislators, governors, other public officials, and her own staff. And while her long career in public policy spanned a range of issues, health care — especially access for low-income Californians — remains a major focus.


Ed’s Note: This interview originally appeared here on the website of the California Health Care Foundation, which gave Capitol Weekly permission to republish it. Sigrid Bathen, a former newspaper reporter, teaches journalism at Sacramento State and is a regular contributor to Capitol Weekly. The interview has been condensed and lightly edited.

Q: Your family has deep roots in the Central Valley, and you were born and raised in Modesto. Tell us about your early years.

A: My father was born there, and my mother moved there when she was three. Both my parents went to high school in Modesto, and I attended public schools. My father was a salesman with Leslie Salt Co., and my mom was an elementary school teacher. Stone was my maiden name. Our roots are still strong in the community. My mom is 90 now and still lives in Modesto. My father died about 20 years ago. My sister, Ann Falk, who worked in local government, lives in Turlock.

Q: You were active in debate in high school, and 4H, and were strong academically, attending Stanford University on a state scholarship. You also worked in university food services during the school year and summers in a tomato processing plant near Modesto. How did those vastly different cultural and academic experiences affect you?

A: I always knew that if I was going to attend college, I would need to get a scholarship. Luckily, a guidance counselor at my high school — we still had guidance counselors in those days — was a huge help to me, just to figure out how to navigate the waters when applying for college. I was a strong academic student, and had also been on the debate team. So I had a chance to actually visit a number of campuses throughout California for debate tournaments. One of them was Stanford, and I became very interested in that as a possibility. And UC Santa Cruz was just starting about the time I was graduating from high school, and I was quite intrigued by the cluster-college model. So those were the two places I applied, and fortunately, I got in to both.

Q: And then an opportunity to study in Sweden intervened, and that became a significant experience in your life.

A: Yes. After I was accepted at Stanford, I was also accepted into the American Field Service Program (AFS), which is based in New York City and matches the interests of accepted students with families around the world. And they felt that a family up in Umeå, Sweden, which is just shy of the Arctic Circle, was the best fit for me. . . . Stanford was really terrific about it. They said that while they couldn’t guarantee me a slot for the next year, they thought that it was a wonderful idea to participate [in AFS in Sweden] and to go — and, in effect, reapply. So that’s what I decided to do.

Q: Did you know any Swedish?

A: No. I had studied Latin and Spanish. Growing up in Modesto, we had gone up to the snow once, but I had never seen snow fall out of the sky. I really didn’t understand whole sentences for quite some time. But after three months, you know, I became more conversant. It was kind of comparable to a junior college-level education, which is a difference between the system in Europe and the American high school system.

Q: And you‘ve remained in touch with your Swedish family over the years?

A: It will be 50 years ago in 2018 that I went to live with them. And my children know my host sister’s children, and the next generation, our grandkids, are starting to know each other now that the world is a little smaller, with Skype and Facetime and the Internet.

Q: You remarked in the oral history that the families of some of your roommates at Stanford spent more on groceries in a week than your family did in a month. How did your different backgrounds and experiences affect your time there? How did you adjust?

A: I think the wonderful thing about growing up in California is that you’re influenced by all these different things. I had a really good public education. Then I had the opportunity to go to Sweden and learned a great deal about cultural differences, and had a different view of the United States from the outside looking in, which was really valuable. And I learned you could still have an incredible commonality with people even if your backgrounds were perhaps totally different. And I think it’s kind of driven by the Golden Rule, to be honest. Do unto others as I’d like them to do unto me, and that seemed to work out pretty well in terms of being professional and fair. At Stanford, I think that served me well. I was a bit unusual, being a scholarship student. I was very fortunate, and once the university admitted you, they sent you a strong message that they wanted you to succeed and would be helpful in seeing you through. . . . And again, I could learn from my colleagues there; I was fortunate that a new major had started when I was a freshman, called the Program in Human Biology, to try to look at folks by integrating biology and the behavioral sciences, which was actually an experimental program supported by the Ford Foundation — a nice tie to philanthropy. I just thought it was fascinating.

Q: You did food-service work at Stanford, where you held a job as a “hasher.”

A: That was what they called us in my day. I worked around 20 hours a week, and I later became the head of the hashing crew at our little part of Lagunita, which was the dorm complex where I lived. And then the human biology program had student advisors, and I was paid for that. And I worked in the summers, first at Contadina putting “eight great tomatoes in that itty-bitty can.” I also picked peaches and berries.

Q: You have said that experience gave you an appreciation for the challenges facing other workers at the Contadina plant.

A: Absolutely. The canning industry is seasonal by definition, depending on — in our case — peaches and tomatoes. And sometimes there are rains in the Central Valley in the summer. And when it rains, sometimes there are layoffs for a few days when the fruit isn’t harvested. I remember, very vividly, when we were laid off for a couple days, and I was walking behind some ladies as we left that evening, and they said, “Gee, I just don’t know how I’m going to make it without the couple days of income for that work.” And that struck me. I was earning money to be able to go to college. They were there just to make ends meet.

Q: Your major at Stanford was human biology, but you decided to focus on public policy, especially during your internship at the state Department of Transportation (now CalTrans).

A: The major at Stanford wasn’t a classic biology major, although a number of my colleagues in the major did go on to medical school and public health. Because it was a melding of biology and the behavioral sciences, there was a contingent of us who went into related areas like public policy, sociology, and psychology. It was fantastic. At first, I thought I would like to work in nutrition. And then I took my first chemistry-related course, and I realized, nope. . . . I can do nutrition, but not from the scientific point of view of a nutritionist.

Q: The program required an internship?

A: Yes, during the academic term. I became acquainted with Claire Dedrick, who later became secretary of resources under Jerry Brown during his first or second term. And I got very excited about public policy. I then had a chance to work with Assemblymember Clare Berryhill from the Modesto area who actually went to high school with my parents. I found I really enjoyed government. And the people of California had given me an opportunity to go to college with taxpayer dollars through the California Scholarship, supplemented by financial aid from the university. I was really interested in giving back through public service.

Q: After graduating from Stanford, you were accepted at the Goldman School of Public Policy at UC Berkeley, where you earned a master’s degree, working during the summer at Caltrans. After grad school, you went directly to the analyst’s office?

A: First I spent a year in Sweden as a Fulbright Scholar studying their transportation systems. Interestingly enough, when the analyst’s office had an opening upon my return, I was hoping it would be in transportation, but there was nothing available. So I ended up in criminal justice as my policy area.

Q: This was a very different policy area from transportation. Could you discuss the interrelationships among the various areas of public policy analysis — how health care, for example, is impacted by education, social services, criminal justice issues, even transportation?

A: One advantage that we had at the analyst’s office, as a small office, is that I encouraged the staff that if they thought an issue they were looking into had implications for another policy area in the office, they were supposed to walk down the hall and talk to a colleague about what the interaction was and where they could potentially partner on a potential solution. We clearly have huge health care needs in state prisons that also have some implications for the Medi-Cal budget, substance abuse, mental health. The interrelationship of those policy issues was something I really tried to emphasize during my time as legislative analyst. That’s not to say it’s easy to break down those barriers. I’m well aware that it isn’t. But that cross-fertilization I think enabled us to make some important recommendations. In 1993, for example, we made a proposal called Making Government Make Sense, and that encompassed not only health but social services, criminal justice — a whole variety of policy issues. And we were concerned about uniformity in service, particularly in health issues, so that you wouldn’t have as much variation from county to county. And so again, that kind of cross-fertilization certainly came to bear in our proposals.

Q: You clearly have a strong preference for data-driven objective analysis, while maintaining the historically nonpartisan nature of the LAO. How did the presence or absence of data and objective analysis influence policy outcomes when you headed the office?

A: A good example is our work on welfare reform. In 1997, the state had to respond to the elimination of the Aid to Families with Dependent Children’s (AFDC) program at the federal level. And we had been, of course, following social-services and welfare-related issues, cash-grant and work-related programs for many, many years. A lot of evaluations had been done of these programs. So when it came time in 1997 to assist the legislature in crafting the state’s response to the new federal requirements, one of the things we did was to point to the evaluation literature. What worked? But we also had a sense that some of the data wasn’t crystal-clear and wasn’t a full-powered evaluation, and was, frankly, more anecdotal evidence as to what might work. And so what we did in coming together with a proposal for the legislature on welfare reform was exactly to that question. . . . We thought, “Here are some really important messages coming out of this anecdotal evidence that the legislature should consider.” So sometimes, not enough work has been done to come to a conclusive decision. But you give it your best judgment, and you be explicit as to what has been “proven,” and what is instead anecdotal. And so we did that with a good deal of success in our welfare reform proposal.

Q: Do you think data-driven, objective analysis is well utilized in state government generally?

A: Objective analysis is one of many things that policymakers have to take into consideration. I think sometimes its impact may not be clear in the immediate term but becomes clearer in the long term. As local Assembly member Phil Isenberg would say, “Information is power,” and to get your facts straight and know where the weaknesses are in the information — and also the strengths. That can have a very powerful effect on decisionmakers.

Q: It must have been difficult when public officials would balk at your analyses, or sometimes yell at you or make profane comments.

A: I think when you work in the policy environment, you have to understand that analysis is one of many factors, that politics is kind of a contact sport, that my chosen line of profession was making powerful people uncomfortable, oftentimes with objective analysis. And so there were clearly going to be times that officials were not pleased. But if they knew you could be a straight shooter, be objective, evenhanded, and appreciate that they were elected to make decisions, and as staff we were employed to be advisers, not decisionmakers, it worked out. And I think sometimes folks don’t understand that difference, between advice and decision.

Q: You have told the story about the time when Assembly member Maxine Waters said she planned to vote for a budget item you were analyzing, and she told you, “I want you guys to be as hard as nails on that proposal. I want it to be improved.” Did most members have that view of your work?

A: Members who had been around quite some time understood what a neutral third-party could do for them in the policy arena. I think in the early years of a term-limited legislature, some new members had a harder time understanding how they could use the resources of the office . . . to benefit their decisionmaking.

Q: You always had an unusually good relationship with the news media during your tenure — certainly not the norm in government. How did you handle media requests, interviews?

A: We were always of the view that we had so much in common with reporters — trying to explain how state government worked, what was happening. We wanted to be as transparent and open as possible about that, and had the view that all of our staff should talk on the record and not offer their own opinions. But we also thought that the individuals who were responsible for the analysis were usually the best people for the media to talk to because they had the most expertise. I mean, you could talk to me about education, but it would be far better to talk to our education expert. We had debated, “Gee, in this media world, should we have a public information officer?” But ultimately, we decided that the way we were doing it — trying to connect media folks with our experts and talking on the record — was really important.

Q: You’ve said that health care has always been an important interest of yours. How does health policy differ from other types of policy?

A: That’s a really good question. In the analyst’s office, we were dealing with a whole variety of issues, from mental health to substance abuse to developmental services, public health, and Medi-Cal. And Medi-Cal is far and away the largest health program in California. While I didn’t do a deep dive into health [policy] in the analyst’s office, I was responsible for the overall analyses of the health budget. I think health is unique in that, while there are other policy areas that have some similarities, in health particularly it’s a partnership between the state and federal government, particularly when it comes to Medi-Cal. . . . When I retired [in 2009], roughly 6.5 million Californians were served by Medi-Cal; now that number is over 13 million. So it’s changed significantly, and largely because of the passage of the Affordable Care Act.

Q: In 2011, you decided to join the California Health Care Foundation board. What did you find appealing about that role?

A: It was right around the time that the Affordable Care Act was going in, and everybody has some health stories in their families. In my case, in the 1990s my mom had had fourth-stage fallopian tube cancer, a very rare cancer. And she, amazingly, pulled through. She was treated here in Sacramento at UC Davis — she’s 90 now. . . . And having dealt with health over the years, in all of its various permutations, I thought, “Gee, it would be really nice to do more of a deep dive.” Health affects everybody, and with the Affordable Care Act, hopefully I could be helpful to CHCF with my own state experience. I didn’t know that much about philanthropy, but CHCF was, I thought, really unique in that it was willing to work with government and find opportunities where it could be helpful to the government process, again with information, analysis, and data. And that was very intriguing to me . . . with many similarities to what we did in the analyst’s office. . . . I’ve found it incredibly interesting — great staff, great board of directors. And I think that the mission of CHCF is so important — to be sure that there is access to high-quality care for all Californians, with a particular focus on low-income individuals who often don’t have access, or the system isn’t working well for them.

Q: Have you found that your background in behavioral health, going back to your studies at Stanford in human biology, has been a factor in your work with the foundation?

A: We are really moving the foundation more into the behavioral health environment, which is a newer endeavor for us. But I think trying to see the whole person — both the physical and behavioral health ailments and the substance abuse issues that are also a part of behavioral health — that is very important, as is our continued emphasis on access to care, quality care.

Q: And end-of-life issues?

A: The foundation has done important work in that area. I’m a baby boomer, and knowing how many of us are coming, to be sure that high-quality care follows the patient’s wishes is really important. We also have a number of collaborations with other entities that are underway. We’re a fairly small foundation, and being able to collaborate with other partners to make a difference in people’s lives is really important.

Q: You utilized that collaborative philanthropic model to work with the UC Davis Comprehensive Cancer Center after your mother was successfully treated there.

A: I’ve had the opportunity as a CHCF board member to work with the Comprehensive Cancer Center at UC Davis to initiate a women’s cancer-care program. And I’m really pleased with how that’s been able to develop with a little seed money that I was able to direct their way as a director at CHCF. That happens to be where my mom got care, and I wanted to see if there were some things that we could do for other folks going forward. So it’s been an exciting time.

Q: As analyst, you emphasized the importance of field research to learn firsthand about the issues you were examining. In the oral history, you spoke of an early experience, a meeting in Los Angeles with a social worker and a client with a child in her lap trying to apply for Aid to Families with Dependent Children (AFDC). And you were struck by the complexity of the paperwork, and the challenges faced by that caseworker and her client. What did you learn from that experience?

A: That intake experience gave me a profound appreciation for what eligibility workers were facing as they were trying to manage a caseload of several hundred people, to be sure they were meeting all the requirements of federal and state law, and the client who was juggling a one-year-old on her lap as she was trying to answer all the eligibility questions and be honest and factual, and she wasn’t trying to cheat the system. . . . Ultimately, what the state budget and public service are about is understanding people’s needs and how to provide services in the most cost-efficient and beneficial way. And so it really brought it home to our little world in the analyst’s office and in explaining to members of the legislature how programs actually work, what it takes to deliver services in a cost-effective way.

Q: You went through draconian budget cuts in the LAO during your tenure. How did you maintain the quality of the work following passage of Proposition 140 in 1990, when term limits were imposed in the legislature, and your budget was slashed by 60%?

A: It was a challenging time. I think each legislative analyst has been shaped by some unique event during their tenure. Mine was certainly the Proposition 140 experience. The standards for excellence certainly predated me, and they were among the things that attracted me to the office. So when we lost 60% of our staff, we basically had to figure out how could we maintain our excellence, how could we keep the analytical focus, and how can we keep producing things that were required by statute — largely our ballot work — as well as what the legislature expected us to do on the state budget.

Q: How did you manage priorities?

A: We went from 105 to 43 employees at one point, over a two-year period — at the same time the state was in an incredible recession. I approached the legislative leadership and said, “We can’t do the same amount with 60% fewer people,” and I recommended to them that we no longer do all the bill analyses. I just didn’t see a physical way the office could do that. We still operated on a special-request basis, but we would no longer produce 3,000 bill analyses a year.

Q: What about the budget analyses?

A: In previous years, we analyzed every single item of the budget. After Prop. 140, we made a decision each year about where we were going to concentrate our efforts, but that basically, we were going to concentrate our staff resources where most of the money was, and the overall revenue and expenditures of the state. In effect, we tripled all of the analytical staff’s budget assignments as a way to make up for the loss of staff. . . . I think it is a really good case in point of the dedication of my colleagues at the Legislative Analyst’s Office who remained when a very dark cloud was hanging over our heads — and still produced solid, professional work. I think it’s a real testament to public servants.

Q: You were the first woman to be named legislative analyst, in 1986, when you were eight months‘ pregnant with your second child, your daughter. How did you manage issues of work-life balance and the needs of families versus demanding careers?

A: You know, I think for all of us, the work-life balance is a constant struggle. I was very fortunate in that my husband was very supportive of me working at the analyst’s office and throwing my hat into becoming the analyst even though I was eight months’ pregnant at the time that I was appointed. He worked at CSU Sacramento most of that time, and other than May, our schedules were different enough that we could complement each other. But May was particularly trying, both for the academic and the budgetary calendar. Initially, we didn’t have any family residing in Sacramento, and so we had to rely on neighbors and friends to help with picking up children. When our children got sick, one of us would take off in the morning, and one would take off in the afternoon. Clearly, during my tenure in the office, overtime was a big component, year-in and year-out and also during tough budgetary times. The budget often wasn’t done in time for summer vacation, so that always affected things as well. So it was tough on my kids at times. But it was also my dream job, my kids were flexible, and with my husband’s support we made it work.

Former California Legislative Analyst Liz Hill, Renowned Straight Shooter, Turns Her Focus to Health Policy

LizHill

Published April 20, 2016 on the California Health Care Foundation website.

After 22 years navigating state political waters, a respected policy expert looks back on a career that depended on objective facts and data, and explains why she chose to serve on the board of the California Health Care Foundation.

Elizabeth Hill became the first woman to head the California Legislative Analyst’s Office in 1986 when she was eight months’ pregnant with her second child. For 22 years, she held one of the most important positions in state government — advising the 120-member legislature during fractious times and sometimes clashing over policy recommendations in an increasingly partisan environment beset by the passage of term limits, deep budget cuts, and recession.

Through it all, she quietly maintained a reputation as a no-nonsense, nonpartisan, data-driven, objective analyst of legislation, the state budget, and a growing number of ballot initiatives. She testified in countless hearings, was peppered with questions from legislators, state agency heads — even governors — and was always open with the news media, always on the record.

Sometimes the disagreements would devolve into invective, but Hill never wavered from her even, fact-based analysis, acknowledging that her job sometimes made her unpopular. “It comes with the territory,” she once told a reporter. At one point, she managed this mammoth, sometimes thankless responsibility with a staff of only 43.

Yet restrictions on budget and staff did not limit her ability to shape public policy, and in 2015, because of her influence on the state’s political and public developments, she was asked by the Center for California Studies at California State University, Sacramento, to be the subject of a detailed oral history (PDF) for the California State Archives.

Hill joined the LAO as a program analyst in 1976, following a steady climb from humble roots in the Central Valley city of Modesto, where she was born and raised. She earned degrees from Stanford and the University of California, Berkeley; served as a Fulbright Scholar in Sweden; and had stints with several state and local agencies. Four years after she was appointed to the top job, voters passed Proposition 140, the term-limits initiative that also cut legislative budgets and slashed the analyst’s office by 60%.

“It had a seismic effect on the office,” said Dan Carson, a former San Diego Union-Tribune Capitol bureau reporter who left journalism and joined the analyst’s office in 1995 — and stayed for 17 years. “But we found ways to develop new roles that were in keeping with the resources we had. And Liz pushed us forward on computer technology.”

Despite the cuts, Carson and others said, Hill was personally and deeply involved in day-to-day decisions, while emphasizing a collaborative approach. “Any significant fiscal issue — she personally read and edited it, as the last line of defense for us,” he said. “She was very cognizant. She didn’t phone it in.”

Her employer was the Legislature — all 120 members — and she was widely viewed on both sides of the aisle as even-handed, thoroughly prepared, and a straight shooter. “She’s a solid shot with absolute, impeccable integrity. Couldn’t be any better,” John Vasconcellos, a powerful Santa Clara Democrat in the state senate, told a reporter when Hill announced her retirement in 2008. (Vasconcellos died in 2014.)

“Everyone in that office is dedicated to the ethic of nonpartisanship,” former Republican Assembly member Roger Niello of Fair Oaks said when Hill retired, “because Liz has developed it that way.”

Echoing other legislators, Denise Ducheny, a Democratic senator from San Diego at the time, said Hill’s departure “will leave a huge hole.” During legislative ceremonies after she announced her retirement, the San Francisco Chronicle reported how “evidence of her legacy rippled through the standing ovations from both sides of the aisle.”

With characteristic humility, Hill says nonpartisanship has been a hallmark of the office since it was created in 1941. From its inception, the analyst maintains credibility through nonpartisanship, she said, “providing untainted advice that is objective,” giving lawmakers the tools to make decisions about programs and policy.

When Hill left government, she said she initially spent time “decompressing,” traveling with her husband, Larry, who retired as director of cooperative education at California State University, Sacramento. She also wanted to spend more time with their two children, Erik, 34, and Kristina, 29, and two grandchildren. Today, at 66, Hill continues to focus on public policy issues in retirement, mainly health care and higher education.

In a wide-ranging April 4 interview at her home in Sacramento, Hill spoke with veteran Sacramento journalist Sigrid Bathen about her path to becoming one of the most trusted and sought-after public policy experts in the state, and about how solid policy analysis can influence future decisions. Her recall for complex details, dates, and names is precise, razor-sharp — a quality often lauded by legislators, governors, other public officials, and her own staff. And while her long career in public policy spanned a range of issues, health care — especially access for low-income Californians — remains a major focus.

This interview has been condensed and lightly edited.

Q: Your family has deep roots in the Central Valley, and you were born and raised in Modesto. Tell us about your early years.

A: My father was born there, and my mother moved there when she was three. Both my parents went to high school in Modesto, and I attended public schools. My father was a salesman with Leslie Salt Co., and my mom was an elementary school teacher. Stone was my maiden name. Our roots are still strong in the community. My mom is 90 now and still lives in Modesto. My father died about 20 years ago. My sister, Ann Falk, who worked in local government, lives in Turlock.

Q: You were active in debate in high school, and 4H, and were strong academically, attending Stanford University on a state scholarship. You also worked in university food services during the school year and summers in a tomato processing plant near Modesto. How did those vastly different cultural and academic experiences affect you?

A: I always knew that if I was going to attend college, I would need to get a scholarship. Luckily, a guidance counselor at my high school — we still had guidance counselors in those days — was a huge help to me, just to figure out how to navigate the waters when applying for college. I was a strong academic student, and had also been on the debate team. So I had a chance to actually visit a number of campuses throughout California for debate tournaments. One of them was Stanford, and I became very interested in that as a possibility. And UC Santa Cruz was just starting about the time I was graduating from high school, and I was quite intrigued by the cluster-college model. So those were the two places I applied, and fortunately, I got in to both.

Q: And then an opportunity to study in Sweden intervened, and that became a significant experience in your life.

A: Yes. After I was accepted at Stanford, I was also accepted into the American Field Service Program (AFS), which is based in New York City and matches the interests of accepted students with families around the world. And they felt that a family up in Umeå, Sweden, which is just shy of the Arctic Circle, was the best fit for me. . . . Stanford was really terrific about it. They said that while they couldn’t guarantee me a slot for the next year, they thought that it was a wonderful idea to participate [in AFS in Sweden] and to go — and, in effect, reapply. So that’s what I decided to do.

Q: Did you know any Swedish?

A: No. I had studied Latin and Spanish. Growing up in Modesto, we had gone up to the snow once, but I had never seen snow fall out of the sky. I really didn’t understand whole sentences for quite some time. But after three months, you know, I became more conversant. It was kind of comparable to a junior college-level education, which is a difference between the system in Europe and the American high school system.

Q: And you’ve remained in touch with your Swedish family over the years?

A: It will be 50 years ago in 2018 that I went to live with them. And my children know my host sister’s children, and the next generation, our grandkids, are starting to know each other now that the world is a little smaller, with Skype and Facetime and the Internet.

Q: You remarked in the oral history that the families of some of your roommates at Stanford spent more on groceries in a week than your family did in a month. How did your different backgrounds and experiences affect your time there? How did you adjust?

A: I think the wonderful thing about growing up in California is that you’re influenced by all these different things. I had a really good public education. Then I had the opportunity to go to Sweden and learned a great deal about cultural differences, and had a different view of the United States from the outside looking in, which was really valuable. And I learned you could still have an incredible commonality with people even if your backgrounds were perhaps totally different. And I think it’s kind of driven by the Golden Rule, to be honest. Do unto others as I’d like them to do unto me, and that seemed to work out pretty well in terms of being professional and fair. At Stanford, I think that served me well. I was a bit unusual, being a scholarship student. I was very fortunate, and once the university admitted you, they sent you a strong message that they wanted you to succeed and would be helpful in seeing you through. . . . And again, I could learn from my colleagues there; I was fortunate that a new major had started when I was a freshman, called the Program in Human Biology, to try to look at folks by integrating biology and the behavioral sciences, which was actually an experimental program supported by the Ford Foundation — a nice tie to philanthropy. I just thought it was fascinating.

Q: You did food-service work at Stanford, where you held a job as a “hasher.”

A: That was what they called us in my day. I worked around 20 hours a week, and I later became the head of the hashing crew at our little part of Lagunita, which was the dorm complex where I lived. And then the human biology program had student advisors, and I was paid for that. And I worked in the summers, first at Contadina putting “eight great tomatoes in that itty-bitty can.” I also picked peaches and berries.

Q: You have said that experience gave you an appreciation for the challenges facing other workers at the Contadina plant.

A: Absolutely. The canning industry is seasonal by definition, depending on — in our case — peaches and tomatoes. And sometimes there are rains in the Central Valley in the summer. And when it rains, sometimes there are layoffs for a few days when the fruit isn’t harvested. I remember, very vividly, when we were laid off for a couple days, and I was walking behind some ladies as we left that evening, and they said, “Gee, I just don’t know how I’m going to make it without the couple days of income for that work.” And that struck me. I was earning money to be able to go to college. They were there just to make ends meet.

Q: Your major at Stanford was human biology, but you decided to focus on public policy, especially during your internship at the state Department of Transportation (now CalTrans).

A: The major at Stanford wasn’t a classic biology major, although a number of my colleagues in the major did go on to medical school and public health. Because it was a melding of biology and the behavioral sciences, there was a contingent of us who went into related areas like public policy, sociology, and psychology. It was fantastic. At first, I thought I would like to work in nutrition. And then I took my first chemistry-related course, and I realized, nope. . . . I can do nutrition, but not from the scientific point of view of a nutritionist.

Q: The program required an internship?

A: Yes, during the academic term. I became acquainted with Claire Dedrick, who later became secretary of resources under Jerry Brown during his first or second term. And I got very excited about public policy. I then had a chance to work with Assemblymember Clare Berryhill from the Modesto area who actually went to high school with my parents. I found I really enjoyed government. And the people of California had given me an opportunity to go to college with taxpayer dollars through the California Scholarship, supplemented by financial aid from the university. I was really interested in giving back through public service.

Q: After graduating from Stanford, you were accepted at the Goldman School of Public Policy at UC Berkeley, where you earned a master’s degree, working during the summer at Caltrans. After grad school, you went directly to the analyst’s office?

A: First I spent a year in Sweden as a Fulbright Scholar studying their transportation systems. Interestingly enough, when the analyst’s office had an opening upon my return, I was hoping it would be in transportation, but there was nothing available. So I ended up in criminal justice as my policy area.

Q: This was a very different policy area from transportation. Could you discuss the interrelationships among the various areas of public policy analysis — how health care, for example, is impacted by education, social services, criminal justice issues, even transportation?

A: One advantage that we had at the analyst’s office, as a small office, is that I encouraged the staff that if they thought an issue they were looking into had implications for another policy area in the office, they were supposed to walk down the hall and talk to a colleague about what the interaction was and where they could potentially partner on a potential solution. We clearly have huge health care needs in state prisons that also have some implications for the Medi-Cal budget, substance abuse, mental health. The interrelationship of those policy issues was something I really tried to emphasize during my time as legislative analyst. That’s not to say it’s easy to break down those barriers. I’m well aware that it isn’t. But that cross-fertilization I think enabled us to make some important recommendations. In 1993, for example, we made a proposal called Making Government Make Sense, and that encompassed not only health but social services, criminal justice — a whole variety of policy issues. And we were concerned about uniformity in service, particularly in health issues, so that you wouldn’t have as much variation from county to county. And so again, that kind of cross-fertilization certainly came to bear in our proposals.

Q: You clearly have a strong preference for data-driven objective analysis, while maintaining the historically nonpartisan nature of the LAO. How did the presence or absence of data and objective analysis influence policy outcomes when you headed the office?

A: A good example is our work on welfare reform. In 1997, the state had to respond to the elimination of the Aid to Families with Dependent Children’s (AFDC) program at the federal level. And we had been, of course, following social-services and welfare-related issues, cash-grant and work-related programs for many, many years. A lot of evaluations had been done of these programs. So when it came time in 1997 to assist the legislature in crafting the state’s response to the new federal requirements, one of the things we did was to point to the evaluation literature. What worked? But we also had a sense that some of the data wasn’t crystal-clear and wasn’t a full-powered evaluation, and was, frankly, more anecdotal evidence as to what might work. And so what we did in coming together with a proposal for the legislature on welfare reform was exactly to that question. . . . We thought, “Here are some really important messages coming out of this anecdotal evidence that the legislature should consider.” So sometimes, not enough work has been done to come to a conclusive decision. But you give it your best judgment, and you be explicit as to what has been “proven,” and what is instead anecdotal. And so we did that with a good deal of success in our welfare reform proposal.

Q: Do you think data-driven, objective analysis is well utilized in state government generally?

A: Objective analysis is one of many things that policymakers have to take into consideration. I think sometimes its impact may not be clear in the immediate term but becomes clearer in the long term. As local Assembly member Phil Isenberg would say, “Information is power,” and to get your facts straight and know where the weaknesses are in the information — and also the strengths. That can have a very powerful effect on decisionmakers.

Q: It must have been difficult when public officials would balk at your analyses, or sometimes yell at you or make profane comments.

A: I think when you work in the policy environment, you have to understand that analysis is one of many factors, that politics is kind of a contact sport, that my chosen line of profession was making powerful people uncomfortable, oftentimes with objective analysis. And so there were clearly going to be times that officials were not pleased. But if they knew you could be a straight shooter, be objective, evenhanded, and appreciate that they were elected to make decisions, and as staff we were employed to be advisers, not decisionmakers, it worked out. And I think sometimes folks don’t understand that difference, between advice and decision.

Q: You have told the story about the time when Assembly member Maxine Waters said she planned to vote for a budget item you were analyzing, and she told you, “I want you guys to be as hard as nails on that proposal. I want it to be improved.” Did most members have that view of your work?

A: Members who had been around quite some time understood what a neutral third-party could do for them in the policy arena. I think in the early years of a term-limited legislature, some new members had a harder time understanding how they could use the resources of the office . . . to benefit their decisionmaking.

Q: You always had an unusually good relationship with the news media during your tenure — certainly not the norm in government. How did you handle media requests, interviews?

A: We were always of the view that we had so much in common with reporters — trying to explain how state government worked, what was happening. We wanted to be as transparent and open as possible about that, and had the view that all of our staff should talk on the record and not offer their own opinions. But we also thought that the individuals who were responsible for the analysis were usually the best people for the media to talk to because they had the most expertise. I mean, you could talk to me about education, but it would be far better to talk to our education expert. We had debated, “Gee, in this media world, should we have a public information officer?” But ultimately, we decided that the way we were doing it — trying to connect media folks with our experts and talking on the record — was really important.

Q: You’ve said that health care has always been an important interest of yours. How does health policy differ from other types of policy?

A: That’s a really good question. In the analyst’s office, we were dealing with a whole variety of issues, from mental health to substance abuse to developmental services, public health, and Medi-Cal. And Medi-Cal is far and away the largest health program in California. While I didn’t do a deep dive into health [policy] in the analyst’s office, I was responsible for the overall analyses of the health budget. I think health is unique in that, while there are other policy areas that have some similarities, in health particularly it’s a partnership between the state and federal government, particularly when it comes to Medi-Cal. . . . When I retired [in 2009], roughly 6.5 million Californians were served by Medi-Cal; now that number is over 13 million. So it’s changed significantly, and largely because of the passage of the Affordable Care Act.

Q: In 2011, you decided to join the California Health Care Foundation board. What did you find appealing about that role?

A: It was right around the time that the Affordable Care Act was going in, and everybody has some health stories in their families. In my case, in the 1990s my mom had had fourth-stage fallopian tube cancer, a very rare cancer. And she, amazingly, pulled through. She was treated here in Sacramento at UC Davis — she’s 90 now. . . . And having dealt with health over the years, in all of its various permutations, I thought, “Gee, it would be really nice to do more of a deep dive.” Health affects everybody, and with the Affordable Care Act, hopefully I could be helpful to CHCF with my own state experience. I didn’t know that much about philanthropy, but CHCF was, I thought, really unique in that it was willing to work with government and find opportunities where it could be helpful to the government process, again with information, analysis, and data. And that was very intriguing to me . . . with many similarities to what we did in the analyst’s office. . . . I’ve found it incredibly interesting — great staff, great board of directors. And I think that the mission of CHCF is so important — to be sure that there is access to high-quality care for all Californians, with a particular focus on low-income individuals who often don’t have access, or the system isn’t working well for them.

Q: Have you found that your background in behavioral health, going back to your studies at Stanford in human biology, has been a factor in your work with the foundation?

A: We are really moving the foundation more into the behavioral health environment, which is a newer endeavor for us. But I think trying to see the whole person — both the physical and behavioral health ailments and the substance abuse issues that are also a part of behavioral health — that is very important, as is our continued emphasis on access to care, quality care.

Q: And end-of-life issues?

A: The foundation has done important work in that area. I’m a baby boomer, and knowing how many of us are coming, to be sure that high-quality care follows the patient’s wishes is really important. We also have a number of collaborations with other entities that are underway. We’re a fairly small foundation, and being able to collaborate with other partners to make a difference in people’s lives is really important.

Q: You utilized that collaborative philanthropic model to work with the UC Davis Comprehensive Cancer Center after your mother was successfully treated there.

A: I’ve had the opportunity as a CHCF board member to work with the Comprehensive Cancer Center at UC Davis to initiate a women’s cancer-care program. And I’m really pleased with how that’s been able to develop with a little seed money that I was able to direct their way as a director at CHCF. That happens to be where my mom got care, and I wanted to see if there were some things that we could do for other folks going forward. So it’s been an exciting time.

Q: As analyst, you emphasized the importance of field research to learn firsthand about the issues you were examining. In the oral history, you spoke of an early experience, a meeting in Los Angeles with a social worker and a client with a child in her lap trying to apply for Aid to Families with Dependent Children (AFDC). And you were struck by the complexity of the paperwork, and the challenges faced by that caseworker and her client. What did you learn from that experience?

A: That intake experience gave me a profound appreciation for what eligibility workers were facing as they were trying to manage a caseload of several hundred people, to be sure they were meeting all the requirements of federal and state law, and the client who was juggling a one-year-old on her lap as she was trying to answer all the eligibility questions and be honest and factual, and she wasn’t trying to cheat the system. . . . Ultimately, what the state budget and public service are about is understanding people’s needs and how to provide services in the most cost-efficient and beneficial way. And so it really brought it home to our little world in the analyst’s office and in explaining to members of the legislature how programs actually work, what it takes to deliver services in a cost-effective way.

Q: You went through draconian budget cuts in the LAO during your tenure. How did you maintain the quality of the work following passage of Proposition 140 in 1990, when term limits were imposed in the legislature, and your budget was slashed by 60%?

A: It was a challenging time. I think each legislative analyst has been shaped by some unique event during their tenure. Mine was certainly the Proposition 140 experience. The standards for excellence certainly predated me, and they were among the things that attracted me to the office. So when we lost 60% of our staff, we basically had to figure out how could we maintain our excellence, how could we keep the analytical focus, and how can we keep producing things that were required by statute — largely our ballot work — as well as what the legislature expected us to do on the state budget.

Q: How did you manage priorities?

A: We went from 105 to 43 employees at one point, over a two-year period — at the same time the state was in an incredible recession. I approached the legislative leadership and said, “We can’t do the same amount with 60% fewer people,” and I recommended to them that we no longer do all the bill analyses. I just didn’t see a physical way the office could do that. We still operated on a special-request basis, but we would no longer produce 3,000 bill analyses a year.

Q: What about the budget analyses?

A: In previous years, we analyzed every single item of the budget. After Prop. 140, we made a decision each year about where we were going to concentrate our efforts, but that basically, we were going to concentrate our staff resources where most of the money was, and the overall revenue and expenditures of the state. In effect, we tripled all of the analytical staff’s budget assignments as a way to make up for the loss of staff. . . . I think it is a really good case in point of the dedication of my colleagues at the Legislative Analyst’s Office who remained when a very dark cloud was hanging over our heads — and still produced solid, professional work. I think it’s a real testament to public servants.

Q: You were the first woman to be named legislative analyst, in 1986, when you were eight months’ pregnant with your second child, your daughter. How did you manage issues of work-life balance and the needs of families versus demanding careers?

A: You know, I think for all of us, the work-life balance is a constant struggle. I was very fortunate in that my husband was very supportive of me working at the analyst’s office and throwing my hat into becoming the analyst even though I was eight months’ pregnant at the time that I was appointed. He worked at CSU Sacramento most of that time, and other than May, our schedules were different enough that we could complement each other. But May was particularly trying, both for the academic and the budgetary calendar. Initially, we didn’t have any family residing in Sacramento, and so we had to rely on neighbors and friends to help with picking up children. When our children got sick, one of us would take off in the morning, and one would take off in the afternoon. Clearly, during my tenure in the office, overtime was a big component, year-in and year-out and also during tough budgetary times. The budget often wasn’t done in time for summer vacation, so that always affected things as well. So it was tough on my kids at times. But it was also my dream job, my kids were flexible, and with my husband’s support we made it work.

Sigrid Bathen, adjunct professor of journalism and communications, California State University Sacramento

California Health Care Foundation


Herrmann Spetzler Remembered as “Visionary” Who Developed California Rural Clinics

Published May 1, 2018

In 1977, idealistic young people were moving to California’s strikingly beautiful but impoverished Humboldt County to escape urban congestion and do good works. One of them was Herrmann Spetzler, who came to the tiny city of Arcata to run a small counterculture health clinic called Open Door. Spetzler, a tall, bearded man with a German accent, wanted a safe, uncomplicated place that would suit a young family just starting out. He got that — and then he stayed for 40 years to pursue his vision of a health care system accessible to everyone regardless of income. Because of Spetzler’s leadership, thousands of people of all income levels in California’s rural northwest region receive medical care in an expanded network of modern facilities.

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Mario Gutierrez: Improving Access for All, “Giving Voice to the Voiceless”

Published September 7, 2017

 

Debra Johnson vividly recalls the day she met her future husband, Mario Gutierrez. She was a young physician interviewing for a position in an Indian health clinic in Mendocino County, and he was working for the California Rural Indian Health Board. It was 1982.

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LizHillFormer California Legislative Analyst Liz Hill, Renowned Straight Shooter, Turns Her Focus to Health Policy

Published April 20th, 2016

Elizabeth Hill became the first woman to head the California Legislative Analyst’s Office in 1986 when she was eight months’ pregnant with her second child. For 22 years, she held one of the most important positions in state government — advising the 120-member legislature during fractious times and sometimes clashing over policy recommendations in an increasingly partisan environment beset by the passage of term limits, deep budget cuts, and recession.

READ MORE

 

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