Sigrid Bathen

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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.

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.

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

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