Sigrid Bathen

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The Elderly Health-Care Crisis Sneaking Up on Davis

by Sigrid Bathen published March 07, 1999


As Gov. Gray Davis relentlessly presses his education-reform agenda, other state business is seriously neglected. State department heads remain unappointed and policy in many key areas is virtually paralyzed. Many admirers and critics alike blame Davis’ legendary propensity to micromanage for the administration’s slow pace. One story has it that Davis is so obsessed with the minuscule details of his new administration that he has been known to spend 20 minutes pondering which secretary to send out on the next Federal Express run.

Perhaps nowhere is the current dearth of broad policy reexamination more apparent than in health care. Millions of children are without health care, and their elders face the daunting prospect of life in one of the state’s many substandard nursing homes, increasingly targeted by consumer activists.

This crisis in care for the state’s burgeoning elderly population could well become Davis’ health-care debacle, much as appalling conditions in state mental hospitals hammered his former boss, Gov. Edmund G. “Jerry” Brown Jr., in the 1970s. Recent reports about substandard conditions in state-licensed care facilities must have a deja-vu quality for Davis, who was frequently put in the awkward position of having to clean up the media and administrative messes in health care created by his unfocused boss. It may well be Davis’ memory of those years that infuses his achingly deliberate pace, but his caution could blow up in his face.

Last summer, the General Accounting Office (GAO), the investigative arm of Congress, issued a highly critical report on the quality of care in the state’s more than 1,400 nursing homes. Federal investigators found that one-third of them had been cited by state inspectors for “serious or potentially life-threatening care problems.” Many of the cases examined by the GAO involved the “early deaths” of elderly residents whose conditions went untreated.

The report is a sad and seemingly endless litany: patients lying in urine- and feces-soaked beds, bedsores to the bone; patients pleading for help and repeatedly ignored; nursing-home staff reporting therapy that was not provided, falsifying documents, failing to provide fluids and food, refusing to take patients to the toilet, failing to notify physicians or family members about the serious deterioration of patients.

It is troubling but familiar terrain for elder-care advocates like Charlene A. Harrington, a nursing and sociology professor at UC San Francisco. Director of licensing and certification of health-care facilities in the old state Health Department in 1975 and ’76, Harrington is doubtless remembered by Davis, who was Brown’s chief of staff at the time. Harrington was fired by Brown after she “decertified” state-run hospitals because of repeated, egregious licensing violations; parallel efforts to toughen enforcement sanctions against nursing homes were also largely ignored. She recalls that a scathing Little Hoover Commission report on nursing homes nearly a quarter-century ago came up with the same proportion of substandard nursing homes as the recent GAO report. “We’re not regulating the industry,” she says. “We’re not enforcing what is on the books now, and what is on the books is too low.” Much as she did more than two decades ago, she recommends tougher enforcement of licensing and care standards for nursing homes.

She and other elder-care advocates point to surveys showing that only about one-third of nursing-home budgets are spent on patient care, a figure the industry hotly disputes, and that CEO salaries and profits of the big nursing-home chains that increasingly dominate the industry are rising fast. (In 1997, industry revenue was about $5 billion, 70% of which was public funds.) In contrast with CEO compensation, the wages of “certified nursing assistants,” the backbone of the nursing-home industry, average just over $7 an hour. Industry officials agree that staffing and salaries must be improved, but they balk at increased fines.

But stiffer fines–the maximum is currently $25,000–and tougher enforcement are likely to command considerable legislative attention this session, as will efforts to tighten the current appeal process so that fines assessed by licensing inspectors are actually paid. “If you’re going to fine a facility for killing your mother,” says Patricia L. McGinnis, executive director of California Advocates for Nursing Home Reform (CANHR), “make it $100,000, not $25,000. My God, you can leave someone naked and tied to a wheelchair and you get a $500 fine. There are higher fines imposed for killing a dog in California.”
Recognizing the expanding universe of elder care, advocacy groups like CANHR and the American Assn. of Retired Persons are devoting more and more resources to other forms of in-home and residential care beyond the state’s nursing homes, which have beds for 120,000. As the population ages, the political climate may finally be ripe for major reform. As Californians increasingly “age in place,” that is, remain in their own homes as long as possible, services must become more available, affordable and safer. State law only recently required that nursing assistants and home health-care aides have criminal-background checks, but nonmedical, county-based In-Home Support Services personnel, funded by the state and federal governments, have no such requirement.

Criminal prosecutions involving elder abuse are increasing in frequency, and the state attorney general’s office is likely to step up such prosecutions in nursing homes through its Medi-Cal Fraud Bureau, which filed few cases under former Atty. Gen. Dan Lungren but is expected to have a much higher profile under Bill Lockyer. At the local level, prosecutors say it’s often pure happenstance when a case comes to the attention of law enforcement. Although some cases involve murder or assault by family members, other “caregivers” and nursing-home employees, more and more cases grow from financial exploitation of seniors, often in their own homes.

If stepped-up criminal prosecutions and increased state sanctions don’t stimulate nursing-home reform, civil suits and the threat they pose to companies’ bottom lines may be the spark. The California Supreme Court, in a landmark decision last week, upheld lower-court decisions awarding nearly $400,000 to the family of 88-year-old Kay Delaney, who died in 1993 at a Lake County nursing home after suffering from severe bedsores and lying in her own waste. In the unanimous ruling, justices raised the financial-liability limits of health-care providers that recklessly endanger the elderly. Also last week, the family of 75-year-old Ruth Witten, who choked to death last November in a nursing home near Sacramento, filed suit, contending that chronic understaffing at the Roseville Convalescent Hospital led to her death.

Fortunately, there are some signs that Davis is taking up health care. Early on, the governor named Grantland Johnson, a former federal health administrator and Sacramento County supervisor, as his health and human services secretary. “We have to look at tougher and more effective enforcement,” Johnson says. “We can be tough on the books, but if it’s not effective, it’s meaningless.” Johnson added, “It’s going to take us a while to settle on a methodical approach to this.”

But nursing-home and other residential care for the elderly has been the subject of countless state and federal hearings and reports over the decades. There are mountains of data pointing to horrific suffering and early deaths in nursing homes. The last thing elder-care reform needs is a “methodical” approach, which generally, in the language of government, means it will take a lot of time–a luxury Davis does not have.


Sigrid Bathen is senior editor of the California Journal, a monthly magazine about politics and government.

Can Another Task Force Lead Us to Education Reform?

by Sigrid Bathen published November 22, 1998


The day after Lt. Gov. Gray Davis’ gubernatorial victory, Assemblywoman Kerry Mazzoni (D-San Rafael), a former school-board member and current chair of the Assembly Education Committee, made a telling observation. “The voters have thrown us the ball,” she said. “We’d better not drop it.”

Not only had voters elected as governor a candidate whose No. 1 issue was education, they had passed a whopping $9.2-billion statewide school bond and numerous local bonds and sent a strong message that the state’s crumbling education system must be fixed. Mindful of this, Davis moved swiftly to appoint a 13-member task force on education, naming Barry Munitz, the former California State University chancellor and current president of the J. Paul Getty Trust, to head it. The team is charged with making immediate recommendations on how to fix California’s education network.

Yet another study group to ponder the state’s ailing education system, with its complex and special mix of problems, is hardly a new idea, though Davis’ task force is something of a precedent. The difference now is the extraordinary attention and money being focused on the schools, at all levels, and the pressing sense of urgency that reforms must come before yet another crop of ill-educated students graduate.

What is especially striking about Davis’ education task force is the influence of higher education on the panel (six of the 13 members are connected with the state college and university systems), which partly reflects the growing concern over the sorry state of teacher training, the main duty of the state’s colleges, and the heavy demands being placed on the system by unprepared high-school graduates who require intensive remedial education in college. California also needs to train considerably more, better-prepared teachers for schools facing huge population increases, as well as to meet the demands of class-size reduction.

Although the panel represents a broad spectrum of the education community–teachers’ union representatives, a pioneering elementary-school principal, the superintendent of a large district (San Diego), and charter-school advocates–it also includes business leaders and pointedly excludes the heads of several major statewide education groups routinely named to such study groups in the past. “Everyone wanted a seat,” Munitz says, “but this is not like a two-year study commission to look at the root causes of problems in K-12. We have key deadlines to meet, and we have to move quickly. . . . Our single most important deadline is to call a concurrent special session [on education].”

Among the notably absent are the state’s overburdened community colleges, with their maze of locally elected boards and a statewide governance system with limited authority. Nor are the state’s plethora of local school boards represented–some 1,000, all elected, with wide variations in district size and, many critics say, general competence–or the obscure county boards of education, one for each of California’s 58 counties, all elected, except for L.A. County’s, which is appointed by the Board of Supervisors. Perhaps the most daunting task of the education panel will be what, if any, recommendations it makes about this unwieldy system of governance, a subject hardly mentioned in any of the quick-fix political-reform proposals but at the heart of the state’s education quagmire. “It’s got to be streamlined,” Munitz says. At some point, he added, “we have to take a look at this massive truckload of an education code.”

Not only does California have a constitutionally mandated state superintendent–Delaine Eastin, elected to a second term–who has little real power over either the state education budget or local schools, but policy authority is vested in an 11-member state Board of Education appointed by outgoing Gov. Pete Wilson. Since Davis will have at least five–six by this summer–appointments to the board, the currently divisive relationship between the board and Eastin will doubtless change. It is unclear what, if anything, Davis will do about the “education secretary” position created by Wilson, the latter’s attempt to create a Cabinet-level education post that was repeatedly rebuffed by the Legislature.

While Eastin and Davis reportedly have dealt with the fallout from Eastin’s decision in the primary to do a TV ad extolling then-Democratic candidate Al Checchi for supporting her education-funding proposals, she will be expected to toe the line and defer to the governor-elect on education. Munitz puts it bluntly: “[Davis] is the sole, senior intellectual leader, and she is a member of that team.”

A key member of the Davis task force is Gary K. Hart, a former state senator and Santa Barbara high school teacher who is codirector of California State University’s Institute for Education Reform. Former chair of the Senate Education Committee, Hart says the diverse backgrounds of task-force members represent both “its strength and its challenge” in reaching consensus on such issues as teacher preparation, early reading instruction and the twin reform buzzwords of “accountability” and “excellence.” A school-accountability measure, which would have held local school-site officials responsible for student performance, was vetoed by Wilson last session. Some type of accountability proposal–“one with teeth,” Munitz says–will probably be a centerpiece of the education package Davis submits to the Legislature. “We have to explore many options,” says Hart. “No one has a corner on this market. If you want to put together a package that is credible, and will get through the Legislature, all sides have to come to the table. Everyone, including the employee groups [the teachers’ unions] will have to give up something.”

Task-force members are moving through some uncharted territory in devising legislation for a special session. The announcement Thursday by the state legislative analyst that a $1-billion budget deficit may be looming for the 1999-2000 fiscal year puts a damper on new spending proposals. But the legislative proposals will probably target teacher preparation and training, school accountability and early reading proficiency, to name a few.

The California Teachers Assn. was a major Davis contributor and will certainly influence the content of the task force’s recommendations, though Munitz says “no constituency owns this governor.” The task force’s staff director, named two weeks ago, is Rick Simpson, a former teachers association lobbyist and longtime legislative staffer who is education advisor to Assembly Speaker Antonio R. Villaraigosa (D-Los Angeles). He takes on the staff role, he says, “with the speaker’s” blessing.

Simpson concedes that the accountability or “rewards and consequences” aspect, clearly one of the most difficult legislative elements of the education-policy stew, will present the most formidable challenge for the panel. What rewards? What consequences? At the individual, school or district level? What about factors such as poverty and language differences? “It is fraught with political land mines,” he says, “and some technical land mines, as well. . . . You need to do it carefully, and not punish them for factors that are not in their control.”


Sigrid Bathen, a longtime education writer, is senior editor of California Journal, an independent monthly magazine that covers state government and politics.

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