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


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

Tackling the teacher tenure issue

The reasons for job security provisions are valid and date back decades, but the system needs streamlining.

by Sigrid Bathen published May 20, 2009


Well into the 20th century, teachers in the United States were treated as school property, paid meager salaries and expected to do the bidding of boards and principals. Black teachers of either sex could teach only in substandard segregated schools, and female teachers — black or white — could be summarily dismissed for all variety of reasons: wearing skirts above the ankle, being out in the evenings or even getting married.

Mary Louise Phillips was a young elementary school teacher in Phoenix in the fall of 1941. She was teaching her first class of third-graders in a segregated school and quietly seeing a fellow teacher she had met in college, Wilson Riles, who worked seven hours of treacherous mountain roads away, at a one-room school for the children of black sawmill workers in the tiny northern Arizona town of McNary.

The two young teachers wanted to get married — but if they did, she would lose her Phoenix job immediately. “Wilson said I had to consent to marry him,” recalls Mary Louise Riles, now 89, “or he’d have to stop making that drive.” So they eloped, managing to keep the marriage secret for a couple of months, until she joined her husband as a teacher in McNary, where the rules for married teachers were less rigid.

Three decades later, Wilson Riles would be elected California superintendent of public instruction, becoming California’s first African American elected to statewide office.

The origins of teacher tenure are firmly rooted in rank discrimination against women and were closely tied to the women’s rights movement. California was the first state to mandate “permanent” status for teachers, after two years on the job, in 1921. Other states followed. But most of those gains were swept away in the midst of the Depression. And in one form or another, capricious, even sexist rules governing teachers were commonplace well into the 1960s and ’70s. All teachers were at risk if they spoke out at board meetings or engaged in political activity that went against prevailing opinions in their districts.

In one key California case, Paul Finot, who taught at John Muir High School in Pasadena, was reassigned to home teaching in 1963 for refusing to shave a beard he’d grown over the summer. Eventually vindicated by an appeals court, he was asked in a lower court hearing if his beard was “an outgrowth” of his “radicalism,” and he replied that it was “an outgrowth of my six-week fishing trip.”

It was in that era that newly emergent teachers unions used their growing clout to challenge the laws and push for tenure everywhere — along with better pay, collective bargaining and due process in disciplinary actions that included the establishment of a quasi-judicial system to oversee dismissals. But nearly four decades after those victories, the system originally designed to improve working conditions and protect teachers against arbitrary terminations has evolved into a tangled and costly bureaucratic nightmare.

Critics argue that tenure protects incompetent teachers beyond all reason, keeping them on at a time when schools face draconian budget cuts, high dropout rates and gaping inequalities. Teachers’ groups counter that teachers deserve due process and that administrators fail to properly document and prove poor teaching.

Although measures to curb abuses of the dismissal process, and even to abolish tenure altogether, have been recently introduced in several states, such measures continue to meet fierce opposition from teachers unions, which are loath to give up any of the hard-won job protections built up over decades.

Clearly, the public’s patience is wearing thin. (A recent Times series documented the cumbersome discipline and dismissal process for teachers in horrific detail.) The layoffs of thousands of mostly younger, newly minted teachers in budget-strapped California has only exacerbated disaffection with the deeply troubled seniority system, which governs layoffs as well as assignments of “surplus” teachers when schools are closed or programs cut.

Privately, and sometimes publicly, traditionally warring education organizations — teachers unions and school administrators — insist they want lousy teachers removed from the classroom. But they rarely stand together on even the general parameters of a viable solution. Schools need better documentation of incompetent teaching, more support for teachers and fewer standardized directives on how to teach. All of this requires cooperation and compromise, and costs money.

Any overhaul of “post-tenure” teacher discipline must peel away multiple layers of administrative and legislative changes made over decades in order to create a more sensible and coherent system — one that recognizes the due process rights of teachers as well as ways to help them move on.

But any movement toward streamlining the process must begin with less finger-pointing and more serious dialogue among the key players in state education policy. This is not a new sentiment — but one that remains singularly unpopular in the state Capitol, where teachers unions (and their hefty campaign contributions) wield enormous clout.


Sigrid Bathen is a longtime education writer who teaches journalism at Cal State Sacramento.

A Success Story for Kids Who Can’t Make It in Regular School

by Sigrid Bathen published January 02, 2000


For 30 years, Miles P. Richmond was a special-education teacher and administrator in some of the poorest, toughest schools in the Sacramento area, retiring in 1990 as director of special ed for the Grant Joint Union High School District. He is legendary for maintaining a model special-ed program in the impoverished, fractured, politically volatile district that, most recently, made national headlines when a popular senior was murdered in a shop classroom after school, allegedly by an ex-con working as a janitor.

Grant is not a district usually touted as a model to follow in this age of education reform. But Richmond and a group of mostly retired colleagues are quietly working small miracles in a battered old school in a bleak north Sacramento neighborhood. They are part of a growing “alternative school” movement, education bureaucratese for programs that offer alternatives to the regular classroom for the huge population of students who cannot, for many reasons, attend regular classes. While they are students most clearly in need of help from an education system now targeted for unprecedented infusions of attention and cash, it remains to be seen how much they will actually benefit. Veterans like Richmond are understandably skeptical.

Unlike the developmentally disabled kids who were the focus of Richmond’s work for decades, students at the Grant Independent Learning Center, in general, are not physically or mentally limited. Their low achievement has more to do with their lives at home, where drug use, abuse and grinding poverty narrow their options. They may be in foster care, wards of the juvenile-dependency court, and they may have committed crimes. Many are teen mothers headed straight for public dependency. Some are unusually bright, bored and uninspired by the regular curriculum.

They are kids like Jessica (not her real name), who never believed that she could succeed in school. Gifted in art and a voracious reader, she was unable to enroll in the regular school curriculum because she is needed at home to help care for her mother and baby brother. Five other siblings were removed from the home because of her mother’s lifestyle, which Richmond described simply as “men, booze and drugs.” There is no mention of a father.

One of Jessica’s recent paintings was of a forest after a fire. “All the trees were burned, but there was some green coming up out of the earth,” says Richmond. “It was about her mom, her family, the drugs.” When Jessica met Richmond’s wife, Betty, she wanted to know how long they had been married. Answer: 46 years.

Long-term personal commitment isn’t a quality the kids at Grant Independent Learning Center know well, if at all. The stories of the 2,500 kids who have gone through the program in the past five years–most have graduated, many going on to college–are nothing if not daunting.

Like the homeless girl living with her family in their car, who was at the center for two weeks, then disappeared. While at the center, she wrote a poem about homelessness. Entitled “The Other People,” it spoke of “babies in the street, families without hope” and urged onlookers “disgusted” by the homeless not to be too quick to judge. “If you ask me,” the girl concluded, “without the money and the fancy things, we’re all the same.”

“That just grabbed my heart,” recalls Richmond. “We’re going to lose some really bright, valuable kids unless we discover them, and they’re not all wearing Polo sweatshirts.”

A key element of Richmond’s work with the kids in this alternative school, who must sign a contract, complete all assignments and meet with their teachers once each week–more frequently if they don’t finish their work–is the creation of a personal journal. Every morning, students take 15 minutes to write their thoughts down–about anything they choose. There are no computers, no word processors, not even any typewriters in this classroom, and generally none in the homes where the kids live.

Like many unusual and largely unsung alternative programs throughout California, the Grant center is something of a haven for these kids, though it mirrors inner-city schools everywhere–inadequate facilities and funding for books and supplies, technology or the arts. “We’re lucky if we have enough paper and pencils,” says Richmond, “and for a while last winter, we didn’t have any heat.” Yet, the kids have become so enamored of their newfound ability to put thoughts on paper that if he forgets to have them do their journal writing, they remind him.

He especially remembers one student’s entries. “She had a perfect attendance record, was doing great and thinking maybe she really could be a writer,” says Richmond. “One day before school, her boyfriend came over. He had the day off and was pestering her to stay home with him.” She persistently refused, saying she had to go to school, and he kept pressuring her to stay home.

“Finally–and she wrote these very words in her journal that day–she told him; ‘F— you, I’m going to school.’ ” And she did.

“We thought about translating that into Latin, if that’s possible,” Richmond mused, “and putting it on a banner on the wall as a kind of monument to this one girl’s determination to go to school. She lives in two worlds: the world here in independent study, where she has dignity, and the other world, where she is a survivor.”

The personal hurdles many of the kids in programs like Grant’s must overcome are often so overwhelming that their teachers mainly concentrate on just getting them to attend school. While many teachers give mightily of their own resources and time to kids with seemingly insurmountable problems, as Richmond did and does, many others “do their time” and get out, transferring as soon as possible to schools in better neighborhoods.

The 11,000-student Grant district, which includes 12 senior high and middle schools, has expanded the successes of the five-year-old Independent Learning Center (recently named Keema High School, after a popular former district superintendent, Elwood J. Keema) into four community outreach centers, and will send teachers into students’ homes if necessary. Randy Orzalli, director of education options for the district and principal of Keema, is working to expand the program further. He hopes to make the school a center for training teachers in the needs of alternative-school students.

Richmond and his mostly retired-teacher colleagues–the program includes five former principals on its faculty–meet every school day with the kids in the independent learning center, bringing magazines and books from home, eating lunch with their students, saving souls–and a life or two or three–and skeptical that the intense public and political focus on education will translate into money, attention or reform for the state’s most troubled schools and the kids most in need of help. To accommodate the push for class-size reduction, it has been estimated that some 250,000 new teachers must be trained in the next decade. California’s teacher-training system, widely criticized for its rigidity and its mediocrity, will face some serious testing of its own in coming years. Gov. Gray Davis, in his continuing push for education reform, has said he will make teacher training a major priority in his annual budget proposal.

“We can put up a modern building and buy new desks and chairs and bright, shiny textbooks,” says Richmond, “but too often we’ve lost the creativity in education. I don’t think Christ had a credential, or Gandhi, and Plato taught from a stump. Sure, we could use computers, and we need a safe, clean building to work in, and only as many students as you can handle. . . . We have 1975 National Geographics and used textbooks, and we use the free Sacramento Bees we get: the kids say they want practical education, and the stock quotes in the paper are great for teaching math.

“Kids are coming out here, and they’re writing and reading and computing. It’s teaching on the stump. And it works.”

Sigrid Bathen, an adjunct professor at Cal State Sacramento, has written extensively on education.

The Deeper Inequality Behind the AP-Course Suit

by Sigrid Bathen published October 17, 1999

SACRAMENTO — A class-action suit challenging that most fundamental of equal education rights–access–may well force the state’s education establishment to examine its two-tier system of public education, one for the children of the reasonably well-to-do, the other for everybody else. The suit has been likened to the landmark 1971 Serrano vs. Priest, which forced the state to address “wealth-related disparities” in school funding.

“Legally, it’s not a hard case,” said Mark D. Rosenbaum, legal director for the ACLU of Southern California and the lead attorney on the ACLU suit. “The state can turn this case into a model of response. California could, with an appropriate response to the question of these disparities, reassert itself as the crown jewel of education.”

The ACLU sued the state of California, not the governor, who has made education reform his “first, second and third” priority, and not the University of California, though UC’s admissions standards are at the heart of the controversy. Neither does the suit directly target inequality in the early grades, where it all begins, nor UC admissions policies, which were challenged earlier this year in a federal-court suit by a coalition of civil rights groups. Rather, it focuses on the vaunted system of “advanced-placement” college-prep courses that earn extra grade points and are increasingly critical to a student’s admission to UC schools.

In 1998, according to the suit, UC Berkeley rejected 8,000 applicants whose GPAs were 4.0 or higher, instead admitting students who had earned the extra grade points associated with the more rigorous AP courses. At UCLA, last year’s applicants had an average GPA of 4.19, and those students had taken an average of nearly 17 AP and honors classes. These courses are not widely available to predominantly minority students in many inner-city high schools nor to many white students in rural schools.

Although the suit is aimed at all schools with limited AP offerings, the named defendant, in addition to the state and Superintendent of Public Instruction Delaine Eastin, is the Inglewood Unified School District, which offers few AP courses to its predominantly African American and Latino students. The ACLU cites some sobering statistics: Inglewood High School offers only three AP courses; 129 California public high schools with 80,000 students do not offer any AP classes; and 333 schools offer four or fewer. In contrast, Beverly Hills High, with a student body that is 76.6% white, offers 14 AP “subjects” and 45 AP classes; the 144 public high schools in California that offer more than 14 AP classes are 65% white or Asian American. “In the face of its own data,” says Rosenbaum, “with its eyes wide shut, California places hundreds of thousands of its children on uneven playing fields sodded with quicksand.”

Legal hyperbole perhaps, but there is certainly no shortage of hard data to support it. There are also increasing indications that the state’s education bureaucracy is poised to take action on several fronts. Since nobody in the hydra-headed education leadership is interested in taking on the ACLU and its largely unassailable statistics in court, some kind of negotiated settlement is likely and long overdue. The gathering storm of data is overwhelming: the steep drop in minority admissions to UC since passage of Proposition 209 in 1996, and, just last month, the announcement of an alarming disparity between whites and other ethnic groups in college entrance exams.

Michael E. Hersher, general counsel in the state Education Department, says a “programmatic solution” is likely to the dilemma raised by the ACLU suit. “It may take a couple of months to work out between the superintendent and the governor and the plaintiffs, but we have a history of working things out with the ACLU, and they have a pretty pragmatic sense of how far we can go. . . . This is a genuine equity issue, and I think it will have enough political push to bring about a solution.”

In California’s quirky, often unmanageable education-governance system, the elected state superintendent heads the Education Department, but policy is made by the state Board of Education, which is appointed by the governor. Eastin and Gov. Gray Davis are both Democrats but historically sometimes at odds. Davis has been clear from the outset of his administration that it is he, not the superintendent, who sets the state’s education agenda.

Davis’ education secretary, former state Sen. Gary K. Hart, will be a key player. While not addressing the suit directly, Hart says Davis is “certainly enthusiastic” about AP courses. “It is consistent with his theme, his philosophy, his expectations. . . . Anything that encourages students to reach higher and take the toughest courses, he certainly supports that.”

AP courses are a subject Hart knows well. When director of the California State University Institute for Education Reform, Hart initiated a study of AP courses and their impact on student achievement and college readiness. The 21-page, largely unpublicized report, by William Furry, a veteran education advisor to the Legislature and deputy state education secretary in the administration of former Gov. Pete Wilson, reviewed AP courses in California secondary schools for 1997-98.

Noting that the AP program “has enjoyed explosive growth in California high schools in the past decade,” the report concluded that this growth has come “with little public attention and even less analysis.” At the same time, competition for admission to top universities, including UC, has become staggeringly intense, often hinging on the successful completion of AP-course work, which, according to the Furry report, makes college applications “more alluring and weighted for success.” The study utilized state and national databases to determine the availability of AP classes, the rate of student participation and their performance on the crucial AP exams.

In 1988, 39,040 public high school students took 56,668 AP exams. A decade later, those numbers had risen to 87,683 students and more than 145,000 exams. In the fall of 1997, 210,000 students were enrolled in AP classes, although Furry notes that the statewide database does not account for the number of individual students participating in the program, and many students take more than one AP class.

The report notes “certain key concerns,” in addition to the lack of statistical and programmatic analysis, about AP courses. Among them: the “elitist” nature of the program, which favors those “who have access to the best academic preparation–essentially providing only one favored subset of students with important tools for career success.” A corollary concern: “whether there is systematic bias against students because of location, gender or ethnicity.” Although AP courses are offered in inner-city schools, their availability is nowhere near that of many schools in suburban areas. Rural schools fare no better. More than 90% of California’s high schools offer AP courses, but many students, across all ethnicities and socioeconomic strata, have limited AP opportunities.

Furthermore, the report concludes, “in schools across all levels of AP-program size,” Latinos and African Americans participate at rates “substantially below their share of total school enrollment.” Those who do participate score lower than white and Asian students, and nearly one-third don’t take the required post-course exams. In a range of 1-5 (5 being the top score, 3 a passing score), blacks had the lowest scores: 64.6% scored a 1 or 2, Latinos only slightly better. By contrast, 32.7% of whites and 37.4% of Asians who took tests scored 1 or 2.

“In the final analysis, it’s not so much the availability [of AP classes] as the preparation [for them],” Furry says. “In schools with large populations of low-income minority students, the minority students, by and large, are not participating.” But he said the assertion that suburban schools have “a plethora of AP classes” and minority, low-income schools do not “is just not true.” Many schools have added AP courses in the past two years.

“The bottom line is that mandating AP classes is not going to solve the problem,” he says. Asked what will, he said: better preparation, “beginning in kindergarten.”

Better preparation translates into many things: better schools, better teachers, smaller classes, well-equipped facilities and that sometimes elusive but crucial requirement, stable home lives. The idea that kids from impoverished, fractured families in unsafe, drug-ridden central cities have an even chance is ludicrous on its face. But the notion that they can’t succeed if given real opportunity in the form of better schools, textbooks, computer labs and, most important, good teachers is the worst kind of institutional race and class discrimination.

The readiness of students to embark on an AP curriculum without having been prepared throughout their school lives is the deeper issue that educators and politicians are often loathe to address. “It’s not just race, it’s class as well,” says the ACLU’s Rosenbaum. “If it were Beverly Hills High School or Pacific Palisades that had no AP courses, that situation would last for a nanosecond.”

Sigrid Bathen, an adjunct professor of journalism at Cal State Sacramento, has written extensively on education

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.

Viewpoints: Plan to close UC Center seems ill-advised

by Sigrid Bathen, special to The Bee published November 13th, 2009

Twenty-five University of California students and graduates from UC campuses were gathered around a long table in a windowless basement conference room in downtown Sacramento for a brown-bag lunch. On one side were 10 recent graduates, many working in and around the Capitol, who had participated in a popular public policy program – a program they say prepared them more than any other college experience for the realities of working in politics and public policy. Across the table at the recent gathering were 15 current students, many about to graduate with bachelor’s degrees from UC in such diverse fields as political science, mathematics, economics, sociology, psychology and literature.

The session was part of an intensive orientation at the University of California Center in Sacramento before students begin internships in state legislative and government offices, at nonprofits and lobbying and consulting firms. The grads were advising the new students on what to expect in their internships, how to get the most benefit from the experience. “Don’t be afraid to ask questions,” they said. And “show initiative.”

More than 500 students have completed the program since it began in 2004. But this gathering was “bittersweet,” as one student put it, because the fall-quarter class may be the last in a widely praised program that was abruptly suspended by UC President Mark Yudof in August, as UC officials struggle to balance a precarious budget. The action has generated a storm of criticism, and UC administrators are reportedly rethinking how they can keep the effective program in Sacramento.

One of the grads at the brown-bag lunch, Kelly Bradfield, came to the center as a “scholar-intern” in the summer of 2007; she was about to graduate from UC Berkeley with an English degree, specializing in gender and sexuality in literature. While considering a public policy career, she lacked practical experience. Placed in an internship with Planned Parenthood, she wrote a paper on the public policy aspects of mandatory vaccination for the HPV virus that causes cervical cancer and was later hired as a policy analyst at the UC Center. Echoing the views of other grads, she said the program “prepared me more than any other academic experience” for working in the Capitol.

Bradfield’s job and those of four other staffers, several adjunct professors and a visiting scholar were eliminated. Director Gary Dymski, who founded the center six years ago and taught many of its public policy classes, is teaching the current – and likely final – class but is expected to return to his tenured position as a UC Riverside economics professor.

Associate Director A.G. Block, a veteran Sacramento political editor who was hired in 2005 to oversee the center’s summer public affairs journalism internship program, remains as the center’s administrator. While the UC Berkeley Graduate School of Journalism is one of the finest in the nation, UC has no undergraduate journalism major and offers few journalism classes; the intensive summer program was an effort to fill that gaping academic void.

University officials say the cuts to the UC Center saved the budget-strapped UC system $850,000, but those familiar with the center’s most recent proposed budget say it had been slashed to a bare-bones $650,000.

One block from the Capitol, the center served a rich mix of academic and public service functions and fostered an unusual sharing of public policy and media expertise among UC and California State University faculty, legislative and administration officials, nonprofits, lobbyists and other policy experts who participated in seminars on wide-ranging policy issues.

“It’s too valuable an institution to lose,” said Barbara O’Connor, a communications professor who heads the Institute for the Study of Politics and Media at CSUS. She suggests UC administrators help “break down the silos” so ingrained in academic politics and work with CSU and the California Community Colleges to keep the center open.

State legislators and members of the UC Board of Regents have also reportedly urged Yudof to reconsider his decision. Rich Zeiger, chief of staff to Assemblyman Tom Torlakson, D-Antioch, whose daughter was a UC Center intern and whose office employs another intern as a scheduler, said the UC Center is “one of the few programs that demonstrates to policymakers exactly what the university does – the teaching, the research and the public service. All are brought directly into legislators’ offices every day.” To abruptly discard that role is foolish, he added “particularly when UC relations with legislators are not the best.”

UC spokesman Peter King said the UC administration is engaged in “more detailed discussion” about the future of the center, and a decision will likely be made in December. UC Davis spokeswoman Maril Stratton confirmed reports that UCD administrators are having “initial discussions” with Yudof’s office about a possible “lead role” in maintaining the center.

Placing administrative responsibility for the center on one campus creates its own set of political hurdles and potential for inter-campus rivalries. “At the end of the day,” said Zeiger, “this needs to look to the students and the Legislature as it looks now – an independently functioning unit.”


Sigrid Bathen teaches journalism at California State University, Sacramento, and is a volunteer editor and mentor in the University of California Center journalism program. She can be reached at [email protected].

Doctors’ drug tests: a divisive issue

Doctors’ drug tests: a divisive issue

by SIGRID BATHEN posted 10.19.2014

On Oct. 23, 2013, San Diego physician Dr. Scott D. Greer submitted urine and hair samples to an investigator for the Medical Board of California, which oversees physician licensing and discipline.  Laboratory tests found the samples to be positive for opiates and oxycodone, but not for alcohol. Nearly one year later, on Sept. 8, according to Medical Board records, Greer was placed on probation for seven years by the board.  His license was suspended for 30 days, effective Oct. 24; he agreed to myriad restrictions and requirements, including submitting to regular, random alcohol and drug testing and monitoring.
“If he tests positive for anything, he will be notified to immediately cease practice,” said Cassandra Hockenson, public affairs manager for the Medical Board.


The issue of testing doctors for drug use is a key part of Proposition 46, which has become the focus of huge campaign spending — most of it spent to defeat the initiative.  The measure also would raise the cap on pain and suffering awards in medical malpractice cases, which has been $250,000 since the 1970s, to reflect cost-of-living increases. If approved, the new cap would be about $1.1 million.

The tragic deaths of two young children in 2003, killed by a drug-impaired driver who had been prescribed prescription narcotics by several doctors – a practice called “doctor-shopping” — helped spark the measure, which would also require physicians to consult a state prescription database before prescribing addictive drugs. Bob Pack, the father of Troy and Alana Pack — 10 and 7 when they were killed — left his tech job to pursue legislative solutions, and is a principal spokesman for Prop. 46.

Opponents of Proposition 46, mainly medical malpractice insurers and the powerful California Medical Association, are pulling out all stops – dumping some $57 million into the “No” campaign, roughly $50 million more than supporters of the measure, primarily consumer groups and trial lawyers.

In the case of Greer, 62, he had voluntarily sought help for his long history of alcoholism and drug use after an “intervention” by his family in 2012. He had tried to kick his decades-old habit many times before. For several years, starting in 2003, Greer participated in a beleaguered “doctor diversion” program, administered by the Medical Board and abandoned in 2008 as ineffective, failing to protect patients in the care of participating doctors.

Greer admitted to investigators that he relapsed, providing false urine samples while in the controversial diversion program, which was scrapped by the state after multiple government and independent audits revealed major flaws.

In addition to random laboratory drug-testing, a major part of Greer’s probation includes twice-daily use of the Soberlink breathalyzer test. Results are immediately transmitted with a photograph of the subject via a mobile phone attached to the device.

 “The measure as written is a mess,” says Jason Kinney, a spokesman for the No on 46 campaign. “The drug testing provision is particularly problematic.”

The Greer case marks the first use of the technology by the state board for monitoring physician compliance on probation. “It’s potentially a very powerful monitoring tool for those with alcohol problems,” said Greer’s attorney, David Balfour of Carlsbad, who specializes in physician discipline cases, “because it can provide results instantaneously, [unlike] a random urine screen, which is typically how the board has monitored [physicians].”

Details of the disciplinary actions against Greer and other physicians are posted on the state Medical Board website, www.mbc.ca.gov.

Critics of Proposition 46 say the initiative is flawed.

“The measure as written is a mess,” says Jason Kinney, a spokesman for the No on 46 campaign. “The drug testing provision is particularly problematic.”

But testing doctors for drugs is popular with focus groups and in polls of likely voters. It is privately favored by many physicians, especially those recovering from addiction issues, who argue California needs more official incentive for doctors to seek help – and liability protections for colleagues who may be reluctant to report them.

“At its peak, the diversion program had 300 to 400 participants,” says Balfour, yet the number of Medical Board enforcement actions is considerably lower. “Two-thirds are not getting treatment. In the larger context, if 10 percent of the population [has addiction issues], 12,000 doctors would need some level of help. Not having any official program is a bad outcome.”

The investigative function of the Medical Board, a so-called “self-funded” agency supported by physician licensing fees, was moved in July to the state Dept. of Consumer Affairs.

More than 128,000 physicians are licensed to practice in California, and Greer is believed by critics of the state’s doctor-discipline system to be one of hundreds – perhaps thousands — of physicians who abuse alcohol and drugs. Many may well be practicing while “impaired” and do not seek help from a patchwork physician treatment system long acknowledged by experts to be ineffectual and potentially dangerous to patients in the care of drug- or alcohol-addled doctors.

According to the Medical Board’s annual report, 394 physicians were disciplined in some way in 2012-2013, with actions ranging from license revocation (11) to probation (41) or public reprimand (47). Reasons ranged from “gross negligence” (130) to sexual misconduct (24).

Disciplinary actions for “self-abuse” of alcohol or drugs numbered only 46, with nearly half being placed on probation.

California is one of the few states in the U.S. without an official program to direct physician substance abusers into treatment and monitoring. Legislation to create a new diversion/treatment program has repeatedly failed in the state Legislature.

The investigative function of the Medical Board, a so-called “self-funded” agency supported by physician licensing fees, was moved in July to the state Dept. of Consumer Affairs after Gov. Brown signed legislation last year to reorganize board staff. In the spring of 2013, legislative oversight hearings and intense consumer-group protests over excessive physician prescribing of painkillers prompted sharp legislative criticism of the board’s failure to “protect consumers.”

The Legislature ultimately approved extending the board for four more years, but in July moved its 100-plus investigators to the Division of Investigations within the Consumer Affairs Department. The state Attorney General’s office has long had prosecutorial responsibility for board enforcement actions.

The latest legislative effort to create a physician diversion program was AB 2346 by Assemblywoman Lorena Gonzales (D-San Diego), which proposed a diversion program similar to a State Bar program for lawyers.

Julianne D’Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego Law School, has long followed physician discipline issues in California, and is a former state monitor for the Medical Board, issuing one of several scathing audits of the physician diversion program.  She often testifies in the Legislature about physician-discipline issues, and is widely regarded as an expert in the field.

“There are now three layers,” she said of the recent Medical Board reorganization. “The Medical Board, the Division of Investigations and the Attorney General’s office. We won’t know the actual impacts until after the move.” Fellmeth said she would have preferred that investigators be placed in the Attorney General’s office, to work more closely with prosecutors on enforcement cases involving physicians.

Highly critical of the diversion program, she does not favor creation of a similar successor.

“All the doctors insist that [the program] must be secret and confidential, otherwise no doctor will go into it,” she said. “So if there is a program, it [will be] secret. Patients aren’t going to find out about it.” She recalls attending a Medical Board meeting when the diversion program was in effect, when a patient appeared, uninvited, at one of the board’s public meetings, after learning that a plastic surgeon who operated on her, and several others, several years earlier, was in the diversion program.

“It was a botched plastic surgery,” Fellmeth said, “and she told the board she knew a bunch of people who had been injured by him, and they [former patients] had put up a website. Her surgery was in 2001. The physician’s license was finally revoked in 2009 for lying to investigators.”

The latest legislative effort to create a physician diversion program, Fellmeth said, was AB 2346 by Assemblywoman Lorena Gonzales (D-San Diego), which proposed a diversion program similar to a State Bar program for lawyers. “She insisted it be absolutely confidential,” Fellmeth recalled. “The State Bar program has been around for 10 years, and only 11 percent have completed it. I don’t consider that to be a successful program.”

‘A Lame Program’
“The decision to get rid of diversion was progress,” she added. “It wasn’t protecting patients, or doctors. It was a lame program. It could be gamed.”

Many hospitals require some form of drug-testing, but not all doctors have hospital privileges.

“In my experience, the problems are with doctors who don’t have privileges, who work in clinics,” Fellmeth said, citing the highly publicized 1990 case of Dr. Milos Klavana, a Valencia obstetrician who was convicted of second-degree murder in the deaths of eight infants and one fetus. The Medical Board came in for harsh criticism from patient advocates and the judge in the case for failing to intervene.

The recent Greer case is particularly instructive as a bellwether of the discipline system – and the use of high-tech, instantaneous drug testing to monitor doctors on probation.

Greer has been open about his addiction since seeking treatment in 2012, agreeing to a rigorous monitoring program and admitting to past failings. He acknowledged to investigators that he had long been abusing alcohol and drugs while still treating patients, and Medical Board public records show four DUI arrests between 1992 and 2002, with three convictions in 1992, 2000 and 2002. He entered the diversion program in 2003.

“There is no way to trace that. It’s like near-misses, like a drunk driver who has driven 300 times drunk before being caught.”

Medical Board investigators also note several brushes with San Diego law enforcement over assault allegations in 2012 involving a reported attack on a male friend, a former patient, whom Greer threatened with an ax, and an alleged “incident of domestic violence” involving a girlfriend, also a former patient, for whom he was prescribing painkillers. Neither pressed charges, according to Medical Board records, and there were no convictions, although the Sept. 8 disciplinary action by the Medical Board includes writing prescriptions for the former girlfriend without performing a required examination.

“Amazingly, there is no evidence that [Greer’s] drinking has ever resulted in any mistreatment of a patient under his care,” Dr. Mark Kalish, a psychiatrist who evaluated Greer, wrote in a report to the board. “I also don’t think there can be any question that if [Greer] continues to abuse alcohol, patient care will be compromised. The question is not if it will happen, but only when.”

Unless patients are seriously injured, or die, or file lawsuits, it is difficult to determine how many patients may have been harmed by alcohol- and drug-impaired physicians, and patient advocates blame the secrecy of the system for preventing patients from easier access to information about investigations and prosecutions. Statistics and many medical-journal articles show that physicians who do seek help, and are treated by effective programs – called Physician Treatment Programs (PTP’s) or Physician Health Programs (PHP’s) – have a very high rate of success over time, as high as 80 or even 90 percent, according to some articles.

Dr. Stephen Loyd, 47, a Tennessee physician who 10 years ago sought help for his heavy addiction to prescription pain killers through a Tennessee state program, is a frequent, albeit out-of-state, spokesman for Prop. 46. He says “nobody knows” how many patients have been harmed by drug- or alcohol-addled physicians. “There is no way to trace that. It’s like near-misses, like a drunk driver who has driven 300 times drunk before being caught.”

“I had all kinds of potential for harm,” Loyd added. “I wasn’t mean. I wasn’t psychopathic, but I harmed patients in other ways. I had a patient that I got to give me back pills one time. When he found I had gone into treatment for drug addiction, he told me he felt like he ‘caused’ me to ‘get addicted’. . .That is harm, although it didn’t dawn on me at the time that I owed him an apology. I’ve since apologized.”

For doctors who are hiding in bathrooms, they’re miserable, they’re dying. When you first intervene, they’re not going to be happy campers.”

Loyd, chief of medicine at the Mountain Home Veterans Administration Medical Center in Johnson City, Tenn., and an associate professor at East Tennessee State University Medical School, went into treatment after his father confronted him about his drug use. “I’d evaluated myself,” he said. “I was drowning, dying. I self-reported [to the state], and I was in compliance from Day One. I am one lucky SOB. I love my damn life. I get to be a doctor. I used to fuss about the check I had to write every two years for my license. I look at life differently. As bad as it was, my professional life was not suffering. But my wife had had it.”

His son and daughter were 7 and 9 when he went into treatment. His son, now a 20-year-old college sophomore, wants to go to medical school and become an addiction specialist.

Loyd said he supports Prop. 46 because, unlike Tennessee and other states, California has no official system for doctors to get help. “Assuming 2 percent prevalence, there are 2,500 to 3,000 docs who are actively addicted,” Loyd said, “but there is no mechanism, no leverage, to get them into treatment programs.” And while random drug testing of physicians – as called for in Prop. 46 — “won’t be the magic bullet,” he said, “it is an initial deterrent.”

“People look at this as being punitive,” he added. “But for doctors who are hiding in bathrooms, they’re miserable, they’re dying. When you first intervene, they’re not going to be happy campers.”

A September USC/LA Times poll showed weak support for the measure, with 50 percent opposed, 37 percent in favor and 12 percent undecided. Dave Kanevsky of American Viewpoint, the Republican pollster in the bipartisan survey team, characterized approval for the measure as “a mile wide and an inch deep.” Support “looks strong but starts to fold when voters hear both sides,” he told the Los Angeles Times. Sixty-eight percent of those polled favored the provision for drug-testing of doctors.

“We ought to be able to do as well as Alabama, where we were doing about 80 physician interventions a year, in a state with 13,000 practicing physicians.”

Dan Schnur, director of the Jesse Unruh Institute of Politics at USC, said proponents of the measure – mainly consumer groups and trial lawyers – “were very smart. They tried to cover up a controversial measure (limits on malpractice awards) with a popular one (doctor drug testing).” But, he added, “a ballot measure is only as strong as its weakest link.”

Like most legislating-by-initiative, lacking action by a state Legislature repeatedly unable to agree on workable laws to effectively regulate either physician drug use or doctor discipline, the measure is widely regarded as legally flawed – and, like most initiatives, likely to be challenged in court.  Once again pitting doctors and lawyers over malpractice caps, the measure includes provisions such as random drug testing – and a requirement that doctors consult a statewide prescription drug database before prescribing addictive drugs – which are sure to capture public interest.

California Needs Education, Intervention
According to Medical Board records, Greer had been licensed to practice since July 27, 1981. He had graduated magna cum laude in 1974 from UC-Irvine with a Bachelor’s degree in biological sciences, received a Master’s in biochemistry from California State University, Long Beach, in 1976, and a medical degree from the University of Utah in 1980. He did his internship and residency in internal medicine at Los Angeles County/USC Medical Center and a fellowship in gastroenterology at Scripps Clinic.

He entered private practice in 1985 and currently works for the Center for Family Health in San Diego. He is by many accounts a conscientious and caring physician, when he’s clean and sober, which his attorney says he has been since his family intervened and he entered treatment in 2012.

Dr. Gregory Skipper, an addiction specialist and author of many medical-journal articles on physician addiction treatment, is director of the Promises Physician Treatment Program in Santa Monica, where Greer was treated. He cannot discuss specific patients, but is quoted in Medical Board documents as one of the physicians who treated and/or evaluated Greer. Skipper has run or advised physician treatment programs in other states, including Alabama and Oregon, and says California is remiss in not having a program for doctors needing help.

“It’s such a startling fact that California doesn’t have [a program],” Skipper said. “There needs to be a program for education and intervention, which is what other states have. We ought to be able to do as well as Alabama, where we were doing about 80 physician interventions a year, in a state with 13,000 practicing physicians. We are so behind in this in California.”

“If it’s just discipline and enforcement, that’s not enough,” he added. Protection for colleagues who may want to report an impaired physician – sometimes called a “snitch law” – is necessary, he said, which requires physicians to report a colleague’s impairment, but protects the reporting physician from liability. As for drug testing, he said, “if it’s done willy-nilly, it will be unsuccessful.” He favors drug testing of physicians at key junctures in their careers — “before appointment to a hospital, for license renewal.”

And, like most physicians, he favors confidentiality for doctors receiving treatment. “It’s a medical condition,” he said. “It should be private. If doctors refuse to cooperate, they should be reported immediately.”

Ed’s Note: Sigrid Bathen, a Sacramento journalist who has frequently written about physician discipline, is a regular contributor to Capitol Weekly. She teaches journalism at California State University, Sacramento and can be reached at [email protected]

Democrats divided: The race for state schools superintendent

By Sigrid Bathen posted September 23, 2014


For an obscure elective office that is often ignored, unknown or regarded as superfluous in California’s convoluted education bureaucracy, the November election for state Superintendent of Public Instruction is shaping up as one of the most contentious — and costly — races among statewide candidates.

The superintendency typically is viewed as a down-ticket backwater – a nonpartisan office with limited power that some say should be abolished.

Superintendent Tom Torlakson, 65, a mild-mannered former state legislator, Contra Costa County supervisor and high school science teacher, against charter-school administrator Marshall Tuck, 41, a Harvard Business School graduate who worked for several years in Silicon Valley and on Wall Street.

But this year, it has become a lightning rod for widespread dissatisfaction with schools in California, which have consistently been ranked among the lowest-performing and poorly funded in the nation.

At the center of the campaign battle is a Superior Court judge’s blistering decision favoring the plaintiffs in Vergara v. California, a closely watched lawsuit challenging the state’s cumbersome, expensive, teacher-tenure and dismissal system. And while ostensibly nonpartisan, the race between two Democratic candidates in a heavily Democratic state has revealed long-standing divisions among Democrats over education reform.

“This is a battle that has been raging [within] the Democratic Party for about 20 years, but it has become quite fierce,” Dr. Raphael Sonenshein, director of the Pat Brown Institute at California State University, Los Angeles, recently told the education news service, Cabinet Report. “In California, with Democrats so dominant, you look for issues that are going to divide the majority party, and I think this one is pretty close to the top.”

The election pits an embattled but well-funded incumbent Superintendent Tom Torlakson, 65, a mild-mannered former state legislator, Contra Costa County supervisor and high school science teacher, against charter-school administrator Marshall Tuck, 41, a Harvard Business School graduate who worked for several years in Silicon Valley and on Wall Street before founding the highly regarded Green Dot Charter Schools. Later, he was CEO of former Mayor Antonio Villaraigosa’s Partnership for L.A. Schools.

Another round of independent expenditures – which by law cannot be coordinated with the candidates’ campaigns – is expected in the general election season.

While outspent in the primary by Torlakson supporters – primarily massive spending by the California Teachers Association and other unions — Tuck has major support from several wealthy pro-charter donors, including philanthropist Eli Broad and businessman William Bloomfield. Tuck’s campaign benefited from some $1.4 million in independent expenditures, including several large contributions from the California Senior Advocates League PAC, a group funded primarily by Broad and Bloomfield.

Tuck was been endorsed over Torlakson – in the primary — by all major California newspapers, which is unusual so early in the election season.

The CTA and other unions spent $2.6 million in the primary for broadcast and print ads for Torlakson, and another $2 million for “issue ads,” which featured Torlakson but don’t expressly advocate for the candidate.

Another round of independent expenditures – which by law cannot be coordinated with the candidates’ campaigns – is expected in the general election season, although both candidates and their handlers are understandably vague about when or how much. A recent spate of independent expenditures on Torlakson’s behalf came from the CTA, the state and national Federation of Teachers and other labor unions – some $450,000 as of Sept. 19, according to Election Track and the Secretary of State’s office.

According to state financial disclosure records, both candidates reported less than $200,000 cash on hand as of June 30 – $194,550 for Torlakson and $179, 913 for Tuck. Total reported expenditures by each candidate from Jan. 1 through June 30 were very close – more than $1.14 million for Torlakson and just over $1 million for Tuck. But as of mid-September, a sharp uptick in candidate contributions favored Tuck, with $381,000 for Torlakson and $448,000 for Tuck.

Consultant: “There was a horrible turnout in the primary and [likely to be] horrible in the general. It’s very hard to get anybody’s attention — unless you have money.”

“There is a ton of money involved,” said Kim Alexander of the nonpartisan California Voter Foundation, a nonprofit which monitors campaign spending and elections. “The unions appear to be stepping up for Torlakson because he has an opponent who has demonstrated he can raise significant amounts of money.”

Getting the Word Out. . .
A veteran campaign consultant knowledgeable about the election said funding for the schools is improving with the economy and strong public support for school funding, but getting the word out is difficult, and running for a little-known state schools office requires campaign cash.

“Unfortunately for a lot of us who care deeply about these issues,” said the consultant, who asked not to be identified, “this is the most difficult time to run for statewide office. There was a horrible turnout in the primary and [likely to be] horrible in the general. It’s very hard to get anybody’s attention — unless you have money. . .

“If you look at the people who fund Tuck’s campaign, they have a very different view of what is a public school, and ‘reform’ is often code for vouchers. People upset with the schools are upset with the cutbacks — no money for counselors, for nothing but the bare minimum. This was the first spring when there haven’t been pink slips. Because of Proposition 30 (Gov. Brown’s sales and income tax initiative, which was passed in 2012 and strongly supported by Torlakson), there is now some capacity to put money back into the schools.”

“I support due-process rights for teachers, but the law is broken and needs to be changed,” he said. “The tenure process is dysfunctional.” — Gary Hart

Tuck, who has never run for public office, says he decided to run after his efforts in the L.A. Partnership, aimed at turning around 17 dismally performing schools in low-income, central-city neighborhoods, were repeatedly stymied by arcane teacher hiring and dismissal rules in an entrenched education bureaucracy.

The strongly worded Vergara decision on June 10 — and reaffirmed in a final ruling on Aug. 28 — came at a fortuitous time for the upstart young candidate, galvanizing public opinion on school inequality and teacher tenure. Los Angeles County Superior Court Judge Rolf M. Treu said K-12 education in California “shocks the conscience” and is flatly unconstitutional for many students, particularly those in poor and minority neighborhoods – a decision which has focused unusually intense attention on the race, as well as copious amounts of campaign cash.

The decision is almost certain to be mired in a lengthy appeals process, and the issue of appealing Vergara is itself controversial.

“These court battles can go on for many years, and nothing may happen, but I hope this does help generate more attention,” says former state Sen. Gary Hart, D-Santa Barbara, a former high school teacher who chaired the Senate Education Committee for 12 years. He was education secretary to Gov. Gray Davis and is the author of many major education bills, including measures to increase school funding and create charter schools.

“I support due-process rights for teachers, but the law is broken and needs to be changed,” he said. “The tenure process is dysfunctional.”

Those with long experience in California education – some of whom do not want to be quoted by name in a contentious race – say that too often “blame the incumbent” becomes the mantra when public dissatisfaction with schools drives elections. In this election, many say, “blame the teachers” becomes an equally convenient form of scapegoating in a Byzantine state education system with plenty of blame to go around.

A recent Field Poll found Tuck leading Torlakson among likely voters by 31 percent to 28 percent – with a whopping 41 percent undecided. The Tuck campaign issued a jubilant press release about the poll in which campaign manager/communications director Cynara Lilly said “voters are ready for a change” and “when given a choice, will choose the candidate with experience turning around public schools – not the Sacramento insider.”

Gov. Brown chose not to appoint a Secretary of Education, instead focusing on the role of the state board as a policy-making body and emphasizing more local control of schools.

But early polls often do not reflect final outcomes. What does appear likely is this: The coming weeks will unleash a blizzard of campaign ads – mainly paid for by massive infusions of independent expenditures.

“This is a battle between the CTA and so-called education ‘reformers’ who hate the unions, and have their own agendas about the way the schools should be run,” said one veteran political analyst who asked not to be named. “They have a certain notoriety because of the public’s clamor about bad schools. . .Does it matter? Does it make a difference? That depends on what you think about the power of the superintendent.”

Hart and many other longtime educators involved in education politics say the superintendency is a largely ceremonial position, with few powers beyond the “bully pulpit.” Hart, who seriously considered running for the job and ultimately decided against it, has long said the office should be abolished.

The current system, critics say, too often works at cross-purposes, with an elected state superintendent, who heads the state Department of Education, as well as a state Board of Education appointed by the governor, plus hundreds of local school districts and boards, county offices of education and boards.

Gov. Brown chose not to appoint a Secretary of Education, instead focusing on the role of the state board as a policy-making body and emphasizing more local control of schools. In a recent interview with Education Week magazine, board President Michael Kirst, a veteran state and national educator and administrator, said California “for years had a fractured and fractious policymaking system,” creating confusion over “who was in charge.” He said the governor has worked closely with the board and Torlakson, “most of whose positions on education are close to his own.”

‘Blame the Teachers’
Both Torlakson and Brown took considerable heat over their recent decision to appeal the popular Vergara decision. The state’s appeal was filed Aug. 29.

“The system is so convoluted and it can take two to three years or more, costing districts $100,000 (and more). There is no reason for these cases to drag on so long,” — Joan Buchanan

Torlakson says the Superior Court decision is constitutionally flawed and unfairly blames teachers for problems in schools. “The people who dedicate their lives to the teaching profession deserve our admiration and support,” he said in a prepared statement after the August ruling. “Instead, this ruling lays the failings of our education system at their feet.”

“No teacher is perfect,” he added. “A very few are not worthy of the job. School districts have always had the power to dismiss those who do not measure up.” He pointed to a bill he and the governor supported, by Assembly Education Committee Chair Joan Buchanan, D-Alamo, which aims to shorten the arduous hearing and appeal process.

Although critics say the measure provides only limited relief, Buchanan, who served 18 years on the San Ramon Valley school board, including four terms as president, says it is a good first step and brings opposing sides in the controversy to the table. “The system is so convoluted,” she said, “and it can take two to three years or more, costing districts $100,000 (and more). There is no reason for these cases to drag on so long,”

Colleagues and even longtime supporters of Torlakson are often torn about the election, particularly prominent Democratic educators who may be union members.

But they also know firsthand the failings of the teacher-tenure and disciplinary process, which has allowed efforts to discipline or fire clearly incompetent, even abusive, teachers to drag on for years, deterring administrators from even attempting to fire a teacher because of the time and expense of the hearing and appeal process.

“When a district goes into receivership (state takeover), it’s usually been a long way to get there, and it’s a long way to get out. We’ve made real progress, but we still have a ways to go.” — Paul Hefnerf

Also at issue in the election is the current two-year probationary period for new teachers, which critics say is actually only 16 months and is not remotely sufficient to determine a teacher’s competence. Nor, they say, does the current system provide adequate support and mentoring to a new teacher who may be having trouble in the classroom.

Dr. Barbara O’Connor, a prominent retired political communications professor at California State University, Sacramento, who founded the Institute for the Study of Politics and Media, said Torlakson “gets blamed for all the woes of education,” including the financial collapse of many school districts in California. And, while Torlakson is blamed for education’s failings, she added “he also has access to [campaign] finances, so it counter-balances.”

Torlakson campaign manager Paul Hefner says the number of districts in financial trouble has dwindled substantially since Torlakson took office in 2011. “At the height of the crisis, one of three kids attended a school [that was] in financial trouble,” Hefner said. “When a district goes into receivership (state takeover), it’s usually been a long way to get there, and it’s a long way to get out. We’ve made real progress, but we still have a ways to go.”

As a former department chair, O’Connor said she often faced personnel and tenure issues, which come with different rules at the university level, and much longer “probationary” periods. “In the universities, you have to wait seven years,” she said. “It’s an onerous process. To have collective bargaining and tenure is tough. I can’t imagine [granting tenure] after only 16 months.”

A union member (the California Faculty Association in the CSU) throughout her long career in higher education, O’Connor says, “I believe in unions.” At the same time, “I’m not always happy with them (the unions). . .I’m ready for some people who want to take some risk.” She has not taken a position in the election. She says she has visited Tuck’s Green Dot Schools and was impressed. “He’s nontraditional,” she said, “and smart.”

“And I’ve always supported Tom Torlakson, since he was in the Assembly,” O‘Connor added. “He’s a great human being, and his daughter Tamara is a friend (Tamara Torlakson is a senior associate at Dewey Square Group, a political consulting firm).”

‘Crippling Bureaucracy’
In an interview with Capitol Weekly, Tuck said the state’s education system “has been broken for a long time, and we do need real change. I’m not a politician, I’ve learned what it takes to do this work.”

But he’s vague on the specifics of how he would change a system entrenched in layers upon layers of legislative, administrative and legal requirements, both state and federal. He said he favors a collaborative approach – a position similar to Torlakson’s.

“The [state] Education Code constrains what can be done, and it’s a crippling bureaucracy,” Tuck said. “There is no individual position that is all-powerful, but this (the superintendency) is a uniquely influential position, for setting the vision, for fundamental change. It is the one position that is non-partisan, focused only on kids, with the ‘bully pulpit’ and specific assigned powers to drive unique change and move the work forward. But it has to be a collective effort.”

As for teacher discipline, he favors major changes in the process, one in which “you touch a kid, and you’re gone.” Working in challenging L.A. schools as part of the partnership with Villaraigosa and L.A. Unified, Tuck said, “We had teachers who literally hit kids and pushed them around, but we were told we couldn’t fire them.”

At the same time, he said, the increasingly controversial “last-hired-first-fired” system of union-backed hiring meant that many excellent teachers were regularly facing pink slips every spring – a particularly serious issue in low-performing schools in poor areas with high teacher turnover. “We had to lay off teachers of very high quality,” Tuck said. At one school, he said, half the teachers got layoff notices, while at other, more desirable schools, “only 5 percent received layoff notices.”

Tuck insists he favors tenure, and disagrees with the pro-voucher, anti-tenure views of some of his well-heeled supporters. “I’ve only worked in union schools,” he added. “I’m an independent, first and foremost.”

Former state Superintendent Delaine Eastin, who founded the California Teacher of the Year Foundation to provide funding for recognition of outstanding teachers and is on Torlakson’s list of supporters, said many top teachers favor significant changes in the probationary and tenure system which is at the heart of the current election. “Some of those teachers are not in favor of the current tenure system,” she said. “Many favor a three-year probationary period, with levels of [job] protection. . .I do think it’s too hard and too expensive to fire a teacher for doing evil things, let alone incompetence.”

California remains one of the lowest among the states in per-pupil spending.

Whatever happens in the superintendent’s election, with its promises of reform and a blizzard of campaign cash, the role of the office comes down to educating kids in an increasingly diverse, economically divided state with some 6 million kids currently attending public schools – an estimated one-fourth of them poor, many attending substandard facilities with overcrowded classrooms, too many failing to complete high school.

And while teacher tenure has become a driving issue in the election, adequate school funding is hardly mentioned. “Both sides agree on the need for more funding,” says Sonenshein. “They disagree about how education should be delivered.”

Post-recessionary infusions to K-12 budgets, with emphasis on poor and low-performing schools, in the governor’s budget are a good start, Eastin and others say, but hardly address the overcrowded classes, aging buildings, staff cutbacks and other gaping holes in the system that began with the 1978 passage of the property-tax limitation initiative, Proposition 13.

California remains one of the lowest among the states in per-pupil spending. “The solution is a long-term plan to get us back to where we fully fund K-12,” says Eastin.

As a young community college teacher in southern California in the 1970s, who became a state legislator and state schools superintendent, Eastin also taught youths at a juvenile detention facility – an experience that helped drive her views of public education in California, which spends far more to incarcerate young people than to educate them.

“It was an excellent experience for determining policy,” she mused. “The state Constitution doesn’t say that the first priority is incarceration. It says the first priority is education.”

Ed’s Note: Sigrid Bathen is a longtime education writer who teaches journalism at California State University, Sacramento.

Changes in mental health care system spur new optimism


Changes in mental health care system spur new optimism


Massive changes in how mental health care is delivered to Californians – including abolishing or restructuring the two state departments responsible for mental health and substance-abuse programs – are being closely watched by care providers and advocacy groups.

They say they are “cautiously optimistic” that Gov. Brown’s plan will result in a coordinated, community-based system of care for the thousands of people who historically have faced a dizzying patchwork of care, or no care at all.

But advocates emphasize that mental-health care must have a prominent position in the state bureaucracy.

“We need somewhere to go to at a very high senior policy level,” said Mark Gale, chairman of the public policy committee for the California arm of the National Alliance for the Mentally Ill and the father of a mentally ill son. “We need someone at the highest level who understands core mental health policy, law and regulations, someone who has lived it. If we don’t get this right, the system will become extremely dysfunctional. If we get it right, there is great opportunity.”

Financed in part through a one-year appropriation of $861 million in the 2011-12 budget from the so-called “millionaire’s tax” approved by voters in 2004 as Proposition 63 to fund new mental health programs, the reorganization aims for a coordinated approach to mental health – and a major shift from the state to the counties for funding and managing mental-health programs, with state oversight.

Some services are being moved to the huge state Department of Health Care Services. There is talk of two new departments – one under the rubric of “Behavioral Health” or “Mental Health and Substance Abuse,” and another for “Institutions” or “State Hospitals” to administer the remaining state hospitals, which primarily house the criminally insane.  A recent spate of assaults, including the strangulation death of a psychiatric technician at Napa State Hospital last October, has prompted a series of state and federal crackdowns at those facilities, which currently house nearly 6,000 patients.

A major concern is abolishing the Department of Mental Health.

“There is tremendous fear in the mental health community about eliminating the Department of Mental Health,” said Rusty Selix, longtime executive director of the Mental Health Association in California. Selix is the co-author, with state Senate President Pro Tempore Darrell Steinberg, D-Sacramento, of the landmark Mental Health Services Act, passed by voters in 2004 as Proposition 63.

“Where are we left if the next administration doesn’t have the same level of interest?” Selix added.

Representatives of advocacy and professional groups are vocal participants in public hearings held throughout the state in August and September by the state Health and Human Services Agency and the soon-to-be defunct Department of Mental Health. The hearings solicit comments for the complex reorganization plan taking shape at the state and local level.

“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,” said Randall Hagar, government affairs director for the California Psychiatric Association, who has followed mental health issues for decades and is the father of a schizophrenic son. He says the Brown administration’s reorganization proposals come at a critical juncture for both providers and families. “Some of the tools are there already, but we have a system that has evolved piecemeal for nearly five decades.”

Rose King, a legislative and state policy expert on mental-health issues (who is the widow, mother and grandmother of mentally ill family members), has regularly attended the ongoing “stakeholder” meetings and expresses increasing concern that the vague outlines of a new system still fail to address historic discrimination against the mentally ill, despite state and federal laws requiring parity in treatment for mental as well as “physical” health.

But she says the reorganization “has great potential” and “creates an opportunity for the integration of mental illness and substance abuse disorders” – and to close the disparities in treatment of mental  and physical health care.

Pat Ryan, executive director of the California Mental Health Directors Association, which represents county mental health directors, said the goal of the reorganization “is to get people help sooner rather than later, to avoid both incarceration and institutionalization. If you starve the system and don’t have money specifically intended for prevention and early intervention, you’re never going to get there, because you’re always going to be dealing with crises.” Like other advocates and providers, Ryan said “leadership is critical” in any new system – in which the counties will play an increasingly larger role under the Brown administration proposals and federal health care reform.

“The idea is to get the money flowing directly to counties with fewer strings and less bureaucracy,” said  Farah McDaid Ting, senior legislative analyst for the California State Association of Counties.  “It’s an opportunity for counties to take an integrated approach and offer a continuum of services. We haven’t had that opportunity before.”

Central to the reorganization are lessons learned from the tortuous implementation of Proposition 63, which levied a 1 percent tax on millionaires and provided $900 million to $1.5 billion annually in additional revenue for local mental health programs.

Hailed as the first significant infusion of state funding for mental health since the closures of decrepit, understaffed and overcrowded state mental hospitals nearly four decades earlier – dumping huge numbers of mentally ill people on communities ill-equipped to handle them – Prop. 63 became both an important harbinger of change and a bureaucratic nightmare.

Critics of its implementation – including some of those who helped write the law – say the process was plagued by red tape, glacially slow state Medi-Cal payments to counties, high consultant fees, accusations of cronyism,  and only a trickle of funds for actual programs.

While success stories emerged from communities where homeless mentally ill for the first time found coordinated housing and treatment with Prop. 63 funding, thousands more received little or no treatment, continuing on a tragic downward spiral of homelessness, institutionalization and incarceration, worsened by the severe economic downturn and draconian budget cuts.

The state required counties to jump through an array of bureaucratic hoops and “pre-approvals,” infuriating local officials.  At the same time, there were broad state and local cuts to social programs, with some Prop. 63 funds used in recent years to help balance the precarious California budget.

“The planning process went on and on,” says former Yolo County Supervisor and state Assemblywoman Helen Thomson, D-Davis, who chaired the Joint Legislative Committee on Mental Health and the Assembly Health Committee and is a former psychiatric nurse married to a psychiatrist.

“Every county hired a different kind of consultant. A lot of money was going into the Prop. 63 fund, and it was bureaucratized.” While some new Prop.-63-funded programs provided services, she said, “clinics were closing, beds eliminated.” Intended to supplement existing services and create new programs, Prop. 63 funds were used by cash-strapped counties to finance dwindling mental-health services.

Hagar says the language of the law included “something for everybody, to get everybody on board,” in order to ensure its passage. “Unfortunately, it was so diffuse that we had a lot of exemplary projects developed, doing a wide range of things – suicide prevention, school-based services – while heavy-duty services, core services for those who were homeless or not ‘engaged’ in the system,  did not receive the same level of support.”

Steinberg remains one of its most passionate proponents, and is clearly stung by what some say is the scapegoating of a landmark law.

“You can’t blame [Prop. 63] for the problems of a mental health system that has been decades in the making,” he said.  Quick to criticize the cumbersome implementation process, he is hopeful the current reorganization will address flaws in the process. “The process has been faulty, and it has gone too slowly at times. It’s been way too slow off the mark in reporting data.” Still, he added that despite setbacks, the 2004 law “remains a monumental accomplishment,” and, when fully implemented, will help provide coordinated care and keep the mentally ill out of jails and prisons.

“The fact is that we’re living through the worst recession in 50 years, and we’ve cut budgets in ways I abhor,” he added. “Prop. 63 was never intended to be the solution for all of the system’s problems. It was intended to provide comprehensive care for people with severe mental illness, with the main goal of keeping people out of the system. ”

The law included specific requirements that funds be used only for “new” services (not existing programs), and not for jails or prisons. The complex approval process that evolved, administered by the state Department of Mental Health, will likely be scrapped by 2012-13, along with the department – “reorganized” or “redirected” in state budgetary parlance – as will the state Department of Alcohol and Drug Abuse.

While state administrators are deep in a widely publicized “Public Safety Realignment,” less has been said publicly about the administration’s lower-key efforts to coordinate mental-health and substance-abuse programs with the state’s vast and costly correctional system, which faces massive court-ordered population reductions and mandated improvements to all aspects of prison health care.

Since many prisoners are also mentally ill and vast numbers are serving time for drug-related crimes, advocates say coordination of mental-health and substance-abuse services at the local level is critical to any reorganization plan, and could help avert much more expensive, sometimes deadly, arrests and incarceration.

Local officials express relief that some of the bureaucratic hoops, especially the much-maligned “pre-approval” process for Prop. 63 funding, will be eliminated, and that Medi-Cal reimbursement backlogs – which often stacked up for months, leaving counties holding the bag – will be reined in.

Newly appointed Health and Human Services Agency Undersecretary David Maxwell-Jolly, the former state Health Care Services Department director who is overseeing the reorganization with Agency Secretary Diana Dooley, said technological improvements have dramatically reduced the paperwork blizzard and Medi-Cal backlogs. He noted that state officials were “less responsive and perhaps less efficient than we could be.”

But officials are adamant that state oversight and especially “evaluation of outcomes” will be a high priority under the reorganization, and that mental health will remain high on the administration agenda regardless of its placement in the state bureaucracy.

Among those assigned to this daunting and often thankless task is a career state administrator, Cliff Allenby, recently appointed by Gov. Brown as interim director of the Mental Health Department. A veteran state Finance Department administrator who has headed several state agencies, including the Department of Developmental Services, Allenby has no illusions about the challenges inherent in reshaping a flawed and broken mental health system.

“We don’t have all the answers,” Allenby said. “We really don’t. The stakeholder process is very important – what should remain, and how that should be [reorganized].  I’m not here to prejudge, and we really will listen carefully at the stakeholder meetings to what they have to say, then prepare a proposal for the 2012-13 budget.”

“I’ve been around a long time, and Sacramento is just not the place to establish policies that work in all 58 counties,” he added, borrowing an oft-repeated anecdote from the governor’s proposals. “What works in L.A. isn’t necessarily what works in Redding.”

Many aspects of the proposed reorganization are unknown, including the specifics of long-term funding sources and state oversight of local programs. “Somehow we must have a very high-level policy visibility that is not buried in some bureaucracy somewhere,” says the Psychiatric Association’s Hagar. “The track record hasn’t been great.”  But despite sometimes heated disagreements among the various “stakeholders,” there is widespread consensus that the administration push toward coordination of mental-health services is long overdue.

Advocates and providers are hopeful that much-touted plans for “integration of services” will carry more weight than the hollow promises of decades past.  They point to the badly fragmented system  that resulted, in which the streets, jails, prisons and state mental hospitals for the criminally insane have become both the first and last resort for the severely mentally ill, who might have been helped with earlier intervention.

“The jails are full of people who are mentally ill, and hospitals are ringed with barbed wire and security guards,” says veteran mental-health advocate and former Assemblywoman Thomson.  “It’s the ‘trans-institutionalization’ of mental illness, and it’s tragic.”

Sigrid Bathen teaches journalism and communications at California State University, Sacramento. She is a former Sacramento Bee and California Journal reporter and editor who has covered mental health issues for more than 30 years.

Out of the Snakepit, Part 1

by Sigrid Bathen posted September 9, 2005

outofsnakepitRose King has seen it all.

A widely recognized expert on mental health issues, she has served in the trenches of the mental health wars for more than 30 years–even before the 1969 suicide of her husband, who suffered from what was then called manic depression. Years later, her son also committed suicide—after suffering from the same illness, known now as bipolar disorder.

She saw the emptying of the state hospitals during the 1960s–ultimately, some 87 percent of 36,000 patients were “deinstitutionalized”–that began under Gov. Ronald Reagan and continued through the 1970s by Gov. Jerry Brown. She saw the legions of homeless mentally ill roaming the streets, passing through temporary shelters and jails, victims of the state’s failure to pay for community mental health care as promised when the state hospitals were shuttered.

Today, only 4,700 mental patients remain in state hospitals.

She saw families struggling with health insurers and public mental health programs to get help from a failed system plagued by lack of money, understaffing and disorganized services. The hard lesson learned: Care is often available to the mentally ill only when they are in a state of severe crisis.

“It hasn’t really changed since my husband became ill,” says King, who lives in East Sacramento. “It remains crisis-driven, crisis-perpetuating and fragmented.”

“We turn mental health clients away and tell them to return when their symptoms are so severe and persistent that they cannot meet their own needs, and may no longer even recognize that they need care,” the Little Hoover Commission noted in a 2000 report.

But last year, voters approved Proposition 63, the landmark mental-health initiative that taxes the wealthy at 1 percent of all income over $1 million. That means Californians will now see the first major infusion of money into mental health care in decades—an estimated $1 billion a year, specifically for community mental health care.

King and other activists hope that the money will transform the wretched conditions that blight urban streets and consign millions of afflicted Californians and their families to lives of poverty and desperation.

But the story of Rose King and her family is not just a story of the struggle for mental health care. It is the story of a system so flawed that it harms the very people it is supposed to protect.

Rose and Joseph King first sought help from their health insurer–Kaiser–as Joseph began to experience frightening symptoms of depression and paranoia in 1968. Joseph “saw the doctor who had treated him for asthma, and was told there was no psychiatrist on staff in Sacramento,” Rose recalled. An urban planner who worked for regional planning agencies in California and Alaska, Joseph soon became so disturbed that he could no longer work.

Desperate, they drove to DeWitt State Hospital in Auburn–which was in the process of closing.

“They wouldn’t accept him at DeWitt,” she said. “He didn’t look ill, and they said he ‘didn’t meet their criteria.’ We had no idea where to go.” He was finally admitted “for a couple of weeks” to a mental health clinic run by Sacramento County, where his wife said he was seen by a psychiatrist twice, and sent home on a weekend pass. That night in 1969, at age 36, Joseph King killed himself.

Grief-stricken and now a single mother to 8-year-old twins and their 6-year-old sister, King, who had been a homemaker and volunteer political activist, went back to college, earning a Bachelor’s in government-journalism at California State University, Sacramento, and a Master’s in journalism at the University of California-Berkeley.

She interned in the Capitol for Democratic Sens. George Moscone and Mervyn Dymally, and worked for $25 a week in the unsuccessful 1970 gubernatorial campaign of Assembly Speaker Jess Unruh. She later worked in paid jobs for a succession of powerful Democratic legislators–including Assembly Speaker and Lt. Gov. Leo McCarthy, Senate Leader David Roberti and Assembly Speaker Antonio Villaraigosa.

But her first introduction to mental health issues had been in 1967, the year before her husband became ill, when she ran an unsuccessful but well-publicized campaign to recall Reagan, in which many of the core activists were medical and psychiatric workers infuriated by conditions for the mentally ill.

As she became more involved in the issue, she pressed politicians, pollsters and the media to lift the heavy curtain of ignorance and stigma that has long surrounded mental health policy. She helped staff a statewide task force on mental health issues under McCarthy when she was his chief of staff in the lieutenant governor’s office.

“Nobody even asked what public opinion was on the subject,” she says. “I asked Mervin Field to start putting [questions about mental health] in his surveys, and there were two statewide polls done for the [Senate] Rules Committee when I was working for Roberti in the 1980s. The importance of the subject of mental health to citizens was first in one poll, second in the other.”

In 1984, her 23-year-old son Michael was diagnosed with bipolar disorder, which is often hereditary and can surface with frightening symptoms in late adolescence or early adulthood. Years later, after battling the disease for nearly two decades, Michael committee suicde. He was 42 years old.

In 1990, King worked on an initiative to raise the alcohol tax to fund mental health care.

“It was unsuccessful, but not because people didn’t think something should be done about mental health,” she says. She was chief consultant to the Joint Legislative Committee on Mental Health Reform convened by Senate Leader John Burton in 2000 and co-chaired by former Assemblywoman Helen Thomson, author of numerous mental health measures over the years and a former psychiatric nurse who is now a Yolo County Supervisor. Thomson was termed-out of the Legislature in 2002, and King, who was principal consultant to the Assembly Health Committee that Thomson chaired, retired the same year.

King’s oldest daughter, Michael’s twin sister, does not have the condition, says King, but her youngest daughter was diagnosed with bipolar disorder at age 30, following childbirth, which can be a “trigger” for emergence of the disease. King’s youngest daughter, now 43, a college graduate with two degrees earned before the onset of the disease, “manages her condition quite well and works in her profession,” her mother says.

Recently, a teen-age grandchild has shown symptoms of the disease, and the 66-year-old King once again finds herself in the mental health trenches, seeking help from a still-fragmented system of mental health care that has bedeviled California families like the Kings for decades.

As California gears up to put Proposition 63 into effect, former Assemblyman Darrell Steinberg, who authored the measure, King and other supporters are carefully following its progress.

“I’m hopeful,” King says of the flawed, crowded mental health care system. “It’s not like we don’t know what works or what needs to be done…It’s not unusual for a case manager to have a caseload of 120, all people in crisis.”

She adds: “The system today is really no better than it was in the late 60s when my husband became ill.”

Next week: The devil is in the details: putting the voters’ will into effect.

Sigrid Bathen teaches journalism and communications at California State University, Sacramento. She has covered mental health issues for 30 years, winning several California and National Mental Health Association awards–and a Pulitzer nomination–for her mental health coverage in the Sacramento Bee and the California Journal.

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