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Brown gets push-back on school reform

Published: May 20, 2013 | No Comments

By Daniel Weintraub

Gov. Jerry Brown and his fellow Democrats in the state Legislature are headed for a showdown over the way California pays for its public schools.

Brown is proposing a revolutionary plan to give extra state aid to schools that teach large numbers of poor and immigrant children. But he is getting pushback from some in the Legislature who think his plan goes too far – at the expense of the general-purpose money that every school district receives.

Brown argues that few things are more urgent than the need to improve schooling for California’s most vulnerable children, which would improve their lives, lower social welfare costs and boost the economy. Characterizing his idea as part of a civil rights battle, Brown last month said opponents are in for “the fight of their lives” if they think they are going to block his plan.

“I’m not going to give up until the last hour, and I’m going to fight with everything I have, and whatever we have to bring to bear in this battle, we’re bringing it,” Brown said.

The governor has the public on his side. Polls show voters like the idea of focusing state resources on students from low-income families. A recent poll by the Public Policy Institute of California, for example, found that two-thirds of Californians think schools with more low-income students should receive more state funding.

But critics of Brown’s plan say that several years of budget cuts have left all schools so short of resources that it would be unfair to divert money from mainstream programs until everyone catches up. Brown’s formula, critics say, would hurt students in suburban districts that have relatively low enrollments of poor and immigrant students. Even the needy students in relatively affluent districts would be shortchanged by Brown’s plan, some legislators say.

The governor, though, is determined to seize a rare opportunity for radical reform arising out of the state’s slow but steady economic recovery and the tax increase voters approved at the ballot box last November. Tax revenues are rising again, and a state constitutional provision requires the Legislature and the governor to set aside much of that new money for schools.

Public school enrollment, meanwhile, is flat or even shrinking, thanks to the state’s changing demographics. That means that the amount of money per student California spends on education is almost certainly going to be rising in the years ahead.

Rather than spreading that money around the way it’s always been done, Brown proposes a fundamental shift. He wants to give every school district a basic grant per student, then add 35 percent more per child for each student who is either low-income or learning English as a second language.

On top of that, districts with more than half their enrollment made up of low-income students or “English learners” would get another bump of 35 percent per student to deal with the challenges of educating high concentrations of disadvantaged pupils.

Under Brown’s plan, no district would get less than it received last year, and eventually, every district would get back to the per-student funding they had before the recession. But the growth rate would be faster for districts with high numbers of poor and immigrant children.

To show how this would play out over time, Brown’s Department of Finance recently released projections showing how much every school district in the state would get under his plan compared to the status quo. The numbers include only the state money that would be affected by Brown’s proposal, which excludes restricted funds such as paying for special education, federal funds and locally raised revenues such as parcel taxes.

Consider the schools in Santa Ana and San Juan Capistrano.

Today, Santa Ana Unified gets about $400 more per student than Capistrano, but 78 percent of Santa Ana’s students are poor and more than half are English learners, while in Capistrano, 23 percent are low-income and just 10 percent are still learning English.

Under the status quo, according to Brown’s numbers, that modest funding gap would pretty much remain through the rest of the decade, with Santa Ana getting $10,135 per student in 2019-2020 and Capistrano receiving $9,875.

But under Brown’s plan, Santa Ana would do much better, eventually qualifying for $11,804 per student, while Capistrano would get $8,964 per child. Capistrano’s funding would still increase by nearly 50 percent during this period. But Santa Ana’s would climb by 84 percent.

Brown’s plan would require school districts getting the bonus to spend that extra money on low-income children and English learners, but they would have tremendous flexibility in how they did that. They could hire more tutors, teachers’ aides, or translators. They could buy enrichment materials or computers, or extend the school day or the school year for certain students. Those decisions would be up to each district.

Democrats in the Legislature say they agree with Brown that poor and immigrant students should get more resources. Just not as much as he suggests.

One proposal backed by Senate leader Darrell Steinberg would eliminate the extra 35 percent bump Brown proposes for the most heavily impacted districts, which the governor calls a “concentration” grant. Instead, half of that money would go to general aid, distributed statewide on a per pupil basis. The other half would go toward increasing the per-student bonus Brown proposes for the targeted children.

Overall, that would mean less growth in the budgets for heavily impacted districts like Santa Ana. But it would mean a bit more money for districts where low-income and immigrant kids make up a substantial share of the enrollment yet fall short of a majority.

Given Brown’s commitment to this issue, it seems likely that some form of his plan will make it through the Legislature this year. His allies are starting to put pressure on Democratic lawmakers to go along. And an unexpected surge in tax receipts this year might help smooth the way by providing enough money to ease the fears of the districts that would be relative losers under Brown’s proposal.

One way or another, parents, teachers and anyone with a stake in public education should be prepared for some big changes ahead.

Daniel Weintraub has been covering public policy in California for 25 years. He is editor of the California Health Report at www.healthycal.org

 

LAO projects $3 billion more than governor

Published: May 17, 2013 | No Comments

The state’s legislative analyst says Gov. Jerry Brown’s revised budget proposal is too pessimistic — to the tune of $3.2 billion. That’s how much more revenue the analyst expects by the end of the next budget year than the governor is forecasting. This shouldn’t be a big surprise. In good times, governors tend to take the most conservative approach to economic forecasting in an effort to keep money off the table for the Legislature. But the analyst says the governor’s forecast for capital gains taxes does not take into account higher taxes investors will pay on this year’s gains even if the stock market is flat for the rest of the year. The analyst strongly encourages the Legislature to use the extra money to pay down debt and start building a rainy day fund for the future. See the full report here.

 

Counties still not prepared to offer expanded mental health care

Published: May 16, 2013 | 1 Comment

Photo: Julien Haler/Flickr

By Alexia Underwood
California Health Report

More than one million people in California suffer from mental illness – the largest number of any state. When the final phase of the new federal health care law starts in January of next year, more California residents than ever before will be able to seek help for problems ranging from depression, anxiety, and addiction to schizophrenia and bipolar disorder.

But mental health providers in the state’s Central Valley are unprepared for an influx of thousands of patients. State and county officials remain in the planning phases, even though new patients will be able to access these services in less than nine months.

Manuel Jimenez, director of Merced County’s Mental Health and Alcohol and Drug Services, said that they haven’t begun expanding programs just yet.

Counties are awaiting more information from the state about how to handle the new caseload and have yet to enact any changes. Jimenez meets regularly with other county officials, in addition to safety-net clinics, like Golden Valley Health Centers and Livingston Medical Group, to discuss what to expect in January.

He believes that health-care reform will make roughly 30,000 more people eligible for Medi-Cal in his county. “Maybe ten percent will qualify for mental health or drug and alcohol services. That’s conservatively speaking,” Jimenez said.

Demand is difficult to predict, in part because of the pervasive and widespread stigma attached to mental illness, according to the National Alliance on Mental Illness (NAMI). One in five Americans lives with some form of mental illness, and nearly two-thirds of all people afflicted do not seek treatment, out of fear of societal discrimination, rejection or lack of knowledge.

This problem is compounded by spotty and unequal health insurance coverage for mental illness. Congress passed the Mental Health Parity and Addiction Act in 2008 to try to eliminate these discriminatory practices and force insurers to cover mental illness as they would other illnesses.

Lawmakers say that the new health care law, the Affordable Care Act (ACA) will further improve mental health and addiction coverage for 62 million Americans.

Mental health services constitute one of the “Ten Essential Benefits” of the new law, which mean they must be covered by most health insurance plans in the future. This applies to plans offered on state-sponsored insurance exchanges – websites like Covered California where people can shop for the best private insurance available to suit their needs.

The new health care law also expands the Medi-Cal program, which assists low-income residents, seniors and other vulnerable members of the community. A joint UCLA and UC Berkeley study released in January predicts that about 1.4 million more California residents will be eligible for Medi-Cal benefits under the new law.

Though exact numbers are of people who will seek care are difficult to predict, about 120,000 people in Stanislaus, San Joaquin and Merced counties will be eligible for some sort of government-subsidized health insurance come January, according to a Families USA report released last month. All of them would have access to mental health services if they needed it.

In the meantime, Merced county health officials are discussing education and outreach to the thousands of new potential patients – how to let them know they are qualified and can apply for services. Beyond this, they’re waiting to find out what the new health care law is going to entail. “It’s going to be a gradual build up,” Jimenez said. “I think the state is a little unsure about how we’re going to roll it out.”

Pete Duenas, the manager of neighboring Stanislaus County’s Behavioral Health and Recovery Services, also said that he was waiting for state guidance. He suggested that he would have a better idea of how programs offering mental health care would develop in six or seven months, around the time when reforms will be in full force.

Just this Tuesday, the governor announced that the state will oversee the expansion of Medi-Cal. Before that, legislators and the governor were considering whether or not counties should oversee the expansion.*

Mental health services, however, will still be administered through counties. A combination of budget cuts and a brutal economic recession has left the mental health system in parts of the Central Valley overloaded and overwhelmed in recent years. An award winning investigation last year by the Modesto Bee and the California HealthCare Foundation Center for Health Reporting presented a bleak picture of the situation in Stanislaus County – deep budget cuts had left many with nowhere to turn for help. It also revealed that incarceration rates in the county for the mentally ill had gone up by almost fifty percent since 2007.

Joyce Plis of the National Alliance on Mental Illness in Stanislaus County believes that the new law may lead to an onslaught on the existing mental illness services in the area, and that local clinics and providers are already overburdened. There’s a shortage of psychiatrists, she added. “We’ve had cut after cut after cut and now we can’t cut anymore.”

Plis’ son was diagnosed with schizophrenia in the 1980s, on his twentieth birthday, so she has seen her fair share of the ins and outs of the mental health system over the past few decades. She was pleased that the health care reform bill allowed children up to 26 years old to be covered by their parent’s insurance, but disillusioned with the existing mental health care system as a whole. “It’s bare-boned,” she said.

Alex Abarca, the director of behavioral health services with the Golden Valley Health Centers, agreed that there was a huge need in the area for more mental health services, going back to when the most severe budget cuts began in 2005.

While the counties are mandated to serve the seriously mentally ill, a category that includes people who are diagnosed as severely depressed, or have bipolar or schizophrenic disorder, this is really a small percentage of the population, Abarca said. Safety-net clinics like Golden Valley end up serving large segments of the population who don’t fit into those categories, but who still need help. Many of their patients are low-income, and about 60 percent speak primarily Spanish.

“Let’s say you’re a common person who has some anxiety, or depression, that’s not that severe but could be if left untreated,” Abarca said. “Those people…wouldn’t get those services, they don’t meet the criteria.”

The Golden Valley Health center network, which has clinics throughout the Central Valley, employs 15 therapists who see about 12,000 clients a year, Abarca estimated. Golden Valley already treats some uninsured patients, so the new law will be beneficial in that they will now be getting compensation for those services.

But the reality is that nobody knows what to expect at this point, Abarca said. “What we do know is that 20 to 30 percent of our patients that weren’t insured are going to now meet the criteria. That’s 20 to 30 percent more patients coming through the door.”

Ideally, they plan to grow, perhaps open another clinic, or hire another doctor or two. “Everyone is making plans,” he said. “If they can prepare, they’re going to try.”

* An earlier version of this story incorrectly stated that a county-based expansion of Medi-Cal was still under consideration.

 

Curanderismo is alive and well in America

Published: May 15, 2013 | No Comments

By Lorena Anderson

When Charles Garcia looks at a garden, he doesn’t see plants. He sees medicine, heritage, art and magic.

A curandero, Garcia practices traditional folk healing – curanderismo – the way his mother, grandmother and grandfather did.

“It’s a combination of what the Spanish padres, the ranchers and the natives practiced,” Garcia said. “That was the beginning of California curanderismo.”

Curanderismo is still widely used in Mexico, Central and South America, and is making a comeback here in California and across the Southwest, especially as immigrant populations grow.

“In rural areas, people had no choice but to rely on home remedies,” said Professor Eliseo Torres, of the University of New Mexico. “When the Spanish came in the 1500s, they brought their remedies, including what they had learned from the Moors, and they learned from the natives here. It’s a nice blend of many cultures, and complements mainstream medicine.”

Immigrants often come with few English language skills and no health insurance, so they look to the healers they are familiar with from home, Torres said. If a condition is serious, a curandero will refer the patient to a mainstream doctor or hospital. But if the healer can, he or she will make the patient feel better.

“Curanderos and shaman (Asian healers) have no illusions about what they can and cannot cure,” said Dr. Jim McDiarmid, a clinical psychologist who helps train medical residents at Mercy Medical Center in Merced. “They understand their limits.”

Torres teaches a curanderismo workshop each summer that draws people from around the country who want to reconnect with their heritage and learn more about how to cure minor ailments and even mental and spiritual problems by using herbs and other traditional methods.

Garcia, who teaches some courses in Modesto and ran a school in the Bay Area for several years, said a curandero or curandera is like a village’s general practitioner, using healing herbs and foods and gentle psychology.

He offered an example: One patient, an older woman, wouldn’t eat and was losing her vitality. He spent time talking to her and realized her problem was two-fold.

She had empacho, a digestive problem that can get so bad people waste away. He blended a sweet-milk-and-basil drink and recommended she take that often to help her gain weight, stimulate her appetite and calm her stomach.

But she was also feeling useless, her children having grown into independent adults. He suggested her children take part in her healing by asking for her advice, her recipes, her stories and memories.

They made her feel needed again. Garcia said she hasn’t had a relapse in the decade since he treated her.

While curanderismo might seem foreign or “new-agey,” everyone is familiar with it in some form, from grandma’s chicken soup to herbal supplements such as cinnamon to help lower blood sugar, fish oils to help prevent heart disease.

“We get aspirin from the willow tree, but the Native Americans were using it for headaches long before we were,” McDiarmid said. “Same with digitalis, which comes from foxgloves. We still use that to treat heart conditions.”

Herbal supplements are a $5 billion a year industry in America, spawning such chains as GNC.

That’s curanderismo at its most basic.

In some cases, curanderos are just trying to get a patient to feel better so their own immune systems can work more efficiently, McDiarmid said.

“Western medicine would call it a placebo effect, but some of Western medicine is a placebo effect, too, although doctors don’t like to admit that,” he said.

There are also rituals that often go with healing. Torres said some people seek healers to help them with susto, or “magical fright,” often associated with a traumatic experience.

“But who’s to say that’s not something similar to post-traumatic stress disorder?” Torres said. “There are treatments for that in mainstream psychology, so why not through traditional methods?”

Native Americans often used sweat lodges for healing, he said, and they are still prevalent in Mexico and are coming back in the Southwest, as well, helping people deal with addictions and helping veterans returning from war.

“They are warm, dark, nurturing places where people can cry, scream, sing – do what makes them feel better,” Torres said.

Garcia agrees that illness can be caused by hidden emotional distress, which sometimes can be relieved by spiritual cleansing, ritual – magic, for want of a better word.

“You let people talk,” he said. “You might also give them lemon balm as a skullcap to ease the mind, and something to help soothe the stomach.” He also might use religious icons or rituals his patients relate to, which helps them.

Some people feel they are cursed or haunted, and no one but a curandero can help them.

“There is some psychology to it,” Torres said. “Some people are afraid of curanderismo – they think it is witchcraft. But we’re trying to improve people’s lives. There are many wonderful plants that can help our bodies, and curanderismo is simply a holistic approach – body, mind and spirit.”

McDiarmid agrees, and said part of what helps people feel better through the often lengthy rituals is that there are people around them, laying hands on them, offering good thoughts and well wishes, so there is some social support that has a positive effect.

That’s not to say curanderismo is all a placebo. Becoming a curandero takes many years, Garcia said, and requires study and apprenticeship. You don’t just become a curandero after one or two classes.

Torres pointed to schools in Mexico that are developing certificate programs in folk healing, and said some of the attendees at his annual two-week workshop have gone to such institutions.

“It really is an evolving practice,” Torres said. “They are incorporating Chinese medicine, reflexology, massage, acupuncture and acupressure, cupping, juicing, they learn to prepare tinctures, salves and ointments and how to prepare plants.”

Despite the years of study and practice, like many community healers, Garcia doesn’t charge for his services. He has regular clients, but he also takes his healing to the streets to help the homeless, as he did in the Bay Area.

He has also lectured at medical schools, and said he worked with an oncologist to teach traditional diagnostic methods.

“A hundred years ago, doctors diagnosed without all the tests and instruments we have now – you have to learn to really look at a person, track the illness like a scout, understand what the body is telling you,” he said. “I’d hate to live without things like blood tests, but I could.”

 

Poor health care moving from prison to jails

Published: May 15, 2013 | No Comments

By Mary Flynn
California Health Report

California’s sweeping criminal justice reform plan was meant to sharply reduce the state’s prison population. But the changes may have also had the unintended consequence of passing along to county jails the biggest problem associated with overcrowding – poor health care.

The reform, also known as prison realignment or AB 109, transferred authority for people convicted of certain non-violent felonies from the state to the counties in 2011.

The changes were based in part on the idea that counties, which provide public health and social services, are better suited to meet the needs of the non-violent inmate population. The switch was California’s solution to alleviate the swollen populations of its state prisons, which had reached 200 percent of their designed capacity.

While the counties were encouraged to pair incarceration with options like treatment and community supervision rather than replacing prison time with jail time, they were not required to do so. Counties can and do decide to send people to jails, which were intended for short stays, for long sentences.

In some counties the inmate population has surged, while in others it’s been a mere trickle. The counties’ ability to attend to their population – and provide adequate health services – varies from one county to the next, and some are finding they’re not up to the task.

“The biggest challenge is that the scope of the mission has changed,” said Aaron Maguire, a Legislative Representative for the California State Sheriffs Association.

County jails are typically meant to house people for up to a year, he said, and even then that’s only in rare cases (say, someone awaiting a murder trial). Now jails are getting inmates sentenced to up to five years, some over 10. In Los Angeles County, an inmate has been sentenced to over forty years, Maguire said.

“That’s not someone moving out of the system,” he said. “And if they have health care needs, whether it’s a chronic illness or whatever, the delivery of that care becomes much more challenging.”

The effects of overcrowding on inmate populations are not new territory for California corrections facilities. In the past, two federal class action lawsuits alleged the California Department of Corrections and Rehabilitations (CDCR) committed constitutional violations of inmates’ health rights. They determined that the overcrowding of the prisons was the primary reason for what was considered cruel and unusual punishment.

The first case, Coleman v. Brown, involved inmates’ mental health care and the second, Plata v. Brown, involved inmates with serious medical conditions. The lawsuits led to the formation of a three-judge panel that eventually ordered California to reduce the prisons population by 30,000 inmates – or to 137.5 percent of capacity – by 2013.

But now the health problems related to overcrowding are starting to plague county jails. Law firms advocating inmates’ rights have filed lawsuits in several counties, including Riverside, Fresno and Alameda.

Three prisoners in the Riverside Jail system have filed suit alleging that the County is subjecting them to cruel and unusual punishment for denying them adequate mental and medical health care.

The lawsuit points to specific cases of failures in the jail health-care system. For example, one female plaintiff had a temporary filter placed in her heart before entering the jail system. Because the jail failed to provide proper follow-up care, the suit alleges, scar tissue developed and the filter could no longer be removed safely. As a result, the 26-year-old inmate will remain on anticoagulation medications and will be at risk of fatal bleeds and other complications for the rest of her life.

Riverside County declined to comment on the accusation, citing pending litigation. According to the complaint, Sheriff Stanley Sniff informed the Board of Supervisors that the lack of infrastructure and staff to deliver life-saving care had resulted in a “crisis in the jail system.”

The lawsuit against Fresno County alleges the jails’ poor design and inadequate staff makes inmates vulnerable to attacks from other inmates. It also alleges that its inmates are continually denied treatment for medical issues, mental health and dental problems.

In Alameda, a disability advocacy group alleged that the county facilities lacked infrastructure accessible to inmates in wheelchairs, and that disabled inmates weren’t able to access programs and services.

While Maguire and others are concerned these may be the beginning of many more lawsuits aimed at counties, not everyone is stumbling.

“For us, it hasn’t been an abrupt shift,” said Susan Kole, Director of Correctional Health in San Mateo County.

Kole said that while she and her staff are seeing an increase in the number of patients requiring multiple medications, they hadn’t yet experienced many changes in the medical conditions that inmates were presenting. She said the county had plans to build a new jail in a few years to allow for more space, “but for now, the space and staffing we have is adequate to meet treatment standards.”

San Mateo’s success may be in how it chooses to spend its state aid: a whopping 58 percent of their 2011-2012 realignment funds from the state were spent on health, treatment and services. Riverside and Sacramento counties, in contrast, allocated 20 percent and 0 percent respectively on health, treatment and services.

However, many of those funds were not intended for direct health care. Instead, they went to continue support programs for inmates on their way out of the system. Louise Rogers, Deputy Chief for San Mateo County Health System, said that while there was much controversy about how to use state funds, the county opted to focus on decreasing the likelihood of inmates returning to jail.

“We’ve had some pretty active reentry efforts historically here,” she said.

In 2009, San Mateo was awarded a grant that funded a program they dubbed Achieve 180, which created support networks for former inmates based on their particular needs. Securing housing and employment, substance abuse treatment or gang prevention counseling are some of the services the county focuses on in an attempt to reduce recidivism.

Another advantage is that San Mateo is not dealing with a huge jail population. “Our numbers are not enormous compared to other counties,” she said.

Maguire agrees. He suggests that a county’s success in delivering health care to its inmate population depends largely on the number of inmates it took on under realignment, and the length of their sentences.

While some counties in the state don’t have any inmates serving more than 10 years, Los Angeles County has approximately 40 people sentenced to more than 10 years.

“Health care needs are different for those people than someone who’s there for six months,” he said.

 

Brown endorses state-run Medi-Cal expansion

Published: May 14, 2013 | No Comments

Gov. Jerry Brown committed Tuesday to a state-based expansion of subsidized health care for low-income Californians, abandoning a proposal he had floated that would have required each of the state’s 58 counties to provide care for the low-income people in their communities.

But Brown, in his revised budget for the coming year, said he still wants to redirect the lion’s share of the money the state now gives the counties to provide care to the uninsured.

His rationale: the expansion of Medi-Cal under the federal health reform law Jan. 1 will mean that far more people have insurance, and far fewer people end up as the responsibility of the counties. It is only fair, the governor says, to shift the money that has been used to reimburse the counties for the cost of that care.

Brown said he wants to enact the shift over several years, and base it on the counties’ actual cost for providing care to those who remain uninsured. He estimates that the counties will give up $300 million in the first year, $900 million in year two and $1.3 billion in the the third year after the expansion of Medi-Cal takes place.

Brown is also proposing a shift of responsibility for a number of health services, including a state takeover of a program that provides care to children with special health care needs.

–Daniel Weintraub

 

A dangerous complication: Domestic violence in pregnancy

Published: May 14, 2013 | No Comments

Photo: Flickr/Bies

Affordable Care Act provisions help but aren’t enough, advocates say

By Hannah Guzik
California Health Report

When Margot Newman* went into labor, her boyfriend broke her cell phone and hogtied her to the toilet in their cramped bathroom. If she left, or screamed, he said he’d kill her.

As her contractions grew stronger, she pleaded for him to let her go to the hospital. Finally, he allowed her to go to her sister’s house nearby, and she took Newman to the Ojai Valley Community Hospital.

“I prayed and prayed and prayed that I could get through the day,” Newman said. “We finally got to the hospital and my blood pressure was really high, and I had really high contractions, because he had put me in to labor.”

Her son, Landon, was born after 30 hours of labor and a number of medical interventions, due to Newman’s high blood pressure and other complications, likely stemming from the abuse she’d experienced in the days before, her doctor said.

Her doctor didn’t know about the severity of abuse beforehand, but had provisions of the Affordable Care Act been in place, he might have. Under the new federal law, health care providers are required to offer domestic-violence screening and counseling to all women, and health insurance companies are required pay for those services.

“An estimated 25 percent of women in the United States report being targets of intimate partner violence during their lifetimes,” reads a fact sheet on the coverage from the federal Department of Health and Human Services. “Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women.”

Health care providers statewide have been working to implement the new requirements since they took effect in August 2012. Meanwhile, activists and those who work with domestic violence victims say the provisions are a good start, but still not enough to solve the problem.

“I just think this is a really big problem and I think we have to improve the OBGYN comfort level with intervening and improve the skills set to intervene,” said Priya Batra, a women’s health psychologist who helps lead a domestic violence taskforce in Sacramento. “The most helpful intervention is saying, ‘This is not OK, you do not have live this way, there is hope out there for you.”

If they didn’t do so already, most health care providers have added a domestic-violence screening aspect to their “well-woman exams,” or annual checkups. But, depending on the provider, the screening could range from simply asking women experiencing abuse to check a box on an intake form to the physician taking several minutes to ask each patient a series of questions.

“I encourage clinicians to ask, ‘How are things at home?’ something that’s a conversation,” said Brigid McCaw, an internal medicine doctor and the medical lead of Kaiser Permanente’s Family Violence Prevention Program in Northern California.

“I will often follow it up with, ‘Do you ever feel physically or emotional threatened or hurt by your partner or spouse?’” To help them comply with the new law, some doctors, nurses and therapists are also receiving special training on how to help women experiencing domestic violence, something McCaw believes should be standard, she said.

“This is so common, unfortunately — one out of four women will experience intimate-partner violence in their lifetime — and you can’t tell just by looking on an age or social or economic status or education or religion or sexual preference,” she said. “So screening every woman when they come in for a well-woman visit or other conditions or concerns is absolutely warranted. There’s no way to know unless you ask.”

There’s also a lack of emergency shelters and transitional housing for victims, whose ability to escape the abuse often hinges on having another place to live, Batra said.

According to the 2012 National Census of Domestic Violence Services, a survey taken by all domestic violence agencies statewide on Sept. 12, the agencies served 5,258 victims in California that day. On that same day, the groups were unable to meet 1,170 requests from victims for help. About 68 percent of those requests were for housing — both emergency and transitional.

Domestic violence often escalates during stressful life events, such as pregnancies, particularly if they’re unplanned or occur in tangent with economic difficulties, according to the California Partnership to End Domestic Violence.

Women who have been pregnant within the last five years experience 12 percent higher rates of intimate partner violence, according to the 2005 California Women’s Health Survey cited by the nonprofit.

Of those experiencing physical intimate partner violence, 75 percent of the victims in the survey had children under the age of 18 at home.

Domestic violence and abuse — whether emotional or physical — can take a toll on both a pregnant woman and her developing fetus, McCaw said.

“We’re just beginning to understand in the last 10 to 15 years how important the maternal experience is for how babies do,” she said. “The fear and stress related to intimate partner violence, even if there aren’t direct injuries, certainly has an impact on the developing baby and those risk can stay with the baby over time.”

Pregnant women living with abuse face higher chances of pre-term delivery, as well as pregnancy complications, such as high blood pressure. They also have higher incidences of depression, post-traumatic stress disorder and anxiety disorders, McCaw said.

A pregnancy can make it more difficult for a woman to leave an abusive relationship, particularly if she’s reliant on her partner for health insurance, money or housing, said Krista Kotz, program director for Kaiser’s Northern California Family Violence Prevention Program.

“In general, things that would make a woman more financially vulnerable make it more difficult for her to leave,” she said.

Ventura mother Dena Lopez* experienced severe abuse when pregnant with all three of her children, giving birth twice with black eyes, bruises and broken ribs, she said. Finally, after giving birth to a stillborn baby who she “felt sure was brain damaged because of the beatings,” she left her husband.

That was more than 30 years ago, and she’s now a grandmother and teacher at an adult education program in Ventura County. Lopez also volunteered at a local shelter for domestic violence victims.

“I talk to the women who are in the same state of mind that I was in, and I try to tell them, ‘You don’t try to stay together for the kids. In the end, the decision to leave, it’s a life or death choice,’” she said. “The biggest thing is just knowing you’ve got some outside support and that’s the one big reason that you stay or return.”

Newman, who was also beaten multiple times while pregnant, left her son’s father a few days after he was born, with $3 in her bank account. She wasn’t sure how they’d survive, but she found work as a waitress, got an apartment in Ojai and obtained full custody of her son.

Landon is now two and doesn’t remember his father.

“I didn’t want Landon to grow up thinking that it’s OK to treat women that way,” Newman said. “He’s such a sweet and loving boy. What happened before almost seems like a dream.”

* Names have been changed to protect the safety of victims of abuse.

 

How will Brown balance oil, environmental interests?

Published: May 13, 2013 | 1 Comment

By Daniel Weintraub

California’s economy has been powered for decades by technology, trade and tourism — businesses and jobs mostly near the coast from San Diego to Los Angeles and around the San Francisco Bay Area. The state’s great inland valleys, while serving as a breadbasket for the world, have not been a land of high-paying employment or tax-producing industry.

A glance at the most recent unemployment numbers reflects this reality. While the state’s overall jobless rate is still high by historic standards, it has fallen to 6.3 percent in Orange County, 6.0 percent in San Francisco and 5.7 percent in San Mateo County. In the Central Valley, by contrast, unemployment remains in double digits from Kern County (13.6) all the way to San Joaquin (14.1).

Could Big Oil change all that?

A revolution in the oil industry that’s been taking place in Pennsylvania, Ohio and North Dakota is poised to sweep through California’s oil patch, with the potential to produce hundreds of thousands of jobs and billions in tax revenue for the state.

But there’s a big catch. That same revolution also brings the chance of environmental degradation, threatening the water supply and abetting a carbon-based economy that many were hoping would soon become a thing of the past. That might not be a problem in the rust belt or the job-starved upper Midwest, but environmental protection is one of California’s passions. It is also one of its attractions.

At issue is the future of what is known as the Monterey Shale, a geologic formation that stretches beneath the Central Valley from Bakersfield to Modesto. Parts of this region have been a source of oil for generations. Despite recent declines, California still ranks fourth among the states in crude oil production, behind Texas, Alaska and a surging North Dakota, and most of that oil comes from the southern Central Valley and the surrounding hills.

Geologists say the Monterey Shale dwarfs the oil fields now under development. It holds an estimated 15 billion barrels of oil, or two thirds of the shale-oil reserves in the United States, according to the US Energy Information Administration. If fully developed, the oil field could create as many as 2.8 million jobs and, on an annual basis, $24 billion in extra tax revenue, according to an industry-funded study by University of Southern California economists.

Those numbers might be inflated. But even a fraction of that benefit could transform California’s economy. To put things in perspective, consider that California today still has 140,000 fewer jobs than it did before the recession in 2007, and before that, it took the state more than 20 years to create 2.8 million jobs – from all sources.

The oil in the Monterey Shale, however, can only be retrieved using the technique known as hydraulic fracturing, or fracking. This involves injecting massive amounts of water and, possibly, chemicals into the ground thousands of feet below the surface to break the rocks and free the oil locked within them.

The oil industry has used fracking in California for generations, without incident, according to industry trade associations. But operations in other parts of the country have been blamed by residents and environmentalists for contaminating the water table with toxic chemicals. No one wants that to happen here.

And even if every local environmental risk could be resolved, fracking raises another question for California. The state has been a leader in the fight to limit greenhouse gases, which are blamed for warming the earth and come primarily from the burning of carbon-based fuels. Does California now want to be in a position of enabling the retrieval of vast amounts of oil that will postpone the day at which we might have to confront our carbon dependency?

Gov. Jerry Brown, who all his life has straddled the line between environmentalists and the business world, seems eager to see fracking move forward in California, if he can be assured that it will be done safely. From building a bullet train to transforming the state’s water system and overhauling the way we finance education, Brown is using his second round as governor to build a record that might one day rival his famous father’s. Ushering in a new economic boom that puts the state’s budget on firm footing at last would help cement that legacy.

But Democrats in the Legislature, alarmed at what they say has been lax oversight from Brown’s administration, are trying to put a stop to new fracking operations. Legislation moving through the state Assembly would place a moratorium on the practice and order state regulators to study it and then allow fracking again only if it poses no risk “to the public health and welfare, environment or economy of the state.” The moratorium could last until 2019.

Would Brown sign such a measure if it reached his desk? Probably not. The bill’s intent implies that the governor does not already have the state’s best interests at heart, and it infringes on his powers as chief executive. If Brown wants more studies of fracking, or wants a pause in the practice, he can make that happen without orders from the Legislature.

Absent a moratorium, Brown will remain in the driver’s seat. It will be fascinating to watch him balance so many competing interests on a decision that, one way or the other, could have a profound effect on California’s future.

Daniel Weintraub has covered California public policy for 25 years. He is editor of the California Health Report at www.healthycal.org

 
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