Public Health

Why and how we endorsed what we did

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As I sort through the barrage of positive and negative feedback to the election endorsements that we published today — which included some tough calls that have surprised some of our progressive allies — I’d like to take a moment to explain how we at the Guardian approach our political endorsements and what they represent.

First of all, let me state clearly and categorically that our corporate owners had nothing to do with our decisions, which were made entirely by the Guardian’s editorial board, which includes me, News Editor Rebecca Bowe, and Staff Writer Joe Fitzgerald Rodriguez. And the three of us found consensus on all of our choices, sometimes after long discussions, even when we had differing initial views on a particular race or measure.

The other important point to make is that it’s long been the Guardian’s philosophy to avoid choosing “no endorsement” whenever possible. If voters have to make a tough decisions among bad or equally attractive options, then we shouldn’t shrink from making that decision as well, even if that risks the scorn of a segment of our readership. This was the approach that I learned from former Guardian editors Bruce Brugmann and Tim Redmond, and it’s an approach that I’ve encouraged us to continue as editor.

Finally, there’s the philosophical question of what it means to endorse a candidate, a question that we’ve spent a lot of time pondering and discussing during this election cycle. There’s not a clear and simple answer to the question, so I’ll just discuss what I think it means.

At its most basic, our endorsement means that we think our readers should vote for this person or position in this election. That’s all. It isn’t a validation of everything a politician does or stands for, and our endorsements are often driven by a weak field of challengers more than the strength of an incumbent. Frankly, there’s only one challenger in the five supervisorial races this fall who is well-qualified for the board and running a strong campaign, Tony Kelly in District 10, and we endorsed him.

The endorsement that we’re catching the most shit for right now is Scott Wiener in District 8, which was a tough call that we spent a lot of time discussing. To many progressives, Wiener is the devil, someone who has taken strong and inflexible positions on housing and regulatory issues that have angered many on the left.

But I don’t think Wiener is the devil, even though I’ve helped blast him for his bad positions as strongly as anyone in town. I think he’s a complicated person and politician who, in addition to his bad stands, has shown important political leadership and integrity on issues we do support, including transportation, nightlife, and public health. I’ve also found him to be more honest and accessible than his more progressive colleague, Sup. Jane Kim, who we also endorsed with some reservations. If you want to understand why we endorsed them, read our endorsements, it’s all in there.

Personally, for me, the hardest endorsement in our package was going no on Prop. H, and I’m still not sure whether we made the right call — or how I’m going to vote on this measure. I’ve sympathetically covered the political battles over artificial turf and this Beach Chalet project for years, and I viscerally don’t like this project, feeling like it just doesn’t belong right there on the coast.

But I understand the need for more playing time on the city’s fields, we’ve visited the site and seen how tucked away from the surrounding area it really is, and I was persuaded that it’s time to let this project proceed after six-year-long fight. Our strong rejection of the companion measure Prop. I also gives me confidence that we’re not opening the door to a rapid conversion of city playing fields to artificial turf.

Did we get it right? That’s for readers and voters to decide based on their political perspectives, but I can tell you that we made a good faith effort and spent many hours trying. And if you have doubts about the calls we made, please listen to the audio recordings of our endorsement interviews and form your own opinions. Democracy is messy business, imperfect by design, and sometimes “least bad” is the best choice. 

In the end, I’m proud of our endorsements, which provide a valuable public service in helping voters sort through a long and complicated ballot, offering a more neutral and public-spirited perspective than that of the paid advocacy that is filling up voters’ mailboxes and billboards around town right now.

Good luck this election season, and don’t forget to vote by Nov. 4.  

Prop. L puts cars over people

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By Fran Taylor

OPINION Just as climate change most affects people who contributed little or nothing to causing it, pollution and injury from traffic most affect communities least likely to create traffic. Nationally, people of color are four times more likely than whites to rely on public transportation. At the same time, African Americans have a pedestrian fatality rate 60 percent higher than that of whites. For Latinos, that rate is 43 percent higher.

Locally, Chinatown and the Tenderloin have some of the lowest rates of car ownership in San Francisco. Yet these poor neighborhoods suffer some of the highest rates of pedestrian injury and death, including a woman killed in a crosswalk at Stockton just last month.

Instead of acknowledging these inequities, the proponents of Proposition L on the November ballot have cast themselves as victims, claiming that pedestrian and bicycle safety improvements create impediments to their ability to drive fast and park easily.

But streetscape improvements don’t make it impossible to drive. They help make it possible to not drive. And the ability to get around without a car benefits everyone, as a matter of health and fairness.

Fewer speeding cars on the road means fewer injuries and deaths, which in San Francisco disproportionately affect people walking. Of the 19 traffic deaths so far in 2014, 13 have been pedestrians. In the wider Bay Area, these pedestrian deaths are almost twice as likely to occur in poor communities.

The Prop. L campaign claims that streetscape improvements worsen pollution by forcing drivers to idle engines and circle for parking. Free-flowing car movement is the measure’s goal. If fast traffic is so much healthier, freeways must be the healthiest of neighbors. Yet studies show that not only is asthma much more widespread near freeways, but uncontrolled asthma is twice as prevalent within two miles of that ideal zooming traffic. Meanwhile, lack of walkable access to schools and parks contributes to epidemic levels of obesity and diabetes, particularly in low-income populations and communities of color.

Medical costs throughout the city for pedestrian injuries alone amount to about $15 million a year, while the total annual health-related costs of traffic, including asthma and other conditions, come to $564 million, according to the San Francisco Department of Public Health.

The national average annual cost of owning a car is close to $10,000, likely more in San Francisco. Were families more easily able to reduce that cost by having one car instead of two or living car-free entirely, they would free up needed money for food, housing, and education. And that housing would be cheaper without parking requirements. The construction of off-street parking can add costs of up to 20 percent per unit. Prop. L demands more garages, so cars can have homes in a city where so many humans lack them.

The recent transformation of Cesar Chavez Street, led by the community group CC Puede, personifies the type of project Prop. L proponents object to. Changing a six-lane freeway on the ground did indeed slow traffic and remove some parking at intersections to accommodate pedestrian bulbouts and improve visibility, both proven safety fixes. It also made it easier for parents to cross the street with their children to Flynn and St. Anthony’s elementary schools. It made it safer for seniors and pregnant women to reach St. Luke’s Hospital. Bicycle ridership on the street has increased 400 percent. Lately, no cars have crashed into homes, a regular occurrence on the old six-lane speedway.

Prop. L proponents decry the loss of parking, but where are those spaces going? A parking lot at 17th Street between Folsom and Shotwell in the Mission is about to be ripped up to make a park designed in part by children living nearby. In a dense neighborhood with little greenery, half of the parking lot will give families crammed into crowded housing a place to walk to. The other half will eventually be used for affordable housing.

We could hardly have a clearer choice of priorities. Parking lots or parks? Parking lots or affordable housing? Prop. L is a vote for parking over people. Vote No on L.

Fran Taylor is cochair of CC Puede.

 

Racing for solutions

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rebecca@sfbg.com

Although there are five seats on the San Francisco Board of Supervisors up for reelection this fall, incumbents face few contenders with the requisite cash and political juice needed to mount a serious challenge. The one race that has stirred interest among local politicos is the bid to represent District 10, the rapidly changing southeastern corner of San Francisco that spans the Bayview, Hunters Point, Visitacion Valley, Dogpatch, and Potrero Hill neighborhoods.

Sup. Malia Cohen, who narrowly beat an array of more than a dozen candidates in 2010, has raised way more money than her best-funded opponent, progressive neighborhood activist Tony Kelly, who garnered 2,095 first-place votes in the last D10 race, slightly more than Cohen’s, before the final outcome was determined by ranked-choice voting tallies.

For the upcoming Nov. 4 election, Cohen has received $242,225 in contributions, compared with Kelly’s $42,135, campaign finance records show. But Kelly, who collected the 1,000 signatures needed to qualify for the November ballot and qualified for public financing, has secured key progressive endorsements, including former Mayor Art Agnos, Assemblymember Tom Ammiano, Sups. David Campos and John Avalos, and the Potrero Hill Democratic Club.

Others who’ve filed to run for this office include Marlene Tran, a retired educator who has strong ties to families in the district, especially in Visitacion Valley, through her teaching and language-access programs (she’s known by kids as “Teacher Tran”); Shawn Richard, the founder of a nonprofit organization that offers workshops for youth to prevent gun violence; and Ed Donaldson, who was born and raised in Bayview Hunters Point and works on economic development issues. DeBray Carptenter, an activist who has weighed in on police violence, is running as a write-in candidate.

But the outcome in this dynamic district could be determined by more than campaign cash or political endorsements. That’s because the D10 supervisor faces the unique, unenviable challenge of taking on some of the city’s most intractable problems, which have disproportionately plagued this rapidly changing district.

Longstanding challenges, such as a high unemployment and crime rates, public health concerns, social displacement, and poor air quality, have plagued D10 for years. But now, fast-growing D10 is becoming a microcosm for how San Francisco resolves its growing pains and balances the interests of capital and community.

 

MIX OF CHALLENGES

While candidate forums and questionnaires tend to gauge political hopefuls on where they draw the line on citywide policy debates, such as Google bus stops or fees for Sunday parking meters, neighborhood issues facing D10 have particularly high stakes for area residents.

While other supervisors represent neighborhoods where multiple transit lines crisscross through in a rainbow of route markers on Muni maps, D10 is notoriously underserved by public transit. The high concentration of industrial land uses created major public health concerns. A Department of Public Health study from 2006 determined that Bayview Hunters Point residents were making more hospital visits on average than people residing in other San Francisco neighborhoods, especially for asthma and congestive heart failure.

Unemployment in D-10 hovers near 12 percent, triple the citywide average of 4 percent. Cohen told us efforts are being made on this front, noting that $3 million had been invested in the Third Street corridor to assist merchants with loans and façade improvements, and that programs were underway to connect residents with health care and hospitality jobs, as well as service industry jobs.

“The mantra is that the needle hasn’t moved at all,” Cohen noted, but she said things are getting better. “We are moving in the same downward trend with regard to unemployment.”

Nevertheless, the high unemployment is also linked with health problems, food insecurity — and violence. In recent months, D10 has come into the spotlight due to tragic incidents of gun violence. From the start of this year to Sept. 8, there were 13 homicides in D10.

Fourth of July weekend was particularly deadly in the Bayview and D10 public housing complexes, with four fatal shootings. Cohen responded with a press conference to announce her plan to convene a task force addressing the problem, telling us it will be “focused on preventing gun violence rather than reacting to it.”

The idea, she said, is to bring in expert stakeholders who hadn’t met about this topic before, including mental-health experts and those working with at-risk youth.

“I think we need to go deeper” than in previous efforts, Cohen said, dismissing past attempts as superficial fixes.

But Cohen’s task force plan quickly drew criticism from political opponents and other critics, including Sheriff Ross Mirkarimi, who dismissed it as empty rhetoric.

“How many people are cool with yet another task force?” Kelly said in a press statement challenging the move. “We can’t wait any longer to stem the deadly tide of violence in District 10. Supervisor Cohen’s task force won’t even propose solutions till 2017. We can’t wait that long.”

Kelly told us he’s formulated a five-point plan to tackle gun violence, explaining that it involved calling for a $10 million budget supplemental to bolster family services, reentry programs, job placement, and summer activities aimed at addressing poverty and service gaps. Kelly also said he’d push for a greater emphasis on community policing, with officers walking a beat instead of remaining inside a vehicle.

“How do you know $10 million is enough?” Cohen responded. “When you hear critics say $10 million, there is no way to indicate whether we’d need more or less.” She also took issue with the contention that her task force wouldn’t reach a solution soon enough, saying, “I never put a timeline on the task force.”

Cohen also said she wanted to get a better sense of where all of the past funding had gone that was supposed to have alleviated gun violence. “We’ve spent a lot of money — millions — and one of the things I am interested in doing is to do an audit about the finances,” she said.

She also wants to explore a partnership with the Guardian Angels, community volunteers who conduct safety patrols, to supplement policing. Cohen was dismissive of her critics. “Tony was not talking about black issues before this,” she said. “He hasn’t done one [gun] buyback. There’s no depth to what any of these critics are saying.”

Tran, who spoke with the Guardian at length, said she’d started trying to address rampant crime in Visitacion Valley 25 years ago and said more needs to be done to respond to recent shootings.

“There was no real method for the sizable non-English speaking victims to make reports then,” Tran wrote in a blog post, going on to say that she’d ensured materials were translated to Chinese languages to facilitate communication with the Police Department. “When more and more residents became ‘eyes and ears’ of law enforcement, community safety improved,” she said.

Richard, whose Brothers Against Guns has been working with youth for 20 years and organizing events such as midnight basketball games, said he opposed Cohen’s task force because it won’t arrive at a solution quickly enough. He said he thought a plan should be crafted along with youth advocates, law enforcement, juvenile and adult probation officers, and clergy members to come up with a solution that would bolster youth employment opportunities.

“I’ve talked with all 13 families” that lost young people to shootings this year, Richard said, and that he attended each of the funerals.

 

CHANGING NEIGHBORHOOD

Standing outside the Potrero Terrace public housing complex at 25th and Connecticut streets on a recent sunny afternoon, Kelly was flanked by affordable housing advocates clutching red-and-yellow “Tony Kelly for District Supervisor” campaign signs. The press conference had been called to unveil his campaign plan to bolster affordable housing in D10.

Pointing out that Cohen had voted “no endorsement” at the Democratic County Central Committee on Proposition G — the measure that would tax property-flipping to discourage real estate speculation and evictions — Kelly said, “This is not a time to be silent.”

While Cohen had accepted checks from landlords who appeared on the Anti-Eviction Mapping Project’s list of worst offenders for carrying out Ellis Act evictions, Kelly said he’s pledged not to accept any funding from developers or Ellis Act evictors. Asked if any had offered, Kelly responded, “Some. They’re not knocking down my door.”

Cohen told us that she hadn’t supported Prop. G, a top priority for affordable housing advocates, because she objected to certain technical provisions that could harm small property owners in her district. As for the contributions from Ellis Act evictors, she said the checks had been returned once the error was discovered. Her formal policy, she said, is not to intentionally take money from anyone involved in an Ellis Act eviction.

Speaking outside Potrero Terrace, Kelly said he thought all housing projects built on public land should make at least one-third of their units affordable to most San Franciscans. He also said renovation of public housing projects could be accelerated if the city loaned out money from its $19 billion employee retirement fund. Under the current system, funding for those improvements is leveraged by private capital.

Mold, pests, and even leaking sewage are well-documented problems in public housing. Dorothy Minkins, a public housing resident who joined Kelly and the others, told us that she’s been waiting for years for rotting sheetrock to be replaced by the Housing Authority, adding that water damage from her second-floor bathroom has left a hole in the ceiling of her living room. She related a joke she’d heard from a neighbor awaiting similar repairs: “He said, Christ will come before they come to fix my place.”

Lack of affordable housing is a sweeping trend throughout San Francisco, but it presents a unique challenge in D10, where incomes are lower on average (the notable exceptions are in Potrero Hill, dotted with fine residential properties overlooking the city that would easily fetch millions, and Dogpatch, where sleek new condominium dwellings often house commuters working at tech and biotech firms in the South Bay).

Home sale prices in the Bayview shot up 59 percent in two years, prompting the San Francisco Business Times to deem it “a hot real estate market adorned with bidding wars and offers way above asking prices.”

One single-family home even sold for $1.3 million. Historically, the Bayview has been an economically depressed, working-class area with a high rate of home ownership due to the affordability of housing — but that’s been impacted by foreclosures in recent years, fueling displacement.

Although statistics from the Eviction Defense Collaborative show that evictions did occur in the Bayview in 2013, particularly impacting African Americans and single-parent households, Cohen noted that evictions aren’t happening in D10 with the same frequency as in the Tenderloin or the Mission.

“When it comes to communities of color in the southeast, it’s about foreclosure or mismanagement of funds,” explained Cohen.

She said that a financial counseling services center had opened on Evans Street to assist people who are facing foreclosure, and added that she thought more should be done to market newly constructed affordable units to communities in need.

“There’s an error in how they’re marketing,” she said, because the opportunities are too often missed.

But critics say more is needed to prevent the neighborhood from undergoing a major transformation without input from residents.

“This district is being transformed,” Richard said. “A lot of folks are moving out — they’re moving to Vallejo, Antioch, Pittsburg. They don’t want to deal with the issues, and the violence, and the cost.”

At the same time, he noted, developers are flocking to the area, which has a great deal more undeveloped land than in other parts of the city.

“The community has no one they can turn to who will hold these developers accountable,” he said. “If the community doesn’t have a stake in it, then who’s winning?”

 

He hates these cans! How helping Muni becomes hating nonprofits

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While I’m reluctant to give this self-serving poverty pimp any more attention or web traffic, it’s hard to ignore the latest misleading hit piece that Randy Shaw has written on behalf of Mayor Ed Lee, going after Sup. Scott Wiener and his Muni funding measure Prop. B.

As many local media outlets have reported, the Mayor’s Office has been fuming that Wiener dared to put the measure on the ballot in response to Lee reneging on his promise to put a local vehicle license fee increase on the fall ballot to help Muni serve a growing population of residents and workers — and threatening political retaliation.

So Shaw has been using his BeyondChron website to defend the financial interests of his city-supported Tenderloin Housing Clinic and other pet projects that this nascent Tenderloin power broker has been working on, in the process providing propaganda pieces for the Mayor’s Office, which supports Shaw with money from city taxpayers.

This cozy and symbiotic relationship is never disclosed by Shaw when he writes stories that he promotes as actual journalism, a practice that we’ve repeatedly taken issue with. We also contacted Shaw for comment, something he doesn’t do when attacking the Guardian, but we got no response.  

Wiener isn’t always the most progressive supervisor, but he’s been a solid and consistent supporter of Muni and modernizing the city’s transportation infrastructure, arguing correctly that San Francisco needs good public transit to function well, a point that civic groups ranging from SPUR to Livable City also regularly make.  

But the only reason Shaw can see for Prop. B is that Wiener hates nonprofits: “I understand why Wiener backs Prop B. Wiener is the Board member most opposed to nonprofits. He fought to eliminate the nonprofit exemption on Transit Impact Development Fees.  Wiener pushed for the proposed Vehicle License Fee to go 100 percent to transit, though it had originally been intended to be partially available for human services.”

The argument, of course, is ludicrous. In fact, it reminds me of the scene in The Jerk where a sniper aiming for Steve Martin misses and hits oil cans, causing Martin’s dim-witted character to conclude, “He hates these cans!.

No, Randy, Wiener doesn’t hate nonprofits. He supports Muni, which is also the common denominator in that list you cited. And no, Randy, the salaries of nonprofit workers aren’t the only place to find $20 million in the General Fund, as the Guardian showed during our city budget overview earlier this year.   

Shaw also claims Muni funding has kept pace with population growth — which, if true, would mean it wouldn’t get any more money under Prop. B — but Shaw uses misleading data that ignores the SFMTA reorganization measure Prop. A from 2007, the raid of SFMTA funding that followed using “work orders” from city departments, Muni’s deferred maintenance backlog of more than $2 billion, and the fact that SFMTA’s budget increases lag behind other major departments (such as the Department of Public Health and the Police Department) even with this week’s 25-cent Muni fare increase.

As former Guardian Editor/Publisher Tim Redmond used to say regularly: not everything gets better when you throw more money at it, but schools and public transit do. Money translates directly into more capacity to serve students or riders, including the growing number of local workers Muni is serving on top of the increasing local population.

This makes sense to most people, whether or not they support Prop. B and giving more General Fund money to Muni, a legitimate question about which well-meaning people can have good-faith differences of opinion over. But Shaw isn’t one of those people, and to him, Wiener just hates those cans. 

Tom’s legacy

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steve@sfbg.com

At a moment when San Francisco politics has slid toward the slippery center — when one-time progressives align with business elites, the political rhetoric seems hollow, and the vaunted value of “civility” in City Hall increasingly looks more like a deceptive power grab by the Mayor’s Office — it feels so refreshing to talk with Tom Ammiano.

For one thing, he’s hilarious, always quick with quips that are not only funny, but often funny in insightful ways that distill complex issues down to their essence, delivered with his distinctive nasally honk and lightning timing. Ammiano developed as a stand-up comedian and political leader simultaneously, and the two professional sides feed off each other, alternatively manifesting in disarming mirth or penetrating bite.

But his humor isn’t the main reason why Ammiano — a 72-year-old state legislator, two-time mayoral candidate, and former supervisor and school board member — has become such a beloved figure on the left of state and local politics, or why so many progressives are sad to see him leaving the California Assembly and elected office this year for the first time since 1990.

No, perhaps the biggest reason why public esteem for Ammiano has been strong and rising — particularly among progressives, but also among those of all ideological stripes who decry the closed-door dealmaking that dominates City Hall and the State Capitol these days — is his political integrity and courage. Everyone knows where Tom Ammiano will stand on almost any issue: with the powerless over the powerful.

“Don’t make it about yourself, make it about what you believe in,” Ammiano told us, describing his approach to politics and his advice to up-and-coming politicians.

Ammiano’s positions derive from his progressive political values, which were informed by his working class upbringing, first-hand observations of the limits of American militarism, publicly coming out as a gay teacher at time when that was a risky decision, standing with immigrants and women at important political moments, and steadily enduring well-funded attacks as he created some of San Francisco’s most defining and enduring political reforms, from domestic partner benefits and key political reforms to universal health care.

“He has been able to remain true to his values and principles of the progressive movement while making significant legislative accomplishments happen on a number of fronts,” Sup. David Campos, who replaced Ammiano on the Board of Supervisors and is now his chosen successor in the California Assembly, told the Guardian. “I don’t know that we’ve fully understood the scope of his influence. He has influenced the city more than most San Francisco mayors have.”

So, as we enter the traditional start of fall election season — with its strangely uncontested supervisorial races and only a few significant ballot measures, thanks to insider political manipulations — the Guardian spent some time with Ammiano in San Francisco and in Sacramento, talking about his life and legacy and what can be done to revive the city’s progressive spirit.

 

 

LIFE OF THE CAPITOL

Aug. 20 was a pretty typical day in the State Capitol, perhaps a bit more relaxed than usual given that most of the agenda was concurrence votes by the full Senate and Assembly on bills they had already approved once before being amended by the other house.

Still, lobbyists packed the hall outside the Assembly Chambers, hoping to exert some last minute influence before the legislative session ended (most don’t bother with Ammiano, whose name is on a short list, posted in the hall by the Assembly Sergeant-at-Arms, of legislators who don’t accept business cards from lobbyists).

One of the bills up for approval that day was Ammiano’s Assembly Bill 2344, the Modern Family Act, which in many ways signals how far California has come since the mid-’70s, when Ammiano was an openly gay schoolteacher and progressive political activist working with then-Sup. Harvey Milk to defeat the homophobic Briggs Initiative.

The Modern Family Act updates and clarifies the laws governing same-sex married couples and domestic partners who adopt children or use surrogates, standardizing the rights and responsibilities of all parties involved. “With a few simple changes, we can help families thrive without needless legal battles or expensive court actions,” Ammiano said in a press statement publicizing the bill.

Ammiano arrived in his office around 10am, an hour before the session began, carrying a large plaque commending him for his legislative service, given to outgoing legislators during a breakfast program. “Something else I don’t need,” Ammiano said, setting the plaque down on a table in his wood-paneled office. “I wonder if there’s a black market for this shit.”

Before going over the day’s legislative agenda, Ammiano chatted with his Press Secretary Carlos Alcala about an editorial in that morning’s San Francisco Chronicle, “Abuse of disabled-parking program demands legislators act,” which criticized Ammiano for seeking minor changes in a city plan to start charging for disabled placards before he would sponsor legislation to implement it. The editorial even snidely linked Ammiano to disgraced Sen. Leland Yee, who is suspended and has nothing to do with the issue.

“I’ve had these tussles with the Chronicle from day one. They just want people to be angry with me,” Ammiano told us. “You stand up for anything progressive and they treat you like a piñata.”

He thought the criticism was ridiculous — telling Alcala, “If we do a response letter, using the words puerile and immature would be good” — and that it has as much to do with denigrating Ammiano, and thus Campos and other progressives, as the issue at hand.

“Anything that gets people mad at me hurts him,” Ammiano told us.

But it’s awfully hard to be mad at Tom Ammiano. Even those on the opposite side of the political fence from him and who clash with him on the issues or who have been subjected to his caustic barbs grudgingly admit a respect and admiration for Ammiano, even Lt. Gov. Gavin Newsom, who told the Guardian as much when we ran into him on the streets of Sacramento later that day.

Ammiano says he rarely gets rattled by his critics, or even the handful of death threats that he’s received over the years, including the one that led the San Francisco Police Department to place a protective detail on him during the 1999 mayor’s race.

“You are buoyed by what you do, and that compensates for other feelings you have,” Ammiano said of safety concerns.

Finally ready to prepare for the day’s business, he shouts for his aides in the other room (“the New York intercom,” he quips). The first question is whether he’s going to support a bill sponsored by PG&E’s union to increase incentives for geothermal projects in the state, a jobs bill that most environmental groups opposed.

“That is a terrible bill, it’s total shit, and I’m not going to support it,” Ammiano tells his aide. “It’s a scam.”

As Ammiano continued to prepare for the day’s session, we headed down to the Assembly floor to get ready to cover the action, escorted by Alcala. We asked what he planned to do after Ammiano leaves Sacramento, and Alcala told us that he’ll look at working for another legislator, “but there would probably be a lot more compromises.”

 

 

SPARKING CHANGE

Compromises are part of politics, but Ammiano has shown that the best legislative deals come without compromising one’s political principles. Indeed, some of his most significant accomplishments have involved sticking to his guns and quietly waiting out his critics.

For all the brassy charm of this big personality — who else could publicly confront then-Gov. Arnold Schwarzenegger at a Democratic Party fundraiser in 2009 and tell him to “kiss my gay ass!” — Ammiano has usually done the work in a way that wasn’t showy or self-centered.

By championing the reinstatement of district supervisorial elections and waging an improbable but electrifying write-in campaign for mayor in 1999 (finishing second before losing to incumbent Willie Brown in the runoff election), Ammiano set the stage for progressives to finally win control of the Board of Supervisors in 2000 and keep it for the next eight years, forming an effective counterbalance to Gavin Newsom’s pro-business mayoralty.

“I just did it through intuition,” Ammiano said of his 1999 mayoral run, when he jumped into the race just two weeks before election day. “There was a lot of electricity.”

After he made the runoff, Brown and his allies worked aggressively to keep power, leaning on potential Ammiano supporters, calling on then-President Bill Clinton to campaign for Brown, and even having Jesse Jackson call Ammiano late one night asking him to drop out.

“That’s when we realized Willie really felt threatened by us,” Ammiano said, a fear that was well-founded given that Ammiano’s loss in the runoff election led directly into a slate of progressives elected to the Board of Supervisors the next year. “It was a pyrrhic victory for him because then the board changed.”

But Ammiano didn’t seize the spotlight in those heady years that followed, which often shone on the younger political upstarts in the progressive movement — particularly Chris Daly, Matt Gonzalez, and Aaron Peskin — who were more willing to aggressively wage rhetorical war against Newsom and his downtown constituents.

By the time the 2003 mayor’s race came, Ammiano’s mayoral campaign became eclipsed by Gonzalez jumping into the race at the last minute, a Green Party candidate whose outsider credentials contrasted sharply with Newsom’s insider inevitability, coming within 5 percentage points of winning.

“I just bounced back and we did a lot of good shit after that,” Ammiano said, noting how district elections were conducive to his approach to politics. “It helped the way I wanted to govern, with the focus on the neighborhoods instead of the boys downtown.”

Perhaps Ammiano’s greatest legislative victory as a supervisor was his Health Care Security Ordinance, which required employers in San Francisco to provide health coverage for their employees and created the Healthy San Francisco program to help deliver affordable care to all San Franciscans.

The business community went ballistic when Ammiano proposed the measure in 2006, waging an aggressive lobbying and legal campaign to thwart the ordinance. But Ammiano just quietly took the heat, refused to compromise, and steadily lined up support from labor, public health officials, and other groups that were key to its passage.

“Maybe the early days of being a pinata inured me,” Ammiano said of his ability to withstand the onslaught from the business community for so long, recalling that in his 1999 school board race, “I really became a pinata. I got it in the morning from the Chronicle and in the afternoon from the Examiner.”

Ammiano kept Newsom apprised of his intentions and resolve, resisting entreaties to water down the legislation. “I kept talking to him and I told him I was going to do it,” Ammiano said. “Eventually, we got a 11 to zip vote and Newsom couldn’t do anything about it. That was a great journey.”

In the end, Newsom not only supported the measure, but he tried to claim Ammiano’s victory as his own, citing the vague promise he had made in his 2007 State of the City speech to try to provide universal health care in the city and his willingness to fund the program in his 2007-08 budget.

But Ammiano was happy with the policy victory and didn’t quibble publicly with Newsom about credit. “I picked my battles,” Ammiano said, contrasting his approach to Newsom with that of his more fiery progressive colleagues. “I tried to go after him on policy, not personality.”

Ammiano isn’t happy with the political turn that San Francisco has taken since he headed to Sacramento, with the pro-business, fiscally conservative faction of the city controlling the Mayor’s Office and exerting a big influence on the Board of Supervisors. But San Francisco’s elder statesman takes the long view. “Today, the board has a moderate trajectory that can be annoying, but I think it’s temporary,” Ammiano said. “These things are cyclical.”

He acknowledges that things can seem to a little bleak to progressives right now: “They’re feeling somewhat marginalized, but I don’t think it’s going to stay that way.”

 

FLOOR SHOW

Back on the Assembly floor, Ammiano was working the room, hamming it up with legislative colleagues and being the first of many legislators to rub elbows and get photos taken with visiting celebrities Carl Weathers, Daniel Stern, and Ron Perlman, who were there to support film-credit legislation

“Ron Perlman, wow, Sons of Anarchy,” Ammiano told us afterward, relating his conversation with Perlman. “I said, ‘They killed you, but you live on Netflix.’ I told him I was big fan. Even the progressives come here for the tax breaks.”

When Little Hoover Commission Chair Pedro Nava, who used to represent Santa Barbara in the Assembly, stopped to pose with Ammiano for the Guardian’s photographer, the famously liberal Ammiano quipped, “You’ll get him in trouble in Santa Barbara. Drill, baby, drill!”

Ammiano chairs the Assembly Public Safety Committee, where he has successfully pushed prison reform legislation and helped derail the worst tough-on-crime bills pushed by conservatives. “We have a lot of fun, and we get a chance to talk about all these bills that come before us,” Bob Wieckowski (D-Fremont), who chairs the Judiciary Committee, told the Guardian when asked about Ammiano. “You can see how these bad bills get less bad.”

Ammiano gave a short speech when his Modern Family Act came up for a vote, noting that it “simplifies the law around these procedures,” before the Assembly voted 57-2 to send it to the governor’s desk, where he has until Sept. 30 to act on it. “I think he’ll sign it,” Ammiano told the Guardian, “even though it’s about reproduction and naughty bits.”

“He’s a hoot,” Assemblymember Reggie Jones-Sawyer (D-Los Angeles) said of Ammiano, whose desk is right behind his own. Jones-Sawyer said that he’d love to see Ammiano run for mayor of San Francisco, “but he’s waiting for a groundswell of support. Hopefully the progressives come together.”

Jones-Sawyer said Ammiano plays an important role as the conscience of a Legislature that too often caters to established interests.

“There’s liberal, progressive, socialist, communist, and then there’s Tom,” Jones said. “As far left as you can go, there’s Tom, and that’s what we’re going to miss.”

Yet despite that strong progressive reputation, Ammiano has also been an amazingly effective legislator (something that might surprise those supporting the campaign of David Chiu, which has repeatedly claimed that ideological progressives like Ammiano and Campos can’t “get things done” in Sacramento).

Last year, Ammiano got 13 bills through the Legislature — including three hugely controversial ones: the TRUST Act, which curbs local cooperation with federal immigration holds; the Domestic Workers Bill of Rights; and a bill protecting transgender student rights in schools, which was savaged by conservative religious groups — all of which were signed into law by Gov. Jerry Brown.

“A lot of it is personal relationships, some is timing, and some is just sticking to it,” Ammiano said of effectiveness.

Some of his legislative accomplishments have required multiyear efforts, such as the Domestic Workers Bill of Rights, which was vetoed in 2012 before being signed into law last year with only a few significant changes (see “Do we care?” 3/26/13).

“Tom Ammiano was so incredible to work with,” Katie Joaquin, campaign coordinator for the California Domestic Workers Coalition, for whom the bill had long been a top priority, told the Guardian.

The large grassroots coalition backing the bill insisted on being a part of the decision-making as it evolved, which is not always easy to do in the fast-paced Capitol. But Joaquin said Ammiano’s history of working with grassroots activists made him the perfect fit for the consensus-based coalition.

“That’s difficult to do in the legislative process, and working with Tom and his office made that possible,” Joaquin told us. “He wanted to make sure we had active participation in the field from a variety of people who were affected by this.”

When the bill was vetoed by Gov. Brown, who cited paternalistic concerns that better pay and working conditions could translate into fewer jobs for immigrant women who serve as domestic workers, Joaquin said Ammiano was as disappointed as the activists, but he didn’t give up.

“It was really hard. I genuinely felt Tom’s frustration. He was going through the same emotions we were, and it was great that he wanted to go through that with us again,” Joaquin told us. “Sometimes, your allies can get fatigued with the long struggles, but Tom maintained his resolve and kept us going.”

And after it was over, Ammiano even organized the victory party for the coalition and celebrated the key role that activists and their organizing played in making California only the second state in the nation (after New York) to extend basic wage, hour, and working condition protections to nannies, maids, and other domestic workers excluded under federal law.

“He has a great sense of style,” Joaquin said of Ammiano, “and that emanates in how he carries himself.”

 

 

COMING OUT

Ammiano came to San Francisco in 1964, obtaining a master’s degree in special education from San Francisco State University and then going on to teach at Hawthorne Elementary (now known as Cesar Chavez Elementary). He quickly gained an appreciation for the complex array of issues facing the city, which would inform the evolution of his progressive worldview.

“In teaching itself, there were a lot of social justice issues,” Ammiano said. For example, most native Spanish-speakers at the time were simply dumped into special education classes because there wasn’t yet bilingual education in San Francisco schools. “So I turned to the community for help.”

The relationships that he developed in the immigrant community would later help as he worked on declaring San Francisco a sanctuary city as waves of Central American immigrants fled to California to escape US-sponsored proxy wars.

Growing up a Catholic working class kid in New Jersey, Ammiano was no hippie. But he was struck by the brewing war in Vietnam strongly enough that he volunteered to teach there through a Quaker program, International Volunteer Service, working in Saigon from 1966-68 and coming back with a strong aversion to US militarism.

“I came back from Vietnam a whole new person,” he told us. “I had a lot of political awakenings.”

He then worked with veterans injured during the war and began to gravitate toward leftist political groups in San Francisco, but he found that many still weren’t comfortable with his open homosexuality, an identity that he never sought to cover up or apologize for.

“I knew I was gay in utero,” Ammiano said. “I said you have to be comfortable with me being a gay, and it wasn’t easy for some. The left wasn’t that accepting.”

But that began to change in the early ’70s as labor and progressives started to find common cause with the LGBT community, mostly through organizations such as Bay Area Gay Liberation and the Gay Teachers Coalition, a group that Ammiano formed with Hank Wilson and Ron Lanza after Ammiano publicly came out as a gay teacher in 1975.

“He was the first public school teacher to acknowledge that he was a gay man, which was not as easy as it sounds in those days,” former Mayor Art Agnos told us, crediting Ammiano with helping make support for gay rights the default political position that it became in San Francisco.

San Francisco Unified School District still wasn’t supportive of gay teachers, Ammiano said, “So I ran for school board right after the assassinations [of Mayor George Moscone and Sup. Harvey Milk in 1978] and got my ass kicked.”

Shortly thereafter, Ammiano decided to get into stand-up comedy, encouraged by friends and allies who loved his sense of humor. Meanwhile, Ammiano was pushing for SFUSD to name a school after Milk, as it immediately did for Moscone, a quest that dragged on for seven years and which was a central plank in his unsuccessful 1988 run for the school board.

But Ammiano was developing as a public figure, buoyed by his stand-up performances (which he said Chronicle reporters would sometimes attend to gather off-color quotes to use against him in elections) and increased support from the maturing progressive and queer communities.

So when he ran again for school board in 1990, he finished in first place as part of the so-called “lavender sweep,” with LGBT candidates elected to judgeships and lesbians Carole Migden and Roberta Achtenberg elected to the Board of Supervisors.

On the school board, Ammiano helped bring SFUSD into the modern age, including spearheading programs dealing with AIDS education, support for gay students, distribution of condoms in the schools, and limiting recruiting in schools by the homophobic Boy Scouts of America.

“I found out we were paying them to recruit in the schools, but I can’t recruit?” Ammiano said, referencing the oft-raised concern at the time that gay teachers would recruit impressionable young people into homosexuality.

As his first term on the school board ended, a growing community of supporters urged Ammiano to run for the Board of Supervisors, then still a citywide election, and he was elected despite dealing with a devastating personal loss at the time.

“My partner died five days before the election,” Ammiano said as we talked at the bar in Soluna, tearing up at the memory and raising a toast with his gin-and-tonic to his late partner, Tim Curbo, who succumbed to a long struggle with AIDS.

Ammiano poured himself into his work as a supervisor, allied on the left at various points in the mid-late ’90s with Sups. Sue Bierman, Terrence Hallinan, Leland Yee, Mabel Teng, Angelo Alioto, and Carole Migden against the wily and all-powerful then-Mayor Brown, who Ammiano said “manipulated everything.”

But Ammiano gradually began to chip away at that power, often by turning directly to the people and using ballot measures to accomplish reforms such as laws regulating political consultants and campaign contributions and the reinstatement of district supervisorial elections, which decentralized power in the city.

“People frequently say about politicians, when they want to say something favorable, that they never forgot where they came from,” Agnos told us. “With Tom, he never forgot where he came from, and more importantly, he never forgot who he was…He was an authentic and a proud gay man, as proud as Harvey Milk ever was.”

And from that strong foundation of knowing himself, where he came from, and what he believed, Ammiano maintained the courage to stand on his convictions.

“It’s not just political integrity, it’s a reflection of the man himself,” Agnos said, praising Ammiano’s ability to always remain true to himself and let his politics flow from that. “A lot of politicians don’t have the courage, personal or political, to do that.”

 

 

WHAT’S NEXT

Ammiano’s legacy has been clearly established, even if it’s not always appreciated in a city enamored of the shiny and new, from recent arrivals who seem incurious about the city’s political history to the wave of neoliberal politicians who now hold sway in City Hall.

“Tom has carried on the legacy of Harvey Milk of being the movement progressive standard bearer. He has, more than anyone else, moved forward progressive politics in San Francisco in a way that goes beyond him as an individual,” Campos said, citing the return of district elections and his mentoring of young activists as examples. “He brought a number of people into politics that have been impactful in their own right.”

Campos is one of those individuals, endorsed by Ammiano to fill his District 9 seat on the Board of Supervisors from among a competitive field of established progressive candidates. Ammiano says he made the right choice.

“I have been supportive of him as a legislator and I think he’s doing the right things,” Ammiano said of Campos, adding an appreciation for the facts that he’s gay, an immigrant, and a solid progressive. “He’s a three-fer.”

Ammiano said that Campos has been a standout on the Board of Supervisors in recent years, diligently working to protect workers, tenants, and immigrants with successful efforts to increase tenant relocation fees after an eviction and an attempt to close the loophole that allows restaurants to pocket money they’re required to spend on employee health care, which was sabotaged by Chiu and Mayor Lee.

“I like his work ethic. He comes across as mild-mannered, but he’s a tiger,” Ammiano said of Campos. “If you like me, vote for David.”

But what about Ammiano’s own political future?

Ammiano said he’s been too busy lately to really think about what’s next for him (except romantically: Ammiano recently announced his wedding engagement to Carolis Deal, a longtime friend and lover). Ammiano is talking with universities and speakers bureaus about future gigs and he’s thinking about writing a book or doing a one-man show.

“Once I get that settled, I’ll look at the mayor’s race and [Sen. Mark] Leno’s seat,” Ammiano said, holding out hope that his political career will continue.

Ammiano said the city is desperately in need of some strong political leadership right now, something that he isn’t seeing from Mayor Lee, who has mostly been carrying out the agenda of the business leaders, developers, and power brokers who engineered his mayoral appointment in 2011.

“Basically, he’s an administrator and I don’t think he’ll ever be anything but that,” Ammiano said. “We are so fucking ready for a progressive mayor.”

If Ammiano were to become mayor — which seems like a longshot at this point — he says that he would use that position to decentralize power in San Francisco, letting the people and their representatives on the Board of Supervisors have a greater say in the direction of the city and making governance decisions more transparent.

“I don’t believe in a strong mayor [form of government],” Ammiano said. “If I was mayor, all the commission appointments would be shared.”

But before he would decide to run for mayor, Ammiano says that he would need to see a strong groundswell of public support for the values and ideals that he’s represented over nearly a half-century of public life in San Francisco.

“I don’t want to run to be a challenger,” Ammiano said. “I’d want to run to be mayor.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Did Big Soda swing a key endorsement by a progressive democratic club?

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Did the soda industry buy a prominent progressive political endorsement? Sunday’s San Francisco Chronicle raised the question in a story by Heather Knight, who goes on to air a number of rumors propagated by the soda tax supporters against the Harvey Milk LGBT Democratic Club.

First things first: the sugary beverage tax already has a lot of progressive support. Unions, health groups, and loads of other San Franciscans have backed the two cents per ounce tax on sugary beverages, Proposition E, which is slated to appear on this November’s ballot. The endorsement of “No on E” by the Milk Club is certainly a bit out of left field, and rightfully raised eyebrows in political circles.

That’s the argument Knight uses in her Sunday article, using a few quotes from the soda tax’s paid public relations’ people to take a big swing at Sup. David Campos, alleging this is a big ole scheme he’s orchestrated in order to get Coca Cola’s money to fund the Milk Club’s slate card, which would also feature Campos, giving him a boost in his Assembly race against Sup. David Chiu.

It’s a seemingly convincing scenario, and we’re not soothsayers. Maybe it’s true. But there are a number of reasons to not believe the hype.

First, we at the Guardian heard those same rumors and whispers too, but that wasn’t all we heard. One politico told us the beverage industry might be funding the Milk Club with $300,000 in campaign funds for their November ballot fliers. Our reaction was “um, what?!”

That’s more money than techie-billionaire Ron Conway spent backing Mayor Ed Lee’s major pet projects on the June ballot. Hell, it’s more money than some candidates raise in their entire races. That should’ve been the first red flag for the “soda milking the Milk Club” theory, but it wasn’t the last.

Second, though the club did accept money from the American Beverage Association, it wasn’t anywhere within spitting distance of $300,000. Tom Temprano, co-president of the Milk Club, told us they accepted $5,000 from the beverage industry to put on their annual gala. For context, SEIU Local 1021 donated $4,000 to the dinner. This is all data that would come out publicly in a few months through ethics filings anyhow, but long after the rumor of big beverage industry money would’ve caused its damage.

“All you get for sponsoring our dinner is a mention in the program and a plug on the stage,” Temprano told us. “If the [beverage industry] paid us anywhere near what the rumors are, I would’ve flown out Elton John to serenade [Assemblymember] Tom Ammiano in person.”

Though the $5,000 is not chump change to the Milk Club, its leadership doesn’t make endorsement decisions, which are enacted by a vote of the club’s members. In a heated exchange last week, Milk Club political wonks batted soda tax points back and forth like a beach ball. There was hardly a consensus on the matter.

“They didn’t vote the way I wanted but the process was very democratic,” Sup. Eric Mar told us. Mar was one of the authors of the soda tax, and even he doesn’t believe the Milk Club’s palms were greased by big soda’s big money.

“I feel that there are rumors being spread to undercut the integrity of the Harvey Milk Club, the strongest progressive voice and political leadership in the city right now,” he said. “I stand behind them even though they voted no on [the soda tax].”

Laura Thomas, co-president of the Milk Club, told us she is actually in favor of the soda tax. It’s easy to see why. As Deputy State Director of the Drug Policy Alliance, she has day-to-day experience with public health, and she sees the far reaching affect of soda’s loads of sugar on San Francisco’s kids.

“I do support [the tax], and I’ve spoken passionately for it in our meetings,” Thomas told the Guardian. “I’d say it’s something we’re passionate on all sides about.”

The last stickler in the money-influence theory is a bit trickier. Many we talked to traced some of these rumors back to Chiu’s campaign spokesperson, Nicole Derse. When we spoke to her, she pounced on the subject like a hyena on carrion.

“The Harvey Milk Club has sold out to the soda industry,” she told us. “What would Harvey Milk think of this gross display of hypocrisy? David Campos needs to answer some serious questions on his position on the soda tax and his campaign.”

Notice how she shifted the Milk Club assertion, which we asked her about, straight into a Campos critique. She’s affable, she’s smart, but in that moment, Derse also sounded gleeful.

We then asked Derse if the rumor about the Milk Club and Campos came from her.

“I am not the person that started this rumor. But do you really think it’s a coincidence David Campos is broke and needs a vehicle to fund his campaign? I think it speaks for itself, if it happens,” she said. “If the Milk Club does not take hundreds of thousands of dollars from the American Beverage Association, I will happily be wrong.”

Actually, when it comes to spreading rumors through news outlets, being right or wrong doesn’t really matter. All you need to do is raise the question of impropriety, proof or no. It’s grandma’s classic recipe for a good political smear, as old as the hills, and very, very easy to do.

Update [8/26]: This story stirred up quite a bit of controversy, and folks called, emailed, Facebooked and Tweeted at us with one point: sure the Milk Club didn’t take all that much money from the American Beverage Association for the gala, but what about the future? Would they take a large sum from the ABA? Tom Temprano answered: “I find that completely unlikely. I’m going to say that’s not a situation we’re going to be in. But I haven’t had a conversation with anyone with anybody about money yet. Our entire board and PAC chair make decisions on fundraising.”

So there you are. If a donation in the tens of thousands of dollars should land on the Milk Club’s doorstep, Temprano is now on the record.

More time, same crime

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joe@sfbg.com

Roll up a dollar bill, snort a line of coke, sit back and smile: If your cocaine use leads to a conviction, your drug of choice will be spared from the harsher penalties associated with inhaling the substance through a glass pipe. When it comes to busts for cocaine possession and dealing, those caught with a rock instead of the powdered stuff are kept behind bars longer. But that could soon change.

The drug is the same, the punishment is not — and a new bill may soon end that decades-long disparity, one that critics have called racist. But crack cocaine use is now at a historic low in San Francisco, raising a question: What took so long?

The California Assembly voted 50-19 Friday [8/16] to pass the Fair Sentencing Act, which aims to lower the sentence for possession with intent to sell crack cocaine to be on par with that of powder cocaine.

The bill, authored by Sen. Holly Mitchell (D-Los Angeles), is seen as championing racial justice.

“The Fair Sentencing Act will take a brick out of the wall of the failed 1980s drug-war era laws that have devastated communities of color, especially black and Latino men,” Lynne Lyman of the Drug Policy Alliance said in a prepared statement.

Crack cocaine rocks have tended to be more heavily used by African Americans, while powdered cocaine tends to be the province of rich white folks. The bill would lessen the maximum sentence for crack cocaine possession with intent to sell to four years, down from five. It would still constitute a felony.

In California, having a drug-related felony on record can prevent the formerly incarcerated from accessing housing assistance and food stamps, further feeding a cycle of poverty. The Fair Sentencing Act now awaits Gov. Jerry Brown’s pen. But some say this disparity should have been addressed some 30 years ago.

The 1980s gave rise to the “crack epidemic” narrative, a supposedly sweeping addiction promulgated by media reports on crack’s outsized harm to pregnant women and newborn babies. But those health impacts are now understood to be on par with tobacco use during pregnancy, rather than the terrifying danger it was presented to be.

Still, the images and narratives from that era were powerful.

In a television news report that aired in the 1980s, an unnaturally tiny baby quivers and shakes on the screen. Then-First Lady Nancy Reagan appears and hammers the point home: “Drugs take away the dream from every child’s heart, and replace it with a nightmare.” Flash forward to the future, and university researchers have produced studies showing that the babies born to crack-using mothers that so frightened the country were simply prematurely born, and went on to lead healthy lives.

True or not, people were outraged. The change in laws happened “virtually overnight,” Public Defender Jeff Adachi told us. Crack cocaine hit San Francisco hard.

Paul Boden, executive director of the Western Regional Advocacy Project, remembers it well. He had just come out of homelessness in the Tenderloin in the ’80s. Just prior to starting as a staffer at Hospitality House, he saw the worst of it.

“People were killing each other over the stupidest shit. It got really violent,” he said. “What crack cocaine did is it divided a community against itself. I never thought I’d get to a point where I missed heroin.”

But, he added, “I do think the advent of crack and the assumption that every black male was doing crack gave the cops carte blanche for all of their racist patterns.”

According to the Drug Policy Alliance, people of color accounted for over 98 percent of men sent to California prisons for possession of crack cocaine for sale. Two-thirds were black, and the rest were Latino.

Long since the days when cops regularly raided the Tenderloin on a hunt for every glass crack pipe, the SFPD is now a somewhat more lenient beast in the drug realm. Drug arrests in the city dropped by 85 percent in the last five years, according to California Department of Justice data. Police Chief Greg Suhr downsized his narcotics unit, shifting to focus on violent crime.

“People that sell drugs belong in jail because they’re preying upon sick people,” Suhr told the Guardian, although he added, “People with a drug problem need to be treated, as it’s a public health issue.”

Suhr said he supports the lower sentencing for crack cocaine to make it on par with powder.

“Cocaine,” he said, “is cocaine.”

District Attorney George Gascon’s office also prosecutes mostly violent and property crimes as opposed to drug possession, reflecting a rare show of agreement between the Public Defender’s Office, the SFPD, and the DA. San Franciscans battling drug problems are often diverted to drug courts and rehabilitation programs.

Crack cocaine has largely moved on from San Francisco, leaving its ugly legacy. Meanwhile, heroin use is on the rise, but nevertheless carries the same harsh sentence as crack cocaine for possession with intent to sell.

“It’s the pathetic state of politics today that it took this long for this to happen,” Boden told us, on sentencing reform. “Now it won’t cost me anything, I’ll show what a great liberal I am.”

 

Film festival organizers call for safer San Francisco streets

Editor’s Note: Aug. 19 marks the Bay Area Global Health Film Festival, hosted by the Institute for Global Orthopaedics and Traumatology. The theme of this year’s festival is “Road Traffic Safety Locally … and Globally,” and is geared toward raising awareness about the need for road traffic safety improvements. In this opinion piece, representatives from the University of California at San Francisco Orthopaedic Trauma Institute, at San Francisco General Hospital, describe how all-too-common accidents can permanently injure pedestrians and bicyclists. And they voice support for Proposition A, the San Francisco Transportation and Road Improvement Bond.

By Amber Caldwell and Nick Arlas

San Francisco is a transit-first city. Everyone shares the need to get safely from point A to point B, preferably quickly. And the various options for doing so span the full spectrum from driving, biking, and walking, to public transit like MUNI and Bart, rideshare programs, taxis, and companies like Uber and Lyft.

As we go about our daily lives, transportation is one of the most important public infrastructure systems that San Francisco relies upon. It encompasses many controversial issues and is linked to other social equity campaigns including housing advocacy and urban gentrification.

Yet the issue of pedestrian and bike safety in San Francisco has made disheartening headlines as of late. 2013 was an especially deadly year, with 21 pedestrian and four bicyclist fatalities. San Francisco General Hospital alone cared for over 1,000 road traffic injuries, with an estimated $60 million annual cost. Organizations like the SF Bicycle Coalition and WalkSF have made biking and walking leading issues in debates over transportation policy and traffic safety. Mayor Ed Lee and our city government have responded by introducing a $500 million transportation bond measure for the Nov. 4th ballot. If it passes, a portion of the funding will be allocated for improving pedestrian and cyclist safety.

Less often discussed, however, is what happens to the pedestrians and bicyclists who are hit while going about their daily routines and permanently affected by all-too-common accidents. At the UCSF SFGH Orthopaedic Trauma Institute (OTI), these patients fill our wards, the operating room schedule and our hearts as we help to heal them from these injuries. We struggle with the balance between doing what we can and what should be done to curb the growing volume of patients we see annually due to preventable accidents.

What is alarming is the socio-economic impact these accidents have, not only on the person affected, but on the hospital and our city as a whole. Even in cases where the driver is at fault, it is rare for them to even be cited for a traffic violation in most cases. More importantly, personal injury insurance and health coverage barely cover the emergency services needed for these accidents, and most services offered at the hospital are subsidized by taxpayer dollars, which means we are paying for this on all sides. This is unacceptable.

There is currently a wave of momentum to address these complex issues and attempt to tease through how we as a city can rebuild, redefine and reinforce the safety in our city. This movement is supported by a global platform addressing road traffic safety as a public health campaign, through the World Health Organization’s Decade of Road Traffic Safety. This campaign tackles the myriad polices and resource investments needed to address the enormous impact road traffic accidents have on the world. 

Injuries, mainly those resulting from road traffic accidents, account for greater disability and death than HIV, TB and Malaria combined.  An average 5.8 million die annually, and for every death caused by these accidents, eight to 10 more are permanently injured.

To bring collective awareness around this issue and to change the landscape, the community needs to stand together not only in San Francisco but also around the world, to demand safer streets. The city is doing its part to outline a roadmap to curbing these alarming statistics, and a greater global campaign is underway to promote awareness and inspire activism.

We must stand up for the injured and for ourselves as local citizens to demand safer streets and protection from when accidents occur.  We may not be able to prevent every accident, but we can improve the choreography of their outcome if we work together.    

Amber Caldwell and Nick Arlas are Director of Development and Community Outreach Coordiator, respectively, at the Institute for Global Orthopaedics and Traumatology, UCSF Orthopaedic Trauma Institute, San Francisco General Hospital.

The Bay Area Global Health Film Festival begins Tue/19 at 6 p.m. at Public Works, 161 Erie, in San Francisco.

Public hospitals are too Lean

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OPINION

The San Francisco Department of Public Health is paying Rona Consulting Group, an out-of-state consulting firm, $1.3 million of taxpayer dollars to implement a program called “Lean,” allegedly to improve patient services. The “Lean” program is based on the Japanese Toyota automobile production model.

Hospital quality improvement schemes such as the Lean promise decreased waiting times, improved communication, more satisfied patients, and safer care. Quality care should also decrease the incidence of hospital-acquired conditions so that patients leave the hospital without getting new infections, falling, or getting pressure ulcers such as “bed sores.”

Hospital administrators are telling health care workers and patients that Lean will achieve these widely shared goals. Yet despite years of efforts, there is no evidence that it works, and growing concern that resources must be increased rather than prescribing the Lean diet to an already starving public health infrastructure.

Health care should be based on the best available science — not corporate sales. The Lean program encourages the hospital staff to consider its workplace as a factory shop floor, and to consider their patients and work as a product. The competition for well-insured patients and improved satisfaction for reimbursement has caused hospital administrators and Lean consultants to propose surgical clinics that resemble Nordstrom or the Hyatt Regency.

Lean’s management methodology, based on Toyota’s selected Japanese words, is used to mystify and dazzle. Instead of the pharmacy window, we are told that all staff must go to the “gemba,” which the consultants (not the dictionary) say is Japanese for “where the work happens.” Many highly paid hospital administrators and even clinical staff have been re-named as “kaizen promotion office” leaders. Those who have completed advanced training are awarded a “black belt.” The use of Japanese terms is clearly meant to add a sense of authority.

Evidence-based medicine and nursing have been examining high-quality studies of the effectiveness of improvement schemes such as Lean. According to “Guiding Inpatient Quality Improvement: A Systematic Review of Lean” (The Joint Commission, 2012), “the true impact of these approaches is difficult to judge, given that the lack of rigorous evaluation or clearly sustained improvements provides little evidence supporting broad adoption.” This leads to very expensive, wishful thinking. When consultants are paid from $4,700 to $25,000 a day from public funds intended to construct a seismically sound hospital (see “Toyota work methods applied at General Hospital” San Francisco Bay Guardian, May 7, 2014) it seems important to consider what randomized controlled trials tell us. The taxpayers have a right to know what to expect from this scheme, but there are no controlled scientific studies to tell us.

Despite more than 10 years of multiple published studies, very few consulting firms even report statistics. Those that do show weak evidence of effectiveness, and none show sustained improvement. If Lean were a medication, it would never receive approval from the Food and Drug Administration, as we don’t know if it helps or hurts the care of patients. As it is, hospitals are performing a single-group intervention study without ethical approval or consent from the workers and the patients.

Hospitals should be providing their patients with the best care, not the cheapest. Even if Lean didn’t come with a price tag to taxpayers ranging in millions of dollars for consultants to do the work that administrators should be doing, the underlying notion of speed is dangerous in health care. Public health patients are even more vulnerable with increased prevalence of poverty-related co-morbidities, from diabetes to tuberculosis. If there were a way to more quickly cure our population of its many ills, we would embrace Lean.

Nobody likes to wait around, but the human connection between caregiver and patient takes time. Efficiency should not be valued over safety. Furthermore, many patients would be unhappy to learn that they are being viewed as inanimate products on an assembly line. Nor does it please health workers to think of themselves as robots.

Hospital safety under Lean is being modeled after the same automobile corporation that was just forced to pay $1.2 billion for concealing safety defects (“Toyota Is Fined $1.2 Billion for Concealing Safety Defects” New York Times, March 19, 2014). The safety defects were implicated in unintended acceleration of some Toyota vehicles that led to injury and death. Speed was certainly not helpful in that situation. Perhaps DPH should critically examine Lean before prescribing a diet to our vulnerable safety-net patients. Maybe we need more, not faster, health care workers.

Ed Kinchley has worked for DPH for 30 years, after spending nine years in Japan.

Until we legalize marijuana, reduce arrests

By Endria Richardson

Last week, the Editorial Board of the New York Times called for the federal government to repeal its ban on marijuana. Marijuana legalization would be a strong step towards reducing the impact of the drug war, especially on communities of color. But, as coverage by the New York Times may be missing, legalization is a small – and slowly moving – step towards ending mass incarceration. Reducing arrests in California can do more to impact mass incarceration now.

Federal legalization of marijuana will be a slow, perhaps decades-long, process. In the meantime, we should not get caught up in the excitement of what might be, and forget about the casualties of continuing criminal penalties for illegal drug use and possession. In 2012, there were 79,270 misdemeanor drug arrests in California, and 120,995 felony drug offense arrests. Of the individuals arrested for misdemeanor drug offenses, 30,067 were Hispanic, and 8,433 were Black.

It has long been acknowledged that who is arrested often depends less on who is actually committing a crime, than on deeply entrenched beliefs about who commits crimes and who deserves punishment. Nowhere is this more apparent than with drug offenses. And yet, perhaps more than any other tool in the criminal system, arrests disregard the social context in which they occur. There is no time to consider complex sociological questions about why crimes are committed, or what the impact of arrest will be on a person’s community.

An interim strategy of challenging arrest practices can reduce these numbers. This could start with asking state legislatures to take arrest or incarceration off the table for all misdemeanor drug offenses, and replacing criminal penalties with infractions. Police officers could be trained on alternative responses to offenses that we, as a society, have decided should not be paid for in arrest, incarceration, or a criminal record.

In California, this has already made a difference in the number of arrests for misdemeanor marijuana possession. In 2010, there were 54,849 misdemeanor marijuana arrests. After the state made possession of under an ounce of marijuana an infraction, that number plummeted – to 7,768 in 2011. Felony marijuana arrests remained high – at 13,434 in 2012.

Other states are also taking an aggressive approach to reducing incarceration and arrests for drug crimes. Washington state’s Law Enforcement Assisted Diversion (“LEAD”) program, launched in 2011 and designed by a coalition of law enforcement, district attorneys, public defenders, and community members, diverts people with low-level drug and prostitution offenses into community-based services after arrest, but before booking. The Vera Institute of Justice recently found that, in 2013, six states enacted or strengthened pretrial drug treatment diversion programs, 11 instituted or expanded access to “problem-solving” courts that rely less heavily on incarceration, and three codified graduated responses to violations of supervision conditions, including issuing written reprimands instead of immediate arrest or incarceration in one state.

California should reduce the impact of the War on Drugs, safely and quickly, by relying less on arrests and incarceration. Misdemeanor drug offenses are a good place to start. Eventually, we can shift more completely towards a public health approach to drug use and misuse, one that eschews entirely the criminal system. In the interim, treating simple drug use or possession as infractions would save the state millions of dollars in booking, court, and jail fees – money that could more profitably be invested in treatment, education, employment, and housing opportunities.

(Sources: Crime in California 2012 and Vera Institute of Justice Report)

Endria Richardson is a graduate of Stanford Law School and is currently a fellow at Legal Services for Prisoners With Children. She can be reached at endria@prisonerswithchildren.org.

Everyone’s hospital

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rebecca@sfbg.com

“I am a survivor of the AIDS epidemic,” Daniel volunteered, beginning to tell us his very San Francisco story.

He was diagnosed with HIV in the 1980s. Working in fine dining rooms of San Francisco hotels at the time, he had health insurance, and had gone to Kaiser for an unrelated procedure. That led to a blood test — and then wham.

“They just bluntly, without any compassion, just told me: You have it,” Daniel said. “Like telling you that you have a pimple on your nose or something.”

All around him, friends were dying from the disease. “I didn’t freak out, because that’s just my personality,” he recalled. “I know a lot of people who have been diagnosed, and they want to take their lives or whatever.”

Today, he’s unemployed and living on a fixed income. He lost his left eye years ago to an infection linked to HIV; he now has a prosthetic eye.

“I’m single, disabled, and low-income,” reflected Daniel, who didn’t want his last name printed due to privacy concerns. Originally from El Salvador, his family came to the U.S. when he was 10 and Daniel has permanent resident status. But despite the disadvantages he faces, Daniel still isn’t freaking out. His medical needs are met.

He got on MediCal after having to drop Kaiser. “And then I ended up at SF General,” he said, “with some of the most professional staff, doctors rated worldwide. It has some of the most professional health care providers for HIV, all in one place.”

Daniel is one satisfied San Francisco General Hospital patient, and he might as well be a poster child for how public health is supposed to work in big cities. Rather than being deprived of primary care and then showing up at the emergency room with preventable complications stemming from his disease, he’s keeping everything in check with regular doctor’s visits — and he can access this high level of care even though he’s on a very tight budget.

There’s a concerted effort underway in the San Francisco Department of Public Health to give more patients precisely the kind of experience Daniel has had, while also expanding its role as the region’s go-to trauma center.

But a difficult and uncertain road lies ahead of that destination, shaped in part by federal health care reform. The new course is being charted amid looming financial uncertainty and with more patients expected to enter the system and the doors of SF General.

Not every General Hospital patient is as lucky as Daniel. For scores of others, SF General is the last stop after a long, rough ride.

 

EMERGENCY CARE

Craig Gordon and Dan Goepel drive an ambulance for the San Francisco Fire Department, regularly charging through congested city streets with sirens blaring as they rush patients to SF General and other care facilities. They see it all: Patients who are violent and psychotic and need to be restrained in the back of the ambulance, folks who’ve just suffered burns or gunshot wounds.

Sometimes, in the thick of all of this, SF General’s Emergency Department is closed to ambulances — in public safety lingo, it’s called being “on diversion” — so the medics will have to reroute to different hospitals.

SF General might go on diversion because the Emergency Department is too slammed to take on anyone new, or because it’s too short-staffed to take on new patients without pushing nurse-to-patient ratios to unsafe levels.

For serious trauma cases, strokes, heart attacks, or traumatic brain injuries, however, the doors are always open. Patients with less-serious cases are the ones to be turned away when the hospital is on diversion.

Patients who wind up en route to SF General in Gordon and Goepel’s ambulance might be living on the margins. “If you’re kind of living on the cusp … you’re not likely going to pursue getting a primary care physician,” Goepel pointed out. “When something comes up, then you find yourself in the emergency room.”

Or their patients might be getting rescued from a spectacularly awful situation, like a plane crash. In this densely populated, earthquake-prone region, there is only one top-level trauma center between Highway 92 and the Golden Gate Bridge: SF General. Anyone in the city or northern San Mateo County unfortunate enough to experience a life-threatening incident — a car wreck, shooting, nasty fall, boating accident — winds up there, regardless of whether they’re rich or poor, indigent or insured. Ranked as a Level 1 trauma center, SF General is equipped to provide the highest level of care.

“In the summer, when school is out, we have a high season of gunshot wounds and stab wounds,” explained Chief Nursing Officer Terri Dentoni, who recently led the Guardian on a tour of the Emergency Department. “When it’s really nice outside, you have a lot of people who get into bike accidents, car accidents. … Last week, we were just inundated with critical care patients.”

Around 100,000 patients flow through SF General’s doors each year, and more than 3,900 need trauma care. On July 6, 2013, when Asiana Airlines’ Flight 214 crash-landed at San Francisco International Airport, more than 60 crash victims were rushed to SF General with critical issues ranging from organ damage to spinal injuries.

“It was a very big tragedy,” Dentoni said. “But it was amazing how many people we took care of, and how well we took care of them.”

Aside from being the sole trauma center, SF General is also designated as the county’s safety-net hospital, making it the only healthcare option for thousands who are uninsured, poor, undocumented, homeless, or some combination thereof. This makes for complex cases. Patients might require translators, be locked in psychiatric episodes, or need a social worker to help them get to a medical respite facility after being discharged if they’re too weak to fend for themselves and don’t have anyplace to go. There isn’t always a place to send them off to.

“We’re seeing people who are dealing with poverty, and often homelessness, in addition to mental health issues,” explained Jason Negron, a registered nurse in the Emergency Department. “You’re seeing patients who often have a number of things going on. Someone who has multiple illnesses — HIV, heart failure, Hepatitis C — even under the best of circumstances, they would be juggling medications. So what happens when they’re out on the streets?”

San Francisco ranks high on the list of health-conscious cities, a haven for organic food aficionados, yoga addicts, and marathon runners. It’s also a world of high stakes struggles and mounting economic pressures. With the city’s skyrocketing cost of living, sudden job loss can spell disaster for someone without a financial cushion. SF General is the catchall medical care facility for anyone who’s slipped through the cracks.

But while rank-and-file hospital staff must tackle grueling day-to-day problems, like how to juggle multiple patients with complex health issues when all the beds are full and the hospital is understaffed, hospital administrators face an altogether different challenge.

For the past several years, the city’s Department of Public Health has been preparing for the implementation of the Affordable Care Act, aka Obamacare, the federal policy that is reshaping the health care landscape. Since public hospitals are mandated to provide safety-net care, they are uniquely impacted by the ACA.

Even with a sweeping new rule mandating health insurance for all, some segment of the population will nevertheless remain uninsured. But they’ll still need medical care — and when health crises come up, they’ll turn to SF General. Trouble is, no one knows exactly how much funding will be available to meet that need as the financial picture shifts.

 

FUNDING CUTS LOOM

Even as ACA aims to increase access to medical care, it’s also going to trigger major funding cuts at the local level. With both state and federal funding being slashed, San Francisco’s county health system stands to lose $131 million in financial support over the next five years, a budgetary hit totaling around 16 percent.

That’s a significant shortfall that will directly impact SF General — but the cuts are being made with the expectation that these gaps will be filled by reimbursements riding in on the waves of newly insured patients enrolled in ACA. Before federal health care reform took effect, around 84,000 San Franciscans lacked health insurance. At the start of this year, 56,000 became eligible to enroll in a health insurance plan.

SF General serves most of the area’s MediCal patients, the subsidized plan for people living on less than $16,000 a year. And since the county gets reimbursed a flat rate for each patient, the expansion of MediCal under federal health care reform will presumably help San Francisco absorb the state and federal funding losses.

“There’s a certain set of patients who previously were not paid for, who now will have MediCal,” explained Ken Jacobs, an expert in health care policy and professor at the UC Berkeley Labor Center.

But there’s a catch. Since MediCal and insured patients will be able to choose between San Francisco’s public system (called the San Francisco Health Plan) and a private medical provider, SF General also runs the risk of losing patients. If too many decide to go with Anthem Blue Cross instead, the system could veer into the red.

“There’s some question of what share of those we’ll keep,” Jacobs noted.

Asked about this, hospital CEO Sue Currin sounded a note of confidence. “Because our outcomes and our quality of care has been so high…75 percent of everyone who’s enrolled in MediCal managed care default to the Department of Public Health,” she told us.

But the journey toward ACA has only just begun, and things are still falling into place. Costs are projected to rise if nothing is done to improve efficiency, while at the same time, the pending state and federal funding shortfalls could take a toll.

Retaining and attracting insured patients is the only way to avoid a resource crunch — but patients could always walk away if they’re dissatisfied. This uncertainty “makes financial planning and management of risk even more challenging,” according to a report issued by the City Controller.

“We don’t know yet today how the Affordable Care Act will impact the safety net,” acknowledged Erica Murray, CEO of the California Association of Public Hospitals, which represents 21 public safety-net institutions throughout the state. “How are these health care systems evolving to be competitive? How do we continue to fulfill our core mission of being the safety net? That is the fundamental challenge. And we don’t know today, and we can’t be certain, that these public health systems will have sufficient funding.”

It’s all “very dynamic,” Murray said. “We don’t have sufficient data to be able to draw any definitive conclusions. It’s just too short of a time to be able to make any predictions. It will take several years.”

For all the newly insured patients under ACA, a certain segment will continue to rely on the safety net. Undocumented immigrants who don’t qualify will be left outside the system. Some individuals can be expected to outright refuse ACA enrollment, or be too incapacitated to do so. Others will opt out of Covered California, the ACA plan for people who make more than about $29,000 a year, because their budgets won’t stretch far enough to afford monthly payments even though they technically qualify. They’ll need safety-net care, too.

Yet under the new regime, “We can’t, as a safety net, go forward only with uninsured patients — because there won’t be funding to sustain the whole organization,” explained hospital spokesperson Rachael Kagan. “We will still have uninsured patients, always. But it won’t be sufficient to serve only them.”

Mike Wylie, a project manager in the Controller’s Office, worked on the city’s Health Reform Readiness project, an in-depth assessment performed in tandem with DPH and consultants. “The million dollar question is: Are we going to be on target with the projections?” Wylie asked.

Instead of standing still, San Francisco’s health system must transform itself, the Health Reform Readiness study determined. Ask anyone who works in health care management in the city, and they’ll tell you that DPH has been working on just that. The idea is to focus on network-wide, integrated care that runs more efficiently.

“We need to switch from being the provider of last resort, to the provider of choice,” Wylie noted, voicing an oft-repeated mantra.

This could mean fielding more patient calls with nursing hotlines, or using integrated databases to improve communication. There’s also emphasis on increasing the number of patients seen by a care provider in a given day. The report urged the department to ramp up its productivity level from 1.5 patient visits per hour, where it currently stands, to 2.25 patient visits per hour. Currin noted that the hospital has also been looking into group patient visits.

“Part of getting ready for health care reform was creating more medical home capacity,” Currin said, referring to a system where multiple forms of care are integrated into a single visit, “so we knew we needed to have better access to primary care.”

If no changes are made, the Health Reform Readiness study found, the city’s General Fund contribution to DPH is projected to rise substantially — to $831 million by 2019, up from $554 million in 2014-15.

“We’re a little concerned about this rising General Fund support,” Wylie noted. And even though staffing represents a major expenditure, “They didn’t assume cuts in staff,” while performing the assessment, he said. “What they’re trying to get is more outputs, more efficiency. The managers went over this and said: in order for us to survive, we’ve got to get more out of our system. We may have to cut money — we may have to cut later, if city leaders don’t commit to this rising General Fund. We’ve got to do all these best practices.”

Throughout crafting this road map, he added, “There were some uncomfortable meetings and uncomfortable moments. But I think [DPH Director] Barbara Garcia got everyone to agree to these strategies.”

Talk to rank-and-file hospital staff, however, and some will tell you that getting more out of the system is a tall order — especially when the system already feels like it’s busting at the seams.

 

SPACE CRUNCH, STRESSED STAFF

“We hit capacity every single day,” said Negron, the RN in the Emergency Department. Patients are regularly placed on beds in the hallways, he said. Wait times for the Emergency Department can last four to six hours, or even longer. The hospital is working on limiting those waits, not just because it’s better in practice, but because timely patient care is mandated under ACA.

“Now, we have 26 or 27 licensed beds in our Emergency Department,” Negron said. But in reality, on a regular basis, “We function with 45 to 50 patients.”

A nurse who works in the Psychiatric Emergency Services unit described her work environment as “a traffic jam with all lanes blocked. This is totally business as usual.”

The workload is on the rise, she added. “The psych emergency room used to see 500 patients a month,” she said. “Now we see 600 patients a month, sometimes more. People are moving faster and faster through the system.”

Her unit is the receiving facility for anyone who is placed on an involuntary psychiatric hold, known as a 5150, for individuals who are a danger to themselves or others or gravely disabled.

“It doesn’t matter who they are,” she said. “We get homeless and destitute. We get CEOs. And we have had CEOs — it’s an experience for everyone involved.” Some patients have been involved in criminal activity. “I’ve had high profile people in my unit; people who have done things that, if I tell you what they did, you would easily be able to Google them.”

Patients who come to her wing need to be evaluated, because someone has determined that they are dangerous. It could be that they are “eating rotten food, or running naked in the street, or suicidal, or want to jump off Golden Gate Bridge, or their family thinks they’re out of control.” Sometimes, patients have to be let go once they’re no longer deemed to be a threat, but they still aren’t altogether recovered, she said.

In the psychiatric inpatient unit, meanwhile, the total number of beds has declined from 87 to 44 in the past five years — leading some staff members to voice concerns.

“There is more to do, and there’s less time to do it,” said another staff member who did not want to be named. This person said one psych unit was essentially shut down and another left open — “but then … a patient climbed up into the ceiling, broke some pipes, and flooded the room” in the open unit, so everything was shifted back to the closed unit.

In part, the daily patient crunch is due to a vacancy rate in the hospital nursing staff that hovers around 18 percent — but steps are being taken to address this problem, caused in part by the city’s Byzantine hiring process.

“The nurses are concerned about how, on a day-to-day basis, they don’t feel they have the support and resources they need,” said Nato Green, who represented the nurses’ union, SEIU Local 1021, in recent contract negotiations. “Staff was expected to do more with less. SF General chronically operates at a higher capacity than what it is budgeted for.”

Currin, the hospital CEO — who started out as a nurse herself — rejected this assertion, saying it is not the norm for the hospital to operate over budget. She added that she would like to reduce the nursing staff vacancy rate down to just 5 percent.

“We have had a fairly significant vacancy rate,” she acknowledged. “But just like any other hospital in the city and the country, you have countermeasures that you put in place to address staffing shortages. And so we use nurse travelers. We use as-needed staff, who work here part-time. We’ve been able to fill those gaps with these other staffing measures. We do want to have a more permanent workforce. We’re working with the city and [DPH] to bring in new hires.”

Roland Pickens, director of the San Francisco Health Network (the patient-care division of the Department of Public Health), said he was working with the city’s Human Resources Department to further streamline operations and get a jump on filling vacancies.

“[Chief Financial Officer] Greg Wagner is working with City Controller’s office and the Mayor’s Office, so everyone is addressing the issue of having a more expedited hiring process,” he said.

Negron, the RN, seemed to think it couldn’t happen soon enough. “For us, at the end of the day, who do we actually have that’s on the schedule, that’s on the floor?” he said. Being fully staffed is important, he added, “so we don’t have any more shortages. So we don’t close beds, or go on divert unnecessarily.”

Staff members, who deal hands-on with a vulnerable patient population, lament that there doesn’t seem to be enough resources flowing into the system to care for people who are at the mercy of the public safety net. After all, San Francisco is a city of incredible wealth — shouldn’t there be adequate funding to care for the people who are the most in need?

“Poor people are not profitable,” Green said. “Without regulatory intervention, poor people would not have adequate health care.”

 

EVOLVING INTO THE FUTURE

For all the concerns about staffing and the financial uncertainty caused by ACA, SF General still has plenty to brag about. For one, it’s moving into a brand new, nine-story facility in December 2015, which will be equipped with a seventh-floor disaster preparedness center and nearly twice as much space in the Emergency Department.

It will have 283 acute care beds, 31 more than there are now. Most of the patient rooms will be private, and the new hospital will be seismically sound — a critical upgrade in a city prone to earthquakes. The hospital construction was funded with an $887.4 million bond approved by voters in 2008.

“In a new care environment, it will be more comfortable for the patients and the staff,” Currin said. “It’s just a much better environment. We’re hoping with the expansion … the wait times [in the Emergency Department], instead of taking four to six hours, we’re hoping to decrease that by 50 percent,” she said. “There will be more nurses, physicians, housekeepers.”

Pickens, the Health Network director, said he felt that “the stars had aligned” to have the hospital rebuild nearing completion just as ACA gets into full swing, since the new facility can help attract the patients needed to make sure the health system is fully funded.

The hospital has also launched an initiative to reduce patient mortality linked to a deadly infection. “Sepsis is a reaction the body has to a severe infection,” explained Joe Clement, a medical surgical unit clinical nurse specialist. “It causes organ dysfunction, and in some cases death. It’s very common, it’s growing, there’s more and more of it every year, and about a third of hospital deaths have been associated with sepsis in some way.”

In 2011, SF General began implementing new practices — and successfully reduced the hospital mortality rate from 20 percent in 2010 to 8.8 percent in 2014.

SF General was also recently lauded in The New York Times for being a top performer in quality and safety scores for childbirth. In San Francisco, low-income women who may be uninsured and dealing with harsh life circumstances can nevertheless get full access to multilingual doctors, midwives, lactation consultants, and doulas. The World Health Organization has even designated it as “Baby Friendly,” because of practices that support breastfeeding.

As things move ahead, management is projecting a sense of confidence that SF General’s high-quality care will allow the hospital to attract patients and maintain a healthy system that can continue to support the insured and uninsured alike.

“Value, we usually define as improving health outcomes, and optimizing the resources we have, for as many people as we can,” said William Huen, associate chief medical officer.

Speaking about the sepsis initiative, he said, “This is kind of our model program of, how do you focus on one area where you know you can improve health outcomes, with integration throughout the system, education at every level … and then having the data and perfecting the care. That can be applied to anything. So as a system, I think we’ve developed infrastructure to support that type of work.”

But for the staff members who are actively involved in the union, it continues to be a waiting game to see if the promises of new staffing levels are realized. Until then, many have said that the low staffing levels are a threat to patient safety. “They are waiting to see if DPH lives up to its commitment to hire the people they said they were going to hire, and staff it at the level they were going to staff at,” Green said.

It all comes down to providing care for people who really have nowhere else to turn, Negron told us in the Emergency Department. “I’m sure we see the highest portion of uninsured patients in the city,” he said. “We’re doing that in many different languages, with people from all over the world. I feel like it’s a real honor to be able to work there in that context. I feel honored to meet a need — that’s not always able to be met.”

San Francisco to study dropping speed limit to 20 mph for pedestrian safety

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As a part of a citywide effort to eliminate all pedestrian deaths by 2024, San Francisco will study the impact of reducing speed limits to 20 mph. 

“This is a reasonable issue to look into making San Francisco streets safer,” Sup. Eric Mar said, in a public statement. “There is too much excellent work and research going into it nationally and internationally to ignore.” 

The study was proposed by Mar as part of Vision Zero – a Swedish concept adopted by San Francisco at the behest of Sup. Jane Kim earlier this year. The initiative aims to reduce pedestrian deaths to zero within 10 years, with a focus on educating drivers, engineering roads for safety, and enforcing traffic laws (which the SFPD agreed to reform ealrier this year). Data from the study should be available in early fall. 

Where the speed changes would occur is the subject of the study. “We’re going to the experts,” Peter Lauterborn, Mar’s aide, told the Guardian. That’s the whole point of the study, he said, to figure out where and by how much speed could be reduced in the city to save lives. 

Modest adjustment to speed limits lowered pedestrian mortality rates in cities across the world.

Paris, London, cities in Sweden, and New York all implemented speed limit reductions to save pedestrian lives. According to the British Medical Journal, serious traffic-related fatalities or injuries decreased by 46 percent in 20 mph zones in London. 

The San Francisco Municipal Transportation Agency and the San Francisco Police Department got on board with the Vision Zero pedestrian safety plan, proposed by Sup. Jane Kim, earlier this year. 

According to California’s Office of Traffic Safety, San Francisco was ranked number one for traffic fatalities and injuries in 2011, compared to other similarly sized cities. 

“The overall frequency of traffic fatalities in the City of San Francisco constitutes a public health crisis,” the SFMTA warned in its Vision Zero web post. 

The statistics the SFMTA presented may seem dry, but tell the tale of preventable pain pedestrians suffered at the mercy of autos: Over the ten years from 2002 to 2011 the City lost a total of 310 lives to traffic fatalities. Each year alone on average 800 people are injured and 100 severely injured or killed while walking in San Francisco.

Sweden also saw fewer pedestrian crashes, despite increased traffic density. 

Walk SF has repeatedly advocated to fix intersections that are known to be especially dangerous, as only six percent of SF intersections are responsible for 60 percent of pedestrian crashes. Most of these areas are located in SoMa and the Tenderloin districts, the latter is where 6-year-old Sofia Liu was killed on New Year’ Eve

Walk SF’s Executive Director Nicole Schneider told us 20 mph zones would make it easier for cars to stop, expand drivers’ view of streets, and decrease the force of impact. 

In 2011 the city instituted 15 mph school zones after strong advocacy from Walk SF and other groups. While Schneider didn’t have any statistics about the impact of the speed limit on hand, she did say that there is a “perception of change” in these zones. 

But there are environmental benefits of slower speeds as well, Lauterborn told us: driving slower uses less gas. 

The U.S. Department of Energy says that speeding, rapidly accelerating, and frequently braking can decrease gas mileage by 33 percent. A lower speed limit would decrease driving costs as well as protect pedestrians. 

Lauterborn said even if the study shows a 20 mph speed limit would be beneficial, there are state laws that might prevent SF from lowering the speed limit. Local governments can only set the speed limit lower than 25mph on streets smaller than 25 feet wide or in business, residential, or school zones. To lower the speed limit to 20mph on a street like Sunset, the city would likely need state permission. 

At a fiery Board of Supervisors hearing on Vision Zero in January, a pedestrian who was hit by a car in 2013 named Jikaiah Stevens offered a scathing critique of current vehicle collision policies. “What is their incentive to drive safely when there are no consequences?” Stevens asked the board that night. A 20 mph limit may go a long way towards preventing pedestrian injuries like Stevens’.

Pumping up awareness

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Warning! This is just a friendly reminder that your petroleum habit is hurting us all.

Berkeley’s Community Environmental Advisory Commission recently approved the concept of stickers to be placed on gas pump handles that warn drivers that greenhouse gases such as those emitted from automobile tailpipes contribute to global warming. If it makes sense to warn that cigarette smoking increases the likelihood of developing lung cancer, then hey, why not remind drivers that by using fossil fuels, they’re increasing the planet’s temperature and volatility.

The campaign is led by 350 Bay Area, a grassroots environmental organization affiliated with 350.org, a global climate movement. The name reflects its main goal: follow scientists’ warnings to reduce the amount of C02 in the atmosphere from its current level of 392 parts per million to below 350 ppm, a crucial threshold of climate instability.

While Berkeley has gained the most political traction for 350 Bay Area’s “Beyond the Pump” campaign, 350 Bay Area is also working on getting San Francisco to adopt the gas pump stickers and other planet-saving tactics.

Since last year, advocates with 350 Bay Area worked in collaboration with Sup. John Avalos on a 10-Point Climate Action Work Plan that was officially adopted in April. This plan commits the Bay Area Air Quality Management District to reducing greenhouse gas emissions to 80 percent of 1990 levels by 2050. The group has also been in contact with Avalos and his legislative aide Jeremy Pollack about sponsoring an ordinance to place the warning stickers on gas pumps in San Francisco.

“I think it’s great. We need reminders about the impact of fossil fuels on an individual basis,” Avalos told the Guardian. “We have choices, and this is a great way to build awareness of those choices.”

Avalos said that his office has already started looking into the idea of putting stickers on gas pumps. Right now, he’s still waiting on enough research to ensure the stickers can pass legal muster against any challenges by the petroleum industry.

“Hopefully it will work out. The City Attorney is looking into it, and we’re waiting to see what happens with Berkeley,” Pollack told the Guardian. “We tried something similar with warnings about cell phone radiations, but the court struck it down.”

He’s referring to the nearly three years of legal battles with the mobile phone industry group CTIA over a San Francisco law passed in 2011 that had required every store selling cell phones in the city to display the specific absorption rate of radiation expected from each phone model.

CTIA took San Francisco all the way to the 9th Circuit US Court of Appeals, saying the law interfered with their free speech rights. And, it won. Finally, last May, San Francisco gave in and killed the warning law. Those legal battles are not something San Francisco is likely to forget, no matter what environment-happy warning labels come along.

Yet the San Francisco public might not mind a gentle push. According to a recent poll by the Yale Project on Climate Change Communication, 77 percent of San Franciscans think that residents should be doing more to address climate change. The stickers could serve as a gentle push in that direction, and though Avalos is confident his city will get stickers eventually, it looks like Berkeley residents will get their warnings first.

“We’re not going to stop at Berkeley,” Jack Lucero Fleck, 350 Bay Area Steering Committee member, told us. “Right now, there’s no clues in gas stations that fossil fuels might be a problem. But advertising works. That’s why corporations spend billions on it. The human mind can’t ignore it.”

The campaign — the only one in the country with political fraction — is parallel to a Toronto campaign called Our Horizon. But unlike the stark, graphic warnings in Canada, 350 Bay Area takes heed from failed attempts by the US Food and Drug Administration to pursue graphic cigarette warning labels.

Right now, thanks to tobacco advocates who’ve aggressively protected their free speech rights, warnings on US cigarette packaging are tame. But if you go to Canada for a smoke, you’ll find packaging that reads, “This is what dying of lung cancer looks like,” followed by the image of an emancipated, corpse-like body. The least graphic image is of a gentle crib, but even that’s followed by information about the connection between smoking and Sudden Infant Death Syndrome.

Berkeley could opt for similar, hardcore carbon emission warning graphics (picture it now: baby polar bears balancing on ice, fish washed up on shores, massive dust clouds about to drown villages), but 350 Bay Area is more mindful of the legal fallout that would likely follow.

Instead, the Berkeley warning sticker samplers are downright peppy. In hot pink, the sticker shouts, “Global warming alert!” followed by a pastel blue that informs drivers, with the gentle nudge of a concerned parent, “Burning gasoline emits C02. The City of Berkeley cares about global warming.” Then there’s a picture of a cute little car emitting a cloud of murky C02.

“We wanted the language to be careful and the facts noncontroversial,” 350 Bay Area Campaign Manager Jamie Brooks told us. “We have to be as gentle as possible. It’s tough love.”

One sticker sampler reads, “The State of California has determined that global warming caused by C02 emissions poses a serious threat to the economic well-being, public health, natural resources, and the environment of California.”

You can’t really argue with that, it’s even enshrined in California law. Plus, the stickers aren’t anywhere near the gruesome Canadian samples that show famine in deserts and unhappy kids suffering from smog-induced asthma.

Berkeley City Council member Kriss Worthington, who sponsored the council item in support of the stickers, said, “We made sure we had language that wasn’t questionable and that it wasn’t pre-emptive to state or federal law. The language in the stickers is language already law in the state of California.”

Sure enough, the California Global Warming Solutions Act, adopted in 2006 as Assembly Bill 32, already states that emissions are harmful to humans and the environment.

Yet Western States Petroleum Association’s President Catherine H. Reheis-Boyd isn’t pleased. She issued what Brooks called a “love letter” to the advisory committee. Just as tobacco lobbyists argued that cigarette warnings are forced — and therefore not free — speech, Rheis-Boyd ignores the global warming debate and instead focuses on the US Constitution.

“Far less restrictive means exist to disseminate this information to the general public without imposing onerous restrictions on businesses and forcing unwanted speech in violation of the First Amendment,” she wrote.

Reheis-Boyd goes on to appeal to Berkeley’s history in the Free Speech Movement: “Perhaps no city in our nation has as rich a tradition in the exercise of the First Amendment right to freedom of speech as the City of Berkeley.” She also accuses 350 Bay Area of advancing messages that are not “purely factual” but a “policy determination by the State of California.”

This is true; the stickers do reflect policy determination from AB 32, which mandates the state to reduce greenhouse gas emissions, and that’s why they’re likely to stick.

Besides, the stickers will likely only appeal to global warning believers; they’re meant to remind drivers that there are ways to curb their appetite for gas, such as by choosing public transit or other alternatives modes of transportation. The campaign’s technical advisor, Dr. Kirk R. Smith, said, “The cigarette analogy isn’t perfect, because gas is only one factor in climate change. But individual decisions are important.”

The question is whether or not such peppy stickers can get drivers thinking about the implications of their transportation choices.

The campaign in Berkeley isn’t done yet. After the Energy Commission votes in July, the sticker proposal will head to the Berkeley City Council in September. And from there, 350 Bay Area will see if those in San Francisco might like some friendly warning stickers on their gas pumps.

Nob Hill neighbors seek to block mental-health clinic relocation

A San Francisco mental-health clinic that has been in operation since 1975 is in danger of shutting down if it can’t find a new place to operate. But its possible relocation to medical offices on Hyde Street, subject to city approval, has prompted neighbors to organize in opposition.

Cindy Gyori, executive director of Hyde Street Community Services, has been scrambling to find a new home for her organization since being hit with the news of a pending rent increase. Its Tenderloin Mental Health Clinic serves about 1,200 clients per year, making it the third-largest outpatient clinic in the city.

Rent in its current space, on Golden Gate Avenue in the Tenderloin, is about to increase to almost double, Gyori said. Larkin Street Youth Services, another service provider in the process of consolidating to a single location, is lined up to rent the entire building. That means the clinic must relocate by Sept. 15, Gyori said.

When she first began the search, “It was impossible to find an adequate space,” she explained. Several possibilities would have required months of renovation, impossible to accomplish given the time constraint. But 815 Hyde Street, a medical office building connected to St. Francis Memorial Hospital, seemed viable. “We’ve really been focusing on moving there,” she said. Negotiations have been underway for several months.

The clinic serves individuals dealing with mental illness, past exposure to trauma, or substance abuse problems, making it just the sort of facility that’s needed to stabilize a population that’s at risk of homelessness, or in recovery from life on the streets.

But neighborhood resistance to the clinic’s planned move is proving to be problematic. “We’re getting pushback from some individuals in the community, who are concerned about our clients, and their behavior, and whether it would be disruptive to the community,” she said. The new facility would be at the Nob Hill intersection of Hyde and Bush streets. A boutique hotel is located nearby, and the area is regularly saturated with tourists.

Hyde Street Community Services is contracted with the San Francisco Department of Public Health to provide care for Central City residents. That means the Health Commission must sign off on any relocation proposal. But at a June 17 committee meeting, health commissioners opted to delay approval in the face of vociferous neighborhood opposition. They directed the nonprofit to hold community meetings about the planned relocation, tabling the vote till July 15.

Robert Garcia, president of Save Our Streets, is organizing neighborhood opposition. “This area, lower Nob Hill, is an historic hotel and apartment district,” he said in an interview. “There are a lot of tourists here.”

He described Save Our Streets as a “not-for-profit neighborhood group” that for years has engaged in “fighting crime, and [fighting] a lot of prostitution.” He added, “We live here. This is our neighborhood. We’re not asking for anything, just trying to protect what belongs to us – and that’s our neighborhood.”

“We just don’t need any more problems here,” Garcia went on. “When they’re bringing in people with behavioral problems, that says something.”

The delay has left Gyori in a bit of limbo. “The time crunch is really problematic,” she said, emphasizing that if the move to 815 Hyde Street does not go as planned, and the clinic cannot find any other options, then it could be forced to shut its doors.

“We want to respond to the community as best we can,” she added. “People said they were afraid they would see streams of shopping carts headed up Hyde Street,” she noted, but sees this notion as a misinformed reaction to the people who congregate on the sidewalk on Golden Gate. “We have to convince the neighborhood people that the people on the street in the Tenderloin aren’t the same as our clients,” she said. “The number one complaint from our clients, mostly, is that they have to run the gauntlet to get through the door,” she added. 

The first of the community meetings will be held tomorrow, June 26, at the Hotel Carlton, 1075 Sutter, from 6:30 to 8pm.

Standing Up for Children Exposed to Trauma

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By Suzy Loftus

OPINION Sasha’s only 9 years old, but she has already experienced significant trauma and adversity. Whenever her father drank too much, he would hit and verbally abuse Sasha and her mother. After her father went to jail, Sasha’s mother lost her job, the family became homeless and eventually moved into subsidized housing. Sasha had also witnessed high levels of community violence. Exposure to trauma has taken its toll on Sasha; she has a hard time focusing on assignments in class and struggles with reading and math. She gets frustrated and acts out at home and in class. Her teacher thinks Sasha has learning problems, and has recommended her for special education.

We have often looked at childhood trauma such as Sasha’s as a social problem or a mental health problem — but emerging data provides a more complete picture. At the Center for Youth Wellness, in Bayview Hunters Point, we are part of a growing national movement that is looking at childhood exposure to chronic adversity through a different lens: as a public health threat.

Children, like Sasha, are screened for exposure to chronic adversity and toxic stress during their pediatric visits, through a partnership between the Bayview Child Health Center and the Center for Youth Wellness.

Dr. Nadine Burke Harris discusses ACEs and toxic stress as the next massive public health threat.

In the Bayview and across California, chronic adversity and toxic stress stand in the way of the health and success of many children. Now more than ever, we are beginning to understand the impact of early adversity — known as Adverse Childhood Experiences (ACEs) — on the developing brains and bodies of children like Sasha.

ACEs are traumatic experiences over which a child has no control. Examples include abuse, neglect, household dysfunction, exposure to community violence, homelessness, discrimination, involvement in foster care, and others.

A study conducted by Dr. Burke Harris, founder of the Center for Youth Wellness, found that a majority of the 700 participants, all patients from Bayview with a median age of 8 — 67 percent —were exposed to one or more ACEs.

Beyond the Bayview, exposure to childhood trauma is surprisingly common among Californians. In fact, a San Diego study found that two-thirds of 17,000 participants reported at least one adverse childhood experience, and 20 percent of participants reported three or more ACEs.

ACEs can result in toxic stress, which can affect the fundamental biological functioning of the body and, in many children, the healthy development of their brain architecture. Without support and protection from adults, children who experience toxic stress are at higher risk for health problems, like asthma, diabetes, and obesity. Toxic stress also may make it difficult to sit still in school or to control emotions in challenging situations. If left untreated, toxic stress can lead to increased risk of adult diseases including heart disease and cancer as well as behavior problems such as depression, substance use, and suicide.

That’s why exposure to Adverse Childhood Experiences has been called the greatest unaddressed public health threat of our time. This is a public health crisis with clear implications beyond health — from education to public safety to our economy.

Our approach: screen every child for toxic stress and pilot and evaluate interventions that heal the impact of ACEs. Our goal is to share best practices in ACEs treatment with others around the country. We believe that the pediatric home offers an important entry point into addressing ACEs and toxic stress with families.

Even before a child goes to school or interacts with other systems, he or she usually visits a pediatrician for a routine well-child check. With the ability to touch countless numbers of children exposed to ACEs, pediatricians can be on the frontlines of preventing, screening, and healing toxic stress. Other healthcare professionals who work with children, such as school nurses, also are in a unique position to screen for toxic stress and help families access the services they need.

The science is clear — we must do more to prevent, screen, and heal the impacts of ACEs and toxic stress. A crucial first step in addressing this crisis is raising awareness among parents, pediatricians, educators, and policymakers that ACEs are a public health threat that we cannot afford to ignore. We must do more to identify toxic stress in our kids before it leads to a lifetime of challenges for children, families and our communities.

Suzy Loftus is chief operating officer of the Center for Youth Wellness and a member of the San Francisco Police Commission.

PrEP school

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Two weeks ago, the Centers for Disease Control and Prevention announced that it was recommending physicians consider Truvada, a medication used to treat HIV/AIDS, to prevent infection for high-risk patients who are HIV negative. Seen as a miracle drug by some and a “party drug” by others, Truvada has struggled to take off as a preventative measure and, prior to the CDC’s endorsement, foundered under its own controversy.

The drug regimen is known as pre-exposure prophylaxis, or PrEP, and involves taking one pill of Truvada daily. The most common side effects are initial nausea and headaches, but even those generally subside after a couple of weeks. Most impressive is the efficacy rate: Studies point to a reduction in risk of contracting HIV that is higher than 90 percent for individuals who take the medicine daily as recommended.

Additionally, the CDC has recommended PrEP only for high-risk patients — meaning gay men who have sex without condoms; intravenous drug users; and couples, gay or straight, where one partner is HIV positive and the other is negative.

“While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today,” said Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, in a press release.

But PrEP comes with its detractors, the most vocal of whom have come from within the HIV/AIDS and gay community. PrEP users often carry the stigma of being hypersexual gay men, looking to justify their promiscuous sex lives and disavowal of condoms with a daily pill. The label “Truvada whore” soon emerged as a means to shame PrEP users (though the term is now being reclaimed by PrEP activists as a source of pride through hashtags and T-shirts).

However, the loudest critic by far has been the AIDS Healthcare Foundation, a nonprofit organization based in Los Angeles that provides care to HIV positive patients around the globe.

“This is a position I fear the CDC will come to regret,” said AHF President Michael Weinstein in a public statement. “By recommending widespread use of PrEP for HIV prevention despite research studies amply chronicling the inability to take it as directed, and showing a limited preventive effect at best, the CDC has abandoned a science-driven, public health approach to disease prevention — a move that will likely have catastrophic consequences in the fight against AIDS in this country.”

The push for PrEP is playing out like a grand battle between two formidable foes. On one side is the multi-billion dollar pharmaceutical company that produces Truvada, Gilead Sciences, headquartered just a few miles south in Foster City. On the other is AHF, the largest provider of HIV/AIDS medical care in the US. While on the surface it may seem like a massive corporation taking on the not-for-profit underdog, the reality is much more complex.

 

THE TRUVADA TRAIN

When Truvada was first approved by the Food and Drug Administration 10 years ago, it was a revolutionary new pill used in combination with other drugs to help control the virus in HIV-positive patients. At a time when most HIV medications required taking pills throughout the day and carried intolerable side effects, Truvada was a once-a-day godsend.

Since then, Gilead has established itself as one of the leading companies for HIV medications, producing or helping to produce many top drugs, such as Atripla, Complera, and Stribild, all of which use components of Truvada in their formulas.

But Truvada’s truly revolutionary moment came in July 2012, when it became the first drug approved by the FDA to reduce the risk of HIV infection in negative individuals.

Controversy immediately ensued.

Medicating healthy people is not a popular approach, especially when those drugs cost $13,000 annually per patient (most insurance companies, as well as Medicare and Medicaid, cover PrEP). In comparison, the CDC estimates that the annual cost to treat someone who already has HIV is $23,000. If all of the 500,000 high-risk Americans who the CDC recommends use PrEP were to begin the therapy, the gross revenue for Gilead would be $6.5 billion — all for people who aren’t even sick.

Despite the potential for astronomical profits, as of September 2013 only 2,319 unique individuals had been prescribed Truvada as PrEP, according to Gilead. Half of those patients are women, suggesting that gay men are not being aggressively targeted for PrEP. When PrEP users who are part of research studies are included, the total number of patients is still estimated to be under 10,000.

One reason for the slow start is a lack of awareness. Outside of big cities, there is less dialogue surrounding HIV and prevention techniques. And even in metropolitan areas, familiarity with Truvada is often limited to the HIV specialist doctors treating patients who already have HIV and wouldn’t benefit from PrEP.

“We get a fair number of patients here who are rejected for PrEP from other physicians in the city,” said Dr. John Nienow of One Medical Group in the Castro. “I haven’t heard about widespread adoption in other offices, but I have heard of other physician groups not wanting to prescribe Truvada for PrEP.”

When asked whether the recent CDC announcement endorsing PrEP would change that, Nienow was hopeful.

The CDC announcement “will educate and legitimize PrEP’s use on a widespread basis,” he said. “I think physicians might be uncomfortable prescribing it, and this will make them more comfortable.”

Another reason PrEP has failed to gain traction is that Gilead has spent virtually no money on advertising its own drug. Well, sort of. It is true that Gilead has avoided advertising campaigns — drug companies that push their own drugs tend to stir up controversy — but many of the organizations that have come out publicly in favor of PrEP have received grants from Gilead. According to tax forms, Project Inform and the San Francisco AIDS Foundation, two prominent local nonprofits that support PrEP, have both received large donations from the pharmaceutical company.

One such grant was awarded to Project Inform, for the group to produce videos about PrEP targeted toward young gay men, particularly men of color, according to David Evans, director of research advocacy.

Was this donation a part of Gilead’s marketing strategy? It’s tough to say for sure; Gilead did not return Bay Guardian calls seeking comment.

Regardless of money, it is clear that a new approach is needed for combating HIV. New infections in the US have stubbornly hovered at around 50,000 incidences per year since the ’90s, despite pushes for condom usage and education efforts.

“Yes, PrEP is working. It works when it’s adhered to,” Nienow said. “It’s been extensively studied in populations at risk for HIV, and the conclusion was that it is dramatically successful. So much so that one expert even said that the debate about efficacy is now over.”

 

FROM SELF-PROTECTION TO “SLUT”

It’s true that the AIDS Healthcare Foundation is no billion dollar corporation such as Gilead. But with an operating budget this year of $904 million and a presence in 28 countries, AHF is still a force to be reckoned with.

Though the list of organizations that are loyal exclusively to condoms as a method of prevention is dwindling, AHF has been one of the most powerful and resolute allies of latex protection since the very beginning. Even before Truvada was approved by the FDA as PrEP in 2012, AHF campaigned to prevent it from happening. Even though AHF may be growing more and more isolated in its anti-PrEP stance, it is anything but ready to give way.

Though the efficacy rate for using PrEP is upwards of 90 percent reduction in risk, AHF and other critics consistently cite a drastically lower 40 percent reduction. The difference between these two figures lies in patient behavior: When Truvada is taken correctly, that is, every day without skipping doses, then it’s been shown to reduce new HIV infections by over 90 percent. However, when research studies publish data they must include all participants, regardless of whether they took the dosage as instructed. Average out the effectiveness of the drug between participants who adhered religiously and those who didn’t take it at all, and you arrive at about a 40 percent reduction in risk.

But as AHF points out, the outcome for the participants who did not follow instructions is an important reality that should not be overlooked.

“When you read these studies carefully, what they say is that research modeling can be whatever percent effective, but research modeling is not real-world applicable,” said Ged Kenslea, AHF director of communications. “In every study participants were given incentives and paid to participate,” yet still didn’t adhere to instructions consistently.

“We can’t even get people who already have HIV to take their pills as prescribed,” Kenslea added.

Even amid legitimate concerns about health risks associated with improper use of PrEP or its inability to act as a safeguard against other STDs, much of the debate has become infused with anti-PrEP rhetoric rooted in stereotypical assumptions about the promiscuity of gay men. Patients who use it to protect themselves are reduced to “Truvada whores,” men who live capriciously and are always on the lookout for their next fuck.

“The last couple of years that we’ve been prescribing [Truvada], there have been reports from patients who have received negative reactions from some people,” said Nienow. “Some people, particularly online, regard it as a marker for whores and promiscuity, and others as a marker for self-protection. The stigma kind of ranges from, ‘Great, you’re protecting yourself,’ to, ‘Horrible, you’re a slut.’ My patients have seen all of those.”

Just last month, AHF President Michael Weinstein referred to Truvada as a “party drug,” setting off such a fury that a petition to remove him as head of the organization is now circulating around the Internet. It has amassed nearly 4,000 signatures.

AHF’s policy of championing condoms above any other method is strange, considering that it cites poor adherence to Truvada as the drug’s primary downfall. While the efficacy of the drug clearly drops when it is not taken correctly, AHF critics point out that condoms are not used consistently either, and having multiple methods of protection is better than one.

After viewing donations by Gilead to HIV/AIDS groups, the Bay Guardian requested a list of donors from the AHF as well, but the organization provided a 2012 tax form that did not include a donor list.

PrEP does have some efficacy, Kenslea said, and AHF clinicians are free to prescribe Truvada as a preventative drug.

“If an AHF physician feels that prescribing PrEP is appropriate, then we do not stop that,” Kenslea said.

Still, AHF’s uncompromising reluctance to consider endorsing PrEP is puzzling. AHF leaders repeatedly list reasons that the drug will not work, despite mounting scientific evidence stating the contrary. There is no doubt that PrEP should not be taken lightly or with a blasé attitude, but why eschew it with such fervor?

“We are not refuting the science,” Kenslea said. “We are disagreeing on the understanding of human nature.”

 

A DAILY ROUTINE

When Damon Jacobs re-entered the dating game in 2011, it was a completely different playing field from what he remembered. At first, he wasn’t sure what to expect after coming out of a seven-year relationship with his boyfriend, but he quickly realized there were some significant differences since he had last played the field.

“For me, getting back into the dating world and the cruising world, I was realizing that people were not using condoms as they were a decade earlier,” Jacobs said. “And I wasn’t using them like I was in 1990’s San Francisco either.”

But even scarier than Jacobs’ risky behavior was the reasoning behind it.

“I noticed that my thinking had changed,” he admitted. “I started thinking of HIV as a ‘when,’ not an ‘if.'”

It was during that time when the PrEP studies were just beginning to be published. After attending a forum about using an HIV treatment drug to prevent HIV, Jacobs gathered all of the information he could on this unconventional approach and ran back to his doctor. He knew he wasn’t being as diligent to prevent HIV as he once had, and PrEP seemed like an effective way to stay negative.

His physician had never heard of giving Truvada to a patient without HIV, but Jacobs showed him the research and promising results. He began taking PrEP in July 2011, exactly one year before its FDA approval for HIV-negative individuals.

“Those of us using PrEP now, we were the first ones asking for this, so we’ve had to be the educators and the advocates,” Jacobs said. “We even educate the doctors. Some doctors take that and say, ‘yes, I want to work with you.’ Others give tacit dismissal, and then some tell outright lies about it.”

In the past three years, Jacobs has never missed one of his daily pills. He has built it into his everyday routine: eat breakfast, brush teeth, take PrEP. If you can remember to brush your teeth, he postulates, you can remember to take your pills.

Unfortunately, Jacobs has dealt with the stigma that surrounds PrEP as well.

“If I’m on a date with someone who is negative and he finds out, he’ll ask me, ‘Oh, so you’re a whore? Do you have sex with everybody?'” Jacobs lamented. “It’s not a common reaction, but it stems from a misunderstanding of what PrEP is.”

Instead of being offended, embarrassed, or angry, he takes the time to educate, often resorting to the same analogy: that it’s very similar to women taking birth control; it reduces the unwanted consequences of condom-less sex.

Even though Jacobs disagrees with today’s critics of PrEP, he seems to understand where they are coming from. He volunteered with the Stop AIDS Project in San Francisco in 1992, while HIV was crippling the gay community and condoms were considered the only safeguard from a then-fatal virus.

“Michael Weinstein’s message has been that people should use condoms,” said Jacobs. “When I started volunteering at Stop AIDS [Project], we had a marketing campaign where we gave out pins and T-shirts at local bars and clubs that said, ‘100%’ because we knew that if everybody used condoms 100 percent of the time, we could eradicate AIDS by 2000. “Well I ask you, how did that pan out?”

Lawsuit claims SROs owned by city contractors are unsafe, moldy, rodent-infested

It’s often rumored that housing conditions in certain single-room occupancy hotels, or SROs, throughout San Francisco are atrocious. And when it comes to SROs under ownership of one family in particular, a lawsuit filed today by City Attorney Dennis Herrera now alleges not only that conditions are unhealthy and inhospitable – they’re also illegal.

Hotel owners, managers and operators Balvantsinh “Bill” Thakor, his wife Lataben B. Thakor, and their sons Kiransinh and Bahavasinh Thakor are all named in Herrera’s suit, which alleges that the business owners are renting uninhabitable residential rooms to vulnerable occupants, depriving SRO occupants of tenancy rights, maintaining public nuisances, doing construction work without required permits or contractors’ licenses, and making false claims for payment from the city.

The SRO owners hold contracts with the city. Herrera’s complaint alleges that taxpayer dollars are flowing into the hands of landlords who have allowed their properties to remain moldy, rodent-infested, and unsafe to occupants who are too poor to seek out other options.

We left a message for Balvantsihn “Bill” Thakor and will update this post if we receive a response.

Under the city contracts, homeless people who are pulled off the street by the Department of Public Health’s Homeless Outreach Team are temporarily placed in stabilization beds in SROs under the Thakor’s ownership. DPH rents out blocks of rooms to provide this temporary transitional housing, while low-income residents may live permanently in other units in the same buildings under their own private arrangements.

“San Francisco’s response to our affordable housing crisis must include aggressively protecting our most vulnerable residents — and that’s exactly what this case is about,” said Herrera. “The Thakor family has exploited low‐income residents by denying them tenancy rights. They’ve defiantly thumbed their noses at city inspectors over pervasive code violations, which endanger residents and neighbors alike. And they’ve billed taxpayers for providing clients of city programs with ‘clean, safe, habitable’ housing, when it was anything but clean, safe, or habitable.”

A litany of charges in Herrera’s complaint gives an idea of what conditions in some of these properties are like: “[Health and safety code violations include] rampant cockroach and bedbug infestations, failure to provide adequate fire protection and safety, failure to provide adequate security, failure to provide plumbing adequate to avoid repeated sewage leaks, failure to provide safe and functional wiring, failure to provide residential rooms and bathrooms free of mold and mildew, and failure to provide adequate heat.”

City Attorney spokesperson Matt Dorsey noted that there had been a host of health and building code violations issued against the hotel operators, but that fines and notices of violation still had not resulted in necessary repairs. With all administrative avenues exhausted, the city is now moving forward with a lawsuit.

“With litigation,” Dorsey said, “we have the ability to bring a level of fear that the administrative process cannot.”

Meanwhile, a quick search for court records revealed that this isn’t the first time Balvantsinh “Bill” Thakor has been named in a lawsuit brought by the City Attorney against SRO hotel owners.

In 2002, records show, then-City Attorney Louise Renne named him along with a host of other defendants in a suit relating to the ownership and operation of the Warfield Hotel, a 63-unit Tenderloin SRO where defendants had allegedly “failed to correct life-safety hazards … thereby forcing residents to live in substandard conditions in violation of applicable state and local housing laws.” According to this 2003 editorial in the San Francisco Chronicle, that particular SRO later went “from horrible to habitable.”

But even back then, Thakor was described in the Chronicle as “not known for his quick response to code violations.” All of which begs the question: With such a terrible track record, how do these hotel owners manage to land city contracts?

Toyota work methods applied at General Hospital

San Francisco’s Department of Public Health has a $1.3 million contract with Seattle-based Rona Consulting Group to implement the Toyota Management System, a workflow methodology based on the auto-manufacturing model, at San Francisco General Hospital.

This new model, which aims for greater workflow efficiency, is being implemented just as healthcare staffers raise concerns that staffing levels at SFGH are dangerously low.

“Nurses often work through their breaks, and they stay after their shifts to get charting done,” said David Fleming, a registered nurse who has been at SFGH for 25 years. “I think nurses are getting the job done – but they’re at the edge.”

A group of healthcare workers spoke out at the May 7 Budget & Finance Committee meeting, during which supervisors discussed the DPH budget. Public employee union SEIU 1021, which represents healthcare workers, is in the midst of contract negotiations but Fleming said they had been grappling with reduced staffing for awhile.

According to a contract request to the Health Commission sent anonymously to the Bay Guardian, DPH entered into a 24-month contract with Rona totaling just over $1.3 million, for the purpose of implementing the Toyota Management System methodology as part of the transition to the new SFGH acute care facility, scheduled to open in December 2015.

The Bay Guardian received a copy of the contract request via BayLeaks, which uses encryption software known as SecureDrop to enable sources to anonymously submit documents.

The $1.3 million came from “General Funds (Rebuild Funds)”, according to the contract request. In 2008, voters approved Prop. A, funding the $887.4 million General Hospital rebuild through general obligation bonds. Use of the voter-approved, taxpayer-supported funds is restricted to hospital construction under a state law that limits the use of bond money to specified purposes.

However, Iman Nazeeri-Simmons, chief operating officer at DPH, said funding for the Rona contract came from a “hospital rebuild transition budget,” which she said provides for needs beyond construction costs.

Specialized consulting to educate hospital staff in the ways of the Toyota Management System doesn’t come cheap. A single meeting between the consultant and “key leaders” to “discuss needs and develop operational project plans” cost $25,225, the document showed. A one-day “visioning session” facilitated by the contractor was priced at $16,814. Five-day workshops fetch Rona $42,032 each. Based on estimates included in the contract request, the consulting firm would earn the equivalent of $4,707 per day.

The $1.3 million consulting contract was awarded even as unions remind city officials of staffing cuts during the economic downturn in 2008 that still have not been restored.

Here’s some video testimony from hospital staffer Heather Bollinger regarding how tough things can get at the General Hospital’s trauma center. “We do have staffing issues, and they do affect patient safety,” she said in public comment to the Health Commission on April 15.

Nato Green, who is representing nurses as a negotiator on behalf of public employee union SEIU 1021, described the staffing levels at SFGH as “unsafe and unsustainable.” There are currently 90 vacancies for nurses that haven’t been filled, he said. That’s a 14 percent vacancy rate, Green noted — typically substituted with traveling nurses, temps, and overtime labor.

Nazeeri-Simmons said the consulting was necessary for the transition to the new SFGH facility, for “doing it in the best way, and understanding there’s a completely different physical environment over there.” Rona is a pioneer in healthcare performance improvement, she said, and they are “leading us in very interactive workflow designs that are simulation-based,” geared toward “maximizing value and driving out waste.”

But does “driving out waste” translate to staffing cuts? “It certainly hasn’t happened here,” Nazeeri-Simmons responded when asked about that. Instead, the consultants have helped management to “right-size services to meet the demand,” she said, noting that wait times in urgent care had been significantly reduced as a result. Decisions such as using a portable X-Ray machine that eliminated the need for patients to walk ten minutes across the hospital grounds had dramatically reduced wait times, she added.

“We need to make sure the staff are working to the highest of their capability,” she added.

Heidi Gehris-Butenschoen, a spokesperson for Rona, said the goal of transforming work practices under the Toyota Management System is to improve patient care. Asked whether the consulting tends to affect staffing levels, Gehris-Butenschoen said, “That’s really up to the hospital. It’s definitely in our workshop not something we focus on. The Toyota system is not about cutting heads at all.”

SFGH has been working with Rona since July 2012. One of the company partners was formerly the CEO of Productivity, Inc., which advised “large-scale transformations for Fortune 100 companies,” according to the contract request. The workflow methodology is rooted in Lean principles, integrating a “just in time” staffing concept that’s been applied in corporate settings such as Walmart.

The Health Commission approved the $1.3 million contract at its Dec. 17, 2013 meeting as part of the consent calendar, which is summarily approved by a single vote.

Fleming, the RN, was skeptical of how much the Lean system had actually accomplished. They had literally “rearranged the furniture” since the program was implemented, he said, and observers had silently monitored staffers’ activities.

“When we work with anyone, we go out to the gemba, and we observe,” Rona’s Gehris-Butenschoen explained, noting that gemba refers to “the place where work happens.” The observations help hospitals identify where waste can be reduced, she added, such as moving a supply cabinet if time is being taken up by crossing the room to get to it.

But Fleming said he wasn’t convinced that applying a corporate efficiency method, borrowed from manufacturing, would provide the greatest benefit in a healthcare setting.

“We are not taking care of cars on an assembly line,” he said. “When it comes to another human being’s body, I don’t know that faster is necessarily better.”

Don’t police the pot docs

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By Ahimsa Porter Sumchai

OPINION

Senate Bill 1262 was introduced in the California Senate on Feb. 21 by veteran legislator Lou Correa. It is a medical marijuana bill designed to regulate physicians, dispensaries, and cultivation sites via rigid government oversight. Sponsored by the California Police Chiefs Association, SB 1262 promises to “provide a clear road map for the responsible implementation of Proposition 215 in California since voters approved it in 1996.”

The Compassionate Use Act of 1996, which created Heath & Safety Code 11362.5, ensures that seriously ill Californians have the right to obtain and use marijuana for medical purposes when the use is deemed appropriate and recommended by a physician.

As a licensed physician with a registered medical practice in San Francisco, I have reviewed the wording of SB 1262. The bill is highly punitive, clearly seeking to punish doctors who recommend medical marijuana (MM). SB 1262 concerns me most because it duplicates and violates existing state and federal statutes that clarify the physicians’ role in recommending MM.

In the 2002 case Conant v. McCaffrey, the federal government was enjoined by the US District Court in San Francisco from punishing physicians for recommending MM. That ruling affirms physicians’ First Amendment right to make recommendations.

SB 1262 requires the Medical Board of California to audit any physician who recommends MM more than 100 times a year. On April 2, the US Supreme Court struck down limits on federal campaign donations under the auspices of First Amendment free speech rights. Thus, a SCOTUS precedent was set that can be legally interpreted to defend a physician’s free speech right to authorize as many patients to use MM as deemed medically necessary.

SB 1262 establishes requirements for prescribing and record-keeping for physicians who recommend MM in a bill sponsored by law enforcement officials who lack medical or relevant education training. Guidelines and accepted standards for recommending MM were developed by licensed California physicians and adopted by the MBC on May 7, 2004.

SB 1262 violates the California law that protects the privacy of patient medical information — The Confidentiality of Medical Information Act — as well as federal law protecting health information, by mandating physicians report all MM recommendations along with private patient records. The Health Insurance Portability and Accountability Act (HIPAA) requires patient authorization for disclosure of patient health information. HIPAA is a federal regulation, and MBC has no authority to evaluate HIPAA violations.

SB 1262 mandates a training and certification requirement for any doctor who recommends MM, with a $5,000 fine for noncompliance. I support SB 1262’s efforts to establish standards for quality assurance and testing of marijuana cultivated for medical use, but even that section duplicates guidelines developed and adopted by the Attorney General’s Office in 2008.

Physicians are capable of regulating their practice standards without law enforcement oversight and SB 1262 is opposed by the California Medical Association, which issued guidelines for physicians recommending MM in 2004, which includes proper record-keeping and annual examinations.

“Medical marijuana evaluation clinics are engaged in the practice of medicine, and physicians are responsible for their patients,” that 20-page Digest for Medical Marijuana Clinics affirms.

Marijuana remains listed in Schedule 1 of the federal Controlled Substances Act and has no accepted medical use. The lack of dose response curve research conducted in large population-controlled trials coupled with the lack of standardized cannabinoid profiling, potency, pesticide, and microbiological testing make it difficult for the physician to offer dosing recommendations for MM short of the adage “start low, go slow.”

The American Public Health Association, American Academy of HIV Medicine, and many other medical institutions join Americans for Safe Access — the largest member-based marijuana advocacy organization in the country — in promoting safe and legal access to MM for therapeutic uses and research. Polling shows Americans of all political stripes support medical marijuana, and SB 1262 would be a step backward that the public doesn’t want to take.

Ahimsa Porter Sumchai is a physician and former District 10 supervisorial candidate.

Where there’s smoke

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news@sfbg.com

It was April 20 in Golden Gate Park, the fabled 4/20 in the parlance of pot smokers, and we found Nick and Chris standing under the shade of a tree with a cluster of friends, including Geoff, the proud owner of a five-foot bong.

Nick had done several hits through the supersized smoking device that day. Beside him, Chris took hits from his own handheld bong. “I’m feeling good,” Nick reported. “But I’m also kinda hungry. I could go for some Chinese food. Ohh, and some Sapporo!”

Administering a hit of marijuana through such unwieldy paraphernalia is quite the operation, requiring one person to stand and hold one end, another to light the marijuana once it’s packed into the bowl, and a third to inhale the five-foot column of milky smoke that rises through the chamber. The smokers on the receiving end contorted their faces as they inhaled, inevitably coughing and laughing as they breathed out, seemingly amazed by the experience. The college-age friends were in 420-induced bliss.

The annual 420 celebration in Golden Gate Park is unpermitted, with no official organizers, yet thousands of festivalgoers nevertheless flock to it year after year. It’s a quintessentially San Francisco experience: Young and old congregate for a collective daylong smoke-out, bringing drums, dogs, grills, shade structures, hand-blown glass, tie-dyed tapestries, Hacky Sacks, sound systems, and other picnic paraphernalia along with them.

The area around Hippie Hill — at the eastern end of the park, near Kezar Stadium — was a jumble of humanity crammed elbow to elbow, reeking of pot smoke. The crowd reflected a wide range of ethnicities and brought out many displaying an outlandish sense of fashion, sporting shiny plastic marijuana-leaf necklaces, sleeve tattoos, piercings, face paint, and piles upon piles of dreadlocked hair.

San Francisco maintains an iconic status as a weed-friendly city. While 420 in Golden Gate Park is a lighthearted scene that’s also proved irksome for city agencies plagued by leftover trash and traffic jams, serious year-round marijuana advocacy efforts continue to mark the Bay Area as a hotbed for drug policy reform and thriving, legitimate pot-based entrepreneurship.

 

GREEN BEACON

The movement to legalize marijuana for medical purposes started in San Francisco, the lovechild of the city’s hippie movement and its caregiving response to the AIDS epidemic. It was Dennis Peron and other activists here who wrote Proposition 215, the statewide legalization measure that California voters approved in 1996.

A decade ago, the San Francisco Board of Supervisors approved a comprehensive set of regulations for its two dozen or so medical marijuana dispensaries, guidelines that have proven to work well and be a model for other jurisdictions to follow, elevating pot purveyors into accepted members of the business community (see “Marijuana goes mainstream,” 1/27/10).

Some have even begun to regard the Bay Area as a model for how to implement a sensible approach to regulating marijuana. On April 16, US Rep. Dina Titus (D-Las Vegas) traveled to San Francisco on a fact-finding mission after Clark County, Nevada legalized medical marijuana, with Las Vegas and other Nevada cities expected to follow shortly.

“I want the state to learn from someone who’s done it right,” Titus told the Guardian as she toured The Apothecarium on Market Street, an elegant dispensary reputed to be one of San Francisco’s finest.

In addition to helping guide Nevada’s implementation of medical marijuana legalization, Titus said she’s working on federal legislation that would better protect small businesses involved with a marijuana industry that is growing rapidly in the US, thanks to Colorado and Washington taking the next step and legalizing even recreational uses of marijuana.

For example, Titus wants to make sure marijuana businesses have full access to banking services, something that the US Department of Justice has occasionally interfered with. As Titus told us, “The federal government shouldn’t be wasting time and going after people who are abiding their state laws.”

 

BLISS AND BOUNDARIES

Back at 420 on Hippie Hill, Amber and Charlie lounged on a blanket with Gizmo, an affectionate pooch they’d adopted from “this guy who lives in a tree house” in Santa Cruz. The young couple, ages 18 and 20 respectively, had hitchhiked to California from Washington. Yes, “we may have done some weed,” Charlie said before letting out a peal of laughter.

“It’s been pretty awesome,” Amber said. “Literally, there was smoke coming from everywhere,” the moment 4:20pm arrived. As far as the eye could see, she said, the scene was nothing but “people smoking weed. It was crazy.”

Lilian was at the park with a friend, wearing a crown of daisies she’d woven with flowers plucked from nearby the park entrance. “All day we’ve been doing joints and blunts and pipes,” she explained. “We haven’t had any bong hits yet, but we had a couple vape hits, because they were like giving free test trials here at the park. So we were like, alright, why not?”

Lilian exulted the “positive vibes” of the event, but it wasn’t all weed and roses. A short while later, reports of gunfire sent police cars racing into the park with sirens wailing. While police later reported that they never found evidence of anyone actually discharging a weapon, two different individuals were arrested on charges of possessing a firearm.

Emergency personnel responded to four medical calls, police reported the following day, including one person who had a seizure, someone who suffered an abrasion at Haight and Ashbury streets, and two underaged individuals who experienced problems after becoming overly intoxicated. For a crowd of thousands pushed the boundaries of indulgence, quite a small number suffered harm.

Eight other arrests stemmed from charges of selling marijuana or possessing it for sale, possession or sale of opiates, one warrant arrest, and another on charges of “malicious mischief,” according to police.

A few days before the unpermitted gathering, city officials held a press conference announcing a “comprehensive plan” to crack down on the anticipated debauchery, which included not only the Golden Gate Park marijuana celebration but the “Hunky Jesus” competition, a countercultural hallmark held annually on Easter Sunday in Dolores Park.

“Last year we had a lot of challenges,” said Sup. London Breed, whose District 5 encompasses Golden Gate Park. “We need to make the city and streets safe this year. We want people to come and enjoy San Francisco, but we also want them to respect San Francisco.”

Thus, city agencies ramped up deployment of both plainclothes and uniformed police officers, and sent out more parking and traffic control officers.

The previous year, when massive amounts of debris had been left strewn throughout the park, it took 25 city employees over 12 hours to clean up five tons of trash left by intoxicated visitors, said Phil Ginsburg, general manager of the city’s Recreation and Parks Department. The Department of Public Works’ tab for cleanup exceeded $10,000.

But the main draw of the event, in true San Francisco fashion, was behavior Police Chief Greg Suhr hinted in advance would essentially be tolerated. “The sale of marijuana is still a felony,” Suhr emphasized, “but I don’t think [the SFPD is] naive enough to believe that we can stop people from smoking on 4/20.”

 

CANNABIS AS MEDICINE

Advocates for legalizing even recreational use of marijuana had hoped to make the November ballot this year, but the campaign’s signature-gathering effort has sputtered out.

Sponsored by the California Cannabis Hemp Initiative, the legalization measure was named for Jack Herer, a renowned cannabis advocate who passed away in 2010. The campaign is now ramping up for another try in 2016, when some advocates hope the presidential election will drive younger voters to the polls.

But while efforts to legalize weed in California for recreational use falter for now, the legitimate use of cannabis for medicinal purposes has giving rise to healthy businesses and research on health benefits. At the April 16 event at the Apothecarium, Titus had lots of questions for Allie Butler, an expert in marijuana who has a master’s degree in public health and told Titus, “I want to do cannabis research for the rest of my life.”

Butler introduced Titus to the various strains of marijuana, explaining what ailments each is good for. The CaliWidow can be a cure for headaches, she explained, and Blue Dream is “good for nausea. We prescribe that for cancer patients all day.” She indicated another strain, saying, “this is the Jack Herer, it’s my mom’s favorite.” Fancy, knowledgeable, and above ground, this isn’t your mom’s marijuana business anymore.