In a 60-page report sent Monday to the legislature, the California Department of Housing and Community Development recommended lawmakers set a maximum safe indoor air temperature of 82 degrees Fahrenheit for the Golden State’s estimated 14.6 million residential dwelling units.

“This is a big deal,” said C.J. Gabbe, an associate professor of environmental studies at Santa Clara University. “We’re seeing more and more concerns about the increase in heat-related morbidity and mortality in California, which is leading to these kinds of maximum indoor temperature guidelines.”

If the housing proposal is adopted, California could have the most comprehensive requirements in the nation, Gabbe said. Some local jurisdictions, including Phoenix, Dallas, and New Orleans, have set their own standards, and the city and county of Los Angeles are exploring their own protections.

Last year was the planet’s warmest on record, and extreme weather is becoming more frequent and severe, according to the National Oceanic and Atmospheric Administration. Even though most heat deaths and illnesses are preventable, about 1,220 people in the United States are killed by extreme heat every year, according to the Centers for Disease Control and Prevention. Heat stress can cause heatstroke, cardiac arrest, and kidney failure, and it’s especially harmful to the very young and the elderly.

State law protects renters in the winter by requiring all rental residential dwelling units to include functioning heating equipment that can keep the indoor temperature at a minimum of 70 degrees, but there is no similar standard giving renters the right to cooling.

The release of this report is a key milestone, but it’s just the first step of a long road, vulnerable to legislative politics and an influential housing industry that has successfully delayed similar proposals in the past. In 2022, state lawmakers directed the housing department to issue cooling recommendations after proposed legislation stalled when landlords, real estate agents, and builders raised concerns such a standard would be cost-prohibitive.

Those concerns remain. Many California rental units are older homes, sometimes 90 to 100 years old, and installing air conditioning would require expensive changes, including upgrading the electrical system, said Daniel Yukelson, CEO of the Apartment Association of Greater Los Angeles.

“These types of government mandates, absent some kind of financing or significant tax breaks, would really put a lot of smaller owners out of business,” said Yukelson, who added that he’s concerned it would lead to housing getting bought by large corporations that would spike rent prices.

The report recommends lawmakers provide incentive programs for owners to retrofit residential units so the cost isn’t passed along to renters. It also suggested a variety of strategies that could be deployed to keep homes cool: central air conditioning, window units, window shading, fans, and evaporative room coolers.

For new construction, housing officials suggested new standards incorporating designs to keep indoor temperatures from topping 82 degrees, such as cool roofs and cool walls designed to reflect sunlight, or landscaping to provide shade.

Whether the legislature will take up the housing department’s recommendations is unclear. Spokespeople for Democratic Assembly Speaker Robert Rivas and Sen. Henry Stern, Democrats who co-authored the 2022 cooling standard bill, declined to comment.

Californians largely stand behind the idea, according to a 2023 poll from the University of California-Berkeley Institute of Governmental Studies and co-sponsored by the Los Angeles Times. Sixty-seven percent of voters said they supported the concept of the state establishing cooling standards for residential properties.

As temperatures rise and heat waves become longer and more intense, the report cautions, deaths in California could rise to 11,300 a year by 2050. And deaths from all causes “may be up to 10% higher on hot nights compared with nights without elevated temperatures,” according to a February presentation by the Los Angeles County Department of Public Health.

That’s because it can be particularly dangerous when people can’t cool off at night during extended heat waves, said David Konisky, a professor of environmental policy at Indiana University.

“When you can’t count on evening cooling off and allowing the body to readjust,” he said, “that’s when things get really dangerous for people’s health.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

En un informe de 60 páginas enviado el lunes 3 de febrero a la Legislatura, el Departamento de Vivienda y Desarrollo Comunitario de California recomendó a los legisladores establecer una temperatura máxima segura del aire interior de 82 grados Fahrenheit para las cerca de 14,6 millones de unidades de vivienda residencial del estado.

“Es un gran problema”, dijo C.J. Gabbe, profesor asociado de estudios ambientales en la Universidad de Santa Clara. “Estamos viendo cada vez más preocupaciones sobre el aumento de la morbilidad y la mortalidad relacionadas con el calor en California, lo que está llevando a este tipo de pautas de temperatura máxima interior”.

De adoptarse la propuesta de vivienda, California podría tener los requisitos más completos del país, dijo Gabbe. Algunas jurisdicciones locales, incluidas Phoenix, Dallas y Nueva Orleans, han establecido sus propios estándares, y la ciudad y el condado de Los Ángeles están explorando sus propias protecciones.

El año pasado fue el más cálido registrado en el planeta, y los fenómenos meteorológicos extremos se están volviendo más frecuentes y severos, según la Administración Nacional Oceánica y Atmosférica (NOOA). Aunque la mayoría de las muertes y enfermedades causadas por el calor se pueden prevenir, alrededor de 1.220 personas mueren cada año en el país por esta causa, según los Centros para el Control y Prevención de Enfermedades (CDC). El estrés térmico puede causar insolación, paro cardíaco e insuficiencia renal, y es especialmente perjudicial para los muy jóvenes y los adultos mayores.

La ley estatal protege a los inquilinos en el invierno al exigir que todas las unidades residenciales de alquiler incluyan equipos de calefacción que funcionen y puedan mantener la temperatura interior a un mínimo de 70 grados, pero no existe una norma similar que otorgue a los inquilinos el derecho a la refrigeración.

La lanzamiento de este informe es un hito clave, pero es solo el primer paso de un largo camino, vulnerable a la política legislativa y a una influyente industria de bienes raíces que ha retrasado con éxito propuestas similares en el pasado. En 2022, los legisladores estatales ordenaron al departamento de vivienda que emitiera recomendaciones sobre refrigeración después que la legislación propuesta se estancara cuando propietarios, agentes inmobiliarios y constructores plantearan la preocupación de que la norma resultaría prohibitiva en términos de costos.

Esas preocupaciones persisten. Muchas unidades de alquiler de California son casas antiguas, a veces de entre 90 y 100 años, e instalar un sistema de aire acondicionado requeriría cambios costosos, incluida la actualización del sistema eléctrico, dijo Daniel Yukelson, director ejecutivo de la Apartment Association of Greater Los Angeles.

“Este tipo de mandatos gubernamentales, en ausencia de algún tipo de financiación o exenciones fiscales significativas, realmente dejarían sin trabajo a muchos propietarios más pequeños”, dijo Yukelson, quien agregó que le preocupa que esto lleve a que las grandes corporaciones compren viviendas, lo que aumentaría los precios de los alquileres.

El informe recomienda que los legisladores ofrezcan programas de incentivos para que los propietarios modernicen las unidades residenciales para que el costo no se traslade a los inquilinos. También sugirió una variedad de estrategias que podrían implementarse para mantener las casas frescas: aire acondicionado central, unidades en ventanas, persianas, ventiladores y enfriadores de habitación por evaporación.

Para las nuevas construcciones, los funcionarios de vivienda sugirieron nuevos estándares que incorporen diseños para evitar que las temperaturas interiores superen los 82 grados, como techos y paredes frescos diseñados para reflejar la luz solar, o paisajismo para tener sombra.

No está claro si la Legislatura aceptará las recomendaciones del departamento de vivienda. Voceros del presidente de la Asamblea demócrata Robert Rivas y del senador Henry Stern, demócratas que fueron coautores del proyecto de ley de estándares de refrigeración de 2022, no quisieron hacer comentarios.

Los californianos en gran medida respaldan la idea, según una encuesta de 2023 del Instituto de Estudios Gubernamentales de la Universidad de California-Berkeley y co-patrocinada por Los Angeles Times. El 67% de los votantes dijeron que apoyaban el concepto de que el estado estableciera estándares de refrigeración para propiedades residenciales.

Según el informe, a medida que las temperaturas aumenten y las olas de calor se hagan más largas e intensas, las muertes en California podrían aumentar a 11.300 al año para 2050. Y las muertes por todas las causas “pueden ser hasta un 10% más altas en las noches calurosas en comparación con las noches sin temperaturas elevadas”, según una presentación de febrero del Departamento de Salud Pública del condado de Los Ángeles.

Esto se debe a que puede ser particularmente peligroso cuando las personas no pueden refrescarse por la noche durante las olas de calor prolongadas, dijo David Konisky, profesor de política ambiental en la Universidad de Indiana.

“Cuando no se puede contar con que las personas se refresquen por la noche y permitan que el cuerpo se reajuste, es cuando las cosas se ponen realmente peligrosas para la salud de las personas”, agregó.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

He pulled to the side of the road and cried at the sight of residents trying to save their homes.

“I could see people standing on the roof, watering it, trying to protect it from the fire, and they just looked so hopeless,” said Ramirez, a community outreach worker with the Pasadena Public Health Department.

That evening, the 49-year-old volunteered for a 14-hour shift at the city’s evacuation center, as did colleagues who had also been activated for emergency medical duty. Running on adrenaline and little sleep after finding shelter for homeless people all day, Ramirez spent the night circulating among more than a thousand evacuees, offering wellness checks, companionship, and hope to those who looked distressed.

Local health departments, such as Ramirez’s, have become a key part of governments’ response to wildfires, floods, and other extreme weather events, which scientists say are becoming more intense and frequent due to climate change. The emotional toll of fleeing and possibly losing a home can help cause or exacerbate mental health conditions such as anxiety, depression, post-traumatic stress disorder, suicidal ideation, and substance use, according to health and climate experts.

Wildfires have become a recurring experience for many Angelenos, making it difficult for people to feel safe in their home or able to go about daily living, said Lisa Wong, director of the Los Angeles County Department of Mental Health. However, with each extreme weather event, the county has improved its support for evacuees, she said.

For instance, Wong said the county deployed a team of mental health workers trained to comfort evacuees without retraumatizing them, including by avoiding asking questions likely to bring up painful memories. The department has also learned to better track people’s health needs and redirect those who may find massive evacuation settings uncomfortable to other shelters or interim housing, Wong said. In those first days, the biggest goal is often to reduce people’s anxiety by providing them with information.

“We’ve learned that right when a crisis happens, people don’t necessarily want to talk about mental health,” said Wong, who staffed the evacuation site Jan. 8 with nine colleagues.

Instead, she and her team deliver a message of support: “This is really bad right now, but you’re not going to do this alone. We have a whole system set up for recovery too. Once you get past the initial shock of what happened — initial housing needs, medication needs, all those things — then there’s this whole pathway to recovery that we set up.”

The convention center in downtown Pasadena, which normally hosts home shows, comic cons, and trade shows, was transformed into an evacuation site with hundreds of cots. It was one of at least 13 shelters opened to serve more than 200,000 residents under evacuation orders.

The January wildfires have burned an estimated 64 square miles — an area larger than the city of Paris — and destroyed at least 12,300 buildings since they started Jan. 7. AccuWeather estimates the region will likely face more than $250 billion in economic losses from the blazes, surpassing the estimates from the state’s record-breaking 2020 wildfire season.

Lisa Patel, executive director of the Medical Society Consortium on Climate and Health, said she’s most concerned about low-income residents, who are less likely to access mental health support.

“There was a mental health crisis even before the pandemic,” said Patel, who is also a clinical associate professor of pediatrics at Stanford School of Medicine, referring to the covid-19 pandemic. “The pandemic made it worse. Now you lace in all of this climate change and these disasters into a health care system that isn’t set up to care for the people that already have mental health illness.”

Early research suggests exposure to large amounts of wildfire smoke can damage the brain and increase the risk of developing anxiety, she added.

At the Pasadena Convention Center, Elaine Santiago sat on a cot in a hallway as volunteers pulled wagons loaded with soup, sandwiches, bottled water, and other necessities.

Santiago said she drew comfort from being at the Pasadena evacuation center, knowing that she wasn’t alone in the tragedy.

“It sort of gives me a sense of peace at times,” Santiago said. “Maybe that’s weird. We’re all experiencing this together.”

She had been celebrating her 78th birthday with family when she fled her home in the small city of Sierra Madre, east of Pasadena. As she watched flames whip around her neighborhood, she, along with children and grandkids, scrambled to secure their dogs in crates and grabbed important documents before they left.

The widower had leaned on her husband in past emergencies, and now she felt lost.

“I did feel helpless,” Santiago said. “I figured I’m the head of the household; I should know what to do. But I didn’t know.”

Donny McCullough, who sat on a neighboring green cot draped in a Red Cross blanket, had fled his Pasadena home with his family early on the morning of Jan. 8. Without power at home, the 68-year-old stayed up listening for updates on a battery-powered radio. His eyes remained red from smoke irritation hours later.

“I had my wife and two daughters, and I was trying not to show fear, so I quietly, inside, was like, ‘Oh my God,’” said McCullough, a music producer and writer. “I’m driving away, looking at the house, wondering if it’s going to be the last time I’m going to see it.”

He saved his master recording from a seven-year music project, but he left behind his studio with all his other work from a four-decade career in music.

Not all evacuees arrived with family. Some came searching for loved ones. That’s one of the hardest parts of his shift, Ramirez said. The community outreach worker helped walk people around the building, cot by cot.

A week in, at least two dozen people had been killed in the wildfires.

The work takes a toll on disaster relief workers too. Ramirez said many feared losing their homes in the fires and some already had. He attends therapy weekly, which he said helps him manage his emotions.

At the evacuation center, Ramirez described being on autopilot.

“Some of us react differently. I tend to go into fight mode,” Ramirez said. “I react. I run towards the fire. I run towards personal service. Then once that passes, that’s when my trauma catches up with me.”

Need help? Los Angeles County residents in need of support can call the county’s mental health helpline at 1-800-854-7771. The national Suicide & Crisis Lifeline, 988, is also available for those who’d like to speak with someone confidentially, free of charge.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

At least one medical clinic burned down. Senior patients were evacuated by ambulance from nursing facilities as embers swirled around them and their providers. Medical offices have closed, and routine appointments have been canceled. Some providers have lost homes or had to evacuate their neighborhoods, keeping them from work in many cases and making it a challenge for some health care centers to maintain sufficient staffing.

Amid the maelstrom, doctors, nurses, and other caregivers did their jobs.

On Tuesday night, Ravi Salgia, an oncologist at City of Hope National Medical Center in Duarte, saw the house above his Eaton Canyon home go up in flames. As debris and sparks fell, he, his wife, and their older daughter estimated they had no more than seven minutes to get out. In the middle of the night, Salgia got a call that the hospital had become an emergency command center and was at risk of evacuation, meaning he needed to help evaluate patients and make discharge preparations.

Salgia arrived at the hospital at 2:30 a.m. Wednesday. He was joined by colleagues, many of whom had also evacuated their homes.

“We all felt very strongly that we needed to take care of our patients — no matter what’s happening to us physically and emotionally, what’s happening to our houses — that we need to make sure that the people we serve were taken care of,” Salgia said in an interview.

He doesn’t know if his house is still standing.

In Pacific Palisades, St. John’s Physician Partners, a primary care and pediatric clinic affiliated with Providence Health & Services, burned down, said Patricia Aidem, a spokesperson for the large Catholic hospital chain based in Renton, Washington.

Not far from the eastern edge of the Palisades Fire, Providence St. John’s Health Center in Santa Monica, one of the group’s major LA-area hospitals, was so close to evacuating that it called other hospitals in the area to find space for patients who would be displaced, Aidem said. USC Verdugo Hills Hospital, in Glendale, also faced potential evacuation, along with other hospitals in the region.

“All hospitals in close proximity to the fires remain on high alert and are prepared to evacuate if conditions worsen,” the Hospital Association of Southern California said in a statement. “The fires are creating significant operational hurdles,” the association added.

The association also said emergency services have been strained by high call volumes, while road closures have impeded the transport of patients, supplies, and health care workers. Some health facilities have been hit by power outages, the association said, while “many staff members are directly impacted by evacuations and fire-related disruptions, further complicating operations.”

The California Department of Managed Health Care on Thursday ordered health plans to ensure enrollees affected by wildfires have access to all needed medical services, including prescription drug refills.

Aidem said some doctors and other health workers at Providence St. John’s in Santa Monica and Providence Holy Cross Medical Center in the San Fernando Valley have lost homes or been evacuated, making them miss work and creating challenges to ensure adequate staffing.

Hospitals across the county said their emergency rooms had treated patients for burns, smoke inhalation, and eye irritation.

Over 700 people — and possibly far more — have been evacuated from nursing homes and other care facilities, according to the California Department of Public Health.

On Wednesday, West Valley Health Center, operated by Los Angeles County’s Department of Health Services, closed due to a power outage, the department said. And UCLA Health said the closure of some of its clinics in Pasadena and on L.A.’s Westside was due partly to “utility shutoffs.”

Children’s Hospital Los Angeles said two of its specialty care clinics, in Encino and Santa Monica, were closed Thursday “due to the impacts from the wind storm, power outages and wild fires.”

Providence also has shut several clinics this week.

The two biggest blazes, the Palisades Fire in the parched coastal hills of western L.A. County and the Eaton Fire on the Eastside, have together torched more than 50 square miles, burned thousands of structures, reduced beloved cultural landmarks to ashes, killed at least 10 people, and severely injured many more.

The monster winds that fueled the explosion of the fires on Tuesday and Wednesday have begun to quiet down, though significant gusts are still expected to complicate the task of firefighters for the next several days.

Routine medical care will likely be disrupted for thousands in the days ahead.

Kaiser Permanente, the giant HMO and medical provider, said it closed multiple medical sites Thursday due to the fires, including a pharmacy and laboratory and an eye clinic.

Huntington Hospital in Pasadena, close to the Eaton Fire, said some of its outpatient offices were affected by evacuation notices and heavy smoke.

Dignity Health, another large health system, said some of its hospitals were operating on generator power due to high winds, and some, including Glendale Memorial Hospital, had canceled elective surgeries. Other hospitals, including USC Verdugo Hills and Providence St. John’s, temporarily halted nonemergency surgeries due to the impact of the wildfires.

Christine Kirmsse, a registered nurse, evacuated her Santa Monica home on Wednesday night and is staying at a hotel an hour away. But she said she feels strongly that she needs to come into work.

“There’s obviously so much help that’s needed,” Kirmsse said. “And it’s important to me because I have the skills to be able to help. In times like this, this is when community is the most powerful.”

KFF Health News’ Chaseedaw Giles and Tarena Lofton contributed to this report.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Al menos una clínica médica se ha incendiado por completo. Pacientes mayores han sido evacuados de hogares de vida asistida en ambulancias, mientras las brasas volaban alrededor de ellos y de sus proveedores. Consultorios médicos han cerrado y se han cancelado citas de rutina.

Algunos proveedores han perdido sus hogares o han tenido que ser evacuados, lo que en muchos casos les impide trabajar y dificulta que algunos centros de salud tengan el personal suficiente para atender.

Pero en medio del caos, médicos, enfermeros y otros cuidadores no dejaron de hacer su trabajo.

El martes 7 de enero por la noche, Ravi Salgia, oncólogo del City of Hope Duarte Cancer Center, vio cómo la casa situada más arriba de la suya, en Eaton Canyon, se incendiaba. Mientras caían escombros y chispas, él, su esposa y su hija mayor calcularon que solo tenían unos siete minutos para salir.

En plena noche, Salgia recibió una llamada informándole que el hospital se había convertido en un centro de comando de emergencias y que corría el riesgo de tener que evacuar, lo que significaba que debía ayudar a evaluar a los pacientes y preparar las altas.

Salgia llegó al hospital a las 2:30 am del miércoles. Lo acompañaron sus colegas, muchos de los cuales también habían sido evacuados de sus hogares.

“Todos sentimos con fuerza que necesitábamos cuidar a nuestros pacientes, sin importar lo que nos estuviera pasando física y emocionalmente, o lo que les estuviera pasando a nuestras casas. Necesitábamos asegurarnos de que las personas a las que servimos recibieran atención”, dijo Salgia en una entrevista.

Al cierre de este artículo, todavia no sabia si su casa seguía en pie.

En Pacific Palisades, se quemó por completo la St. John’s Physician Partners, una clínica de atención primaria y pediátrica afiliada a Providence Health & Services, según informó Patricia Aidem, vocera de la gran cadena de hospitales católicos con sede en Renton, Washington.

No lejos del extremo este del incendio de Palisades, Providence St. John’s Health Center en Santa Mónica, uno de los principales hospitales del grupo en el área de Los Ángeles, estuvo tan cerca de evacuar que llamó a otros hospitales de la zona para encontrar espacio para pacientes que iban a ser desplazados, dijo Aidem. El hospital USC Verdugo Hills, en Glendale, también enfrentó una posible evacuación, junto con otros centros de salud de la región.

“Todos los hospitales ubicados cerca de los incendios siguen en alerta máxima y están preparados para evacuar si las condiciones empeoran”, dijo la Hospital Association of Southern California en un comunicado.

“Los incendios están creando obstáculos operativos significativos”, agregó la entidad.

También informó que los servicios de emergencia se han visto afectados por un alto volumen de llamadas, mientras que los cierres de carreteras han dificultado el traslado de pacientes, suministros y trabajadores de salud.

Algunas instalaciones de salud se han quedado sin luz, a la vez que “muchos miembros del personal están directamente afectados por las evacuaciones y las interrupciones relacionadas con los incendios, lo que complica aún más las operaciones”.

El jueves, el Departamento de Atención Médica Administrada de California ordenó a los planes de salud que garantizaran el acceso de sus miembros afectados por los incendios a todos los servicios médicos necesarios, incluido el surtido de medicamentos recetados.

Aidem dijo que algunos médicos y otros trabajadores de salud de Providence St. John’s en Santa Mónica y Providence Holy Cross Medical Center en el Valle de San Fernando han perdido sus casas o han sido evacuados: por todo esto tener suficiente personal se ha vuelto un desafío.

Hospitales en todo el condado informaron que sus salas de emergencia habían atendido pacientes con quemaduras, problemas por inhalación de humo e irritación en los ojos.

Más de 700 personas —y posiblemente muchas más— han sido evacuadas de hogares de adultos mayores y de otras instalaciones de atención, según el Departamento de Salud Pública de California.

El miércoles, el West Valley Health Center, operado por el Departamento de Servicios de Salud del condado de Los Ángeles, cerró a causa de un corte de luz, dijo el departamento. Y UCLA Health informó que el cierre de algunas de sus clínicas en Pasadena y en el lado oeste de Los Ángeles se debió en parte a “cortes de servicios públicos”.

El Hospital Infantil de Los Ángeles informó que dos de sus clínicas de atención especializada, en Encino y Santa Mónica, estuvieron cerradas el jueves “a causa de los impactos de la tormenta de viento, los cortes de luz y los incendios”.

Providence también cerró varias clínicas esta semana.

Los dos incendios más grandes, el de Palisades en las áridas colinas costeras del oeste del condado de Los Ángeles y el de Eaton en el lado este, han quemado juntos más de 50 millas cuadradas, destruido miles de estructuras, reducido a cenizas importantes sitios culturales, matado al menos a 10 personas y herido gravemente a muchas más.

Los vientos descomunales que alimentaron la explosión de los incendios el martes y miércoles han comenzado a menguar, aunque se esperan ráfagas significativas que seguirán complicando la tarea de los bomberos.

Por todo esto, es probable que miles de personas no puedan recibir atención de rutina en los próximos días.

Kaiser Permanente, el gigante proveedor de atención médica, dijo que el jueves tuvo que cerrar múltiples sitios médicos por los incendios, incluidas una farmacia, un laboratorio y una clínica oftalmológica.

El Hospital Huntington en Pasadena, cerca del incendio de Eaton, informó que algunas de sus oficinas ambulatorias se vieron afectadas por avisos de evacuación y por el denso humo.

Dignity Health, otro gran sistema de salud, informó que algunos de sus hospitales estaban operando con generadores debido a los fuertes vientos, y algunos, como el Glendale Memorial Hospital, habían cancelado cirugías electivas.

Otros hospitales, como USC Verdugo Hills y Providence St. John’s, suspendieron temporalmente las cirugías no urgentes a causa del impacto de los incendios forestales.

La enfermera Christine Kirmsse evacuó su hogar en Santa Mónica el miércoles por la noche y está en un hotel a una hora de distancia. Pero dijo que siente la necesidad de ir a trabajar.

“Obviamente se necesita mucha ayuda”, dijo Kirmsse. “Y es importante para mí porque tengo la capacidad para poder ayudar. En momentos como este, es cuando la comunidad es más poderosa”.

Chaseedaw Giles y Tarena Lofton de KFF Health News colaboraron con este artículo.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Lightbourne served as head of the state’s Department of Social Services for seven years before retiring in 2018 and had already returned to service once, as interim head of the Department of Health Care Services at the height of the covid-19 pandemic. On Nov. 4, he was tapped to lead the state’s Mental Health Services Oversight and Accountability Commission after executive director Toby Ewing announced he would step down.

Documents obtained by KFF Health News showed that Ewing took a trip to the U.K. funded by Kooth, a London-based company that the state contracted to build a youth mental health app. At the same time, he was working to protect Kooth’s $271 million contract.

During a public hearing the day he announced his resignation, advocates for mental health services accused the commission of favoring the interests of corporations over those of the people it is supposed to serve.

Lightbourne, 75, is now leading the commission, an independent body charged with ensuring that funds from a millionaires tax are used appropriately by counties for mental health services. He said he’ll focus on making the commission as open as possible, as a nationwide search for the next executive director begins.

He comes to the mental health commission at a moment of change. With the passage of the Behavioral Health Services Act last year and its approval by voters this year as part of Proposition 1, the commission will be integrating 11 new members starting in January. And in July 2026, it will stop overseeing county funds for mental health innovation and will instead get its own bucket of up to $20 million a year to spend on innovation. Conversations are already underway about how to spend the funds.

Lightbourne directed social service agencies in Santa Clara, San Francisco, and Santa Cruz counties before being named director of the state social services department, where he launched an effort to move more foster children out of institutions and into family-based settings.

Lightbourne spoke to KFF Health News correspondent Molly Castle Work about his goals for state mental health services. The interview has been edited for length and clarity.

Q: You already came out of retirement once, to lead DHCS during the pandemic. How were you convinced to take this job?

A: Back when I was at DHCS, quite a bit of what is now the sort of health reconceptualization in California happened.

There’s a point where you feel a sense of paternal relationship for a lot of the initiatives. What the commission does in terms of the detailed finish work is really going to be important for this thing to work.

Q: Executive Director Toby Ewing resigned amid accusations of favoritism with the contracts. How can the public have faith that this won’t happen again?

A: I want to be very careful now, because the way you phrase the question implies that I accept the proposition, and I have no way of knowing. What I’ve always said in any setting that I’ve been in is always deal the cards face up. Just be transparent. Be open. When possible, use competitive processes.

There’s the famous three intersecting points of contracting: You can have speed, you can have quality, you can have a good price. Pick two. You can’t have three. And you know, my instinct is always to be a little bit more skeptical of urgency. I mean, there are huge human needs out there that we want to solve, but to say everything should go by the wayside because things have to happen yesterday — let’s take a beat.

Q: As the interim executive director, are there guardrails that you think need to be in place to ensure that taxpayer money is being spent wisely?

A: I don’t know that there’s anything that I am particularly worried about, but I think it’s my role to help the commission as it transitions into Prop 1, into BHSA, and into a permanent executive director — just make sure that they’ve got all the procedures that they think they need — and that we build a culture where we are sure that they are able to fully see things coming in front of them.

It’s going to be interesting that come January we’re going to add 11 commissioners. It’s a huge jump. And doing it in a way that everybody stays engaged — I don’t have an answer yet.

The value-add of this organization is that it’s got a commission of pretty damn committed people who take it very seriously and bring a lot of skill to it. And you wouldn’t want to see that lost.

Q: Our country has seen the mental health crisis spike over the past few years. Are there specific areas you want to focus on?

A: I always want to be a little careful about having one more bright idea. There is definitely initiative fatigue on the ground. People have got that glazed look. So if there are things that the commission can do to bring more resources, more players, more solutions that help, then that’s great. I just don’t want us to be piling on new ideas.

Some of the things the commission has already invested in, and I’m trying to get more familiar with this, like the early psychosis interventions — that could be a real game changer as I understand it.

Q: How do you think funding for mental health initiatives should be prioritized?

A: Certainly the old notion of full-service partnerships is important. It means whatever takes — put a team together, wrap it around the person, address their core needs, like housing.

Don’t think that with somebody sleeping under the bus shelter that you can address their needs while they’re still sitting there, you know? Move them into a setting where they can feel safe, they have dignity, they have their personal human needs met, and also whatever therapeutic needs or medication needs or medically assisted treatment needs.

Q: What are you most looking forward to in this role?

A: Because of where I’ve been previously, I think there are some obvious connections to make. We don’t want to subordinate the commission to the other systems. It’s got to have its own thing. But just knowing who to dance with can be helpful.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Two years ago, Bonta, a Democrat who heads the state justice department, directed his staff to draft legal analyses against a possible national abortion ban after the U.S. Supreme Court overturned 50 years of abortion protections under Roe v. Wade. Bonta said they thought through arguments, even going so far as to decide in which court they would file suit.

Bonta said his team had a strategy in place starting from Election Day.

After the Dobbs decision, Trump boasted that he “was able to kill” Roe v. Wade. He said he would veto any federal abortion ban after declining to say whether he’d veto one. And Project 2025’s Mandate for Leadership, a road map for the next conservative president that was crafted by many former Trump advisers, described the overturning of Roe as “just the beginning.” It also calls for ending a requirement that Obamacare plans cover emergency contraceptives; the mailing of medication abortion pills; and federal funding of Planned Parenthood and other clinics that provide abortion.

By comparison, Californians have enshrined rights to abortion and contraception into the state constitution. The state in 2022 also enacted 15 bills and approved $200 million in new spending to expand abortion protections in the Golden State and make it easier for low-income and out-of-state patients to get care.

Bonta, who was appointed attorney general in 2021 by Gov. Gavin Newsom, has sued a national anti-abortion group and a chain of anti-abortion crisis pregnancy centers for marketing unproven and potentially harmful “abortion pill reversal” procedures. In September, he sued Providence St. Joseph Hospital, a Catholic hospital that had allegedly denied a patient an emergency abortion, instead discharging her with an offer of a bucket and towels. Last week, Bonta reached a settlement with the city of Beverly Hills over its alleged blocking of an abortion clinic from opening.

He has joined other states in lawsuits over medication abortion, emergency abortions, and travel between states for care. For Bonta, the issue of abortion is personal. His wife, Assembly member Mia Bonta, shared in 2022 that she had an abortion when she was 21. As her boyfriend, Bonta held her hand when she made the decision.

Bonta spoke to KFF Health News correspondent Molly Castle Work about his passion to protect women’s reproductive health rights and how his upbringing influences his legal decisions. This interview, which took place Oct. 31, has been edited for length and clarity.

Q: How do you think your upbringing prepared you for this job?

A: It starts with inspiration from my parents. They learned that you can’t just hope and wait for the things that you want; you have to fight. They joined the United Farm Workers of America. My dad worked in the front office with Cesar Chavez, my mom with Dolores Huerta. They were fighting for the people that feed our state and our nation but weren’t being treated right.

I remember growing up, I would go with my mom … to protests and rallies and demonstrations. I was at her side, slogans in my throat and fist in the air, or placards in my hand, calling out the human rights abuses. There was that belief that everyday people cannot accept the unacceptable, and if something’s not right, we’ll fight, and can and do create the change that they seek.

I want to be the person that comes in with my positional power, my authority, the reach and the strength of this office behind me and on my side working together to protect those people who are being mistreated and wronged.

Q: You’ve been a longtime champion of reproductive rights. Why are you so passionate?

A: Some things you just feel in your gut. And you have your own personal story. My wife has told the story, and it’s her story to tell. She had an abortion, and I accompanied her and held her hand. It was her choice and her right and her decision and her bodily autonomy and self-determination. And every woman deserves that.

And I don’t like bullies. I don’t like people who attack others and try to take things away from them. It’s wrong and it’s my role to protect those rights. And these are not imagined rights — before Dobbs, they existed for 50 years for every woman in the United States of America.

We’re in a fight for freedom right now, certainly including reproductive freedom, and it’s something that I think the entire nation has some connection to, and it’s wrong for elected officials, presidential candidates, to make political decisions, to get in the way of a decision that should be made between a woman, her doctor, her faith.

Q: Tell me more about your wife’s decision to share her own abortion story after the U.S. Supreme Court issued the Dobbs decision. Why was it important for you both to share that story?

A: We talked about it, of course, but it was her decision. And it’s not something that’s easy to talk about, but I think it was important to talk about, especially given that moment.

It was painful to see that people lost faith and trust in the Supreme Court and it was important for people to know that their leaders are side by side with them, have experiences and passions and cares just like them, have worries and fears just like them.

And I think it was important to Mia to emphasize the impact of these decisions on women of color and vulnerable women, poor women. It was important for her to lift up her voice and, through her pain, own her power and show her strength and communicate with others about her own experience.

Q: You have joined and led multistate efforts to defend abortion in states such as Idaho and Texas. Why is it California’s place to push for access outside its borders?

A: We fight the fight wherever it is. We get involved in all sorts of different types of issues, supporting transgender and gender-nonconforming youth, supporting commonsense constitutionally lawful gun safety laws. And certainly when it comes to reproductive health care, we do the same. There are strategic, intentional, deliberate attacks, by design, in certain courts outside of California. And so it’s very important for us to bring our knowledge, our expertise, our legal insight into those fights.

Q: What happens if Trump wins the election? How does that change your job? And what type of preparations are you making?

A: We’ve been preparing since the Dobbs decision dropped. Shortly after that, I asked my team to start writing the brief for a national abortion ban: Just think it through, you know. Think through the arguments. Do we have a pathway to challenge it in court?

Hopefully we’ll never have to challenge it in court. There’s no national abortion ban, and maybe there never will be, but we want to be ready if there is. We want to have thought through it when we had time and been able to do the in-depth and the nuanced review.

I think the people of our state and the people of our country want us to have been doing that.

Q: So, I’m sure you know I have to ask: Are you considering a run for governor?

A: There will be a time to make that decision after the election. That time is not now. I am honored and grateful that I’ve gotten lots of encouragement from people. That gives me inspiration about the work that my team is doing.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Toby Ewing, executive director of the Mental Health Services Oversight and Accountability Commission, will step down effective Nov. 22. Documents obtained by KFF Health News show that he tried in June to protect state funding for Kooth, a London-based digital mental health company with a contract to develop a virtual tool to help California tackle its youth mental health crisis.

He had been on paid administrative leave pending an investigation since September.

Ewing’s resignation was announced after a four-hour closed session of the mental health commission. During a public hearing before the announcement, advocates for mental health services accused the commission of favoring corporations over serving people with mental health and substance use issues.

The commission is an independent body charged with ensuring that funds from a millionaires tax are used appropriately by counties for mental health services.

“You are being co-opted by big corporations,” said Susan Gallagher, executive director of Cal Voices, a mental health advocacy organization, during Thursday’s meeting. “You’re lobbying behind the scenes for these people to get money. That is not your job. You serve the people.”

Ewing declined to comment.

Kooth last year signed a four-year, $271 million contract with the Department of Health Care Services, which is separate from the commission, to create Soluna, a free mental health app for California users ages 13 to 25.

The app, along with one for younger users by the company Brightline, launched in January to fill a perceived need for young Californians and their families to access professional telehealth free of charge. It’s one component of Gov. Gavin Newsom’s $4.7 billion youth mental health plan.

The apps have seen very slow uptake since their launch in January. In May, the Newsom administration proposed a $140 million budget cut for the apps. Both the state Assembly and Senate budget committees proposed eliminating the entire program to save the state $360 million in the face of California’s $45 billion deficit.

But the funding for Kooth’s app wound up restored. It’s unclear why. Emails and calendars reviewed by KFF Health News showed Ewing pressed legislative staffers in June to restore the proposed cut.

About two weeks later, Ewing was accompanied by MHSOAC commissioners Mara Madrigal-Weiss, Bill Brown, and Steve Carnevale on a trip to London. Public disclosure forms show Kooth paid $15,000 in travel expenses for Ewing, Madrigal-Weiss, and Brown. The forms do not show the company paid for Carnevale’s travel.

While Ewing was in London, a colleague told him that the final state budget was approved with funding restored for Kooth’s app. Ewing emailed a Kooth executive ideas to improve its teletherapy app. About a week later he wrote, “We expect you to be involved in whatever we dream up.”

At Thursday’s commission meeting, Stacie Hiramoto, director of the Racial and Ethnic Mental Health Disparities Coalition, said the public will view the London trip as a serious conflict of interest.

“Maybe there was no wrongdoing, and maybe the company was good,” said Hiramoto, referring to Kooth. “But don’t you understand the appearance of the conflict?”

Carnevale said in Thursday’s meeting that the Newsom administration asked the commission to engage the legislature during budget negotiations.

“The governor’s office reached out to us to ask us to help them support the arguments and that’s what we did,” Carnevale said. “We went back and explained our positions on the digital solutions provided generally, without any particular comment on any company or any product in particular.”

Newsom’s office didn’t immediately respond.

Carnevale said the U.K. trip was not related to the budget. He said the trip “was very successful” for exchanging ideas with mental health policy leaders.

DHCS Director Michelle Baass told lawmakers in May that roughly 20,000 of the state’s more than 12.6 million children and young adults had registered on the apps. Together, they had been used for only about 2,800 coaching sessions. The department has not provided more recent figures to KFF Health News.

Madrigal-Weiss defended her support of the mental health apps, lauding the youth-led design. She cited data that a majority of Kooth’s users liked the virtual coaching sessions and more than half were from underserved communities.

According to Kooth’s contract, obtained through a records request early this year, its payment is partially contingent on how many people use its app. Kooth will not get a pay increase until it reaches 366,000 users.

Kooth’s stock price fell about 20% on Thursday after KFF Health News published an article about Ewing’s efforts to restore funding for its contract and the London trip.

Gabe Brison-Trezise contributed to this report.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Emails and calendars reviewed by KFF Health News show Toby Ewing, executive director of the Mental Health Services Oversight and Accountability Commission, made efforts to protect funding for Kooth, a London-based digital mental health company the state hired to develop a virtual tool to help tackle its youth mental health crisis. Ewing pressed key legislative staffers to maintain its contract, even as Democratic Gov. Gavin Newsom and lawmakers proposed cuts in the face of California’s $45 billion deficit.

When Ewing and three commissioners — Mara Madrigal-Weiss, the commission chair; Bill Brown; and Steve Carnevale — left for London in June, Ewing wasn’t sure whether he had saved Kooth’s funding. On the second day of their trip, staff informed him that lawmakers had restored the money.

A few days later, he emailed Kooth Chief Operating Officer Kate Newhouse suggestions he had shared with Assembly and Senate staff to improve Kooth’s youth teletherapy app. “We expect you to be involved in whatever we dream up,” Ewing wrote to Newhouse in another email.

It’s unclear why Kooth picked up a $15,000 tab for state officials to travel to London. It’s also unclear why Ewing pushed to protect its app from a spending cut. The commission is a 16-member independent body appointed by various elected officials to help ensure funds from a millionaires tax are used appropriately and effectively by counties for mental health services. Kooth’s contract is with the Department of Health Care Services, which is separate from the commission.

Kooth last year signed a four-year $271 million contract to create Soluna, a free mental health app for California users ages 13 to 25. The app, along with another, by the company Brightline, for younger users, launched in January to fill a need for young Californians and their families to access professional telehealth free of charge. It’s one component of Newsom’s $4.7 billion youth mental health plan.

Ewing, who reports to the commission, started in 2015 and earned $175,026 in 2023, according to The Sacramento Bee. He was placed on paid administrative leave in September pending an investigation. Commission chief counsel Sandra Gallardo said the commission does not comment on personnel matters. Ewing did not respond to requests for comment.

Three commission employees filed whistleblower complaints against Ewing in September with the California State Auditor. They spoke with KFF Health News on the condition that their names not be used due to fears of workplace retaliation. They say Ewing’s conduct advancing a private company’s agenda as a public official crossed a line.

The agenda for Thursday’s commission meeting listed a personnel matter to be discussed in closed session. The whistleblowers said Ewing is the subject of the discussion.

Madrigal-Weiss said she couldn’t comment on Ewing’s actions. However, she said the commission supports virtual mental health resources for youth.

“These resources are less expensive and have proven valuable for youth, especially those who struggle to access services in typical brick-and-mortar spaces,” said Madrigal-Weiss, who is also executive director of student wellness and school culture for the San Diego County Office of Education.

Brown and Carnevale didn’t respond to requests for comment.

Kooth is committed to advancing youth access to behavioral health services, said Caroline Curran, of Metis Communications, a public relations firm representing Kooth.

“As a leader in youth behavioral health services with over 20 years of experience in the United Kingdom and the United States, we regularly convene sector-leading organizations to facilitate learning through sharing expertise and diverse perspectives on youth behavioral health,” Curran said.

As KFF Health News reported in April, the Kooth and Brightline app rollouts have been slow, with few children using them. In May, Newsom proposed a $140 million budget cut. DHCS Director Michelle Baass said in a hearing that it was due to low use but that the state expects more users to come on board over time, according to CalMatters’ Digital Democracy tool.

She told lawmakers on May 16 that roughly 20,000 of the state’s more than 12.6 million children and young adults had registered on the apps, and they had been used for only about 2,800 coaching sessions.

State Sen. Caroline Menjivar (D-Van Nuys) asked Baass at the hearing whether “there’s room to get out” of the contract altogether. Senators later voted unanimously to cut the entire platform budget to save the state $360 million.

Ewing texted a colleague on June 3: “Kooth is freaking out.  Is the cut coming from the Admin or the Leg.? Do we know if it’s a done deal?”

State lobbying records show Kooth has paid around $100,000 this year to the firm Capital Advocacy. At the same time, Ewing’s emails and calendars show that he pushed for Kooth’s funding to be retained. For instance, his June 4 calendar shows he was scheduled to meet with Laura Tully, an executive from Kooth USA, at a coffee shop near the Capitol.

The next day, a whistleblower said, Ewing met with key Senate staff members: Scott Ogus, deputy staff director of the Senate Budget and Fiscal Review Committee, and Marjorie Swartz, a consultant for Senate President Pro Tempore Mike McGuire. They said Ewing also discussed Kooth’s contract that week with Rosielyn Pulmano, a health policy consultant for Assembly Speaker Robert Rivas.

“Toby kept saying that ‘California has to have a digital strategy,’” recalled the whistleblower, who attended both meetings. “He kept pushing Marjorie and Scott, saying that he would give them ideas to make the platform better.”

Ewing emailed ideas to the legislative aides on June 10 and 12.

About two weeks later, he and the commissioners left for the seven-day trip to the U.K. According to documents filed with the state Fair Political Practices Commission, receipts, and emails reviewed by KFF Health News, Kooth covered the costs of four-star hotels, meals, train tickets, and international flights.

Public disclosure forms show Kooth paid expenses for Ewing, Madrigal-Weiss, and Brown. The forms do not show the company paid for Carnevale’s travel.

Under California law, state officials generally must report travel payments to the FPPC, which Ewing and his fellow commissioners did.

Kooth postponed a mental health investment conference in London in June, emails and documents show, but then organized new events for the California commissioners to attend instead.

On May 23, Newhouse informed Carnevale and Ewing in an email that Kooth needed to postpone the planned June event. Carnevale, a venture capitalist, described the news as “disappointing for all,” especially “because we have already booked trips, including family members of Commissioners who were planning to turn this into a holiday.”

Acknowledging the disruption, Newhouse told Carnevale that she “would like to think creatively as to whether we could try to arrange a meeting where you can talk about the CYBHI,” referring to Newsom’s Children and Youth Behavioral Health Initiative.

“I know though from our conversation that we need to cover the ‘purpose’ of your trip and not sure what is possible or not,” she wrote.

Curran, the Kooth spokesperson, said the company “adapted by holding a knowledge exchange between representatives from international policy institutes, research foundations, and non-profit organizations.”

Madrigal-Weiss defended the trip, which she said included meetings with “members of the government, service providers, education, and finance” who shared ideas on how “to enhance funds for public mental health needs” through private and philanthropic partnerships.

One of the whistleblowers said many of the commissioners back in California were not aware of the trip until their colleagues were halfway across the world. Sami Gallegos, a spokesperson for the California Health and Human Services Agency, said the Department of Health Care Services did not participate in the travel.

Ewing was put on leave before Kooth’s rescheduled conference this month in London.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Providence St. Joseph Hospital, in the small Northern California coastal city of Eureka, refused to provide the care she required because doctors could detect fetal “heart tones,” Nusslock said at a news conference Monday. California Attorney General Rob Bonta filed a lawsuit against the Catholic hospital detailing Nusslock’s dangerous experience and alleging the hospital violated multiple state laws when it discharged Nusslock — with an offer of a bucket and towels — to go elsewhere for what he described as standard medical care.

Bonta also filed a motion for a preliminary injunction in Humboldt County Superior Court, asking that it require Providence to treat anyone with an emergency medical condition. “The need for immediate relief is about to intensify,” the motion said. That’s because Mad River Community Hospital, where Nusslock ultimately got care 12 miles up the road, is slated to close its birth center this month.

Providence will be the only hospital within about 85 miles to offer labor and delivery, according to a KFF Health News analysis. When care is more than an hour away, academic researchers typically define the area as a hospital desert.

“It begs the question, what happens next time someone in Anna’s situation shows up at Providence? There will be no Mad River for them to go to,” Bonta said at a news conference. “With a dire lack of services, even here in California, and an influx of patients from states with abortion bans, we need hospitals to follow the law.”

The case illustrates how even in California, where the right to an abortion is enshrined in state law, there’s a glaring loophole. Catholic hospitals, which restrict reproductive health care because they follow the church’s “Ethical and Religious Directives,” are aggressively expanding nationally by acquiring secular hospitals. In swaths of the country, including parts of Northern California, they are the only choice. At the same time, maternity wards are closing rapidly, leaving more patients to contend with religious directives instead of accepted medical standards.

California’s lawsuit also comes amid uncertainty that emerged after the Supreme Court in 2022 overturned the constitutional right to an abortion: whether federal law requires hospitals to provide abortions as emergency medical care even in states that have banned the procedure. The high court punted on the question this summer. The Biden administration reaffirmed its policy that the Emergency Medical Treatment and Labor Act requires hospitals to stabilize or treat any patient who shows up at an emergency room. Texas is suing the administration over the policy.

The issue is also playing out in the presidential election. During the Oct. 1 vice presidential debate, Democratic Minnesota Gov. Tim Walz noted a Georgia woman who died because a hospital delayed care. Sen. JD Vance (R-Ohio) answered, in part, by asking Walz if he wanted to force Catholic hospitals to perform abortions against their religious beliefs, saying that “Kamala Harris has supported suing Catholic nuns.”

With federal protections in limbo, Bonta said California must rely on its state laws to protect patients. Specifically, Bonta, who is widely expected to run for governor, alleges that Providence violated a California law mandating that hospitals provide care “necessary to relieve or eliminate the emergency medical condition.”

Nusslock’s case isn’t an isolated incident, the lawsuit said. “One to two women per year receive abortion care at Mad River, after being refused care at Providence Hospital,” the lawsuit said. "These individuals, like Anna Nusslock, had all been discharged from Providence Hospital with instructions to go somewhere else." Bonta said his office is investigating how widespread cases are in California, where Catholic hospitals represent 15% of hospital beds.

In an Oct. 1 letter to employees that was obtained by KFF Health News, Providence Northern California Service Area Chief Executive Garry Olney said the hospital is “heartbroken” about Nusslock’s experience, which “did not meet our high standards for safe, quality, compassionate care.” He added the hospital is revisiting its training, education, and escalation processes to ensure it doesn’t happen again.

Providence spokesperson Bryan Kawasaki said its 51 hospitals abide by applicable federal and state laws, including EMTALA. Kawasaki declined to comment specifically on Nusslock’s case.

More women are running into barriers to obtaining care as Catholic health systems have gained market power, a KFF Health News investigation found. Four of the 10 largest hospital chains by number of beds are Catholic, according to federal data from the Agency for Healthcare Research and Quality.

Many Americans don’t have a choice — ambulances may take patients to a Catholic-run health system without giving them a say. Non-Catholic hospitals could be out of their insurance networks or too far to reach in an emergency. In the U.S, nearly 800,000 people have only Catholic or Catholic-affiliated birth hospitals within an hour’s drive, including pockets of Northern California.

Pregnant women who must drive farther to a delivery facility are at higher risk of harm to themselves or their fetus, research shows.

“It's really concerning, especially in a state like California, where people expect to have comprehensive access to care,” said Debra Stulberg, a family medicine physician at the University of Chicago. “The growth of Catholic hospitals, especially in this post-Dobbs era, continues to constrain the quality of care people get.”

The directives guiding care at Catholic-based health systems are issued by the U.S. Conference of Catholic Bishops. They state that abortions are “intrinsically evil” and “never permitted.”

The document does offer this guidance as an exception: Treatments that could cure “a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”

“The church, I would say, helps Catholic hospitals to apply some of our deepest beliefs and moral principles to very, very complex situations,” said John Brehany, executive vice president of The National Catholic Bioethics Center, an ethics authority for Catholic health institutions. “And one of those beliefs is that you can never directly intend to end the life of a developing human being."

Brehany wouldn’t comment on Nusslock’s case but gave the example that if a woman needed cancer treatment, the church would allow her to proceed with the treatment even if it “results in the death of an unborn child.” He added that some situations are “more debatable” than others.

As Catholic-based systems have consolidated and acquired more medical facilities, their care denials have been compounded by other hospitals closing their labor and delivery wards at alarming rates across the country. In California, 56 hospitals have shuttered their maternity wards in the past 12 years, according to an investigation by CalMatters. Nationwide, at least 267 hospitals closed labor and delivery units between 2011 and 2021, representing about 5% of the country’s hospitals, according to Chartis, a health analytics and consulting firm.

With each closure, patients could lose options for abortion care, contraceptives, tubal ligations, and gender-affirming care, said Mona Shah, senior policy and strategy director with Community Catalyst, a national health equity organization.

Nusslock’s 12-mile trip for care at Mad River cost her, according to the lawsuit and her public statement. She had passed an “apple-sized blood clot” and was hemorrhaging in “blinding pain,” she said, by the time she reached the operating room. In the lawsuit, Nusslock said her doctor told her later that her test results showed she most likely had an infection.

It’s a trip Bonta described as “patient dumping” and one Nusslock should never have made.

Seven months later, Nusslock said, she has trouble sleeping, recalling how Providence sent her away.

“I’ll never forget looking at my doctor, tears streaming down my face, my heart shattered into a million pieces, and just pleading with her, ‘Don’t let me die,’” she said.

KFF Health News data editor Holly K. Hacker contributed to this article.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).