Since October, two Bay Area student athletes have died while playing basketball, and one survived a near-lethal cardiac arrest. Joshua Ellison, the 17 year-old co-captain of El Sobrante Calvary Christian Academy, collapsed on the court and died on January 29. De La Salle freshman Darius Jones, 14, died during a preseason basketball camp at Diablo Valley College on October 11. A third student, El Cerrito High School sophomore David Gurganious, went into cardiac arrest on February 2 while sitting on the bench, but was saved by CPR administered by his basketball coach, who is a Richmond police officer, and parents in the stands.

The three schools, along with Oakland’s Life Academy High School, will each receive defibrillators, as well as AED and CPR training for ten staff members and CPR training for 30 students. The donation, which was announced Tuesday on the basketball court of Oakland’s Leonard J. Meltzer Boys and Girls Club, comes from the Ronny Turiaf Heart to Heart Foundation, which Turiaf established in 2009 to help provide medical care for children without health insurance. Through the foundation, Turiaf hopes to provide EKGs, heart surgeries and defibrillators to kids in need.

About 100 students attended Tuesday’s event, along with representatives from the schools, the American Heart Association and Cardiac Science, the company that manufactures the defibrillators and provides training. Some members of the audience also wore black armbands with “Josh #1” in white writing in honor of Ellison.

“I don’t get nervous very often,” Turiaf said. “I play in front of 20,000 people.” But he said that talking about things that matter to him, in front of a crowd that was mostly composed of high school students, as well as some parents, coaches and younger kids in Warriors apparel, was a little more nerve-wracking.

Kent Mercer, head athletic trainer De La Salle, a private Catholic school in Concord, is glad to have the defibrillator, particularly after the death of Jones, whose “dream was to play basketball at La Salle,” he said.

“It’s a great thing that they’re doing to have something in place to save somebody—not only students at the school, but anyone who comes to the school,” Mercer said. “Hopefully, it continues to spread.”

El Cerrito High School Assistant principal Marcos Garcia said he will be relieved to have a defibrillator on campus, even though coaches at El Cerrito have already been trained in CPR. “The health and safety of our students is our utmost concern,” he said. “We’re very grateful.”

As for Gurganious, the sophomore who survived cardiac arrest thanks to quick action by coach Michael Booker, he was released from the hospital last week, and is expected to make a full recovery. “We want to bring him back slowly,” Garcia said.

“It’s a whole transition between collapsing on the basketball court and going back to a full academic load,” said Kenny Kahn, head football coach at El Cerrito High and Gurganious’s creative writing teacher. “I’m looking forward to his poems and creative writing—he’s quite the poet.”

Dr. Junaid Khan, a heart surgeon at Alta Bates Summit Medical Center in Oakland and president of the East Bay division of the American Heart Association, addressed the students directly, telling them not to be too scared about sudden cardiac arrest: it’s highly unusual in teens, he said, and very rare to see three cases at the same time in the same area. Chances are better that a young person would die in a car accident, or of cancer, Khan said. “It’s like lightening striking the same place twice,” he said. “It’s that rare. In a 26 year period, there were only 30 events around the country.”

But, when it does happen, CPR and defibrillators increase survival rates significantly. Only five percent of people survive sudden cardiac arrest without CPR or defibrillation. With CPR, the odds go up to 30 percent. If a defibrillator is present, they go up to 50 percent. “Automatic defibrillators really are the key to saving lives,” Khan said. “These things are so easy to use. Just put them on and they do the rest of the work. But the devices alone, not including the training to use them, can cost between $1,500 and $2,500.

Brett Reisner, a representative from Cardiac Science who lost his own brother to sudden cardiac death, applauded Turiaf for his donation, and advocated for a new State Assembly bill that would require schools to have defibrillators available at sports contests and practices. The bill is co-sponsored by State Assembly Members Mary Hayashi (D-Hayward) and Jerry Hill (D-Castro Valley). “Fourteen states in the US have laws requiring AEDs in schools,” he said. “California is not one of them. We need to support bill 1647.”

Turiaf started his charity, the Ronny Turiaf Heart to Heart Foundation, in 2009, but he had been thinking about starting a charity for a long time. “I played basketball my whole life to make a living for my family,” said Turiaf. “In 2005, I finally signed a contract. I thought everything was perfect.”

Two days after he signed with the Los Angeles Lakers in 2005, Turiaf, now 27, was diagnosed with an enlarged aortic root during a physical exam. His doctor, Stanford surgeon Craig Miller, told him had two options: quit basketball, or have surgery. Turiaf told the crowd of students that Miller told him to have the surgery, and that he had “confidence in my ability to get you back on track.”

Turiaf believed him. “If the guy that’s going to open me up like a lobster tells me I’m going to be able to play basketball again, I have confidence in myself to do the rest,” he said.

The open-heart surgery lasted six hours, and Turiaf was back on the court in less than six months. “After I went through my surgery,” he said, “I told myself that if one day I was financially stable enough, I would do whatever I could to give back to the community.”

During the Haiti Earthquake Relief Concert, the voices of the Grammy Award-winning San Francisco Boys Chorus and acclaimed mezzo sopranos Frederica von Stade and Zheng Cao reverberated throughout the fish bladder-shaped worship space at the Cathedral of Christ The Light, as if that the music would actually reach to Haiti.

“I think it is a good cause to help Haiti, because they are not doing so well. By doing this we can give all the support to them,” said James Bartan, 12-year-old San Francisco Boys Chorus member. His friend Lamar Turner agreed. “I really feel that we could reach them and we can help them. I do feel great about this,” he said.

Indeed, the boys came up with the idea for this fundraising concert. “I got calls from boys who said, ‘How we can help the people in Haiti?’” said Brian MacInerney, the executive director of the San Francisco Boys Chorus, which has in the past put on fund raising concerts for Hurricane Katrina and tsunami relief.  “So I said, ‘Why don’t we do it again?’”

The San Francisco Boys Chorus spearheaded the project and within ten days, some of the Bay Area’s renowned divas, including von Stade and Cao, members of the San Francisco Opera Chorus and the International Orange Chorale, were on board.

Even though they did not have time to rehearse as a group, audience members were mesmerized by their music during Sunday night’s performance. Attendees were asked donate at least $25 and all the money directly went to the Haiti Response Fund through Catholic Relief Services. “This was a wonderful concert with a wonderful cause. Why not pay as much as I pay for an opera? It turned out that it was much better than opera, and the money is going to Haiti,” said Hugh Coughlin from Sonoma County, who donated $250.

Although donors sometimes question how their contributions will be used, audience members at the concert were confident that their money will be used for good causes. “The money we contributed directory goes to orphanage the pastor of the church knows. I also heard that only five percent of the money goes to advertisement,” said Anneliese Haas, who drove from Napa Valley for the concert.

“I heard all the tarps [Haitian residents] used to for tents were torn.  That hit me the most. Unfortunately, all the homes are gone but it is nice to know that my money is go to help shelter the people,” said Rosie Vensa, an Oakland resident.

The San Francisco Boys Chorus called the concert a great success, and said that it attracted 2,000 people. So far, the event has raised at least $27,000. “We had about five times more people come than when we did a fundraising concert for tsunami [relief],” said Christine Weicher, a board member at the San Francisco Boys Chorus.

Catholic Relief Services is still accepting donations For more information, click here.

For Haitians living in Oakland, news of the disaster brought panic, confusion, and despair as people frantically tried to get in touch with loved ones in Haiti. Longtime Oakland resident Antoine Bellot was at work when he heard the news of the quake, and hoped desperately that that his brother and sister in Port-au-Prince were not two of the untold thousands who were killed, crushed, or buried alive. He had just talked to his brother in Port-au-Prince on the phone an hour before the earthquake, but it would be days before he would hear news of their fate. ”I couldn’t sleep,” Bellot said. “I was watching TV day and night, and I began to even see people that looked like my sister — but it wasn’t my sister. It was heavy. I can’t even explain it — it was a very painful situation.”

Finally, after four days of waiting, news came from Haiti that Bellot’s brother and sister had survived.”When I heard, it was like, you were thirsty in a desert and you finally find a glass of water,” Bellot said. “It was one of the best feelings of my life –not for me only, but for my entire family.”

It has been a time of mixed emotion for Haitians here—away from the disaster and far from home, there is little they can do but hope and pray for their country and try to send help. Maria Labossiere and her husband Pierre organize the Haiti Action Committee, an Oakland-based group that Pierre Labossiere founded in 1991 to promote democracy and development in Haiti. The two have been organizing fundraisers and other public events to support the recovery effort, but feel powerless, being so far away.

“I still feel like I’m in a dream, in a daze really,” Maria Labossiere said, her voice trailing off for a moment. “It’s been very hard to absorb. We spent the first couple days searching for loved ones in panic, and watching the images with horror and disbelief. Luckily our family members are fine, but we were watching the suffering of the Haitian people with a broken heart.”

The Haiti Action Committee and other local groups are organizing events in the community to help the relief effort in Port-au-Prince. On Sunday, the San Francisco Boys Choir will perform at Christ the Light Cathedral in Oakland, and Pierre Labossiere will speak at a fundraiser at the Black Dot Café. On Monday, the Haiti Action Committee is organizing a demonstration in San Francisco at Market and Powell streets to protest the US military presence in Haiti.

By ten days after the quake, Americans had donated over $380 million to non-profits in Haiti that are providing much-needed supplies for earthquake victims. But many, exasperated at reports of food and medical supplies being stockpiled at Port-au-Prince’s airport rather than being distributed to those still waiting for relief, are concerned that not all of these funds are being used effectively. (The New York Times has offered these three tips to anyone considering making a donation.)

Labossiere said that public support for her home country since the earthquake has been a source of inspiration. “What gives me strength, really, and the courage to go on has been the outpouring of support throughout the world, and the Bay Area particularly,” she said. “For the first few days, the calls were coming in every minute: What can we do? How can we help? It’s been so comforting to see that, and it gives us courage and hope.”

But she said she was most frustrated by the priority given in the days after the earthquake to military planes over those carrying supplies and medical equipment. There are now over 16,000 US soldiers in Haiti, troops that have been sent to prevent chaos during the distribution process. Since the disaster, concerns over security and reports of looting and other forms of disruption have created a bottleneck in the flow of rations and medical supplies.

Labossiere said that she doesn’t see the looting as a symptom of chaos, but rather a simple act of necessity. “If you’re in a disaster as such,” she said, “and you find a store with water and food, what are you supposed to do? Should you not try to feed yourself?”

Though humanitarian aid is now starting to flow more smoothly — about 120 to 140 flights per day are now landing at Port-au-Prince’s single-runway airport, compared with 25 the day after the quake — Labossiere expressed regret for the many Haitians who died needlessly because medical relief was stalled by the US military response.  “What the Haitian people need now are doctors and nurses,” Labossiere said. “Marines are arriving with loaded guns, but what we need is gauze for these people.”

While some Haitian groups in Oakland have focused their criticism on the US relief effort, they also recognize the historical role that America has played in Haiti’s development. Many charge the US with adopting exploitative policies that have helped create the widespread poverty that is the real cause of the tragedy in Port-au-Prince. “We look at this disaster as an unnatural disaster,” said Gerald Lenoir, director of the Black Alliance for Just Immigration, a group active in Oakland’s African-American community that hosts workshops and forums at local churches that educate the community about the global causes of poverty and immigration.

Lenoir said that the United States’ economic policies and its support for “dictator after dictator” in Haiti has crippled the country with debt and made the US “complicit in keeping people exploited and poor.” Haiti, once a prosperous, independent republic, said Lenoir, is now the poorest country in the Western Hemisphere, which helps explain the earthquake’s unimaginable death toll. 

The poor living conditions and unstable structures in Port-au-Prince made the city exceptionally vulnerable to an earthquake. By comparison, the 1989 Loma Prieta earthquake, which like the Haitian quake registered a 7.0 on the Richter Scale, killed 63 people in the Bay Area and left as many as 12,000 people homeless, and was considered one of the worst natural disasters in modern American history. Ten days after the Haitian quake, the United Nations reported that the official death toll was over 110,000 and growing, with 600,000 others left homeless.

BAJI partnered with the Haiti Action Committee last year to support Haitian immigrants in the United States who sought Temporary Protected Status (TPS) here after a series of hurricanes in 2008 destroyed entire Haitian cities and took away 60 percent of its harvest that year. This status allows immigrants who are in the US without visas (many of whom under final orders of deportation) to avoid being sent back to a country that is currently engaged in armed conflict or one that is suffering in the aftermath of a natural disaster. Temporary Protected Status has been granted to immigrants of five other countries — Honduras, Nicaragua, Somalia, El Salvador, and Sudan — since 1999.

Of the nearly 522,000 Haitians that live in the United States, mostly on the East Coast, Census estimates show that there are only about 3,000 Haitian immigrants in California. The largest Haitian community in the Bay Area is in Marin County, where there are an estimated 800 to 2,000 Haitians. While many Haitians like Labossiere would like to be in Haiti to help the relief effort, they also recognize that for those at risk of deportation, Temporary Protected Status means a chance to work and live in stable conditions. “[TPS] is basically designed to allow people not to have to go back to Haiti,” said Angela Bean, an Oakland attorney who has been practicing immigration law for over 25 years. “But it’s not an earthquake relief program—it’s a political animal.”

The political nature of immigration programs has created complications in the past, she said, for many Haitians and other immigrants desperate for a better quality of life in the United States.  Bean recalled one Haitian boy that she fought for all the way to federal court—only to see him be denied citizenship and deported. “He came to the US as a permanent resident when he was 11,” Bean explained. “His dad became a US citizen, but his mother was in Haiti and he never knew her. This child should have received US citizenship through his father, but fathers are discriminated against in immigration law.”

If it had been his mother who had come to the United States and naturalized, the child would have become a citizen automatically, but immigration law at the time required fathers to prove in court that they had been separated from the child’s mother for that to occur. Since the boy’s mother and father never were actually married, and the father couldn’t prove their relationship, the boy was denied citizenship and sent back to Haiti. “I’ve worried about him,” Bean said of the boy. “I hope he made it through [the earthquake]. He might be dead already.”

Last week, the Obama administration announced it would be granting Temporary Protected Status to Haitian nationals who have been in the United States since before January 12^th, the day of the Haitian quake. Lenoir said BAJI is glad that Haitians are finally being granted this status, but that the US protection was “very long overdue.”

While temporary protected status will only grant Haitians protection for 18 months, Lenoir said that it’s possible that the Haitians could stay for longer. “Nicaraguans were granted TPS in ‘99, and it’s been renewed continually since,” Lenoir said, which allowed them to continue to live and work in America. “We expect and hope that will be the case with the Haitians.”

Even if that is the case, Marie Labossiere of the Haiti Action Committee said that the future of Haiti may depend on those migrants returning to help rebuild the country’s infrastructure and economy. “The most important thing is for Haitians to first of all come together as a whole, to reunite and take the lead and responsibility for rebuilding,” she said. “What we don’t want is for a country to come in and impose on us the rebuilding of Haiti. We the Haitian people must come together and do that.”

Oakland’s Antoine Bellot is one local Haitian who was at work rebuilding his country long before this month’s earthquake. Over the course of his 51 years, Bellot has watched his homeland change: he’s seen its farmland washing away, its forest slowly disappearing — and the health of its people along with it.

Bellot spent the first half of his life on Ile de la Tortue, a rural island off the north coast of Haiti. The son of a prosperous farmer and community leader on the island, he remembers Haiti as a fertile place of plenty, where his father was able to grow enough food to share his crops with his neighbors and friends despite the fact that he had twenty of his own children to feed.

“I lived many happy days in Haiti, days when you could cut a big banana and eat it, a big potato and eat it, a big pumpkin and eat it,” said Bellot in a thick French accent that at once demands attention and puts one completely at ease. After moving to Oakland 15 years ago, Bellot periodically returned to Haiti to visit family, and every time he did, it seemed that things were getting worse. “Every time I went back to Haiti I began to see the disappearance of the land,” he said. “Now its very sad, all the land is arid. The land has become dead.”

In 2004 Bellot and his brother Will founded the Oakland-based Bellot Idovia Foundation, which aims to fight the widespread deforestation and erosion that has crippled Haiti’s agricultural output and its ability to provide for itself. According to the US Library of Congress, nearly 60 percent of Haiti was covered with forests in 1923. Today, that figure is only two percent.

Antoine Bellot and Denise Pittman.

Bellot and his co-director, Denise Pittman, organize trips to Ile de la Tortue that are geared toward agricultural education and reforestation projects. The Bellot Idovia team works with local Haitians to plant trees, build local infrastructure, and adopt better farming practices “Our goal is to teach [Haitians] to plant trees and crops, to make the land profitable again,” Bellot said.  “We want to share the knowledge of how to take care of the land, so the land will take care of them.”

Bellot Idovia also provides other resources for the island’s community. During their latest trip to Haiti two months ago, the group helped refurbish a medical center and installed solar panels on its roof, so that electricity can run twenty-four hours a day.

Pittman said that deforestation and poverty have created a culture of dependency, in which Haitians rely on foreign aid for survival. “Haitians are used to people coming in and solving problems for them,” she said. “That’s no way to sustain yourself. We want to help them learn to govern themselves better.”

Bellot Idovia helped install solar panels on a medical center in Il de la Tortue, Haiti.

Bellot said that the outpouring of support for victims of the Haitian earthquake is heartening, but warned that short-term disaster relief will not solve the problems that created the squalor and the scale of destruction in Port-au-Prince.

He hopes that the generosity of the international community toward victims of the earthquake will extend to groups like Bellot Idovia that are focused on long-term solutions to the poverty problem in Haiti. Bellot and Pittman are currently fundraising for their next trip to Il de La Tortue in March.

Bellot believes that by successfully reforesting the island of Il de la Tortue, he can show that Haitian land is not lost; that with education and smart agricultural practices, it can be reclaimed and become productive for the people again. His vision is that the island project will serve as a model for the rest of Haiti to follow. If that were to happen, he said, then US aid money would not only be going toward rebuilding Haiti’s capital, and the shanty towns that surround it. Instead, it would be providing a foundation for the Haitian people to come home to, and a chance to build a new country for themselves.

“When I look at Haiti, it’s a very sad situation,” Bellot said. “That’s why we’re motivated more every day to help. But we don’t want to do something today and tomorrow have them go back to the same situation. We want to empower them with resources and education to allow them to fend for themselves.”

As part of California’s Mental Health Services Act, Alameda County has received $140 million in new funding for prevention, early intervention and service needs in the field of mental health. Funds may also contribute to necessary improvements in mental health facilities, technology and training. The Mental Health Services Act dates to 2004, when California voters approved Proposition 63, a 1 percent tax on personal income above $1 million for mental health funding.

A motion to use Mental Health Services money to create 25 new positions in Alameda County’s Health Care Services Agency was the most contentious agenda item at Tuesday’s board meeting. Supervisor Scott Haggerty said it felt “schizophrenic” to hire 25 people while considering layoffs in other departments. He asked Alex Briscoe, the agency’s acting director, to guarantee that all 25 new positions would be filled by internal hires, but Briscoe would not do so. Four of the positions require professional certifications, and Briscoe said that county employees facing layoffs might not have the skill set necessary to fill a social worker or psychologist position.

At the beginning of the discussion, both Supervisors Carson and Haggerty said they would vote against the 25 positions. “This is pointing out a problem in which the state tries to fund programs that we have,” Haggerty said.

Briscoe said that 18 of the proposed positions are necessary to speed up the agency contract process. These are finance positions that could likely be filled from within the county.

Haggerty said this staffing move did not get to the root of improving mental health, but Briscoe responded that creating these positions represents only $2.5 million of the  $140 million coming to Health Care Services through the Mental Health Services Act. He said the vast majority of the money has gone toward field service and support.

The board ultimately approved the motion unanimously, with the requirement that the Health Care Services Agency only hire internally. “Any hiring from outside the county needs to come back to the board for approval and justification,” Haggerty said.

Supervisor Nate Miley hugs Marcie Hodge, sister of Jason Terry Hodge who died Dec. 6.

In other business, Supervisor Nate Miley read a proclamation honoring youth and education advocate Jason Terry Hodge, who died in December at age 34. In 1995, a 21-year-old Hodge became the youngest school board member in the history of the Oakland Unified School District. “His passing was a shock,” Miley said.

Hodge’s sister Marcie Hodge was at the meeting to receive the honor. She said in the last year of his life, her brother ran a group home for boys. “He talked about kids needing a stable environment,” Marcie Hodge said. The family created a scholarship fund for Hodge’s alma mater, Skyline High School, and contributions can be sent to the Jason Hodge Scholarship Fund at PO Box 5100 Oakland, 94605.

The board also acknowledged “the state of emergency relative to transmission of HIV and other blood-borne pathogens through contaminated needles.”  Oakland resident Darnell Levingston said the county should fund education and prevention programs to address the problem.

“When it became a ‘black folks’ problem the funds seemed to dry up,” Levingston said. Supervisor Carson acknowledged Levingston’s concern and said his staff is organizing a meeting of people involved with the issue. “I know you’ve been there every step of the way,” Carson said when he asked Levingston to participate in the meeting.

Alameda County Public Health Officer Dr. Muntu Davis also presented the latest information on the H1N1 pandemic. According to Davis, H1N1 continues to be the predominant circulating virus in Alameda County. So far 490 people have been hospitalized and 28 have died. Alameda County distributed 425,000 doses of the vaccine through health care providers. Public Health also plans further vaccine distribution through local pharmacies. “We are second only to L.A. for distribution in California,” Davis said.

“There’s nobody out here today who looks like a criminal,” said the 35-year-old marijuana advocate, who is preparing to spend the next 12 months in federal prison.

“We want to be part of this community,” he said to the 100 or so supporters, including Oakland City Councilmember Rebecca Kaplan and Berkeley City Councilmember Kriss Worthington, who met on Monday afternoon to protest Martin’s imminent imprisonment.

Mellody Gannon, 52, was one of Martin’s clients. She used marijuana to alleviate cancer symptoms.

“He brought magic to those of us who were sick. He was our spoonful of sugar,” said the San Francisco resident, raising her shirt to show a long vertical scar from an operation to remove a tumor. “His kids are going to suffer, and that’s not right.”

Martin, an Oakland resident, founded the nonprofit company Compassion Medicinal Edibles in 2000. For seven years, the shop near the corner of 40th Street and Broadway produced brownies, chocolate bars and other sweet treats laced with marijuana to be sold in local medical dispensaries.

Then, on September 26, 2007, the feds knocked on his door.

According to Martin, the federal Drug Enforcement Agency raided five facilities connected with his company, including his shop—which he said operated in accordance with state and city laws. DEA agents also raided his house and a cultivation facility.

“It was a pretty traumatic thing to deal with,” Martin said. “My wife and kids went through a lot.”

After the DEA discovered more than 100 marijuana plants at his growing facility, Martin was charged with conspiracy to manufacture and distribute marijuana, which carries a 10-year minimum sentence. He eventually pleaded guilty to the lesser charge of conspiracy to manufacture and distribute products containing trace amounts of Tetrahydrocannabinol (THC) and was sentenced to two years in prison. He has already served the first year at home under house arrest.

“It’s senseless,” Martin said. “It’s a pretty violent thing to experience for making brownies for sick and dying people in California.”

Martin is scheduled to report today to the U.S. Bureau of Prisons Cornell Correctional Facility in San Francisco, where he will serve the final year of his sentence.

Protesters march in downtown Oakland on Monday afternoon.

“Mickey Martin is not a criminal,” Berkeley City Councilmember Kriss Worthington said during speech at the protest yesterday. “Incarcerating Mickey Martin is a crime.” Worthington added that the health-care reform bill in Congress should include provisions to allow people like Martin to provide medicinal marijuana products to patients.

Oakland Councilmember Rebecca Kaplan, who did not discuss Martin’s case specifically during her remarks, said that Oakland has been in the forefront “both of what is beautiful and what has been troubling on this [medical marijuana] issue.”

On the local level, Kaplan said that Oakland has taken steps to protect providers and consumers of medical marijuana—such as awarding legal permits for medical dispensers. She also said Oakland makes sure that the medicinal marijuana dispensary system “is being run in a responsible, accountable way.”

Kaplan said that medicinal marijuana could also become an important source of revenue to the city, which faced close to a $100 million deficit last year. She also referred to the proposal initiated by cannabis guru and Oaksterdam University’s president Richard Lee for statewide legalization and taxation of marijuana, which supporters say will be on the California ballot in 2010.

On the federal level, however, things are complicated. Kaplan cited a 2005 case where the Supreme Court denied one of her constituents with a brain tumor the right to use medical marijuana, even if the woman could prove that the treatment improved her condition.

“Let’s be clear on this,” Kaplan said. “They said even if she would die without it, they would take it away from her. That is the face of what we are up against.”

For consumers of medical marijuana in Oakland today, the risk of getting in trouble with federal authorities is slim. Still, some at the protest said they constantly worry that the murky legal situation means they may inadvertently be breaking the law by purchasing medicinal marijuana.

Cecile Bonaudi, a retired Oakland resident who uses marijuana to alleviate chronic pain, said she follows all the rules. She gets a prescription from her doctor and buys products only from the four legal dispensaries in Oakland. Yet she’s still worried about it.

“I do what I think is legal,” Bonaudi said. “But yet there’s always the fear that if they want me, they could come get me.”

Bonaudi, who said she’s been suffering from chronic pains for over ten years and much prefers marijuana to other drugs such as oxycontin, said that she feels fortunate to live in California.

“I would never live in a place where I didn’t have access,” Bonaudi said. “I couldn’t. I don’t even travel. When I travel, I suffer.”

“Did you choke your girlfriend and force her out of the car?” Judge Gloria Rhynes asked a short, stocky man in his twenties on last month’s first Friday.

“No.”

“She told you about a miscarriage?”

“Yes.”

“But the baby wasn’t yours?”

“No.”

“So you waited for her outside her car by her work?” Rhynes asked. “Did you choke her then? Did you follow her?”

“No. If I did, why didn’t she call the police?” the man asked with some agitation. “If this were happening to me, I would tell someone. All these allegations are fabrications. Any logical person would call the police.”

Rhynes paused, and started explaining something she had explained many times before. “Unfortunately, that’s not the case with domestic violence victims,” she said to the man. “Victims don’t act as we would predict them to because of the nature of the relationship.”

The bailiff would go on to call more than 100 names during this domestic violence court session. The room was full of men and women who reflected the diversity of the Bay Area—white and black, Asian and Hispanic, gay and lesbian. Several people were dressed in suits and ties and could afford their own attorneys. Others wore frayed tracksuits or tattered jeans and represented themselves.

Sign language interpreters translated the judge’s instructions to an estranged husband and wife, both deaf. Alameda County sheriffs in gray uniforms carried revolvers and reminded members of the audience to be quiet, turn off cell phones and refrain from chewing gum. Three babies squealed at different intervals. An older gentleman walked in with the help of a cane.

Some former couples seemed amiable, like two women who had a relationship that had included a broken nose and neck bruises, but now were mostly worried about who will have custody of their dog. But in another instance, one woman kept jumping up and down before her name was called, convinced that a man who was not in the courtroom was going to come and get her. (“Even if he does come in here, he won’t touch you. I’ll make sure of that,” the bailiff assured her.) Another woman talked about how her husband tried to run her off the road when she was driving. Her two children were with her.

A version of these stories—sometimes less violent, sometimes more—plays out in Oakland and other parts of Alameda County several times a day. In 2008, Alameda County law enforcement responded to almost 7,000 domestic disturbance calls, with the Oakland Police Department handling the vast majority of these cases. That averages out to a distress call somewhere in the county every 90 minutes. More than 2,500 of these calls led to criminal cases. Countless other incidents go unreported, because victims feel some combination of fear, shame and confusion about their situation. With domestic violence cases, it’s rarely easy to ask and never easy to tell when someone needs help.

That’s why Alameda County established a Family Justice Center (FJC) in 2005 to help victims of domestic violence navigate the many legal and social services available to them, and ultimately, to help represent them here in court. Two of the center’s lawyers were at the court that day in November, consoling one well-dressed woman in the front row before she gave testimony in her case against her former husband.

“We’re going to help you,” the attorneys assured the woman, as they led her toward the front row of the court gallery and waited with her until her case was called.

The Family Justice Center’s primary innovation has been bringing police, the District Attorney’s Office, and social service agencies all to an office on Oakland’s 27th Street between Broadway and Telegraph Avenue. This centralization of resources is meant to allow people who are enduring one of the most difficult experiences of their lives to move more smoothly through the daunting process of finding shelters, counseling and legal aid. “Putting everything in one place means you’re not telling a victim, ‘You need to go across town to get a restraining order,’” said Family Justice Center site manager Harold Boscovich, a former Oakland police officer. “You’re not telling a victim, ‘You need to go back across town to talk to police, you need to go back across town to the witness center.’”

When it was founded, the Alameda Family Justice Center was only the second such center in the nation, but within the last few years other counties have begun to copy this model. Funded by the District Attorney’s office, public grants and private gifts, the FJC has helped county attorneys prepare better domestic violence cases for trial. It has also eased social service providers’ efforts to help victims with psychological counseling, job training and onsite childcare. More than 7,000 people—a majority of whom are women with children—have used the center this year.

“Over the last year or so, we have seen an increase in clients’ repeated visits for varying services,” said Nadia Davis-Lockyer, the center’s executive director. “Not due to new incidents of family violence, but due to their realizing that additional services beyond immediate crisis intervention can help them achieve a happy and healthy home. Wherever you’re at, however you want to proceed, when you walk in our door, we can help you.

*** 

Law enforcement officials and the criminal justice system have only recently begun to understand how to confront violence in intimate relationships—which encompasses crimes ranging from felony sexual assault to misdemeanor battery. High-profile assault cases involving celebrities like Rihanna and Chris Brown briefly shine a light on this phenomenon, but the crime can be overlooked when people don’t come forth because of fear and shame. Family and friends of people affected often either aren’t aware of the problem or don’t know how to handle sensitive information when it comes to light.

“In the old days, there wasn’t even a crime called ‘domestic violence’,” said Nancy O’Malley, Alameda County’s district attorney who helped write some of California’s domestic violence laws in the 1990s. “It was recognized as a family matter.“

Police used to be trained to “walk the perpetrator around the block to give a little separation, time to cool down,” she continued. “But we’ve been challenging our legislators, challenging law enforcement, challenging prosecutors, challenging social services to start recognizing domestic violence as a real crime.”

Boscovich, who was an Oakland police officer during the 1970’s, pointed out that police officers had few options before it was possible to refer victims to places like the Family Justice Center. “Back then, we often had to say ‘Sorry I can’t do anything else for you.’ We’d keep going back, but the seventh or eighth time, sometimes a guy went too far and killed,” he said.

The law has now begun to catch up with the reality that domestic violence is the most common form of violent crime in the country. In 2005, according to the National Center for Victims of Crime, 467,000 people in the United States were victimized by an intimate partner. From 2001 to 2005, 67 domestic violence incidents in Alameda County led to fatalities, including 26 shootings and 18 stabbings.

In addition, more than 3,000 restraining orders are issued in Alameda County every year, meaning that, on average, nine times every day the county determines someone can no longer be trusted to be in the same space as his or her former spouse or partner. Randy White, the Oakland police officer who serves as a subject matter expert for the domestic violence unit at the Family Justice Center, said these numbers translate into victims coming into the center on a regular basis. “Almost every few hours, every day, someone comes in here requesting services because they were a victim of a rape or domestic violence,” he said.

Just as the law has come to recognize the prevalence of domestic violence, so have government-funded social service agencies. The full-service Family Justice Center is the result of a decades-long cultural shift and a testament to the way services for people affected by domestic violence have moved out of the shadows. “In the 1970s, the domestic violence movement started in garages and people’s homes,” said Raeanne Passantino, the center’s assistant director. “This new movement makes a huge difference for clients, who can get many services at one time.”

But it’s still a crime that often leaves people feeling helpless or isolated, and reluctant to seek help.

“I think a lot of people who are caught in relationships with domestic violence stay in them because the feel they are without options or hope,” said Casey Bates, Alameda County’s assistant district attorney in charge of supervising domestic violence prosecutions. “Maybe some of those views can be changed if they talk to people who say, ‘This is what we can do for you. You don’t have to feel trapped in this house. We can protect you. We can put you in a safe place while you get established.’”

Brenda Hatcher-Santiago, the site’s “navigator” or intake coordinator, is the person who conducts the first interview when victims call or visit. She said that even though domestic violence victims come from all walks of life, many of them face similar obstacles when seeking out help. “Sometimes our clients know people from the neighborhood, they know people from church. But they don’t have close friends,” she said. “They don’t feel like they can go to just anyone and say, ‘My husband is doing this to me, can I stay at your house?’ That’s just not an option.”

In trying to find a way to overcome the silence and confusion domestic violence can cause, the Family Justice Center has helped law enforcement and criminal justice officials reach out to victims in the county in more human terms.

“It allows us to tell victims: ‘We care about you, criminal justice is secondary. Social service is secondary,’” District Attorney O’Malley said. “We can say, ‘We care about you and we care about how you’re doing and how your kids are doing.’ That’s our primary motivation for all this.”

*** 

While the Family Justice Center was created to serve some of the functions of a police station and a district attorney’s office, it’s structured not to look like either. In the front lobby, for instance, there’s no bulletproof glass separating staff from clients.

Throughout the building, the color scheme follows a palette of blues and whites, designed to make people feel welcome. In December, winter holiday decorations deck the halls, with stockings, red tinsel and white snowflakes brightening up the lobby. Posters in English and Spanish highlight domestic violence services. A table of brochures offers information—sometimes in Mandarin or Korean—about topics ranging from self-defense to legal aid. The center tries to provide as many services as its can to clients, and always provides them without charge.

“Services are free to everyone,” said Cherri Allison, director of the Family Violence Law Center. “Even if you or your spouse have a good job, you might not have access to the money you make. In one case, we had someone who couldn’t take $40 out of the bank. The abuser monitored everything.”

A “Curious George” cartoon plays on the lobby television, the first of many signs of the center’s kid-friendly nature. This child-conscious approach is essential, because close to two-thirds of the center’s clients have children. Upstairs, the supervised “KidZone” play area allows children who witness traumatic events at home to escape into diversions—board games like Candy Land, dollhouses and books featuring Clifford the Big Red Dog and Heloise. Mothers can see their children through a Plexiglas partition, which allows them to speak privately with a counselor but also know their children are safe.

“KidZone is so important,” Passantino said. “If these women don’t have child care, they won’t come. It’s onsite, kids stay as long as a parent needs. Every kid is offered a snack and a new toy, regardless of how many times they have come in. It’s a place where kids can be kids.”

But even in this more welcoming atmosphere, staff takes security seriously. Tinted windows allow for privacy from the outside, and an Alameda County sheriff with a service revolver is stationed on the first floor. No one is allowed beyond the reception area without an escort and a visitor’s badge, and batterers are not allowed on the premises under any circumstances.

“You don’t want people walking around here like it’s the supermarket,” Hatcher-Santiago said. “Ninety-nine percent of the time when someone comes in here, it’s on the downlow. If we let someone come in here, they’re either a client, they work here, or they’re visiting someone who works here.”

The center’s staff does its best to anticipate the logistical challenges that seeking help can present. The abusive husband or boyfriend sometimes controls the woman’s bank account. One case worker at the center said Spanish-speaking immigrants threaten immigrant wives or girlfriends from Mexico or El Salvador with deportation if they tell anyone about domestic abuse. Some boyfriends or spouses monitor a woman’s cell phone and keep a tight rein on her movements.

To deal with some of these challenges, the center has BART, taxi and bus vouchers, giving clients transportation to the site no matter what their circumstances are. A mobile response team reacts to calls people make to a countywide 24-hour hotline. The center also has women’s and children’s clothing and toiletries on hand to be able to provide for people who leave a dangerous situation in a hurry.

“We’ll send someone to a hotel for one or two days and then we’ll help find a shelter,” said Allison. “At the hotel, we’ll drop off food vouchers, Pampers, formula. These women are leaving with nothing, so these kinds of things can be very valuable.”

Just as important, the center’s staff takes care to account for a client’s emotional state. Hatcher-Santiago said she has clients do one-on-one interviews with her first, which is meant to prevent them from reliving trauma by having to tell the same story multiple times. She can assess the situation, determine how the client wants to proceed and then quickly refer her to the appropriate personnel on site.

Hatcher-Santiago also said the center is careful not to impose a solution or course of action on a client. The staff works to address what the center’s clients view as their most pressing needs. “Our clients come in here with a huge problem in their lives and you have to respect their wishes and what it is they want to do,” she said. “They may have one main concern—maybe it’s to put their children in counseling. So we put that at #1 because that’s what they want to do first. They’ve been victimized so long that just by giving them control over what we’re going to do, you empower them.”

*** 

Giving domestic violence victims more control over their immediate priorities has a variety of benefits. Many of the center’s staffers say that having so many social services all in once place is not only helping clients get the services they need, but also helping the county prosecute their legal cases. “Victims are more willing to work with us on cases, we’ve had a higher rate of convictions, and this type of facility is able to better provide a full range of services,” said Bates, the assistant district attorney in charge of domestic violence prosecutions.

The proximity of Oakland police officers and country attorneys at the Family Justice Center—literally across the hall from each other—also means they can brief each other when they meet up at the water cooler. Each agency’s investigative needs are different—police often have to work quickly, based on the probable cause that a crime has occurred or is about to, while the DA’s office needs to establish cases beyond a reasonable doubt in the minds of twelve jurors. But the two agencies still have plenty of room for cooperation.

“Having the DA and police department right across from each other is crucial,” police officer Randy White said. “The DA will say ‘Don’t forget to do this. Or ‘Did you properly Mirandize the person?’ The quality of investigations is getting better and better resulting in more cases being charged. This results in a higher conviction rate.”

“I can hear them, they can hear me,” Bates agreed. “I can tell them ‘I need pictures,’ or I need this.’ They can ask me, ‘I have this case, what do I need to get it over the hurdle of beyond a reasonable doubt?’ There’s a lot more coordination to make these cases solid.”

Bates also said the presence of a social service agency like the Family Violence Law Center has also meant the DA’s office can give survivors of domestic violence other options when their cases don’t meet the burden of proof for criminal charges. “I can say to a victim: ‘Let me put you in touch with the Family Violence Law Center. You can speak to an attorney there and get a civil restraining order,’” he said. “I find it’s extremely satisfying to provide good service to people who’ve been victimized.”

The model has worked well enough that other counties are following suit. Over the last few years, Family Justice Centers have started up in San Jose, Fresno, and other cities around the country. Officials from several California counties, including Contra Costa and Solano, have visited Alameda County’s center site in recent months with an eye toward creating their own centers. “It’s a model that is being reproduced all over,” Bates said.

Yet plenty of challenges remain. In a place as diverse as Alameda County, for instance, the multiplicity of languages and cultures can make it difficult for people to seek help outside their own communities. Staff members including Hatcher-Santiago speak Spanish, which helps bridge the gap with a significant number of domestic violence survivors, some of whom believe they shouldn’t seek help because of fears of deportation. (The center does not turn away clients because of their immigration status or attempt to deport anyone.)

However, there are other language barriers: the need for confidentiality issues keeps the center from relying on volunteers to translate for clients from other communities, including speakers of Farsi, Hindi and Korean. This often means calling the Alameda County language line, where staff and domestic violence survivors can put on the speakerphone and communicate through an interpreter.

Having speakers of more languages available in person at the center has made a difference in the past. According to Family Violence Center director Cherri Allison, her legal services team experienced a significant spike in cases from the Chinese-American community when they had a staff member who spoke Cantonese. She said it showed her the importance of being able to provide culturally competent services. “People from that community felt safe to call,” she said. “Each community has its own set of issues around domestic violence. People don’t feel comfortable going outside their community, no matter how compassionate someone is. Being able to go to someone who speaks like you and looks like you is huge.”

Even when staff can match people with the right resources, the demands of constantly working with a population under threat can take an emotional toll. Protocol sometimes requires staff to decide which clients to call first based on who is most likely to be killed. Allison said she encountered a caseworker crying one day because the list had gotten out of control. “The woman at the bottom of the list had been stabbed in the face several times. That’s how bad things were,” she said.

Staff members also have to overcome challenges regarding the public’s misperceptions of domestic violence. According to several Family Justice Center staff members, the most common misunderstanding is that a person encountering a genuinely threatening situation will know to leave immediately—but that’s not always the case. “When I do domestic violence workshops, I ask if anyone has ever been in a bad relationship before that they knew they should leave. Almost everyone raises their hands,” Passantino said. “Then I tell them to imagine adding the fear and confusion of violence into the situation. It’s not as easy. It’s always important to understand that leaving is a process.”

The Family Justice Center continues to expand its services. In 2010, the staff plans to offer new counseling sessions and on-site medical services to let victims follow up with a physician in cases that require medical evidence. Now that counties like Alameda have done more to focus attention and resources on domestic violence, more people are finding the help they need.

“In the past, there was really nowhere to go,” Hatcher-Santiago said. “People wanted to get out, but what could they do? There were shelters, but nothing like the Family Justice Center. It’s helped people to understand that there’s a place they can reach out to rather than feeling like there’s nowhere they can turn.”

The Alameda County Family Justice Center is located at 470 27th Street in Oakland. Call (510) 267-8800 for more information.

The health care reform bill the House of Representatives approved last month (HR 3962) adds up to 2,014 pages, most of them containing a lot of Roman numerals and subclauses in parentheses. As the Senate has debated its version of a health care bill, we recently printed out the whole daunting pile that is HR 3962 and asked San Francisco-based health policy expert Lucy Johns to haul it to her office for a few days to examine its potential impact on four East Bay residents, each of whom faces a different health insurance situation.

Click the play button below for an interactive presentation on Maureen, a nurse insured by her employer; Sadri, a coffee shop owner who insures himself and his employees; Micah, a shop clerk with no health insurance; and Jesse, an HIV patient on disability. The text of the article about the House health care bill continues after the presentation.

HR 3962: a quickie intro to the House bill’s biggest things
The health care reform bill the House of Representatives approved in November is intended, according to its legislative preface, “to provide affordable, quality health care for all Americans and reduce the growth in health care spending.” Assuming the Senate’s apparently finalized version of health care legislation is approved this week, as expected, both bills will be then brought to a conference committee in an effort to merge the two documents – which will likely differ on important points that include abortion, the public option and whether younger Americans can buy into Medicare.

If the conference committee can come to agreement, the joint bill will return to the House and Senate for a vote.  At that point, any individual senator might still be able to hold up the bill by filibustering–but over the weekend, the Democrats appeared to have secured the 60 votes necessary to end a filibuster.

Senate Majority Leader Harry Reid had said he hoped to hammer out a bill by Christmas.  But according San Francisco-based health care consultant and policy analyst Lucy Johns, a more realistic timeline suggests the conference committee meeting will take place after the New Year. Meanwhile, the House bill is the principal tangible document that outlines possible major changes in the health care system during the coming years.

And what’s in this mammoth document, anyway? Not a lot of specifics, according to Johns.

“Everything we say now is completely speculative,” she said. “Conference committee is where the real pressure to get something done happens.”

The House bill covers an enormous amount of territory, including a long section dedicated just to Indian Health Services. But its main provisions affecting the majority of Americans are these: It prohibits insurance companies from denying coverage on the basis of pre-existing conditions, or from dropping insured people because they have developed costly health problems. The bill raises the income threshold for Medicaid, the government health care program for the poor, making many more eligible for those benefits.

It creates a national health insurance exchange in which people who do not have employer-provided coverage, and who are not eligible for public programs, can buy insurance. It also provides subsidies to help lower-income people afford coverage. The bill requires employers in all but the smallest businesses to buy health coverage for their full-time workers, or else pay into a national exchange fund; the bill provides credits to certain small businesses to help offset that cost. And it requires most individuals to have “acceptable health coverage,” through their work or the policies they buy themselves, or else pay an annual penalty based on income.

Trying to apply those legislative provisions to specific personal cases is a challenge, Johns said. Much of the language in HR 3962 is vague. Nonetheless, Johns agreed to consider the situations of four Oakland and Berkeley residents and suggest what might be in store for them, based on what’s in the current House bill. (Her answers appear in the multimedia presentation above.)

The “public option”: three common misconceptions.
This health care policy fight often presents itself as one great mess of misconceptions and language hardly anyone really understands. Johns offered her clarifications on three of the misconceptions, all regarding the much-discussed and ill-understood “public option.”

First misconception: That the “health insurance exchange” proposed in the House bill is the public option. The health insurance exchange will be a single point of entry, Johns said, one place where uninsured people can choose among many health options to provide them with health insurance. The public option is intended to be one of those choices–health insurance, like Blue Cross, but in theory cheaper because the government is providing it.

Second misconception: That the public option would necessarily save money, either overall or for individual buyers. “The concept of the public option is that the federal government would provide access to health services, including doctors, hospitals, drugs and other services,” Johns said. Since the government would be such a big purchaser, and cover so many people, in theory it would then be able to set the rates it would pay providers. The House proposal last summer set payment at current Medicare rates. “There was a great uproar,” Johns said. “Medicare does not pay as much as providers think they need.”

So now the House bill says the public option will pay the providers “negotiated” rates. With many thousands of providers, Johns said, such negotiation would likely be the task of a health commissioner. “A public option won’t be able to save money unless they can negotiate reasonable rates,” she said.

Third misconception: That insurance through a public option would be available to anyone. Not the case, according to Johns. The public option as currently envisioned would be “terrific” for some of the “35 million uninsured people buying through the exchange,” she said, but many would be kept out. Insurance companies have fought vigorously against a public option, she points out. “All summer they pushed back very hard, directly and indirectly through privately-funded organizations, with a simple message: if we have a public option available, the insurance industry will die.” The House didn’t buy that argument; the current bill includes a public option, but it is still unclear whom it would cover, what it would cost individuals and what it would provide. That is one of scores of details and disagreements to be resolved in a House-Senate conference committee–now that the Senate appears to have agreed on a bill of its own.

Meet Alessandra Chesley, a 26-year-old with a good job as a site coordinator for the Boys & Girls Club of San Leandro. She earns between $30,000 and $40,000 a year. This past August, her position was reclassified—she kept the job, which she loves, but in the reorganization she lost her company-provided health benefits.

If she lived across the bay, in San Francisco, here’s what probably would have happened next:

She’d qualify for Healthy San Francisco, the city’s health care program. That would allow Chesley access to a city clinic, a primary care physician, and hospital services, regardless of any pre-existing condition or immigration status. She would have to pay only a quarterly enrollment fee to participate, along with a small co-payment for each visit to a doctor.

In the midst of the national debate about health care—who deserves it, who should pay for it, how it should be provided—Healthy San Francisco is one delivery model many people are examining. This controversial but so far successful program offers health care services to uninsured, low-to-moderate income residents of San Francisco.

Too bad Chesley lives in Oakland.

Chesley isn’t without options—not now, anyway. When her employer stopped providing her insurance benefits, she opted for coverage under COBRA (the Consolidated Omnibus Budget Reconciliation Act), the federal law that allows individuals to keep paying on their own for health benefits formerly provided by an employer. She now pays $224 per month to continue receiving the health coverage she lost.

But COBRA only gives her 18 months of coverage. And Chesley’s got a complication; she contracted viral meningitis encephalitis while working in Europe nearly three years ago. When she returned to the U.S., before she got her Boys & Girls Club job, she applied for private health insurance. She was denied, because her illness qualified her as having a pre-existing condition.

As it happens, her initial meningitis treatment, under Austria’s national health care system, cost Chesley only a few hundred dollars. “Socialized medicine saved my life,” she said. “I came back to my own country and was denied for medical insurance.”

Chesley’s situation, like that of many thousands of others whose health care access is limited by income, employment status or a pre-existing condition, begs the question: If San Francisco can start up its own municipal health care program, why aren’t there others around the Bay Area? What are the possibilities for a comparable program called Healthy Oakland?

How Healthy San Francisco works: The city-county advantage
San Francisco has certain luxuries few other cities in the country can claim. It is California’s only consolidated city–county, which means its city and county governments are unified. The city is also geographically contained—at 47 square miles, and with only 800,000 residents, it isn’t hard to offer health care services in locations accessible to residents in every neighborhood.

When city leaders decided three years ago to develop a health care program for all San Francisco’s uninsured, they looked to the well-established county health care program. The county system has several public health clinics and a public hospital, which were already serving many uninsured, low-income individuals. “The key thing to stress, from our vantage point, is [the program] is successful because we had this infrastructure in place to support the uninsured prior to Healthy San Francisco,” said Lindsey Angelats, senior health program planner at Healthy San Francisco.

Across the bay, Oakland is San Francisco’s closest Alameda County neighbor, especially in terms of size—Oakland is only slightly larger than San Francisco, at 56 square miles. But while Oakland is Alameda County’s most populated city, only 400,000 people call it home. It is also one of 14 cities in the county. That means 14 different city councils must agree how to serve the county’s nearly 1.5 million people.

That’s part of the answer why there’s no Healthy Oakland initiative.

Each California county is required by law to provide its neediest residents with assistance programs, health care chief among them. In 2006, San Francisco’s Board of Supervisors was able with one new ordinance to turn the city and county’s existing program into Healthy San Francisco—to provide all uninsured residents access to health care. The program began in July 2007. It now serves nearly 50,000 uninsured low- and middle-income  residents of San Francisco, providing them a medical home and access to regular health care over the last two years.

It’s not an insurance plan, experts point out. Healthy San Francisco offers care only within the city limits; people who participate don’t have coverage if they need medical help outside the city. It provides medical care services at 27 clinics and four hospitals around the city, including primary and specialty care. Services labeled “non-medical”—such as dental, vision and acupuncture—are excluded.

To be eligible for Healthy San Francisco, one must be a resident of San Francisco, be ineligible for any other federal health program (such as Medicare), and have been uninsured for at least 90 days. Income eligibility is based on the federal poverty level, a national standard set by the Department of Health and Human Services. In San Francisco, people who earn up to five times the federal poverty level—that means $54,150 for a single person, $110,250 for a family of four—are eligible to enroll in Healthy San Francisco.

By comparison, many federal and county assistance programs in California have much tighter eligibility rules for their programs, limiting them to people at no more than twice the federal poverty level. That makes Healthy San Francisco one of the broadest-reaching programs in the country.

The County of San Francisco continues to receive federal and state money and contribute county funds to Healthy San Francisco, just as it did for its preceding county health care program. But the supervisors-approved measure that created Healthy San Francisco also requires employers to contribute a certain dollar amount per employee per hour worked if the business meets a city-determined employee quota. (For-profit businesses must have at least 20 employees; nonprofits, 50.)

Most people admitted to the program must pay a part of their premium every quarter, and co-pay when they receive services. Both payments are set on a sliding scale to reflect a person’s income: If Chesley could participate in Healthy San Francisco, she would most likely pay $150 each quarter, with co-payments ranging from $5 to $50 per visit, depending on the kind of medical care she received.

Many professionals have praised the Healthy San Francisco program since its inception. President Obama referred to the program in a speech to U.S. mayors last February, praising San Francisco Mayor Gavin Newsom for “ensuring that those in need get [health care].” Despite a weak economy, the program continues to add between 500 and 1,000 new participants each month, moving closer to reaching all 60,000 of the uninsured in San Francisco. “Healthy San Francisco is one of the mayor’s key priorities right now,” Angelats said.

But not everything has run smoothly for the program in the last two years. The biggest obstacle, still ongoing, has been a lawsuit filed by the Golden Gate Restaurant Association, a nonprofit trade group. The association argued in its suit that forcing employers to pay into the city’s program violates federal law.  “It’s absolutely a back-breaker for our industry,” said Kevin Westlye, the association’s executive director. “This is a survival issue.”

A federal court initially upheld the restaurant association’s position, but an appellate court overturned that ruling in 2008, and the employer mandate went into effect. A new appeal has been sent to the U.S. Supreme Court, but so far, there has been no word as to whether the court will hear the case.

Westlye said cost containment is a large concern for restaurants and other businesses. He is worried that employer contribution requirements will rise once the lawsuit’s outcome is decided.

These concerns would likely be amplified in Oakland, a city that has more than 63,000 uninsured residents and no public health department of its own.

Alameda County’s existing resources, and the daunting cost of expansion
Alameda County does offer health services to the poor, as all California counties are required to do. The county’s two programs just aren’t widely publicized. The first, called the County Medically Indigent Services Plan, serves just under a third of Alameda County’s 196,000 uninsured residents. County residents are eligible if their incomes are at or below twice federal poverty level and are not eligible for other federal health programs. Like Healthy San Francisco, the program provides medical services in the county hospital and clinics: the Alameda County Medical Center, which includes Highland Hospital; and nine community clinics. Dental and vision services, among others deemed non-medical, were cut from the Indigent Services Plan’s budget last summer.

The second program, Alameda County Excellence, is a disease management plan for people who are eligible for the county’s indigent services program and have a diagnosed chronic medical ailment like congestive heart failure, diabetes or asthma.

Alameda County spends nearly $102 million each year on thsee programs, almost $25 million less than San Francisco currently spends on Healthy San Francisco. About half the Alameda County participants live in Oakland.

A group of Alameda County government, medical and social agency leaders has explored the notion of a Healthy San Francisco parallel that might extend throughout Alameda County. Two plans providing health coverage to children and adults were examined—one, a full insurance plan; the other, a limited-by-geography plan similar to Healthy San Francisco.

Alex Briscoe, interim director of the Alameda County Health Care Services Agency

The additional costs for the plans, depending on how such a program might be structured, ranged from $50 million to more than $750 million per year. It’s money the county simply doesn’t have. “I heard this great line once,” said Alex Briscoe, interim director of the Alameda County Health Care Services Agency, the department that runs the county health care programs. “Alameda County has San Francisco’s politics, Los Angeles’s problems and Fresno’s resources.”

Funding a new program isn’t the only deterrent for the county. For a plan like Healthy San Francisco to succeed, Alameda County’s current health care delivery system—how it provides health services to its residents—would need to be overhauled. “The health care debate is largely a discussion about finance and insurance,” Briscoe said. “It’s missing the point that the system is broken, that costs are rising way faster. You have to re-engineer how services are delivered.”

In order to serve Alameda County’s large uninsured population, Briscoe would like to add additional services to the county’s hospital and clinics—acute care centers, non-traditional health care sites like schools and a 24/7 nurse hotline—to help residents manage and maintain their own preventive care routines. This would make medical care available to people before they become very sick, which would cut down on emergency room visits—the most common and expensive way the county cares for the uninsured who don’t participate in the county’s current health care programs.

Much of what will happen to Alameda County’s proposed health care service programs depends on what is passed in Congress this winter. Briscoe said he understands that any universal health care implemented in Alameda County will only happen with “significant financial assistance.” He and other county officials are closely watching the congressional health care debates to see what will eventually be promised at the county and city level to cover the uninsured. “We would love to do a Healthy San Francisco program,” Briscoe said. “With federal health care reform, we’ll be close.”

Briscoe and other county leaders envision a universal plan for Alameda County within the next five years, but he said he won’t be ultimately satisfied with a geographically limiting plan. “Healthy San Francisco is a stopgap measure,” he said. “The future of health care isn’t a local indigent health program that is geographically restricted. It’s to have full health coverage for everybody.”

But nearly 40 percent of the graduating class of 2009 are without hospital jobs due to the recent economic downturn. In this video, we follow one recent nursing graduate from North Oakland’s Samuel Merritt College who is looking for work.