ON HEALTH AND HUMAN SERVICES
WILL BEGIN. GOOD MORNING.
EVERYONE LATER START THAN USUAL.
UM SO THAT MEANS EVERYONE'S
GONNA HAVE FIVE SECONDS TO
PRESENT ON ALL THEIR ITEMS SO WE
CAN GET OUT HERE IN A GOOD
DECENT TIME. TIME HAS NOT BEEN
MY FRIEND FOR THE PAST COUPLE OF
WEEKS. I MADE IT LIKE 30 SECONDS
BEFORE BOARDING STARTED LAST
WEEK. WE WERE OK, THOUGH. UM
LEARNED MY LESSON. HAVE A LATER
FLIGHT TONIGHT, SO IT'S OK. ALL
RIGHT. SO TODAY WE'RE ONLY GONNA
BE DOING ONE DEPARTMENT EVEN
THOUGH IT'S JUST ONE. WE HAVE A
LOT TO COVER. UM IN THE NEXT
COUPLE OF HOURS, A LOT OF GREAT
THINGS THAT I'M LOOKING FORWARD
TO DIVE INTO. WE'RE GONNA, UM,
BE REVIEWING OUR DEPARTMENT OF
PUBLIC HEALTH. AND WE'RE GOING
TO KICK OFF WITH AN OVERVIEW.
IT'S AN INFORMATIONAL HEARING.
OUR DIRECTOR IS GOING TO BE
GIVING US THE STATE OF THE
STATE'S HEALTH PRESENTATION. I
WELCOME THE ADMINISTRATION TO
COME UP. TO THE WELL. WELCOME
ELLIE, YOUR DEPARTMENT OF
FINANCE TO JOIN US. SO WE CAN
START WITH OUR Ó OVERVIEW ISSUE
NUMBER ONE ON DEPARTMENT OF
PUBLIC HEALTH. HELLO, DIRECTOR
OF TOMAS. GOOD MORNING. I TALK.
TOMAS ARAGON, DIRECTOR OF èC Dð
, P HÌ, AND, UH, WE'RE GONNA
HAVE, UM BRANDON NUNES, WHO'S
GONNA GIVE THE OVERVIEW OF THE
BUDGET AND THEN I'LL GIVE THE
STATE OF THE PUBLIC HEALTH
REPORT PERFECT. GOOD MORNING,
BRENDAN NUNES. I AM THE CHIEF
DEPUTY DIRECTOR FOR OPERATIONS
HERE AT THE DEPARTMENT. UM, SO
FOLLOWING THE RULE OF QUICKLY,
UM SO WE HAVE, UM, JUST KIDDING
FOR OUR DEPARTMENT. UM FOR
GOVERNOR'S BUDGET 2425. WE HAVE
A TOTAL BUDGET REQUEST OF
5,000,000,815 MILLION OF THAT
COMING FROM OUR GENERAL FUND 2.2
BILLION COMING FROM FEDERAL
FUNDS AND THEN ANOTHER 2 BILLION
COMING FROM ROUGHLY 50 DIFFERENT
SPECIAL FUNDS SOURCES THAT HELP
SUPPORT OVER 200 DIFFERENT
WITHIN THE DEPARTMENT. BECAUSE
YOUR AGENDA LAYS OUT VERY WELL.
THE PROGRAMS WITHIN THE
DEPARTMENT ALL KIND OF JUST GO
INTO A HIGH LEVEL OVERVIEW OF
OUR BUDGET FOR THIS YEAR. UM FOR
THIS YEAR, OUR DEPARTMENT DOES
HAVE SOME PROPOSALS THAT ADDRESS
THE BUDGET DEFICIT, UM,
SPECIFICALLY IN THE AREA OF SOME
GENERAL FUND SAVINGS ITEMS. SOME
FUND SHIFTS AND THEN SOME
GENERAL FUND LOANS ON THE FIRST
AREA OF GENERAL FUND SAVINGS. UM
AND ALL THESE WERE GOING TO BE
TALKING ABOUT IN MORE DETAIL
TODAY, SO I'LL JUST GIVE YOU A
HIGH LEVEL. BUT WE HAVE A
$900,000 GENERAL FUND REDUCTION
BEGINNING IN CURRENT YEAR AND
ONGOING. THESE ARE FOR SAVINGS
ASSOCIATED WITH NOW HOSTING THE
COVID-19 WEBSITE WITHIN OUR
DEPARTMENT'S INFRASTRUCTURE
RATHER THAN THE SEPARATE
COVID-19 WEBSITE. WE'LL HAVE
THAT AGAIN. WE'LL BE DISCUSSING
THAT, UM, A $1.7 MILLION.01 TIME
SAVINGS IN THE CURRENT YEAR FOR
GENERAL FUND. UM, THESE ARE
ANTICIPATED SAVINGS JUST RELATED
TO OUR DISEASE SURVEILLANCE. I
Tð SYSTEMS. THESE ARE KIND OF
NATURAL SAVINGS THAT WE THINK
WE'LL HAVE IN THE CURRENT YEAR
AND THEN THREE POINT MILLION
GENERAL FUND AGAIN ONE TIME IN
THE CURRENT YEAR FOR CLIMATE AND
HEALTH SURVEILLANCE PROGRAM
ANTICIPATED SAVINGS THAT WE
AGAIN FORESEE IN THE CURRENT
YEAR FOR THAT PROGRAM, UM,
RELATED TO FUND SHIFTS. THERE
WERE A COUPLE OF PROPOSALS THAT
HAPPENED IN IN LAST YEAR'S
BUDGET THAT WE'RE GOING TO BE
SHIFTING TO DIFFERENT FUNDING
SOURCES. THE FIRST ONE IS IN OUR
CENTER FOR HEALTHCARE QUALITY,
AND THERE WAS $4 MILLION
PROVIDED TO US IN GENERAL FUND,
UM FOR, UM, SKILLED NURSING
FACILITY STAFFING AUDITS. WE'RE
GOING TO BE SHIFTING THAT TO THE
SPECIAL FUND WITHIN THAT
PROGRAM. AND AS WELL AS WITHIN
CURRENT YEAR AND BUDGET YEAR,
THERE WAS 9.7 MILLION. UM,
THAT'S PROPOSED TO BE SHIPPED
FROM THE GENERAL FUND TO PROP 56
TOBACCO FUNDS, UM, SPECIFICALLY
TO SUPPORT OUR CLINICAL DENTAL
ROTATIONS. AND THEN FINALLY ON
THE GENERAL FUND LOAN FRONT. UM,
THERE IS A LOAN FROM OUR AIDS
DRUG ASSISTANCE PROGRAM, A $500
MILLION LOAN FROM THAT FUND TO
THE GENERAL FUND. THAT STILL
LEAVES A ROUGHLY 100 SOME ODD
MILLION DOLLARS. 78 THANK YOU
MILLION DOLLAR RESERVE IN THE
FUND, SO WE DON'T ANTICIPATE ANY
PROGRAM IMPACTS THERE. BUT AGAIN
, THAT'S ON THE AGENDA A LITTLE
BIT IN FURTHER DETAIL. UM, WITH
THAT, THEN WE HAVE SOME JUST
MISCELLANEOUS ADJUSTMENTS THAT
WE NORMALLY MAKE TO OUR
DIFFERENT ESTIMATES AS WELL AS
OUR, UM, TOBACCO REVENUE
ACCOUNTS. 56 AND 99 AGAIN THAT
WE'LL BE DISCUSSING TODAY. IT'S
A VERY HIGH LEVEL OVERVIEW AGAIN
. WE GOT A LOT OF DETAIL ON SOME
OF THESE OTHERS, AND I CAN PASS
IT OVER TO THE STATE OF THE
STATE. IF YOU LIKE OR TAKE
QUESTIONS, NÓ, CHIEF DEPUTY,
WE'LL GO OVER INTO EACH I ITEM.
IT SOUNDS GREAT. THANK YOU SO
MUCH. OK GOOD MORNING CHAIR. I'M
DR TOMAS ARAGON, STATE PUBLIC
HEALTH OFFICER AND DIRECTOR OF
THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH. IT'S AN HONOR TO
BE HERE TODAY TO PRESENT THE
STATE OF PUBLIC HEALTH IN
CALIFORNIA. AT èC Dð P. OUR
MISSION IS TO ADVANCE THE HEALTH
AND WELL BEING OF CALIFORNIA'S
DIVERSE DIVERSE PEOPLE AND
COMMUNITIES WITH A VISION THAT
ALL CALIFORNIANS ENJOY HEALTHY
COMMUNITIES WITH THRIVING
FAMILIES AND INDIVIDUALS. PUBLIC
HEALTH IS OUR COLLECTIVE EFFORT
TO PROMOTE AND PROTECT AND
IMPROVE THE HEALTH OF ALL
COMMUNITIES IN CALIFORNIA. THIS
YEAR, CDPH SUBMITTED THE
INAUGURAL STATE OF PUBLIC HEALTH
REPORT HIGHLIGHTING KEY PUBLIC
HEALTH INDICATORS, HEALTH
DISPARITIES AND LEADING CAUSES
OF MORBIDITY AND MORTALITY. THIS
REPORT SERVES AS A FOUNDATIONAL
TOOL FOR MONITORING POPULATION
HEALTH, INFORMING PUBLIC HEALTH
ACTION AND PROMOTING SHARED
ACCOUNTABILITY. OUR APPROACH TO
SAFEGUARDING AND ENHANCING
HEALTH IN CALIFORNIA IS GUIDED
BY FOUR PILLARS IN PUBLIC
HEALTH. FIRST ECOLOGICAL SOCIAL
ENVIRONMENTS. THIS PILLAR
CENTERS ON THE CONNECTIONS
BETWEEN INDIVIDUALS, THEIR
FAMILIES AND SOCIAL CIRCLES AS
WELL AS THEIR INTERACTION WITH
THEIR NEIGHBORHOOD AND
ENVIRONMENT. SECOND THE LIFE
COURSE PERSPECTIVE, THIS PILLAR
ACKNOWLEDGES THAT HEALTH IS
INFLUENCED BY EXPERIENCES
THROUGHOUT ONE'S LIFE IN THE
LIVES OF PAST GENERATIONS, THIRD
EQUITY AND HEALTH EQUITY THIS
PILLAR FOCUSES ON CREATING FAIR
AND JUST CONDITIONS WHERE
EVERYONE HAS THE OPPORTUNITY TO
ACHIEVE OPTIMAL HEALTH FREE FROM
DISCRIMINATION AND RACISM.
FOURTH PREVENTION FOCUS THIS
PILLAR PRIORITIZES PRIMARY
PREVENTION. PARTICULARLY
INTERVENING EARLY TO ADDRESS
POTENTIAL HEALTH PROBLEMS BEFORE
THEY ARISE. OVER THE PAST 20
YEARS, THE HEALTH AND WELL BEING
OF CALIFORNIANS HAVE IMPROVED.
THESE ACHIEVEMENTS ARE DUE IN
PART TO OUR COLLECTIVE PUBLIC
HEALTH PREVENTION STRATEGIES AND
INVESTMENTS. LIFE EXPECTANCY
INCREASED OVER THIS PERIOD, WITH
DECLINES IN MORTALITY FROM
ISCHEMIC HEART DISEASE, STROKE,
LUNG CANCER, CHRONIC OBSTRUCTIVE
PULMONARY DISEASE, PROSTATE
CANCER AND BREAST CANCER. OUR
TOBACCO PREVENTION EFFORTS LED
TO A 59% REDUCTION IN LUNG
CANCER DEATH RATES, AND WE BOAST
THE SECOND LOWEST SMOKING RATES
IN THE NATION. SIMILARLY PUBLIC
HEALTH AND MEDICINE CONTRIBUTED
TO A 60% DECLINE IS IN ISCHEMIC
HEART DISEASE DEATHS.
INTERVENTIONS INCLUDED PROMOTING
HEALTHY EATING PHYSICAL ACTIVITY
AND ACCESS TO QUALITY HEALTH
CARE. CALIFORNIA'S INFANT
MORTALITY RATES RANK RANK AMONG
THE LOWEST IN THE COUNTRY.
DRIVEN BY MATERNAL AND CHILD
HEALTH PROGRAMS THAT INCLUDE
NUTRITIONAL SUPPORT, GENETIC
DISEASE SCREENING HOME VISITING
AND WIC PROGRAMS. DESPITE
IMPORTANT GAINS, THERE ARE
LONG-TERM INCREASES IN DEBTS DUE
TO ALZHEIMER'S DISEASE.
HYPERTENSIVE HEART DISEASE AND
DRUG OVERDOSES. AND RACIAL,
ETHNIC AND SOCIO GEOGRAPHIC
DISPARITIES PERSIST ACROSS THESE
AND OTHER LEADING CAUSES OF
DEATH. THE COVID-19 PANDEMIC
PRESENTED UNPRECEDENTED
CHALLENGES, WITH LIFE EXPECTANCY
FALLING FOR THE FIRST TIME IN 20
YEARS. THE PANDEMIC UNDERSCORED
AN AMPLIFIED LONG-STANDING
RACIAL, ETHNIC AND SOCIO
GEOGRAPHIC HEALTH INEQUITIES.
OUR COVID-19 RESPONSE MITIGATED
THE HEALTH, SOCIAL AND ECONOMIC
IMPACTS OF THE PANDEMIC. AS A
RESULT, AS A RESULT, COVID
IMPACT HAS SHIFTED FROM HIGH
RATES OF HOSPITALIZATIONS AND
DEATHS TO A LESS SEVERE ENDEMIC
STATUS WE HAVE TODAY. AS WE
NAVIGATE THE POST PANDEMIC
RECOVERY, WE REMAIN FOCUSED ON
PROTECTING THE HIGHEST RISK
COMMUNITIES AND PATIENTS. TAKING
LOOKING AT THIS FROM A LIFE
COURSE APPROACH INFORMS OUR
PREVENTION STRATEGIES. I WILL
WALK YOU THROUGH A FEW OF THE
STAGES OF THE LIFE COURSE
HIGHLIGHTING THOSE AREAS. FIRST
WE'RE GONNA START WITH EARLY
STAGES OF LIFE. A HEALTHY START
IN LIFE IS CRUCIAL FOR LONG TERM
WELL-BEING. FACTORS SUCH AS
PRENATAL CARE, ACCESS TO
HEALTHCARE, ECONOMIC, HOUSING
AND FOOD SECURITY AND POSITIVE
SOCIAL CONNECTIONS, INFLUENCE
HEALTH OUTCOMES. ADVERSITY AND
HEALTH DISPARITIES EARLY IN LIFE
DRIVE UNEQUAL HEALTH OUTCOMES
THROUGHOUT LIFE. ALTHOUGH
CALIFORNIA HAS SOME OF THE
LOWEST INFANT AND PREGNANCY
RELATED MORTALITY RATES IN THE
NATION, BLACK INFANTS AND
FAMILIES EXPERIENCE SIGNIFICANT
DISPARITIES IN PERINATAL
OUTCOMES. IN 2022, THE MORTALITY
RATE WAS THREE TIMES HIGHER FOR
BLACK CHILDREN AND NEARLY TWO
TIMES HIGHER FOR LATINO CHILDREN
. COMPARED TO WHITE CHILDREN.
INFANT MORTALITY RATES ARE ALSO
SIGNIFICANTLY HIGHER IN
NEIGHBORHOODS WITH HIGHER RATES
OF POVERTY. ALTHOUGH THE RATE IS
IMPROVING, BLACK WOMEN WERE
THREE TO SEVEN TIMES MORE LIKELY
TO DIE FROM PREGNANCY RELATED
CAUSES. STRUCTURAL AND
INTERPERSONAL RACISM IS A KEY
DRIVER OF THESE DISPARITIES
IMPACTING NEIGHBORHOOD
CONDITIONS, CHRONIC STRESS AND
ACCESS TO RESPECTFUL CARE.
DISPARITIES ARE ALSO OBSERVED IN
ADVERSE CHILDHOOD EXPERIENCES,
WHICH ARE LINKED TO NEGATIVE
HEALTH OUTCOMES THROUGHOUT THE
LIFE COURSE. NATIVE AMERICAN
PACIFIC ISLANDER BLACK AND L GB
Tð Q, PLUS COMMUNITIES
EXPERIENCE MORE ACES THAN OTHER
GROUPS. FROM 2016 TO 2020,
CALIFORNIA'S YOUTH EXPERIENCED
AN INCREASE IN DEPRESSION OR
ANXIETY SYMPTOMS FROM 7% TO
ALMOST 12. L GB Tð Q STUDENTS
REPORTED EXPERIENCING DEPRESSION
OR ANXIETY SYMPTOMS AT LEVELS
TWICE AS HIGH AS HETEROSEXUAL
IDENTIFYING STUDENTS ABOUT 63%
VERSUS 26. AS WE MOVE ALONG THE
LIFE COURSE YOUNG ADULTS AND
ADULTS AGES 25 TO 44 ARE FACING
A SIGNIFICANT BURDEN OF INJURY
RELATED DEATHS, MENTAL HEALTH
STRUGGLES AND INTERPERSONAL
VIOLENCE FOR CALIFORNIANS AGED
25 TO 44, THE LEADING CAUSES OF
DEATH IN 2022 WERE FROM DRUG
OVERDOSES. ALCOHOL RELATED
DEATHS, TRAFFIC INJURIES,
SUICIDE AND HOMICIDE. YOUNG
ADULTS HAD THE HIGHEST RATES OF
MENTAL HEALTH RELATED EMERGENCY
VISITS AND HOSPITALIZATIONS WITH
BLACK YOUNG ADULTS EXPERIENCING
SIGNIFICANTLY HIGHER RATES.
YOUNG ADULTS AGED 18 TO 34
EXPERIENCED THE HIGHEST
PREVALENCE OF POOR MENTAL HEALTH
AND DEPRESSION. YOUNG ADULTS
ALSO EXPERIENCE THE HIGHEST
RATES OF HOMICIDE DEATHS. BLACK
MALES EXPERIENCE HOMICIDE RATES
EIGHT TIMES GREATER THAN THE
OVERALL POPULATION, WITH
HOMICIDE BEING THEIR LEADING
CAUSE OF DEATH AMONG YOUNG AMONG
BLACK, YOUNG ADULT MALES.
FIREARMS ACCOUNTED FOR 72% OF
ALL HOMICIDES. COMMUNITIES WITH
THE HIGHEST LEVELS OF VIOLENCE
FACED SECONDARY TRAUMA FROM
EXPOSURE TO VIOLENCE, SUCH AS
HEARING GUNSHOTS AND WALKING TO
SCHOOL OR WORK NEAR SITES WHERE
VIOLENCE EVENTS HAVE OCCURRED.
SUICIDE AND SELF HARM ARE MAJOR
PREVENTABLE PUBLIC HEALTH
OUTCOMES THAT HAVE EMOTIONAL
COMMUNITY IMPACTS. THE HIGHEST
SUICIDE RATES WERE IN NATIVE
AMERICANS AND WHITE INDIVIDUALS,
WHILE OLDER ADULTS AGE 85 AND
OLDER HAD THE HIGHEST RATES OF
SUICIDE. RECENT TRENDS REFLECT
CONCERNING INCREASES AMONG YOUTH
AND YOUNG ADULTS. FIREARMS ARE
THE MOST COMMON MEANS OF SUICIDE
WITH RURAL COMMUNITIES IN
NORTHERN REGIONS EXPERIENCING
THE HIGHEST MORTALITY RATES. THE
PREVALENCE OF MENTAL HEALTH
CONDITIONS IS HIGHER AMONG L GB
Tð Q, PLUS ADULTS WITH GÂY AND
BISEXUAL ADULT MALES TWO TO
THREE TIMES MORE LIKELY TO
EXPERIENCE A SERIOUS MENTAL
HEALTH CONDITION THAN STRAIGHT
MALES. L GB Tð Q, PLUS
INDIVIDUALS EXPERIENCE MORE
SOCIAL STIGMA, DISCRIMINATION,
LOWER QUALITY OF HEALTH CARE,
WHICH IMPACTS THEIR MENTAL
HEALTH AND GENERAL HEALTH
WELL-BEING. AS WE MOVE ALONG THE
LIFE COURSE TO OLDER ADULTS, 55
AND OLDER CHRONIC DISEASES ARE
THE MAJOR BURDEN. CARDIOVASCULAR
DISEASE, INCLUDING STROKE IS THE
LEADING CAUSE OF DEATH IN
CALIFORNIA. RISK FACTORS ARE
MORE COMMON IN LOWER INCOME
COMMUNITIES AND COMMUNITIES OF
COLOR. THESE COMMUNITIES FACE
BARRIERS TO REGULAR PHYSICAL
ACTIVITY, HEALTHY FOOD ACCESS,
GAINFUL EMPLOYMENT AND QUALITY
EDUCATION, ALTHOUGH DEATH RATES
HAVE GENERALLY DECLINED, CANCER
REMAINS A SIGNIFICANT CAUSE OF
DEATH, CLAIMING OVER 60,000
DEATHS IN CALIFORNIA IN 2022.
ALZHEIMER'S DISEASE WAS A
LEADING CAUSE OF DEATH FOR
ADULTS OLDER THAN 85 YEARS OLD.
SO WHAT ARE WE DOING AT CDPH? WE
PROMOTE COMMUNITY BASED
INTERVENTIONS AT THE EARLIEST
STAGES OF LIFE, AND WE PROMOTE
PREVENTION AND UPSTREAM
STRATEGIES TO IMPROVE SOCIAL
DRIVERS OF HEALTH AND EQUITY.
ADDRESSING GROWING BEHAVIORAL
HEALTH CHALLENGES IS A TOP
PRIORITY. WE'RE INTEGRATING
BEHAVIORAL HEALTH INTO OUR
PUBLIC HEALTH STRATEGIES
FOCUSING ON PREVENTION,
RESILIENCY AND EQUITY MORE THAN
50 DIFFERENT PROGRAMS AT èC Dð
P HÌ ARE WORKING TO IMPROVE
BEHAVIORAL HEALTH OUTCOMES,
INCLUDING OUR OFFICES OF SCHOOL
HEALTH. SUBSTANCE ADDICTION AND
PREVENTION AND SUICIDE
PREVENTION UNDER CAL HÌ HÌ S¼,
THE CALIFORNIA CHILDREN AND
YOUTH BEHAVIORAL HEALTH
INITIATIVE, CDPH IS LEADING
COMMUNITY-BASED SUICIDE
PREVENTION, MEDIA AND OUTREACH
CAMPAIGN. WE HAVE A PUBLIC
HEALTH CAMPAIGN COSIGN WITH
YOUTH TO REDUCE STIGMA AROUND
BEHAVIORAL HEALTH AND TO
INCREASE INCREASE HEALTH SEEKING
BEHAVIOR AND WELLNESS SUPPORT.
THE YOUTH SUICIDE REPORTING AND
CRISIS RESPONSE PILOT PROGRAM IS
TESTING MODELS WHERE YOUTH
SUICIDE AND ATTEMPTED SUICIDE
EVENTS LEAD TO A RAPID AND
COMPREHENSIVE LOCAL COMMUNITY
RESPONSE. ADDITIONAL INITIATIVES
AND BEHAVIORAL HEALTH PREVENTION
INCLUDE GOVERNOR NEWSOM'S MASTER
PLAN FOR TACKLING THE FENTANYL
AND OPIOID CRISIS, INCLUDING A
ONE STOP RESOURCE WEBSITE,
OPIOIDS DOT CæA DOT GOV. WE ALSO
HAVE THE INNOVATIVE CALIFORNIA
REDUCING DISPARITIES PROJECT,
WHICH IS USING COMMUNITY DEF.
EVIDENCE PRACTICES TO PROMOTE
AND IMPROVE MENTAL HEALTH. AND,
OF COURSE, OUR LANDMARK FUTURE
PUBLIC HEALTH INVESTMENT
INITIATED BY THE GOVERNOR AND
LEGISLATURE IN 2021 IS A PIVOTAL
STEP IN STRENGTHENING OUR PUBLIC
HEALTH INFRASTRUCTURE,
DEVELOPING OUR WORKFORCE,
PROMOTING COMMUNITY HEALTH AND
DEVELOPING FOR FUTURE AND
PREPARING FOR FUTURE EMERGENCIES
AND THREATS. WE WILL USE THIS
REPORT TO SEEK COLLABORATION
OPPORTUNITIES TO WORK TOWARDS
EQUITABLE OUTCOMES. CALIFORNIANS
ARE ENJOYING MAJOR IMPROVEMENTS
IN HEALTH AND WELL-BEING OVER
THE PAST 20 YEARS. CALIFORNIA
CONTINUES TO BOLDLY ADDRESS THE
EMERGING PUBLIC HEALTH
CHALLENGES. I LOOK FORWARD TO
WORKING WITH YOU TO ACHIEVE OUR
SHARED VISION TO PROTECT AND
IMPROVE THE HEALTH AND WELL
BEING, FOR ALL CALIFORNIANS.
THANK YOU FOR YOUR LEADERSHIP
AND PARTNERSHIP IN THESE
EFFORTS. AT THIS TIME, I CAN
TAKE SOME QUESTIONS. AND THEN WE
WERE GONNA HAVE WE WERE GONNA
ADDRESS THE QUESTIONS, UH, THREE
THROUGH SIX THAT WERE IN THE
PACKET THAT HAD TO DO WITH THE
SOJI DATA AUDIT. BECAUSE THREE
THROUGH SIX IS GONNA TAKE A
LITTLE BIT MORE. LET'S DO SOME
QUESTIONS REGARDING THE STATE OF
THE STATE'S PUBLIC HEALTH RIGHT
NOW, MY FIRST QUESTION IS
REGARDING, UM, THE NUMBERS YOU
GAVE IN 2022 60,000 DEATHS, UM,
RELATED TO CANCER. LATER ON AT
THE END OF THIS HERE, WE'RE
GONNA BE HEARING REGARDING
CANCER REGISTRY. I'D LIKE TO ASK
SINCE I HAVE YOU RIGHT HERE
RIGHT NOW. THE CONCERNS WE'RE
HAVING IN HAVING THE SYSTEM GO
DARK. UM, WHAT HAPPENS IF WE NÓ
LONGER ABLE TO COLLECT THIS
DATA? YEAH, SO THE CANCER
REGISTRY IS AN INCREDIBLY
IMPORTANT POPULATION HEALTH
REGISTRY THAT COLLECTS DETAILED
INFORMATION ABOUT EVERY CANCER
DIAGNOSIS IN CALIFORNIA. WE'VE
HAD THIS FOR THE LONGEST TIME.
AND BECAUSE CALIFORNIA IS SO BIG
EVERYTHING THAT WE DO
CONTRIBUTES ALSO TO THE
KNOWLEDGE WE HAVE AROUND CANCER,
UM IN IN THE IN THE COUNTRY. SO
ONE OF THE CHALLENGES THAT WE'VE
HAD CONNECTS TO OUR TOBACCO. I
MENTIONED THAT TOBA TOBACCO HAS
GONE DOWN. LUNG CANCER HAVE GONE
DOWN AND SOME OF THE REVENUE
STREAMS FROM FROM THAT HAS GONE
DOWN. SO WE HAVE HAD TO
BACKFILL. UM THE BUDGET IN
PREVIOUS YEARS LOOKING FOR MONEY
WITHIN CDPH, AND, UM WE DO NEED
TO FIND A LONGER TERM SOLUTION.
BECAUSE THE CANCER REGISTRY IS
IN IS AN IMPORTANT AREA. I DON'T
KNOW, BRANDON. IF YOU HAVE
ANYTHING ELSE BEFORE DEPARTMENT
OF FINANCE. ARE WE AT RISK OF
LOSING FEDERAL FUNDS IF WE DON'T
FIND A WAY TO KEEP THE SYSTEM
GOING. NÓ I THINK IT'S ON. GOOD
MORNING, MADAM S¼, NICK MILLS
DEPARTMENT OF FINANCE. UM I
DON'T HAVE THAT INFORMATION
AVAILABLE WITH ME, BUT I CAN
WORK WITH YOUR STAFF TO PROVIDE
A RESPONSE AT A LATER DATE AND I
KNOW DIRECTOR YOU MENTIONED, YOU
KNOW, WE'RE A LARGE STATE, BUT
IT SEEMS LIKE WE MIGHT BE THE
ONLY STATE ACROSS THE NATION
THAT'S BEEN STRUGGLING TO BEEN
UNABLE TO KEEP IT GOING AS
STRONG AS POSSIBLE. NÓ WE? WE'VE
BEEN ABLE. WE'VE BEEN ABLE TO
BACKFILL THE PREVIOUS, UH,
BUDGET DEFICITS USING INTERNAL
MONEY WITHIN CITY PHÐ. WE HAVE
TO FIGURE OUT A LONG TERM,
LONGER TERM SOLUTION FOR THIS
BECAUSE AS AS I MENTIONED AS WE
AS FOR EXAMPLE, UH, CANCER GOES
DOWN OR IMPACTS, FOR EXAMPLE FOR
TOBACCO GO DOWN. WE HAVE TO FIND
OTHER REVENUE STREAMS. I AGREE
WITH THAT. WOULD LIKE TO ADD
SOMETHING TO THAT. NÓ AND I KNOW
THAT WE HAVE A TEAM THAT'S
AVAILABLE TO KIND OF GO INTO
SOME OF THE DETAILS OF THE
FEDERAL FUNDS AND THE MATCHING
RESPONSIBILITIES AND THE LIKE,
AND SOME OF THE LATER AGENDA,
BUT NOTHING TO ADD. MY SECOND
QUESTION IS REGARDING. UM I
WOULD SAY, MAYBE THE GROUPS OF 0
TO 5 YEAR OLDS, UM CALIFORNIA
RANKS 46 OUT OF 50 IN THE NATION
IN REGARDS TO, UM ACCESS FOR THE
WELL BEING OF A CHILD BETWEEN
THE AGES OF 0 TO 5. HOW ARE WE
LOOKING AT THIS IN TERMS OF DATA
COLLECTING THE BEHAVIORAL HEALTH
THAT COULD BE REALLY DECREASING
IN THIS YOUTH AND THIS FUTURE
GENERATION AS WE'RE SEEING,
BECAUSE I THINK LAST YEAR WE
WERE 42ND, AND WE'VE DROPPED
DOWN FOUR PLACES MORE. UM HOW
ARE WE ADDRESSING THIS POTENTIAL
PUBLIC HEALTH ISSUE WITH THIS
GENERATION SO 0 TO 5 IS A
CRITICAL PERIOD FOR
NEURODEVELOPMENT OF CHILDREN.
AND SO IF YOU THINK ABOUT WHERE
KIDS SPEND MOST OF THEIR TIME
IT'S NOT IN HEALTH CARE. SETTING
IT'S AT HOME. IT'S IN THE
COMMUNITY. AND SO WE NOW WE NOW
KNOW A LOT MORE ABOUT ADVERSE
CHILDHOOD EXPERIENCES, AND WE
ARE WORKING CLOSELY WITH THE
SURGEON GENERAL DIANA RAMOS,
WHO'S BEEN LEADING THE EFFORT
AROUND, UM, ACE ACE AWARENESS
AND ALSO PRIMARY CARE SCREENING
FOR ACES IN THE IN THE CLINICAL
SETTING, SO IT'S BOTH THE
CLINICAL SETTING IS ONE AREA BUT
IT'S REALLY IN THE COMMUNITY.
HOW DO WE RAISE AWARENESS AROUND
ADVERSE CHILDHOOD EXPERIENCES?
THE IMPACT THAT HAS ON
CHILDREN'S BRAIN DEVELOPMENT
BECAUSE THOSE THOSE YEARS ARE
CRITICAL. THEY CHANGE YOUR BRAIN
BEHAVIOR AND BIOLOGY FOR YEARS
TO COME. AND SO THAT'S PART OF
WHAT WE DO AT èC P HÌ. WE ALSO
HAVE WE HAVE OUR CENTER FOR
FAMILY HEALTH HAS A W I PROGRAM
WE HAVE HOME VISITING MATERNAL
CHILD AND ADOLESCENT HEALTH, SO
THERE'S A LOT OF EFFORT, BUT
THERE'S ABSOLUTELY MORE THAT WE
WANT TO BE ABLE TO DO. I'M
ABSOLUTELY ABSOLUTELY THINK IT
FEELS LIKE WE'RE GOING BACKWARDS
IN TERMS OF THE RATINGS, SO I
JUST WANTED AND ALSO MY
UNDERSTANDING THAT THIS IS MY
FIRST, UH, ADDRESS FOR THE
STATE. WELL I ADDRESS FOR THE
STATE OF THE PUBLIC SOUTH. WHAT
COMES AFTER THESE? YOU PUT
TOGETHER THESE NUMBERS, UM, DO
RECOMMENDATIONS AND GO OUT TO
THE DIFFERENT PROGRAMS UNDER èC
Dð P HÌ TO PERHAPS IMPLEMENT
SOME OF RECOMMENDATIONS, OR, UM,
PREVENT ANY FURTHER. ANY FURTHER
DIGRESSION OR ANY FURTHER, YOU
KNOW, NEGATIVE IMPACTS ON WHAT
YOU'RE FINDING. YEAH SO WE USE
THIS BOTH TO HELP OUR STRATEGIC
PLANNING UNDERSTANDING WHAT THE
HIGHEST BURDENS OF MORBIDITY AND
MORTALITY ARE FOR THE
POPULATION. IT ALSO ALLOWS US TO
MONITOR FOR EMERGING TRENDS. AND
THEN THE OTHER IMPORTANT THING
IS TO REALLY IS TO GET THIS
INFORMATION OUT THERE BECAUSE IT
REALLY TAKES IT TAKES, UM, A
WHOLE ALL OF STATE APPROACH TO
ADDRESS THESE ISSUES BECAUSE
ULTIMATELY WE HAVE TO IMPROVE
THE QUALITY OF LIFE SOCIAL
DETERMINANTS OF HEALTH. AND
PUBLIC HEALTH DOESN'T CONTROL
THAT. BUT WE CAN PROVIDE THE
DATA AND THE GUIDANCE AND THE
SCIENCE TO HELP OTHER SECTORS
IMPROVE IMPROVE THOSE CONDITIONS
WHERE PEOPLE WHERE PEOPLE GROW
UP CALIFORNIA ON AVERAGE DOES
BETTER THAN THAN THAN MOST
STATES. BUT THERE'S CERTAIN
AREAS WHERE WE WHERE THE
DISPARITIES CONTINUE TO EXIST.
ONE AREA WHERE I WOULD SAY WE'RE
DOING I WOULD SAY THAT WE'RE
VERY DIFFERENT FROM OTHER STATES
IS THAT PUBLIC HEALTH IS VERY
INTENTIONAL IN EMBRACING
BEHAVIORAL HEALTH AS AN
IMPORTANT COMPONENT OF OUR
STRATEGY FOCUSING ON PRIMARY
PREVENTION. A LOT OF BEHAVIORAL
HEALTH IS VERY FOCUSED ON SEVERE
MENTAL ILLNESS, WHICH IS
INCREDIBLY IMPORTANT, BUT WE
WANT TO FIGURE OUT HOW CAN WE
WORK WITH COMMUNITIES AND
PARTNERS TO DO MORE PRIMARY
PREVENTION AROUND BEHAVIORAL
HEALTH OUTCOMES, OK? UH,
COLLEAGUES TO MY RIGHT. CALLING
TO MY LIFE. I THANK YOU, MADAM.
SURE I JUST HAVE ONE. FOLLOW UP
QUESTION. UH THE CHAIR MENTIONED
THAT WE FELL FROM 34TH TO 39TH
TO THE 46. OK, I'M SORRY 42 TO
46 REMIND ME OF WHAT SPECIFIC
DATA POINT THAT WAS IN A
RESPONSE TO THIS WHEN SHE PULLS
THAT UP. I GUESS MY QUESTION IS,
IS IT HOW MUCH MONEY DID WE
SPEND? AND THEN WE STILL FELL?
AND THE REASON WHY I'M ONLY
ASKING IS BECAUSE I THINK THAT
YOU KNOW, BEING A BUSINESS
OWNER. YOU BEING DIFFERENT
WORLDVIEWS TO THIS BODY. UM
EVERYBODY HAS THEIR OWN LIFE
EXPERIENCES WHEN WE USE
SOMETHING IN THE BUSINESS WORLD
AND INVEST A SIGNIFICANT AMOUNT
OF DOLLARS. WE CHANGE IT IF IT
DOESN'T WORK, SO IF WE HAVE FELL
IN WHAT WAS THE SUBJECT MATTER,
SO TWO WEEKS AGO, L A TIMES CAME
OUT WITH THIS REPORT, AND WE
BETWEEN ZERO AND FIVE. YEAR
OLDS. I JUST HAD IT RIGHT HERE,
UM, FAILED TO 46 IN TERMS OF
BEING ABLE TO GET A WELL CHILD
VISIT. SO IF WE TRUSTED, YEAH,
HOLISTICALLY, ENSURING THAT
WE'RE MEETING THOSE
DEVELOPMENTAL MILESTONES,
BEHAVIORAL YEAH, THAT'S A GOOD
QUESTION. I DON'T HAVE THE
ANSWER TO THAT. SPECIFICALLY
WE'D HAVE TO THAT'S GONNA BE
THAT'S PROBABLY GOING TO BE
MONITORED IN THE OTHER. THE
DEPARTMENTS THAT MONITOR
HEALTHCARE BUT YES, I DON'T IN
TERMS OF CHILDHOOD VISITS. I
DON'T I DON'T HAVE THE ANSWER TO
THAT. WE WE'LL HAVE TO GET BACK
TO YOU ON SO AS CDPH AS A WHOLE.
WHEN YOU LOOK AT THAT, UM YOU
KNOW, WE'RE ALL ABOUT ACCESS TO
HEALTH CARE. SPECIFICALLY I
THINK MY COLLEAGUE OVER TO MY
RIGHT UM BECAUSE OF THE RCA, UM,
BUT IF THEY'RE NOT GETTING
ACCESS TO HEALTH CARE BECAUSE
THEY FOR WHATEVER THE REASON IS.
THE HOSPITALS AREN'T MAKING THE
APPOINTMENTS AND JUST LIKE THE
CHAIR JUST REFERENCED WERE
DROPPING FROM 46 TO 49TH IN THE
NATION ABOUT GETTING WELLNESS
VISITS, EVEN TO START I REALIZE
THAT MAY NOT BE UNDER YOUR
PURVIEW, BUT IT SHOULD SOMETHING
THAT WE SHOULD LOOK AT, BECAUSE
WE ALL WANT TO SEE ACCESS TO
HEALTH CARE. WE'RE INVESTING A
SIGNIFICANT AMOUNT OF MONEY TO
MAKE THAT HAPPEN. BUT YET OUR
OUR MY CONSTITUENTS AREN'T
HAVING ACCESS TO ADEQUATE ACCESS
TO GOOD HEALTH CARE. SO I
APPRECIATE YOU GUYS LOOKING INTO
THAT AND MAYBE GETTING BACK TO
US. AND MAYBE IT'S NOT RIGHT AT
YOUR LEVEL, BUT MAYBE A LEVEL
UNDERNEATH YOU OR SO I WOULD
APPRECIATE THAT. THANK YOU,
MADAM CHAIR FOR THAT, AND I
RECOGNIZE THAT AND I KNOW THIS
IS MORE OF COLLECTING AND JUST
PUBLIC HEALTH AS A WHOLE, AND I
WAS TRYING TO FIND SOME
CONNECTION TO THAT. THAT'S HOW
WE'RE LOOKING AT THIS BECAUSE I
LOOK AT THIS ISSUE AS A PUBLIC
HEALTH ISSUE. UM A HUGE PRO
PROPORTION OF OUR OF OUR YOUNG
KIDS, UM, POTENTIALLY FALLING
BEHIND I COMPLETELY WE AGREE
WITH YOU AND SO ACCESS TO AND
YOU CAN THINK OF ACCESS NOT JUST
TO HEALTH SERVICES, BUT ALL
SERVICES, IT MIGHT BE AROUND
HOUSING, FOOD INSECURITY, SOCIAL
DETERMINANTS OF HEALTH YOU NEED
YOU WANT TO HAVE ACCESS TO ALL
OF THOSE, UM AND THEN THERE ARE
THE THERE ARE OTHER CONDITIONS
THAT HAPPEN THAT YOU WANT TO.
YOU WANT TO PROMOTE, SO WE
COMPLETELY WE COMPLETELY AGREE
WITH YOU. UM THAT'S AN AREA THAT
THAT'S AN AREA THAT IN IN IN
THIS AGE, I HAD THIS
CONVERSATION JUST LAST WEEK WITH
AN EPIDEMIOLOGIST. THAT STUDIES
THIS SPECIFIC AGE AGES 0 TO 10,
AND THAT'S ACTUALLY ONE OF THE
MORE CHALLENGING AREAS FOR US TO
GET DATA. WE GET DATA WHEN
PEOPLE TOUCH SYSTEMS, SO WHEN
PEOPLE TOUCH A SERVICE SYSTEM,
OR THEY'RE IN SCHOOL OR WHEN
THEY'RE BORN, WE ARE WHEN THEY
VISIT A DOCTOR. WE GET DATA, BUT
IT'S SORT OF THIS IN BETWEEN AGE
WHERE THEY NOT VISITING DOCTORS.
YES EXACTLY. SO I THINK THAT'S A
REALLY BIG FOCUS AREA THAT WE
SHOULD REALLY SOMEHOW PIVOT
TOWARDS BECAUSE AGAIN, WE'RE
JUST FALLING FURTHER BACK ON
THIS POPULATION. WELL, IT IS ON
MY RADAR. BECAUSE OF THE
CONVERSATION I HAD LAST WEEK AND
WE CAN FOLLOW UP WITH THAT
BECAUSE I KNOW THERE IS A TEAM
IN MATERNAL CHILD AND ADOLESCENT
HEALTH THAT SPECIFICALLY WORKING
ON HOW DO WE FIGURE OUT WHAT'S
HAPPENING IN THAT AGE GROUP?
BECAUSE IT'S HARDER TO MEASURE
UNTIL PEOPLE GO TO THEY HIT. FOR
EXAMPLE, KINDERGARTEN SENATOR
AGM. UH, THANK YOU FOR BEING
HERE, DRAGON. UM SO, UH, THE
SENATOR FROM KERN COUNTY AND I
SIT ON THE RULES COMMITTEE OF
ONE OF THE ONE OF THE BOARDS
THAT IS GETTING FILLED IS THE,
UM TO CALL MAINTAIN HEALTHCARE
COSTS. HEALTH CARE
AFFORDABILITY. THANK YOU VERY
MUCH. YEAH, THERE'S A LOT, UH,
HEALTHCARE AFFORDABILITY. UM AND
YOU KNOW WE WERE INTERVIEWING
THE DOCTORS AND THE ONE
PHYSICIAN SAID, AND I USE THE
ANALOGY OF HIGHWAYS RIGHT?
BECAUSE WE HAVE SEVERE HOSPITAL
SHORTAGES IN THE VALLEY,
ESPECIALLY, UM, BUT THAT WE'RE
NOT GONNA GET HEALTHIER BY MORE
HOSPITAL BEDS, RIGHT? AND IF
WE'RE TRYING TO CONTAIN OUR
COSTS, WE HAVE TO FOCUS WAY MORE
ON THE PUBLIC HEALTH SIDE AND
MAKE SURE WE HAVE A HEALTH
HEALTHY POPULATION BECAUSE THAT
HELPS DECREASE COST AT THE END
OF THE DAY. YOU KNOW YOU DON'T
WANT PEOPLE IN HOSPITALS. YOU
WANT TO BE TO BE HEALTHY. UM SO
CAN YOU TELL ME A LITTLE BIT
ABOUT THE 100 MILLION OR THE 100
MILLION? HENCE IT WAS RIGHT FOR
THE FUTURE OF PUBLIC HEALTH AND
HOW YOU SEE US BEING ABLE TO
COMPENSATE FOR THE LACK OF
HOSPITAL BED BY PRODUCING A
HEALTHIER POPULATION, SO WE DO
HAVE A WHOLE PRESENTATION JUST
ON FUTURE PUBLIC HEALTH, SO I
DON'T KNOW IF WE IF WE WANNA IT.
I THINK IT'S I THINK IT'S ISSUE
TOO. IT'S ISSUED TOO. SO WE DO
HAVE A TEAM THAT WILL THAT WILL
SUMMARIZE FOR YOU IN IN IN
DETAIL OF WHAT PUBLIC HEALTH
THAT I'LL ASK AGAIN LATER. S¼
GROVE. THANK YOU. YOU JUST
EXPANDED YOUR AUTHORITY BASED ON
YOUR COMMENT THAT YOU MADE ABOUT
YOU KNOW, SURROUNDING PEOPLE
WITH WRAPAROUND SERVICES
BASICALLY, IS THE BRIEF TERM FOR
IT. HOUSING UM THINGS LIKE THAT,
UM, AFFORDABLE HOUSING, FOOD,
SECURITY. ALL OF THOSE THINGS.
UM, I GUESS MY QUESTION TO YOU
IS, IS THAT UH, WHICH AGAIN IS
NOT UNDER YOUR PURVIEW. BUT WE
HAVE AN INSURANCE CRISIS IN THE
STATE OF CALIFORNIA AND I HAVE A
GROUP OF HABITAT HUMANITY,
HUNDREDS OF HOUSES THAT ARE
AVAILABLE AT A LOW COST FOR LOW
INCOME FAMILIES, BUT THEY CAN'T
SECURE A MORTGAGE BECAUSE THEY
CAN'T GET INSURANCE AND YOU HAVE
TO HAVE INSURANCE TO BACK YOUR
MORTGAGE. SO I THINK EVEN THOUGH
YOU WERE A èC Dð P HÌ, YOU HAVE
A HUGE PROBLEM BECAUSE YOU'RE
GOING TO HAVE TO BRING IN
DIFFERENT AGENCIES OR DIFFERENT
DEPARTMENTS TO BE ABLE TO HELP
SOLVE THIS PROBLEM, AND I THINK
DR GALLEY AND YOU AND YOU GUYS
HAVE THE ABILITY TO DO THAT.
BECAUSE IF YOU'RE TALKING ABOUT
THE WHOLE THE PERSON THERE ARE
MAJOR PROBLEMS GOING ON WITH OUR
STATE REGARDING HOUSING. UM THIS
SKILLED NURSING FACILITIES, YOU
GUYS IN 2020 WHEN WE HAD, COVID
SAID, YOU KNOW, ONE MIDNIGHT
OVERSTAY AND YOU COULD STAY AT A
SKILLED NURSING FACILITY. AND
NOW YOU'RE REQUIRING THAT FALLS
OFF BECAUSE WE DON'T HAVE THE
COVID RULES ANYMORE, AND NOW
THEY HAVE TO STAY IN A SKILLED
NURSING FACILITY FOR 30 MIDNIGHT
STAYS, WHICH TAKES UP A BED AND
A SKILLED NERVE, FUSING
FACILITIES FOR PEOPLE WHO REALLY
NEED THEM. UM THAT MAY BE ABLE
TO BE DISCHARGED IN A FEW DAYS
BACK TO THEIR FAMILY, BUT THEY
HAVE TO STAY. 30 DAYS ON A
REQUIREMENT WITHOUT THAT COVID
RULE THAT HAS NOW FALLEN OFF, SO
I THINK THAT, UM I DIDN'T
REALIZE THAT YOU GUYS HAD
EXPANDED. I MEAN, YOUR YOUR ROLE
REALLY GETS LARGER BECAUSE TO
TREAT THE WHOLE PERSON YOU DO
HAVE TO ADDRESS THOSE THINGS.
FOOD SECURITY. YOU NEED WATER TO
GROW FOOD. I REPRESENT THE TOP
THREE FOOD, PRODUCE AND COUNTIES
IN THE WORLD. WHEN YOU THINK
ABOUT ALL THOSE THINGS THAT WE
HAVE TO DO FOR WRAP AROUND
SERVICES, AND I APPRECIATE YOUR
YOUR REPORT. UM, AGAIN. THIS IS
ONLY MY SECOND ONE BEING ON THIS
COMMITTEE. I BELIEVE WITH MADAM
CHAIR, BUT I APPRECIATE YOUR
REPORT, BUT THERE ARE SERIOUS
HEALTH ISSUES FACING
CALIFORNIANS AND A MAJORITY OF
IT IS BECAUSE OF THINGS THAT ARE
HAPPENING OUTSIDE YOUR PURVIEW
THAT ARE CAUSING HOMELESSNESS.
RIGHT HOW DO YOU TREAT THE WHOLE
PERSON WHEN PEOPLE ARE ONLY
ALLOWED TO TREAT THE WOUND THAT
COMES IN, BUT THEY CAN'T TREAT
THE MENTAL HEALTH THAT'S CAUSING
THEM TO POKE THEIR ARM. YOU KNOW
WHAT I MEAN? OR WHATEVER THAT
CAUSES THE WOUND, SO I THINK
THAT YOU'RE YOU'RE GONNA
EXPANDING YOUR TERRITORY BASED
ON THE INFORMATION YOU JUST
PROVIDED. YOU WILL HAVE TO
PARTNER WITH A LOT OF DIFFERENT
AGENCIES TO TRY TO SOLVE THIS
PROBLEM, AND I THINK YOU GUYS
CAN DO IT. IF CONFIDENCE DR
GALLEY HAS SHOWN CONFIDENCE, UM
IN STUFF, THE STUFF THAT HE'S
WORKED WITH ME ON. UM I WISH YOU
THE BEST OF LUCK AND THANK YOU
SO MUCH. AND I DO WANT TO, UH,
JUST REALLY DO A SHOUT OUT. OF
COURSE, WE'RE PART OF THE HÌ HÌ
S¼ FAMILY. SO IT'S THERE'S
REALLY THERE'S 12 DEPARTMENTS
AND WE'RE ONE WE'RE ONE OF THEM,
AND WE WORK REALLY CLOSELY
TOGETHER UNDER DOCTOR GALLI. SO
THANK YOU SO MUCH. WE CAN NOW
MOVE ON TO, UH, QUESTION NUMBER
THREE. OK? WANT BEER. HØI BEAM.
THEY'RE SORRY. I WANT HIM TO BE
HERE.
ALL RIGHT, UH, GOOD MORNING,
MADAM CHAIR MEMBERS OF THE
COMMITTEE AND GUESTS. I AM DANA
MOORE. PRONOUN SHE HER, UH I'M
THE DEPUTY DIRECTOR FOR THE
CENTER FOR HEALTH STATISTICS AND
INFORMATICS. I'M THE STATE
REGISTRAR OF VITAL RECORDS AND
VITAL STATISTICS. AND I AM ALSO
THE ACTING CHIEF DATA OFFICER
FOR THE DEPARTMENT. I'M JOINED
TODAY BY MY COLLEAGUE AND
SUBJECT MATTER EXPERT JASON AND
HE'LL INTRODUCE HIMSELF HØI GOOD
. GOOD AFTERNOON. GOOD MORNING.
STILL UH, MY NAME IS JASON TES.
I AM THE MANAGER OF THE GENDER
HEALTH EQUITY SECTION. OF THE
OFFICE OF HEALTH EQUITY AT èC
Dð P HÌ. UH, WE WANNA THANK YOU
TODAY FOR THE OPPORTUNITY TO
SPEAK WITH YOU AND ADDRESS YOUR
INQUIRIES REGARDING THE
CALIFORNIA STATE AUDITORS,
FINDINGS AND RECOMMENDATIONS FOR
THE COLLECTION OF SEXUAL
ORIENTATION AND GENDER IDENTITY,
PUBLIC HEALTH DATA. WE DO SHARE
YOUR VISION AND DESIRE TO
IMPROVE THE LIVES OF THE L GB Tð
Q PLUS CALIFORNIANS THROUGH
AMELIORATING WHAT DATA WE
COLLECT HOW WE COLLECT IT, HOW
WE REPORT IT AND HOW WE DISPLAY
IT. AS YOU KNOW, CDPH
UNDERSTANDS THE VALUE OF DATA
THAT IS EQUITABLE, ACCURATE AND
INCLUSIVE. OUR PROGRAMS ALSO
VALUE DATA COLLECTED IN A MANNER
THAT IS SAFE FOR THE L GB Tð Q,
PLUS COMMUNITY AND DONE IN A WAY
THAT BALANCES BOTH THE FIDELITY
OF THE SCIENTIFIC METHOD AND
PRIVACY LAWS WITH THE
FLEXIBILITY OF COMMUNITY INPUT
FOR DATA THAT IS CONTINUOUSLY
RELEVANT TO THEM. WHEN LOOKING
AT ADDING SOJI DATA TO FORUMS
THAT ALREADY COLLECT DEMOGRAPHIC
DATA SUCH AS RACE AND ETHNICITY.
OUR CDPH SO WORK GROUP SEES SOJI
DATA IS BEING COMMUNITY DRIVEN,
WHEREAS RACE AND ETHNICITY DATA
ARE INSTITUTIONALLY DRIVEN.
PEOPLE ARE USED TO ANSWERING
STATIC, DISCRETE AND OFTEN
OVERLY BROAD NONREPRESENTATIONAL
AND ETHNICITY DATA. SUJI DATA,
HOWEVER, IS FLUID COMPLEX AND
WILL ALWAYS BE CHANGING WITH
EACH GENERATION OR INFLUENCED IN
SHORTER EPOCHS THAN OTHER
STANDARDIZED DATA. VOLUNTARY
DATA COLLECTION IS COMPLEX,
PARTICULARLY WHEN THE SOURCE OF
COLLECTION IS WITHIN THE HEALTH
CARE SYSTEM. WE SHARE THE
CONCERNS THAT A LACK OF
UNDERSTANDING OF THE IMPORTANCE
OF COLLECTING THIS DATA BY
PROVIDERS PATIENTS PROGRAM
PARTIC AND PROGRAM PARTICIPANTS
SIGNIFICANTLY IMPACTS THE
USEFULNESS OF DATA THAT WE CAN
REPORT TO THE PUBLIC. CULTURAL
AND LINGUISTIC DIFFERENCES,
CONFLATION SEX AND GENDER
IDENTITY. PERCEIVED LACK OF
RELEVANCE OF SEXUAL IDENTITY,
ALL LEAD TO A HIGH PROPORTION OF
MISSING DATA AT EVERY POINT
WHERE DATA IS COLLECTED AND DATA
FLOWS, DATA LOSS CAN OCCUR. THIS
COMES IN THE FORM OF LOSS IN
TRANSLATION. ANSWERS OF UNKNOWN
AND NON RESPONSE. THAT END USING
THE RECOMMENDATIONS FROM THE
AUDIT AND FEEDBACK FROM OUR
PARTNERS AT LOCAL HEALTH
JURISDICTIONS AND IN THE
COMMUNITY. AS WELL AS REVIEWING
THE LATEST INFORMATION AND
RESEARCH FROM THE CALIFORNIA
HEALTH INTERVIEW SURVEY, STATE
AND NATIONAL ORGANIZATIONS AND
OTHER EXPERTS. IT IS èC Dð, P
H'S INTENT AND PUBLIC HEALTH'S
ROLE TO PROVIDE TECHNICAL
ASSISTANCE AND GUIDANCE ON
POLICIES AND BEST PRACTICES. IN
RESPONSE TO THE 2023 STATE AUDIT
FINDINGS. èC Dð P HÌ HAS BEEN
WORKING DILIGENTLY TO ADDRESS
THE FINDINGS AND RECOMMENDATIONS
OF THE AUDITORS. THE CDPH SO G
DATA WORKGROUP THAT CONVENED IN
2022 IS CONTINUING THEIR WORK
INCORPORATING FEEDBACK FROM
LOCAL HEALTH JURISDICTIONS AND
COMMUNITY ORGANIZATIONS INTO AN
UPDATED SET OF DATA COLLECTION
STANDARDS AND IS WELL UNDERWAY
WITH RECOMMENDATIONS FOR SOJI
DATA VISUALIZATION STANDARDS. MY
TEAM AND I PRESENT A MONTHLY
REPORT TO CDPH EXECUTIVE STAFF
ON THE PROGRESS OF MEETING ALL
OF THE SOCHI DATA COLLECTION,
AUDIT RECOMMENDATIONS. OUR TEAMS
ARE ON TRACK TO MEET THE
FOLLOWING MILESTONES AND KEY
RESULTS THAT ARE FULLY INCLUSIVE
OF AND WILL MEET THE AUDIT
RECOMMENDATIONS BY THE DATES AS
FOLLOWS. GAINING DIRECTORATE
APPROVAL OF SOJI WORK, GROUP
DATA, BEST PRACTICES AND
STANDARDS BY OCTOBER 2020 THREE
THAT IS COMPLETE. THROUGH THE
WORK GROUP DEVELOP A SOCHI DATA
COLLECTION REFERENCE DOCUMENT
FOR LOCAL CULTURE JURISDICTIONS
AND OTHERS OUTSIDE OF èC Dð P
HÌ, WITH THE ADDITION OF
DEVELOPING BEST PRACTICE
STANDARDS FOR DISPLAY BY AUGUST,
2024. OUR TEAM IS ON TRACK AND
THIS IS STILL IN PROGRESS.
DEVELOP PROCESSES FOR COUNTIES,
UH, COMMUNICABLE DISEASE
PROGRAMS THAT ARE NOT USING CAL
READY INCLUDING COMPLIANCE WITH
SOJI DATA REPORTING REQUIREMENTS
. BY MARCH 2026. THIS IS IN
PROGRESS AND ON TRACK. ENSURE
HOW READY USERS AND PUBLIC
HEALTH PROGRAMS CAN EXTRACT SOJI
DATA FOR ALL REPORTABLE DISEASES
IN CREDY THROUGH THE CRETI DATA
DISTRIBUTION PORTAL BY APRIL
2024. THIS IS ALMOST COMPLETE.
THE SOJI WORK GROUP CREATE
PROCESSES, POLICIES AND
PROCEDURES FOR STANDARDIZED FORM
, REVIEW AND MONITORING. THIS
INCLUDES LEGISLATIVELY MANDATED
FORMS AND STANDARDS FOR DATA
COLLECTION BY SEPTEMBER, 2024.
THE TEAM IS IN PROGRESS AND ON
TRACK THE ONE AREA OF
OPPORTUNITY THAT HAS BEEN
DELAYED IS BEING ABLE TO ENSURE
THAT COW READY AND THE FUTURE
DISEASE SURVEILLANCE SYSTEM CAN
RECEIVE SOJI DATA FROM LOCAL
HEALTH JURISDICTIONS. THE GOAL
WAS TO ACHIEVE THIS BY JULY,
2026. THE MILESTONE IN AUDIT
RECOMMENDATION IS, OF COURSE,
INCUMBENT UPON FUNDING. CDPH
DOES NOT HAVE THE FUNDING NEEDED
TO MEET THIS RECOMMENDATION.
HOWEVER OUR TEAMS ARE ACTIVELY
IN THE PROCESS OF IDENTIFYING
FUNDING OPPORTUNITIES AND
SOURCES AND ARE OPEN TO
EXPLORING DIFFERENT ALTERNATIVES
AND AVENUES FOR FUNDING.
QUESTION FOUR. SO èC Dð P HÌ
CONTINUES TO RE EVALUATE. THE
FORMS THAT WERE BROUGHT UP IN
THE AUDIT. A KEY LESSON LEARNED
IN THE PROCESS OF EVALUATING THE
FORMS AND ADDRESSING THE AUDIT
RECOMMENDATION FOR THE 105
IDENTIFIED WAS THAT IT ACTUALLY
SHOULDN'T BE ASSUMED THAT THE
105 FORMS AREN'T COLLECTING SOJI
DATA. THE AUDIT LIST HAS NON
APPLICABLE RESPONSES, WHICH
SHOULDN'T BE ASSUMED TO MEAN THE
FORMS DO NOT COLLECT SOI DATA,
FOR EXAMPLE, THE BEHAVIORAL RISK
FACTOR SURVEILLANCE SYSTEM HAS
NA IN THE AUDIT LIST. BUT WE
FOUND IT ACTUALLY DOES COLLECT
SOJI DATA. MANY OF THE NON
APPLICABLE IN THE AUDITOR LIST
ARE FEDERALLY MANDATED FORUMS
LISTED AS A FEDERALLY MANDATED
FORMS MAY STILL BE COLLECTING
SOJI DATA FOR SOME FORMS, THOUGH
IT DOES NOT MAKE SENSE TO
COLLECT SOG DATA, FOR EXAMPLE,
THE PERINATAL HEPATITIS èC
REPORT IS LISTED AS NÓ, BUT THE
FORM FOR CHILDREN 2 TO 36 MONTHS
CAN WHO CANNOT SELF REPORT THEIR
STATUS. HOWEVER THE FORM HAS NÓ
DEMOGRAPHIC INFORMATION ON THE
MOTHER CLEARLY AN OPPORTUNITY.
èC Dð P HÌ IS TAKING THIS
INFORMATION AND IS NOW ASKING
ALL OF OUR PROGRAMS WHO HAVE
FORMS LISTED AS N. A SO
THEREFORE WE'RE EXEMPT AS TO
WHETHER OR NOT THEY COLLECT SOJI
DATA. THE TEAM WILL THEN ADD
SOJI QUESTIONS TO THOSE FORMS
THAT ARE MISSING IT AS WELL AS
EVALUATING THE REST OF THE FORMS
IN THE DEPARTMENT THAT ARE
RELEVANT. I WILL NOW HAND IT
OVER TO JASON. THANK YOU. GOOD
MORNING, AGAIN CHAIRPERSON AND
COMMITTEE MEMBERS FROM OUR
MATERNAL CHILD AND ADOLESCENT
HEALTH PROGRAMS TO OUR OFFICE OF
AIDS AND INJURY, VIOLENCE
PREVENTION PROGRAMS AND GENDER
HEALTH EQUITY SECTION PROGRAMS.
CDPH ADMINISTERS A WIDE VARIETY
OF PROGRAMS THAT FOCUS
SPECIFICALLY ON L, GB Tð Q, PLUS
COMMUNITIES. WE WORK IN
PARTNERSHIP WITH LOCAL HEALTH
JURISDICTIONS, AND L GB Tð Q,
PLUS COMMUNITY BASED NONPROFITS
TO FACILITATE ONGOING
COMMUNICATIONS IN REAL TIME ON
ISSUES IMPACTING SPECIFIC
POPULATIONS. IN ADDITION, CPH
PARTNERS WITH AND FUNDS WELL
RESPECTED L GB Tð Q, PLUS
RESEARCH INSTITUTIONS LIKE U èC
L, A. S¼ WILLIAMS INSTITUTE, UC
SANTA BARBARA'S SOCIAL AND
HEALTH EQUITY LAB AND THE FENWAY
INSTITUTE IN BOSTON. èC P USES
THESE CLOSE PARTNERSHIPS TO HELP
US FORECAST ISSUES AND ADDRESS
LONG STANDING SYSTEMIC BARRIERS
EXPERIENCED BY L GB Tð Q
CALIFORNIANS. èC P USES
EXISTING RESEARCH TO INFORM THE
DESIGN OF PROGRAMS AUTHORIZED BY
THE LEGISLATURE TO ADDRESS
INEQUITIES EXPERIENCED BY
VULNERABLE SUBPOPULATIONS IN
RECOGNITION THAT L GB Tð Q PLUS
POPULATE COMMUNITIES ARE NOT A
MONOLITH AND EACH REQUIRES
CUSTOMIZED INTERVENTIONS. THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH'S GENDER HEALTH EQUITY
SECTION, FOR EXAMPLE,
ADMINISTERS PUBLIC HEALTH
PROGRAMS APPROVED AND FUNDED BY
THE LEGISLATURE FOCUSED ON L GB
Tð Q HEALTH INEQUITIES WHILE WE
WHILE THE OVERALL PRIOR
PRIORITIES ARE CONVEYED BY THE
LEGISLATURE, WE USE THE MOST
RECENT L GB Tð Q, PLUS HEALTH
STUDIES AND COMMUNITY FEEDBACK
TO DESIGN FUNDING PROGRAMS THAT
FOCUS ON THE MOST VULNERABLE
POPULATION POPULATIONS,
INCLUDING TRANSGENDER. GENDER
NON CONFORMING AND INTERSEX
CALIFORNIANS AND LB Tð Q WOMEN
WHO FACE SYSTEMIC AND UNIQUE
BARRIERS IN ACCESS TO CARE. THE
GENDER HEALTH EQUITY SECTION IS
CURRENTLY FUNDING RESEARCH
FOCUSED ON ASSESSING BARRIERS TO
GENDER AFFIRMING CARE AND
HORMONES FOR TRANSGENDER AND
NON-BINARY LATIN YOUTH. WE ARE
FUNDING RESEARCH, ASSESSING
SURGICAL DISPARITIES AND THE
IMPACT OF GENDER MINORITY STRESS
AND SUBOPTIMAL OUTCOMES AMONG
PATIENTS. REFUNDING NEEDS
ASSESSMENTS OF BLACK INDIGENOUS
AND, UH IN INDIGENOUS PERSONS OF
COLOR. I IN LB, Tð Q WOMEN AND
TRANS IDENTIFIED BY PERSONS IN
SOUTHERN CALIFORNIA AND THE SAN
GABRIEL VALLEY. HEALTH HEALTH
LLB Tð Q HEALTH IN THE EASTERN
SIERRA AND EXPERIENCES OF LB, Tð
, Q AND TRANSGENDER MEN AND
WOMEN WITH CHILD PROTECTIVE
SERVICES. THESE RESEARCH TOPICS
WERE ALL DRIVEN BY LOCAL CBOS
AND RESEARCH INSTITUTIONS WHO
SERVE L GB, Tð Q, PLUS PERSONS
AND RESEARCHERS. WITH DECADES OF
EXPERIENCE. WE LISTENED AND
FUNDED GAPS IN KNOWLEDGE THAT
WILL HELP COMMUNITIES ADDRESS
LOCAL INEQUITIES AND INFORM OUR
FUTURE RECOMMENDATIONS TO
IMPROVE L GB Tð Q PLUS HEALTH.
IN COLLABORATION WITH L GB Tð Q,
PLUS CBOS ACROSS THE STATE THAN
GENDER HEALTH EQUITY SECTION
ALSO FUNDS A SET OF STRATEGIES
TO BUILD THE CAPACITY OF HEALTH
CARE PROVIDERS TO DELIVER,
CULTURALLY AND LINGUISTICALLY
APPROPRIATE HEALTH CARE SERVICES
TO THEIR LB Tð Q, PLUS PATIENTS.
THE GOAL IS FOR FUNDED PARTNERS
TO ENHANCE THE CAPACITY OF
PROVIDERS, RESULTING IN BETTER
QUALITY AND QUANTITY OF SOJI
DATA REPORTED TO CDPH THROUGH
LJ'S. THESE PROGRAMS ARE SMALL
SCALE AT THIS TIME AND AS WE
EVALUATE THEIR EFFECTIVENESS èC
Dð P EXPECTS THAT THEY WILL
PROVIDE DATA DRIVEN DIRECTION
FOR FUTURE INVESTMENTS IN THIS
AREA. IN ADDITION, THE CPH IS
OFFICE OF AIDS LEADS CO
ORDINATION OF STATE PROGRAMS,
SERVICES AND ACTIVITIES RELATED
TO HÌ. I VÆ AND A I Dð S¼ AND
PROVIDES FOR THE NEEDS OF THE
IMPACTED CALIFORNIANS. THE
OFFICE OF AIDS STATEWIDE
PLANNING BODY IN COLLABORATION
WITH THE, UH WITH OUR S¼ Tð Dð
CONTROL BRANCH AND THE
CALIFORNIA PLANNING GROUP
INCLUDES COMMUNITY MEMBERS AND
STAKEHOLDERS WITH A MAJORITY
IDENTIFYING AS L GB Tð Q, PLUS
PERSONS IMPACTED BY THE HÌ. I VÆ
SYND. AND OPERATES AS A PLANNING
AND ADVISORY BODY TO ADVISE THE
OFFICE OF AIDS AND THE S¼ Tð Dð
CONTROL BS ON COMMUNITY NEEDS
AND GAPS AGAIN. èC IS STRONG
COMMUNITY PARTNERSHIPS.
PARTNERSHIPS WITH RESEARCH
INSTITUTIONS AND WITH LOCAL
HEALTH JURISDICTIONS OFFER US AN
INSIGHT THAT WE USE TO IDENTIFY
AND ADDRESS PUBLIC HEALTH ISSUES
THAT SPECIFICALLY IMPACT L GB Tð
Q COMMUNITIES. THANK YOU, JASON.
GAPS IN SOJI DATA COLLECTION ARE
THE RESULT OF SEVERAL CHALLENGES
WE FACE IN A GRATING MANY
SYSTEMS AND INDUSTRIES THAT
COLLECT AND REPORT SOJI DATA.
HOWEVER CDPH HAS IDENTIFIED
MULTIPLE OPPORTUNITIES TO EXPAND
SOJI DATA COLLECTION, WHICH
INCLUDES BUT ARE NOT LIMITED TO
THE FOLLOWING. LOOKING AT MODELS
A MODEL TO HELP GUIDE LOCAL
EFFORTS TO INCREASE SOJI DATA
COLLECTION. IT MAY INCLUDE A
STATEWIDE PROTOCOL AND GUIDANCE
FOR LOCAL ADAPTATION LOOKING AT
OUR DATA SYSTEMS. OF COURSE,
ALIGNMENT OF DATA SYSTEMS GIVES
THE OPPORTUNITY TO ENSURE
ACCURACY AND COMPLETENESS OF SO
G DATA, WHICH IS RELATED TO
PUBLIC HEALTH DATA
MODERNIZATION. COMMUNICATIONS
CONSISTENT MESSAGING FROM èC Dð
P TO COMMUNICATE SO MANDATES AND
ONGOING TECHNICAL ASSISTANCE BY
èC Dð P HÌ TO SUPPORT LOCAL
CULTURE DICTION STAFF TO
UNDERSTAND WHAT IS REQUIRED
RESOURCES. SIGNIFICANT RESOURCES
MAKE CHANGES TO ER, S¼ AND R
DATA SYSTEMS TRAIN AND EDUCATE
THE PUBLIC PROVIDERS AND
LABORATORIES AND DEVELOP
CULTURAL AND LINGUISTIC
TRANSLATIONS AND FACILITATE
COORDINATIONS TO RESOLVE
BARRIERS TO TRANSMITTING DATA
ACROSS PLATFORMS. FEEDBACK LOOPS
èC Dð P HÌ WILL CONDUCT ENSURE
SOJI DATA ANALYSIS WITH LOCAL
HEALTH HEALTH JURISDICTIONS, SO
A FEEDBACK LOOP CAN HELP
IDENTIFY GAPS IN LOCAL SOJI DATA
COLLECTION. USE OF NEW
TECHNOLOGIES TO EXPAND THE
COLLECTION OF SELF REPORTING
DATA DEVELOPMENT OF CONNECTIONS
WITH HEALTH INFORMATION
EXCHANGES TO DIRECTLY QUERY
MEDICAL RECORDS TO FILL IN
MISSING DEMOGRAPHIC INFORMATION.
EXPANSION OF ELECTRONIC CASE
REPORTING AND DEVELOPMENT OF
TECHNOLOGIES TO LINK INFORMATION
ACROSS MULTIPLE SYSTEMS AT THE
INDIVIDUAL LEVEL SO THAT
DEMOGRAPHIC DATA CAN BE SHARED
AND THEN VALIDATED ACROSS
SYSTEMS. ENGAGEMENT WITH
ORGANIZATIONS THAT SET NATIONAL
DATA STANDARDS TO ADVOCATE FOR
THE INCLUSION OF SOJI DATA
FIELDS IN DATA STREAMS FOR
ELECTRONIC CASE REPORTING,
SYNDROMIC SURVEILLANCE AND OTHER
NATIONAL DATA COLLECTION
SYSTEMS. IMPLEMENTING THE
VIRTUAL TRAINING ACADEMY, A
COLLABORATION BETWEEN THE
UNIVERSITY OF CALIFORNIA, LOS
ANGELES AND SAN FRANCISCO, ALONG
WITH èC, Dð P HÌ TO PROVIDE
EDUCATION, TRAINING AND SUPPORT
TO FRONT LINE STAFF.
COMMUNICATING REQUIREMENTS TO
LOCAL HEALTH JURISDICTIONS AND
OTHER CRITICAL PARTNERS AND
LASTLY, PROVIDING INFORMATIONAL
UPDATES DURING REGULAR MEETINGS
AND ALL OPPORTUNITIES OF
COMMUNICATION WITH èC Dð WITH,
UH LOCAL HEALTH JURISDICTIONS IN
èC B Ó S¼. THE SOJI DATA WORK
GROUP IS PLANNING TO SURVEY
EVERY PROGRAM IN CDPH AS TO WHAT
FORMS THEY USE, IRRESPECTIVE OF
WHETHER THEY WERE IDENTIFIED IN
THE AUDIT OR NOT, WHETHER THEY
ARE FOLLOWING OUR MOST RECENT
RECOMMENDATIONS FOR BEST
PRACTICES FOR SOJI COLLECTION
REASONS IF THEY ARE NOT, AND A
PLAN TO ADD SOJI QUESTIONS IF
THEY ARE NOT AGAIN, JASON AND I
THANK YOU FOR THE OPPORTUNITY TO
SHARE OUR PROGRESS ON MEETING
THE REQUIREMENTS OF THE AUDIT.
AND OF COURSE, WE SHARE YOUR
VISION AND ARE WELCOME TO
FURTHER DISCUSSION. THANK YOU
WILL DOES HAVE ANY COMMENTS ON
THIS ISSUE? FROM WILLOWS WITH
THE LEGISLATIVE ANALYST OFFICE.
NOTHING THAT AT THIS TIME, BUT
AVAILABLE FOR QUESTIONS. THANK
YOU. UM DANA. CORRECT THAT IS
CORRECT, TINA. I WANTED TO GO
BACK TO AND ONE OF THE EARLIER
EARLIER TALKING POINTS YOU
STARTED TALKING ABOUT, UM, SOME
OF THE FORMS THAT HAD N A WENT
BACK AND REALIZED THAT THEY DID
ACTUALLY ASK THAT QUESTION. UM
IS THERE AND THEN YOU HAVE ASKED
THAT EVERY SINGLE FORUM THAT
CAME BACK WITH N A TO BE
REREVIEWED? IS THERE A TIMELINE
OF WHEN WE CAN ANTICIPATE
HEARING FEEDBACK ON WHICH ONE OF
THOSE IN FACT, DO HAVE THAT
QUESTION? I DON'T HAVE IMMEDIATE
TIMELINE WITH ME, BUT I CAN
CONNECT. THERE ARE SO WORK GROUP
AND GET BACK TO YOU WITH THAT.
GREAT THANK YOU. UM MY OTHER
QUESTION IS REGARDING THE ONES
THAT DO HAVE THAT THAT, UH,
QUESTION EMBEDDED IN THE FORM.
IT SEEMS THAT IT APPEARS THAT 24
OF THEM, UM, CAME BACK WITH THEY
DO HAVE THE QUESTION. HOWEVER UM
, SEVEN OF THEM DID NOT COLLECT
THE COMPLETE DATA. SO I KNOW
WE'RE ENCOUNTERING SOME BARRIERS
WHERE IT'S NOT ON THE FORM. NOW
PART TWO IS IT IS ON THE FORM,
BUT NOT THE FULL INFORMATION IS
BEING COLLECTED. CAN YOU BREAK
IT DOWN? WHAT WE'RE EXACTLY
ASKING. IS IT ACROSS THE SAME,
UM IN ALL 58 COUNTIES AND
PROVIDERS DOES ONE FORM US MORE
SOJI INFORMATION AND THE OTHER
ONE SO THIS GOES BACK TO OUR SO
G WORK GROUP WHERE, WHEN WE'RE
EVALUATING FORMS AND DEVELOPING
THE BEST PRACTICES OR
RECOMMENDATIONS, UH, SO THIS
COMES FROM FEEDBACK FROM OUR
LOCAL JURISDICTIONS AND
COMMUNITY BASED ORGANIZATIONS SO
THAT THERE IS A BROADER AND MORE
APPROPRIATE RANGE OF QUESTIONS,
AS OPPOSED TO INCONGRUENT
QUESTIONS. ARE THERE OTHER
PIECES FROM THE WORK GROUP THAT
YOU WOULD HAVE TO ADD? NÓ. I
DON'T THINK SO AT THIS TIME.
BECAUSE YOU KNOW OF THE ONE THAT
DIDN'T COME BACK WITH A FULL
COMPLETION OF DATA. ONE OF THEM
IN PARTICULAR, IS COMPLETELY
CONNECTED TO THE L GB Tð PLUS
COMMUNITY WHEREAS THE ADULT HÌ I
VÆ AND A I Dð S¼ CASE REPORT
FORM. I THINK AT THAT MINIMUM
SHOULD HAVE OUR FULL FULL DATA
ON IT. SO I'M I'M WONDERING.
MAYBE IF YOU COULD GO A LITTLE
BIT MORE FURTHER AS TO I GET THE
FIRST PART RIGHT? THE SECOND
PART. IF IT'S ON THERE, WHY WE
NOT COLLECTING ALL OF IT. IS A
GOOD QUESTION. I'LL HAVE TO WORK
WITH OUR HÌ. I VÆ TEAM TO GET A
LITTLE MORE INFORMATION ON THAT,
OK AND THEN ALSO, MY OVERARCHING
QUESTION IS, YOU KNOW THIS. IT'S
BEEN AROUND FOR A WHILE. THE
WORKING GROUP STARTED 2022. IT'S
WE'RE ALMOST TWO YEARS IN AT
WHAT POINT HAVE WE LEARNED
EVERYTHING WE NEED TO LEARN TO
MOVE FORWARD WITH THIS. THAT IS
A GOOD QUESTION. UM, I THINK AS
WE MOVE FORWARD, WE'VE HAD A LOT
OF LESSONS LEARNED. AS I
MENTIONED WE, WE FOUND OUT THAT
THERE ARE ACTUALLY A LOT OF
SURVEYS AND FORMS THAT ACTUALLY
DID COLLECT THEIR G DATA. WE'RE
FINDING OPPORTUNITIES THAT
WEREN'T EVEN EVALUATED AS A FORM
WHERE WE CAN ADD SO DATA. UM,
WHILE WHILE WE CAN GO BY THE
LETTER OF THE AND THE LETTER OF
THE AUDIT AND WE ALL OF THE
RECOMMENDATIONS. I DON'T THINK
WE'LL TRULY EVER BE FINISHED AS
I MENTIONED EARLIER. RACE AND
ETHNICITY ARE INSTITUTIONALLY
DRIVEN DATA POINTS, SO G DATA AS
WE SEE IT, AND AS THE WORK GROUP
SEES, IT IS TRULY DRIVEN BY THE
COMMUNITY AND IS ADAPTED
DEPENDING ON DIFFERENT PARTS OF
THE COMMUNITY, SO WE WILL
CONSTANTLY BE IN A QUALITY
IMPROVEMENT PROCESS CONNECTING
WITH THE COMMUNITY RE EVALUATING
DATA, ENSURING IT'S
REPRESENTATIVE AND THAT IT'S
ACTUALLY MEANINGFUL DATA SO THAT
WE CAN INTERVENE. ARE THE
INTERVENTIONS APPROPRIATE? AND
ARE THEY WORKING? IS THIS STILL
THE MINDSET OF CDPH THAT THE WAY
THE LANGUAGE WITHIN THE BILL
READS IS THAT IT DOES NOT
REQUIRE BUT RATHER PERMITS IN
SOME OF THESE FORMS TO COLLECT
SO SOJI INFORMATION. SO SORRY.
WHAT'S THE QUESTION? IS THIS
STILL THE MENTALITY? UH, THE
UNDERSTANDING OF èC Dð P HÌ
THAT THE WAY THE DEPARTMENT IS
READING THE STATUTE IS THAT THE
VERBIAGE ONLY ALLOWS PERMITS.
SOME OF THESE FORMS TO COLLECT
THIS DATA. RATHER THAN REQUIRING
TO COLLECT THIS DATA. SO
ULTIMATELY OUR VISION IS TO
MAXIMIZE THE COLLECTION OF SOJI
DATA. WHEREVER POSSIBLE, UM,
PERMITTING THAT IT DOESN'T
VIOLATE FEDERAL OR STATE LAW OR
PRIVACY LAWS. UH, THE IDEA IS TO
AGAIN LOOK AT AS MANY FORMS AS
MANY OPPORTUNITIES WHERE WE
CONNECT WITH THE COMMUNITY. UM
WHERE WE CONNECT WITH HEALTH
CARE AND FIGURE OUT HOW TO
INTEGRATE THAT FROM MY
UNDERSTANDING. COULD YOU BREAK
DOWN WHY PRIVACY LAWS WEREN'T BE
AND I JUST DON'T KNOW.
PERSONALLY, THE FOR THIS
INFORMATION AND NOT FOR RACE.
I'M PRIVACY LAW IS VERY
DEPENDING ON THE DATA SETS, UM
IS ULTIMATELY WHAT IT COMES DOWN
TO. SO FOR EXAMPLE, I WORK IN
METAL RECORDS AND VITAL DOTS. WE
HAVE PRIVACY LAWS AROUND BIRTH
DATA THAT ARE INCREDIBLY
DIFFERENT THAN HÌ. I VÆ DATA.
UH, SOME PRIVACY LAWS ALLOW FOR
UNIDIRECTIONAL SO WE CAN GET
DATA. BUT WE ARE NOT
BIDIRECTIONAL. WE MAY NOT BE
ABLE TO GIVE DATA, SO IT REALLY
DEPENDS ON THE TYPE OF DATA AND
THE TYPE OF END LEVEL OF
PRIVACY. THAT IS BEING
PROTECTIVE OF THAT DATA SET,
WHETHER IT'S INDIVIDUAL OR
RECORD LEVEL DATA VERSUS
POPULATION HEALTH DATA. DO WE
KNOW? DO WE HAVE AN
UNDERSTANDING OF WHAT? IN
PRIVACY LAWS ARE IN PLACE THAT
ARE PREVENTING US FROM
COLLECTING THIS DATA. I WOULD
HAVE TO WORK WITH OUR PRIVACY
ATTORNEY. WE DO KNOW THE LAWS
AND AGAIN IT VARIES BY DATA SET
AND DATA PROGRAM, BUT THAT'S
SOMETHING WE CAN GET TO YOU.
ANYBODY ELSE? UM II. I ALSO HAVE
MY HAT AS THE, UH, L GB Tð Q
CAUCUS CHAIR. AND SO WE'VE, UM
IT IT IS A FREQUENT TOPIC OF
DISCUSSION. UH, DEPARTMENT OF
PUBLIC HEALTH, BOTH WITH A DEPTH
PROGRAM AS WELL AS THIS, UM SO I
GUESS IT JUST HOW DO WE? HOW
DOES THE CAUCUS IS THERE A WAY
THE CAUCUS CAN WORK MORE
COLLABORATIVELY WITH YOU TO BE
ABLE TO? IT'S BECAUSE IT'S BEEN
AN ONGOING SOURCE OF FRUSTRATION
THAT THE DATA HASN'T BEEN
COMING. SO ARE ARE THERE WAYS WE
CAN PARTNER WITH YOU IN BETTER
WAYS TO BE ABLE TO, YOU KNOW,
PROBABLY LESSEN THE FRUSTRATION
FOR ALL OF US. THAT'S A GOOD
QUESTION. I THINK AN OPPORTUNITY
AS WE GO THROUGH AND EVALUATE R,
SO GG DATA AND, UH, BEST
PRACTICES AND RECOMMENDATIONS, I
THINK OF, FOR EXAMPLE, THE CAL
HÌ HÌ S¼ JEDI COUNCIL, JUSTICE,
EQUITY DIVERSITY AND INCLUSION
COUNCIL. UM WHICH IS A GROUP
THAT WE WOULD PARTNER WITH AT A
POLICY LEVEL TO GET FEEDBACK
FROM SO THE CAUCUS COULD ALSO BE
AN OPPORTUNITY TO HEAR WHAT OUR
RECOMMENDATIONS ARE. AS
REPRESENTATIVE THAT THE
COMMUNITY PROVIDING FEEDBACK. I
THINK THAT WOULD BE A GOOD WAY
TO DO THAT. MAYBE WE CAN COME
FOR AN UPDATE. THAT WOULD BE
GREAT. THANK YOU SO MUCH. I DO
APPRECIATE THAT. YOU APPRECIATE
OUR GOOD QUESTIONS, BUT I
APPRECIATE IT. BETTER ANSWER FOR
A GOOD QUESTIONS. ALWAYS HAPPY
TO DO MORE RESEARCH AND BRING IT
BACK. THANK YOU. THANK YOU SO
MUCH. UH, THANK YOU FOR THIS
PRESENTATION. WE'RE GONNA ONE
LAST QUESTION HERE. THANK YOU,
MADAM CHAIR. I'M JUST GONNA
FOLLOW UP ON THAT. IS THERE A
DIFFERENT STATUTORY REGULATIONS
OR DIFFERENT RULES FOR THAT DATA
TO BE GIVEN TO US SO THAT THEY
DATA COMES TO US? UM BASED ON
WHETHER IT'S HÌ. I VÆ
INFORMATION OR AS YOU MENTIONED
EARLIER IN YOUR COMMENTS, BIRTH
RATE INFORMATION OR BIRTH
INFORMATION? YES SO THERE ARE
DIFFERENT STATUTORY AND
REGULATORY REQUIREMENTS AND
PRIVACY LAWS THAT VARY DEPENDING
ON THE PART OF THE HEALTH AND
SAFETY CODE. UM AND FOR EXAMPLE,
LIKE VITAL RECORDS, UH, WE HAVE
FEDERAL LAWS THAT ALSO PROTECT
THE PRIVACY OF INDIVIDUALS. UM I
AM UNCERTAIN ABOUT HÌ. I VÆ DATA
, BUT AGAIN, IT IS VARIATION
ACROSS THE HEALTH AND SAFETY
CODE THAT PROVIDES FOR EACH DATA
TYPE. BUT THE PROBLEM THAT WE
HAVE IS LEGISLATIVE AS THE
LEGISLATORS AND OF COURSE, LIKE
THE MY COLLEAGUE FROM STOCKTON
MENTIONED AND ALSO THE CHAIR IS
LIKE WE'RE LOOKING FOR DATA
RIGHT? AND WE WANT TO KNOW WHY
YOU CANNOT PROVIDE IT. IF IT'S
LEGISLATIVE. TELL US. IT'S
LEGISLATIVE, AND I'M SURE
EVERYBODY WILL WORK TO FIX THAT,
IF IT'S COOPER OPERATION OF
PARTNERING WITH OTHER
ORGANIZATIONS LIKE THE JUSTICE
ORGANIZATION THAT YOU MENTIONED
OR THE L GB Tð CAUCUS, THEN TELL
US AND I'M SURE THAT WE'LL MAKE
THAT HAPPEN. UH, SO WHAT IS THE
REASON YOU CAN'T PROVIDE US THAT
DATA? I'LL BE A LITTLE BIT MORE
DIRECT THAN MY COLLEAGUES WHO
ARE SO POLITE. NOT MUCH
APPRECIATED. THERE IS MUCH OF IT
THAT IS LEGISLATIVE MUCH OF HIS
LEGISLATIVE SO LIKE THE CHAIR
MADAM CHAIR WHO READ THAT
STATEMENT THAT CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH IS
SAYING THAT IT'S PERMISSIVE.
WHAT'S PERMISSIVE, BUT THAT'S
NOT WHAT REQUIRED SO IF WE
CHANGE THAT TO WORD INSTEAD OF
IT, BEING PERMISSIVE FOR YOU TO
PROVIDE THAT REGULATION AND
REQUIRED YOU TO DO THAT, THEN
YOU WOULD BE REQUIRED TO GIVE US
THAT EVEN THOUGH WE WERE TRYING
TO BE KIND IN THE LEGISLATION
AND SAY WE'D LIKE YOU TO GIVE US
THIS SO THAT WE CAN MAKE GOOD
POLICY DECISIONS, BUT YOU'RE
CHOOSING NOT TO. SO NOW WE NEED
TO REQUIRE YOU TO DO IT. WOULD
SAY THAT WE ARE NOT CHOOSING NOT
TO. BUT REQUIREMENT DEFINITELY
HAS A, UH MORE MORE POWERFUL
LANGUAGE TO BE ABLE TO HELP US
WITH PARTNERS THAT WE GET. THIRD
PARTY AND SECOND PARTY DATA FROM
WHERE ITS REQUIREMENT CEDAR
GROVE. I'M NOT ALWAYS NICE IN
THE SUB COMMITTEE, I PROMISE. UM
OTHER DEPARTMENTS CAN ATTEST TO
THAT. UM THANK YOU. THANK YOU SO
MUCH. UM BUT I JUST WANNA, UM,
ACTUALLY JUST SUMMARIZE. I'M
VERY INTERESTED IN GETTING THE
TIMELINES FOR WHEN WE'RE GONNA
BE REVIEWING ALL THOSE FORMS
THAT DON'T HAVE THE N A, UM AND
THEN UM IT WAS MY OTHER PART.
JUST ANY PRIVACY LAWS THAT ARE
IN OUR ABILITY TO COLLECT THAT
THAT DATA AND THEN IF YOU COULD
REPORT YOU SEND THAT UP TO US.
THAT'D BE REALLY HELPFUL.
ABSOLUTELY AS A MEMBER OF THE
COMMUNITY. I APPRECIATE THE WORK
THAT'S BEING DONE HERE. THANK
YOU. OK, WE'RE GONNA MOVE ON TO
OUR ISSUE NUMBER TWO. IT ISSUE
NUMBER TWO. THE FUTURE OF PUBLIC
HEALTH, OUR INVESTMENTS IN THE
STATE AND LOCAL PUBLIC HEALTH IS
GONNA BE IN A LITTLE OF A PANEL
FORM DISCUSSION. THE
DEPARTMENT'S GONNA BE WELCOMED
BY REPRESENTATIVES FROM OTHER
COUNTIES. AND ORGS. WE MIGHT
NEED LET'S SEE. BECAUSE WE OR
MORE OK, FEELS GOOD NOW. I'M
GOING TO TAKE THE ADVICE FROM
SENATOR ROTH AND HAVE YOU
PRONOUNCE AND INTRODUCE YOURSELF
SO THAT I MAY NOT BUTCHER YOUR
NAMES. LIKE THIS GUY OR. WE'RE
GONNA HAVE SARAH. I CAN
PRONOUNCE. UM, SARAH. HELLO,
SARAH. JUST KIDDING. THE
DEPARTMENT WHO IS REPRESENTING
GOING TO HAVE CDPH GO FIRST.
HØI. I'LL INTRODUCE MYSELF. I'M
JULIE NAGASAKA. I'M THE DEPUTY
DIRECTOR OF THE OFFICE OF POLICY
AND PLANNING. I HAVE TWO
COLLEAGUES FROM CITY P HÌ WITH
ME. GOOD MORNING. MY NAME IS AMY
. ZING. I AM THE COMMUNITY
EQUITY BRANCH MANAGER FOR THE
OFFICE OF HEALTH EQUITY. ALL
RIGHT. UM SO I THINK AMY'S GONNA
LEAD US OFF ADDRESSING THE FIRST
QUESTION, AND THEN I'LL ADDRESS
THE REMAINING QUESTIONS RELATED
TO THE FUTURE OF PUBLIC HEALTH
AND WORKFORCE INVESTMENTS. THE
OFFICE OF HEALTH HEALTH EQUITY.
WE HAVE BEEN WORKING WITH AGENCY
TO OBTAIN THE $1.6 MILLION FOR
THE RETROSPECTIVE ANALYSIS, AND
WE WILL BE CONTRACTING WITH THE
UNIVERSITY OF CALIFORNIA OF SAN
FRANCISCO TO CONDUCT THE WORK
AND THAT INTERAGENCY AGREEMENT
WILL BE BEGINNING. JULY 1ST 2024
. WE ARE ALSO WORKING ON HIRING
A RETROSPECTIVE ANALYST WHO WILL
BE CONDUCTING THE WORK TO
SUPPORT U S¼ F, AND THIS
POSITION IS FOR TWO YEARS. THANK
YOU. CHAIR MEMBERS OF THE
COMMITTEE. I'M NOW GOING TO
PROVIDE AN OVERVIEW RELATED TO
THE FUTURE OF PUBLIC HEALTH
INVESTMENT. UM I'M SHARING THIS
UPDATE ON BEHALF OF MANY èC Dð
P PROGRAMS WHICH ARE SUPPORTED,
SO THERE'S QUITE A BIT OF
INFORMATION TO COVER THE PURPOSE
OF THE LANDMARK FUTURE. PUBLIC
HEALTH INVESTMENT IS TO
STRENGTHEN AND TRANSFORM
CALIFORNIA'S PUBLIC HEALTH
SYSTEM, ADDRESSING CRITICAL GAPS
IN CORE INFRASTRUCTURE, THIS
INITIATIVE FOCUSES ON GROWING A
SKILLED REPRESENTATIVE AND WELL
SUPPORTED WORKFORCE, IMPROVING
SYSTEMS PREPAREDNESS. RESILIENCE
CONTRIBUTING TO EQUITY AND
PROTECTING AND IMPROVING THE
HEALTH OF COMMUNITIES THROUGHOUT
THE STATE. MOST SIGNIFICANTLY IN
THE FIRST TWO YEARS. THESE
RESOURCES HAVE ENABLED AN
IMPORTANT EXPANSION OF THE
PUBLIC HEALTH WORKFORCE, THE
HEART OF OUR PUBLIC HEALTH
SYSTEM. CDPH AND LOCAL HEALTH
JURISDICTIONS HAVE HIRED OVER
1200 NEW PUBLIC HEALTH STAFF
STATEWIDE OVER 300 AT THE STATE
LEVEL AND OVER 900 AT THE LOCAL
LEVEL. THESE OBJECTIVES OF THE
FUTURE OF PUBLIC HEALTH
INITIATIVE ARE ACHIEVED BY
ADDRESSING PRIORITIES WITHIN THE
FOUNDATIONAL PUBLIC HEALTH
SERVICES THAT ARE CRITICAL TO
STRENGTHENING AND SUSTAINING OUR
STATE'S PUBLIC HEALTH
INFRASTRUCTURE. I'LL SHARE A FEW
UPDATES AND HIGHLIGHTS FROM EACH
OF THESE FOUNDATIONAL PUBLIC
HEALTH SERVICE AREAS, UM, IN
SOME OF THE RELATED PROJECTS.
THE FIRST IS WORKFORCE.
FOUNDATION OF PUBLIC HEALTH
SERVICE AREA FOR WORKFORCE
DEVELOPMENT, RECRUITMENT AND
RETENTION. INCLUDES $57.9
MILLION TO INCREASE STAFFING
CAPACITY THROUGH 270 POSITIONS,
226 OF WHICH HAVE CURRENTLY BEEN
HIRED TO PROVIDE SUPPORT TO BOTH
PROGRAM AND OPERATIONAL
ACTIVITIES, IMPROVING CAPACITY
RANGE OF EXPERTISE AND LIVED
EXPERIENCE REFLECTED ACROSS OUR
DEPARTMENT. KEY PROJECTS HAVE
ALSO FOCUSED ON WORKFORCE
DEVELOPMENT, INCLUDING
INCREASING OUR HÌ R STAFFING,
LAUNCHING A NEW HIRING SYSTEM,
EXPANDING MARKETING AND PIPELINE
EFFORTS TO PROMOTE CAREERS IN
PUBLIC HEALTH. èC Dð P HAS ALSO
DEVELOPED A NEW PUBLIC HEALTH
CORE COMPETENCIES SYSTEM,
MODULAR PUBLIC HEALTH TRAININGS
AND A CAREER MANAGEMENT PROGRAM
TO HELP SUPPORT THE PROFESSIONAL
DEVELOPMENT AND RETENTION OF
PUBLIC HEALTH PROFESSIONALS AND
STATE SERVICE. CDPH HAS ALSO
ESTABLISHED NEW STRUCTURES,
INCLUDING OUR OFFICE OF POLICY
AND PLANNING, WHICH SUPPORTS
PRIORITY INITIATIVES ACROSS THE
DEPARTMENT AND OUR NEW REGIONAL
PUBLIC HEALTH OFFICE TO SUPPORT
LOCAL HEALTH JURISDICTIONS WITH
KEY PROJECTS AND BIDIRECTIONAL
CO-ORDINATION. IN THE AREA OF
EMERGENCY PREPAREDNESS AND
RESPONSE. THIS FOUNDATIONAL
PUBLIC HEALTH SERVICE AREA
INCLUDES 77 POSITIONS AND $27.6
MILLION. THE PRIMARY STAFF
CLASSIFICATIONS IN THIS AREA ARE
EMERGENCY SERVICES COORDINATORS,
PROGRAM MANAGERS, RESEARCH.
SCIENTISTS ANALYSTS, HEALTH
PROGRAM SPECIALIST MANAGERS,
RESEARCH DATA SPECIALISTS AND
PUBLIC HEALTH MEDICAL OFFICER
ROLES. AT THIS TIME, 40
POSITIONS HAVE BEEN HIRED WITH
ADDITIONAL ROLES IN ACTIVE
RECRUITMENT. ONE KEY PREPARED
INITIATIVE IS THE 24 7
INTELLIGENCE HUB TO INTEGRATE
NEW AND EXISTING DATA STREAMS TO
PROACTIVELY DETECT EMERGING
THREATS. THIS HUB IS AN ACTIVE
DEVELOPMENT WITH A FOCUS ON DATA
ARCHITECTURE, REDESIGNING
EXISTING PROCESSES FOR PROACTIVE
INTEGRATION AND RECRUITMENT OF
DEDICATED STAFFING. THE 24 7
INTELLIGENCE HUB IS RELATED TO
SYNDROMIC SURVEILLANCE OR
BIOSENSE EFFORTS IN THE INPUTS
FROM THAT DEVELOPING SYNDROMIC
SURVEILLANCE CAPACITY WILL BE
ONE OF THE DATA STREAMS
INTEGRATED INTO THE INTELLIGENT
STRUCTURE. IT IS DISTINCTLY
DIFFERENT IN THAT IT WILL ALSO
ANALYZE DATA FROM OTHER SOURCES
SUCH AS EM S¼ DATA HOSPITAL
CENSUS DATA. STATE THREAT
ASSESSMENT CENTER AND MANY
OTHERS TO CREATE COMPREHENSIVE
REPORTS ABOUT CURRENT AND
EMERGING THREATS TO CALIFORNIA'S
PUBLIC HEALTH. CDPH HAS ALSO
EXPANDED PLANNING, TRAINING,
EXERCISE AND EVALUATION
CAPABILITIES. EXAMPLES OVER THE
PAST YEAR INCLUDE INITIATING A
REVIEW AND UPDATE OF THE CDPH
EMERGENCY OPERATIONS. RESPONSE
PLAN INPUT, INCLUDING REVIEWING
AND REVISING THE EMERGENCY
SUPPORT FUNCTION, EIGHT PUBLIC
HEALTH AND MEDICAL ANNEX TO THE
STATE EMERGENCY PLAN
PARTICIPATING IN REGIONAL
MEDICAL COUNTERMEASURE EXERCISES
AND NATIONAL DISASTER SYSTEM
MEDICAL SYSTEM EXERCISES. STAFF
SUPPORT THROUGH FUTURE PUBLIC
HEALTH ALSO CONTRIBUTED TO
CONDUCTING HOT WASHES OR
DEBRIEFS, UM, AND THE
DEVELOPMENT OF AFTER ACTION
REPORTS FOR INCIDENTS WHERE èC
Dð P HÌ PARTICIPATED. PLANNING
TEAMS ALSO DEVELOPED THREAT
SPECIFIC RESPONSE GUIDES AND
PLAYBOOKS, INCLUDING EXTREME
HEAT, WILDFIRE AND WILDFIRE
SMOKE WINTER STORMS AS WELL AS
WORK ON INITIATIVES FOR NUCLEAR
RADIOLOGIC THREAT AND EBOLA,
MARBURG AND SPECIAL PATHOGENS
PLANNING EFFORTS. CDPH IS
ACTIVELY WORKING ON A REGIONAL
DISASTER HEALTH REPRESENTATIVE
PROGRAM. REGIONAL MEETINGS HAVE
BEEN HELD WITH PUBLIC HEALTH
OFFICIALS, REGIONAL DISASTER
MENTAL HEALTH SPECIALISTS AND
MENTAL AND HEALTH OPERATIONAL
AREA COORDINATORS TO IDENTIFY
GOALS FOR INTEGRATION INTO
REGIONAL NETWORKS WITH
RECRUITMENT FOR THESE REGIONAL
ROLES CURRENTLY UNDERWAY. CDPH
HAS ALSO ESTABLISHED A DEDICATED
RECOVERY UNIT, WHICH WAS
DEPLOYED TO WORK COLLABORATIVELY
WITH CAL OES PARTNERS ON THE
RECOVERY FOR WINTER STORMS AND
TROPICAL STORM HILARY. THIS TEAM
INITIATED THE DEVELOPMENT OF A
PUBLIC HEALTH, MEDICAL RECOVERY,
FRAMEWORK AND COMMUNITY
RESILIENCE PLAN AND IDENTIFIED
GAP AREAS FOR FOCUS SUCH AS
DISASTER BEHAVIORAL HEALTH. THE
FOUNDATIONAL SERVICE AREA FOR
PREPAREDNESS ALSO INCLUDES
INVESTMENTS IN STATE LABORATORY
EMERGENCY RESPONSE SUPPORT
HIRING KEY STAFF IN TECHNICAL
LABORATORY CLASSIFICATIONS TO
SUPPORT PREPAREDNESS AND
RESPONSE ACTIVITIES, INCLUDING
TESTING FOR PATHOGENS AND
OUTBREAKS. IN THE AREA OF
INFORMATION TECHNOLOGY, DATA,
SCIENCE AND INFORMATICS. THE
FUTURE OF PUBLIC HEALTH
INVESTMENT INCLUDES A FOCUS ON
IMPROVING HEALTH TECHNOLOGY
INFRASTRUCTURE IN CRITICAL AREAS
TO SUPPORT IT SYSTEMS AND
SOLUTIONS FOR ADDRESSING
EMERGING THREATS. FOR EXAMPLE,
EXPANSION OF COVERAGE FOR THE
CALIFORNIA BIRTH DEFECTS
MONITORING PROGRAM, OTHER
ACTIVITIES IN SUPPORT OF THIS
FOUNDATIONAL SERVICE AREA ARE
ADDRESSED UNDER THE SEPARATE
BUDGET ALLOCATION, INFORMATION
TECHNOLOGY, DATA SCIENCE AND
INFORMATICS FRAMEWORK. 21ST
CENTURY PUBLIC HEALTH SYSTEM,
WHICH INCLUDED $54.8 MILLION TO
SUPPORT FOUNDATIONAL STRATEGIC
PLANNING, DATA SHARING
UPSKILLING OF OUR IT WORKFORCE,
ESTABLISHING A FRAMEWORK FOR
MODERNIZATION OF OUR IT
PLATFORMS, DATA INTEROPERABILITY
AND CLOUD INFRASTRUCTURE. THIS
INVESTMENT INCLUDED 30 THREE
POSITIONS AT THIS TIME 28
POSITIONS HAVE BEEN HIRED. IN
ADDITION TO CRITICAL PERSONNEL,
THESE RESOURCES SUPPORT SOFTWARE
LICENSING PROFESSIONAL SERVICE
CONTRACTS IN ORDER TO ACCOMPLISH
PROACTIVE SUPPORT FOR RAPID DATA
ANALYSIS WITH REAL TIME INSIGHTS
, AUTOMATED FILE TRANSFER,
REDUCING DUPLICATION AND
LEVERAGING OUR RESOURCES FOR
COMMON INVESTMENTS FOR THE
FUTURE SEPARATELY FROM FUTURE
PUBLIC HEALTH, THE DISEASE
SURVEILLANCE READINESS RESPONSE,
RECOVERY AND MAINTENANCE OF I Tð
OPERATIONS IS ANOTHER KEY
INVESTMENT, CONTRIBUTING TO
PUBLIC HEALTH INFRASTRUCTURE,
WHICH INCLUDED A TOTAL OF 133
POSITIONS IN 2223 AND 144
POSITIONS IN 20 THREE 24 TO
SUPPORT MAINTENANCE AND
OPERATIONS OF MULTIPLE IT
SYSTEMS, INCLUDING THOSE
ESTABLISHED DURING THE COVID-19
PANDEMIC. IN THE AREA OF
COMMUNICATIONS AND PUBLIC
EDUCATION. UM INCLUDED 4.5
MILLION TO ACHIEVE A
COMMUNICATION STRATEGY TO REACH
CALIFORNIA'S DIVERSE POPULATION,
WITH AN EMPHASIS ON INCREASING
DIGITAL, LINGUISTICALLY AND
CULTURALLY RESPONSIVE
COMMUNICATIONS ON PUBLIC HEALTH
PREVENTION AND EMERGING ISSUES.
THE OFFICE OF COMMUNICATIONS HAS
HIRED 25 OF ITS 26 NEW POSITIONS
IN ROLES, INCLUDING DIGITAL
COMMUNICATION, SOCIAL MEDIA
STRATEGY, HEALTH PROGRAM
SPECIALISTS AND BILINGUAL
INFORMATION OFFICERS. RESOURCES
HAVE ALSO SUPPORTED WEB
DEVELOPMENT TOOLS AND MEDIA
STUDIO ENHANCEMENTS, THE
CREATION OF THESE NEW STAFF
ROLES AND RESOURCES HAVE
IMPROVED PUBLIC HEALTH
COMMUNICATIONS CAPABILITIES BY
EXPANDING PROACTIVE OUTREACH
EFFORTS AND ENGAGEMENT THROUGH
EXPERTS THAT REPRESENT DIVERSE
POPULATIONS, INCLUDING RURAL AND
OTHER UNDERSERVED GEOGRAPHIC
REGIONS, AS WELL AS IMPROVED
CAPACITY FOR DISSEMINATION OF
TOOLKITS VIDEOS AND SOCIAL MEDIA
ACROSS A VARIETY OF CHANNELS.
FOR EXAMPLE, èC Dð P DEVELOPED
THE CALIFORNIA'S OPIOID ITS
WEBSITE, WHICH WAS PRODUCED
INTERNALLY IN LESS THAN A MONTH
THROUGH SUPPORT OF AN F Ó
POSITION RATHER THAN EXTENDED
AND MORE COSTLY PROCESS THROUGH
A CONSULTED CONTRACT. ADDITIONAL
EXAMPLES OF MESSAGING AND
COMMUNICATION TOOLS DEVELOPED IN
A LINGUISTICALLY AND CULTURALLY
COMPETENT MANNER AND TAILORED TO
SPECIFIC POPULATIONS INCLUDE
OUTREACH MESSAGING TO REACH
RURAL AGRICULTURAL WORKERS THIS
SPRING ON VALLEY FEVER AWARENESS
AND PREVENTION, A SOCIAL MEDIA
TOOLKIT ON EXTREME COLD,
INCLUDING INFORMATION ON SAFE
GENERATOR USE IN PREPARATION FOR
WINTER STORM SEASON, MANY
CAMPAIGNS AND TOOLKITS TO
ADDRESS RESPIRATORY VIRUS AND
COVID PREVENTION. HEALTH
EDUCATION MATERIALS ON TOPICS
SUCH AS TUBERCULOSIS CONTROL.
XYLAZINE WOUND TREATMENT, YOUTH
SUICIDE PREVENTION AND
ALZHEIMER'S DISEASE, AS WELL AS
RESOURCE MATERIALS ON RECENT
MEASLES OUTBREAKS, AND S¼ Tð Dð
INCREASES. IN THE AREA OF
COMMUNITY PARTNERSHIP. THERE
WERE FIVE POSITIONS AND $2.9
MILLION TO DEVELOP A COMMUNITY
PARTNERSHIP STRATEGY AND PLAN
WITH A DEDICATED TEAM OF
COMMUNITY ENGAGEMENT PERSONNEL.
èC Dð P HÌ HAS HIRED A BLACK
HEALTH EQUITY SPECIALIST, TRIBAL
HEALTH EQUITY SPECIALIST, RURAL
HEALTH, EQUITY SPECIALIST
COMMUNITY ENGAGEMENT SPECIALIST
AND MANAGER. THESE POSITIONS AND
RESOURCES HAVE STRENGTHENED
RELATIONSHIPS WITH COMMUNITY
PARTNERS BY BUILDING ROBUST
PARTNERSHIPS WITH POPULATIONS
EXPERIENCING SOME OF THE
GREATEST DISPARITIES. THESE
POSITIONS HAVE ESTABLISHED
POPULATION FOCUSED ADVISORY
GROUPS, INCLUDING A LIVED
EXPERIENCE ADVISORY BOARD FOR
PEOPLE EXPERIENCING HOMELESSNESS
, A BLACK HEALTH EQUITY ADVISORY
BOARD AND TRIBAL HEALTH EQUITY
ADVISORY BOARD. THESE GROUPS
STRENGTHEN OUR RELATIONSHIP WITH
PARTNERS BY DRASTICALLY
INCREASING THE FREQUENCY
INTENSITY AND SPECIFICITY OF OUR
BIDIRECTIONAL ENGAGEMENT. CDPH
IS ALSO WORKING WITH KEY
PARTNERS TO CORE A BRIDGE TO
PARTNERSHIPS BLUEPRINT TO ENSURE
THAT èC Dð P HÌ DEVELOPS
GOVERNMENTAL INFRASTRUCTURE THAT
CAN CONVENE AND SUSTAIN
COMMUNITY PARTNERSHIPS. THE MAIN
PURPOSE OF COMMUNITY
PARTNERSHIPS IS TO ESTABLISH A
COLLABORATIVE NETWORK THAT CAN
BE MOBILIZED QUICKLY AND
EFFECTIVELY SUPPORT CALIFORNIA'S
STATE AND LOCAL GOVERNMENTAL
PUBLIC HEALTH EFFORTS TO ADDRESS
COMMUNITY HEALTH NEEDS. CDPH IS
SUPPORTING ALL 61 LOCAL HEALTH
JURISDICTIONS IN JOINT EFFORTS
TO GROW THEIR EQUITY
COMPETENCIES WITH A VIRTUAL
EQUITY TOOLKIT, WHICH INCLUDES
DOZENS OF RESOURCES FOR
PRACTITIONERS, INCLUDING
COMPETENCIES TO SUPPORT
EXTENDING THE REACH OF
GOVERNMENTAL PUBLIC HEALTH VIA
TRUSTED COMMUNITY PARTNERS. CDPH
IS ALSO DEEPENING CROSS SECTOR
PARTNERSHIPS WITH CONTINUUM OF
CARE AND HOMELESS SYSTEMS OF
CARE TO IMPROVE HEALTH OUTCOMES
FOR PERSONS EXPERIENCING
HOMELESSNESS THROUGHOUT THE
STATE. THE SIXTH AREA OF THE
FOUNDATIONAL SERVICES IS
COMMUNITY HEALTH IMPROVEMENT.
ALL OF THESE WORKFORCE AND
SYSTEM IMPROVEMENTS CONTRIBUTE
TO THE BROADER GOAL OF COMMUNITY
HEALTH IMPROVEMENT WITH 6.1
MILLION FOCUSED ON ADDITIONAL
STRATEGIES TO ADVANCE LIFE
COURSE EQUITY AND PREVENTION AND
STRENGTHENING PARTNERSHIPS
ACROSS HEALTH SYSTEMS, HEALTH
PLANS AND LOCAL COMMUNITIES TO
SUPPORT COMMUNITY HEALTH
INVESTMENT. CDPH HAS IMPLEMENTED
AN INITIATIVE TO DEVELOP A
FINANCING STRATEGY PLANNING
GUIDE THAT OUTLINES VARIOUS
OPPORTUNITIES FOR PUBLIC HEALTH
SYSTEM TO MAXIMIZE EXISTING
REVENUE STREAMS AND
OPPORTUNITIES TO ALIGN WITH
HEALTHCARE SYSTEM PARTNERS. AS
WELL AS A LOCAL HEALTH
DEPARTMENT PLAYBOOK TOOL THAT
PROVIDES AN ASSESSMENT OF THE
CURRENT FUNDING FOR CORE PUBLIC
HEALTH FUNCTIONS THAT CAN BE
USED TO ASSESS GAPS IN FUNDING
AND CAPACITY NEEDED TO
ADEQUATELY IMPLEMENT
GOVERNMENTAL PUBLIC HEALTH.
ANOTHER KEY COMMUNITY HEALTH
IMPROVEMENT PRIORITY IS THE CDPH
BEHAVIORAL HEALTH PLANNING
INITIATIVE, CDPH IS ENGAGED IN A
DEPARTMENT WIDE EFFORT TO
ADDRESS THE CURRENT BEHAVIORAL
HEALTH CRISIS IN CALIFORNIA.
THIS INITIATIVE INVOLVES CROSS
CUTTING PLANNING ENGAGING OVER
50 CDPH PROGRAMS, ADDRESSING
BEHAVIORAL HEALTH AND THE
LANDSCAPE ANALYSIS OF PARTNER
INITIATIVES TO INFORM THE
DEVELOPMENT OF A PREVENTION
FRAMEWORK FOR BEHAVIORAL HEALTH.
CDPH HAS LEVERAGED FUTURE PUBLIC
HEALTH RESOURCES TO EXPAND
CAPACITY AND BEHAVIORAL HEALTH
ACROSS THE DEPARTMENT. FOR
EXAMPLE, THE MATERNAL CHILD AND
ADOLESCENT HEALTH DIVISION
ESTABLISHED A NEW COMMUNITY
RESILIENCE AND SUPPORT SECTION,
IMPLEMENTING AN INITIATIVE
FOCUSED ON IMPROVING AND
PROTECTING MENTAL HEALTH FOR THE
M èC, A HÌ STATEWIDE WORKFORCE
AND POPULATIONS WHILE
INTEGRATING PRIMARY PREVENTION
AND A LIFE COURSE APPROACH.
ADDITIONAL DEDICATED STAFFING
WAS ALSO ADDED OR EXPANDED FROM
MULTIPLE EXISTING BEHAVIORAL
HEALTH PROGRAMS, INCLUDING IN
THE AREAS OF INJURY AND VIOLENCE
PREVENTION, SAFE SCHOOLS,
SUBSTANCE AND ADDICTION
PREVENTION PROGRAMS. COMMUNITY
HEALTH IMPROVEMENT IS ALSO
ADVANCED BY ENHANCEMENTS TO THE
STATE HEALTH ASSESSMENT AND
IMPROVEMENT PLANNING FUNCTIONS,
INCLUDING THE INAUGURAL STATE OF
PUBLIC HEALTH REPORT RELEASED
THIS YEAR. NOW SHARE A SHORT
OVERVIEW OF CDPH ADMINISTRATION
OF THE LOCAL ASSISTANCE FUNDING
UNDER FUTURE PUBLIC HEALTH. CDPH
ADMINISTRATION OF THIS FUNDING
IS FACILITATED BY THE NEWLY
ESTABLISHED REGIONAL PUBLIC
HEALTH OFFICE. FUNDING IS
DISTRIBUTED TO EACH JURISDICTION
USING AN ALLOCATION METHODOLOGY,
WHICH INCLUDES A FOCUS ON
REDUCING HEALTH DISPARITIES WITH
A BASE GRANT OF THREE $150,000
FOR EACH JURISDICTION WITH THE
REMAINING BALANCE OF
APPROPRIATION PROVIDED TO LJ'S
PROPORTIONALLY, UM, UNDER A
FORMULA OF 50% POPULATION SIZE
25% BASED ON POPULATION AND
POVERTY AND 25. BASED ON
PROPORTION OF BLACK AFRICAN
AMERICAN LATINX, OR NATIVE
HAWAIIAN PACIFIC ISLANDER
POPULATION REQUIREMENTS INCLUDE
THAT AT LEAST 70% OF FUNDS MUST
BE DEDICATED TO THE SUPPORT OF
HIRING PERMANENT STAFF LIE.
CHASE HAD MADE STRONG PROGRESS
ON HIRING OVER 900 POSITIONS
HAVE BEEN FILLED IN
JURISDICTIONS ACROSS THE STATE,
REFLECTING 74% OF PLANNED HIRES.
ULTIMATELY FUTURE PUBLIC HEALTH
WOULD BE ADDING OVER 1200
POSITIONS TO THE LOCAL PUBLIC
HEALTH SYSTEM. HIGHLIGHTS SO FAR
INCLUDE 90 EPIDEMIOLOGISTS.
SHOULD PUBLIC HEALTH PHYSICIANS
AND NURSES 140 COMMUNITY HEALTH
WORKERS, ADDITIONALLY, OVER 500
STAFF HAVE BEEN HIRED IN ROLES
THAT INCLUDE A FOCUS ON
ADDRESSING HEALTH DISPARITIES
AND EQUITY STAFF ARE FOCUSED IN
MANY PROGRAM AREAS, INCLUDING
CHRONIC DISEASE INFECTIOUS
DISEASE ADMINISTRATION, PUBLIC
HEALTH LABS, FINANCE,
ENVIRONMENTAL, HEALTH, FAMILY
HEALTH AND PREPAREDNESS WITH THE
STAFFING PRIORITIES BASED ON THE
NEEDS OF EACH LOCAL HEALTH
JURISDICTION. JURISDICTIONS ARE
ALSO REQUIRED TO SUBMIT A THREE
YEAR PUBLIC HEALTH WORK PLAN.
INFORMED BY THEIR LOCAL
PRIORITIES, INCLUDING THEIR
COMMUNITY HEALTH ASSESSMENT AND
IMPROVEMENT PLAN AND STRATEGIC
PLAN. THESE WORK PLANS INCLUDE
AN EVALUATION APPROACH, METRICS
STAFFING PLAN AND PUBLIC HEALTH
FOCUS, DESCRIBING HOW THE PUBLIC
HEALTH ISSUES TO BE ADDRESSED
ARE ELEVATED FROM THEIR
COMMUNITY HEALTH ASSESSMENT
PROCESS AND ALIGN WITH THEIR
LOCAL HEALTH IMPROVEMENT PLANS
AND STATE HEALTH IMPROVEMENT
PLAN. THE PLAN SPECIFY
STRATEGIES FOR ACTION BASED ON
THE FOUNDATION OF PUBLIC HEALTH
SERVICES. THEY ALSO DESCRIBE HOW
L HÌ J S¼ WILL ACHIEVE KEY
REQUIREMENTS SUCH AS 24 7
HEALTHCARE OFFICER COVERAGE. THE
FIRST THREE YEAR WORK PLANS WERE
DUE AND FULLY APPROVED BY
DECEMBER 2020. THREE 100% OF
LOCAL HEALTH JURISDICTIONS HAVE
ALL SUCCESSFULLY SUBMITTED AND
NOW HAVE APPROVED WORK PLANS AND
SPEND PLANS FOR EVALUATION.
LOCAL HEALTH JURISDICTIONS ALSO
CONDUCT AN ANNUAL SELF
ASSESSMENT OF CAPACITY BASED ON
THE FOUND. OF PUBLIC HEALTH
SERVICES. THE FIRST SELF
ASSESSMENT ROLLED OUT FALL
WINTER 20 THREE 24 TO ESTABLISH
BASELINE CAPACITY AND THE NEXT
WILL BE CONDUCTED IN JUNE. 2024
TO ASSESS CHANGES AFTER THE
INITIAL IMPLEMENTATION OF FUTURE
PUBLIC HEALTH FUNDS. THE FUTURE
OF PUBLIC HEALTH IMPLEMENTATION
FRAMEWORK SUPPORTS BOTH
ALIGNMENT AND FLEXIBILITY. JUST
A FEW EXAMPLES OF THE DIVERSITY
OF LOCAL WORK AND ACTION INCLUDE
EVERYTHING FROM COLLABORATIONS
TO EXPAND IMMUNIZATION COVERAGE
FOR CHILDREN OF FARM WORKERS,
COMMUNITY EDUCATION ON DEMENTIA
CARE AND FALL PREVENTION.
QUALITY IMPROVEMENT TO DECREASE
OUTBREAKS IN SKILLED NURSING
FACILITIES, A NEW GENOMIC
SEQUENCING TEAM IDENTIFYING
HEPATITIS A OUTBREAKS
IMPROVEMENTS TO FISCAL AND
BILLING PROCESSES. ADDRESSING
PUBLIC HEALTH REACCREDITATION
REQUIREMENTS OR BUILDING A NEW
PUBLIC HEALTH LABORATORY
FACILITY. THE AVAILABILITY OF
SUSTAINABLE NON CATEGORICAL
FUNDING IN PUBLIC HEALTH
INFRASTRUCTURE ENABLES LOCAL
HEALTH JURISDICTIONS TO ADDRESS
ISSUES THAT ARE RELEVANT AND
MEANINGFUL TO THEIR UNIQUE
COMMUNITY NEEDS, WHILE ALSO
CONTRIBUTING TO COLLECTIVE
IMPACT AND ADDRESSING KEY GAPS
IN THE PUBLIC HEALTH SYSTEM.
ADDITIONAL PUBLIC HEALTH
WORKFORCE INVESTMENTS SUCH AS
THE CALIFORNIA PUBLIC HEALTH,
EQUITY AND READINESS OPPORTUNITY
OR HERO INITIATIVE, EFFECTIVELY
COMPLEMENT THE FUTURE PUBLIC
HEALTH INFRASTRUCTURE
INITIATIVE. A FEW HIGHLIGHTS OF
CURRENT IMPLEMENTATION REFLECTS
STRONG PARTICIPATION, OFTEN AT
DOUBLE THE RATES OF PRIOR YEAR
LEVELS IN THESE IMPORTANT
PROGRAMS TO PREPARE PUBLIC
HEALTH PROFESSIONALS IN KEY
ROLES. 56 CALIFORNIA
EPIDEMIOLOGIC INVESTIGATION
SERVICE FELLOWS WERE TRAINED
WITH A GOAL OF TRAINING 100
FELLOWS BY 2029 59, PUBLIC
HEALTH MICROBIOLOGIST TRAINEES
AND 18 LAVIS FIRE FELLOWS, WHICH
ARE BEING TRAINED TO AS FUTURE
PUBLIC HEALTH LAB DIRECTORS HAVE
BEEN TRAINED DURING THE FIRST
YEARS OF THIS PROGRAM.
ADDITIONALLY THE CALIFORNIA
PATHWAYS CALIFORNIA PATHWAYS
INTO PUBLIC HEALTH OR PATHWAYS
INITIATIVE PROVIDES TRAINING
SUPPORT AND HANDS ON WORK
EXPERIENCE TO COMMUNITY COLLEGE
AND UNIVERSITY STUDENTS WHO ARE
STUDYING PUBLIC HEALTH RELATED
DISCIPLINES. THROUGH THIS
PROGRAM, STUDENTS ARE OFFERED AN
OPPORTUNITY TO WORK AT LOCAL
HEALTH DEPARTMENTS ACROSS THE
STATE AND RECEIVE TRAINING,
PROFESSIONAL DEVELOPMENT AND
PAID WAGES. TWO COHORTS OF
FELLOWSHIPS HAVE PLACED 87
FELLOWS AT 37 LOCAL HEALTH
JURISDICTIONS ACROSS THE STATE.
MANY OF WHOM WENT ON TO ACCEPT
POSITIONS AT CALIFORNIA LOCAL
HEALTH DEPARTMENTS FOR EACH
COHORT MORE THAN 90% OF
PARTICIPANTS COME FROM
HISTORICALLY UNDERREPRESENTED
AND DIVERSE BACKGROUNDS,
INCLUDING FIRST GENERATION
COLLEGE STUDENTS, ABILITY TO
SPEAK ENGLISH, PLUS ANOTHER
LANGUAGE BELONGING TO A RACIAL,
ETHNIC MINORITY GROUP. L GB Tð Q
, PLUS IDENTITY LIVING WITH A
DISABILITY OR THOSE WHOSE
HIGHEST LEVEL OF SCHOOL
COMPLETION IS A HIGH SCHOOL
DIPLOMA, OR GE Dð, A HIGH
PERCENTAGE OF FELLOWS ARE PLACED
IN EITHER THEIR HOME COUNTY OR A
NEARBY COUNTY. TO REDUCE
RELOCATIONS AND INCREASE THE
POTENTIAL FOR ALUMNI RETAIN IN L
HÌ Dð POSITIONS IN THEIR
COMMUNITY. I KNOW THIS HAS BEEN
A LOT OF INFORMATION, AND IT IS
STILL A VERY HIGH LEVEL UPDATE
OF THE ACCOMPLISHMENTS TO DATE
AND PLANS GOING FORWARD FOR THE
FUTURE OF PUBLIC HEALTH. WE PLAN
TO KEEP THE LEGISLATURE UPDATED
ABOUT MILESTONES. WITH THIS
IMPORTANT INVESTMENT. THIS
INVESTMENT WOULD NOT HAVE BEEN
POSSIBLE WITHOUT THE
COLLABORATION AND SUPPORT OF THE
ASSEMBLY AND SENATE BUDGET
COMMITTEES AND STAFF AND WE'RE
TRULY GRATEFUL FOR THAT ONGOING
PARTNERSHIP. WE'D BE HAPPY TO
ADDRESS ANY QUESTIONS AND
CONTINUE IN DISCUSSION. THANK
YOU SO MUCH. THANK YOU SO MUCH.
I JUST HAVE ONE QUESTION HERE,
UM, REGARDING THE COMMUNICATIONS
PUBLIC EDUCATION TO PROMOTE
BEHAVIOR. THE REASON WHY I'M
ASKING BECAUSE THE DIRECTOR
MENTIONED THAT STROKE IS LEADING
AND DEATHS ACROSS CALIFORNIA.
ARE WE DOING ANY, UM, OUTREACH
COMMUNICATION AROUND STROKE? I'M
CERTAIN THAT WE ARE. I WOULD
LOVE TO BE ABLE TO GET MORE
DETAILED INFORMATION WHEN WE ARE
DOING HEALTH EDUCATION
INITIATIVES FOR èC Dð P HÌ. IT
HAPPENS BOTH THROUGH OUR PROGRAM
. SO WE HAVE PROGRAMS THAT FOCUS
ON VARIOUS CHRONIC DISEASES,
INCLUDING STROKE AND THEN OUR
COMMUNICATIONS APPARATUS THAT
HELPS WITH SOCIAL MEDIA AND
CAMPAIGNS. SO BE HAPPY TO GET
INFORMATION ABOUT WHAT WE'RE
DOING IN TERMS OF EDUCATION ON
STROKE. THANK YOU. THANK YOU.
AND THANK YOU FOR THAT OVERVIEW,
ALTHOUGH IT IS HARD TO FOLLOW SO
MUCH. I'M SORRY. UM, I. I JUST
WANT TO GO BACK TO THE HIRING
WE'RE DOING IN THE INVESTING IN
MENTAL HEALTH AND THE PLANS.
EVERYONE SUBMITTED A PLAN FOR A
WORK PLAN. AND WE'RE GONNA WHO
WHO REVIEWS THOSE PLANS. AND
THEN HOW DO WE USE THAT AS A
MEASUREMENT GOING FORWARD AND
ARE ALL THE PLANS DO THEY HAVE
SIMILAR DATA THAT WE CAN MEASURE
ACROSS? YES SO OUR REGIONAL
PUBLIC HEALTH OFFICE, WHICH IS
ONE OF THE, UM UM NEW
INITIATIVES ESTABLISHED AS A
STRUCTURE WITHIN THE DEPARTMENT.
THEY PROVIDE THE ADMINISTRATIVE
OVERSIGHT FOR THOSE PLANS, SO
THEY'LL BE REVIEWING ALL OF
THEM. THEY ARE ALL COLLECTING,
UM, CONSISTENT INFORMATION SO
THAT WE CAN HAVE COMPARISON AND
BE ABLE TO LOOK AT THE IMPACT OF
WHAT ARE THE ISSUE AREAS. WHAT
ARE THE TYPES OF, UM THE
DIFFERENT CLASSIFICATIONS THAT
ARE BEING ADDED TO PUBLIC HEALTH
WORKFORCE. AND WHAT ARE THE
STRATEGIES THAT ARE BEING
EMPLOYED? SO WE'RE, UM WE JUST
THOSE REPORTS THOSE WORK PLANS
WERE FINALIZED. DECEMBER WE ARE
PREPARING A SUMMARY OF THAT
WHICH IS GOING TO BE PUBLICLY
AVAILABLE LATER THIS MONTH. OK?
AND THEN THERE'LL BE ONGOING
REVIEWS. YES, ABSOLUTELY. THERE
IS ALSO A QUARTERLY, UM, THAT WE
ALSO RECEIVE IN ADDITION TO
THOSE THREE YEAR WORK PLANS,
QUARTERLY WORK PLAN AND SPENDING
PLAN MONITORING THAT WE DO WE
ALSO HAVE THROUGH THE REGIONAL
PUBLIC HEALTH OFFICE OFFICE
HOURS AVAILABLE FOR CONSULTATION
WITH LOCAL HEALTH JURISDICTIONS,
BOTH TO FOLLOW UP ON QUESTIONS,
BUT PRIMARILY TO SEE WHAT WE CAN
DO TO PROVIDE SUPPORT AND HOW WE
CAN LEARN FROM THE EFFORTS
UNDERWAY AT THE LOCAL HEALTH
JURISDICTIONS. THANK YOU. SEE
NOTHING FURTHER. ON OUR END.
WE'RE GOING TO MOVE OVER TO OUR
LOCAL HEALTH OFFICERS AND
REPRESENTATIVES NOW KICKING US
OFF AS THE COUNTY OF MADERA,
SARAH. AFTERNOON GOOD AFTERNOON.
I'M THE MEDORA COUNTY PUBLIC
HEALTH DIRECTOR. IT'S MY
PLEASURE TO BE HERE TODAY TO
SHARE WITH YOU THE IMPACT OF THE
FUTURE OF PUBLIC HEALTH
INVESTMENT IN MADERA COUNTY, THE
MADERA COUNTY DEPARTMENT OF
PUBLIC HEALTH INCLUDES
COMMUNICABLE DISEASE MITIGATION
AND CLINICS. PUBLIC HEALTH
LABORATORY IMMUNIZATION,
EMERGENCY PREPAREDNESS,
CHILDREN'S MEDICAL SERVICES,
MATERNAL CHILD ADOLESCENT
HEALTH, HOME VISITATION, W, I
AND COMMUNITY WELLNESS PROGRAMS
SUCH AS TOBACCO AND CAL. FRESH,
HEALTHY LIVING. MADERA COUNTY
RECEIVES AN ANNUAL ALLOCATION OF
JUST OVER 1.2 MILLION IN FUTURE
PUBLIC HEALTH. WITH THOSE
DOLLARS AT WORK, OUR DEPARTMENT
IS BETTER PREPARED FOR AN
EMERGENCY AND BETTER EQUIPPED TO
IMPROVE POPULATION HEALTH IN
ADDITION TO INVESTMENTS IN
COMMUNICABLE DISEASE, WE ARE
IMPLEMENTING INTERVENTIONS
DESIGNED TO IDENTIFY AND ADDRESS
CHRONIC CONDITIONS AND THAT
CONNECT PEOPLE WITH PRIMARY CARE
. SO WITHIN THE NEXT VIRUS
EMERGES, OUR POPULATION IS
HEALTHIER AND BETTER ABLE TO
AVOID ACUTE ILLNESS. WE FOCUSED
OUR FUTURE OF PUBLIC HEALTH. IN
MADERA EXCLUSIVELY ON STAFFING.
MUCH OF MADEIRA'S FIRST FUTURE
PUBLIC HEALTH WORK PLAN FOCUSES
ON KEY PLANS REQUIRED BY PUBLIC
HEALTH ACCREDITATION AND BY THE
FUNDING REQUIREMENTS. MADURO WAS
ACCREDITED IN FEBRUARY OF 2023.
SO WE WERE DUE FOR THE NEXT
ROUND OF THESE PLANS. SO OUR
COMMUNITY HEALTH ASSESSMENT WAS
PUBLISHED IN 2020 THREE AND WE
ARE WORKING ON PUBLISHING OUR
STRATEGIC PLAN AND COMMUNITY
HEALTH ASSESSMENT IN 2024. THIS
SPRING, WE HIRED PERMANENT STAFF
TO BE ABLE TO COMPLETE THESE
PLANS AND THE TEAM INCLUDED A
SECOND EPIDEMIOLOGIST FOR A
DEPARTMENT. WE HAVE NEVER BEFORE
HAD A SECOND EPIDEMIOLOGIST IN
MADERA, SO THAT'S SUPER EXCITING
. SO THIS EXPANDED OUR CAPACITY.
IT REALLY REVOLUTIONIZED OUR
ABILITY TO AN APPROACH TO OUR
COMMUNITY HEALTH ASSESSMENT IN
THIS ROUND HAVING THAT EXTRA
CAPACITY AND IS CERTAINLY
CONTRIBUTED TO THE QUALITY OF
OUR HEALTH IMPROVEMENT PLANNING.
UM IN OUR, UH, COMMUNITY HEALTH
ASSESSMENT IN THIS ROUND. I JUST
REALLY WANNA HIGHLIGHT HOW WE
HAVE PARTNERED WITH COMMUNITY
BASED ORGANIZATIONS WE WERE IN
JUST LITTLE MADERA COUNTY
160,000 POPULATION. WE DID
PRIMARY DATA COLLECTION AND
COLLABORATION WITH FOUR
COMMUNITY BASED ORGANIZATIONS
COLLECTING NEARLY 1700 SURVEYS,
11 DIFFERENT FOCUS GROUPS OR
DIFFERENT GEOGRAPHIC AREAS AND
TARGETING DIFFERENT POPULATIONS
AND 21. KEY INFORMANT
INTERVIEWS. BASED ON THAT WE
WORKED WITH OUR COALITION. UM,
WHICH IS CALLED L. WELL, MADERA
COUNTY, UM, THAT DATA AS WELL AS
THE EXPERTISE AND EXPERIENCE
ACROSS THAT COALITION, WHICH
INCLUDES COMMUNITY BASED
ORGANIZATIONS, OTHER AGENCIES
AND LEADERS ACROSS THE COMMUNITY
AND RESIDENTS TO BE ABLE TO
IDENTIFY KEY PRIORITIES FOR OUR
COMMUNITY. IN SELECTING THOSE
GOALS. UM, THE PARTNERSHIP WAS
REALLY THE COMMON PRACTICE THAT
HAD BEEN WELL ESTABLISHED LONG
BEFORE COVID BUT WAS CERTAINLY
TESTED DURING COVID. AND SO WE,
UM, CONTINUALLY INTERACTED WITH
THOSE COMMUNITY BASED
ORGANIZATIONS AND WITH THOSE
PARTNERS IN IDENTIFYING WHAT THE
KEY PRIORITIES WERE FOR MADERA
COUNTY. UM THEY LAND WE LANDED
ON DIABETES AND HEART DISEASE.
DOMESTIC VIOLENCE AND CHILD
ABUSE, SUBSTANCE USE DISORDER
AND ACCESS TO CARE. AND AS
EXAMPLE OF HOW WE HAVE BEGUN
IMPLEMENTING ON THOSE EFFORTS,
ACCESS TO HEALTHCARE IS A
PARTICULAR NEED IN CENTRAL
CALIFORNIA. AS YOU ALL KNOW, AND
MADERA COUNTY, HAVING LOST OUR
HOSPITAL. UM BUT WHAT'S OFTEN
LOST IN THE HIGHLIGHT OF THE
HOSPITAL KIND OF TRAGEDY AND
DISPARITY THAT HAS RESULTED IS
THAT OUR HEALTHCARE SYSTEM IN
CENTRAL CALIFORNIA WAS ALWAYS
PROBLEM A BIG PROBLEM AND WHEN
WE LOOK AT THE DATA, EACH OF OUR
HEALTHCARE PROVIDERS IS SERVING
BETWEEN 45% AND 50% MORE
PATIENTS PER PROVIDER IN
COMPARISON TO THE REST OF THE
STATE. AND SO IT'S REALLY
SOMETHING THAT WE'RE WORKING
REGIONALLY TO ADDRESS, AND WE'RE
CURRENTLY WORKING WITH SENATOR
CABALLERO AND ASSEMBLY MEMBER
SOA ON A PROPOSAL TO INCREASE
MEDICAL RATES SO THAT WE CAN
WORK UPSTREAM AND KEEP PEOPLE
OUT OF THE HOSPITAL. BUT WITH
THE, UM THE INVESTMENT IN OUR
EPIDEMIOLOGY IN THAT TEAM THAT'S
REALLY BEING ABLE TO LEAD THAT
EFFORT AROUND OUR CHILD AND OUR
CHIP. WE'RE ABLE TO TACKLE DATA
PROJECTS THAT WE'VE NEVER BEEN
ABLE TO. WE'RE LOOKING AT A
REGIONAL GAP ASSESSMENT AROUND
THAT HEALTH CARE CONTINUUM. WE
ARE ALSO IN THE PROCESS OF
DEVELOPING OUR NEW STRATEGIC
PLAN. IT INCLUDES EXTENSIVE
ASSESSMENT, INTERNAL AND
EXTERNAL AND THE FIRST TIME
WE'VE EVER DONE EQUITY
ASSESSMENT IN OUR DEPARTMENT AND
DEPARTMENTWIDE EQUITY TRAINING,
AND THAT'S BEING INCORPORATED
INTO THE GOALS OF OUR STRATEGIC
PLAN. I WANT TO HIGHLIGHT JUST A
COUPLE OF OTHER TEMPERATE THINGS
THAT WE WERE ABLE TO DO THAT
WERE TEAMS THAT WERE TEMPORARY
STAFFING THAT WE WERE ABLE TO
CONVERT TO PERMANENT STAFFING
AFTER COVID USING FUTURE PUBLIC
HEALTH, BUT IF YOU COULD START
WRAPPING UP AS WELL, PLEASE, IT
WAS WE ADDED AN INFORMATICS TEAM
, WHICH WAS DEPLOYED FIRST TO
MAKE OUR TESTING AND VACCINATION
, SMOOTH AND ABLE TO COLLECT ALL
THE DATA THAT YOU YOU'RE
INTERESTED IN FOR SURE, SOCHI
DATA AND ALL OF THE OTHER GREAT
DATA THAT REALLY HELPS US WITH
WORK FLOWS AND EFFICIENCIES. WE
HIRED A BILINGUAL MOBILE HEALTH
TEAM. THAT WAS, UM, INITIATED
FOR TESTING OF VACCINATION BUT
IS NOW BEING DEPLOYED ACROSS A
WHOLE HOST OF ISSUES AND
MOBILIZED TO DO WELLNESS CHECKS
IN ADDITION TO OTHER
COMMUNICABLE DISEASES, AND IS
THOU, THE CENTRAL HUB OF ONE
STOP SHOPS OF MANY, MANY
AGENCIES AND OTHER PARTNERS. WE
WERE JUST IN FAIRMEAD, A TINY
COMMUNITY THAT STRUGGLES WITH
TRANSPORTATION. WE BROUGHT ALL
OF THE 20 AGENCIES AND PARTNERS
TO THEM, AND THAT MOBILE HEALTH
TEAM IS THAT ANCHOR. UM, OR
COMMUNICATIONS @M
TO SUSTAIN AFTER COVID. UM WHICH
HAS JUST BEEN SO HUGE IN
REACHING IMPORTANT COMMUNITIES
THROUGH EVERYTHING FROM SOCIAL
MEDIA, VIDEO RADIO ALL OF THOSE
THINGS AND WE MAINTAIN THAT TEAM
FINAL THOUGHTS. FINAL THOUGHTS
ARE WE JUST REALLY APPRECIATE
HONESTLY HOW THIS IS
REVOLUTIONIZED OUR DEPARTMENT. I
CAN'T EMPHASIZE ENOUGH HOW
DIFFERENT OUR DEPARTMENT LOOKS
FROM BEFORE FUTURE OF PUBLIC
HEALTH AND WHAT IT LOOKS LIKE
NOW, AND I REACHED JUST REALLY
APPLAUD THE FORETHOUGHT OF THE
ADMINISTRATION. AND THE
LEGISLATION IN PUTTING THIS
FUNDING IN PLACE FOR PUBLIC
HEALTH. THANK YOU SO MUCH MOVING
TOWARDS THE RIVER, UH, RIVERSIDE
COUNTY PUBLIC HEALTH DIRECTOR
THANK YOU. GOOD AFTERNOON, CHAIR
AND MEMBERS. MY NAME IS KI¾M
SARWARI. I'M THE DIRECTOR OF
PUBLIC HEALTH FOR RIVERSIDE
COUNTY AND THE IMMEDIATE PAST
PRESIDENT OF THE COUNTY HEALTH
EXECUTIVES ASSOCIATION OF
CALIFORNIA OR G, A THANK YOU FOR
HAVING ME HERE TODAY. I WAS
GOING TO TALK ABOUT SOME OF THE
PROGRAMS WE HAVE, BUT THEY ARE
COVERED THOSE WE ALL HAVE
SIMILAR PROGRAMS IN OUR PUBLIC
HEALTH DEPARTMENTS, SO I'LL JUMP
RIGHT INTO THE FUTURE OF PUBLIC
HEALTH PIECE. COVID CLEARLY
HIGHLIGHTED THE IMPACTS OF
DECADES OF DISINVESTMENT IN
PUBLIC HEALTH INFRASTRUCTURE AND
THE INVESTMENTS THAT WERE MADE
PRIOR TO AND DURING COVID WERE
CATEGORICAL DISEASE SPECIFIC AND
TIME LIMITED THESE FUNDING
CHALLENGES MADE AND CONTINUE TO
MAKE IT DIFFICULT TO HAVE A
WORKFORCE THAT IS CROSS TRAINED
AND CAPABLE OF RESPONDING TO
EMERGENCIES. LIKE WILDFIRES,
FLOODS OR WORLDWIDE PANDEMIC AND
THIS IS WHY THE FUTURE PUBLIC
HEALTH FUNDING IS SO CRITICAL TO
MAINTAINING OUR PUBLIC HEALTH
WORKFORCE. THE FUNDING IS
FLEXIBLE AND ONGOING, SO WE CAN
HIRE THE POSITIONS WE NEED TO
SUPPORT OUR MOST VULNERABLE
COMMUNITIES AND ACCOMPLISH THE
WORK LAID OUT IN OUR COMMUNITY
HEALTH IMPROVEMENT PLANS ALSO
KNOWN AS OUR CHIP, I'M HAPPY TO
REPORT THAT WE'RE MAKING GREAT
STRIDES IN IMPROVING OUR PUBLIC
HEALTH INFRASTRUCTURE AND OUR
ABILITY TO EFFICIENTLY RESPOND
TO EMERGENCIES. WE ARE NOT WHERE
WE NEED TO BE, OF COURSE, BUT
WE'RE HEADED IN THE RIGHT
DIRECTION. AND MUCH OF THAT. IS
DUE TO THIS █200 MILLION OF
FUNDING THROUGH FUTURE PUBLIC
HEALTH TO LOCAL HEALTH
DEPARTMENTS IN RIVERSIDE COUNTY.
WE RECEIVE ALMOST $12 MILLION OF
FUNDING PER YEAR, WHICH IS
ALLOWED US TO HIRE BOTH NEW
POSITIONS AND TRANSITION
POSITIONS THAT WE HIRED DURING
COVID INTO PERMANENT. IN TOTAL.
WE'RE FUNDING 107 POSITIONS OR
78.5 F Tð WITH FUTURE PUBLIC
HEALTH FUNDING TO IMPROVE OUR
CAPACITY IN COMMUNICABLE DISEASE
RESPONSE, CHRONIC DISEASE AND
COMMUNITY HEALTH, INCLUDING
CLIMATE CHANGE, DATA,
MODERNIZATION REPORTING AND
ANALYSIS, EMERGENCY RESPONSE,
LABORATORY CAPACITY, OUTREACH
AND EDUCATION, PARTICULARLY TO
OUR MOST UNDER-RESOURCED
COMMUNITIES. WE'VE HIRED NURSES,
MICROBIOLOGISTS, EPIDEMIOLOGISTS
, COMMUNICABLE DISEASE
SPECIALIST COMMUNITY HEALTH
WORKERS, HEALTH EDUCATORS,
ACCOUNTANTS. LESS CAREERS AND
OTHERS, ALL WITH THE GOAL OF
SERVING OUR COMMUNITY, IMPROVING
THE OVERALL HEALTH OF OUR
RESIDENTS AND ENHANCING OUR
RESPONSE CAPABILITIES. AS OF
TODAY, WE FILLED 100 AND FOUR OF
THE 107 POSITIONS, OR 97.2% OF
THE 78.5 F Tð E S¼, SUPPORTED BY
THE FUTURE OF PUBLIC HEALTH
FUNDING, AND THE THREE REMAINING
POSITIONS ARE AN ACTIVE
RECRUITMENT. WITH THESE
ADDITIONAL STAFF IN PLACE. WE'RE
STARTING TO SEE RESULTS. OUR
OUTREACH TEAMS ATTENDED 610
EVENTS AND 17,249 COMMUNITY
MEMBERS RECEIVED HEALTH,
EDUCATION AND CONNECTION TO
PUBLIC HEALTH AND OTHER
RESOURCES WE DEVELOPED AND
EXPANDED DISEASE SURVEILLANCE
TEAM TO ENHANCE DISEASE
DETECTION AND REPORTING. AND AS
OF TODAY, APPROXIMATELY 99% OF
OUR TIER ONE DISEASES ARE
INVESTIGATED WITHIN THE REQUIRED
24 HOUR TIMEFRAME PREVIOUSLY,
THAT WAS 80 TO 85% WE CREATED
IMMUNIZATIONS, MOBILE TEAMS AND
DURING PRETEEN VACCINE WEEK IN
SCHOOL ENROLLMENT, WE OFFERED 48
CLINICS AND ADMINISTERED 8431
TOTAL DOSES OF VACCINE TO 7197
UNIQUE PATIENTS. UM, IN ADDITION
TO THE STAFFING SUPPORT, 30% OF
THE FUTURE OF PUBLIC HEALTH
DOLLARS CAN BE USED TO SUPPORT
EQUIPMENT. APPLIES TRAVEL AND
PROFESSIONAL SERVICES. SO IN
RIVERSIDE COUNTY, WE USE THESE
FUNDS TO PROVIDE TRAINING TO
STAFF PURCHASE EQUIPMENT TO
ENHANCE OUR IT. INFRASTRUCTURE
AND DATA STORAGE CAPACITY,
IMPLEMENT A LEAN PERFORMANCE
IMPROVEMENT PROCESS ACROSS THE
DEPARTMENT. AND CONTRACT WITH
THE CITY TO CONDUCT WASTEWATER
SURVEILLANCE TO FURTHER ENHANCE
OUR DISEASE DETECTION
CAPABILITIES. I DO WANT TO
ACKNOWLEDGE THAT ON A STATEWIDE
LEVEL, IT TOOK SOME TIME TO GET
THESE FUNDS INTO PLACE TO GET
THEM ACCEPTED THROUGH EACH OF
OUR BOARDS OF SUPERVISORS AND TO
HIRE THE STAFF, SO AS A RESULT,
THERE PROBABLY IS A SMALL AMOUNT
OF MONEY LEFT UNSPENT, AND WE
WOULD PROPOSE REPURPOSING THAT
THROUGH A PROPOSAL WE'RE CALLING
P AND A PATH. UM P N A PATH
WOULD SUPPORT LOCAL HEALTH
DEPARTMENT WORK AND DEVELOPING
THEIR COMMUNITY HEALTH
ASSESSMENTS AND THEIR COMMUNITY
HEALTH IMPROVEMENT PLANS. UM
THAT ARE NOW BEING SYNCHRONIZED
WITH THE NEW STATE REQUIREMENT,
HAVING A SYNCHRONIZED CYCLE OF
ASSESSMENT, SO I'D LIKE TO END
MY COMMENTS TODAY BY THANKING
THE COMMITTEE FOR THEIR SUPPORT
OF GOVERNMENTAL PUBLIC HEALTH.
THE FUTURE OF PUBLIC HEALTH
INVESTMENT IS IMPROVING PUBLIC
HEALTH INFRASTRUCTURE, AND BY
DOING THAT WE ARE SAVING LIVES,
IMPROVING COMMUNITIES AND
EXTENDING HEALTHY LIVING. THANK
YOU SO MUCH FOR YOUR TIME TODAY.
THANK YOU. JUST A QUICK QUESTION
WHEN YOU SAID THAT YOU'RE
PUTTING A REQUEST TO, UH UM
REPURPOSE SOME OF THAT FUNDING
TO YOUR BOARD OF SUPERVISORS, OR
YOU'RE ASKING THE STATE
DEPARTMENT. UM WE'RE ACTUALLY
WORKING WITH èC Dð P HÌ. OK
THANK YOU SO MUCH, UM, MOVING ON
TO OUR NEXT PANELIST, UM, A
DEPUTY HEALTH OFFICER FROM SANTA
CLARA COUNTY. THANK YOU. I'M UH
GOOD AFTERNOON, MADAM CHAIR AND
MEMBERS. I'M DOCTOR. SARAH
REDMAN, DEPUTY HEALTH OFFICER
FOR THE COUNTY OF SANTA CLARA
AND DIRECTOR OF OUR INFECTIOUS
DISEASE AND RESPONSE BRANCH. I'M
HERE ALSO ON BEHALF OF BOTH THE
COUNTY AND THE COUNTY HEALTH
EXECUTIVES ASSOCIATION OF
CALIFORNIA AND THE HEALTH
OFFICERS ASSOCIATION OF
CALIFORNIA WITH A SPECIFIC ASK
THAT WE SUSTAIN FUNDING FOR THE
CAL CONNECT SYSTEM, ALONG WITH
SUPPORT FOR CORE RESOURCES FOR
LOCAL PUBLIC HEALTH CAPACITY,
SUCH AS THE FUTURE FOR PUBLIC
HEALTH FUNDING. SO I HAD A
UNIQUE ROLE DURING THE COVID
PANDEMIC WITH SANTA CLARA COUNTY
DIRECTLY LEADING ELEMENTS OF OUR
CORE PUBLIC HEALTH RESPONSE,
INCLUDING OUR CONTACT TRACING
AND OUR OUTBREAK INVESTIGATION
WORK, SO I REMEMBER ACUTELY THE
PAINFUL EARLY DAYS WHEN WE IN
SANTA CLARA COUNTY WERE
REDIRECTING NEARLY EVERY
RESOURCE WE HAD TO BOTH PERFORM
THESE CORE PUBLIC HEALTH
ACTIVITIES AND TRY TO BUILD OUR
OWN SYSTEM FOR THE DATA THAT WE
NEEDED AND THE WORK WE NEEDED,
BUT WE STILL DIDN'T HAVE THE
SYSTEM. WE NEED TO TRACK EVEN
THE RELATIVELY FEW CASES OF
COVID WE HAD AT THAT POINT, WE
STRUGGLED TO CREATE OUR OWN
SYSTEMS ON PAPER OR IN
INDIVIDUAL MICROSOFT EXCEL
SPREADSHEETS AND FOUND WE
ULTIMATELY COULDN'T DO IT
OURSELVES WITHOUT A STATEWIDE CO
ORDINATED RESPONSE. THEN I
REMEMBER WHAT A GAME CHANGER CAL
CONNECT WAS WHEN IT FINALLY CAME
ALONG AND ALLOWED US THE ABILITY
TO VITAL PUBLIC HEALTH DATA
ASSIGNED WORK IN A TIMELY
FASHION. REACH OUT VIRTUALLY VIA
UM, SOFT PHONE OR TEXT AUTOMATE
COMPONENTS OF WHAT WE WERE DOING
, AND SHARE INFORMATION ACROSS
JURISDICTIONS. AND ULTIMATELY, I
HAVE NÓ DOUBT THAT THE CAL
CONNECT SYSTEM SAVED LIVES,
ESPECIALLY WHEN CASE RATES THEN
INCREASED BY ORDERS OF MAGNITUDE
AND WE SIMPLY COULDN'T HAVE KEPT
UP WITHOUT SOMETHING SO
STREAMLINED. CAL CONNECT
EFFICIENCY AND CAPABILITIES LED
US TO REDIRECT SAVED RESOURCES
TO OTHER EFFORTS LIKE
VACCINATION. IT MEANT WE COULD
OVERLAY ADVANCED ALGORITHMS AND
INTERACT WITH OTHER DATABASES,
WHICH HELPED US DO THINGS LIKE
IDENTIFY WHICH CASES AND
CONTACTS WERE VACCINATED OR
PREDICT WHICH CASES WOULD NEED A
CALL FROM SOMEONE WHO SPOKE
SPANISH OR STREAMLINED THE
REPORTS THAT WERE COMING IN FROM
SCHOOLS AND OTHER AGENCIES. IT
MEANT WE COULD FINALLY WORK
ACROSS JURISDICTION FOR SHARED
INVESTIGATION AND AVOID
DUPLICATING EFFORTS ACROSS THE
STATE. IT MEANT WE HAD A MODERN
SYSTEM TO LET US ANALYZE OUR
INVESTIGATION DATA TO ASSESS
QUALITY AND HIGHLIGHT NEW KEY
FINDINGS TO GUIDE POLICY
DECISIONS. WE COULD UPDATE THE
INFORMATION WE COLLECTED OR THE
RESOURCES WE WERE OFFERING
ALMOST OVERNIGHT, EVEN WHEN WE
WERE PEAKED AT A STAFF OF ABOUT
1000 STAFF AND VOLUNTEERS
UTILIZING THE SYSTEM, FOR
EXAMPLE, WE RECOGNIZED EARLY
THAT THROUGH OUR ANALYSIS THAT
BECAME CAPABLE IN CAL. THAT WE
WERE UNDER COLLECTING AND
INCOMPLETE COLLECTING SOCHI DATA
AND ALLOWED US TO USE THE SYSTEM
TO DEPLOY A TRAINING THAT
INCREASED STAFF'S ABILITY TO DO
SO AND THEREFORE HAVE MEANINGFUL
FINDINGS WITH RESPECT TO THESE
DATA. AND MOST IMPORTANTLY, WE
COULD DO MUCH MORE RAPIDLY OFF
LIFE SAVING INTERVENTIONS, AND I
EVEN REMEMBER A COUPLE OF
OCCASIONS WHERE OUR STAFF HAD TO
CALL 911 AND BRING EMERGENCY
MEDICAL ASSISTANCE TO OFFER LIFE
SAVING CARE TO A PATIENT THEY
REACH THROUGH CAL CONNECT AND
WITHOUT THE RAPID CASE
PROCESSING AND ASSIGNMENT SYSTEM
THAT ALLOWED IT, WE NEVER WOULD
HAVE REACHED THOSE CASES IN
TIME. NOW THIS BUILD WASN'T EASY
TO GO FROM NOTHING TO THE
FUNCTIONALITIES IN CAL CONNECT.
I JUST DESCRIBED TOOK MONTHS IN
SOME CASES YEARS AND INCLUDED
NOT ONLY THE SIGNIFICANT
INVESTMENT AT THE STATE LEVEL
THROUGH FEDERAL FUNDING, BUT AT
THE LOCAL LEVEL TO OFFER INPUT,
TEST CHANGES AND TRAIN OUR STAFF
, WHICH WE WOULD HAVE TO FIND
RESOURCES TO RECREATE AT THE
SYSTEM LAPSED. BUT NOW THAT WE
HAVE IT, WE'VE COME TO RELY ON
IT COMPLETELY. NOT JUST FOR
COVID, BUT FOR OX FOR EBOLA AND
MARBURG THREATS AND RIGHT NOW,
USING TO SUPPORT MEASLES
INVESTIGATIONS. WE ALSO KNOW
THAT SYPHILIS AND TUBERCULOSIS
ARE GROWING THREATS NOT ONLY IN
THE STATE, BUT ESPECIALLY IN
SANTA CLARA, WHERE WE ARE SEEING
THE HIGHEST RATE OF CONGENITAL
SYPHILIS IN GENERATIONS, AND A
20% INCREASE IN Tð B CASES IN
JUST THE LAST YEAR AND IS NOW
POISED TO BE READY TO SUPPORT US
WITH BOTH OF THOSE
INVESTIGATIONS AND AGAIN A GAME
CHANGING WAY, BECAUSE THE SYSTEM
IS SO ADAPTABLE AND WELL
DESIGNED FOR WHAT WE DO IN
PUBLIC HEALTH, THERE MAY EVEN BE
OTHER FUTURE USES FOR NON
INFECTIOUS DISEASES SUCH AS LEAD
POISONING, WHICH OF INTEREST TO
US AND COUNTY. SO I ASK
SPECIFICALLY TODAY IS THAT THE
LEGISLATOR, PLEASE REDIRECT
UNEXPENDED CDPH STATE OPERATION
FUNDS FROM THE 2022 AND 2020
THREE BUDGET ACT IN ORDER TO
SUSTAIN AND CONTINUE. CAL
CONNECT. THIS MAY INCLUDE FUNDS
THAT WERE DEDICATED TO DISEASE
SURVEILLANCE, READINESS,
RESPONSE AND RECOVERY AND
MAINTENANCE OF IT, OR STATE
FUTURE OF PUBLIC HEALTH FUNDS.
WE ALSO ASK THAT THE LEGISLATURE
AND ADMINISTRATION EXPLORE
FEDERAL ENHANCED LABORATORY
CAPACITY OR èC FUNDING THAT CAN
BE DEDICATED FOR CONTINUING THIS
SYSTEM WITHOUT SUSTAINING CAL. I
FEAR WE RISK TAKING A MAJOR STEP
BACKWARD AND UNDOING YEARS OF
PROGRESS WE MADE IN DISEASE
INVESTIGATION DURING THE ENDEMIC
. SO THANK YOU FOR YOUR
ATTENTION TO THIS ISSUE, AND
I'LL BE HAPPY TO ANSWER ANY
ADDITIONAL QUESTIONS. THANK YOU
SO MUCH. MOVING ON TO OUR NEXT
PANELIST. MANAGING DIRECTOR OF
POLICY CALIFORNIA èC, A èC, A
UH, GOOD MORNING, MADAM CHAIR
AND MEMBERS. RONALD COLEMAN
BAEZA, MANAGING DIRECTOR OF
POLICY FOR THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK, èC P.
SLEEPING IS A STATEWIDE POLICY
ADVOCACY ORGANIZATION THAT WORKS
CLOSELY IN PARTNERSHIP WITH
COMMUNITIES OF COLOR TO ADVANCE.
HEALTH EQUITY. èC P A HAS
HISTORICALLY ADVANCED POLICY
ADVOCACY FOCUSED ON PREVENTION
WITHIN PUBLIC HEALTH, BUT OUR
DEEPER PUBLIC HEALTH POLICY
PORTFOLIO WAS DEVELOPED AS A
RESULT OF THE COMMUNITY NEEDS
THAT BECAME APPARENT THE MOMENT
THE PANDEMIC BEGAN. èC P N HAS
BEEN FRUSTRATED WITH THE LACK OF
INVESTMENT TOWARDS PUBLIC HEALTH
IN OUR COMMUNITIES. WE
UNDERSTAND THAT PUBLIC HEALTH AT
ALL LEVELS OF GOVERNMENT HAS
BEEN UNDERFUNDED, WHICH HAS
RESULTED GENERAL UNDER
PREPAREDNESS TO RESPOND TO ANY
PUBLIC HEALTH EMERGENCY, HOWEVER
, WITH THE LIMITED DOLLARS THAT
HAVE BEEN AVAILABLE, WE ALSO
KNOW THAT HISTORICALLY SYSTEMIC
AND INSTITUTIONAL RACISM HAS
STRONGLY CONTRIBUTED TO THE LACK
OF ATTENTION, FUNDING AND
ENGAGEMENT BROADLY ACROSS OUR
COMMUNITIES OF COLOR FOR FAR TOO
LONG. OUR COMMUNITIES HAVE JUST
BEEN IGNORED. IT ACTUALLY WASN'T
JUST COVID-19. THAT WAS A PUBLIC
HEALTH CRISIS, RACISM AND THE
IMPACTS AND EFFECTS OF RACISM
ARE ALSO A PUBLIC HEALTH CRISIS
IN CALIFORNIA CONTINUES TO FALL
SHORT AT ACKNOWLEDGING THAT OR
ESTABLISHING TARGETED MECHANISM
FOCUSED ON RACIAL EQUITY FOR
SPECIFIC POPULATIONS. FROM THE
START OF THE PANDEMIC, THERE WAS
OFTEN NÓ SEAMLESS MECHANISM TO
DO OUTREACH AND EDUCATION
RELATED TO COVID-19 TO ALL
COMMUNITIES. LANGUAGE ACCESS
STANDARDS WERE COMPLETELY
IGNORED. CONTRACT TRACING WAS
COMPLETELY LIMITED, OR
NON-EXISTENT AND MANY LOCAL
PUBLIC HEALTH DEPARTMENTS HAD NÓ
WAY TO LINK WITH èC B Ó S¼,
WHO COULD SUPPORT THESE EFFORTS,
COMMUNITIES OF COLOR STRUGGLE TO
GET THE ACCURATE INFORMATION
NEEDED TO PROTECT THEMSELVES AND
THEIR FAMILIES, DESPITE THE WELL
DOCUMENTED RISK THAT THEY WERE
MOST BEING IMPACTED BY COVID-19
LACK OF DATA IN A INADEQUATE
DATA COLLECTION METHODS OFTEN
OBSCURED CONSEQUENTIAL HEALTH.
OUTCOMES AND DISPARITIES FOR
MANY COMMUNITIES, INCLUDING
INDIGENOUS AND MANY ASIAN
AMERICAN NATIVE HAWAIIAN PACIFIC
ISLANDER COMMUNITIES.
DISPARITIES WITHIN THESE
COMMUNITIES OFTEN GO UNREPORTED
OR SUBSUMED UNDER GENERAL
CATEGORIES THAT COULD BE BETTER
UNDERSTOOD. IF DISAGGREGATED AS
A RESULT, WE DON'T HAVE A FULL
PICTURE OF THE WAY DISPARITIES
IN EQUITIES ARE TRULY PLAYING
OUT IN OUR COMMUNITIES. WE DON'T
KNOW IF RACE WE DO KNOW THAT
RACE ITSELF DOES NOT LEAD TO
THESE DIFFERENCES, RATHER
SYSTEMIC RACISM IN HEALTHCARE
AND THROUGHOUT SOCIETY OF THE OF
THESE DISPARATE HEALTH OUTCOMES
FOR COMMUNITIES OF COLORS, AND
THESE DISPARITIES ARE OFTEN
INTERSECTIONAL DUE TO
OVERLAPPING EFFECTS OF SYSTEMIC
DISCRIMINATION OF SEX, GENDER,
IDENTITY, SEXUAL ORIENTATION OR
EVEN DISABILITY STATUS. AS WE
HEARD FROM èC Dð P HÌ. GIVEN
THE DEEP STRUCTURAL INEQUITIES
ACROSS COUNTIES AND AROUND THE
STATE. IT IS NOT SURPRISING THAT
THE DISPARITIES WE SEE IN HEALTH
OUTCOMES WERE GENERALLY MIRRORED
IN COVID-19 INFECTION RATES
RELATED MORBIDITY AND MORTALITY.
THIS WAS ALSO EVIDENT IN THE
HICCUPS CONNECTED WITH THE ROLL
OUT OF VACCINES TO COMMUNITIES
UNTIL AND PARTNERS STEPPED IN TO
PUSH THE STATE ON VACCINE EQUITY
TO ENSURE VACCINES WERE GOING TO
THE COMMUNITIES THAT NEEDED THEM
THE MOST BECAUSE OF TRANSITION
AND TRANSMISSION AND IMPACTS.
èC P RECOGNIZES THAT THE STATE
AND LOCAL GOVERNMENT WERE
STRUGGLING TO DO WHAT THEY CAN,
BUT THE INFRASTRUCTURE THEY WERE
WORKING OFF OF ALREADY DIDN'T
FOCUS ON THE MOST PRESSING NEEDS
FOR COMMUNITIES OF COLOR. MANY
PUBLIC HEALTH DEPARTMENTS DIDN'T
HAVE STRONG RELATIONSHIPS WITH
DIVERSE COMMUNITIES BEFORE THE
PANDEMIC, AND AGAIN IT WAS VERY
DIFFICULT, IF NOT NEARLY
IMPOSSIBLE FOR THEM TO DO THAT.
IN THE MIDST OF THE PANDEMIC. IT
TOOK èC P, A TWO TO THREE
MONTHS TO ACTUALLY SIT DOWN AND
GET A MEETING WITH èC Dð P HÌ
IN THE PANDEMIC. MANY
ORGANIZATIONS ALSO CITED LACK OF
TRUST WITH PUBLIC HEALTH
DEPARTMENTS DUE TO LACK OF
ENGAGEMENT AND LACK OF
REPRESENTATION WITHIN LOCAL
GOVERNMENTS. AS A RESULT, CBOS
WERE THE ONES TO STEP UP FOR
THEIR COMMUNITIES. èC B Ó S¼
EMPLOYS STAFF FOR FROM THEIR
COMMUNITIES THEY SERVE, UH THOSE
COMMUNITIES AND TRUSTED TO GET
OUT ACCURATE AND RELIABLE
INFORMATION IN A CULTURALLY
COMPETENT WAY IN LANGUAGE. èC B
Ó S¼ OFTEN USE TRAUMA INFORMED
APPROACH TO HELP EASE THE
BURDENS AS AN APPROACH TO
DELIVERING SERVICES OFTEN
MEETING PEOPLE WHERE THEY ARE.
THIS INCLUDED èC B Ó S¼ USING
TEAM BASED CARE MODELS,
SOMETIMES WORKING WITH PROVIDERS
OR MENTAL HEALTH PROFESSIONALS,
WHILE OFTEN ORGANIZING AND
HOSTING. MOBILE COVID-19 TESTING
AND VACCINATION SITES AROUND THE
STATE. èC B S¼ WERE RESPONSIBLE
FOR KEEPING COMMUNITY SOCIALLY
CONNECTED AND ENGAGED. WE SAW
FROM BRUTE'S COMMUNITY HEALTH
CENTER HOSTED WEEKLY BRIEFINGS
TO RAISE AWARENESS OF THE
COVID-19 IMPACTS IN BLACK
COMMUNITIES IN LOS ANGELES, A
COLLABORATIVE ASIAN AMERICAN
NATIVE HAWAIIAN PACIFIC ISLANDER
RESIDENTS USE THEIR èC W S¼ TO
CONDUCT OUTREACH AND EDUCATION
TO CONNECT RESIDENTS WITH RENTAL
AND FOOD ASSISTANCE CRITICALLY
NEEDED DUE TO LOST WAGES, WHILE
THEY ALSO ESTABLISH COVID-19 AND
VACCINATION SITES. WE ALSO SAW
MIXTE IN COMMUNITY ORGANIZING
PROJECT, MICO USE ITS RADIO
STATION, WHICH REACHES TENS OF
THOUSANDS OF INDIGENOUS LANGUAGE
SPEAKERS ACROSS CALIFORNIA TO
DISSEMINATE INFORMATION ABOUT
COVID-19. WE ALSO SAW GOOD MOVES
FROM LOCAL PUBLIC HEALTH AND
COUNTIES, WHO DID MOVE IN THE
RIGHT DIRECTION TO WORK TO
CENTER EQUITY, DEVELOP
COALITIONS AND TASK FORCES TO
ACTUALLY WORK IN PARTNERSHIP
WITH èC B Ó S¼, BUT MORE NEEDS
TO BE DONE. AS A RESULT OF WHAT
PLAYED OUT DURING THE PANDEMIC.
WE KNOW EXACTLY WHAT NEEDS TO
HAPPEN TO ENSURE OUR PUBLIC
HEALTH SYSTEM WORKS SEAMLESSLY.
WE SHOULD BE INVESTING FUNDING
AND RESOURCES TO CBOS. START
WRAPPING IT UP, PLEASE. WE
SHOULD BE INVESTING FUNDING THE
CLINICS, CBOS AND TRIBES TO
STRENGTHEN THEIR ROLE AS VITAL
PARTNERS TO MEETING COMMUNITY
NEEDS. èC P I AND PARTNERS
PROPOSED THE HEALTH EQUITY AND
RACIAL JUSTICE FUND, WHICH WOULD
HAVE DONE JUST THAT WOULD HAVE
CREATED A GRANT PROGRAM WITHIN
èC Dð P HÌ TO DELIVER GRANTS TO
COMMUNITIES TO MOVE COMMUNITY
PROJECTS AT THEIR DIRECTION,
PARTICULARLY ON HEALTH, EQUITY
AND RACIAL JUSTICE. WE ALSO BE
ACTIVELY ENGAGING COMMUNITY
PARTNERS AND ORGANIZATIONS.
THERE SHOULD BE STRONG
CONNECTIONS TO WORKFORCE
DEVELOPMENT, PARTICULARLY
THROUGH èC HÌ, èC HÌ W S¼. WE
WERE PLEASED TO SEE THE MEDICAL
BENEFIT ESTABLISHED THEM, BUT
REIMBURSEMENT RATES ARE A
APPARENTLY LOW, MAKING IT HARD
FOR THE PROGRAM TO GET OFF THE
GROUND. STATE AND LOCAL
GOVERNMENT SHOULD ALSO BUILD
CAPACITY AND PARTNERSHIPS WITH
GOVERNMENT INSTITUTIONS AND
COMMUNITY STAKEHOLDERS ON
COMMUNITY STRATEGIES, SUCH AS
ACTIVE LISTENING CULTURAL MELODY
. CULTURAL LINGUISTIC COMPETENCY
, ACKNOWLEDGING PAST WRONGS AND
FAILURES, AND, UM TECHNIQUES TO
BUILD RELATIONSHIPS AND
COMMUNITY. THE ONE THING THAT IS
GOING TO BE CRUCIALLY IMPORTANT,
MOVING FORWARD IS MAKING SURE
THAT WE CAN INVOLVE COMMUNITY IN
THE CONVERSATIONS AROUND PUBLIC
HEALTH COMMUNITY. PARTICIPATING
BUDGETING IS ABSOLUTELY
ESSENTIAL. THANK YOU. THANK YOU
SO MUCH, SIR. I MEAN, I
DEFINITELY AGREE. I MEAN, I WAS
ONE OF THOSE. I LED A TEAM IN A
IN A NONPROFIT IN MY DISTRICT ON
MOBILE CLINICS ON COMMUNITY
HEALTH WORKERS REACHING AND
KNOCKING ON DOORS IN MY DISTRICT
. SO I AGREE WITH YOU 100% ON
THAT NOW, IN FACT, I WAS, UH, A
LITTLE STAFFER BACK THEN AND ON
MY OWN, I WOULD HOLD WEEKLY
CALLS WITH DIFFERENT èC B Ó S¼
JUST TO GIVE INFORMATION BECAUSE
WE ALL KNOW IT WAS JUST
CONVOLUTED AND JUST EVERYONE WAS
JUST VERY CONFUSED IS A
PRESIDENT, CEO OF PUBLIC HEALTH
INSTITUTE. GOOD AFTERNOON,
CHAIRMAN OF OUR AND MEMBERS OF
THE COMMITTEE. MY NAME IS
MELISSA STAFFORD JONES. AND I AM
THE PRESIDENT AND CEO OF THE
PUBLIC HEALTH INSTITUTE. PH I
ADVANCES WELL BEING AND HEALTH
EQUITY WITH COMMUNITIES IN
CALIFORNIA, ACROSS THE COUNTRY
AT THE FEDERAL LEVEL AND IN
COUNTRIES AROUND THE WORLD. FOR
60 YEARS PH HAS SERVED AS A
CONVENER, COLLABORATOR AND
IMPLEMENTING PARTNER WITH THE
STATE OF CALIFORNIA, LOCAL
HEALTH JURISDICTIONS AND
COMMUNITIES AS WELL AS THE
FEDERAL GOVERNMENT IN OUR ROLE
AS A THOUGHT LEADER, CATALYST, A
TRUSTED PARTNER IN AN
INTERMEDIARY. OUR WORK INCLUDES
PROGRAM DESIGN IMPLEMENTATION,
GRANT MAKING, DATA
INFRASTRUCTURE AND ANALYSIS AND
RESEARCH AND EVALUATION. THANK
YOU FOR THE OPPORTUNITY TO SPEAK
TO YOU TODAY ABOUT THIS CRITICAL
WORK HAPPENING TO BUILD PUBLIC
HEALTH INFRASTRUCTURE THROUGH
THE FUTURE OF PUBLIC HEALTH.
ADDRESSING INEQUITIES AND
FOCUSING ON ROOT CAUSES ARE
CENTRAL AS WE ALL KNOW, TO THE
FIELD OF PUBLIC HEALTH. WE MAKE
THE MOST POWERFUL IMPACTS BY
FOCUSING ON PREVENTION AND ON
CREATING THE CONDITIONS FOR
HEALTH AND WELL BEING,
PARTICULARLY FOR THE MOST
UNDERSTOOD, SERVED. I WANTED TO
HIGHLIGHT TODAY THREE STRATEGIES
TO CONSIDER AS WE CONTINUE TO
ADVANCE THE WORK OF THE FUTURE
OF THE PUBLIC HEALTH. FIRST
CONTINUING TO STRENGTHEN THE
PUBLIC HEALTH, ECOSYSTEM AND
PARTNERSHIP. WHEN WE THINK OF
PUBLIC HEALTH, I THINK THERE'S A
VALUE AND RECOGNIZING THAT IT IS
AN ECOSYSTEM THAT INCLUDES
GOVERNMENTAL PUBLIC HEALTH AT
THE NATIONAL, STATE AND LOCAL
LEVELS, AS WELL AS COMMUNITY
BASED ORGANIZATIONS AND SERVICES
AND COMMUNITIES THEMSELVES. EACH
PART OF THE SYSTEM HAS
PARTICULAR ROLES, CAPABILITIES
AND STRENGTHS THAT CAN BE
DEPLOYED IN OUR COLLECTIVE
EFFORTS. FOR EXAMPLE, THE FUTURE
OF PUBLIC HEALTH EFFORT ON LOCAL
COMMUNITY PLANNING PROCESSES
THAT REALLY ENGAGE THE COMMUNITY
AND INTEGRATE THEM INTO THAT
WORK, I THINK IS A REFLECTION OF
THIS ECOSYSTEM APPROACH THAT WE
THINK IS CRITICAL AND BUILDING
INFRASTRUCTURE AND SUSTAINING
INVESTMENT FOR EACH PART OF THAT
SYSTEM, AND FOR THOSE COMPONENT
PARTS TO WORK TOGETHER IN
PARTNERSHIP IS CRITICAL WHEN
EACH PART OF THE SYSTEM HAS THE
INFRASTRUCTURE APPROPRIATE
RESOURCE IS WORKFORCE AND
CAPABILITIES THAT NEEDS WE CAN
BEST IMPROVED HEALTH AND EQUITY
FOR CALIFORNIANS. SECOND WE
WOULD SUGGEST REALLY
PRIORITIZING THE ROLE OF
COMMUNITIES AND IN A PARTICULAR
WAY. THE FUTURE PUBLIC HEALTH
PILLARS INCLUDE A VITAL FOCUS ON
COMMUNITY PARTNERSHIP AND
COMMUNITY HEALTH IMPROVEMENT,
WHICH WE HEARD ABOUT AS
ESSENTIAL COMPONENTS OF PUBLIC
HEALTH INFRASTRUCTURE. ADVANCING
EQUITY NECESSARILY INVOLVES
SHIFTING POWER. INCLUDING TWO
COMMUNITIES, WHICH IS ALSO
CRITICAL TO REBUILD TRUST IN THE
PUBLIC HEALTH ECOSYSTEM WE SAW
DURING COVID AS LIKE. WE JUST
HEARD FROM MY COLLEAGUE, THE
EFFECTIVENESS OF INVESTING AND
FOCUSING ON EFFORTS AT THE
COMMUNITY LEVEL THROUGH TRUSTED
COMMUNITY BASED ORGANIZATIONS
AND PARTNERS. FOR EXAMPLE, P H.
I S TOGETHER TOWARD HEALTH
WORKED CLOSELY WITH 548 CBOS TO
REACH MORE THAN 27 MILLION OF
OUR MOST UNDERSERVED
CALIFORNIANS. THEY'RE TRUSTED
MESSENGER MODEL CONNECTED JUST
SHY OF 1 MILLION COMMUNITY
MEMBERS TO VACCINES AND
SUPPORTED MORE THAN 250,000 WITH
WORKFORCE DEVELOPMENT
OPPORTUNITIES. WORKING IN CLOSE
PARTNERSHIP WITH TRUSTED CBOS
AND COMMUNITY LED ORGANIZATIONS
IN CONCERT WITH GOVERNMENTAL
PUBLIC HEALTH IS VITAL TO
ACHIEVING OUR PUBLIC HEALTH
GOALS. OUR RECOMMENDATION IS
THAT FUTURE PUBLIC HEALTH
INVESTMENTS SHOULD PRIORITIZE
INFRASTRUCTURE FOR AUTHENTIC,
MEANINGFUL COMMUNITY PARTNERSHIP
THAT IS ONGOING AND SUSTAINABLY
FUNDED AND NOT ONLY IN RESPONSE
TO A PARTICULAR EMERGING ISSUE
OR PARTICULAR PRIORITY, AND WE
HEARD SOME EXAMPLES. I THINK OF,
PERHAPS THE WAY WE ARE STARTING
TO MOVE IN THAT DIRECTION, AND
WE WOULD REALLY ENCOURAGED THIS
DEVELOPMENT OF INFRASTRUCTURE
INVESTMENT AND PRIORITIZATION OF
COMMUNITY ENGAGEMENT IN THE WORK
OF PUBLIC HEALTH. THIRD AND LAST
IS FOCUSING ON INTEGRATING
PUBLIC HEALTH INTO THE OVERALL
HEALTH SYSTEM. I'VE BEEN VERY
FORTUNATE TO WORK ACROSS
MULTIPLE SYSTEMS, INCLUDING
SAFETY, NET HEALTH CARE AND
FINANCING AT THE COMMUNITY LEVEL
IN TERMS OF DIFFERENT SERVICES
AND SUPPORTS AND AT ALL LEVELS
OF GOVERNMENT, AND SO I REALLY
APPRECIATE CALIFORNIA'S
LEADERSHIP RIGHT NOW, IN THE
WAYS IN WHICH WE ARE TRYING TO
THINK ABOUT HOW PUBLIC HEALTH
AND THE SOCIAL DETERMINANTS OF
HEALTH AND THE HEALTH CARE
SYSTEM CAN BE MORE INTEGRATED. I
WANT TO REALLY EMPHASIZE THAT AS
A RECOMMENDATION AT PRIORITY,
AND I THINK SENATOR EDMONDS
COMMENTS EARLIER AROUND THE
CONNECTION BETWEEN HOSPITALS AND
PUBLIC HEALTH WAS REALLY
IMPORTANT IN THIS SPACE. WE HAVE
A TREMENDOUS OPPORTUNITY IN
CALIFORNIA TO INTEGRATE PUBLIC
HEALTH AND HEALTH CARE. TO
SUPPORT AND RESOURCE THE PUBLIC
HEALTH SYSTEM WITH THE HEALTH
CARE DELIVERY AND FINANCING
SYSTEM, PARTICULARLY IN MEDICAL,
GIVEN THE EMPHASIS OF COLLEEN
AND I'M REALLY THINKING ABOUT
SOCIAL DETERMINANTS OF HEALTH
COMMUNITY SUPPORTS AND
PREVENTION AND YOU MAY HAVE SEEN
EARLIER THIS WEEK ACTUALLY, A
NATIONAL COALITION OF HOSPITALS,
PHYSICIANS, HEALTH PLANS AND
KAISER PERMANENTE. ANNOUNCED A
NEW EFFORT TO ADVANCE THE VISION
OF BETTER HEALTH BY
COLLABORATING WITH AND
SUPPORTING PUBLIC HEALTH,
BRINGING PUBLIC HEALTH MORE
EXPLICITLY INTO THE VISION AND
STRUCTURES FOR HEALTHCARE
DELIVERY AND FINANCING, WHICH
STRENGTHEN CALIFORNIA'S EFFORTS
TO INCREASE EARLY AND UPFRONT
PREVENTION. GIVE US YOUR FINAL
THOUGHTS AT THE INDIVIDUAL
COMMUNITY LEVEL, CONNECT THE
DOTS BETWEEN PUBLIC HEALTH AND
HEALTH CARE. AND BUILD
INTENTIONAL CROSS SECTOR
STRATEGIES FOR REDUCING HEALTH
DISPARITIES. THANK YOU FOR THE
OPPORTUNITY TO SPEAK TODAY.
THANK YOU SO MUCH, ELIO. YOU'RE
NOT EVEN I DON'T KNOW IF WELL,
IF YOU HAVE ANYTHING TO ADD TO
THIS. CAN YOU HEAR ME? ALL
RIGHT, GREAT. YES SO WILL ON
WITH THE LEGISLATIVE ANALYST'S
OFFICE, SO WE HAVE NOTHING IN
PARTICULAR TO ADD TO THE FUTURE
PUBLIC HEALTH. I THINK THERE
WERE A COUPLE OF NOTES FROM SOME
OF THE PANELISTS ON POTENTIAL
FUTURE GENERAL FUND SUPPLEMENTS
ALL THAT TO SAY GIVEN THE BUDGET
CONDITION THE LEGISLATURE, WE
WOULD RECOMMEND WEIGH THOSE
AGAINST OTHER LEGISLATIVE
PRIORITIES THAT BEING SAID. OUR
OFFICE HAS WORKED IDENTIFY A
NUMBER OF ONE TIME AND TEMPORARY
SPENDING ITEMS THAT THE
LEGISLATURE MAY WISH TO CONSIDER
, UM, AND WOULD NEED TO WORK
WITH TWO. THEN, UM PROVIDE FOR
THESE GENERAL FUND, OTHER
ADDITIONAL GENERAL FUND
AUGMENTATIONS THAT BEING SAID,
WE'RE AVAILABLE AND READY TO
WORK WITH THE COMMITTEE TO
ASSIST IN IDENTIFYING THOSE
THANK YOU. WELL BEFORE YOU LEAVE
ANYTHING OFF THE TOP OF YOUR
HEAD THAT YOU ARE ON YOUR LIST
OF THOSE ONE TIME WITHIN HIS
FACE. YES. ONE MOMENT. SORRY.
YES SO, UM, THERE ARE A NUMBER
OF ONE TIME SPENDING ITEMS FROM
PRIOR BUDGET X THAT WORK CARRIED
OVER INTO THE CURRENT BUDGET
YEAR. A NUMBER INCLUDE SPENDING
ON PORTIONS OF FUTURE OF PUBLIC
HEALTH FUNDING, AS WELL AS
SPENDING FOR A NUMBER OF, UH,
RELATED SYSTEMS. AND AS WELL, I
BELIEVE AS SOME ADDITIONAL
FUNDING FROM THE CHILDREN'S
BEHAVIOR HEALTH INITIATIVE. THAT
WENT TO THE DEPARTMENT OF PUBLIC
HEALTH. THAT BEING SAID, WE CAN
ABSOLUTELY FOLLOW UP WITH A FULL
COMPLETE LIST AND THEN IDENTIFY
THOSE THAT WE HAVE. I THINK I'VE
ALSO BEEN TRYING TO REALLY PIN
ON HOW MUCH WE HAVE IN THE C Y B
H I FUNDING LEFT. ABSOLUTELY
THERE'S NOT ONLY IS THEIR
CURRENT FUNDING THAT HAS BEEN
CARRIED OVER BUT THERE IS A
RIGHT NOW PLAN FUTURE.
CHILDREN'S BEHAVIORAL HEALTH
INITIATIVE, FUNDING FOR THE
BUDGET YEAR AND BEYOND. THAT
WILL GO TO SEE PH AND WE CAN
HELP IDENTIFY AND WORK WITH THE
COMMITTEE ON THOSE THANK YOU.
DEPARTMENT FINANCE. WOULD YOU
LIKE TO ADD ANYTHING? YOU CAN
SHAKE YOUR HEAD. NO. IF THERE'S
NOTHING, OKAY? YEAH I HAVE TO
WALK OVER HERE. OKAY? UM, JUST I
HAVE THREE QUESTIONS. WHAT? ONE
COMMENT. I JUST FIRST WANT TO
SAY I MEAN, THIS IS WHAT HAPPENS
WHEN WE REALLY AND INVEST IN
WORKFORCE, RIGHT? I THINK WE'VE
BEEN SAYING THIS FOR A LONG
TIME. I MEAN, THIS IS JUST PROOF
OF HOW MUCH I'VE HEARD THE
NUMBERS THAT YOU SHARED. WE'RE
ALMOST CLOSE TO LIKE 95% ON
ALMOST EVERY SINGLE ONE THAT
WE'VE INVESTED IN. REALLY,
REALLY CLOSE ONE OR COUPLE OF
LEFT, RIGHT? SO NOT NOT BAD
INVESTMENT. TWO QUESTIONS I HAVE
IS. I FORGOT WHO MENTIONED
DIABETES. AND IT REMINDED ME AND
I WISH THE DIRECTOR WAS STILL
HERE. DIABETES IS SUCH A HUGE
PROBLEM IN THE LATINO COMMUNITY,
THE BIPOD COMMUNITY AS A WHOLE,
AND IT CONTINUES TO RISE AND IT
COMES UP AND EVERY CONVERSATION
THAT I HAVE IN MY DISTRICT WITH
ANY CLINICS. COUNTIES DPH SEED
PH. WHAT ARE WE DOING AROUND
BECAUSE THE INCREASE OF DIABETES
AND HIGH BLOOD PRESSURE AND OUR
BIBLE COMMUNITIES IN MADERA
COUNTY. WE'RE REALLY LOOKING AT
THE MORE EXTREME MEASURES, SO I
WAS THE ONE WHO MENTIONED
DIABETES AND HER DISEASES
WHENEVER PRIORITIES AND ONE OF
THE THINGS IN OUR COMMITTEE
HEALTH AND PREVENT PLAN IS OUR
COALITION MADE A COMMITMENT TO
REALLY FOCUSING OUR EFFORTS
UPSTREAM. THERE ARE LOTS OF
PROGRAMS LIKE DIABETES
PREVENTION PROGRAM, FOR INSTANCE
, THAT ARE EXPANDING, AND WE
HAVE THAT CAPACITY IN OUR
DEPARTMENT WHERE WE'RE
CONTINUING TO PROVIDE INDIVIDUAL
PATIENTS WITH WITH CARE TO BE
ABLE TO PREVENT IT, BUT UNTIL WE
ADDRESS THE UPSTREAM FACTORS OF
OUR ECOSYSTEM AROUND HEALTHY
EATING AND PHYSICAL ACTIVITY IS
GOING TO CONTINUE TO BE AN ISSUE
ACROSS OUR POPULATION, AND
ESPECIALLY OUR HISPANIC BIPAC,
POPULATIONS AND COMMUNITIES THAT
DON'T HAVE THE SAME.
OPPORTUNITIES THEY THEY'RE
LIVING WITH A GROCERY STORE.
THAT'S MORE LIKE A CONVENIENCE
STORE. AND THEIR NEIGHBORHOODS
ARE NOT SAFE TO BE ABLE TO GET
OUT. SEASIDE ACTIVE
TRANSPORTATION IS NOT AN OPTION.
AND SO THOSE ARE AREAS WHICH
WERE LEANING IN SO WE, FOR
EXAMPLE, ENGAGE OUR RESIDENTS IN
WALK AUDITS OF THEIR
NEIGHBORHOODS, AND WE WORK WITH
THE CITY TO BE ABLE TO FIX
INTERSECTIONS SO KIDS CAN WALK
TO SCHOOL AND WERE CONSISTENTLY
ADDING ADDITIONAL OPPORTUNITIES
FOR PEOPLE TO ACCESS ROUTES AND
VEGETABLES, GARDENING PROJECTS,
AND WE'RE IN THE PROCESS RIGHT
NOW OF PLANNING A COMMUNITY
GARDEN. I MEAN, IT REMINDS ME OF
THE CAL FRESH PILOT PROGRAM,
RIGHT? I MEAN ADDITIONAL REFUNDS
FOR FRUITS AND VEGETABLES.
VOUCHERS FOR FARMERS MARKETS.
EXACTLY WOULD YOU LIKE TO ADD
SOMETHING TO THAT CHAIR AND WE
HAVE OF SANTA CLARA COUNTY? I
THINK, JUST AS MISS FOSS WAS
DESCRIBING FROM MADEIRA, WHAT
WE'VE FOUND IS WE NEED TO BE
PARTNERING CLOSELY WITH OUR
HEALTHCARE DELIVERY PARTNERS IN
IDENTIFYING PREDIABETES,
ENSURING PEOPLE HAVE THE
TREATMENT AND PREVENTIVE
SERVICES. THEY NEED THESE KINDS
OF CROSS CUTTING UPSTREAM
FACTORS. DO YOU HAVE A SAFE
PLACE TO EXERCISE? DO YOU
UNDERSTAND AND HAVE ACCESS TO
THE FOOD THAT WILL HELP PREVENT
DIABETES. DO WE HAVE POLICIES
THAT MAKE THOSE FOODS AND SAFE
ACTIVITIES AFFORDABLE TO YOU?
THE KINDS OF CROSS CUTTING STAFF
WE NEED TO DO THAT WAS ALMOST
IMPOSSIBLE PRIOR TO FUTURE OF
PUBLIC HEALTH BECAUSE WE OFTEN
NEEDED SOMEBODY WHO COULD ONLY
FOCUS ON FOOD BECAUSE THERE WAS
A FOOD RELATED FUNDING STREAM
COULD ONLY FOCUS ON
TRANSPORTATION BECAUSE THERE WAS
A TRANSPORTATION RELATED FUNDING
STREAM. NOW THAT WE'RE ABLE TO
HIRE CROSS CUTTING STAFF WHO MAY
BE ABLE TO MANAGE CONTRACTS IN
ANY OF THOSE AREAS OR GAIN THEIR
OWN EXPERTISE IN ANY OF THOSE
AREAS WERE ABLE TO MUCH MORE
EASILY HAVE THOSE HOLISTIC
CONVERSATIONS WITH THE
COMMUNITIES IMPACTED AND THEN
BRING THEM WHICHEVER PIECES MOST
PRESSING TO THEM IN MOST
IMPORTANT OKAY? OUR PUBLIC
HEALTH HAS TAKEN US TO THE
STREETS. I KNOW SOME SOMEONE
MENTIONED ALSO MOBILE TEAMS, AND
I KNOW THAT IT IS REALLY
LITERALLY THE FUTURE OF PUBLIC
HEALTH. WHAT ARE THEIR
INVESTMENT IN EXPANDING THIS
COUNTYWIDE STATEWIDE? SO, MADAM
CHAIR. I DID MENTION MOBILE
TEAMS IN MY COMMENTS, AND WE
HAVE ACTUALLY RESHAPED THE WAY
WE HAVE DONE PUBLIC HEALTH.
TRADITIONALLY PUBLIC HEALTH
DISEASE INVESTIGATIONS INVOLVED
A LOT OF FIELDWORK AND GOING
INTO COMMUNITY. WE REALLY
LOOKING IN DEPTH ACROSS ALL OF
OUR PROGRAMS. TWO EXAMPLES I
WOULD OFFER FOR YOU OUR
IMMUNIZATION TEAMS WHERE WE'RE
ACTUALLY LOOKING AT THINGS LIKE
HEALTHY PLACES. INDEX DATA.
WHERE ARE WE SEEING THE MOST
UNDER RESOURCED COMMUNITIES
OVERLAYING THAT WITH WHERE WE
KNOW OUR IMMUNIZATION RATES ARE
LOW AND THEN GOING INTO
COMMUNITIES, COMMUNITY CENTERS,
SCHOOLS, CHURCHES, PLACES WHERE
PEOPLE NATURALLY GATHER AND
OFFERING VACCINES SO THAT WE CAN
TRY TO RAISE VACCINATION RATES.
AND WHILE WE'RE THERE OFFER,
ALSO BRINGING WICK STAFF AND
MATERNAL CHILD ADOLESCENT HEALTH
STAFF. WE CAN GET PEOPLE
ENROLLED IN HOME VISITATION
PROGRAMS OR OTHER VOUCHER
PROGRAMS SO THAT THEY CAN GET
SERVICES THEY NEED IN THE
COMMUNITIES THEY LIVE IN. AND
THEN THE OTHER ONE THAT I
MENTIONED BRIEFLY IN MY COMMENTS
WAS OUR EQUITY MOBILE TEAMS. WE
HAVE TEAMS OF ABOUT FOUR PEOPLE
FROM PUBLIC HEALTH, AND WE
PULLED IN ANOTHER COUNTY
DEPARTMENTS AND SO THEY ARE
ACTUALLY EMBEDDED IN THE
COMMUNITY, KNOWN BY THE
COMMUNITIES BY OUR COMMUNITY
BASED ORGANIZATIONS ARE FAITH
BASED COMMUNITY FOLKS SO THAT
THEY ALSO SERVE AS A RESOURCE TO
CONNECT PEOPLE TO SERVICES AND
HELP THEM NAVIGATE. WHAT IS
SOMETIMES BUREAUCRACY RIGHT TO
GET THE SERVICES THEY NEED. I
THINK THAT FUTURE OF PUBLIC
HEALTH FUNDING IS REALLY HELPED
SHIFT US TO THINK THAT WAY ABOUT
TAKING SERVICES INTO THE
COMMUNITY, AND PARTICULARLY INTO
THOSE UNDER RESOURCED
COMMUNITIES THAT NEED THEM THE
MOST. WE'RE DOING A SIMILAR
THING IN MADERA COUNTY, AND I
JUST WANT TO HIGHLIGHT HOW
DIFFICULT IT IS TO DO THAT, UM,
COORDINATED, HOLISTIC MOBILE
KIND OF EFFORT USING CATEGORICAL
FUNDING STREAMS BECAUSE OF THE
REQUIREMENTS. HOW DO YOU CHOP UP
THOSE INDIVIDUAL PEOPLE INTO
DIFFERENT FUNDING POTS? AND SO
BECAUSE FUTURE PUBLIC HEALTH IS
SO FLEXIBLE, WERE ABLE TO PUT
THAT COURT TEAM TOGETHER AND
THEN WE CAN BRING IN THOSE
INDIVIDUALS FROM THE OTHER
CATEGORICAL FUNDS TO SUPPLEMENT
THAT BEFORE THIS, YOU COULDN'T
DO THAT. IT WAS VERY, VERY
DIFFICULT. IT WAS BASICALLY A
FUNDING NIGHTMARE ON THE BACK
END. AND WE WERE CONSTANTLY
FIGURING OUT HOW DO WE ACTUALLY
WEAVE THAT INTO THE SCOPES OF
WORK WHEN THIS COUPLE TRYING TO
FIT A ROUND PEG IN A SQUARE
HOLE? OKAY? COLLEAGUES ANY
FURTHER QUESTIONS, SENATOR ROCK
THANK YOU, MADAM CHAIR. I'M JUST
CURIOUS, PARTICULARLY FOR THE
REPRESENTATIVE FROM A
PARTICIPANT FROM THE CENTRAL
VALLEY. YOU KNOW, WE'VE TRIED
OUR BEST HERE TO IMPROVE THE
OVERALL HEALTH OF OUR POPULATION
, EXPLAINED COLLEAGUES EXPANDING
MEDICARE, AL RATHER DRAMATIC
WAY. UNFORTUNATELY AT LEAST IT'S
MY PERCEPTION THAT FOR MANY
COMMUNITIES AND CERTAINLY
CERTAIN SEGMENTS OF THOSE
COMMUNITIES, THE INITIAL POINT
OF ENTRY INTO OUR HEALTH CARE
CENTER SYSTEM HAS BEEN OUR
HOSPITAL EMERGENCY DEPARTMENTS
AND IN THE CENTRAL VALLEY WHERE
WE THE LAND OF CHALLENGED
HOSPITALS. I THINK I WOULD SAY,
ARE WE MAKING ANY HEADWAY IN
TERMS OF UM REDIRECTING THE
POPULATION TO OUR CLINIC SYSTEM.
WE TALK. WE'VE BEEN TALKING
ABOUT MOBILE SERVICES. AND OF
COURSE, THAT'S WONDERFUL. BUT
YOU KNOW, WE HAVE A SYSTEM OF
CLINICS IN THE STATE AND OTHER
OFFICE BASED DELIVERY SYSTEMS
OTHER THAN THE EMERGENCY
DEPARTMENT THAT HAVEN'T BEEN
UTILIZED QUITE AS HEAVILY AS THE
EMERGENCY DEPARTMENT. ARE WE
MAKING PROGRESS AND REDIRECTING
OUR POPULATION? UM TO THE
CLINICS EARLY AND OFTEN TO TRY
TO CATCH PEOPLE BEFORE THEY NEED
EMERGENCY SERVICES. IS THAT A
FAIR QUESTION? YES IT IS A FAIR
QUESTION WITHIN THE
INFRASTRUCTURE THAT WE HAVE
AVAILABLE OR MAKING AS MUCH
PROGRESS AS WE CAN. SO I CAN SAY
IN MADERA COUNTY. THEY DON'T
HAVE AN EMERGENCY DEPARTMENT.
THEY'RE FORCED TO NOW LEARN WHEN
IT'S APPROPRIATE TO USE URGENT
CARE, BUT OUR MOBILE TEAM, ONE
OF THE CORE THINGS THAT WE DO IS
WE DO WELLNESS CHECKS, AND WE
PROVIDE THE SERVICES THAT ARE
ABOUT PUBLIC HEALTH. THE REASON
WE'RE DOING WELLNESS CHECKS IS
WE'RE WANTING TO IDENTIFY IF
THEY HAVE HIGH BLOOD SUGAR OR
HIGH BLOOD PRESSURE AND GET THEM
CONNECTED AND HELP THEM
UNDERSTAND. LIKE WHO IS YOUR
MEDICAL PROVIDER? DO YOU KNOW
HOW TO GET AHOLD OF THEM? DO YOU
KNOW HOW TO SCHEDULE AN
APPOINTMENT CAN GETTING THEM
CONNECTED? ENROLLED IF THEY'RE
NOT ENROLLED IN MEDICAL SUCH
THINGS, BUT WE STILL HAVE AN
INFRASTRUCTURE THAT IS
INADEQUATE FOR ACTUALLY
PROVIDING FOR PRIMARY CARE.
BECAUSE WE HAVE ABOUT 50% MORE
PATIENTS PER PROVIDER THAN THE
REST OF THE STATE OF CALIFORNIA.
SO THE WAIT TIMES TO BE ABLE TO
SEE YOUR PREMIERE CARE PROVIDER.
HOW MUCH TIME THAT PROVIDER HAS
WITH EACH PATIENT TO BE ABLE TO
TRULY LISTEN TO THEM UNDERSTAND?
CULTURALLY, LINGUISTICALLY
EVERYTHING THAT THEY HAVE GOING
ON. TO BE ABLE TO IDENTIFY AND
ADDRESS SOCIAL DETERMINANT
HURDLES FOR BEING ABLE TO FOLLOW
THROUGH ON TREATMENT PLANS. ALL
OF THOSE THINGS ARE VERY
DIFFICULT AND OVERWHELMED
SYSTEM. THAT'S WHY WE ARE
WANTING TO DO A PILOT IN THE
CENTRAL CALIFORNIA AROUND
AUGMENTING MEDICAL TO SEE IF WE
CAN MAKE AN INVESTMENT UPSTREAM
IN MANAGED MEDICAL, ATTRACT MORE
WORKFORCE AND SEE IF WE CAN
ADDRESS THAT INFRASTRUCTURE, BUT
WE'RE CERTAINLY GOING TO HAVE TO
DO SOMETHING. EVEN URGENT CARE
IS NOT REALLY THE PLACE TO
START. I MEAN, WE OUGHT TO BE AT
FQ, HCS AND OTHER CLINICS THAT
ARE ON THE GROUND DESIGNED FOR
VISITS TO CATCH ISSUES BEFORE
THEY BECOME UM, ILLNESSES OR
OTHERWISE THAT REQUIRE URGENT
TREATMENT OR EMERGENCY
DEPARTMENT TREATMENT AND I'D BE
INTERESTED IN KNOWING WHAT THIS
LEGISLATURE AND CERTAINLY THE
BUDGET COMMITTEE CAN DO,
HOPEFULLY IN BETTER TIMES. TO
TRY TO HELP. EXPAND AND DEVELOP
THE CLINIC OPERATION. MEDICAL OR
OTHERWISE, IN PLACES LIKE THE
CENTRAL VALLEY BECAUSE THE
HOSPITAL SITUATION IS A VERY,
VERY DIFFICULT ONE TO RESOLVE
AND HOPEFULLY WE'LL COME UP WITH
SOME SOLUTIONS. BUT THE BOTTOM
LINE IS AS MY COLLEAGUE TO MY
RIGHT INDICATED THE GOAL IS TO
KEEP PEOPLE HEALTHY OUT OF THE
EMERGENCY DEPARTMENT FOR SURE,
AND OUT OF THE HOSPITAL.
CERTAINLY AS WELL SO I'D BE IN.
YOU KNOW, THIS IS PUBLIC HEALTH.
AND I GUESS THAT IS PUBLIC
HEALTH, KEEPING PEOPLE HEALTHY,
SO I'D BE INTERESTED IN HEARING
FROM YOU DURING THE COURSE OF MY
REMAINING TIME, HOWEVER SHORT
THAT IS AS TO HOW WE CAN HELP
YOU HELP US AND HELP THE
RESIDENTS OF YOUR COMMUNITIES.
THANK YOU, MADAM SHARE BEAR YOU
FOR YOUR FUTURE TO PREPARE YOU
FOR YOUR FUTURE. HAVE A FUTURE
MADAM CHAIRMAN. THANK YOU FOR
THINKING ABOUT THANK YOU FOR
YOUR PRESENTATION TODAY. IN ALL
THE WORK YOU DO, I'M A HUGE FAN
OF PUBLIC HEALTH AND ASK
QUESTIONS ALL DAY. BUT IN THE
INTEREST OF TIME IN THE CHAIRS,
FLIGHT, I'LL BE BRIEF. BUT I
ALSO WANT TO SAY THAT THIS IS
YOUR REAL CHAMPION RIGHT HERE
FOR THE MCO TAX AND BEING ABLE
TO GET MORE MONEY FOR WITH
MEDICAL, UM AGAIN, I CAN ASK
1000 QUESTIONS. BUT JUST I THINK
THAT I THINK THE ISSUE THAT WE
KEEP TALKING ABOUT IS AROUND. WE
HAVE TO KEEP PEOPLE OUT OF THE
HOSPITAL. AND SO I GUESS AS
WE'RE WE JUST HAD A HEARING
YESTERDAY ON CALLE AIM AND
FUNDING SOME OF THE SOCIAL
DETERMINANTS OF HEALTH. AND HOW
IF ANYTHING, DO YOU WILL YOU SEE
THAT IMPACTING YOUR WORK AND THE
ABILITY OF YOUR LOCAL SYSTEMS TO
RESOURCE THERE? THEIR PLANS SO
THAT THEY CAN BE ABLE TO
CONTRACT AND PROVIDE FOR A LOT
OF THOSE SOCIAL DETERMINANTS OF
HEALTH TYPES OF SERVICES. I'M
INTERESTED IN FROM THE PUBLIC
HEALTH DIRECTORS. IF YOU HAVE
ANY THAT'S THANK YOU, SENATOR
EDMUND FOR THAT QUESTION. I
THINK IT ABSOLUTELY WILL GIVE US
AN OPPORTUNITY TO REALLY LOOK
UPSTREAM. AND SO THESE BENEFITS
LIKE MANY OF MY COLLEAGUES
MENTIONED THE COMMUNITY HEALTH
WORKERS IN RIVERSIDE COUNTY.
WE'RE LOOKING AT CREATING A
COMMUNITY HEALTH WORKER HUB IN
PARTNERSHIP WITH OUR COMMUNITY
BASED ORGANIZATIONS SO THAT WE
CAN EXPAND COMMUNITY HEALTH
WORKERS THROUGHOUT ALL OF OUR
PUBLIC HEALTH PROGRAMS. BUT ALSO
WITH OUR HOSPITALS WITH OUR
CLINIC SYSTEMS SO THAT WE CAN
MAKE SURE THAT WE'RE CONNECTING
TO SERVICES WERE GETTING
UPSTREAM WHERE ADDRESSING THE
OTHER ISSUES THAT ARE OUTSIDE OF
THE TRADITIONAL HEALTHCARE'S
SPHERE LIKE HOUSING, LIKE OTHER
SOCIAL SERVICES, RIGHT SO THAT
WE CAN LOOK AT HEALTH
HOLISTICALLY BECAUSE WE KNOW
THAT ALL OF THOSE THINGS IMPACT
HEALTH OUTCOMES AT THE END OF
THE DAY. I THINK KELLYANNE
PROVIDES US WITH A REALLY UNIQUE
OPPORTUNITY TO START LOOKING AT
UPSTREAM INTERVENTIONS AND
RESOURCING THOSE INTERVENTIONS
THROUGH THINGS. LIKE COMMUNITY
HEALTH WORKERS, ENHANCE CARE
MANAGEMENT TEAMS, THOSE
DIFFERENT PROGRAMS. YEAH UM,
ALLOWED FOR SENATE CLARE COUNTY.
ONE OF THE THINGS WE HAVE
APPRECIATED ABOUT COMPONENTS OF
KELLAM IS THE OPPORTUNITY TO
WORK CLOSELY WITH OUR MEDICAL
MANAGED CARE PLANS ON THE
COMMUNITY NEEDS ASSESSMENTS THAT
COMMUNITY HEALTH ASSESSMENTS.
WHAT I HAVE NOTICED, THOUGH, IS
JUST THAT INITIAL LIFT TO BRING
US BOTH TO THE SAME PLACE TO
BRING US TOGETHER, DEVELOPED
SOME OF THE MEMORANDUM OF
UNDERSTANDING THAT ARE USEFUL TO
GET US ON THE SAME PAGE AND URGE
THOSE MANAGED CARE PLANS TO TAKE
THE RIGHT STEPS TO JUST AS
PUBLIC HEALTH HAS FOR MANY
YEARS. LISTEN TO THE COMMUNITY
TO DRIVE WHAT SOLUTIONS WILL
ADDRESS UPSTREAM SOCIAL
DETERMINANTS OF HEALTH. THAT
WORK IS NOT TRADITIONALLY
RESOURCED IN PUBLIC HEALTH
EASIER, EITHER. THIS IS A NEW
ASK. AND UNLIKE MANY OF THE
OTHER COMPONENTS OF CAL AIM THAT
COME WITH A CAL PATH FUNDING
MECHANISM TO SUPPORT THEM. THAT
HASN'T BEEN THE CASE FOR PUBLIC
HEALTH, SO WE ARE LOOKING
FORWARD TO THAT OPPORTUNITY TO
WORK THAT MUCH MORE CLOSELY WITH
OUR MANAGED CARE PLANS AND
ENSURE THAT THEY ARE ABLE TO
LIFT OUT OF PUBLIC HEALTH. SOME
OF THESE DIRECT SERVICE
ACTIVITIES THAT WILL ULTIMATELY
MAKE THEIR MEMBERS HEALTHIER.
BUT WE ARE STILL CONTINUING TO
SEARCH THE FOR THE RESOURCES TO
BE ABLE TO ENGAGE IN THAT EARLY
WORK. I JUST WANT TO HIGHLIGHT
QUICKLY. KELLY IS CONTINUING TO
HIGHLIGHT THE INEQUITIES ACROSS
THE STATE. THAT THOSE
COMMUNITIES THAT HAVE A REALLY
ROBUST ECOSYSTEM FOR PUBLIC
HEALTH ARE ABLE TO UM,
CAPITALIZE ON THE OPPORTUNITIES
OF KELL AM IN A MORE EFFECTIVE
WAY OUR URBAN CENTERS AND
POPULOUS AREAS ABOUT SMALL
COUNTIES, CENTRAL CALIFORNIA THE
RURAL NORTH INLAND EMPIRE
CONTINUED TO STRUGGLE TO BE ABLE
TO FIND ALL THE APPROPRIATE
FENDERS THEY DON'T HAVE. WE
DON'T HAVE THE SAME
INFRASTRUCTURE AND
SOPHISTICATION TO BE ABLE TO
ACCESS THE SUPPORTS THAT ARE
SUPPOSED TO HELP WITH EQUITY. SO
IN SOME WAYS IT MAGNIFIES THE
INEQUITY AND YEAH, SOMETIMES
AMPLIFIES IT. GOOD TO OUR
SOLUTION. DO WE SEE IMPROVEMENTS
IN THAT? I MEAN, NOW THAT WE
HAVE IT'S LIKE THE CHICKEN AND
THE EGG, RIGHT? IT IS THE
CHICKEN EGG. WHAT I'D SAY IS, IS
THAT WHAT I'VE NOTICED IS WE
HAVE TRIED TO CREATE STATEWIDE
FORMULAIC APPROACHES TO EQUITY.
AND WHEN WE DO THAT, WE USE
EXAMPLES OF PLACES WHERE IT'S
WORKING REALLY WELL TO USE A
FORMULA AND THOSE ARE TYPICALLY
PLACES IN WHAT YOU DON'T SEE
QUITE AS MUCH EQUITY FROM A
STATEWIDE PERSPECTIVE. UM AND SO
WE'RE GOING TO HAVE TO DO SOME
VERY TARGETED INFUSION OF
FUNDING AND STRATEGY IN THOSE
GEOGRAPHIC AREAS, WHICH IS
DIFFICULT TO DO WHEN YOU HAVE
SUCH A LARGE STATE. AND NOT TRY
AND FIX THE PROBLEM THAT IS
INHERENTLY ABOUT DIFFERENCES BY
ROLLING OUT SOMETHING THAT IS
UNIFORM ACROSS THE STATE. YEAH
YEAH, IT'S YOU KNOW, WHEN WE
THINK ABOUT IT, IT'S ANALOGOUS
TO THE FOOD ECOSYSTEM, RIGHT
WHEN WE TALK ABOUT DIABETES AND
HYPERTENSION, ALL THOSE THINGS
AND WE KNOW THERE'S NOT EASY
ACCESS TO FRESH FRUITS AND
GROCERIES AND MAYBE JUST A
CORNER MARKET. IT'S THE SAME
THING WHEN YOU'RE TALKING ABOUT
TRYING TO HIRE COMMUNITY HEALTH
WORKERS OR WORK WITH NONPROFITS
AND CBOS. THEY DON'T EXIST IN
THE NEIGHBORHOODS. OR IN THE
REGION. WOULD YOU LIKE TO
SCRATCH UP ANOTHER QUESTION FROM
YOUR 1000 AGAIN? I APPRECIATE
YOUR WORK, AND I APPRECIATE YOUR
SCRAPPINESS AND IN FINDING WHERE
THERE COULD BE SOME MONEY THAT
YOU CAN SNATCH TO THANK YOU SO
MUCH FOR JOINING US TODAY REALLY
APPRECIATE YOUR INSIGHT. THANK
YOU. THANK YOU. FOR MOVING NOW
ON TO ISSUE NUMBER THREE. WHERE
WE'LL BE TALKING ABOUT THE
MAINTENANCE AND OPERATIONS
SUPPORT FOR SAPPHIRE SYSTEM. MM
HMM. GOOD AFTERNOON. GOOD
AFTERNOON. ADRIAN BURRATA,
ASSISTANT DEPUTY DIRECTOR OF THE
CENTER FOR INFECTIOUS DISEASES.
I'LL START WITH AN OVERVIEW OF
THE BCP. AND THEN THERE WERE TWO
QUESTIONS THAT WERE SUBMITTED
THAT I'LL GO INTO UM, SO AGAIN,
STARTING WITH THE BRIEF OVERVIEW
, THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH REQUEST 26.9
MILLION GENERAL FUND IN 2425.
FOR NO SUPPORT FOR THE
SURVEILLANCE AND PUBLIC HEALTH.
INFORMATION REPORTING IN
EXCHANGE FOR THE SAPPHIRE
SYSTEM. THE SAPPHIRE SYSTEM IS A
GATEWAY FOR RECEIVING ELECTRONIC
LAB DATA AND ELECTRONIC CASE
REPORTING AT CPH. THIS DATA
EXCHANGE. EVOLVED OUT OF A
PREVIOUS STATEWIDE IT PLATFORM
THAT CALIFORNIA COVID REPORTING
SYSTEM WHICH WAS DEVELOPED IN
2020 TO INCREASE STATEWIDE
CAPACITY TO MANAGE EXTREMELY
HIGH VOLUMES OF COVID 19
LABORATORY DATA IN THE PANDEMIC
RESPONSE ON THE PRIOR GATEWAY
WAS NOT ABLE TO HANDLE THE
VOLUME SAPPHIRE FUNCTIONALITY
ALLOWS FOR RECEIVING PUBLIC
HEALTH DATA FOR ALL REPORTABLE
CONDITIONS. NOT JUST COVID 19,
INCLUDING INFECTIOUS DISEASES
SUCH AS TUBERCULOSIS. MEASLES
HIV, SYPHILIS AND M PARKS.
PREVIOUS BUDGET EXCEPT FUNDED
THE SAPPHIRE SYSTEM UP TO THE
2324 FISCAL YEAR. AN ADDITIONAL
EXPENDITURE AUTHORITY IS NEEDED
TO CONTINUE OPERATION OF THE
SAPPHIRE SYSTEM IN 2425.
CONTINUED EVER KNOW OF THE
SAPPHIRE SYSTEM IS NEEDED TO
MAINTAIN A TIMELY AND ACCURATE
STATEWIDE HEALTH INFORMATION
EXCHANGE SYSTEM FOR EFFECTIVE
PUBLIC HEALTH SURVEILLANCE AND
DISEASE OUTBREAK RESPONSE. AS
WELL AS COMPLY WITH FEDERAL
HEALTH INFORMATION DATA
TECHNOLOGY REQUIREMENTS. IT IS
HELPFUL. I CAN I CAN GO THROUGH
THE QUESTIONS AT THIS TIME.
PERFECT. TO THE FIRST QUESTION.
THE REQUESTED MAINTENANCE AND
OPERATIONS RESOURCES ARE ONLY 4
24 25. WHAT IS THE PLAN FOR
ONGOING MAINTENANCE AND
OPERATIONS OF THE SYSTEMS? SO
LET ME FIRST SAY SAPPHIRE IS AN
ESSENTIAL SYSTEM THAT SEED PH
USERS TO COLLECT PUBLIC HEALTH
DATA. ON ALL REPORTABLE DISEASES
, AND SO TO THAT END, IT IS AN
INTEGRAL PART OF OUR PORTFOLIO.
THE BUDGET YEAR MM. NO
APPROPRIATION AND REQUESTING THE
BCP ALIGNS WITH THE CURRENT
CONTRACT TERM DATE. AND WE'LL
HAVE TO REVISIT THE OUT YEAR
CONSIDERATIONS AND WORK
INTERNALLY TO DO THAT. THE NEXT
QUESTION. WHAT WOULD BE THE
CONSEQUENCES OF ALLOWING THE
CONTRACT FOR MAINTENANCE AND
OPERATIONS FOR SAPPHIRE TO
EXPIRE? UM MAINTENANCE AND
OPERATIONS FOR THE SAPPHIRE
SYSTEM IS CRUCIAL TO SUPPORT
CALIFORNIA'S CONTINUED PUBLIC
HEALTH RESPONSE BY SUPPORTING
LABORATORY. IN CASE REPORTING
FOR OVER 80 OTHER REPORTABLE
CONDITIONS, INCLUDING INFLUENZA
RSP, COVID, 19, TUBERCULOSIS,
MEASLES, HIV, SYPHILIS AND PARKS
AND MANY OTHERS. THIS ENABLES
CALIFORNIA TO HAVE BETTER
QUALITY TIMELIER AND MORE
COMPLETE SURVEILLANCE FOR
INFECTIOUS DISEASE FACILITATES
MORE RAPID AND ROBUST RESPONSE
TO CURRENT AND FUTURE INFECTIOUS
DISEASE OUTBREAKS AND
EMERGENCIES. WITHOUT FUNDING FOR
SAPPHIRE, CDP H AND L. HJ'S
WANTING TO STOP SOME DATA
STREAMS AND REVERT TO LESS
ROBUST TOOLS FOR LABORATORY
REPORTING, WHICH WILL
DRAMATICALLY SLOW CD PH. AND THE
ABILITY TO RECEIVE TIMELY
REPORTS OF NOTIFIABLE DISEASES.
AND SIGNIFICANTLY HAMPER
CAPACITY TO PREVENT RESPOND TO
AND MANAGE EMERGING DISEASE
OUTBREAKS. IT SHOULD BE NOTED
THAT THESE TOOLS FAILED DURING
THE COVID 19 PANDEMIC AND LIKELY
COULD NOT EFFECTIVELY MANAGE
CURRENT DATA REPORTING NEEDS. IF
THERE ARE ANY OTHER QUESTIONS.
I'M HAPPY TO ANSWER THOSE
DEPARTMENT FINANCE, WOULD YOU?
DO YOU HAVE SOME BAD NOTHING
FURTHER, DAD. THANK YOU. HELLO.
NOTHING FROM THAT AVAILABLE FOR
QUESTIONS. I HAVEN'T ANY
QUESTIONS OF THIS. WE'RE GOING
TO HOLD THE ITEM OPEN. ISSUE
NUMBER FOUR. ABOUT INFORMATION
TECHNOLOGY SAVINGS AND RE
VERSIONS. GOOD AFTERNOON. I'M
JOHN RUSSELL. I'M THE CEO FOR CD
PH. I FINALLY GET TO SPEAK.
THERE YOU GO. FOR SOME REASON
ARE YOU WITH WILL I AM NOT. I'M
WITH THE DEPARTMENT OF PUBLIC
HEALTH, BUT HE JUST LIKES TO SIT
NEXT TO ME. SO UM, SPEAKING ON
THE TWO TECHNOLOGY SAVINGS
ISSUES, THE FIRST ONE IS COVID
WEBSITE AFTER JUNE 2024 THE
COVID 19 CA.GOV U. R L WILL BE
REDIRECTED. FOR THE SEED PH
HOUSES, SIDE COMMUNICATION HAS
BEEN PROVIDED TO THE GOVERNOR'S
OFFICE AND LOCAL HEALTH
JURISDICTIONS FOR THE MIGRATION
TO A CD PH SITE. WE WORKED FOR
THE GOVERNOR'S OFFICE WHO
PROVIDED US WITH APPROVALS FOR
THIS MOVE, WE EXPECT MINIMAL TO
NO USER EXPERIENCE CHANGES. AND
POTENTIALLY, THE GREATEST CHANGE
WOULD BE SITE LAYOUT ARRANGEMENT
WOULD BE SLIGHTLY DIFFERENT. ANY
QUESTIONS ON THAT ONE. DELEON
COMMENT JUST GIVEN THE BUDGET
SITUATION, WE GENERALLY FIND
THIS PROPOSAL BE REASONABLE.
WE'RE GONNA HOLD THE ITEM OPEN.
WE'RE GOING TO MOVE ON TO ISSUE
NUMBER FIVE. WE'RE TALKING ABOUT
AIDS DRUG ASSISTANCE PROGRAM
ALSO KNOWN AS THE AID UP
PROGRAM.
LITTLE MY NAME IS CAN HEAR ME.
OKAY, GOOD. MY NAME IS KRISTEN
WHETHER I WILL BE GIVEN THE
OVERVIEW OF ADAPT AND SOME BRIEF
CHANGES, SO ONE OF THE CURRENT
YEAR, THE 2324 BUDGET ACT
INCLUDED A TIP LOCAL ASSISTANCE.
FUNDING OF 398 MILLION REVISED
CURRENT YEAR. 2324 BUDGET IS
353.9 MILLION, WHICH IS A
DECREASE OF 44.1 MILLION WHEN
COMPARED TO THE 2324. BUDGET ACT
INCREASES, DRIVEN PRIMARILY BY
LOWER MEDICATION EXPENDITURES
AND MEDICAL POCKET EXPENDITURES
IN PREVIOUSLY PREVIOUSLY
ESTIMATED AND THEN FOR BUDGET
YEAR THE PROPOSED ADAPT LOCAL
ASSISTANCE FUNDING YEAR AS 100
66 MILLION WITH NO STATE GENERAL
FUND APPROPRIATION, WHICH THE
DECREASE OF 32.1 MILLION WHEN
COMPARED TO THE 2324 BUDGET ACT.
DECREASES DRIVEN PRIMARILY BY
THE SAME FACTORS, LOWER
MEDICATION EXPENDITURES AND
MEDICAL OUT OF POCKET
EXPENDITURES THAN PREVIOUSLY
ESTIMATED. I WILL PASS IT,
ADRIAN. THERE AREN'T ANY OTHER
QUESTIONS ON THE ESTIMATE. I
UNDERSTAND THERE WAS A QUESTION
SUBMITTED REGARDING THE ADAPT
REBATE LOAN THAT I BELIEVE
DEPARTMENT OF FINANCE WILL BE
FIELDING. SO AH! THE 2425
GOVERNORS BUDGET INCLUDES A
BUDGETARY LOAN OF $500 MILLION
FROM THE FUND TO THE GENERAL
FUND FOR RESOURCES NOT CURRENTLY
PROJECTED TO BE USED FOR
OPERATIONAL OR PROGRAMMATIC
PURPOSES. UM YOU ASKED ABOUT TWO
LOANS, AND SO, UM, TO MENTION
THE PREVIOUS LOAN OF $400
MILLION WAS AUTHORIZED IN FISCAL
YEAR 2324. THERE IS A LOAN
BEFORE THAT OF $100 MILLION THAT
WAS AUTHORIZED IN FISCAL YEAR
2021 AND PAID BACK IN FISCAL
YEAR 2122. IF YOU KEEP POINTS TO
NOTE ABOUT BOTH THE 504 $100
MILLION LOANS, SO THE BUDGET
PROPOSES USES OF FUNDS FROM
AVAILABLE IDOL FUND RESERVES
ALONE DOES NOT CUT ANY
AUTHORIZED EXPENDITURES, AND WE
DO NOT ANTICIPATE THESE LOANS TO
DISRUPT ANY SERVICES AS THE
DEPARTMENT MENTIONED EARLIER IN
THE HEARING. UM AND THE DEPTH
FUND HAS A REMAINING RESERVE
AFTER ACCOUNTING FOR THE
PROPOSED LOAN. UM, THERE IS A
PROJECTED, UH, FUND BALANCE AT
THE END OF CURRENT YEAR OF $670
MILLION AND AT THE END OF 2425
OF $177 MILLION UM, THE LOANS
CAN BE RETURNED WHEN NEEDED FOR
CRITICAL PROGRAM ACTIVITIES PER
LANGUAGE IN THE CONTROL SECTION
13.40 IN THE BUDGET ACT, AND
JUST FEW NOTES ABOUT REPAYMENT.
SO UM, THE STATE IS OBLIGATED,
OF COURSE TO REPAY ALL OF THESE
LOANS, AND THE REPAYMENT DATES
FOR ALL OF THE LOANS WILL BE
ASSESSED, BASED ON PROGRAM
NEEDS, AVAILABILITY OF FUNDS AND
COMPETING PRIORITIES. THROUGH
THE ANNUAL BUDGET PROCESS,
AUTHORIZED SPENDING REVENUES AND
RESERVES WILL BE TAKEN INTO
CONSIDERATION. UM AND THE
LANGUAGE AND CONTROL SECTION
13.40 ENSURES THAT THE FUNDS
MUST BE RETURNED WHEN THERE IS A
NEED FOR THE FUNDS TO UP TO
SUPPORT OPERATIONS AUTHORIZED
UNDER THE TOP FUND IN IN THE
BUDGET ACT IN A GIVEN YEAR, AND
WHEN THAT NEED IS IDENTIFIED IN
THE ANNUAL BUDGET PROCESS,
REPAYMENT WILL BE MADE. MOREOVER
TO ADDRESS THE QUESTION ABOUT
UNDERMINING THE PROGRAM FINANCES
, WORKING WITH THE DEPARTMENT TO
ENSURE THAT THE TIMING OF LOAN
FUND DISBURSEMENTS AND REPAYMENT
DURING THE TERM OF THE LOANS
WILL BE STRUCTURED TO MEET THEIR
CASH FLOW NEEDS. ANY COMMENTS ON
THIS OKAY. COUPLE OF COMMENTS ON
THIS START WITH THE MOST RECENT
COMMENTS YOU SUGGESTED YOU
TALKED ABOUT AND REPAYMENT.
THEIR LANGUAGE AND THEIR SEEMS A
LITTLE LOOSE. WHAT IF WE? THE
PROGRAM HAS A NEED NEXT YEAR
EARNED TWO YEARS AND WE'RE STILL
DEALING WITH THIS KIND OF BUDGET
DEFICIT. WHAT CAPACITY. WE'RE
GOING TO BE IN TO BE ABLE TO PAY
BACK THAT LOAN. MY UNDERSTANDING
IS THE CONTROL SECTION CONTROL
SECTION LANGUAGE HOLDS SO IF
THERE IS A NEED TO SPEND THOSE
FUNDS FOR ACTIVITIES THAT ARE
AUTHORIZED IN THE BUDGET ACT,
THEN THOSE FUNDS WOULD NEED TO
BE RETURNED. AND OF COURSE, IN
THAT ANNUAL BUDGET PROCESS, YOU
KNOW, WE'RE ASSESSING WHAT IS
APPROVED IN IN THE EIGHT UP
CLOSE TO $1 BILLION LOAN. FROM
THIS FROM THIS FUND, AND
ADVOCATES ARE VERY, VERY WORRIED
ABOUT THIS YOU SHARED TO OTHER
PREVIOUS YEAR LOANS IS THERE WAS
THERE WAS THERE WAS THERE ALONE
IN THE RECESSION? BECAUSE WE'RE
GETTING SOMEWHERE THAT DURING
THIS RECESSION, THERE IS A LOAN
AND IT ACTUALLY IMPACTED
PROGRAMS DURING THAT TIME, WHICH
IS WHAT ONE OF THE REASONS THAT
IT'S SOUNDING THE ALARM FOR A
LOT OF ADVOCATES MOVING FORWARD.
IS THAT CORRECT. OR IS THE
INFORMATION IN FRONT OF YOU ONLY
ON LOAN HISTORY FROM THE PAST
TWO YEARS? THAT IS THE
INFORMATION THAT I HAVE ON
PREVIOUS LOANS. UM IF YOU'RE
INTERESTED IN FURTHER BACK THAN
THAT, I CAN LOOK INTO THAT. AND
IF YOU COULD PLEASE LOOK AT THE
RECESSION YEAR, OKAY? AND EITHER
CONFIRM OR CONTRADICT THAT THAT
LOAN IMPACTED THE PROGRAMS.
DURING THAT TIME. I AM REALLY
INTERESTED IN SEEING HOW WE CAN
JUST FURTHER ENSURE FOLLOW UP IF
IT LOOKS LIKE THE LOANS
UNDERMINE FINANCIAL STABILITY OF
THE PROGRAM. WOULD WE? YEAH.
MEDICAL LARA FOR FINANCE JUST TO
ADD ONE THING IN THIS PROGRAM
AREA. THE ANNUAL REVENUES ARE
FAIRLY CONSISTENT WITH THE SPEND
OUT OF THIS POT. SO IN THE MONEY
WE'RE TALKING ABOUT IS OUT OF
THE RESERVE. SO I THINK ON THE
NATURAL, YOU KNOW ALL OTHER
THINGS BEING EQUAL. WE WOULD
EXPECT THAT TREND TO CONTINUE.
BUT AS MY COUNTERPART MENTIONED,
YOU KNOW, WE'LL CONTINUE TO
EVALUATE YOU KNOW THAT THE
REVENUE COLLECTIONS SPENDING
EVERYTHING THROUGH OUR ANNUAL
BUDGET REVIEW. AS WE CONTINUE TO
UTILIZE THIS FUND AS WE'RE DOING
WITH A LOT OF FUNDS RIGHT TO
PULL OUT IN AND BALANCE THE
BUDGET. OUT OF YOUR KIDS WITHIN
THIS GROUP ARE LOOKING TO
UTILIZE SOME OF THE RESERVES FOR
OTHER INVESTMENTS. HAVE WE TAKEN
A LOOK AT HOW WE CAN USE THE
FUND IN THIS THE DOLLARS IN THIS
FUND TO FURTHER INVEST AND OTHER
BIG PROGRAMS? RELATED TO THE
CATEGORIES UNDER UP, I THINK I
WOULD SAY THAT THE RESERVES ARE
STILL AVAILABLE IN THE FUND
WOULD BE THINGS THAT YOU KNOW,
FOLKS COULD REASONABLY CONSIDER
AND STILL AUTHORIZED THE LOANS
THAT ARE IN THE BUDGET. BEFORE
YOU SENATOR EDMUND YEAH, I JUST
TWO AND AGAIN I LOVE PUBLIC
HEALTH. BUT THEN AS THE CHAIR OF
THE LGBT CAUCUS, YOU'RE THE
DEPARTMENT WAGON. THE MOST
COMPLAINTS ABOUT BOTH WITH THIS
PROGRAM AS WELL AS WITH THE
SURGERY ISSUES THAT WE TALKED
ABOUT BEFORE, UM SO DO WE KNOW
WHEN WE'RE SWEEPING IT TO THE
GENERAL POT THAN WHAT THOSE
FUNDS ARE BEING USED FOR? THEY
WOULD JUST BE USED FOR OUR
OVERALL GENERAL FUND STATE
PRIORITIES, SO THERE'S GENERAL
FUND DOLLARS. DON'T HAVE A
SPECIFIC LINKAGE. OKAY BECAUSE I
THINK THE LEGISLATURE WOULD LIKE
TO BE A BIT MORE INVOLVED WITH
THAT. RIGHT SO THAT AGAIN, WE'RE
TALKING ABOUT UP TO A BILLION
DOLLARS. NOW THAT'S BEEN
BORROWED. THIS MONEY WAS, YOU
KNOW, THIS IS I UNDERSTAND. IT'S
A NICE POT THAT THE
ADMINISTRATION SEES LIKE WE'RE
GOING TO HAVE SOME OF THAT. BUT
I THINK WE JUST HEARD FROM THE
LAST PANEL RIGHT THERE REALLY
INTENSE NEEDS THAT EXIST IN THE
PUBLIC HEALTH. UH, ENVIRONMENT.
UM SO I WOULD JUST LIKE TO SAY
THEY CONTINUE TO MAKE THIS THE
SAME BORROW FROM THE SAME POT.
UM IT IS VERY UPSETTING FOR THE
COMMUNITY AND FOR THOSE OF US
WHO TO REPRESENT THAT COMMUNITY
WILL CONTINUE TO HAVE SOME
CONVERSATIONS ABOUT THAT. I
MEAN, IT'S NOT JUST A SLUSH FUND
FOR THE ADMINISTRATION TO USE
WHEN TIMES ARE HARD RIGHT. THAT
MONEY IS THERE FOR A REASON FOR
PURPOSES, ESPECIALLY WITH RECENT
CI FURTHER INCREASES THAT WE'RE
SEEING IN THE STATUS FOR. I
MEAN, THIS GOES HAND IN HAND AND
PREVENTING EVEN FURTHER CASES. I
JUST, YOU KNOW, I'M I GUESS I
WANT TO HEAR A LITTLE BIT MORE
ABOUT HOW WE'RE ADDRESSING THE
ADVOCATES CONCERNS. IT'S I FEEL
LIKE I CAN'T WALK AROUND WALK
AWAY FROM THIS COMMITTEE WHERE I
CAN GO BACK TO THE ADVOCATES AND
SAY SOMETHING THAT'S GONNA THESE
SOME OF THAT CONCERN. I THINK
JUST FROM A BUDGET BALANCING
PERSPECTIVE, YOU KNOW, ONE OF
THE REASONS WE LOOK TO RESERVES
IS BECAUSE THAT'S THE RELATIVE
LESSER OF TWO EVILS AS COMPARED
TO MAKING PROGRAM REDUCTIONS
THAT OTHERWISE MAY BE NECESSARY
OR POSSIBLY RAISING TAXES. SO
THESE ARE JUST SOME OF OUR
DIFFICULT CHOICES THAT WE'RE
HAVING TO MAKE THROUGH OUR
BUDGET DELIBERATIONS ON AVERAGE,
UM, IS ANNUALLY. HOW MUCH GOES
INTO THE FUND? THE RESERVE FUND?
WE HAVE AFTER WE TAKE OUT THE IF
WE SORRY IF WE TAKE OUT THE $500
MILLION WILL BE LEFT WITH $176
MILLION ANNUALLY. UM THERE ARE
ABOUT $259 MILLION OF EXCUSE ME
$325 MILLION OF REVENUE ANNUALLY
AVERAGED JUST AVERAGING BETWEEN
FISCAL YEAR CALENDAR YEAR. THIS
IS AVERAGING BETWEEN PAST YEAR
CURRENT YEAR IN BUDGET YEAR
BETWEEN THOSE THREE YEARS IF YOU
LOOK AT THE FUN CONDITIONS
STATEMENT, IT'S TAKING AN
AVERAGE. SO WOULD YOU SAY THAT
IN THE NEXT BY THE END OF THIS
YEAR, 176 COULD JUMP UP TO IF
YOU ADD UP 3 4,000,400 MILLION I
THINK IT'S I WOULD SAY THAT, YOU
KNOW, IT'S ROUGHLY IN THE $300
MILLION RANGE. YOU KNOW THE
INCOMING AND SPEND FROM THIS
AREA. JUST ROUGH FIGURES. OKAY?
THANK YOU SO MUCH. THIS FROM US
LIKE 10 YEARS REBATE REVENUE.
OKAY. THANK YOU. FROM THE
NUMBERS. UM NO FURTHER QUESTIONS
ON OUR END, BRINGING TO HOLD THE
ITEM OPEN. WE'RE GOING TO MOVE
ON TO ISSUE NUMBER SIX. AND SIX
CAN BE REALLY, REALLY SHORT
BECAUSE DECIDED TUMS. ELIGIBLE
FOR EARLY ACTION. WELCOME GOOD
AFTERNOON. SO I JUST OH, YOU CAN
START. OKAY MY NAME IS MARIA
OCHOA, ONE OF THE ASSISTANT
DEPUTY DIRECTORS IN THE CENTER
FOR HEALTHY COMMUNITIES. AND SO
I WILL BE GIVEN AN OVERVIEW OF
THE CLINICAL DENTAL ROTATIONS
AND TRAILER BILL. SO THE BUDGET
ACT OF 2022 APPROPRIATED A $10
MILLION INVESTMENT IN 10 MILLION
AND ONE TIME INVESTMENT FOR CD
PH. OFFICE OF ORAL HEALTH AND
CONSULTATION WITH THE CALIFORNIA
DENTAL ASSOCIATION, CALIFORNIA
DENTAL SCHOOLS AND OTHER
STAKEHOLDERS TO SUPPORT THE
ESTABLISHMENT OF A COMMUNITY
BASED CLINICAL EDUCATION
ROTATIONS FOR DENTAL STUDENTS IN
THEIR FINAL YEAR, OR DENTAL
RESIDENTS. 2024 25 GOVERNORS
BUDGET PROPOSES TO SHIFT 9.7
MILLION OF THIS INVESTMENT FROM
THE GENERAL FUND TO THE
PROPOSITION 56 STATE DENTAL
PROGRAM ACCOUNT TO ADDRESS THE
BUDGET SHORTFALL. 2022 BUDGET
ACT INCLUDED PROGRAMMATIC AND
PROVISIONAL LANGUAGE THAT ONCE
STATED THAT FUNDS WERE AVAILABLE
FOR ENCUMBRANCE OR EXPENDITURE
UNTIL JUNE, 30TH 2027 PROVIDED A
PUBLIC CONTRACT EXEMPTION,
ESTABLISHED PROGRAM ELIGIBILITY
CRITERIA AND SPECIFIED REPORTING
REQUIREMENTS. BECAUSE PROP 56 IS
NOT SUBJECT TO AN APPROPRIATION
IN THE BUDGET ACT STATUTORY
CHANGES TO THE HEALTH AND SAFETY
CODE, ER ADDED TO MAINTAIN THE
PROGRAMMATIC REQUIREMENTS THAT
WERE ESTABLISHED IN THE
PROVISIONAL LANGUAGE IN THE 2022
BUDGET ACT. AND I CAN GET TO THE
QUESTIONS. OKAY SO THE FIRST
QUESTION WAS AFTER ACCOUNTING
FOR THE USE OF THE UNEXPENDED
FUND BALANCE AND THE STATE
DENTAL ACCOUNT IS THE OFFICE OF
ORAL HEALTH. STILL RECEIVING THE
30 MILLION ALLOCATION REQUIRED
BY STATUTE. AND THE ANSWER IS
YES. THERE ARE STILL RECEIVING
THE 30 MILLION AND DOES THIS
FUND SHIFT OFFSET SOME OF THAT
REQUIRED ALLOCATION AND KNOW THE
SHIFT DOES NOT OFFSET THE
ALLOCATION. AND THEN WHAT IS THE
REMAINING FUND BALANCE IN THE
STATE DENTAL ACCOUNT AND THE
REMAINING FUND BALANCES? 3.5
MILLION. ARE YOU WITH DEPARTMENT
OF FINANCE OR THE OR THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH? THANK YOU FOR HELPING
DEPARTMENT OF FINANCE TWO
QUESTIONS HERE. THE SAME
QUESTION ON THE PREVIOUS FUND.
UM DOES IT GET FUNDED ANNUALLY
DO WE GET IS 3.5 MILLION. WHAT
WE'RE GOING TO HAVE FOR A WHILE.
THE REMAINING BALANCE. 3.5
MILLION IS ENDING BALANCE AT THE
END OF FISCAL YEAR, 2425 FUTURE
YEARS IN THE SPECIAL FUND WOULD
BE DETERMINED BY AVAILABLE
PROPOSITION 56 REVENUE. AND SO
THE REASON WHY I'M ASKING THIS
BECAUSE I'M WONDERING TWO WEEKS
AGO, WE TALKED ABOUT THE
SPECIALTY DENTAL PROGRAM. AND I
KNOW THAT'S A HIGHER PRICE TAG.
BUT I'M WONDERING IF WE CAN LOOK
AT THIS FUND TO OFFSET SOME OF
THE DELAYED COSTS IN THAT
PROGRAM. ARE WE LOOKING AT
UTILIZING THIS FUND? FOR OTHER
PROGRAMS ARE BEING DELAYED. IN
THE DENTAL SPACE. THAT'S UM,
CURRENTLY NOT INCLUDED IN THE
GOVERNOR'S PLEASURE, BUT WE
COULD TAKE THAT BACK. APPRECIATE
THAT WE ALL NEED ADDITIONAL
COMMENT. WE'RE GOING TO HOLD THE
ITEM OPEN. WE'RE GOING TO MOVE
ON TO ISSUE NUMBER SEVEN.
SYNDROME X SURVEILLANCE. GOOD
AFTERNOON AGAIN. I'LL PROVIDE AN
OVERVIEW OF THE TRAILER BILL
LANGUAGE AND THEN JUMP INTO THE
TWO QUESTIONS THAT WERE
SUBMITTED. CALIFORNIA CURRENTLY
DOES NOT HAVE A COMPREHENSIVE
STATEWIDE NEAR REAL TIME
CAPABILITY TO IDENTIFY AND
ANALYZE EMERGING PUBLIC HEALTH
THREATS. CALIFORNIA IS CURRENTLY
BEHIND OTHER STATES AND ADOPTING
SYNDROME IQ SURVEILLANCE. 24% OF
HOSPITALS WITH EMERGENCY
DEPARTMENTS IN CALIFORNIA SUBMIT
DATA TO BIO SINCE THROUGH LOCAL
ARRANGEMENTS COMPARED TO 78% OF
HOSPITALS WITH EMERGENCY
DEPARTMENTS ACROSS THE UNITED
STATES. ARE PROPOSED PLAN IS TO
STAND UP A STATEWIDE SYNDROME IQ
SURVEILLANCE SYSTEM IN
CALIFORNIA PROGRAM RATHER IN
CALIFORNIA. 10 HATS REAL TIME
WIDESPREAD MONITORING OF PUBLIC
HEALTH. THIS TRANSLATES TO MORE
INFORMED, RAPID AND TARGETED
PUBLIC HEALTH ACTION FOR DISEASE
CONTROL AND PREVENTION AND
HEIGHTENED SITUATIONAL AWARENESS
TO FACILITATE MORE EFFECTIVE,
PREPARED AND RESPONSIVE PUBLIC
HEALTH STRATEGIES. AND POLICY
DEVELOPMENT. CITY PH WILL STAND
UP A STATEWIDE SYNDROME IQ
SURVEILLANCE PROGRAM AND BECOME
THE CALIFORNIA STATE
ADMINISTRATOR FOR THE BIOSCIENCE
PLATFORM. THE BIO SETS PLATFORM
IS A FREE CLOUD BASED COMPUTING
ENVIRONMENT HOSTED BY CDCS
NATIONAL SYNDROME IX
SURVEILLANCE PROGRAM THIS SYSTEM
COLLECTS, ANALYZES AND SHARES
ELECTRONIC PATIENT ENCOUNTER
DATA RECEIVED FROM MEMBER AGENCY
DEPARTMENTS WITHIN 24 HOURS OF A
PATIENT'S INITIAL ENCOUNTER. UH
THE PROPOSED TBL GIVES A PHD
EXPLICIT AUTHORITY TO COLLECT
AND REMIT SURVEILLANCE DATA AND
REQUIRE HOSPITALS WITH EMERGENCY
DEPARTMENTS. TO SUBMIT THE DATA
TO THE STATS AND DRAMA
SURVEILLANCE SYSTEM. THEN YOUR
FIRST QUESTION. PLEASE DESCRIBE
THE SPECIFIC PRIVACY PROVISIONS
THAT ARE BARRIERS TO THE
IMPLEMENTATION OF THIS SYNDROME
MAKES SURVEILLANCE SYSTEM THAT
REQUIRE NOTWITHSTANDING ALL
CALIFORNIA PRIVACY LAWS. AND SO
THE SYNDROME IQ SURVEILLANCE
DATA IN CALIFORNIA WOULD BE
GOVERNED BY THE INFORMATION, UM,
PRACTICE PRIVACY PRACTICES ACT
DOES NOT ALLOW CD PH TO SHARE
PERSONALLY IDENTIFIABLE
INFORMATION. WHAT THE FEDERAL
GOVERNMENT UNLESS REQUIRED BY
LAW, THEREFORE, ANY SHARING WITH
THE CDC MUST BE DONE
NOTWITHSTANDING THIS SECTION OF
THE IPA AND WE UNDERSTAND THAT
THERE IS ALSO, UM, BEING
CONCERNED WITH THE CURRENT
LANGUAGE AND THE TRAILER BILL.
UM AND SO WE ARE GOING TO BE, UM
, REPLACING THE NOTWITHSTANDING
ANY OTHER PRIVACY OF THE LAW
LANGUAGE NOTWITHSTANDING THE
INFORMATION ABOUT PRACTICES ACT,
UM, AND THEN WOULD WELCOME THE
LEGISLATURE AS WELL TO WEIGH IN
ON THAT ON THAT LANGUAGE. AND
THEN FOR YOUR SECOND QUESTION.
WITH ANY OTHER ENTITIES. BESIDES
GENERAL QUÊ CARE HOSPITALS WITH
EMERGENCY DEPARTMENTS BE
REQUIRED TO REPORT DATA TO THE
SYSTEM. THE ANSWER IS NO OTHER
ENTITIES COULD BE ADDED TO THE
SYSTEM THROUGH REGULATION IN THE
FUTURE IF THE DATA ARE NEEDED TO
ADDRESS PUBLIC HEALTH NEEDS. AND
I'M HAPPY TO ANSWER ANY OTHER
QUESTIONS. YOU DON'T HAVE ANY
FURTHER COMMENTS NOTHING FURTHER
THERE THIS TIME. NO ADDITIONAL
COMMENTS. THANK YOU. I
APPRECIATE YOU ADDING THOSE
REMARKS AT THE END I BECAUSE
THAT WAS ONE THING WE WERE GOING
TO ASK IF HE COULD, JUST ON THE
MAY REVISE COMEBACK WITH BETTER
LANGUAGE TO BETTER ACCOMPLISHED
FOR YOUR SEEKING IN THE PRIVACY
SECTION. SO THANK YOU SO MUCH
FOR THAT. I HAVE JUST A CUTE
QUESTION ON MY CURIOSITY
REGARDING THE EMERGENCE OF THE
SUPPORT THE EMERGENCY RESPONSES.
WHAT DOES THAT LOOK LIKE? HOW DO
WE SUPPORT EMERGENCY RESPONSES?
RIGHT SO I THINK IT WOULD BE
HELPFUL TO MAYBE PROVIDE JUST A
QUICK OVERVIEW OF HOW SYNDROME
MAKE SURVEILLANCE WORKS WITH
TRADITIONAL SURVEILLANCE TO HELP
KIND OF INFORMED PUBLIC HEALTH
POLICY AND PREVENTION
INTERVENTIONS. UM SO CURRENT
SURVEILLANCE IN CALIFORNIA
REALLY FOCUSES ON REPORTABLE
CONDITIONS AND CONFIRMED
DIAGNOSIS VIA LABS WITH
INDIVIDUALS. SYNDROME X
SURVEILLANCE PROVIDES RAPID
PRELIMINARY INFORMATION AND
SPECIFIC DISEASES AS WELL AS
INFORMATION ON SYNDROMES THAT
MIGHT NOT HAVE A CLEAR CAUSE.
LIKE RESPIRATORY AND GASTRO AND
COUNCIL AND ALL ILLNESS.
INCREASES OR OUTBREAKS, CLIMATE
RELATED HEALTH OUTCOMES. UM UH,
SO EMERGENCY DEPARTMENT VISITS
DUE TO HEAT OR COLD WEATHER
ILLNESS, POOR AIR QUALITY. UM
ALSO WITH MENTAL HEALTH
CONDITION TRENDS, OPIOID
OVERDOSES OR SUICIDE ATTEMPTS
AND OTHER EMERGENCY OR EMERGING
DISEASES RATHER SYNDROME. X
SURVEILLANCE CAN SUPPLEMENT
TRADITIONAL SURVEILLANCE METHODS
BECAUSE IT ALLOWS US TO MONITOR
CONDITIONS AND TEXT TRANS
RAPIDLY BEFORE DIAGNOSIS OR
CONFIRMED. CURRENT TRADITIONAL
SURVEILLANCE INTEREST IN
DRUMMING, SURVEILLANCE OR
COMPLEMENTARY AND UNDERSTANDING
AND RESPONDING TO PUBLIC HEALTH
THREATS. SO FOR EXAMPLE, DOES
THIS MEAN IF HOSPITALET IS
GETTING JUST RECENTLY IN THE
LAST HOUR, 200 PATIENTS WALK IN
WITH WHATEVER A RUSH ONE
SPECIFIC ENTOURAGE. THEY ALL
HAVE THE SAME SYMPTOMS THIS
WOULD BE COLLECTED HERE. YOU'D
BE GETTING THAT LIVE. IN THE
MOMENT DATA. FOR POTENTIAL
OUTBREAK. SO I'M ACTUALLY GOING
TO ASK, UM MY COLLEAGUE, DR
JAMES WATT TO GO AHEAD AND
RESPOND FOR SURE. YEAH NO. I'M
JAMES WATT AND THE OTHER
ASSISTANT DEPUTY DIRECTOR IN THE
CENTER FOR INFECTIOUS DISEASES.
SHORT ANSWER TO YOUR QUESTION IS
THAT'S JUST ABOUT IT. UM, IT
MIGHT NOT BE, YOU KNOW LIVE, BUT
IT'S MUCH MORE QUICK THAN THE
CURRENT SYSTEMS THAT WE HAVE.
NEAR REAL TIME. OKAY PERFECT. SO
THAT'S I JUST WANT TO MAKE SURE
I WAS UNDERSTANDING THIS PROGRAM
CORRECTLY. THANK YOU SO MUCH.
APPRECIATE THAT, DOCTOR. WE'RE
GOING TO HOLD THE ITEM OPEN MOVE
ON TO ISSUE NUMBER EIGHT. IN THE
OFFICE OF PROBATION, GAMBLING,
COMMUNITY BASED ORGANIZATION
GRANTS OKAY. CD PHS REQUESTING
AN INCREASE OF $200,000 AND THE
GAMBLING ADDICTION PROGRAM FUND
TO EXPAND SERVICES AND PROVIDE
COMMUNITY GRANTS TO EXPAND
PREVENTION AND TREATMENT
SERVICES TO PRIORITY
POPULATIONS. THIS PCB WOULD
SUPPORT THE OFFICE OF PROBLEM
GAMBLING AND REACHING PRIORITY
POPULATIONS BY PROVIDING GRANTS
TO AND PARTNERING WITH COMMUNITY
BASED ORGANIZATIONS ARE F A
WOULD OUTLINE SPECIFIC CRITERIA
FOR THE CBOS TO FOLLOW,
INCLUDING REPORTING AND
EVALUATION ACTIVITIES. CDP CDP
PH ANTICIPATES THE INITIAL
FUNDING CYCLE TO BE THREE YEARS
AND ANTICIPATES AWARDING
APPROXIMATELY 50,002. PER YEAR
TO FOUR CBOS. EACH RESULTING IN
A TOTAL OF 200,000 PER YEAR IN
FUNDING EVALUATIONS WOULD BE
CONDUCTED AT THE END OF EACH
GRAB PERIOD BY EXISTING STAFF
AND WILL INFORM PROGRAM DESIGN
AND PRIORITY POPULATIONS. CBOS
HAVE EXPERIENCE IN WORKING WITH
AND OUTREACH TO THEIR
COMMUNITIES OUTCOMES EXPECTED IN
THE FIRST FIVE YEARS OF FUNDING
A 10% INCREASE IN AWARENESS OF
PROBLEM GAMBLING AND APPROPRIATE
TREATMENT SERVICES AMONG
PRIORITY POPULATIONS. 15%
INCREASE IN THE USE OF HELPLINE
SERVICES AMONG PRIORITY
POPULATIONS AND A 15% INCREASE
IN ACCESS TO TREATMENT SERVICES
BY PRO PRIORITY POPULATIONS.
THIS WOULD STRENGTHEN AND EXPAND
. OH PGS PREVENTION, EDUCATION
AND TREATMENT ACTIVITIES, AND IT
WOULD ALSO ALIGN WITH RPG
STRATEGIC PLAN AND MEET OPIE
CHEESE. OH, PGS GOALS HAVE
EFFECTIVELY DELIVERING PROBLEM
GAMBLING, EDUCATION PREVENTION
AND TREATMENT SERVICES TO
CALIFORNIA'S IMPACTED AND
HIGHEST RISK COMMUNITIES. THANK
YOU. WELL ANY ADDITIONAL
COMMENTS? NO CONCERNS WITH THIS
PROPOSAL, OKAY? WAS THAT YOUR
PROPOSAL? RIGHT OKAY. WE'RE
GOING TO HOLD THE ITEM OPEN.
WE'RE GOING TO MOVE ON TO ISSUE
NUMBER NINE HEALTH SURVEILLANCE
PROGRAM REVERSION.
GOOD AFTERNOON. IT'S AFTERNOON
NOW, RIGHT? YES, MA'AM. MADAM
CHAIR AND MEMBERS AND VOLUNTEERS
AND I AM THE ASSISTANT DEPUTY
DIRECTOR WITH THE OFFICE OF
HEALTH EQUITY AT THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH. I
CAN START WITH ADDRESSING
QUESTIONS. PLEASE PROCEED.
APPROXIMATELY 3.1 MILLION IS
BEING REVERTED ON A ONE TIME
BASIS. JUST GO YEAR 2324. TO THE
STATE GENERAL FUND AS A BUDGET
SOLUTION FROM THE OVERALL
ONGOING 10 MILLION ANNUAL
ALLOCATION FOR SURVEILLANCE OF
CLIMATE CHANGE RELATED
CONDITIONS, SUCH AS HEAT RELATED
ILLNESS. THE PROGRAM BUILDS OF
THE BROADER SYNDROME MIX
SURVEILLANCE PROGRAM DISCUSSED
EARLIER AND PROVIDES TRAINING TO
EMERGENCY DEPARTMENTS AND LOCAL
HEALTH JURISDICTIONS ON CLIMATE
RELATED CONDITIONS. AND ALSO
DEVELOPS BROADER SURVEILLANCE
METHODS TO MONITOR CLIMATE
CHANGE RELATED HEALTH CONDITIONS
, SUCH AS STUDIES ON THE MENTAL
HEALTH IMPACTS OF CLIMATE
CHANGE. TOOLS ATTRACT FACTORS
AND DURABILITY INDICATORS FOR
HEALTH IMPACTS OF CLIMATE CHANGE
AND NOVEL EARLY INTERVENTION
METHODS SUCH AS INTERNET
SEARCHES IN 911 CALL DATA. THE
SAVINGS IS DUE TO ANTICIPATED
SAVINGS FROM THE INFORMATION
TECHNOLOGY CONTRACT FUNDS THAT
WILL NOT BE SPENT THIS FISCAL
YEAR. THE CONTRACTS WILL BE
EXECUTED IN FISCAL YEAR 2024 AND
ONGOING TO DEVELOP CLIMATE AND
HELP SAILORS VISITORS STATION
PLATFORMS. FOR YOUR SECOND
QUESTION. YOU WANTED TO KNOW
ABOUT THE DIFFERENCE RIGHT
BETWEEN THE SYNDROME, X
SURVEILLANCE AND OTHER ONES.
THIS PROGRAM ADDRESSES SYNDROME,
IQ SURVEILLANCE FOR CLIMATE
CHANGE RELATED CONDITIONS AND
ALSO BROADER SURVEILLANCE OR
DETECTION AND MONITORING OF
CLIMATE CHANGE RELATED HEALTH
CONDITIONS. SYNDROME. X
SURVEILLANCE PORTION IS
DIFFERENT FROM THE DEPARTMENT'S
OTHERS SYNDROME MIX SURVEILLANCE
EFFORTS AND THAT EMERGENCY
DEPARTMENTS WILL BE TRAINED TO
DETECT AND REPORT CLIMATE CHANGE
RELATED HEALTH OUTCOMES.
UNDERSTAND DATA ON CLIMATE
CHANGE RELATED CONDITIONS AND
PLAN TO COLLABORATE WITH OTHERS
TO ACT ON THE DATA TO PREVENT
FURTHER ILLNESS, INJURY OR
DEATH. THIS INTERACTIVE
DASHBOARDS WILL BE DEVELOPED
SPECIFIC TO CLIMATE CHANGE
RELATED CONDITIONS SUCH AS HEAT
RELATED ILLNESS. WILDFIRE SMOKE
RELATED RESPIRATORY CONDITIONS.
WEST NILE VIRUS, WATERBORNE
DISEASES SUCH AS FIBRIA WILL
FOODBORNE SALMONELLA, OR E. COLI
THAT'S BORN VALLEY FEVER AND
MENTAL HEALTH IMPACTS. THESE
DASHBOARDS WILL BE TAILORED TO
USE SECTORS TO USER SECTORS SUCH
AS CPH, LOCAL HEALTH
JURISDICTIONS AND THE GENERAL
PUBLIC. THE BROADER SURVEILLANCE
FOR CLIMATE RELATED CONDITIONS
GOES BEYOND SAINT JEROME IQ
SURVEILLANCE. IT DETECTS AND
MONITORS CLIMATE CHANGE RELATED
HEALTH CONDITIONS. CONDITIONS
SUCH AS POPULATION LEVEL SURVEYS
, INCLUDING THE BEHAVIORAL RISK
FACTOR SURVEILLANCE SURVEY AND
THE CALIFORNIA HEALTH INTERVIEW
SURVEY STUDIES ON THE MENTAL
HEALTH IMPACTS OF CLIMATE CHANGE
TOOLS ATTRACT RISK FACTORS,
ADAPTIVE CAPACITY AND
VULNERABILITY INDICATORS FOR
HEALTH IMPACTS OF CLIMATE CHANGE
AT THE CENSUS TRUCK LEVELS.
STUDIES COMBINING ENVIRONMENTAL
AND MIRRORED ARTICLE DATA WITH
HEALTH DATA TO DETECT THE
CLIMATE INFLUENCE ON HEALTH
CONDITIONS. CASTING ARE NEAR
RIGHT REAL TIME ESTIMATES OF
HEAT RELATED DEATHS IN THE STATE
USING HISTORICAL PATTERNS OF
PRELIMINARY DEATH COUNTS AND
FINAL DEATH COUNTS TO OVERCOME
REPORTING LAGS. AND THAT
CERTIFICATION ESTIMATING THE
ECONOMIC BURDEN OF THE VARIOUS
HEALTH IMPACTS OF CLIMATE CHANGE
IN CALIFORNIA, AS WELL AS
PROVIDING COST BENEFIT ANALYSIS.
ON THE HEALTH EFFECTS OF
ALTERNATIVE CLIMATE ACTIONS AND
NOVEL EARLY DETECTION METHODS
FOR CLIMATE RELATED CONDITIONS
SUCH AS INTERNET SEARCHES AND
911 CALL DATA. THE HEALTH
IMPACTS OF CLIMATE CHANGE ARE
WIDELY CONSIDERED TO BE THE
GREATEST HEALTH THREATS OF THE
21ST CENTURY. QUERIES AND BIO
SINCE EXISTS FOR CLIMATE RELATED
CONDITIONS OF HEAT RELATED
ILLNESS AND RESPIRATORY
CONDITIONS, EXACERBATED BY
WILDFIRE SMOKE. OTHER QUERIES
MUST BE DEVELOPED FURTHER MORE
DATA ALONE DO NOT INTERPRET
THEMSELVES. LET ALONE DEVELOP
RECOMMENDATIONS, PROGRAMS AND
POLICIES TO PREVENT AND REDUCE
THE CONDITIONS DETECTED DETECTED
IN THE DATA. THE CASES OF
CONDITIONS THEMSELVES MUST BE
COMBINED WITH ENVIRONMENTAL AND
METEOROLOGICAL DATA TO
HALLUCINATE, THE DEGREE OF
CLIMATE INFLUENCE ON THE
CONDITIONS. AND THEN MODELING
TOOLS DEVELOPED TO PROJECT AND
PLAN FOR FUTURE HARM BASED ON
VARIOUS GREENHOUSE GAS EMISSIONS
SCENARIOS. RESOURCES AND
POSITIONS ARE NECESSARY TO
DEVELOP INTERACTIVE DASHBOARDS
SPECIFIC TO CLIMATE CHANGE
RELATED CONDITIONS, SUCH AS HE
RELATED ILLNESS WHILE FIRES MILK
RELATED RESPIRATORY CONDITIONS.
WEST NILE VIRUS WATERBORNE
DISEASES SUCH AS VÆ BEALL.
FOODBORNE SOMEONE ELLA AS WE
MENTIONED EARLIER EQUAL. I WAS
BORN VALLEY FEVER AND MENTAL
HEALTH IMPACTS TAILORED TO USER
SECTORS SUCH AS CD PH, LOCAL
CULTURES, DIRECTIONS AND THE
GENERAL PUBLIC. IN ADDITION,
RESOURCES AND POSITIONS ARE
NECESSARY TO DETECT AND MONITOR
CLIMATE CHANGE RELATED HEALTH
CONDITIONS THROUGH SURVEILLANCE
METHODS. BEYOND SYNDROME IQ
SURVEILLANCE, SUCH AS POPULATION
LEVEL SURVEYS, INCLUDING
BEHAVIORAL RISK FACTOR SURVEY IN
THE CALIFORNIA HEALTH INTERVIEW
SURVEY. STUDIES ON THE MENTAL
HEALTH IMPACTS OF CLIMATE CHANGE
TO THE TRACK AND COMMUNICATE
RISK FACTORS, ADAPTIVE CAPACITY
AND VULNERABILITY INDICATORS FOR
HEALTH IMPACTS OF CLIMATE CHANGE
AT THE CENSUS TRUCKS STRATIFIED
BY RACE AND ETHNICITY AGAIN NOW
CASTING OR THE NEAR RIGHT REAL
TIME ESTIMATES OF RELATED DEATHS
USING HISTORICAL PATTERNS. OF
PRELIMINARY DEATH COUNTS AND
FINAL DEATH COUNTS TO OVERCOME
REPORTING LAGS AND DEATH
CERTIFICATION, ESTIMATING THE
ECONOMIC BURDEN OF VERY HEALTH,
VARIOUS HEALTH IMPACTS OF
CLIMATE CHANGE IN CALIFORNIA, AS
WELL AS PROVIDING COST BENEFIT
ANALYSIS ON THE HEALTH OF
EFFECTS OF ALTERNATIVE CLIMATE
ACTIONS. THE INVESTIGATING,
INITIATING AND MAINTAINING NOVEL
EARLY DETECTION METHODS FOR
CLIMATE RELATED CONDITIONS, SUCH
AS SUCH AS INTERNET SEARCHES AND
911 CALL DATA. FINALLY RESOURCES
AND POSITIONS ARE NECESSARY. TO
TRAIN DEPARTMENTS TO DETECT
REPORT. CLIMATE CHANGE RELATED
HEALTH OUTCOMES THROUGH THIS
PROGRAM AND TO TRAIN LOCAL
HEALTH DEPARTMENTS TO ACCESS AND
UNDERSTAND DATA ON CLIMATE
CHANGE RELATED CONDITIONS AND
PLAN TO COLLABORATE WITH OTHERS
TO ACT ON THE DATA TO PREVENT
FURTHER ILLNESS, INJURY OR
DEATH. THANK YOU. WHERE WOULD
YOU LIKE TO ADD ANYTHING TO
THIS? WOULD YOU LIKE TO ADD
ANYTHING TO FINANCE MOST OF
HEART OF FINANCE JUST TO
REITERATE SOMETHING THAT
DIRECTOR BLINDER SAID EARLIER.
THIS IS ONE TIME REDUCTION AND
WE DON'T ANTICIPATE THAT THIS
WILL IMPACT THE PROGRAM
OPERATIONS. THANK YOU SO MUCH,
NICK. WE'RE GOING TO HOLD THIS
ITEM OPEN. THANK YOU SO MUCH.
WE'RE GOING TO MOVE NOW. MOVE ON
TO ISSUE NUMBER 10. THANK YOU
WERE TALKING ABOUT THE WIC
PROGRAM, WOMEN, INFANTS AND
CHILDREN.
HI GOOD AFTERNOON. CHRISTINE
SULLIVAN FROM DEPARTMENT OF
PUBLIC HEALTH WORK PROGRAM.
LISTEN TO HIM. ISSUE NUMBER 10.
WE HAD A COUPLE OF QUESTIONS
FIRST ADDRESSING THE CASELOAD
EXPENDITURE CHANGES WITH
PARTICIPATION IN CALIFORNIA AND
NATIONALLY HAS BEEN INCREASING
SLIGHTLY OVER THE PAST FEW
YEARS. IN THE OUR BUDGET
ESTIMATE THE CURRENT YEAR.
REVISED ESTIMATE IS 993,000
PARTICIPANTS PER MONTH. WHICH IS
A VERY SLIGHT INCREASE OVER OUR
PREVIOUS ESTIMATE FOR THE
CURRENT YEAR, AND THE ESTIMATE
IS RIGHT IN LINE WITH OUR ACTUAL
NUMBERS. IN FEBRUARY OF LAST
MONTH, WE SERVED 995,000
INDIVIDUALS IN CALIFORNIA. THE
BUDGET YEAR ESTIMATE IS JUST
OVER 1 MILLION PARTICIPANTS PER
MONTH, WHICH IS A 4% INCREASE
OVER THE PREVIOUS THE CURRENT
YEAR. FOOD COSTS HAVE ALSO BEEN
INCREASING DUE TO INFLATION AND
THE SLIGHT INCREASE IN
PARTICIPATION AND I AM VERY
HAPPY TO REPORT THAT LAST WEEK
IN CONGRESS APPROVED IN THE
PRESIDENT SIGNED A BUDGET FOR
THE DEPARTMENT OF AGRICULTURE.
THAT INCLUDED AN INCREASE FOR
THE WIC PROGRAM DUE TO THE
INCREASING PARTICIPATION IN FOOD
COSTS. WE ARE AWAITING
INFORMATION FROM THE USDA WHAT
THE FUNDING LEVELS WILL BE FOR
CALIFORNIA SHOULD BE ABLE TO
INCLUDE THAT IN THE MAIN
REVISION, THE BUDGET CONTINUES
TO SUPPORT THE INCREASE FOR THE
FRUIT AND VEGETABLE BENEFIT AS
WELL. FOR YOUR SECOND QUESTION
ABOUT OUR PROGRAM REACH, WHICH
IS THE PERCENTAGE OF INDIVIDUALS
SERVE COMPARED TO THE ELIGIBLES
IN USDA'S RECENT MOST RECENT
REPORT, LOOKING AT 2021 DATA,
CALIFORNIA SERVED 67% OF OUR
ELIGIBLE INDIVIDUALS AND OUR
RATE HAS BEEN INCREASING OVER
THE PAST FIVE YEARS. THE
NATIONAL AVERAGE LOOK OF 2021
WAS 51. AND THE NATIONAL AVERAGE
AND THE RACE OF OTHER LARGE
STRAIGHT STATES HAVE EITHER BEEN
FLAT OR DECREASING OVER PREVIOUS
YEARS WERE THE ONLY LARGE STATE
WITH AN INCREASING PROGRAM RE
TRAIT AND OF THE 50 STATES. WE
ARE SECOND OVERALL ONLY TO
VERMONT. WELL, COMING. NOTHING
TO ADD ON THIS ISSUE. THANK YOU.
THICK FURTHER TO ADD FOR THEIR
DAD. THANK YOU SO MUCH. I HAD
FINALLY THE HONOR ABOUT A MONTH
AND A HALF AGO TO VISIT MY FIRST
EVER WEEK SITE IN MY DISTRICT,
AND I LOVED EVERYBODY THERE THE
BOOKS THEY HAD THAT THEY WERE
GIVEN AWAY. YOU KNOW THE
COURSES. THEY SHOWED ME ABOUT
BREASTFEEDING AND THEIR THEIR
ROOMS AND SO FORTH. I'M ALWAYS
REALLY APPRECIATIVE OF THE
PEOPLE INVESTED IN OUR CHILDREN
AND FAMILIES, SO OBVIOUSLY, I'M
REALLY EXCITED FOR THE FEDERAL
GOVERNMENT. WE'RE VERY EXCITED.
THAT'S GREAT. YOU KNOW? USUALLY
DON'T THOSE WORDS DON'T COME OUT
OF MY MOUTH WHERE I'M THANKING
THEM FOR SOMETHING WONDERFUL.
THAT'S WHAT THEY'RE DOING. BUT
I'M GLAD THAT IN THE MAY REVISE,
WE'RE GOING TO SEE AN INCREASE
IN RATES. YES, UM NOTHING. WE'RE
GONNA HOLD THE ITEM OPEN AND
MOVE ON TO ISSUE NUMBER 11.
ALRIGHT NUMBER 11 IS WICK
MODERNIZATION. IT'S AN
INITIATIVE BY THE U. S.
DEPARTMENT OF AGRICULTURE TO
REACH AND RETAIN MORE FAMILIES
ADVANCED EQUITY IN THE WIC
PROGRAM AND IMPROVED PROGRAMS
DELIVERY SO THAT MORE FAMILIES
CAN REDEEM MORE OF THEIR FOOD
BENEFITS. OUR BUDGET CHANGE
PROPOSALS SEPARATES THE
PRIORITIES INTO TWO CATEGORIES.
FIRST MODERNIZING TECHNOLOGY AND
SERVICE DELIVERY AT THE LOCAL
LEVEL AND SECOND, IMPROVING THE
SHOPPING EXPERIENCE BY
IMPLEMENTING ONLINE SHOPPING OR
ALSO CALLED ONLINE ORDERING
UNDER THE FIRST CATEGORY, THE
ADDITIONAL STAFF RESOURCES WILL
DEVELOP AND IMPLEMENT NEW
EDUCATION AND TRAINING PRACTICES
THAT OPTIMIST THE LATEST
TECHNOLOGIES. INCLUDING E
LEARNING AND STRATEGIES FOR
REMOTE SERVICE DELIVERY AND
SUPPORT COMMUNICATIONS AND
OUTREACH EFFORTS TO REACH AND
RETAIN FAMILIES. INVESTING IN
EFFORTS AT THE STATE LEVEL WILL
ENSURE THAT WICK LOCAL AGENCY
STAFF RECEIVED THE SUPPORT THEY
NEED TO SERVE FAMILIES AND THE
MODERNIZATION EFFORTS ARE
EFFECTIVE AND EQUITABLE ACROSS
THE STATE. THE SECOND CATEGORY
FOR ONLINE ORDERING ONLINE
SHOPPING IS A WAY TO ALLOW
PARTICIPANTS TO ORDER AND PAY
FOR WIC FOODS ONLINE USING THEIR
WIC BENEFITS AND EITHER PICK UP
THE GROCERIES AT THE STORE OR
HAVE THEM DELIVERED. IT COULD
IMPROVE ACCESS AND CONVENIENCE
OF THE PROGRAM AND REDUCE STIGMA
. THE ADDITIONAL STAFF RESOURCES
WILL PREPARE FOR THE UPCOMING
CHANGES. IN CAGE ENGAGED WITH
STAKEHOLDERS AND PROGRAM
PARTNERS. REVISED STATE
REGULATIONS MANAGED ANY NEW
VENDORS IDENTIFIED DATA MEASURES
AND CONDUCT PROGRAM MONITORING
AND EVALUATION. TO ADDRESS YOUR
SECOND QUESTION. WE EXPECT THAT
OUR CURRENT BRICK AND MORTAR
STORES WILL FULFILL ONLINE SHOP
ONLINE ORDERS, AT LEAST IN THE
FIRST PHASE OR FIRST FEW YEARS
OF ONLINE ORDERING FAMILIES
COULD ORDER ONLINE AND PICK UP
IN THE PARKING LOT OF THEIR
NEIGHBORHOOD STORE, AVOIDING
WALKING STORE AISLES WITH YOUNG
CHILDREN. DELIVERY MAY BE AN
OPTION, DEPENDING ON THE
INDIVIDUAL STORE AND OR WHAT
USDA ALLOWS IN THEIR FINAL
FEDERAL REGULATIONS, WHICH ARE
EXPECTED TO COME OUT NEXT YEAR.
WE DON'T KNOW YET IF USDA WOULD
PERMIT STORES THAT DO NOT HAVE A
BRICK AND MORTAR OPTIONS. AS
PART OF PREPARING FOR THESE
CHANGES, AND FIRST STATE
REGULATION CHANGES. WE WOULD
DISCUSS OUR PLANS AND IDEAS WITH
STAKEHOLDERS AFTER AND CONSIDER
WHAT THE USDA LEARNS THROUGH
THEIR PILOTS WHAT THEY PUT INTO
THEIR FINAL REGULATIONS. IN
ADDITION, BECAUSE WE NEED TO
REVISE STATE REGULATIONS THERE
WILL BE A PUBLIC PROCESS FOR
REVIEWING AND PROVIDING FEEDBACK
ON OUR PLANS, BUT WE WOULD HAVE
DISCUSSIONS WITH STAKEHOLDERS
PRIOR TO THAT PROCESS. KRISTA
CLARIFY IT SOUNDS LIKE WE
HAVEN'T GOTTEN FEDERAL
GUIDELINES ON IF WE'RE GOING TO
ALLOW PLACES LIKE AMAZON TO BE
ELIGIBLE, BECAUSE POTENTIALLY
THEY MIGHT NOT HAVE WHAT THEY DO
HAVE SOME WATER SPREAD. IS THAT
WHAT I'M UNDERSTANDING THAT
WON'T REALLY HURT OUR LOCAL
BRICK AND MORTARS. CORRECT SO
THE FEDERAL GOVERNMENT HAS
RELEASED THEIR PRELIMINARY
REGULATIONS. THERE WAS A LOT OF
PUBLIC COMMENT. WE HAD HOPED
THAT THE FINAL REGULATIONS WOULD
COME OUT THIS YEAR, BUT THE
REVISED ESTIMATE FROM USDA S
THAT WOULD BE TAKE ANOTHER AT
LEAST ANOTHER YEAR BEFORE THEY
KNOW WE DON'T CURRENTLY
AUTHORIZED AMAZON AND SO IN
CALIFORNIA. WE WOULD LIKE TO
START WITH OUR CURRENT VENDORS
ARE CURRENT AUTHORIZED STORES SO
THAT WE ARE IMPLEMENTING ONE
TYPE OF CHANGE AT A TIME ARE
THOSE 170 NEW INTERNET VENDORS
THAT THE DEPARTMENT ESTIMATES
WILL BE ELIGIBLE INTERNET
VENICE, SO THAT'S KIND OF A
BUREAUCRATIC AN ISSUE THERE. SO
WHAT UST WHAT WE EXPECT, USDA
WILL SAY IS, FOR EXAMPLE, STORE
PICK SAFEWAY, FOR EXAMPLE, THEY
ARE AN AUTHORIZED VENDOR. RIGHT
NOW EVERY SINGLE SAFEWAY
LOCATION IS CONSIDERED A
SEPARATE VENDOR. IF THEY ADD AN
INTERNET FACE THAT WOULD COUNT
AS ANOTHER NUMBER OF VENDORS FOR
US, SO IT'S A DIFFERENT VENDOR
CONTRACT FOR US TO MANAGE IT. IT
INCREASES THE TOTAL NUMBER OF
VENDORS THAT WE HAVE, AND WE
HAVE TO DO ON SITE VISITS AND
MONITORING VISITS FOR A
PERCENTAGE OF OUR TOTAL. SO IF A
STORE LIKE CURRENTLY AUTHORIZED
GROCERY STORE AS INTERNET
AUCTIONS THAT COULD DEFINITELY
INCREASED THE NUMBER OF OUR
TOTAL COUNT OF STORES. OKAY,
EVEN THOUGH IT MIGHT BE
PHYSICALLY, THE SAME BRICK AND
MORTAR ONE ISN'T WALK IN AND DO
IT THIS WAY, AND ONE IS DO YOUR
TRANSACTION ONLINE. THAT ONE
PLACE MY ACCOUNT ACTUALLY HAS TO
DO WITH THAT IN MIND. SEEMS THEN
ONCE SOMEBODY SEEMS REALLY LOW
SO WE DON'T KNOW THAT WE DON'T
KNOW YET. IF, UM FOR EXAMPLE, I
COULDN'T TELL YOU HOW MANY
SAFEWAY LOCATIONS WE HAVE, BUT
HAVING AN INTERNET FACE TO
SAFEWAY THAT MIGHT COUNT AS ONE
INSTEAD OF 100 DON'T QUITE KNOW
YET WHAT USDA WILL DO YOU TALK
TO ME ABOUT FRAUD PROTECTIONS
WHEN IT COMES TO THE DELIVERY
SERVICES. I KNOW. YOU KNOW, WE
HEARD REGARDING SOME VENDORS WHO
ALREADY HAD THAT IN PLACE FOR
THE REST OF THEIR CUSTOMERS THAT
IF A DELIVERY SAFE FROM SAFER OR
BONDS DELIVERS IN THE FOOD IS
ONE ITEM IS MISSING. DELIVERY
PERSON STOLE IT X Y Z. ARE THOSE
PROTECTIONS GOING TO APPLY FOR
WIC CUSTOMERS AS WELL? SO
DELIVERY IS REALLY A BIG ISSUE
IN AND OF ITSELF. WHAT WE DON'T
EXPECT IT IS POSSIBLE, BUT WE
DON'T EXPECT THAT WIC FUNDS
WOULD BE ABLE TO PAY FOR
DELIVERY SO IT COULD BE
SOMETHING OUTSIDE OF THE SCOPE
OF THE WIC PROGRAM. THERE COULD
CERTAINLY BE AN OPTION THAT
COULD BE POSSIBLE THAT A STORE
MIGHT WAVE DELIVERY FEES, TRYING
TO REALLY FOCUS ON THE ACTUAL
ONLINE ORDERING PIECE RIGHT NOW
AND THEN, SO THERE'S A LOT OF
DIFFERENT CURBSIDE PICKUP
CURBSIDE PICKUP WEEKS EFFECT.
THAT MIGHT BE A BIG PIECE OF OUR
ONLINE ORDERING NOW THAT IT
COULD BE THAT AN INDIVIDUAL
WOULD PAY, USE THEIR OWN CASH
THEIR OWN MONEY TO PAY FOR
DELIVERY. IF THE STORE DOES THAT
THERE HAVE BEEN SOME OF OUR WICK
AUTHORIZED STORES DURING THE
COVID PANDEMIC THAT PILOTED, UM,
SOMETHING WHERE THEY DID. IT
WASN'T ACTUALLY ORDERING AND
PAYING FOR THE STORY FOR THE
FOOD PRODUCTS GET IT WAS JUST
CURBSIDE. TRANSACTIONS TO SPEAK,
SO THERE WAS NO DELIVERY OPTION
THERE, SO IT'S POSSIBLE THAT
DELIVERY MIGHT BECOME PART OF
THIS, BUT IT'S UM PROBABLY
WOULDN'T BE ALLOWED. BUT WITH
QUICK DOLLARS MAKE CERTAINLY
MIGHT CHANGE WHEN THE FEDERAL
REGULATIONS COME OUT, BUT IT'S
REALLY JUST ABOUT THE ONLINE
ORDERING AND CURBSIDE PICKUP IS
OUR BIGGEST FOCUS, REALLY WHICH
WHICH IS WHY WE EXPECT THE
CURRENT AUTHORIZED BRICK AND
MORTAR STORES TO BE THE ONES
FULFILLING THE ORDERS. OKAY AND
THEN, UM TWO QUESTIONS FROM
THAT. OH, MY GOODNESS. YES YOU.
YOU SAID THAT THE FEDERAL
REGULATIONS THAT ARE GONNA BE
COMING OUT IN ANOTHER YEAR. DO
WE HAVE THEN WITH THAT IN MIND,
POTENTIAL TIMELINE OF WHEN WEEK
PARTICIPANTS WILL BE ABLE TO
START THIS NEW MODERNIZATION SO
WE HAVE DRAFTED A TIMELINE THERE
. SO IN OUR BUDGET CHANGE
PROPOSAL AND ALSO IN OUR TRAILER
BILL REQUEST, SO THAT TRAILER
BILL REQUEST WE PUT IN SO THAT
WE CAN EXPEDITE THE STATE
REGULATION PROCESS. WE HAVE
CURRENT, UM HEALTH AND SAFETY
CODE STATIC STATUTE THAT ALLOWS
US TO DO WHAT'S CALLED A
BULLETIN PROCESS IS REALLY AN
EXPEDITED STATE REGULATION
PROCESS FOR A FEW CATEGORIES OF
WHAT WE WOULD PUT INTO STATE
REGULATIONS. FOR EXAMPLE, THE
FOODS THAT WE AUTHORIZE IN THE
WIC PROGRAM THAT WAS PUT IN
PLACE IN 2012. AND WE HAVE BEEN
USING IT MANY, MANY TIMES SINCE
THEN, SUCCESSFULLY WORKING WITH
STAKEHOLDERS MAKING CHANGES TO
VENDOR AUTHORIZATION CRITERIA,
THE FOODS THAT WE AUTHORIZE AND
SO WE ARE REQUESTING TO ADD
ANOTHER SCENARIO WHERE WE COULD
USE THAT SAME EXPEDITED PROCESS
SO THAT WE COULD DO THE STATE
REGULATIONS THROUGH A LITTLE BIT
FASTER PROCESS SO IT WILL
PROBABLY STILL BE A COUPLE YEARS
OUT BEFORE WE COULD GO THROUGH.
WE NEED TO GET THE FEDERAL REGS
KNOW EXACTLY WHAT THEY'RE GOING
TO DO, AND THEN WE WOULD GO
THROUGH OUR OWN PROCESS REALLY
LOOKING AT THOSE FEDERAL RIGHTS
TALKING WITH OUR STAKEHOLDERS IN
2025, AND THEN PROPOSE OUR STATE
REGULATIONS AND HAVE THAT PUBLIC
COMMENT PROCESS BUT THAT STATE
RAG PUBLIC COMMENT PROCESS WOULD
BE FASTER THAN IF WE DID NOT
HAVE THIS EXEMPTION TO THE A P
A. AND FINALLY, ARE WE BEING
SENSITIVE WITH THE GEOGRAPHIC IN
TERMS OF PERHAPS NOT EVERY
SINGLE BRICK AND MORTAR RIGHT
NOW THAT ACCEPTS WEEK IS GOING
TO BE ABLE TO DO THE ONLINE THAT
COULD POTENTIALLY CREATE A
BARRIER. FOR SOME. I KNOW IT'S
CRIB SIGN. NOT EVERYONE HAS THE
VEHICLE QUESTION. WE'RE TALKING
ABOUT THIS KIND OF DEMOGRAPHIC
THAT WE'RE GOING TO BE SENSITIVE
THAT THERE WILL BE SOME ONLINE
OPTIONS. IN EACH GEOGRAPHIC AREA
. YES. SO WE'VE HAD A LOT OF
DISCUSSIONS INTERNALLY ABOUT
THAT. WE'VE HAD SOME STORES THAT
HAVE VOLUNTEERED. IF WE'RE GOING
TO DO A PILOT, WE'RE HAPPY TO DO
IT. AND WE THOUGHT, WELL, WE
DON'T WANT TO JUST HAVE IT BE
VERY LIMITED TO SOME AREAS. WE
WANT TO BE VERY PROACTIVE AND
CAREFUL, THOUGHTFUL ABOUT HOW WE
MAKE SURE THAT WE DON'T YOU KNOW
? LOSE GROUND ON EQUITY?
CERTAINLY BY DOING THESE TYPES
OF CHANGES THAT THE WHOLE
PURPOSE OF THIS IS TO PROVIDE
LOW INCOME FAMILIES WITH THE
SAME OPTIONS THAT EVERYBODY ELSE
HAS. AND SO WE WANT TO DO THAT
IN A VERY, VERY THOUGHTFUL AND
CAREFUL WAYS. IT'S REALLY
IMPORTANT TO US, TOO. SERVE
FAMILIES WELL AND NOT NOT LOSE
ANY GROUND THAT WE'VE BEEN
MAKING ON AND SUPPORTING EQUITY.
THANK YOU. THANK YOU SO MUCH.
WE'RE GOING TO HOLD. WELL DID I
ASK YOU FOR A COMMENT? I DON'T
KNOW. I KNOW, BUT WE HAVEN'T SO
HAPPY TO ANSWER QUESTIONS LIKE
NOTHING FURTHER TO ADD. THANK
YOU SO MUCH. WE'RE GONNA HOLD
THIS ITEM OPEN MOVE ON TO ISSUE
NUMBER 12. DISEASE SCREENING
PROGRAM. GOOD AFTERNOON. I'M
LESLIE GAFFNEY, THE ACTING
DEPUTY DIRECTOR AT THE CENTER
FOR FAMILY HEALTH WITH OVERSEAS
AND GENEROUS C SCREENING
PROGRAM. GSP IS ADJUSTING THEIR
CURRENT BUDGET THIS YEAR
DOWNWARD BY $20 MILLION IN
EXPENDITURES IN $24 MILLION IN
REVENUE THAT'S ATTRIBUTED TO
BOTH THE ONGOING DECREASE IN THE
BIRTH RATE, AS WELL AS THE LOSS
OF EXCLUSIVITY FOR THE PRENATAL
SCREENING PROGRAM THAT HAPPENED
AS A RESULT OF A LAWSUIT THAT WE
LOST WHEN WE WENT LIVE WITH CF
DNA SCREENING IN SEPTEMBER. 22
IN THE LAWSUIT WAS BROUGHT BY
LABORATORIES THAT WERE NOT
PARTICIPATING IN STATE PROGRAM
AND SO THAT WAS RESOLVED IN
DECEMBER, AND WE HAVE LOST
EXCLUSIVITY PERMANENTLY. SO WE
HAVE SEEN ABOUT A 20% DECREASE
SINCE THE BEGINNING OF SCREENING
PRIOR TO THE LOSS OF EXCLUSIVITY
. WE WERE SCREENING 72% OF BIRTH
AND WE'RE NOW SCREENING 52% OF
BIRTH. AND THEN FOR BUDGET YEAR
WE EXPECT TO SEE A NET DECREASE
OF JUST OVER $6 MILLION COMPARED
TO THE CURRENT YEAR THAT
DECREASES AGAIN ATTRIBUTED TO
THE LOWER CASE LOAD AND THE
LOWER UPTAKE OF PRENATAL
SCREENING, AS WELL AS A
REDUCTION OF THE $7.4 MILLION.01
TIME FUNDING YOU GAVE US LAST
YEAR TO DO A MOVE OF OUR DATA TO
THE CLOUD PLATFORM AND SOME
ADJUSTMENTS UPWARD OF $1.2
MILLION INCREASE IN CONTRACT
RATES. AND $4.4 MILLION
INCREASE. FOR SCREENING COSTS
FOR TWO NEWBORN SCREENING
DISORDERS THAT ARE BEING ADDED
THIS SUMMER. SO FOR BUDGET YEAR,
THE REVENUE PROJECTIONS WILL SEE
AN INCREASE OF $6.2 MILLION, AND
THOSE ARE ATTRIBUTED TO THE
INCREASE THAT ARE COMING. WE
WILL BEGIN SCREENING FOR SEX
CHROMOSOME AND EMPLOYEES AS PART
OF THE PRENATAL SCREENING
PROGRAM ON APRIL 1ST AND A
COUPLE OF WEEKS AND THEN JULY
1ST. WE WILL BE RAISING THE FEE
TO ACCOUNT FOR THAT EASIER TO DO
IT AT THE BEGINNING OF THE
FISCAL YEAR AND THAT WILL RAISE
THE FEE $112 AND IT WILL BE
$344. AND THEN $12.11. RIGHT 32
23 44. IT WILL BE STARTING JULY
1ST AND THE NEWBORN SCREENING IS
ADDING TO DISORDERS THIS SUMMER
POLICY CREDO, SIS TYPE TWO AND
WANNA DINO ACETATE METAL
TRANSFER IS DEFICIENCY AND
PRACTICE PRACTICE AND THAT WE
WILL BE RAISING THE NEWBORN
SCREENING FEE $15 FROM 2 11 2 TO
26 PAYS FOR THAT. INSURANCE
MEDICAL AND GENERALLY IF
INSURANCE DOESN'T PAY THE
HOSPITALS BECAUSE WE BILL
HOSPITALS DIRECTLY, AND THEN THE
HOSPITALS ARE, UM GETTING THE
FEEDBACK THROUGH THEIR INSURANCE
COVERAGE. SO THIS YEAR, WE
SHOULD HAVE A FUND BALANCE ABOUT
10. NEXT YEAR. WE PROJECTED TO
BE 9. THANK YOU COMMENT ON THIS.
NOTHING FOR THEIR DAD. NICK
NOTHING FOR THEIR DAD. THANK YOU
SO MUCH. WE'RE GOING TO HOLD THE
ITEM OPEN. WE'RE GOING TO MOVE
ON TO ISSUE NUMBER 13. SHOULD
NUMBER 13 IS ON THE CENTER FOR
HEALTH CARE QUALITY ESTIMATE.
WE'RE GOING TO HAVE A SMALL
PANEL DISCUSSION ON THIS. HERE
IN THE SUBCOMMITTEE NUMBER THREE
WE REQUESTED POUNDED TO COME
DISCUSS THE DEPARTMENT'S
ENFORCEMENT OF 2019 STATUE.
ESPEED 2 TO 7. I ASKED THAT ONLY
THE PEOPLE WHO ARE ON THE PANEL
TO PLEASE COME TO THE WELL, IF
YOU WOULD BE SPEAKING, PLEASE
COME TO THE WELL. YOU HAVE AN
OPPORTUNITY TO PROVIDE PUBLIC
COMMENT. AFTER. I ASKED FOR THE
DEPARTMENT REPRESENTATIVE TO BE
HERE. MM HMM. THE REPRESENTATIVE
FROM S E I U LOCAL 1 TO 1 OUR
END. AND A REPRESENTATIVE FROM
CALIFORNIA HOSPITAL ASSOCIATION.
WE'RE ALL HERE. GREAT I ASKED.
THE DEPARTMENT OF POLICE KICKED
US OFF. GOOD AFTERNOON. MONICA
NELSON, ACTING CHIEF OF THE
INTERNAL OPERATIONS DIVISION AT
THE CENTER FOR HEALTH CARE
QUALITY. WE HAVE ISSUED 13.
WOULD YOU LIKE ME TO JUST GO
STRAIGHT TO THE QUESTIONS? VERY
GOOD FOR ISSUE NUMBER ONE,
PLEASE PROVIDE A BRIEF OVERVIEW
OF THE CENTER OF HEALTH FOR
HEALTH CARE QUALITY, INCLUDING
REGULATORY RESPONSIBILITIES,
ORGANIZATIONAL STRUCTURE.
FUNDING AND PERFORMANCE. THE
CENTER FOR HEALTH CARE QUALITY
IS RESPONSIBLE FOR REGULATORY
OVERSIGHT OF LICENSED HEALTHCARE
FACILITIES AND HEALTH CARE
PROFESSIONALS TO ASSESS THE
SAFETY, EFFECTIVENESS AND HILKER
QUALITY FOR ALL CALIFORNIANS.
THE CENTER FULFILLS THIS ROLE BY
CONDUCTING PERIODIC INSPECTIONS
AND COMPLAINT INVESTIGATIONS AT
HEALTHCARE FACILITIES AND
PROVIDER AGENCIES TO DETERMINE
COMPLIANCE WITH APPLICABLE STATE
AND FEDERAL LAWS AND
REGULATIONS. THE PROGRAM IS
ORGANIZED INTO 14 DISTRICT
OFFICES AND INCLUDES A
PARTNERSHIP WITH LOS ANGELES
COUNTY, WHICH OPERATES ON THE
RED CONTRACT WITH THE CENTER.
SECURE LICENSES AND CERTIFIES
OVER 14,000 HEALTHCARE
FACILITIES AND AGENCIES IN
CALIFORNIA IN 30, DIFFERENT
LICENSURE AND CERTIFICATION
CATEGORIES. IN ADDITION TO
SECURE OVERSEES THE
CERTIFICATION OF NURSE
ASSISTANCE AID, DIALYSIS
TECHNICIANS AND THE LICENSING OF
NURSING COMMENT MINISTRY TRES,
THE CENTER ALSO HOSTS THE
HEALTHCARE ASSOCIATED INFECTION
PROGRAM, WHICH OVERSEES THE
PREVENTION, SURVEILLANCE AND
REPORTING OF HEALTHCARE.
ASSOCIATED INFECTIONS.
ANTIMICROBIAL RESISTANCE IN
CALIFORNIA'S HOSPITALS AND OTHER
HEALTH CARE FACILITIES. THE
MAJORITY OF CHC QUÊ IS FUNDED BY
THE STATE, THE PERMANENT PUBLIC
HEALTH LICENSING AND
CERTIFICATION PROGRAM FUND 3098,
WHICH IS SUPPORTED BY LICENSING
FEES COLLECTED FROM THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH, REGULATED HEALTH
FACILITIES AND PROVIDERS
THROUGHOUT CALIFORNIA.
DEPARTMENT OF HEALTH AND HUMAN
SERVICES CENTERS FOR MEDICAID,
MEDICARE AND MEDICAID SERVICES.
WORDS FEDERAL GRANT MONEY TO THE
CENTER TO CERTIFY THAT
FACILITIES EXCEPT IN MEDICARE
AND MEDICAID PAYMENTS MEET
FEDERAL REQUIREMENTS. ADDITIONAL
FUNDING INCLUDES REIMBURSEMENTS
ASSOCIATED WITH INTERAGENCY
AGREEMENTS WITH THE DEPARTMENT
OF HEALTH CARE SERVICES AND
GENERAL FUND, WHICH SUPPORTS
SERBIA, ACTIVITIES IN STATE
OWNED AND OPERATED FACILITIES.
YOU LIKE ME TO GO INTO ISSUE
NUMBER TWO, PLEASE PROVIDE AN
UPDATE ON THE LNC PROGRAM.
SPEAKING TO READ, PARTICULARLY
FOR THE HEALTH AND
CLASSIFICATION AND EFFORTS TO
IMPROVE VACANCY RATES. AS OF
FEBRUARY. 2020 FOR THE VACANCY
RATE IS 14.3% FOR THE HEALTH
FACILITY EVALUATED NURSES, WHICH
IS AN INCREASE OF 10.6% POINTS
SINCE THE BEGINNING OF THE COVID
19 PANDEMIC IN FEBRUARY. 2020
THIS INCREASE IS DUE IN PART TO
NEARLY AUTHORIZED POSITIONS, BUT
ALSO BECAUSE OF INCREASED
RETIREMENTS AND SEPARATIONS. CH
SECURITIES CURRENTLY UTILIZING
SOCIAL MEDIA PLATFORMS, SUCH AS
INDEED LINKEDIN TO ATTRACT TO
ATTRACT AN INCREASE ENGAGEMENT
WITH POTENTIAL CANDIDATE WALKING
THEM THROUGH THE COMPLEX STATE
HIRING PROCESS AND THE NATURE OF
THE SURVEYOR ROLE. ACCUSE
RECRUITMENT TEAMS STARTED
ATTENDING IN PERSON JOB FIRST TO
ENGAGE WITH LOCAL CANDIDATES AT
HARD TO RECRUIT LOCATIONS. WE
ARE ALSO PROMOTING ALL INTERNAL
EMPLOYMENT OPPORTUNITIES WITH CH
SECURE STAFF VIA EMAIL. BLESSED
TO CREATE VACANCY AWARENESS.
FINALLY CHC QUÊ HAS ON BOARDING
PROGRAM AS WELL TO WELCOME NEW
HIRES AND INTRODUCE HIM TO SEE
THE PHS CULTURE MISSION AND
VALUES ON BOARDING MEETINGS
HELPED NEW HIRES TO FILL ENGAGED
, INTEGRATED AND PART OF THE
TEAM TO CLOSE CHC QUÊ CONTINUES
TO RE ASSESS AND MONITOR VACANCY
RATE. RECRUITMENT PROGRESS AND
MORE FOCUSING ON THIS AREA HAS
BEEN REACHING OUT TO OTHER
STATES TO UNDERSTAND HOW THEY
ARE ADDRESSING SIMILAR ISSUES,
WHICH INCLUDES THEIR WORKFORCE
COMPOSITION, IN PARTICULAR THE
USE OF INDIVIDUALS OF OTHER
PROFESSIONAL DISCIPLINES. ALL
RIGHT, MOVING ON TO NUMBER
THREE. PLEASE PROVIDE AN UPDATE
ON THE MOST CURRENT TIMELINESS.
METRICS FOR INVESTIGATION OF
COMPLAINTS AND ENTITY REPORTED
INCIDENT. QUARTER ONE OF 2023 24
SECURE COMPLETED 93% OF LONG
TERM KILL IS LONG TERM HEALTH
CARE FACILITY COMPLAINTS WITHIN
60 DAYS OF RECEIPT. THIS
REPRESENTS A 30% IMPROVEMENT IN
THE TIMELINESS OF LONG TERM CARE
COMPLAINTS THAT SEEMS SUPPORTED
FOR 2021 22. AS OF JANUARY, 2024
CHC QUÊ HAS COMPLETED 97.6% OF
BACKLOG LONG TERM CARE
COMPLAINTS THAT EXISTED AS OF
APRIL 1ST 2021. HAS REDIRECTED
RESOURCES TO ADDRESS THIS OPEN
COMPLAINTS WITH THE GOAL OF
ELIMINATING THE BACKLOG BY THE
END OF FISCAL YEAR. 2023 24. IN
TERMS OF GENERAL PERFORMANCE.
CHC QUÊ CONTINUES TO PRIORITIZE
NOT ONLY BACKLOG BUT ALSO THEIR
RESUMPTION OF RECERTIFICATION
AND RELATED SURVEYS ACROSS
NUMEROUS FACILITIES, TYPES STAY
WHITE. THANK YOU. I'M GOING TO
HAVE YOU KICK US OFF WITH THE
POUND DISCUSSION SO YOU CAN MOVE
OUT TO, UM, NUMBER FOUR. THANK
YOU SO MUCH. MY NAME IS CASSIE
DONOVAN, THE DEPUTY DIRECTOR FOR
CENTER FOR HEALTHCARE QUALITY,
AND I'D LIKE TO TAKE THE
OPPORTUNITY TO ADDRESS THIS VERY
IMPORTANT ISSUE. SAGE SECURE
RECOGNIZES THE IMPORTANCE OF
MAINTAINING SUFFICIENT STAFF
RESOURCES IN HEALTH CARE
SETTINGS AND THEIR ROLE IN
PROTECTING SAFETY AND QUALITY OF
CARE, IN PARTICULAR, AMONG
GENERAL QUÊ CARE HOSPITALS WERE
FOR THE SUBJECT OF SP 2 TO 7.
THE CENTER TAKES ALLEGATIONS OF
STAFFING, NON COMPLIANCE VERY
SERIOUSLY AND APPROPRIATELY
ASSIGNED TOP PRIORITY TO
INVESTIGATIONS FOR INADEQUATE
STAFFING. ADDITIONALLY CHC CURES
CONTINUED TO RAISE AWARENESS OF
STAFFING RATIO REQUIREMENTS TO
HOSPITALS AND HOSPITAL
ASSOCIATION MEMBERS IN AN EFFORT
TO ALSO PREVENT FUTURE
VIOLATIONS AS WELL AS OFFERING
ONGOING DIRECTION AND INFORMED
TRAINING TO SURVEYORS ACROSS OUR
ORGANIZATION, IMPLEMENTATION OF
DIRECTIVES AND UPDATED POLICY
DIRECTION HAS RESULTED IN
NUMEROUS PENALTIES BEING ISSUED
TO HOSPITALS. REVISIONS TO DATA
BASES AND PUBLICLY AVAILABLE
DASHBOARDS ARE UNDERWAY TO
INCREASE TRANSPARENCY IN THIS
AREA. IN ADDITION, SIEGE SECURE
HAS ESTABLISHED A RECURRING
MEETING WITH STAKEHOLDERS TO
ADDRESS QUESTIONS AND UNDERSTAND
EXPERIENCES OR CONCERNS FROM
REPRESENTATIVE PERSPECTIVES. THE
CENTER IS ALSO ACTIVELY
EVALUATING EXISTING PROCESSES
AND EXPLORING OPTIONS FOR
LEANING APPROVAL STEPS TO REDUCE
THE TIME BETWEEN INVESTIGATIONS
AND THE ISSUANCE OF RELATED
PENALTIES. I AM HAPPY TO
CONTINUE TO QUESTION FIVE IN
TERMS OF UNANNOUNCED INSPECTIONS
THAT MAY HAVE OCCURRED SINCE I
SEPTEMBER ALL FACILITY LETTERS
THAT ARE CENTERED ISSUED YES. IN
FACT, ALL COMPLAINT
INVESTIGATIONS AND PERIODIC
INSPECTIONS ARE COMPLETED AND
PERFORMED BY CHC QUÊ AS
UNANNOUNCED VISITS. THE CENTER
HAS SUBSTANTIATED VIOLATIONS OF
STAFFING RATIO REQUIREMENTS THAT
SEPTEMBER AND HAS ISSUED
PENALTIES TO HOSPITALS FOR
NONCOMPLIANCE. I WILL SPEAK A
LITTLE BIT MORE DETAIL IN TERMS
OF PENALTIES THAT HAVE BEEN
ISSUED IN THE FREQUENCY OF
EXEMPTION CRITERIA BEING MET BY
FACILITIES. SO YES, THERE HAVE
BEEN CASES WHERE EVIDENCE HAS
LED TO A DETERMINATION OF
EXEMPTION FROM PENALTIES.
HOWEVER BASED ON THE PRELIMINARY
DATA THAT WE WERE ABLE TO GATHER
FOR TODAY, THESE EXEMPTIONS HAVE
BECOME FAR MORE INFREQUENT
COMPARED TO OCCURRENCES THAT MAY
HAVE HAPPENED DURING THE
DECLARED PUBLIC HEALTH
EMERGENCY. ADDITIONALLY IN SOME
CASES, MULTIPLE VIOLATIONS ARE
IDENTIFIED DURING AN
INVESTIGATION AND RESULT IN
MULTIPLE FINDINGS BEING CITED
BUT CONSTITUTE A SINGLE PENALTY.
AS A RESULT DURING CONCLUSIONS
OF COMPLAINT VOLUME TWO
PENALTIES ISSUED IS NOT EXPECTED
TO PROVIDE A DIRECT COMPARISON.
AND AGAIN BASED ON THE
PRELIMINARY DATA, WE WERE ABLE
TO GATHER APPROXIMATELY 75% OF
THE COMPLAINTS THAT WE'VE
RECEIVED. AN INVESTIGATION HAS
BEEN COMPLETED. SPECIFICALLY
RELATED TO STAFFING RATIO,
NONCOMPLIANCE HAVE BEEN
SUBSTANTIATED WAS SOME
ADDITIONAL INVESTIGATIONS THAT
ARE STILL PENDING AND THEN
OTHERS THAT ARE ACTIVELY
UNDERWAY TO DATE ROUGHLY 70% OF
THOSE DETERMINATIONS
SUBSTANTIATED DETERMINATIONS
HAVE OR WILL RESULT IN A
PENALTY. OF COURSE, AS WE
CONTINUE TO ADJUDICATE THOSE
CASES THAT MAIN NUMBER THAT MAY
NUMBER THAT NUMBER MACRO, UM
ONCE THOSE ADDITIONAL CASES ARE
COMPLETED. THANK YOU BEFORE WE
GO ON TO THE PANELISTS SOME
QUESTIONS YOU MENTIONED THE
REOCCURRING MEETING WITH
STAKEHOLDERS WHO MAKES UP THAT
GROUP MEMBERS FROM S. C I U AND
PARTIES FROM MY TEAM, INCLUDING
MYSELF. OKAY? AND THEN DO WE
HAVE ANOTHER HOW MANY COMPLAINTS
WE RECEIVED SINCE I WOULDN'T
WANT TO INVALIDATE AGAIN, WE
PULLED SOME PRELIMINARY DATA
USING ALLEGATION COUNTS, UM, AND
THEN MIRRORED THOSE WITH THE
COMPLAINT CASES THAT WERE ABLE
TO PUT TOGETHER SO I'D LIKE TO
VALIDATE THAT HAPPY TO SHARE
WITH DETAILED DATA FOLLOWING
TODAY'S HEARING. I DON'T KNOW
THE PANDEMIC, PUT A HOT ON THESE
INVESTIGATIONS AND FOLLOW UP AND
THEN SEPTEMBER 2023. THE
DEPARTMENT DID SEND OUT THAT
LETTER. AND I KNOW YOU YOU SHARE
WITH ME SOME DATA SINCE
SEPTEMBER, 2023. BUT WHAT ABOUT
THE YEAR THAT THIS STATUE FIRST
WAS IMPLEMENTED IN 2019 FOR THAT
FORCE? CANTERBURY YEAR? HOW DID
WE DO THAT YEAR? TO MY KNOWLEDGE
THERE WAS STILL SOME DEVELOPMENT
UNDERWAY AS FAR AS HOW WE WERE
GOING TO APPROACH THAT I DON'T
HAVE DATA TODAY TO SHARE BUT I'M
HAPPY TO GO BACK AND LOOK AT
ANYTHING THAT MIGHT HAVE BEEN
PUT IN PLACE OR CITED IN 2019.
WOULD YOU SAY THAT PERHAPS THAT
YEAR WAS USED TO RAMP UP THIS
PROGRAM, AND IN FACT, WE'VE ONLY
BEEN ABLE TO INVESTIGATE SINCE
SEPTEMBER, 2023. POTENTIALLY
OKAY? CAN YOU TELL ME MORE ABOUT
THE BARRIERS THAT EXIST IN THE
TIME IT TAKES TO INVESTIGATE AND
HOW WE'RE FURTHER REDUCING THAT
TIME? SURE AS AS MONACO MY
COLLEAGUE HAD MENTIONED WE'RE
REALLY FOCUSING ON TRYING TO
REDUCE OUR VACANCY RATE BRINGING
ADDITIONAL DISCIPLINES. UM, LOOK
AT WAYS THAT WE CAN MAXIMIZE THE
EFFICIENCY OF OUR TEAMS AND HOW
WE DEPLOY THEM OUT TO
FACILITIES. UM YOU HEARD HER
MENTION WE HAVE 14,000
FACILITIES AND A NUMBER OF
PRIORITIES THAT WE NEED TO
RESPOND TO. OFTENTIMES WE WILL
GATHER NUMEROUS COMPLAINTS
TOGETHER AND BRING THOSE TO MAKE
THE MOST OUT OF A VISIT. SO THAT
MAYBE ONE APPROACH CERTAINLY
SETTING PRIORITIZE AND
READJUSTING AND THEN A NUMBER OF
THE HOSPITALS ACROSS OUR STATE.
OUR ACCREDITED THROUGH A
FEDERALLY ACCREDITED APPROVED
ACCREDITING ORGANIZATION, AND
THERE ARE OPPORTUNITIES WHERE WE
CAN LEVERAGE THEIR AUTHORITY TO
PERFORM SOME OTHER
INVESTIGATIONS ON LOWER PRIORITY
THINGS WHICH CAN THEN IN TURN
FREE UP SOME MORE OF OUR STAFF
TO BE ABLE TO READ THE
RESPONSIVE TO BOTH STATE
PRIORITIES, SUCH AS NURSE
PATIENT RATIO ISSUES. OR OTHER
HIGH HIGH PRIORITY THINGS THAT
HAVE A RISK TO PATIENT SAFETY.
SO IT'S OUR APPROACH IS
CONTINUALLY MODIFYING AND
ADJUSTING AND PRIORITIZING TO BE
RESPONSIVE. AND THEN MY LAST
QUESTION BEFORE WE MOVE ON TO
THE NEXT PANELIST IS SPEAKING
REGARDING THE SINGLE VIOLATIONS
AND THAT SOMETIMES THEY ALL CAN
CONSTITUTE AS EVEN THOUGH
THERE'S A LOT OF SINGLE QUÊ
SPEAK MORE ON HOW YOU'RE JUDGING
THIS AND HOW THEY'RE NOT
STACKING ON TOP OF EACH OTHER SO
THAT THE STATUTE DOES IN TERMS
OF STACKING THAT THE FIRST
VIOLATION WOULD BE A LOWER LEVEL
PENALTY, AND THEN THEY INCREASE
ON THE REPEATED CORRECT, BUT THE
STATUTE ALSO RECOGNIZES THAT
WERE MULTIPLE VIOLATIONS ARE
DISCOVERED DURING AN
INVESTIGATION. IT DOES
CONSTITUTE A SINGLE PENALTY. SO
IN THOSE CASES WHEN WE DO FIND
THAT IF WE GET AN ALLEGATION,
I'LL USE AN EXAMPLE. WE
INVESTIGATED STAFFING RATIO
ISSUE AT A HOSPITAL AND WE FIND
THAT THREE DIFFERENT UNITS ARE
OUT OF RATIO. THAT'S TECHNICALLY
THREE DEFICIENCIES ON OUR PART
TIED TO ONE COMPLAINT AND ONE
INVESTIGATION, AND SO IN THOSE
CASES, IT WOULD NOT THEN
TRANSLATE TO THREE PENALTIES.
THANK YOU. YES, OF COURSE.
SENATOR ROTH. I MEAN, REFRESH MY
RECOLLECTION DID THE PENALTY
START IN 2000 AND 19 THE WAS THE
2019 20 SESSION WHEN THE STATUTE
WAS PASSED, AND THEN, OF COURSE,
SUBSEQUENT 2020 EARLY 2020.
THERE WAS A SHIFT TO BE
RESPONSIVE TO THE YOU KNOW,
ISSUES AROUND COVID 19 AND
STAFFING ISSUES AND THEN
UNDERSTAND, YES STAFFING RATIOS
HAVE BEEN IN EFFECT SINCE 19
MANY YEARS. SO WAS THERE NO
PENALTY ATTACHED TO VIOLATIONS
OF THOSE RATIOS? THERE WAS NO
PENALTY ATTACHED TO THAT UNLESS
IT ROSE TO AN ADVERSE EVENT IN
IMMEDIATE JEOPARDY ISSUE. WHICH
HAS SEPARATE CRITERIA. OF
COURSE, IT'S HARD FOR OBVIOUSLY
THERE'S A LOT OF CONSTERNATION
ABOUT WHETHER IN FACT COMPLAINTS
HAVE BEEN INVESTIGATED. WHETHER
THEY'VE BEEN INVESTIGATED TIMELY
, WHETHER ACTION ANY ACTION WAS
TAKEN, WHETHER ACTION WAS TIMELY
AND WHETHER PENALTIES YOU KNOW
WERE ASSESSED PROPERLY ASSESSED
AT ALL OR ASSESS PROPERLY HAVE
LONG BEEN A PROPONENT OF I MEAN,
I'VE SUPPORTED STAFFING RATIOS.
I'VE ALSO BEEN A PROPONENT OF
ALLOWING HOSPITALS TO HAVE OFF
RAMPS IN CASES WHERE THE
STAFFING RATIOS WERE BREACHED
DUE TO INADVERTENT. WHATEVER THE
INADVERTENT SEE, IS SOMEONE
CALLING OFF SICK WITHOUT PROPER
NOTICE SOMEBODY JUST NOT SHOWING
UP WITHOUT THE PROPER NOTICE,
AND I'M SURE THERE ARE OTHER
EXAMPLES THAT WE CAN COME UP
WITH WHERE IT WOULD PROBABLY BE
INAPPROPRIATE TO ASSESS THE
PENALTY AGAINST THE HOSPITAL.
BUT ON THE OTHER HAND IF
HOSPITALS ARE NOT STAFFING
APPROPRIATELY, AND THERE'S A
PATTERN OF THAT, AND THAT
RESULTS IN A BREACH OF THE
STAFFING RATIOS, AND SOMETHING
SHOULD HAPPEN OBVIOUSLY. IT'S
HARD TO ASK QUESTIONS. IS THERE
A REPORT THAT'S AVAILABLE THAT
LISTS BY COMPLAINTS OR SERIES OF
COMPLAINTS EVEN IF THE
FACILITIES AREN'T NAMED THE
COMPLAINT, THE TYPE OF COMPLAINT
THE ACTION TAKEN THE TIMELINE OF
THE ACTION FROM COMPLAINT OF
FINALIZATION AND THE PENALTIES
THAT WERE EITHER ASSESSED OR
NOT. THE REPORT DOESN'T
CURRENTLY EXIST. BUT AGAIN, OUR
WORK WITH OUR STAKEHOLDERS IS
MOVING TOWARDS NOT ONLY HAVING A
REPORT DEVELOPED A REPORTING
SYSTEM AND TRACKING SYSTEM
IMPLEMENTED, BUT THEN ALSO
INTEGRATING THAT INTO A PUBLIC
FACING DASHBOARD SO THAT
TRANSPARENCY IS AVAILABLE, AND
FOLKS CAN CONTINUE TO TRACK WITH
THE PROGRESSES OR THE FREQUENCY
OF PENALTIES BEING ISSUED. WELL,
IT'S SORT OF HARD TO CONDUCT
OVERSIGHT. IF WE DON'T HAVE THE
DATA, WE CAN PULL THE DATA WE
CAN PULL THE DATA HAS. IS THIS
THE FIRST TIME THAT ANYBODY'S
REQUESTED THAT DATA RECENTLY?
WE'VE BEEN, UM THERE'S BEEN A
REQUEST FOR THAT DATA. AND SO
WE'RE ABLE TO POPULATE THAT. AND
THE REASON I'M CONCERNED IS, OF
COURSE, YOU KNOW, I'VE SPENT A
LOT OF TIME SIX YEARS TO BE
EXACT ON THE BUDGET
SUBCOMMITTEE, NOT THIS ONE
DEALING WITH IT PROJECTS
SOFTWARE. DATA COLLECTION AND
THE LIKE IN THIS BUILDING AND IN
THE STATE AND ITS SEEMS TO TAKE
FOR ABSOLUTE EVER. JUST TO
DESIGN A SYSTEM. AND SO IF WE'RE
WAITING FOR A SYSTEM DESIGN IN
ORDER TO GET DATA, WE'RE
PROBABLY GOING TO BE NONE OF US
WILL BE HERE. CERTAINLY NOT ME.
UM, AND DURING THAT TIME WE
THOSE OF US WHO WERE CHARGED
WITH OVERSIGHT WON'T REALLY BE
IN A POSITION TO CONDUCT
APPROPRIATE OVERSIGHT. AND OF
COURSE, THIS IS A HEALTHCARE
DELIVERY SYSTEM ISSUE, AND WE'RE
TALKING ABOUT PATIENTS AND
SAFETY OF PATIENTS AND
PERFORMANCE AND ALL THE REST SO
I WOULD LIKE TO SEE SOME DATA.
UM BUT I'M NOT THE CHAIR OF THIS
COMMITTEE. SO THAT'S THAT'S JUST
I'M JUST GIVING YOU MY
PERSPECTIVE. I DON'T SPEAK FOR
MY CHAIR. BUT IF SOMEBODY HAS TO
PUT ON A GREEN EYE SHADE AND
TAKE A PENCIL. I THINK WE
PROBABLY OUGHT TO BE DOING THAT
BECAUSE WE NEED TO KNOW WHAT'S
GOING ON. BECAUSE WE GET A LOT
OF COMPLAINTS. WE GET COMPLAINTS
FROM OUR CONSTITUENTS. WE GET
COMPLAINTS FROM PATIENTS ABOUT
CARE ISSUES, AND THEN WE GET
COMPLAINTS FROM CONSTITUENTS WHO
WORK IN HOSPITALS ABOUT THE FACT
THAT THEY REPORT SITUATIONS AND
NOTHING SEEMS TO HAPPEN. AND
THAT MAY OR MAY NOT BE TRUE. BUT
WE NEED TO BE IN A POSITION TO
RESPOND. I APOLOGIZE FOR NOT
HAVING. I GUESS I DID HAVE A
QUESTION BURIED IN THERE. AND
YOU DID ANSWER IT. SO THANK YOU
FOR ANSWERING MY QUESTION. AND I
APOLOGIZE FOR THE SPEECH. OF
COURSE. THANK YOU, MADAM. IF I
MAY I THINK THAT THE BENEFIT IS
THAT WERE ADVANCED IN OUR
DEVELOPMENT. WE ALREADY HAVE A
NUMBER OF DATA METRICS THAT ARE
PUBLISHED PUBLICLY ON OUR CENTER
WEBSITE. SO WE HAVE THE
FRAMEWORK THERE. IT'S JUST
CODING THE SYSTEM TO PULL THE
DATA SO HOPEFULLY WE CAN PRODUCE
A PUBLIC FACING DASHBOARD BEFORE
NOT PART OF THE TEAM HERE, BUT
YOU HAVE TO MOVE RATHER QUICKLY.
OKAY WHAT WOULD BE WHAT'S GONNA
BE ON THAT ON THAT ON THAT
PLATFORM, SO, UM, HAVEN'T FULLY
DEFINED THAT YET, BUT THAT IS
PART OF THE CONVERSATIONS THAT
WE'RE HAVING WITH OUR
STAKEHOLDER GROUP. AS TO WHAT
INFORMATION IS APPROPRIATE, WHAT
INFORMATION THEY WOULD LIKE TO
SEE WHAT IS PUBLICLY MEANINGFUL
TO PEOPLE. WE WANT TO MAKE SURE
THAT THE DATA IS CONSUMABLE BY
FOLKS AND THEN IT'S EASY TO
UNDERSTAND AND GET A PICTURE OF
THE ENFORCEMENT ACTIVITIES THAT
ARE UNDERWAY. SO AGAIN. WE HAVE
THE FRAMEWORK. IT'S A MATTER OF
DEFINING AND MAKING SURE THAT
OUR SYSTEM PULLS THE CORRECT
DATA AND PUBLISHING IT IN A WAY
THAT IS AGAIN DIGESTIBLE BY
FOLKS ON PAGE 42 OF THE
WONDERFUL DESCRIPTION, MR SCOTT
HERE PUT TOGETHER IT SPEAKS ON
THE RATIOS FOR EACH DIFFERENT
TYPE OF UNIT. DID WE HAVE AN
IDEA ON WHICH UNIT WE GET MOST
COMPLAINTS FROM IS IT OR
INTENSIVE CARE, LABOR AND
DELIVERY, NEONATAL CARE, STEPPED
DOWN. I WOULD NEED TO GO BACK
AND REALLY LOOK AT THE DATA. AND
I KNOW THAT TELEMETRY CAME UP
WHEN I WAS BRIEFLY LOOKING AT
THE DATA LAST NIGHT BRIEFLY CAME
UP. FOR CONTEXT. I DON'T THOSE
ARE FOR THE DEFICIENCIES THAT WE
HAVE CITED IN TERMS OF
COMPLAINTS. WE WOULD HAVE TO
ACTUALLY PULL ALLEGATION DATA,
UM AND SEE IF IT WAS THAT
SPECIFIC IN THE COMPLAINT TO
IDENTIFY A PARTICULAR UNIT, BUT
CODING WISE IN THE WAY THAT WE
WRITE THE DEFICIENCY, WE SHOULD
BE ABLE TO PRODUCE A BREAKDOWN
TO GIVE AN IDEA. WHERE WE'RE
SEEING MORE FREQUENT OCCURRENCES
OF NURSE PATIENT RATIO
VIOLATIONS BY UNIT. THANK YOU SO
MUCH SENATOR OFF. AND WILL THAT
DATA REPORT? UM FIRST OF ALL,
WELL, IS IT GOING TO BE THIS IS
SIMPLY PROSPECTIVE, OR IS IT
GOING TO DO HAVE A LOOK BACK TO
THE TIME WHEN THE STAFFING
RATIOS WERE ACTUALLY PUT IN
PLACE? SO GOING BACK PRIOR TO
2007, THE DEPARTMENT OF
DEPARTMENT, HEALTHCARE SERVICES
AND DEPARTMENT OF PUBLIC HEALTH
WAR ONE DEPARTMENT SO ANYTHING
POST 2007. POTENTIALLY WE COULD
GO BACK TO BUT PRIOR TO THAT
ACCESSING DATA IN AN ARCHIVE
PRIOR TO THE EXISTENCE OF OUR
DEPARTMENT, I THINK WOULD BE SO
AT LEAST WE CAN EXPECT DATA FROM
2007 ON I WOULD THINK SO. YES
AND WILL THE DATA REPORT THAT
YOU'RE ABLE TO PROVIDE US WOULD
PROVIDE OBVIOUSLY NOT PATIENT
DATA. BUT WILL IT PROVIDE THE
NAME OF THE INSTITUTION THAT
WE'RE FOCUSING ON? COULD
PROVIDE? YES THE FACILITY NAME
THAT WOULD BE HELPFUL. THANK
YOU, MADAM CHAIR. WE'RE GOING TO
MOVE ON TO OUR NEXT PANELISTS
REPRESENTING STU, LOOK AT 1 TO
1. RN THANK YOU. MY NAME IS
JOYCE PELL. I'M AN EMERGENCY
ROOM NURSE OF 25 YEARS OF
PROVIDENCE SAINT JOSEPH MEDICAL
CENTER IN BURBANK. I'M CURRENTLY
THE SECRETARY TREASURER OF THE U
121 R N. I WANT TO THANK YOU ALL
FOR GIVING NURSES THE
OPPORTUNITY TO SPEAK ON THIS
VERY IMPORTANT ISSUE THAT
IMPACTS US AND THE PATIENTS THAT
WE CARE FOR OUR ALSO JOINED BY
UNIQUE TODAY WHO HAVE JOINED US
IN OUR CAMPAIGN TO ENSURE THAT
LIFESAVING NURSE TO PATIENT
RATIOS. ARE UPHELD WHEN I WAS
HERE LAST YEAR WITH CDU,
CALIFORNIA I TALKED TO THIS
COMMITTEE ABOUT SB 2 TO 7, A LAW
THAT MANDATES FINES FOR
HOSPITALS THAT REPEATEDLY
VIOLATE CALIFORNIA'S NURSE TO
PATIENT RATIOS. UM THAT LAW WAS
NOT BEING ENFORCED SINCE THE
EMERGENCY ORDER WAS LIFTED OVER
A YEAR AGO, THERE STILL ONLY A
HANDFUL OF FINES THAT HAVE BEEN
ISSUED, LEAVING MOST COMPLAINTS
IGNORED AND NOT ACCOUNTED FOR,
AND HAS RESULTED IN CHRONIC
UNDERSTAFFING. THE FINES UNDER
SB 2 TO 7 ARE MEANT TO ACT AS A
DETERRENT TO HOSPITALS THAT
REPEATEDLY VIOLATE THE LAW. BUT
HOSPITAL ADMINISTRATORS KNOW
THAT THERE IS NO REAL
CONSEQUENCES OR ACCOUNTABILITY
WHEN THEY VIOLATE THE LAW.
HOSPITAL ADMINISTRATORS OFTEN
REFER TO OUR RATIOS AS
GUIDELINES, NOT LAWS THAT NEED
TO BE FOLLOWED. OUR MEMBERS HAVE
ISSUED HUNDREDS OF COMPLAINTS
ABOUT RATIO VIOLATIONS AND
NURSES ACROSS THE STATE HAVE
SUBMITTED MANY MORE RESPONSES TO
OUR COMPLAINTS OFTEN TAKE MONTHS
, EVEN CASES WHERE THE
COMPLAINTS INCLUDED PATIENT
DEATH OR DEMONSTRATE THE
PATIENT'S LIVES MAY HAVE BEEN AT
RISK. SOMETIMES WE NEVER HEAR
BACK AT ALL. OUR NURSES ARE
WITNESSING A LACK OF
TRANSPARENCY AND ACCOUNTABILITY
IN THE PROCESS, WHICH HAS
RESULTED IN NURSES LEAVING THE
BEDSIDE. WE HAVE SEEN TOO MANY
OF OUR PATIENTS CARE BE PUT INTO
JEOPARDY DUE TO UNSAFE STAFFING.
I WANT TO THANK JUST YET, ER
HERE. THAT HE AND HIS FAMILY ARE
HERE TODAY. THE SIETE FAMILY
EXPERIENCED A NIGHTMARE AFTER
VISITING AN ER ONE ALL TOO
FAMILIAR FOR OUR NURSES,
ACCORDING TO THE LAWSUIT THAT
HIS FAMILY HAS BROUGHT AGAINST
WEST HILLS HOSPITAL IN L. A
REPEATED PATTERN OF
UNDERSTAFFING TURNED JOSH'S
EMERGENCY ROOM VISIT INTO A LIFE
OF DEPENDENCY ON MACHINES AND
CARETAKERS. MANY COMPLAINTS OF
WORKING OUT OF RATIO ARE
SUBSTANTIATED. YET THEY TOO
OFTEN DO NOT RESULT IN FINES AS
THE LAW REQUIRES. CITY PH DID
ISSUE ONE NURSING RATIO SPECIFIC
FINE AT ONE OF OUR MEMBERS IS
HOSPITAL LOS ROBLES REGIONAL
MEDICAL CENTER RECEIVED A FINE
IN MARCH OF 2023. THIS FINE WAS
BASED ON INVESTIGATIONS THAT
TURNED UP 116 INCIDENTS OF
DEPARTMENTS AS NURSES GOING OUT
OF RATIO. AFFECTING 470 RN
SHIFTS. IN JUNE AND JULY OF 2022
, ONLY ONE OF THE 116 INCIDENTS
WERE FINED. THE INVESTIGATION
CONCLUDED THE FAILURE OF SHORT
STAFFING RESULTED TO STAFF
QUITTING CARE ASSESSMENTS NOT
BEING DONE PLACING PATIENTS AT
HARM'S WAY OF POOR QUALITY CARE,
UNMET MEDICAL AND PATIENT CARE
NEEDS. THOSE IMPACTS WEREN'T
UNIQUE TO THE SPECIAL TWO MONTH
WINDOW AT THAT ONE HOSPITAL THEY
ARE TRUE OF HUNDREDS OF OTHER
TIMES ARE NURSES HAVE BEEN OUT
OF RATIO. IN THE LAST TWO YEARS,
AS SUBSTANTIATED BY CD PH. AS AN
EMERGENCY ROOM NURSE OF MANY
YEARS, I KNOW AND ACCEPT A
CERTAIN LEVEL OF UNCERTAINTY.
EVEN CHAOS IS THE NATURE OF THE
JOB. MY FELLOW NURSES AND I ARE
READY FOR THE CHALLENGE, BUT WE
NEED TO KNOW THAT THERE WILL BE
ENOUGH STAFF TO DO OUR JOB
SAFELY. AND SAFE STAFFING IS A
PROBLEM THAT RESULTS IN REAL
PATIENT HARM, AND IT'S DRIVING
NURSES OUTSIDE, WE CALL ON CD PH
TO BE PART OF THE SOLUTION BY
ENFORCING THE LAW. THANK YOU SO
MUCH. WE'RE GONNA MOVE ON TO OUR
CALIFORNIA HOSPITAL ASSOCIATION
REPRESENTATIVE. GOOD AFTERNOON,
VANESSA GONZALEZ WITH THE
CALIFORNIA HOSPITAL ASSOCIATION.
APPRECIATE THE OPPORTUNITY TO
SHARE WITH YOU HOW HOSPITALS
WORK HARD TO BE IN COMPLIANCE
WITH THEIR STAFFING RATIOS, AS
WELL AS SOME OF THE CHALLENGES
THAT ARISE IN BEING FULLY
COMPLIANT AT ALL TIMES. AS IS
REQUIRED. LET ME BEGIN BY SAYING
THAT HOSPITALS ARE THE BACKBONE
OF I'M SORRY. NURSES ARE THE
BACKBONE OF OUR HOSPITALS, AND
WITHOUT A DOUBT, HOSPITALS WOULD
NOT BE ABLE TO OPERATE WITHOUT A
NURSE IS. ADDITIONALLY PATIENT
SAFETY IS A HOSPITAL'S TOP
PRIORITY, AND FOR MORE THAN A
DECADE, HOSPITALS HAVE WORKED
HARD TO MEAT RATIO REQUIREMENTS
AND ARE DOING EVERYTHING WITHIN
THEIR POWER TO HIRE AND RETAIN
ENOUGH NURSES TO BE ABLE TO MEET
THOSE STAFFING RATIOS AT ALL
TIMES. CALIFORNIA NURSES ARE THE
HIGHEST PAID IN THE NATION AND
IN ADDITION TO PAYING TOP WAGES,
CALIFORNIA HOSPITALS OFFER
COMPREHENSIVE BENEFITS AND
PROGRAMS ON A DAY TO DAY BASIS.
THESE HOSPITALS EMPLOY MANY
STRATEGIES TO STAY WITHIN RATIO,
INCLUDING SCHEDULING EXTRA
NURSES IN ANTICIPATION OF NURSES
CALLING IN SICK OR OTHER
CIRCUMSTANCES ARISING OFFERING
PREMIUM PAY AND BONUSES FOR
NURSES WHO PICK UP ADDITIONAL
SHIFTS ON TOP OF OVERTIME,
IMPLEMENTING AND IN HOUSE FLOAT
POOL AND BACKUP POOLS TO HELP
COVER SHIFTS. PAIN HIGH RATES
FOR TRAVEL NURSES TO HELP STAY
IN RATIO. HOSPITALS TAKE
STAFFING RATIOS VERY SERIOUSLY
AND WORK HARD TO BE COMPLIANT.
HOWEVER THERE ARE CHALLENGES
OUTSIDE OF THE HOSPITALS CONTROL
THAT MAKE IT DIFFICULT TO COMPLY
AT ALL TIMES. AS YOU KNOW,
CALIFORNIA IS IN THE MIDDLE OF A
HEALTHCARE WORKFORCE CRISIS. A
RECENT STUDY BY UCSF SHOW THAT
CALIFORNIA HAD A DEFICIT OF
40,000 REGISTERED NURSES, AND
THAT NUMBER HAS LIKELY GROWN IN
ADDITION TO NURSING NURSING
SHORTAGES. THERE ARE ALSO OTHER
REASONS THE HOSPITAL MAY NOT
HAVE ENOUGH NURSES TO COMPLY
WITH THE RATIO REQUIREMENTS AT
ALL TIMES AND EXPECTED ISSUES
ARISE. SOMETIMES THERE'S A NURSE
MAY COLLINS SICK OR THEY MAY BE
TRAFFIC AND ISSUE BACK AT HOME
THAT THEY MIGHT BE LINKED TO
WORK. AND IN THOSE INSTANCES,
THE HOSPITAL WILL WORK TO MAKE
SURE THAT THERE IS ANOTHER
NURSE. TO BE ABLE TO COVER THAT
TIME SO THERE COULD BE 1015
MINUTES AT THE HOSPITALS OUT OF
RATIO DUE TO AN UNFORESEEN
CIRCUMSTANCE. IN ADDITION TO
UNEXPECTED ISSUES FROM THE
NURSING SIDE, THERE'S ALSO
CHALLENGES THAT ARE ARISE FROM
THE PATIENT'S SIDE. FOR EXAMPLE,
THERE COULD BE A PATIENT THAT IS
READY TO BE DISCHARGED, READY TO
GO TO THE NEXT LEVEL OF CARE. IF
IT IS CALLED NURSING FACILITY,
FOR EXAMPLE, THEY MAY NOT HAVE A
SPOT FOR THAT PATIENT, SO THE
PATIENT END UP HAVING TO STAY IN
THE HOSPITAL FOR LONGER THAN
EXPECTED. THERE COULD BE ANOTHER
EMERGENCY SITUATION WHERE, UM,
THERE WAS AN UNEXPECTED FLOW OF
PATIENTS LIKE A BIG CAR ACCIDENT
AND THERE MAY NOT BE ENOUGH
NURSES TO BE ABLE TO STAY IN
RATIO AT ALL TIMES. UM AND LIKE
I'VE MENTIONED THE REGULATIONS
DO APPLY AT ALL TIMES AND ARE
VERY STRICT. SO THAT MEANS THAT
IF THE NERDS NURSE NEEDS TO GO
TO THE BATHROOM, OR EVEN JUST
STEP OFF THE FLOOR TO MAKE A
PERSONAL PHONE CALL FOR JUST A
FEW MINUTES, THERE MUST BE A
BACKUP NURSE AVAILABLE TO COVER
THAT TIME. AND BECAUSE OF SOME
OF THE CHALLENGES THAT ARISE
OUTSIDE OF THE HOSPITALS CONTROL
, THERE IS SOME FLEXIBILITY FOR
THESE UNFORESEEN CIRCUMSTANCES,
AND THAT'S AS AS NOTED IN THE
HEARING AGENDA. THERE ARE SOME,
UM IT'S LIKE FLEXIBILITIES AND
HOSPITAL WOULD HAVE TO
DEMONSTRATE THAT ALL THREE OF
THE FOLLOWING WERE MET THE THAT
ANY FLUCTUATION IN THE REQUIRED
STAFFING LEVELS WAS
UNPREDICTABLE AND UNCONTROLLABLE
, UNCONTROLLABLE. PROMPT EFFORTS
WERE MADE TO MAINTAIN THE
REQUIRED STAFFING LEVELS AND
THAT THE HOSPITAL IMMEDIATELY
USED AND EXHAUSTED THE HOSPITALS
ON COLLIS OF NURSES AND THE
CHARGE NURSES. BUT OUTSIDE OF
THOSE THREE CIRCUMSTANCES, NURSE
STAFFING RATIOS MUST BE MET AT
ALL TIMES. AND HOSPITALS WORK
HARD TO BE COMPLIANT. WITH THOSE
RATIOS. SO WITH THAT HAPPY TO
ANSWER ANY QUESTIONS AND
APPRECIATE THE TIME, THANK YOU
SO MUCH. YOU KNOW, WE CAN BE
HERE ALL DAY TO TALK ABOUT ALL
THE WORK. THAT HOSPITAL IS DOING
DEPARTMENT CHC QUÊ IS DOING TO
INVESTIGATE THIS, BUT I MEAN, I
HEAR IT. I HAVE FAMILY AND
FRIENDS. I'M A LITTLE COUSIN
ABOUT TO BE A NURSE. I AM
HEARING A DAY IN DAY OUT, UM,
THAT NURSES ARE ONE LEAVING
BEDSIDE RATES WE'VE NEVER SEEN
BEFORE TO JUST BEING BURNT OUT.
BRAKES NOT BEING TAKEN. AND YOU
KNOW WHAT? I'M PART OF THIS
WORLD WHERE, YOU KNOW SOMETIMES
YOU CAN'T TAKE YOUR BREAK. YOU
KNOW LEGISLATORS? SOMETIMES WE
CAN'T TAKE A BREAK. BUT WHEN WE
GO THROUGH A PERIOD OF CALLING
THESE HEROES IN XIROS, EIGHT PM
WE'RE CLAPPING FOR EVERYBODY
DURING THE PANDEMIC, AND THEN
SEEING THAT, UM TRANSFERRING TO
NOW SUPPORT NOT SUPPORTING THEM.
AND SO, HAVING ANECDOTAL STORIES
ON THIS, THERE HAS TO BE SOME A
GAP. SOMETHING'S BEING MISSED.
SOMETHING'S MISSING. IF WE'RE
STILL HAVING NURSES TALK ABOUT
ABOUT THESE ISSUES. IT'S GONNA
BE VERY HARD TO GET TO THE ROOT
OF THIS IN THIS CONVERSATION,
BUT 11 THING THAT THAT CAME TO
MIND IS WHEN WE INVESTIGATE.
WHAT IS THE PERCENTAGE OF
HOSPITALS GETTING THAT EXEMPTION
COMPARED TO FIND? I DON'T HAVE
THAT DATA WITH ME, BUT WOULD BE
HAPPY TO INCLUDE THAT WITH THE
ADDITIONAL DATA THAT WE'RE
PROVIDING. THANK YOU. OH NO,
GOD. UM IS THERE ANYONE IN THE
BACKGROUND WITH YOU HEAR IN THE
BACKGROUND IN THE AUDIENCE HERE
THAT CAN PROVIDE SOME
INFORMATION RELATED TO THAT. I
JUST FEEL LIKE THAT INFORMATION
BE REALLY HELPFUL DURING THE
DISCUSSION. NOT TODAY. UM, BUT I
WOULD VENTURE TO GUESS LESS THAN
10% BASED ON THE PRELIMINARY
NUMBERS THAT I SAW YESTERDAY AND
AGAIN AS WE HAVE MOVED OUT OF
THE DECLARED PUBLIC HEALTH
EMERGENCY. CIRCUMSTANCES FOR
HOSPITALS, AND I CERTAINLY CAN'T
SPEAK FOR THE HOSPITALS.
CIRCUMSTANCES I THINK HAVE
SHIFTED IN TERMS OF, UM,
PLANNING AROUND WHAT STAFFING
MAY USUALLY LOOK LIKE, OR
ANTICIPATING INCREASES THAT MAY
HAVE A SEASONAL RELATIONSHIP TO
FLU OR RSV THAT WE'RE SEEING. UM
BUT YOU KNOW, IN TERMS OF GIVING
A DEFINITIVE NUMBER ON THE
PERCENTAGE OF CASES THAT DO
RESULT IN AN EXEMPTION, I WOULD
FEEL MUCH MORE COMFORTABLE
VALIDATING THAT DATA AND GIVING
YOU FACTUAL NUMBERS. THEIR
INVESTIGATION INCLUDE HIRING
EFFORTS BY HOSPITALS. HER ARE
THEIR POSTINGS FOR NURSING. OR
WHAT DOES THAT INVESTIGATION
LOOK LIKE? SO I BELIEVE IS THE
REPRESENTATIVE FROM ASIA
MENTIONED, UM MEASURES THAT THEY
HAVE TAKEN TO ADDRESS STAFFING
ISSUES AND OFTEN THAT IS CALLING
ADDITIONAL FOLKS THAT ARE ON
CALL, RELYING ON REGISTRY TO
BRING IN TEMPORARY STAFF AND
THEN CERTAINLY JUST THE WORD.
JUST ASKING THAT QUESTION. IS IT
JUST BASED ON THE WORD OF THE
HOSPITALS? NO THERE'S
VERIFICATION ANYTHING THAT WE DO
WE VERIFY THE PROCESSING OF AN
INVESTIGATION INCLUDES
OBSERVATION INTERVIEWS TO VERIFY
WHAT WE ARE SEEING AND REVIEWING
DOCUMENTATION TO ALSO SUPPORT
WHAT OUR FINDINGS ARE OKAY AND
THEN CHEN CHOICE CHOICE AND YOU
KNOW THIS CONSTITUENT OF MINE
SHOULD APOLOGIZE. UM CAN YOU CAN
YOU GIVE ME SOME OF YOUR
EXPERIENCE AND OTHER NURSES
REGARDING IF ONE OF YOUR
COLLEAGUES CALLS OUT SICK? IS
THAT A DRAMATIC IMPACT? WE
TALKING ABOUT THAT KIND OF
IMPACT ON YOUR ON THE STAFFING
ISSUES? ARE WE TALKING OF A
GREATER SCHEME OF WE'RE JUST
SUPER UNDERSTAFFED, OR IS IT DO
JUST BY CALL OUTS? I THINK THAT
I WOULD PUSH BACK ON THE
UNDERSTAFFING THAT THERE IS A
SHORTAGE OF NURSES. THERE IS A
SHORTAGE OF NURSES THAT ARE
UNWILLING TO WORK IN THE UNSAFE
ENVIRONMENT, RIGHT THAT PUTS US
IN OUR PATIENTS AND HARM. THE
BRN REPORTS THAT 30% OF NEW
GRADS LEAVE THE PROFESSION
WITHIN TWO YEARS BECAUSE OF THE
ENVIRONMENT THAT THE HOSPITALS
HAVE CREATED. SO THERE IT'S THE
ENVIRONMENT SO TO ANSWER YOUR
QUESTION? YES EVEN ONE NURSE
PUTS YOU UNDER STRAIN, BUT WE'RE
SEEING MORE THAN ONE NURSE,
RIGHT? WE'RE SEEING HOLES IN OUR
SCHEDULES. BETTER THERE FOR THE
WEEK. THEY'RE APPROVED SCHEDULES
WITH HOLES IN THEM, AND THEN WE
ALSO SEE FLEXING OFF, RIGHT?
WELL THEIR CENSUS IS NOT HERE,
SO WE'RE GOING TO FLEX THEM OFF.
I WOULD ARGUE THAT WE IT MEANS
SEND THEM HOME AND WE SEND THEM
HOME. THERE IS NOT THE CENSUS,
SO WE'RE GOING TO SEND THEM HOME
. THERE'S NOT ENOUGH PATIENTS TO
FILL THOSE BEDS. BUT I WOULD
ARGUE THAT YOU KNOW, YOU DON'T
KNOW WE DON'T SEND OUR FIREMEN
HOME. WHY ARE WE SENDING OUR
NURSES HOME? WE NEED TO HAVE
THEM THERE. FIREFIGHTERS CORRECT
WOMEN TO CORRECT I STAND
CORRECTED Ó. YEAH. KAREN YOU
KNOW, I LISTENED TO THE I KNOW
STUFF HAPPENS. BUT YOU KNOW THE
FACT THAT A NURSE HAS TO GO TO
THE RESTROOM OR TAKE A BREAK TO
ME. ISN'T A REASON TO FALL OUT
OF RATIO BECAUSE THAT'S BEEN A
LEGAL REQUIREMENT IN THE STATE
OF CALIFORNIA FOR A LONG TIME.
AND WE NEED IF WE'RE AN
EMPLOYER, WE NEED TO PLAN ON
RELIEVING INDIVIDUALS WHO WERE
IN THE WORKPLACE WHEN THEY'RE
ENTITLED TO BE RELIEVED, AND
IT'S A REGULAR RECURRING THING
TWICE A DAY. FOR REST BREAKS AND
ONCE A DAY FROM HELL PERIODS
UNLESS YOU HAVE A LONGER SHIFTS,
SO I WOULD CERTAINLY EXPECT
HOSPITALS TO PLAN FOR THAT WHICH
WOULD MEAN PROBABLY KEEPING ONE
OR MORE STAFF MEMBERS ON THE
SHIFT IN ORDER TO PROVIDE THE
RELIEF. UM SO I'M ANXIOUS TO SEE
THE REPORT. AND I'M HOPING IT
GOES INTO DETAIL AND TO SEE
WHETHER THERE'S A PATTERN IN
PRACTICE IN CERTAIN HOSPITALS OR
HOSPITAL SYSTEMS OF NOT STAFFING
UP TO COVER THE LEGAL
REQUIREMENTS THAT WE IMPOSED IN
CALIFORNIA THAT TO ME. OTHER
THINGS ARE ACCEPTABLE, BUT THAT
TO ME PROBABLY FALLS IN THE
UNACCEPTABLE CATEGORY. I AM
INTERESTED IN SEEING WHAT THE
REPORT REFLECTS WITH RESPECT TO
SURGE STAFFING, SO YOU STAFF FOR
A PARTICULAR EXPECTATION OF
PATIENTS CENSUS AND DURING THE
DAY AND THE PATIENT'S SENSES
SUDDENLY FALLS OFF. AND YOU SEND
NURSES HOME. AND THEN FIVE HOURS
LATER, YOU FIND OUT THAT YOUR
CENSUSES CLIMBED, BUT YOU DON'T
HAVE ENOUGH NURSES TO MEET THE
STAFFING RATIOS. I SUSPECT IF
THAT HAPPENS, AND IT'S
UNEXPECTED, AND THERE'S NOT A
PATTERN OF PRACTICE, MAYBE WE
PROVIDE A PASS TO THE HOSPITAL
THAT YOU KNOW THAT GUESSED WRONG
, BUT I'D BE FASCINATED TO SEE
IF IT'S A PATTERN. WHERE IN A
GIVEN POINT IN TIME IN A YEAR
AND OCTOBER OR FLU SEASON, YOU
KNOW, MAYBE MAYBE YOUR SENSES
DROPS OFF, BUT YOU KNOW THAT
AFTER PEOPLE GET OFF WORK, YOUR
CENSUS POPS BACK UP. BUT YOU
DON'T PLAN FOR THAT. YOU LET
YOUR STAFF GO TO SAVE SOME MONEY
BETWEEN TWO IN THE AFTERNOON AND
6 P.M. AND THEN WHEN THE SURGE
HITS YOU DON'T HAVE STAFF TO ME
THAT WOULD FALLS INTO THE
UNACCEPTABLE CATEGORY. SO ONCE
AGAIN, I THINK IT'S GOING TO BE
VERY, VERY HELPFUL. HAVE A
DETAILED REPORT FROM YOUR
ORGANIZATION. AS TO THE NATURE
OF THE COMPLAINTS, YOU KNOW, BY
HOSPITAL OR SYSTEM SO WE CAN
SORT OF TRACK THESE THINGS AND
SEE IF SOMEONE'S PLAYING GAMES
WITH US BECAUSE UP HERE. SOME OF
US HAVE BEEN TALKING ABOUT
STAFFING RATIOS. AND IN OUR CASE
, IN MY CASE FOR 12 YEARS, AND
IN MY COLLEAGUES CASE, PROBABLY
FOR LONGER AND I JUST DON'T
UNDERSTAND WHY WE KEEP TALKING
ABOUT IT AND WHY WE KEEP GETTING
THE LEVEL OF COMPLAINTS THAT WE
GET. IN OUR DISTRICT OFFICES AND
IN OUR CAPITAL OFFICES ABOUT
THIS, SO NO NO CRITICISM. C H A.
I JUST THINK WE NEED TO FIGURE
THIS THING OUT. AND IF WE'RE NOT
STAFFING TO MEET THE LEGAL
REQUIREMENTS AND IT'S NOT
UNEXPECTED. UM OR INADVERTENT
THAN WE NEED TO BE TAKING SOME
ACTION. THANK YOU FOR ALLOWING
ME TO SPEECHIFY MADAM CHAIR, AN
ARGUMENT. OH GO AHEAD. VANESSA
YES, THANK YOU, SENATOR.
SENATOR, AND I THINK ON THE
FIRST POINT OF APOLOGIES IF I
MAYBE MISSPOKE ABOUT WHAT I
MEANT TO SAY, IS THAT THE
STAFFING RATIOS HAVE TO BE MET
AT ALL TIMES. UM AND SO EVEN IN
CASES WHERE THERE'S A NURSE THAT
NEEDS TO GO TO THE BATHROOM AND
I ABSOLUTELY AGREE THEY SHOULD
BE ABLE TO TAKE THEIR BREAKS
AND, YOU KNOW, STEP OFF THE
FLOOR. AND SO WE HOSPITALS DO
PLAN FOR THAT AND HAVE NURSES
READY TO COVER THAT TIME OFF. UM
BUT, YOU KNOW, I KNOW CD PH ALSO
SENT THEIR OF FACILITIES LETTER
IN SEPTEMBER OF LAST YEAR. ALSO
CLARIFYING THAT SOMETHING LIKE A
FLU SEASON IS NOT CONSIDERED
UNEXPECTED, AND WE HAVE ADVISED
OUR MEMBERS TO ENSURE THAT
THEY'RE PREPARING FOR THAT IN
ADVANCE. THANK YOU. THANK YOU.
I'LL TRY NOT TO SPEECHIFY AND
I'M SORRY. MS PARK EARLIER PART
OF THE CONVERSATION, BUT JUST TO
CONCUR WITH WHAT GENERAL ROSS
IS. WE'VE BEEN ASKING YOU TALK
ABOUT THIS DAY THIS FOR A VERY
LONG TIME, AND I WOULD JUST
REITERATE THE IDEA THAT YOU
KNOW, THERE WEREN'T A LOT OF, UM
, UH, BUDGET ISSUES IN PUBLIC
HEALTH, BUT WE WANTED TO TALK
WITH YOU MORE ABOUT OVERSIGHT.
AND IT SEEMS LIKE THERE'S BEEN A
COUPLE EPISODES OF A COUPLE OF
TIMES THAT WE'VE ASKED FOR DATA
AND IT'S. IT'S NOT BEEN
FORTHCOMING. SO I WOULD JUST
REALLY STRESSED THAT WE NEED TO
BE ABLE TO SEE THE DATA ANALYZE,
LIKE IS IT? YOU KNOW WE WERE
HERE? WE CAN HEAR ANECDOTES FROM
EVERYBODY FOR, YOU KNOW FOR
FOREVER, AND WE KNOW THAT REAL
HARM OCCURS SOMETIMES AND WE,
YOU KNOW, FOR ALL KINDS OF
REASONS. SO I WOULD JUST LIKE TO
REITERATE WE NEED THE DATA. I
MEAN, STAFFING RATIOS ARE THERE
FOR A REASON. I UNDERSTAND WHY
AND HOW IT'S DIFFICULT, BUT
WE'RE CREATIVE FOLKS AND SHOULD
BE ABLE TO FIGURE OUT A PATH. UM
IN THE SMALL PERIOD THAT I DID
CLINICAL WORK THAT REMEMBER THIS
PHRASE CALLED THE MAGIC QUESTION
THAT YOU WOULD ASK A PATIENT. IN
A PERFECT WORLD. WHAT IF I WANT
TO ASK THAT MAGIC QUESTION TO
THE THREE REPRESENTATIVES HERE?
IN A PERFECT WORLD WHAT WOULD BE
NEEDED? TO MAKE AND EVEN FOR CH
A TO HELP YOU. MEET THOSE
RATIOS. TO BETTER BE ABLE TO
INVESTIGATE ADEQUATELY AND, UM
MOVE FORWARD AND THEN FOR YOU TO
FEEL SAFE IN THESE ENVIRONMENTS.
I THINK FROM CHS PERSPECTIVE,
WHAT WE HEAR THE MOST FROM OUR
MEMBERS IS NURSING WORKFORCE
SHORTAGES. SO I HOW WE CAN LOOK
AT INCREASING THE PIPELINE. I
KNOW CH IN PARTICULAR HAS BEEN
DOING A LOT OF WORK AND TRYING
TO INCREASE THAT PIPELINE TRYING
TO MAKE SURE WE'RE HAVING AH UM,
ADEQUATE AMOUNT OF NURSES GOING
THROUGH NURSING SCHOOL AND
GETTING LICENSED AND WORKING IN
OUR HOSPITALS. SO I WOULD SAY,
UM, INCREASING THAT NURSING
PIPELINE WOULD IS A BIG ISSUE
FOR YOU TO HAVE SAID THEY WANTS
TO DO ANY LOAN REPAYMENT FOR
NURSES. LET ME KNOW DEPARTMENT.
IN A I THINK ARE ARE THERE IN
TERMS OF OUR ABILITY TO COMPLETE
THE INVESTIGATIONS? I THINK
RIGHT NOW THE VOLUME THAT WE'RE
SEEING CERTAINLY CREATES A
COMPETING DEMAND WITH OTHER
INTAKES THAT WE HAVE THAT ALSO
ARE OF THE MOST PRIORITY AGAIN.
WE SEE THE CRITICAL NATURE OF
ENSURING THAT NURSE PATIENT
NURSE TO PATIENT RATIO STAFFING
LEVELS ARE ABIDED BY AND THAT
THOSE ARE CONSISTENT ACROSS ALL
HOSPITALS. SO I DON'T KNOW THAT
THERE'S A PARTICULAR NEED. FOUR
CHC QUÊ IN TERMS OF BEING ABLE
TO GET OUT AND INVESTIGATE THOSE
, I THINK, IN SOME CASES, THE
NATURE OF THE PROCESS OF THE
INVESTIGATION MAY TAKE MORE TIME
IN TERMS OF IF THERE IS A NEED
FOR US TO INTERVIEW A PARTICULAR
PARTY SPEAK TO A PARTICULAR
NURSE, UNDERSTAND WHAT THEIR
POLICIES OR LOOKING AT
PARTICULAR CENSUS AT ANY GIVEN
TIME TO ESTABLISH WHETHER THAT
RATIO IS MET. UM SO THAT CAN
DELAY THINGS BUT OTHERWISE I
THINK THAT WE HAVE WHAT WE NEED.
JUST GETTING THROUGH. THE
PROCESS, I THINK IS PROBABLY
SOMETHING THAT AGAIN WE'RE
LOOKING AT TRYING TO LEAN THAT.
PROCESS OUT NOT JUST WITH THE
INVESTIGATION, BUT THEN ALSO ANY
SUBSEQUENT PENALTIES THAT MIGHT
BE ISSUED TO ENSURE THAT WE'RE
NOT DELAYING THE EFFICACY OF THE
PENALTY TO REMEDY THE ACTUAL
ISSUE, AND THE CHC QUÊ HAVE
DEDICATED STAFF JUST TO THIS
ISSUE, OR IS THIS STUFF ALSO? DO
IT NOW ARE STAFF ARE ASSIGNED
INVESTIGATIONS ACROSS 31
DIFFERENT FACILITY TYPES. SOME
HAVE SPECIALTIES IN HOSPITALS,
AND WE TRY TO FUNNEL THAT STAFF
WHERE THE EXPERTISE IS, BUT
UNIVERSALLY, OUR STAFF NEED TO
BE CROSS TRAINED. THAT'S RIGHT
CHOICE. IF I HAD TO SAY I WOULD
SAY TRANSPARENCY. I THINK THAT,
UM NURSES HAVE GONE OVER AND
ABOVE TRYING TO BRING THE
DEFICIENCIES ABOUT UNDERSTAFFING
OUT, BUT WE DON'T WHEN CDPH
COMES OUT, THEY GENERALLY COME
OUT WITH THE CHIEF NURSING
OFFICER OR THE RISK MANAGEMENT.
THEY DO NOT SPEAK TO THE NURSES.
THEY COLLECT THEIR DATA AND THE
NURSES ARE NOT. PART OF THAT. UM
SO I THINK TRANSPARENCY MOVING
FORWARD WOULD WOULD HELP AT
LEAST WITH THE MORAL DISTRESS
THAT NURSES HAVE. THAT WOULD BE
MY SOLUTION WAS TRANSPARENCY
WHEN WE WHEN WE PUT IN THESE
FORMS COULD YOU QUICKLY RESPOND
TO THAT? ARE WE NOT TALKING TO
THE RANK AND FILE THAT IS PART
OF THE PROCESS SO DEPENDING ON
WHAT INFORMATION IS DISCOVERED,
OR IN ORDER TO MAKE A
DETERMINATION, THE PROCESS IS
AND MAYBE TALKING TO A
ADMINISTRATION, BUT WE WOULD
EXPECT THAT THEY WOULD ALSO BE
TALKING TO NURSES THAT MAY HAVE
BEEN ON SHIFT ON A PARTICULAR
DAY THAT'S RELATED TO THE
COMPLAINT OR THAT MAY BE ABLE TO
VALIDATE SOME INFORMATION THAT
WE'RE DISCOVERING DURING THE
INVESTIGATIVE PROCESS. AND I, UM
EXCUSE ME. IF I ASK THIS, YOU
KNOW WE'RE GETTING YOU TALKED
ABOUT AND WE'VE BEEN TALKING
ABOUT THE DATA AND SO FORTH. DO
WE HAVE A TIMELINE WHEN WE CAN
EXPECT THIS TO BE MORE
TRANSPARENT PUBLIC? IN TERMS OF
PRODUCING AND PUBLISHING THE WEB
PAGE. I WOULD LIKE TO SAY,
PROBABLY WITHIN THREE MONTHS. AM
HAPPY TO GIVE AN UPDATE ONCE WE
HAVE A BETTER EVALUATION, BUT
AGAIN, THE FRAMEWORK IS THERE.
UM AT THIS POINT, IT IS
IDENTIFYING, UM PARTICULAR
CATEGORIES WITHIN OUR LICENSING
DATABASE TO ISOLATE THOSE
PARTICULAR PENALTIES SO THAT IT
CAN THEN BE AUTOMATICALLY
PUBLISHED TO THE PUBLIC PAGE AND
THEN DOING THE SAME, CREATING
THAT SUBCATEGORY TO IDENTIFY AND
ISOLATE THE DATA WITHIN OUR
ENFORCEMENT SYSTEM TO BE ABLE TO
TRACK THOSE DEFICIENCIES RIGHT
NOW, WHEN WE'RE PULLING DATA, WE
HAVE TO CODE IT MANUALLY, SO WE
JUST NEED TO OVERCOME THAT, AND
THEN WE CAN MOVE TOWARDS
PUBLISH. I WOULD ASK, UM, SINCE
WE'RE STILL GONNA BE IN OUR SUB
COMMITTEE HEARINGS IF YOU COULD
COME BACK IN 34 MONTHS, UM AND
JUST GIVE US AN UPDATE ON THAT.
GREAT THANK YOU. ANY SENATOR
ROTH? JUST HAVE TWO QUESTIONS.
I'LL TRY TO MAKE THEM QUESTIONS
THIS TIME. DO YOU HAVE A SET OF
GUIDELINES OR I WOULD CALL THEM
REQUIREMENTS FOR INVESTIGATORS
WHO WERE CONDUCTING THESE THIS
TYPE OF INVESTIGATION OUT IN THE
FIELD. THERE ARE GUIDELINES FOR
HOW TO CONDUCT THE INVESTIGATION
. IT IS CONSISTENT ACROSS ALL
ALLEGATIONS AND ALL DEFICIENCIES
BOTH AT THE FEDERAL
INVESTIGATION LEVEL ON OUR
BEHALF OF èC, M, S¼. AND THEN,
OF COURSE, THE SAME FOR THE
STATE AND STATE INVESTIGATION,
AND ARE THE GUIDELINES FAIRLY
DETAILED TO THE EXTENT THAT IT
INSTRUCTS INVESTIGATORS? IN
TERMS OF CATEGORIES WHO TO
CONTACT AND IN WHAT ORDER? THAT
TYPICALLY IS ESTABLISHED AS A
SURVEY OR IS IT MOVING THROUGH
THE INVESTIGATIVE PROCESS AGAIN?
UM THERE NEEDS TO BE SOME LEVEL
OF FLEXIBILITY. IF WE PRESCRIBE
YOU, YOU INTERVIEW THESE TWO
PEOPLE IF WE NOTICE THAT THERE'S
AN EXPANSION OF THAT VIOLATION
ARE WE SUSPECT THAT THERE MAY BE
A VIOLATION IN ANOTHER AREA.
SURVEYORS ARE ALLOWED THAT
FLEXIBILITY TO THEN EXPAND, AND
THEY MAY ENGAGE IN, UM,
INTERVIEWS WITH DIFFERENT
INDIVIDUALS. THEY MAY BRANCH OFF
TO ANOTHER. AREA BECAUSE AGAIN
WHEN WE ARE ON SITE, AND WE ARE
INVESTIGATING PAYING ATTENTION
TO EVERYTHING AND NOT JUST
LIMITING THE SCOPE OF WHAT MAY
HAVE DRAWN THEM INTO A FACILITY
AND INSTEAD MAKING SURE THAT
THEY'RE DOING A COMPLETE
ASSESSMENT OF ANYTHING THAT
MIGHT COME TO THEIR ATTENTION.
SO THERE'S A GUIDELINE UH, BUT
THEY'RE NOT STRICT GUARD RAILS
TO LIMIT HOW THEY MAY APPROACH
THE INVESTIGATION. AS A FORMER
FEDERAL INVESTIGATOR, I WAS JUST
TRYING TO ADDRESS THE QUESTIONS
TO THE THAT WERE RAISED BY THE
LADY TO MY LEFT. I THINK THAT
WOULD BE INTERESTING TO TAKE A
LOOK AT THE GUIDELINES THAT YOU
PLACE FOR SURVEYORS. WE'RE IN
HEALTH CARE THE SURVEYORS THAT
GO OUT TO DEAL WITH THESE SORTS
OF COMPLAINTS. AND THEN MY OTHER
QUESTION HAS TO GO TO GOES TO
FUNDING FOR YOUR OPERATION. DO
YOU HAVE THE AUTHORITY TO ASSESS
THE COST OF THE INVESTIGATION
AGAINST THOSE HEALTH CARE
INSTITUTIONS THAT WHERE YOU FIND
, UM, A VIOLATION WHETHER OR NOT
A PENALTY IS ASSESSED? SO
CURRENTLY THE PENALTIES WOULD BE
THE ONLY REVENUE UM OR THE ONLY
FEE THAT WOULD BE ASSESSED TO A
FACILITY THAT WE'RE
INVESTIGATING FOR A RATIO THAT
MAY BE WIDELY DIVERGENT FROM THE
COST OF YOUR ACTUAL
INVESTIGATION. SO THE QUESTION
IS, OBVIOUSLY YOU CAN ASSESS A
PENALTY, BUT APPARENTLY SOME
DON'T FEEL THE PENALTIES HAVE
BEEN VERY HIGH. UM DO YOU HAVE
THE AUTHORITY TO ASSESS THE COST
OF THE INVESTIGATE? YOU WERE
INVESTIGATION, REGARDLESS OF
WHETHER YOU'VE ASSESSED THE
PENALTY AND REGARDLESS OF THE
PENALTY ASSESSED, SO CURRENTLY
THOSE COSTS OF ANY OF THE WORK
THAT OUR PROGRAM CONDUCTS IN
TERMS OF INVESTIGATIONS OR
EXPENSES. INSPECTIONS IS FOLDED
INTO OUR LARGER METHODOLOGY,
WHICH GENERATES THE FEES TO
SUPPORT OUR ORGANIZATION AND THE
WORK THAT WE DO. UM SO
ESSENTIALLY THE COST OF AN
INVESTIGATION FOR A STAFF RATIO
OR ANY OTHER COMPLAINT WOULD BE
DISTRIBUTED REDISTRIBUTED OUT TO
THE FACILITY CATEGORY OR THE
FACILITY POPULATION. SO IN THIS
CASE, THESE ARE INVESTIGATIONS
OF HOSPITALS. HOSPITALS ACROSS
THE STATE WOULD SHARE IN THAT,
IN THAT COST AS AN OVERHEAD FOR
THE OPERATIONS OF OUR PROGRAM.
THEY'RE NOT DISTINCTLY CHARGED
BACK TO THE FACILITY THAT WAS
UNDER INVESTIGATION. SO YOU
SHOULD BE ADEQUATELY FUNDED TO
CONDUCT SURVEYS ARE
INVESTIGATIONS IF THE HOSPITALS
ARE PROVIDING THE MONEY TO DO
SO. ALL OF OUR FACILITIES WOULD
BE PAYING INTO THAT TO THE FEES
THAT WE GENERATE. WE ARE FULLY
FUNDED FOR THE STAFFING AND THE
RESOURCES THAT WE CURRENTLY
POSSESS, UM, WITHIN THE CENTER
TO CONDUCT THESE INVESTIGATIONS
ARE THE RESOURCES THAT THE
HOSPITALS THAT THE FACILITIES I
GUESS IT'S MORE THAN JUST
HOSPITALS ARE THE RESOURCES THAT
THE FACILITIES PAY INTO THE
SYSTEM SUFFICIENT TO FUND YOUR
INVESTIGATIVE ACTIVITY. BASED ON
OUR CURRENT ASSESSMENT. I THINK
WE'RE GOING TO GET MORE INTO OUR
BUDGET AND OUR FEE SETTING.
THERE'S BEEN A LOT OF WORK WITH
OUR PARTNERS AT DEPARTMENT OF
FINANCE TO ASSESS HOW WE
APPROPRIATE OUR FEES TO
HOSPITALS, HOW WE'RE CHARGING
AND HOW WE'RE SETTING THOSE
RATES. UM, AND THE REASON I ASK
IS, I THOUGHT I LISTENED TO SOME
CONVERSATION ABOUT SUGGESTED
THERE WAS SOME DELAY AND DELAY
AND STAFFING, INABILITY,
INABILITY TO PROPERLY STAFF OR
TIMELY STAFF INQUIRIES OR AND
YOUR DATA WILL CERTAINLY SUGGEST
THAT WHEN WE LOOK AT THE DATE,
THE COMPLAINT WAS FILED AND THE
DATE THE INQUIRY WAS COMPLETED,
AND WE CAN ALL HAVE A
CONVERSATION ABOUT WHETHER IT
WAS TIMELY OR NOT. I'M JUST
TRYING TO FIGURE OUT THE
ADEQUACY OF YOUR FUNDING. AND IT
SEEMS TO ME IF I WERE RUNNING A
HEALTH FACILITY, AND I DIDN'T
HAVE ANY COMPLAINTS. I'D BE SORT
OF IRRITATED IF I WOULD HAPPEN
TO BE PAYING FOR THE SURVEYS AND
INVESTIGATIONS THAT WERE
CONDUCTED SOMEBODY ELSE'S
FACILITY WHO WASN'T DOING QUITE
AS GOOD A JOB. I THINK THAT
PROBABLY HAS MERIT ON BEHALF OF
HOW HOSPITALS ARE FEELING. UM
AND THEN THE METHODOLOGY. I'LL
STICK TO THE BUDGET ISSUES, AND
I GUESS THAT'LL COME UP AND
THAT'S GONNA BE KIND OF SIMILAR
TO WHAT WE'RE GONNA BE TALKING
ABOUT ISSUE 14 BECAUSE THAT'S
THE ISSUE AT HAND. YES 14 IS
LOOKING TO ADDRESS THAT VERY
TOPIC. YES THANK YOU. AND IF I
MAY I JUST WANT IN IN CASE I
WASN'T CLEAR. WE'RE LOOKING AT
TRYING TO REFINE OUR PROCESSES
FROM THE TIME THAT WE GET THE
ALLEGATION AGAIN ADDRESSED AND
THEY ASSIGNED TOP PRIORITY,
WHICH MEANS YOU NEED TO GO OUT
RIGHT AWAY AND INVESTIGATE
THESE. THEY'RE NOT DELAYED. UM
AND THEN THE TIME FRAME. IT
TAKES US TO COMPLETE THE
INVESTIGATION. THE NECESSARY
OBSERVATIONS. THE INTERVIEWS,
RECORDS REVIEWS THAT ARE FOR US
TO THEN DRAW THOSE CONCLUSIONS.
UM AND THEN ALSO LOOKING AT WAYS
THAT WE CAN EXPEDITE THE POINT
OF THAT, DRAWING THAT CONCLUSION
FROM THE INVESTIGATION AND THEN
ISSUING THE ACTUAL PENALTY TO
THE HOSPITALS. THAT'S A
SECONDARY STEP. UM WHEN WE'RE
EVALUATING WHETHER OR NOT
THERE'S A PENALTY WARRANTED
BASED ON THE EXEMPTIONS THAT ARE
IN THE STATUTE, SO I APOLOGIZE
IF I WASN'T CLEAR I. I DON'T
THINK THAT THAT PART IS A
NECESSARILY A BUDGET ISSUE. I
THINK IT'S A PROCESS ISSUE FOR
US. YOU WERE CLEAR. I JUST THINK
THAT IF WE HAVE SYSTEMS THAT ARE
NOT FOLLOWING THE RULES THAT IN
ADDITION TO A PENALTY, THE
ASSESSMENT OF THE COST OF THE
INVESTIGATION IS PROBABLY WILL
PROBABLY BE OR MAY BE A
DISINCENTIVE TO DO IT AGAIN. SO
WE PROBABLY OUGHT TO THINK ABOUT
THAT. THANK YOU SO MUCH FOR
PARTICIPATING IN THIS PANEL. UM
WHERE THAT CONCLUDES THIS THIS
PORTION OF THE ISSUE. WE'RE
GONNA HOLD THIS ITEM OPEN AND
MOVE ON TO ISSUE NUMBER 14.
THANK YOU. OK? THANK YOU. THAT
WILL BE ME AS WELL. WE HAVE
THREE MORE ISSUES. HANG IN
THERE, EVERYONE. THREE MAURITIUS
TO GO. LET IT CRY. YEAH. PLEASE
PROCEED. THANK YOU FOR QUESTION
NUMBER ONE, IT SAYS, PLEASE
PROVIDE A BRIEF OVERVIEW OF
THESE PROPOSALS FOR THE CðC Q
APPLICATION AND FEE PROCESSING
EXPANSION. PARDON ME. HUGE
SECURITY IS REQUESTING 11.5
POSITIONS AND 1.1 MILLION IN
2024, 25 AND █1.06 MILLION IN
2025 26 AND ONGOING FROM FUND
398 TO SUPPORT APPLICATION AND
FEE PROCESSING EXPANSION. THE
PROPOSAL INCLUDES ADDING
POSITIONS INTO BRANCHES AT èC
èC Q. THIS IS TO ADDRESS THE
INCREASED WORKLOAD IN THEIR
RESPECTIVE AREAS SUCH AS
APPLICATION PROCESSING AND
PAYMENT PROCESSING. THIS IS
MAINLY BECAUSE A NUMBER OF
HEALTH CARE FACILITIES AND
HEALTH CARE AGENCIES AT OUR
CENTER THAT OUR CENTER LICENSES
AND CERTIFIED HAS INCREASED FROM
11,000 TO 14,000 DURING THE PAST
FEW YEARS. ONE OF THE BRANCHES.
IT'S A CENTRALIZED APPLICATIONS
BRANCH. THEY PROCESS ALL
APPLICATIONS SUBMITTED BY HEALTH
FACILITIES FOR VARIOUS LICENSES
TO CHANGES INCLUDING CHANGES OF
OWNERSHIP, LOCATION, NAME NUMBER
OF BEDS AND VARIOUS KEY
PERSONNEL, SUCH AS ADMINISTRATOR
AND MEDICAL DIRECTOR. THE
CENTRAL LIGHT APPLICATIONS
BRANCH HAS EXPERIENCED IT
STEADILY INCREASING WORKLOAD DUE
TO AN OVERALL INCREASE IN THE
NUMBER OF FACILITIES FOR WHICH
CHC HAS OVERSIGHT. ADDITIONALLY
RECENT LEGISLATION HAS MADE
ESSENTIAL REQUIREMENTS MORE
STRINGENT FOR CERTAIN FACILITY
TYPES, PARTICULARLY HOSPICES AND
NURSING HOMES. FURTHERMORE AN
AREA OF THE CHC Q'S FISCAL
SERVICES BRANCH IS RESPONSIBLE
FOR PROCESSING ALL LICENSING
PAYMENTS, WHICH ARE SUBMITTED
VIA PAPER CHECK, INCLUDING ALL
PAYMENTS RECEIVED FOR REPORTED
CHANGES. ADDITIONAL
RESPONSIBILITIES FOR THIS BRANCH
INCLUDE PROCESSING DEPOSITS,
ANNUAL FEE NOTICES, RENEWAL
APPLICATIONS, PAYMENT
NOTIFICATIONS, RECONCILIATION OF
THE DEPOSITS AND FEES,
REVOCATIONS AND CUSTOMER
SERVICE. SHOULD WE GO STRAIGHT
TO THE TRAILER OF LANGUAGE? OF
COURSE. CDPH IS PROPOSING A
STATUTORY CHANGES TO SET AND
ADJUST FEES FOR APPLICATIONS AND
WRITTEN NOTIFICATIONS FOR
LICENSURE CHANGES SUBMITTED BY
HEALTHCARE FACILITIES, AS WELL
AS TO ASSESS PENALTIES FOR
UNTIMELY PAYMENT AND TO
HARMONIZE NOTIFICATION
REQUIREMENTS FOR A LICENSES.
CONTEXT EACH YEAR SECURE
PROCESSES OVER 10,000 SUBMITTAL
FROM HEALTH FACILITIES FOR
VARIOUS LICENSE INTERCHANGES, AS
MENTIONED ABOUT AND ON THE
PROCESSING THESE FEES, CHANGES
GENERATE SIGNIFICANT WORKLOAD
AND CURRENT LAW LIMITS THE TYPES
OF LICENSE FOR CHANGES FOR WHICH
CDPH MAY CHARGE A FEE.
ADDITIONALLY SOME EXISTING FEES
SUCH AS CHANGE OF OWNERSHIP MAY
EXCEED WORKLOAD COSTS. CDPH
RECENTLY PARTNERED WITH THE
DEPARTMENT OF FINANCE RESEARCH
AND ANALYSIS UNIT TO REVIEW THIS
WORKLOAD AND HAS DEVELOPED AN
UPDATED FEE SCHEDULE THAT BETTER
ALLIANCE FOR REVENUE WITH
WORKLOAD COSTS. TO ALLOW THE
DEPARTMENT TO IMPLEMENT THIS
UPDATED FEE SCHEDULE. THE
PROPOSED AMENDMENTS AUTHORIZE
CDPH TO CHARGE A FEE FOR ALL
TYPES OF LICENSOR CHANGES AND
ADJUST THEM THROUGHOUT THE
REPORT PROCESS THAT IS USED TO
UPDATE ANNUAL HEALTH FACILITY
LICENSING FEES. THE PROPOSAL
ALSO AUTHORIZED THE DEPARTMENT
TO ASSESS PENALTIES FOR LATE
PAYMENT OF FEES FOR LICENSURE
CHANGES AND PROPOSES LANGUAGE TO
STANDARD IDENTIFICATION AND FEE
SUBMISSION. REQUIREMENTS FOR
LICENSURE CHANGES ACROSS ALL
TYPES OF FACILITIES. ADOPTING
THESE AMENDMENTS WILL ALLOW CDPH
TO IMPLEMENT A FEE SCHEDULE FOR
LICENSURE CHANGES THAT ALIGN
FUEL REVENUE WITH WORKLOAD
COSTS. IT ALSO PROVIDES A MORE
EQUITABLE DISTRIBUTION OF COST
AMONGST FACILITIES. IT ADDRESSED
SOME OF THE STAKEHOLDERS'
CONCERNS WITH THE CHANGE OF
OWNERSHIP FEE AND REDUCES COST
PRESSURES TO ANNUAL LICENSING
FEES. ONE LAST THING THAT I
WANTED TO ADD THAT'S IMPORTANT
TO NOTE IS THAT OUR ANNUAL
REPORT HAS BEEN RELEASED AND
REGARDING THE HEALTHCARE
FACILITY LICENSING FEES FOR 2425
SQ. PROPOSES DECREASES FOR THE
MAJORITY OF FACILITY TYPES FOR
STATEWIDE LICENSING FEES, AS
WELL AS A DECREASE TO THE
SUPPLEMENTAL FEE FOR HEALTH CARE
FACILITIES LOCATED IN LOS
ANGELES COUNTY. DUE TO THE
IMPACT OF THE PANDEMIC AND THE
PROGRAMS ONGOING HIGH VACANCY
RATE. èC HÌ èC Q HAS A HIGHER
THAN TYPICAL FUND BALANCE, WHICH
ALLOWS FOR A FEE DECREASE FOR
FISCAL YEAR 2425. THANK YOU.
WELL, ANY COMMENT ON THIS ISSUE?
WITH LOANS WITH THE LAO NÓ
CONCERNS WITH THIS ITEM. NICO IS
YOUR ITEM OR SOMEONE ELSE FROM
THE DEPARTMENT OF FINANCE.
AUDREY BEZOS DEPARTMENT OF
FINANCE. UM, HAPPY TO ANSWER ANY
QUESTIONS? THANK YOU. SENATOR
EDMUND. THANK YOU, UM I GET THE
ASK, BUT TELL ME AGAIN THAT
PEOPLE HAVE TO MAIL WRITE A
CHECK AND MAIL A CHECK AND THEN
YOU HAVE TO PROCESS ALL THAT.
I'M NOT SUGGESTING THE NEW
PROJECT, BUT MY GOODNESS. IS
THAT IS THAT CONSISTENT WITH ALL
OTHER STATE DEPARTMENTS? AM NOT
SURE UNFORTUNATELY ABOUT OTHER
STATE DEPARTMENTS. BUT YOU ARE
CORRECT. THAT IS HER PROCESS.
HOWEVER, WE ARE LOOKING INTO
MOVING AWAY FROM PAPER CHECKS.
OK WHAT STOPS US? I MEAN, PEOPLE
COULD JUST WIRE TO THE COUNT,
RIGHT? THERE'S I MEAN, THERE'S
MUCH EASIER WAYS TO DO IT THAT
MIGHT CUT DOWN THE WORKLOAD.
ABSOLUTELY AND THERE IS ONE OF
THE THINGS THAT WE ARE EXPLORING
. WE ARE DEVELOPING A SYSTEM AS
PART OF OUR CAB APPLICATION
SYSTEM, AND WE ARE TRYING TO
EMBED THE ELECTRONIC PAYMENT.
BUT WE ARE ALSO EXPLORING THIS
FURTHER WITH OUR, UM INFORM IN I
Tð S¼ Z DEPARTMENT BASICALLY AT
AT èC Dð P HÌ TO SEE HOW WE CAN
ELABORATE ON THAT AND IMPROVE
THAT SYSTEM TO MOVE AWAY FROM
PAPER CHECKS. YEAH SO I MEAN,
THIS SEEMS, UH UH, INDICATIVE OF
THE PROBLEM WE HAD DURING THE
PANDEMIC WHEN WE WERE ASKING
PEOPLE TO FAX US REPORTS. YOU
GUYS GOTTA COME UP TO THE TO THE
RIGHT CENTURY. WE'RE GONNA HOLD
THE ITEM OPEN AND WE'RE GONNA
MOVE ON TO ISSUE NUMBER 15. TALK
ABOUT SKILLED NURSING
FACILITIES, STAFFING AUDITS. FUN
SHIFT. ABSOLUTELY. ALL RIGHT,
AND THIS IS A BRIEF OVERVIEW ON
THIS PROPOSED FRIENDSHIP AS THE
STATE GOVERNOR'S BUDGET REFLECTS
A ONE TIME SHIFT OF 4 MILLION IN
2024 25 FROM THE STATE GENERAL
FUND, ONE TO FUND THREE 98 TO
ALLEVIATE PRESSURE ON FUND 001.
SUCH FUNDS WILL SUPPORT MANDATED
ACTIVITIES RELATED TO THE
MONITORING AND ENFORCEMENT OF
SKILLED NURSING FACILITIES,
MINIMUM STAFFING REQUIREMENTS.
THESE ACTIVITIES WILL BE
CONSISTENT WITH ALLOWABLE USES
OF THE LICENSING AND
CERTIFICATION FUND. THIS FUND
WILL SUPPORT THESE ACTIVITIES
FOR AT LEAST ONE YEAR WITHOUT
LICENSING HEALTH FACILITY. I'M
SORRY WITHOUT INCREASING HEALTH
FACILITY LICENSE FEES. AND THEN
I HAVE ALSO, UH QUESTION THERE,
UM, RELATED TO THESE. WHY IS
THIS FUND SHIFT ONLY PROPOSED
FOR ONE YEAR AND NOT FOR THE
CURRENT YEAR AND SUBSEQUENT
FISCAL YEARS. AND SO ON. UM FOR
CONTEXT. èC HÌ èC Q HAS AN
INTERAGENCY AGREEMENT WITH THE
DEPARTMENT OF HEALTHCARE
SERVICES TO PERFORM THIS WORK.
THE CONTRACT USED TO PROVIDE 50%
OF THE FUNDING FOR THE STAFF IN
AUDITS PROGRAM FROM THE DHCS
STATE GENERAL FUND
APPROPRIATION. AND SPECIFICALLY,
THE SNIFF QUALITY AND
ACCOUNTABILITY FUND. THREE 1001,
167 AND 50% FROM A FEDERAL MATCH
. HOWEVER ON DECEMBER 31ST 2022,
THE DHCS S¼ FUND AND THE STATE
APPROPRIATION IS NOW WITH èC Dð
P èC P SUBMITTED A BUDGET
CHANGE PROPOSAL IN 2020 THREE 24
FOR 4 MILLION AN ONGOING FROM
THE STATE GENERAL FUND AUTHORITY
TO SUPPORT THE PROGRAM AND IT
WAS APPROVED. LOOKING FORWARD.
THE ONLY FUND THAT èC HÌ èC Q
ADMINISTERS THAT COULD SUPPORT
THESE IS THIS LICENSING FUND
3098, HOWEVER, SINCE THE
MAJORITY OF THE REVENUES FOR THE
FUND COME FROM THE ANNUAL
LICENSING FEES, A PERMANENT FUND
SHIFT WOULD LIKELY RESULT IN
INCREASED LICENSING FEES FOR
SKILLED NURSING FACILITIES IN
2025 26. THE CQ PROJECTS THAT
I'M SORRY. WHY WOULD IT CAUSE AN
INCREASE? UM AND BECAUSE, UM,
WITH THAT'S PART OF OUR
METHODOLOGY. IN FACT, I AM GOING
INTO THAT NÓ NÓ PROBLEM. èC HÌ
èC Q PROJECTS THAT TO GENERATE
THE ADDITIONAL 4 MILLION TO
SUPPORT THE STAFF IN AUDITS
PROGRAM. THE ANNUALLY SIM FOR
SNIFFS WILL LIKELY BE INCREASED
BY SOMEWHERE BETWEEN 40 TO 60
PER BED. SO, UM THANK YOU.
SORRY. BUT IT'S BECAUSE IT'S
PART OF OUR METHODOLOGY. IN
CREATING THE FEES WE WILL HAVE
TO TAKE INTO ACCOUNT THE
ADDITIONAL WORKLOAD. IN THIS
CASE, WE WILL BE LOOKING AT 4
MILLION AND IT WILL FACTOR BACK
INTO OUR FEES. I GUESS I DON'T
UNDERSTAND. WE DO THIS IN
DOLLARS, SO A FEE IS $2. ALL OF
IT GOES INTO THE FUND. THE FEE
IS GOING TO THE FUND, BUT IT
ALSO WE ALSO USE SOME OF THE
MONEY AS WELL TO COVER OUR
WORKLOAD COSTS AND WHATEVER IS
REMAINDER. WE ACTUALLY I WILL GO
AHEAD AND STOP. I DON'T KNOW IF,
UH, WOULD YOU BE ABLE TO SHARE A
LITTLE BIT MORE DETAIL? UM, SO
THE SO THE FEES ARE ALIGNED SUCH
THAT THE WORK? THEY ARE BASED ON
THE WORKLOAD OF EACH FACILITY
TYPE, SO SNIFFS DRIVES A LOT OF
THE WORKLOAD. SO A LOT OF THE
FEE REVENUE ACTUALLY IS DERIVED
FROM SNIFF, AND IT'S A PER BED
RATE. SO BIGGER SNIFFS PAY MORE
MONEY. UM SO WHAT SHE'S SAYING,
BASICALLY IS THAT IF WE ARE
BASICALLY SAYING THAT WE NEED TO
SHIFT COSTS OVER TO FUND 3098
FROM GENERAL FUND THAT'S GONNA
TRANSLATE INTO HIGHER FEES THAT
SNIFFS PAY IN THE ANNUAL
LICENSING FEE. YOU'RE
ESSENTIALLY IMPOSING MORE COSTS
ON THE PROGRAM AND THEN,
THEREFORE THAT LICENSING FEE
NEEDS TO BE STRUGGLING TO
UNDERSTAND WHY SO THEY PAY A
FEE. THAT FEE COVERS. EVERYTHING
THAT IS INVOLVED IN WORKLOAD
INVESTIGATION IF WE JUST SHIFT
AND IT GOES INTO THE FUN, AND IF
WE JUST SHIFT ALL THAT AND PULL
OUT OF THE FUND, HOW DOES IT SO
THAT COST? SO BASICALLY YOU'RE
SAYING THE COST THE COSTS
IMPOSED ON FUND 1398 WILL
INCREASE BECAUSE WE'RE NÓ LONGER
GONNA PAY WITH GENERAL FUND AND
WE'RE GOING TO PAY WITH FUND
3098. SO OVERALL, WE HAVE TO
COLLECT MORE MONEY TO FUND 3098
TO PAY FOR THIS PARTICULAR
SERVICE. THANK YOU SO MUCH FULLY
UNDERSTANDING. I I'M NOT FULLY
UNDERSTANDING THIS PART WILL SO
IF I IMAGINE I THINK MAYBE THE
ISSUE WAS, UH, PREVIOUSLY THIS
FUNDING WAS DONE IN GENERAL FUND
WITH Dð HÌ èC S¼, SO IT WAS NOT
BEING FUNDED BY THE FEES
COLLECTED SO BY SHIFTING IT FROM
THE GENERAL FUND. HE'S GOT IT TO
THIS FUND. IT WOULD INCREASE THE
THANK YOU WILL WHERE WE KEEP YOU
HERE. WE'LL TALK. WE'LL TALK
HERE. CAROLINE MENTIONED. THERE
WE GO. OK I UNDERSTAND. UM AND
THEN DEPARTMENT OF FINANCE. I
ASKED THIS QUESTION. I THINK TWO
HEARINGS AGO. HOW MUCH DO WE
HAVE IN THE LICENSING
CERTIFICATION FUND? I DON'T KNOW
IF WE WERE ABLE TO GET THAT
ANSWER. THAT IS IN THE B èC P
OR DID SEE YOU NOW OFF THE TOP
OF YOUR HEAD, MONICA. THERE WE
GO. I DIDN THE END OF 2425. IT'S
PROJECTED TO BE 136 MILLION.
THANK YOU SO MUCH. SEE NÓ OTHER
QUESTIONS. WE'RE GOING TO HOLD
THE ITEM OPEN. THANK YOU SO MUCH
. WHAT? WHAT? SORRY WERE THERE
ANY ADDITIONAL COMMENTS NÓ OTHER
THAN THE BUDGET SITUATION, WE
FIND THIS ONE TIME SHIFT TO BE
REASONABLE. A DEPARTMENT OF
FINANCE ANY ADDITIONAL COMMENTS?
GREAT WE'RE GOING TO HOLD THE
ITEM OPEN AND DO OUR LAST ISSUE
PROPOSALS FOR INVESTMENT. WE
HAVE TWO PROPOSALS WE'RE GONNA
BE HEARING FROM TODAY. I ASK
THAT EACH PRESENTER KEEP THEIR
COMMENTS TO THREE MINUTES FIRST
WE'RE GONNA HEAR FROM N THE
EPIDEMICS. COALITION THAT IS
GONNA IN THREE MINUTES. TALK
ABOUT NINE PROPOSALS. WITHIN
THEIR ASK. SEBASTIAN PEREZ.
GOOD AFTERNOON CHAIR AND
MEMBERS. THANKS FOR ALLOWING ME
TO TESTIFY TODAY. MY NAME IS
SEBASTIAN PEREZ AND I WORK FOR
ÁP LE HEALTH IN L. A WE ARE AN
FQ HÌ èC SERVING SOME 12,000
PATIENTS ANNUALLY WITH A FOCUS
ON L GB Tð Q CARE AND HÌ. I VÆ
PREVENTION AND TREATMENT AND I
AM HERE REPRESENTING THE
EPIDEMICS OF STATE WIDE
COALITION THAT ADVOCATES FOR
ENDING HÌ I VÆ S¼ Tð I S¼ VIRAL
HEP AND OVERDOSE IN CALIFORNIA.
OUR BUDGET REQUEST FOCUSES ON
THREE MAIN ISSUES. ONE RESTORING
THE CALIFORNIA OVERDOSE
PREVENTION HARM REDUCTION
INITIATIVE. UH, CRE. FUNDING THE
YOUTH HEALTH EQUITY AND SAFETY
ACT. THANK YOU VERY MUCH, AND
THREE, PROTECTING THE CALIFORNIA
AIDS DRUG ASSISTANCE PROGRAM,
ALSO KNOWN AS A UP AND EXPANDING
SERVICES, WITH ZERO GENERAL FUND
DOLLARS, SO FIRST IN 2023, THE
STATE LEGISLATURE CREATED CRE
AND DESIGNATED 61 MILLION IN
OPIOID SETTLEMENT SPECIAL FUNDS,
BUT IT HAD A SHORT FALL WHEN
SETTLEMENT PARTICIPANTS FILED
FOR BANKRUPTCY. WE REQUEST THE
LEGISLATURE LEVERAGE THE
ATTORNEY GENERAL'S OFFICE.
INCREDIBLE WORK AND DIRECT 6
MILLION TO RESTORE èC. THESE
FUNDS SAVE LIVES BY SUPPORTING
RANGE EXCHANGE SERVICES AND
LOCKS AND DISTRIBUTION. SECOND A
$5 MILLION GENERAL FUND REQUEST
TO FUND THE YOUTH HEALTH EQUITY
AND SAFETY ACT PROPOSED BY
SENATOR MENJIVAR AND S¼ B 954,
WHICH WILL PROVIDE CONDOMS IN
PUBLIC AND CHARTER HIGH SCHOOLS.
S¼ èC I RATES ARE SKYROCKETING,
NOTABLY AMONG YOUTH, SO, UH, IN
CALIFORNIA AND HAD A BEACH
CRISIS LEVELS. AND FINALLY, AID
APP AND THE PREP ASSISTANCE
PROGRAM. THE ADMINISTRATION'S
CURRENT BUDGET PROPOSES 1/5 A
$500 MILLION LOAN FROM THE EIGHT
APP REBATE FUND, AS MENTIONED ON
TOP OF A $400 MILLION LOAN FROM
LAST YEAR'S BUDGET. UH, WHICH
GUTS THE FUND BALANCE LOANS AS
LARGE COULD THREATEN CURRENT AND
FUTURE HÌ. I VÆ SERVICES IN
CALIFORNIA OUR WORRIES SO THE
ADA ABBREVIATE FUND IS EXTREMELY
VOLATILE, AND IT'S NOT A
RESERVE. IT'S NOT A RESERVE.
IT'S A IT'S A BALANCE REBATE
COLLECTION LAGS BEHIND DRUG
PURCHASES BY 6 TO 12 MONTHS, IF
NOT AND COUPLED WITH HUGE
OUTLETS, WHICH ARE FREQUENT. THE
BALANCE FLUCTUATES DRAMATICALLY
MAKING MINIMUM PROJECTIONS
REALLY RISKY TO PINPOINT
EFFECTIVE REBATE COLLECTION,
HOWEVER, HAS ALLOWED THE FUND TO
FUNCTION WITH ZERO STATE GENERAL
FUND SINCE 2008. AND FURTHERMORE
, THE SIZE OF THESE LOANS COULD
IMPEDE ACCESS TO HÌ. I VÆ
MEDICATIONS AND CARE IN
CALIFORNIA AS WELL AS NATIONWIDE
. CALIFORNIA HAS BEEN A LEADER
IN NEGOTIATING VOLUNTARY REBATES
FROM PHARMACEUTICAL COMPANIES
AND ALLSTATE AID APPS AND THESE
LOANS COULD IMPACT THOSE
AGREEMENTS. SO RESPECTFULLY. E
Tð E REQUESTED THE LEGISLATURE
CUT THE LOAN IN HALF. A $250
MILLION LOAN WOULD MAINTAIN
CURRENT SERVICES AND IMPLEMENT
THE LOW COST PROGRAM CHANGES
BEFORE YOU. AND SPARE TIME AS IT
CHANGES WE ARE PROPOSING WOULD
ALLOW CALIFORNIA'S AID APP TO
REDUCE HEALTH DISPARITIES AMONG
LOW INCOME, VULNERABLE
POPULATIONS. CREATE AN OPEN
FORMULARY ADJUST HISTORICAL
INCOME LIMITS FUND, THE
TRANSGENDER GENDER, NON
CONFORMING AND INTERSEX WELLNESS
FUND TO SUPPORT HÌ. I VÆ
TREATMENT AND PREVENTION
SERVICES AMONG Tð G COMMUNITIES
AND FINALLY FIND DATA COLLECTION
NEEDED TO EXPAND PREP SERVICES.
CRUCIALLY THE AID A FINE
REQUESTS WOULD USE ZERO STATE
GENERAL FUND. I KNOW I'M AT TIME
, BUT E Tð OR JUST THE
LEGISLATOR TO HELP US AND THE
EPIDEMICS IN CALIFORNIA. THANK
YOU. SO MUCH FOR YOUR ATTENTION
AND YOUR COMMITMENT TO THE
HEALTH OF ALL CALIFORNIANS, AND
I'M SUPER HAPPY TO ANSWER ANY
QUESTIONS ABOUT ANY OF THE
REQUESTS. THANK YOU SO MUCH.
THANK YOU SO MUCH. I WAS REALLY
PERFECT TIMING. THANKS. GONNA
DEPARTMENT OF FINANCE. I KNOW I
BRIEFLY BROUGHT UP THIS ISSUE
THIS QUESTION EARLIER IN THE
HEARING REGARDING UTILIZING THIS
FUND TO INVEST IN OTHER ISSUES,
NICK MILLS DEPARTMENT OF FINANCE
, UM WE'VE JUST NOTED THAT THESE
PROPOSALS AREN'T INCLUDED IN THE
GOVERNOR'S BUDGET. AND THEN ONE
OTHER THING THAT WOULD NEED TO
BE EVALUATED IS IF THESE
ACTIVITIES ARE CONSISTENT WITH
USES OF THE EIGHT F HUNT, OK? WE
ANY FURTHER COMMENT WITH THE SO
WE HAVE NOT EVALUATED THESE
PROPOSALS, BUT WE STAND READY TO
ASSIST THE LEGISLATURE. OK THANK
YOU SO MUCH. I WOULD BE
INTERESTED TO SEE IF THESE
QUALIFY AS UM, ACTIVITIES WE CAN
USE THE FUND FOR IF WE CAN GET
BACK TO THE SUB-COMMITTEE ON
THAT WOULD BE REALLY HELPFUL.
MOVING ON TO OUR FINAL PROPOSAL
OF INVESTMENT. I'D LIKE TO
REQUEST UM THE PATIENT ADVOCATE.
PUBLIC HEALTH INSTITUTE
REPRESENTATIVE TO PRESENT ON
CANCER REGISTRY YOU HAVE THREE
MINUTES, MA'AM. OK UH, GOOD
AFTERNOON CHAIR MANJAR AND
MEMBERS. I'M JOAN TIÂU. I'M A
PATIENT ADVOCATE, AND I'M HERE
TO SPEAK IN SUPPORT OF THE
CALIFORNIA CANCER REGISTRY, AN
ESSENTIAL RESOURCE THAT IS UNDER
THREAT DUE TO FUNDING CUTS. I
WAS 40. WHEN I WAS FIRST
DIAGNOSED WITH BREAST CANCER, IT
WAS CAUGHT VERY EARLY AND EASILY
TREATABLE. FIVE YEARS LATER, I
WAS DIAGNOSED WITH A SECOND
PRIMARY BREAST CANCER AT THIS
TIME WAS MUCH MORE SERIOUS AND
AFTER SIX SURGERIES AND A YEAR
OF ACTIVE TREATMENT, I HAD TO
LIVE WITH THE KNOWLEDGE THAT
THIS CANCER COULD COME BACK.
WHEN I ASKED MY PHYSICIANS WHY I
GOT CANCER THERE. ANSWER WAS, WE
DON'T KNOW AND THIS. I DON'T
KNOW OF ANY CANCER PATIENT THAT
HASN'T ASKED THAT WIDE QUESTION.
WELL I'LL NEVER KNOW WHY I DID
GET CANCER. WHAT I DO KNOW IS
THAT THE DATA FROM MY CANCER
DIAGNOSIS IN THE CALIFORNIA
CANCER REGISTRY IS CONTRIBUTING
TO THE RESEARCH THAT IS LOOKING
FOR THOSE ANSWERS AND HELPING TO
SAVE LIVES. THE CALIFORNIA
CANCER REGISTRY IS MANDATED BY
LAW TO TRACK EVERY NEW CANCER
THAT OCCURS IN CALIFORNIA. THE
CCR IS EXCEPTIONAL IN THAT IT
LEAVES NÓ ONE OUT WHATEVER THEIR
AGE, RACE, ETHNICITY, GENDER
INCOME, EDUCATION OR OTHER
CHARACTERISTICS. EVERY PATIENT'S
JOURNEY IS RECORDED, SO THE DATA
IN THE REGISTRY IS NOT MERELY
NUMBERS, BUT THE ACTUAL LIVED
EXPERIENCE OF MILLIONS OF
CALIFORNIANS. SO THE INFORMATION
GATHERED IN THE REGISTRY IS
CRUCIAL. IT OFFERS VITAL DETAILS
TO RESEARCHERS. HEALTH CARE
PROVIDERS, PUBLIC HEALTH
OFFICIALS TO BETTER MONITOR AND
ADVANCE CANCER TREATMENTS.
CONDUCT RESEARCH, REDUCE HEALTH
DISPARITIES AND IMPROVE CANCER
PREVENTION AND SCREENING
PROGRAMS. THE IS FUNDED THROUGH
A BLEND OF STATE AND FEDERAL
RESOURCES, WITH MOST FUNDING
PROVIDED THROUGH THE NATIONAL
CANCER INSTITUTE PROGRAM TO
CALIFORNIA'S THREE REGIONAL
REGISTRIES. THOSE FEDERAL FUNDS
REQUIRE A 20% MATCH. SO FOR
DECADES, CALIFORNIA HAS RELIED
ON FUNDING FROM PROP 99
CALIFORNIA'S TOBACCO TAX ITS
STATE SHARE AND UNFORTUNATELY AS
WE HEARD EARLIER THIS MORNING,
DECLINING TOBACCO TAX REVENUES
MEAN THAT CALIFORNIA WILL BE
UNABLE TO MAINTAIN ITS COST
SHARE. THE DEPARTMENT OF PUBLIC
HEALTH ESTIMATES THE PROGRAM
WOULD NEED AN ADDITIONAL 1.9
MILLION JUST TO MAINTAIN FLAT
FUNDING FOR 2024 25. CALIFORNIA
RISKS LOSING $18.5 MILLION
YEARLY FROM FEDERAL FUNDS. HE
WOULD ASK THAT QUESTION EARLIER.
THIS LOSS WOULD DEVASTATE THE
CCR AND ITS REGIONAL REGISTRIES
WITHOUT THE FUNDING FROM THE S¼
E A. THE èC èC R IN ITS
CURRENT FORM, WOULD END SO I
URGE THE SENATE BUDGET COMMITTEE
TO PROTECT THIS VITAL RESOURCE
FOR CALIFORNIA AND TAKE DECISIVE
ACTION IN THIS YEAR'S STATE
BUDGET TO PROTECT THE èC èC R
AND ITS REGIONAL REGISTRIES WITH
AN INVESTMENT OF $7 MILLION.
THANK YOU. YEAH, THANK YOU. LAST
LAST FINAL THOUGHT, OK, THE èC
R HAS BEEN DESCRIBED AS THE EYES
WITH WHICH WE SEE THE CANCER
PROBLEM. WITHOUT IT. WE WOULD BE
BLIND TO HOW A MAJOR CAUSE OF
ILLNESS AND DEATH HAS AFFECTED
THE PEOPLE OF CALIFORNIA.
PRESENTATION. THANK YOU FOR YOUR
TIME AND CONSIDERATION. THANK
YOU. QUESTION. OH, GREAT. ANY
FURTHER COMMENT. AGAIN. WE HAVE
AN EVALUATED THE PROPOSAL BUT
READY TO ASSIST THE LEGISLATURE.
THE ADMINISTRATION WILL CONTINUE
TO EVALUATE ONGOING COSTS
ASSOCIATED WITH THE CANCER
REGISTRY. BUT UM, WE HAVE NOT
EVALUATED THIS PROPOSAL AND HAVE
NÓ POSITION ON IT AT THIS TIME.
THANK YOU SO MUCH WHEN MOVING ON
TO OUR FAVORITE, UM, SECTION
PUBLIC COMMENT. ASK THAT
EVERYBODY'S UM SPEAK FOR MORE
THAN ONE MINUTE. MAY BEGIN, SIR.
UH, MADAM CHAIRWOMAN. WE HAVE
TRAVELED WE TRAVELED FOR OVER
SEVEN HOURS IN THE MIDDLE OF THE
NIGHT TO BE HERE. COULD I PLEASE
ASK FOR JUST A LITTLE BIT MORE
OF TIME? I CAN GIVE YOU TWO
MINUTES, SIR. THANK YOU VERY
MUCH. I APPRECIATE IT. MY NAME
IS STEVE, SAY I AM THE FATHER OF
CONSERVATOR AND ALE FOR MY SON,
JOSHUA SAYA. AND MY DAUGHTER.
JENNIFER IS HERE AS WELL. UH, WE
ARE HERE TO ADVOCATE FOR HIM
BECAUSE HE SUFFERED A TOXIC
BRAIN INJURY DUE TO THE MASSIVE
AH! UNDERSTAFFING. AND
INCOMPETENCY, MEANING THAT THEY
WERE NOT WELL TRAINED NURSES AT
WEST HILLS HOSPITAL IN THE SAN
FERNANDO VALLEY IN 2017 JOSHUA
WAS AN OUTSTANDING HUMAN BEING,
IF YOU OR ANY OF YOUR COLLEAGUES
EVER SAW THE MOVIE, THE
CHRONICLES OF NARNIA, THE LION,
THE WITCH AND THE WARDROBE AS
LONG THE LION WAS ALL COMPUTER
GENERATED 100 AND 50 ARTISTS.
WORKED. THIS MAN. TO CREATE
ASLO. WHEN YOU SEE THAT MOVIE, I
WANT YOU TO SEE THIS FACE. OK,
SO HE SAID, JOSH, MY LITTLE BOY,
HE WENT TO THE HOSPITAL WITH A
STOMACHACHE. AND THEY WERE SO
UNDERSTAFFED. THAT HE WAS LEFT
ALONE A GREAT DEAL OF THE TIME.
I HAD TO LEAVE WITH MY WIFE TO
PICK UP MY GRANDSON, JENS SON
AND, UH, PICK HIM UP FROM, UH UH
, PRESCHOOL, AND SHE STAYED WITH
WITH JOSH UNTIL 1 A.M. SO THE
NOTES FROM THE HOSPITAL SAY THAT
HE SHOULD HAVE GONE TO THE I èC
U THAT HE WAS CRITICAL. ALL THE
RECORDS SAID HE WAS CRITICAL.
BUT THEY PUT HIM IN TELEMETRY.
THEY PUT THEM INTO LEMERY AND
THEN THEY DIDN'T HAVE PROPER
STAFFING FOR HIM. THEY TURN THE
MONITORS OFF. OH, AND WHEN HE
WAS IN, UM IN THE ER, AND THEY
DREW BLOOD TO GO TO THE LAB. THE
LAB WAS NOT STAFFED. THEY HAD TO
SEND THE SAMPLES OUT TO OUT TO
LOS ROBLES HOSPITAL IN 1000
OAKS. HOW ON EARTH CAN THIS LACK
OF STAFFING CONTINUE? AND THEN I
HAVE TO ASK YOU A QUESTION. A
VERY, VERY SERIOUS QUESTION. IF
I MADAM CHAIRWOMAN. I'M SORRY. I
DON'T KNOW THE PROTOCOL. I
APOLOGIZE FOR THAT. BUT, UH UH,
IF I COME TO YOU I KNOW NOTHING
ABOUT YOU. WE DON'T KNOW EACH
OTHER EXCEPT THAT I WENT TO
BIRMINGHAM HIGH SCHOOL, BUT, UM,
UH, IF I FIND YOU A DOLLAR WILL
NOT TEACH YOU ANYTHING. I THINK
NOT. SO IF YOU FILE FINE HEY ONE
THIRD OF A TRILLION DOLLAR
CORPORATION $30,000. YOU THINK
IT MEANS ANYTHING? I THINK NOT.
SO I APOLOGIZE, SIR. AND I
REALLY APPRECIATE YOU COMING UP
HERE. BUT I DO L LINE LAST LINE.
ALL THEY CARE ABOUT IS PROFIT
OVER PATIENCE. THANK YOU SO MUCH
FOR SHARING YOUR STORY. AND I IF
I COULD HAVE MY THREE MINUTES
BECAUSE I FOR ONE MINUTE, MA'AM,
YOUR ONE MINUTE, OK, I TRAVELED
13 HOURS IN THE WIND. UM CAN
PULL THAT UP, DAD. OK, SORRY.
THIS IS THIS IS MY BROTHER JOSH.
RIGHT BEFORE HE WENT IN. UM THE,
UH THE NURSES THEY WERE
UNQUALIFIED FOR THE OWN HOSPITAL
STAFFING JOB REGULATIONS. THEY
WERE SO OVERWORKED THAT THESE
NURSES OUTRIGHT SAID THEY CARRY
NUTS IN THEIR POCKETS AND WHEN
THEY WOULD GO TO THEIR CARS
AFTER THEIR SHIFT, THEY WOULD
BURST INTO TEARS, HOPING THAT
NOBODY DIED ON THEIR SHIFT. IT
IS A NEVER EVENT THAT JOSHUA
WITH A CARDIAC PATIENT, WHICH WE
WERE NEVER EVEN TOLD HE WAS IN
ALL OF HIS MONITORS WERE OFF. HE
SUFFERED AN UNMONITORED CARDIAC
ARREST, DOWNTIME UNKNOWN AND IT
TOOK MORE THAN 15.5 MINUTES TO
RESUSCITATE HIM. THAT'S
IMPOSSIBLE, AND THE NURSES ON
THE FLOOR WERE NOT QUALIFIED
ENOUGH TO EVEN KNOW WHAT TO DO
WITH HIS BODY AS HE LAID THERE
FOR AN HOUR AND A HALF. THIS IS
AN HOUR EVENT IN 16 HOURS, HE
WENT FROM BEING AN OTHERWISE
HEALTHY 40 YEAR OLD MAN WANTING
TO GET MARRIED TO A MOM. THAT
WAS SINGLE. A SINGLE MOM. TO NOW
, THIS ARE OUR MY, MY BROTHER
AND THE WHAT? IT'S A SLAP ON THE
HANDS AND IT PENALTY. UM THIS
THIS MAN RIGHT NOW HE COULD BE
YOUR SISTER. YOUR BROTHER, YOUR
DAD? YOUR MOM YOUR LOVED ONE
THAT GOES TO THE HOSPITAL. AND
JUST LIKE THAT, THEY'RE DEAD
OVER A STOMACH ACHE OVER THE FLU
BECAUSE THEY'RE NOT PAYING
QUALIFIED NURSES OR THEY'RE NOT
MAKING A WORK ENVIRONMENT. YOU,
MADAM AND ALL THE GOOD I COULD
SAY IS BY STATISTICS, IT'S IMP.
WELL HE'S ALIVE. HE HAS LIVED
SEVEN YEARS BY STATISTICS
IMPOSSIBLE, AND HE ALWAYS SAID
HE WOULD LIVE HAS LIVED THE
LIVES OF 1000 MEN. YOU COULD
WRAP UP AND I ABSOLUTELY, AND I
BELIEVE HE HAS LIVED TO TELL
THIS STORY ABOUT NURSING SO HE
COULD SAVE THE LIVES OF MILLIONS
. THANK YOU SO MUCH FOR
REPRESENTING YOUR YOUR BROTHER
AND YOUR SON. THANK YOU VERY
MUCH. EXECUTIVE COMMITTEE. THANK
YOU. MORNING, MADAM CHAIR,
SENATOR. AND SCOTT. I'M HERE TO
COMMENT ON ISSUE NUMBER 14 PAGE
44 OF THE AGENDA IT HAS TO DO
WITH LICENSING FEES IMPACTING
COMMUNITY-BASED ADULT SERVICES.
UH, WE SUBMITTED EXTENSIVE
WRITTEN COMMENTS TO THE
COMMITTEE ABOUT OUR CONCERNS
WITH THE PROPOSAL. WE SUBMITTED
CONCERNS TO CDPH BACK IN
NOVEMBER, UH, HAVE NOT HAD A
RESPONSE SINCE THAT TIME. UM èC
Dð P HÌ DID JUST RELEASE NEW
LICENSING FEE REPORT AND FEES
FOR THE YEAR AND WE ARE VERY
APPRECIATIVE THAT THEY DID. FEES
BY 18% BUT WE REMAIN VERY
CONCERNED ABOUT THEIR PROPOSAL.
UM THEY WHAT WE ARE CALLING
NICKEL AND DIME FEES AS THERE IS
NÓ CORRESPONDING ACCOUNTABILITY
FOR THE DEPARTMENT TO ACT
RESPONSIBLY AND EFFICIENTLY IN
RESPONDING TO AND RECORDING
THINGS SUCH AS CHANGE IN
ADMINISTRATIVE ADMINISTRATOR
POSITION OR CHANGE OF ADDRESS,
AND THIS IS BASED ON COUNTLESS
STORIES FROM PROVIDERS WHO TELL
US THAT èC Dð P HÌ STAFF LOSE.
DOCUMENTS REPEATEDLY ASKED FOR
THE SAME DOCUMENTS ARE NOT
FAMILIAR WITH A Dð. REGULATIONS
DUE TO REORGS AND OF LICENSING
FIELD OFFICES. THANK YOU FOR
YOUR TIME. THANK YOU. GOOD
AFTERNOON CHAIR AND SENATOR
EGLIN JACKIE ANDERSON WITH THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA
REPRESENTING OUR LOCAL HEALTH
DEPARTMENTS THROUGHOUT THE STATE
. UH, WE HAVE A FEW COMMENTS ON
ON A FEW ISSUES. UH, ONE BEING
ON ISSUE NUMBER TWO RELATED TO
FUTURE PUBLIC HEALTH EXPRESSES
OUR SINCERE GRATITUDE TO THE
SUBCOMMITTEE'S COMMITMENT AND
RESOURCING OUR GOVERNMENTAL
PUBLIC HEALTH DEPARTMENTS, UH,
VIA THE THREE $100 MILLION
INVESTMENT FOR WORKFORCE AND
INFRASTRUCTURE, AS WELL AS THE
ONE TIME INVESTMENTS FOR
WORKFORCE DEVELOPMENT AND
TRAINING PROGRAMS FOR OUR PUBLIC
HEALTH DEPARTMENTS ARE 61 LOCAL
HEALTH DEPARTMENTS THROUGHOUT
THE STATE HAVE ADDED OVER 1200
POSITIONS IN AREAS OF CHRONIC
DISEASE AND COMMUNITY HEALTH,
INFECTIOUS DISEASE
ADMINISTRATION AND FISCAL
EMERGENCY PREPAREDNESS AND
PUBLIC HEALTH LABORATORIES.
AMONG OTHER CRITICAL AREAS. THIS
HAS TRULY BEEN A
TRANSFORMATIONAL INVESTMENT IN
GOVERNMENTAL PUBLIC HEALTH AND
OFFERS A FIRST STEP FORWARD IN
FLEXIBLE AND SUSTAINABLE,
ONGOING FUNDING FOR OUR
GOVERNMENTAL PUBLIC HEALTH
DEPARTMENTS AS A KEY PART OF
THIS, UH, INFRASTRUCTURE IS THE
CDPH CAL CONNECT SYSTEM, WHICH
ARE PUBLIC HEALTH DIRECTOR FROM
SANTA CLARA COUNTY, UH, SPOKE TO
THIS MORNING SHE ACT DOES
REQUEST THAT THE LEGISLATURE
PROVIDE RE APPROPRIATED STATE
OPERATIONS FUNDING FROM èC Dð P
TO SUPPORT THE CONTINUATION OF
THE CAL CONNECT SYSTEM, WHICH
HAS BEEN CRITICAL IN CONTROLLING
COMMUNICABLE DISEASES STATEWIDE.
I DID WANT TO CLARIFY ONE THING
RELATED TO THE P AND A PROPOSAL
OK, AND THEN, UM, JUST WANTED TO
MENTION JUST CLARIFYING THAT WE
DO HAVE A REQUEST FOR THE P AND
A PATH PROPOSAL TO RE
APPROPRIATE SOME OF THOSE
UNEXPENDED DOLLARS. UM, AND THEN
ALSO JUST, UH WE HAD SUBMITTED
LETTER RELATED TO THE STATE
DENTAL PROGRAM ISSUE NUMBER SIX,
EXPRESSING CONCERNS ABOUT THE
GENERAL FUND BACKFILL RELATED TO
THE PROPOSITION, 56 AND THEN
LASTLY, ISSUE SEVEN RELATED TO
SYNDROMIC SURVEILLANCE. UM, WE
DON'T HAVE CONCERNS WITH THE
SYNDROMIC SURVEILLANCE PROPOSAL,
BUT WE DO HOPE TO WORK WITH THE
SUBCOMMITTEE'S TO ENSURE THAT
OUR LOCAL HEALTH DEPARTMENTS CAN
ACCESS THE SYSTEM AND ENSURE
THAT WE ARE NOT REQUIRING
DUPLICATE REPORTING. THANK YOU.
THANK YOU. GOOD AFTERNOON, LINDA
WAY WITH WESTERN CENTER ON LAW
AND POVERTY RELATED TO ISSUE TWO
INVESTMENTS IN PUBLIC HEALTH
WANT TO ECHO èC PEN'S COMMENT
REGARDING IMPORTANCE OF
RESOURCES DIRECTLY TO èC, B S¼
AND TRIBAL ORGANIZATIONS TO
SUPPORT HEALTH, EQUITY AND
RACIAL JUSTICE WORK RELATED TO
ISSUE 11 WICK ONLINE TRAILER
BILL WE SUPPORT INCREASING
ACCESS AS LONG AS IT DOESN'T
CONTRIBUTE TO FOOD DESERTS,
RECOGNIZING THE DEPARTMENT IS
AWAITING FEDERAL GUIDANCE. WE
ALSO REQUEST THAT PROTECTIONS BE
IN PLACE. SO THAT WIC RECIPIENTS
WHO ARE LOW INCOME NOT BE
CHARGED ANY FEES, DELIVERY OR
OTHERWISE, AS THIS EATS INTO
THEIR FOOD AND NUTRITION
BENEFITS. THANK YOU. THANK YOU.
MADAM CHAIR, UM STAFF ANDREW
SHANE WITH CHILD POVERTY,
CALIFORNIA THIS IS ON ISSUE 11
ON WHICH ONLINE PURCHASING. WE
REALLY APPRECIATE THE AGENDA,
NOTING THE BRICK AND MORTAR
ISSUE AND ALIGN WITH THE WESTERN
CENTER. UH, THAT ISSUE IS REAL.
BUT THE ISSUE FOR CONSUMER
STANDARDS IS EVEN BROADER THAN
THAT. IF WE DO NOTHING, AND I
APPRECIATE THE DEPARTMENT'S
COMMENTS ON ENSURING THE SAME
EXPERIENCE FOR ALL CONSUMERS,
BUT IF WE DO NOTHING THE FEDERAL
LAW, UNFORTUNATELY, HAS NÓ
PROTECTIONS FOR EP Tð
CARDHOLDERS. THAT IS THE WHOLE
POINT OF WHY WE HAVE SUBMITTED A
LETTER WITH SEVERAL STAKEHOLDERS
ON THE NEED FOR A PARTICIPATORY
PROCESS NOW AND UNFORTUNATELY AS
SOMEONE WHO WORKED ON THIS FOR
SEVERAL YEARS ON CALF FRESH,
THIS FEELS LIKE DEJA VU ALL OVER
AGAIN. THE REQUEST TO EXPEDITE
AND WE DIDN'T EVEN HAVE AN
ANSWER TO THE MISSING OR STOLEN
FOOD ITEMS THAT YOU ASKED. MADAM
CHAIR. THIS IS WHY WE'RE HERE.
THIS IS WHY WE NEED A PROCESS
NOW WE HAD THREE BIPARTISAN
BILLS OVER FOUR YEARS COULD NOT
GET IT DONE ON AND THEN WHEN
COVID HAPPENED, IT WAS RUSHED
THROUGH AND WE DO NOT WANT TO
IMPORT THE SAME PROBLEMS WE HAVE
IN CALF FRESH TODAY, INCLUDING
SOME OF THE REGIONAL ACCESS
ISSUES THAT WAS BROUGHT UP INTO
THE W PROGRAM. THIS IS THE
CHANCE TO DO IT. RIGHT. THANK
YOU SO MUCH, ANDREW. GOOD
AFTERNOON. UH CHAIR. UH, JOZY
GRAY WELL WITH UF èC W WESTERN
STATES COUNCIL ALSO TO COMMENT
ON ITEM 11 IN LINE. OUR COMMENTS
AT THE WESTERN CENTER AND GRACE
UM WE WHILE WE DO SUPPORT WICK
MOVING ONLINE, WE HAVE
SIGNIFICANT CONCERNS WITH THE
LACK OF CONSUMER PROTECTIONS AND
THE GOVERNOR'S PROPOSED TRAILER
BILL. UM THERE ARE TO THE FOCUS
OF TODAY'S DISCUSSION WAS REALLY
ON CURBSIDE PICKUP, BUT IN THE
PROPOSAL ALSO INCLUDES DELIVERY
AND WHEN WE TALK ABOUT DELIVERY,
THERE ARE TWO MODELS THERE. ONE
WHERE FOOD IS DELIVERED BY AN
EMPLOYEE OF THE GROCERY STORE IN
A REFRIGERATED TRUCK. AND THAT
THERE IS THE OPPORTUNITY TO
REPLACE MISSING STOLEN OR, UM
SPOILED GOODS. AND THEN THE
OTHER DELIVERY MODEL IS THE
HANDING OFF TO A POTENTIAL THIRD
PARTY PLATFORM DELIVERED BY AN
INDEPENDENT CONTRACTOR WHERE
THERE IS NÓ RECOURSE TO BE ABLE
TO GET THAT FOOD BACK TO THE
CONSUMER. UM AND APPRECIATE
MADAM CHAIR, A ASKING THE
QUESTION ABOUT WHAT HAPPENS WITH
MISSING AND SPOILED FOOD, AND,
UH, VERY DISAPPOINTED THAT WE
DID NOT GET AN ANSWER TO THAT
QUESTION. UM, WE WOULD LIKE TO
SEE CONSUMER PROTECTIONS TO MAKE
SURE THAT PRODUCTS CAN BE
RETURNED REPLACED. UM AND THEN
ALSO THAT THERE ARE NÓ DELIVERY
FEES, INCLUDING SERVICE FEES,
WHICH IS WHERE A LOT OF THE
HIDDEN FEES ARE. UM AND THEY
JUST AND LAST WANNA END WITH
APPRECIATE THE COMMITTEE'S
ANALYSIS ON THE IMPACT OF THE
BROADER GROCERY INDUSTRY,
ESPECIALLY ITS IMPACT TO FOOD
DESERTS. THANK YOU SO MUCH.
THANK YOU SO MUCH. MADAM CHAIR
OTTA OGDEN SMITH WITH THE
AMERICAN CANCER SOCIETY CANCER
ACTION NETWORK, AND I JUST
WANTED TO SPEAK TO THE
CALIFORNIA CANCER REGISTRY
PROPOSAL FOR INVESTMENT. THE
REGISTRY IS A CRITICAL SOURCE OF
DATA. UM THAT CONTRIBUTES TO
ADVANCED KNOWLEDGE, ENABLE
SCIENTIFIC DISCOVERIES AND
DEVELOP POLICY INITIATIVES THAT
HELP WITH IMPLEMENTING
INTERVENTIONS IN THE FIGHT
AGAINST CANCER ARE REGISTRY HERE
IN CALIFORNIA IS THE LEADING
CANCER REGISTRY IN THE WORLD AND
HAS BEEN THE CORNERSTONE OF A
SUBSTANTIAL AMOUNT OF RESEARCH
ON CANCER IN THE CALIFORNIA
POPULATION. WITH APPROPRIATE AND
ONGOING FUNDING. THE REGISTRY
HAS THE ABILITY TO DO SO MUCH
MORE. AND FOR THESE REASONS, WE
ASK THAT YOU FIND THE MONEY TO
CONTINUE SUPPORTING OUR
REGISTRY. THANK YOU. THANK YOU.
MEMBERS KATHY MOSSBERG, I WILL
ON BEHALF OF THE PUBLIC HEALTH
INSTITUTE. APPRECIATE THE PAN,
ALLOWING OUR ADVOCATE TO SPEAK
TODAY AND ALIGN OUR COMMENTS
WITH WHAT SHE SAID AS WELL AS
THE MS OGDEN SMITH, UM, ON
BEHALF OF ANOTHER CLIENT.
ESSENTIAL ACCESS HEALTH. ONE L
LINE. OUR COMMENTS WITH MR
PEREZ'S STATEMENTS AROUND. UM
ALL THOSE PROPOSALS FROM THE E
Tð E FOLKS AND CERTAINLY WANT TO
SPEAK TO THE INVESTMENT OF THE
YOUTH SAFETY ACT, CALIFORNIA
CURRENTLY AS YOU KNOW, AND AS
YOU HAVE MENTIONED, HAS AN S¼
Tð. PROBLEM WITH OUR YOUTH. WE
THINK THE LEAST WE CAN DO IS
PROVIDE GREATER ACCESS TO
CONDOMS IN SCHOOLS AND KNOW THAT
THIS LIMITED INVESTMENT ONE TIME
ONLY A 5 MILLION WILL GO A LONG
WAY TO PROVIDING ACCESS. I
AGREE. GOOD AFTERNOON, RYAN
SOUZA, REPRESENTING THE SAN
FRANCISCO AIDS FOUNDATION, AND
THE INTEREST OF TIME. I JUST
WANT TO ECHO THE SENTIMENTS, UH,
BY MR PEREZ IN THE IN THE
EPIDEMICS COALITION. WE AGREE,
AND THIS WOULD SUPPORT
CALIFORNIA'S MOST VULNERABLE
RESIDENTS. THANK YOU APPRECIATE
THAT. THANKS. GOOD AFTERNOON,
MADAM. CHAIR JULIA AA WITH THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES HERE IN STRONG SUPPORT
AND APPRECIATION FOR THE FUTURE
OF PUBLIC HEALTH INVESTMENTS
OUTLINED IN AGENDA ITEM TWO OF
YOUR HEARING, UM, THE CRITICAL
INVESTMENTS IN BOTH
INFRASTRUCTURE AND WORKFORCE
ALSO WOULD LIKE TO ECHO THE
SUPPORT THAT WAS PROVIDED BY
DOCTOR REDMAN EARLIER, UH, FOR
CONTINUED INVESTMENT IN THE CAL
CONNECT SYSTEM THAT MANY OF OUR
HEALTH DEPARTMENTS FIND IS A
CRITICAL TOOL. THANK YOU. THANK
YOU. GOOD AFTERNOON, MADAM
CHAIR. JESSICA RAN OF THE
CALIFORNIA DENTAL ASSOCIATION,
UH, HERE TO GIVE COMMENT ON
ISSUE NUMBER SIX APPRECIATE, UH,
THE TOPIC OF THE CLINICAL
ROTATIONS BEING AGENDA. TODAY WE
ARE IN SUPPORT OF THE Tð B TO
SHIFT THE FUNDING. UH, THESE
CLINICAL ROTATIONS ARE REALLY
ESSENTIAL AS THEY GIVE DENTAL
STUDENTS THE OPPORTUNITY TO EARN
THEIR CLINICAL HOURS OR
PRACTICING IN COMMUNITY SETTINGS
. WE HAVE DATA THAT SHOWS THAT
WHEN THEY ARE EXPOSED TO THESE
SITES, THEY ARE MORE LIKELY TO
RETURN TO THEM UPON GRADUATION,
WHICH IS REALLY CRITICAL
CONSIDERING THE WORKFORCE ORDERS
THAT WE HAVE IN CALIFORNIA RIGHT
NOW, UH, LIKE TO THANK THE
SUB-COMMITTEE AND STAFF FOR
INCLUDING THE QUESTIONS ON THE
OFFICE OR HEALTH FUNDING. WE ARE
SUPPORTIVE OF THE OFFICE OF ORAL
HEALTH, RECEIVING THEIR FULL $30
MILLION ALLOCATION AND CHAIR. I
APPRECIATE YOUR COMMENTS ABOUT
SHIFTING SOME FUNDS FROM THERE
TO BE INCLUDED IN OUR, UM OTHER
SPECIALTY CLINIC GRANT PROGRAM.
THIS JUST WANT TO REITERATE THAT
, UH, WE WOULD NOT BE SUPPORTIVE
OF ANYTHING THAT WOULD SHIFT ANY
FUNDS FROM EITHER STATE
OPERATIONS OR LOCAL OPERATIONS
AS WE DON'T WANT TO HAVE ANY
NEGATIVE IMPACT TO THE IMPORTANT
WORK THAT OF HEALTH DOES
IMPLEMENT THE STATE DENTAL
PROGRAM. UH, LOOKING FORWARD TO
SO THAT WOULDN'T BE IDEAL. IF WE
USE SOME OF THE FUNDS FOR THE
PROGRAM, WE'RE WE'RE OPEN TO
HAVING CONTINUED CONVERSATIONS
WITH BOTH THE DEPARTMENT AND THE
SUBCOMITTEE. I JUST WANT TO BE
CAREFUL THAT WE DON'T YOU KNOW,
SHIFT ANY FUNDING THAT WOULD
TAKE AWAY FROM THE PROJECTS
OFFICER. OUR HEALTH IS WORKING
ON. OK BUT CONTINUE
CONVERSATIONS. APPRECIATE IT.
THANK YOU. THANK YOU. MADAM
CHAIR BRUCE PALMER WITH THE
CALIFORNIA ASSOCIATION OF PUBLIC
HEALTH LAB DIRECTORS IN
ALIGNMENT WITH CHIA CO. A AND
èC SAC IN SUPPORT OF THE CAL
CONNECT PROGRAM. THANK YOU.
THANK YOU. I THINK YOU WENT
TODAY SIX SECONDS. HELLO MY NAME
IS JACINTHA LÀ. I AM A 30 THREE
YEAR R N AND I'M A SHOP STEWARD
WITH S¼ EIU. I WORK AT HOLLYWOOD
PRESBYTERIAN HOSPITAL. I WANT TO
PLEASE BEG YOU NOT TO GIVE THESE
HOSPITALS A LOOPHOLE. THEY ARE
NOT TELLING THE TRUTH. THEY'RE
NOT CALLING IN DAY TO DAY
REGISTRY. THEY ARE FLEXI NURSES
HOME. THEY ARE CANCELING NURSES,
AND THEN WE GET BUSY AND
EVERYTHING HAPPENS. JOSH
HAPPENS, PLEASE NÓ MORE JOSHES.
PLEASE NÓ MORE JOSH AS A NURSE
TO SEE HIM AND HIS FAMILY IS SO
PAINFUL. PLEASE DO NOT GIVE THEM
THE LOOPHOLES. THEY ARE NOT
TELLING THE TRUTH. THEY ARE NOT
MAKE THEM INVESTIGATE. THE
HEALTH DEPARTMENT IS NOT
INVESTIGATING. LIKE THEY SHOULD
LET THEM SHOW YOU THE REGISTRY
THEY CALLED THERE'S DAY TO DAY
REGISTRY AVAILABLE. LET SEE THE
STAFFING CALL THE NURSES SEE WHO
WAS CANCELED, WHO WAS FLEXED.
THEY ARE NOT TELLING THE TRUTH.
THEY DON'T CARE. THEY DO NOT
CARE. PLEASE NÓ MORE JOSHES.
PLEASE. THANK YOU. THANK YOU SO
MUCH FOR YOUR COMMENTS. GOOD
AFTERNOON. MY NAME IS ROSANNA
MENDEZ. I'M THE EXECUTIVE
DIRECTOR OF S¼ Ó U LOCAL 121 R
N. THANK YOU FOR THIS TIME
TODAY. UH, THE UNDERSTAFFING OF
NURSES IS EXASPERATED BECAUSE
HOSPITALS ARE NOT ONLY
UNDERSTAFFING NURSES, BUT THEY
ALSO DON'T SCHEDULE OR ALSO
UNDER STAFF SUPPORT STAFF. SO
WHAT HAPPENS IS THAT NURSES RUN
AROUND TRYING TO DO THEIR JOBS
AND EVERYONE ELSE'S SO THEIR
AUTO RATIO THEY DON'T HAVE
SUFFICIENT SUPPORT STAFF. IT IS
IMPOSSIBLE FOR PATIENTS TO GET
TO GET THE CARE THAT THEY
DESERVE QUALITY CARE AND SAFE
CARE. SO THAT IS REALLY
UNFORTUNATE. THE èC HÌ A
REPRESENTATIVE, UNFORTUNATELY.
APPEAR EARLIER PROVIDED AN
OPINION FOR WHY UNDERSTAFFING
OCCURS IN HOSPITALS. THESE ARE
THE SAME TALKING POINTS THAT
THEY REGURGITATE EVERY YEAR.
EXCUSE ME EVERY TIME NURSES
ADVOCATE FOR THEIR PATIENTS AND
TO PROTECT THEIR LICENSES. THE
REALITY OF WHAT NURSES ARE
FACING EVERY DAY IS DIFFERENT
FROM HOW èC èC HÌ A FRAMES IT
NURSES ARE ACTUALLY AT THE
BEDSIDE AND HAVE TO MAKE DAILY
CHOICES BETWEEN THE PATIENTS.
THEY WILL ALLOCATE THEIR TIME
TO. AS A RESULT, PATIENT
MEDICATIONS ARE DELAYED.
PATIENTS FALL OUT OF BED AND ARE
INJURED. THEY AREN'T TURNED OR
MOVED AS NEEDED, AND OFTENTIMES
DEVELOP BED SORTS BEDSORES. GOAL
WITH SB 227 WAS NEVER TO PUNISH
HOSPITALS BUT TO CREATE A
DETERRENT FOR THEM TO CONTINUE
VIOLATING THE LAW. HOWEVER IF
FINES ARE RARELY ISSUED, THERE
IS NÓ REASON FOR HOSPITALS TO
FOLLOW THE LAW AND PATIENTS
SUFFER. èC Dð P HÌ HAS A
RESPONSIBILITY TO PROTECT PUBLIC
HEALTH AS THE REGULATORY AGENCY
WITH THE AUTHORITY TO HOLD
HOSPITALS ACCOUNTABLE AND
PREVENT CONTINUED HARM TO OUR
COMMUNITIES. LOCAL 1 TO 1 R IN
ASK THAT TRANSPARENCY AND
ACCOUNTABILITY BE THE GUIDING
PRINCIPLES FOR HOW THE AGENCY
CONDUCTS ITS WORK. THANK YOU.
THANK YOU PERFECT. GOOD
AFTERNOON. I'M CATHERINE HUGHES,
AND I'M, A REGISTERED NURSE IN
THE EXECUTIVE DIRECTOR OF THE
NURSE ALLIANCE OF S¼ EIU,
CALIFORNIA REPRESENTING ABOUT
30,000 REGISTERED NURSES
THROUGHOUT CALIFORNIA, INCLUDING
ALL OF THE HEALTH FACILITY
EVALUATORS EMPLOYED BY THE
DEPARTMENT OF PUBLIC HEALTH ON
BEHALF OF THE NURSES AND MEMBERS
OF S¼ EIU, CALIFORNIA WE
APPRECIATE THE ATTENTION TO
ENSURING THAT WE HAVE SAFE
STAFFING TO CARE FOR OUR
PATIENTS BEFORE, DURING AND POST
PANDEMIC, IT CONTINUES TO BE A
STRUGGLE TO ENSURE THAT
HOSPITALS ARE MEETING THEIR
NURSE TO PATIENT RATIOS. NURSES
FILE RATIO VIOLATION COMPLAINTS
WITH THE DEPARTMENT OF PUBLIC
HEALTH YET OFTEN OUR CALLS TO
HOLD HOSPITALS ACCOUNTABLE GO
UNHURT OR UNIN INVESTS IN
UNINVESTIGATED. DUE TO THIS LACK
OF ENFORCEMENT, EVEN WHEN THE
COMPLAINTS ARE VALIDATED AND
VIOLATIONS ARE FOUND PLANS OF
CORRECTIONS ARE ISSUED BUT ARE
OFTEN NOT FOLLOWED UP ON AND
EVEN WITH SUBSTANTIATED
COMPLAINTS TO FOR CLEAR
VIOLATIONS, WE SEE A LACK OF
FINES BEING ASSESSED POOR
STAFFING RESULTS IN NEGATIVE
OUTCOMES FOR OUR PATIENTS AND
PUTS THE NURSES AT RISK AND WELL
AS WELL. WHEN WE ARE IN CRITICAL
SHORTAGE OF NURSES HERE IN
CALIFORNIA AT THE SAME TIME, OUR
HEALTH FACILITY EVALUATE OUR
NURSES ARE UNDER DUE TO POOR
RETENTION AND THE DEPARTMENT,
NOT FILLING VACANCIES AND
OVERWORKED WITH MANY OF THEM
FACING INCREDIBLY STRESSFUL WORK
ENVIRONMENT. OUR HEALTH FACILITY
EVALUATORS INFORM ME THAT THEY
ARE SEVERELY SHORT STAFFED
BECAUSE OF BELOW STANDARD PAY OR
BENEFITS AND NÓ LONGER OFFSET,
UH, OFFSET LOW PAY. THANK YOU.
THANK YOU SO MUCH. THANK YOU. MÀ
ON BEHALF OF S¼ U ON ISSUE TWO
AROUND THE PUBLIC HEALTH
FUNDING, JUST WANTED TO EXPRESS
OUR SUPPORT WITH CHIA OAK AND
THE COALITION AS PART OF THAT
COALITION THAT REALLY PUSHED
THAT FORWARD FOR, UH, FUNDING
FORWARD. WE REALLY CAN'T HAVE A
ANOTHER REPEAT OF THE LACK OF
PREPAREDNESS BY THE COVID-19
CRISIS AND SO REALLY APPRECIATE
THE LEGISLATURE'S CONTINUE
INVESTMENT AND FOCUS ON PUBLIC
HEALTH. THANK YOU. THANK YOU.
GOOD AFTERNOON, MADAM CHAIR NORA
LYNN FROM CHILDREN. NOW I'M
RIGHT HERE ON BEHALF OF SEVERAL
GROUPS FROM THE CALIFORNIA
PARTNERSHIP FOR ORAL HEALTH, AND
WE URGE THE SUBCOMITTEE TO
ENSURE THAT THE STATE DENTAL
PROGRAM ITEM SIX RECEIVES 18.493
MILLION IN GENERAL FUND BACKFILL
PURSUANT TO A B 130 THREE, WHICH
WAS CHAPTERED IN 2021, WHICH
CALLED FOR GENERAL TH BACKFILL
TO BE ALLOCATED TO THE STATE
DENTAL PROGRAM IF IT WAS NOT
APPROPRIATED $30 MILLION UM,
ACCORDING TO THE FUND CONDITION
STATEMENTS, IT LOOKED LIKE THE
PROPOSED ADJUSTED BALANCE FOR
FISCAL YEAR. 2425 APPEARS TO
APPLY RESERVES GAINED FROM
PREVIOUS FISCAL YEARS AS IF THEY
WERE REVENUE WHICH IS
INCONSISTENT WITH THE CONTINUOUS
APPROPRIATION OF $30 MILLION
MANDATED BY A B 133. THANK YOU.
THANK YOU, MA'AM. GOOD AFTERNOON
. MY NAME IS KAREN FARLEY. WE'RE
REPRESENTING THE 84 WICK
AGENCIES IN CALIFORNIA, THE
CALIFORNIA WICK ASSOCIATION. I'M
GLAD YOU HAD A GOOD VISIT IN
WICK. THAT'S USUALLY WHAT
HAPPENS. UM, I'M HERE. YOU'VE
HEARD A LOT ABOUT WORKFORCE
SHORTAGES AND I HAVE I WANT TO
PINPOINT ONE SPECIFIC THING.
THERE'S A LOT OF LEADERSHIP
POSITIONS THAT ARE VACANT IN èC
Dð P HÌ, PARTICULARLY IN THE
CENTER FOR FAMILY HEALTH. OUR
ILLUSTRIOUS WIC DIRECTOR IS
RETIRING AND PEOPLE ARE NOT
APPLYING BECAUSE OF SALARY IS
TOO LOW. THESE POSITIONS CAN BE
BUMPED UP IN THEIR
CLASSIFICATION. CDPH ISN'T DOING
IT. IT'S FEDERALLY FUNDED
PROGRAM. UM WE COULD SOLVE ONE
SMALL PROBLEM WITH VACANCY AND
PROVIDE GREAT LEADERSHIP. THIS
PROGRAM IS ON AN UPSWING. YOU
HEARD THE NUMBERS. THEY'RE
MODERNIZING. THEY NEED GREAT
LEADERSHIP, TOO, TO SUPPORT THE
STAFF AND THE W I AGENCIES. SO
THANK YOU VERY MUCH. THANK YOU.
SEE NÓ FURTHER PUBLIC COMMENT,
UH, THAT WILL CONCLUDE BUDGET OF
THREE ON HEALTH AND HUMAN
SERVICES NOW ADJOURNED.