Issue 5

›San Francisco Public Press›

WINTER 2011 — ISSUE 5 SFPUBLICPRESS.ORG

READER SUPPORTED $1 — NO ADVERTISING

INDEPENDENT, NONPROFIT, IN-DEPTH

ECONOMY

HEALTHY SF: WHO PAYS?

PAYDAY LENDERS GET HELP FROM BIG BANKS TO OFFER CASH AT STEEP PRICES

Department of Public Health San Francisco California

Technology adds millions to cost

San Francisco’s Universal Health Care Experiment

S.F. SAYS IT’S AHEAD OF OTHER CITIES WITH DATABASE, BUT CLINCS STRUGGLE TO PAY FOR MEDICAL RECORDS PAGE B1

INDUSTRY BORROWS FOR AS LITTLE AS 5 PERCENT INTEREST AND CHARGES AS MUCH AS 400 PERCENT PAGE A3

INCREASED LIMITS: State lawmakers are considering raising maximum amount on allowed payday loans to $500. PAGE A3 EDUCATION

Program Name: Symptoms:

Healthy San Francisco

Start Date:

2007

As many as 90,000 adults lack

health insurance. Left untreated, patients flood emergency rooms with problems a primary doctor could have solved.

‘RESTORATIVE JUSTICE,’ NOT EXPULSIONS

Treatment:

Provide universal care, covering

at least two-thirds of city’s uninsured.

S.F. SCHOOLS SEE MAJOR REDUCTIONS IN STUDENTS BEING KICKED OUT OF CLASS PAGE A4

Give each a medical home to improve coor-

PUNISHMENT VARIES: County by county, policy ranges widely on student discipline PAGE A4

dination and reduce chance of error. Make

BETTING ON MISSION SCHOOLS

businesses pay for workers’ coverage.

DESIGNING FOR GOOD AT STANFORD SCHOOL WORKS AT SOLVING WORLD’S PROBLEMS

BY COMBINING DISPARATE DISCIPLINES PAGE A5

STATE GRANT MONEY HAS POTENTIAL TO HELP STRUGGLING SCHOOLS, BUT AT A PRICE. PAGE A5

Possible Side Effects:

Increased demand for medical

services strains clinics’ capacity. Paying

CIVICS

for $177M program a problem if grants

MAYORAL CANDIDATES AGREED ON MUNI FIXES

disappear or businesses balk at cost.

Full prescription on page B1

SPEED-UP PLAN INCLUDES ELIMINATING STOPS, ADDING TRANSIT LANES PAGE A7

Firms ditch insurance for city health option

SOME EMPLOYERS END PRIVATE HEALTH COVERAGE TO SAVE WITH REIMBURSEMENT ACCOUNTS FOR WORKERS PAGE B2

Participants like safety net, but see a few holes

INEXPENSIVE COVERAGE CAN BE A GODSEND, BUT HIGHER DEMAND CAN LEAD TO UNEVEN SERVICE PAGE B3

Who are the patients of Healthy San Francisco?

A BARTENDER, AN ILLUSTRATOR, A CAREGIVER, A MORTGAGE BROKER, A STUDENT, A SALESWOMAN PAGE B3 IN EXPENSIVE BALANCING ACT, CITY PAYS FOR RISING HEALTH BILL GRAPHIC, PAGE B2

Produced with assistance from USC Annenberg/California Endowment Health Journalism Fellowships

GREEN

HIDDEN HOUSING: The city has trouble keeping track of illegal inlaw apartments PAGE A7

TAKING A NEW TACK ON HUMAN TRAFFICKING

S.F. POLICE MOVE ENFORCEMENT FROM VICE TO SPECIAL VICTIMS UNIT PAGE A6

SCOURGE OF SEX SLAVERY A global nightmare in our own backyard PAGE A6

BIG MONEY’S OVERSIZE ROLE IN U.S. POLITICS

CLIMATE CHANGE MAKES BAY AREA BIRDS FAT

LAWRENCE LESSIG’S PATH TOWARD CAMPAIGN FINANCE REFORM PAGE A7

UNEXPECTED PATTERN ON WEST COAST; EASTERN BIRDS SHRINK PAGE B4

USED COFFEE GROUNDS PERK UP MUSHROOMS BERKELEY TEAM TURNS COMPOST INTO DO-IT-YOURSELF KITS PAGE B5

MAPPING THE BAY AREA’S FOOD LANDSCAPES THE BAY AREA IS PLENTY URBAN, BUT IT’S ALSO 40% FARMS AND RANGELANDS PAGES B4-B5

MEDIA

ANTI-PANHANDLING ‘CLAMOR’?

ART SPEAKS TO THE MOVEMENT

LOCAL MEDIA HAVE A PROBLEM NAILING DOWN COMPLEX CAUSES PAGE B7

GRAPHIC DESIGNER EDDIE COLLA LIKES THE ODDS OF 99:1 PAGE B7

DEEP LINKS BETWEEN MEDIA IN THE U.S. AND RACISM JOURNALIST SAYS LACK OF DIVERSITY IN OWNERSHIP RESTRICTS VIEWPOINTS PAGE B7

STREETSCAPE

WHO’S BEHIND OCCUPY PROTEST SIGNS? BACKERS OF SAN FRANCISCO ENCAMPMENT HOLD RANGE OF POLITICAL VIEWS PAGE A8

OCCUPY S.F. BELIEVERS IN THEIR OWN WORDS

MANY MEMBERS OF CONGRESS ARE COMFORTABLY LOCATED IN TOP 1%

A SAMPLING OF REASONS FOR CAMPING OUT IN JUSTIN HERMAN PLAZA PAGE A8

DIANNE FEINSTEIN AND NANCY PELOSI MAKE $9 MILLION CUT, BUT BARBARA BOXER FALLS A BIT SHORT PAGE A8

SOCIAL JUSTICE GROUPS AID THE MOVEMENT LOCAL NONPROFITS HAVE A CHANCE TO SPREAD MESSAGE OF ECONOMIC DISPARITY PAGE A7

BECOME A MEMBER

THE TENDERLOIN’S DREAM TOILET

PROTOTYPE OF GREEN, COMPOSTABLE FACILITIES PAGE B8

OCEAN BEACH: Sea level threatens Great Highway PAGE B8

The San Francisco Public Press is a nonprofit news organization committed to producing independent, ad-free, public-interest journalism for readers in the San Francisco Bay Area.

URBAN CROSSROADS: FACES OF SAN FRANCISCO PHOTOGRAPHER JASON WINSHELL CAPTURES INCONGRUOUS IMAGES OF PEOPLE IN THE CITY FOR NEW BOOK PAGE B8

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A2 SF Public Press

Winter 2011 // sfpublicpress.org

ABOUT US FROM THE EDITORS

100% Ad-Free News for the 99%

In the Public Press, elites don’t dictate coverage

B

ehold Issue 5 of the San Francisco Public Press, an ad-free nonprofit local newspaper that models itself on, among other things, public broadcasting. We also takes cues from noncommercial magazines, some of which have become influential of late and have a unique perspective on the news.

Our approach has always been to look for stories that see the city and the Bay Area from the viewpoint of average people instead of just the elites, whose concerns are well represented. We don’t practice advocacy journalism.

We do strive to cover, in depth, stories and communities that commercially funded media don’t often pay attention to.

The biggest story Bay Area news media could not ignore in recent months is the “Occupy X” movement — X being whatever, wherever or whoever comes into the crosshairs of a nebulous but grassroots throng of activists, unemployed professionals and anyone who feels politics and business are corrupt these days.

Less known is the spark behind the movement.

Occupy Wall Street began in New York Sept. 17, when Adbusters, a “culturejammer” ad-free magazine that scrutinizes the advertising industry, called for a show of support for the victims of the financial industry meltdown that took the entire economy with it. Within weeks, the movement spread across the country and around the world — most dramatically in Oakland, where police appear to have overreacted to a long-term protest in which a minority practiced civil disobedience.

Adbusters found its voice in an era of corporate ascendance. Its consistent message, remixed and reinterpreted endlessly in college communications and media studies programs everywhere, is that the media most people consume is imbued with the values of the business

interests that pay for the ads.

When it was launched on the Web in 2009, the Public Press similarly sought editorial independence of a form missing from the mainstream. More than a year after our premiere print edition hit the streets in June 2010, we remain committed to the idea of noncommercial journalism, a model that mixes a modestly priced, ad-free print edition with small donations from members, support from foundations and article syndication.

Our special report on the Healthy San Francisco program, funded by the USC Annenberg/California Endowment Health Journalism Fellowships, investigates a huge local story that’s received scant journalistic coverage, but affects the lives of tens of thousands of working and unemployed city residents. Readers also pitched in for the project with online microdonations via Spot.Us. Our story on “payday” loans by reporter Rick Jurgens questions why some of the biggest banks, including San Francisco-based Wells Fargo, have invested in an industry that offers short-term loans to low-income people at interest once considered usurious by the state of California.

And, of course, we take a deep dive into the Occupiers in Oakland, San Francisco and beyond, focusing mostly on the ideals and ideas for change that participants bring to the vibrant but amorphous picket lines.

While all of our more than two-dozen nonprofit news and civic affairs partners are “public media,” not all of them eschew ads. From our perspective, there has to be a diversity of business models in an industry that is vital to the commonweal but whose economic foundation has been rocked by changes in technology and corporate ownership. The Public Press is run by volunteers and modestly paid freelance writers who believe the news is too important to leave solely in the hands of Wall Street.

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2011

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All membership levels include one free copy of each San Francisco Public Press newspaper published in the next 12 months, as well as free and discounted entry to parties, panel discussions and other events hosted by the Public Press for one year. (Contributions are tax deductible to the extent allowed by law.)

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WHO WE ARE The San Francisco Public Press • Vol. 2, No. 3. (Issue 5) • WINTER 2011 • SFPUBLICPRESS.ORG The Mission of the San Francisco Public Press is to enrich the civic life of San Francisco by delivering public-interest journalism through print and interactive media not supported by advertising.

965 Mission St., Ste. 220, San Francisco CA 94103 • (415) 495-7377 • info@sfpublicpress.org To support our work: sfpublicpress.org/donate Board of Directors: David Cohn • Tom Honig • Maryann Hrichak • Lila LaHood • Marc Smolowitz • Michael Stoll • Louise Yarnall Executive Director: Michael Stoll Publisher: Lila LaHood News Editor: Richard Pestorich

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sfpublicpress.org // Winter 2011

A3 SF Public Press

ECONOMY

BUSINESS

Big Banks Help Payday Lenders Offer Quick Cash At Steep Prices

Wells Fargo, Credit Suisse among biggest backers of profitable low-finance firms

E San Francisco has 32 of California’s more than 2,000 payday loan outlets.

Jason Winshell // Public Press

LEGISLATION

California Legislature May Expand Lending Limit Lawmaker wants to raise payday loan limit to $500; others want restrictions

F

ast Easy Cash when you want it!” That’s the promise on the cover of an application for a “cash ’til payday” loan from DFC Global Corp.

The company operates eight Money Mart stores in San Francisco, more than any other payday lender. Anyone at least 18 years old with a bank account, phone number, photo ID, and job or “steady source Story: of income” (and not in bankRick Jurgens ruptcy or behind on another // Public Press repayment) can get a loan.

But fast money comes at a high price. The $300 shrinks before the borrower walks out the door. The lender normally withholds a $45 fee.

While that might not seem like an exorbitant price for the service, it comes at a shockingly high annualized interest rate that results from the loan’s high fee, small amount and short duration. For the $255 the borrower actually gets, with a two-week repayment deadline, the annual percentage rate is a cool 459 percent.

Greg Larsen, a spokesman for the California Financial Service Providers Association, a trade group of check-cashers and payday lenders, said that using an APR was an “apples to oranges” measure of the cost of a payday loan. “People don’t use the product for 52 consecutive weeks,” he said.

Currently, California has a $300 limit on each payday loan. But legislation pending in Sacramento would raise the maximum amount to $500. While supporters of the bill say the loans benefit working people, consumer advocates worry that borrowing at high interest rates can sink poor people further into debt. That was the concern of the San Francisco city attorney’s office, which this fall settled a suit with a payday lender accused of exceeding the legal limit.

So why borrow money at check cashing and payday loan stores? Alberto Garcia, a restaurant worker from Hayward, said he had never taken out a payday loan but would “if I needed the money.” Garcia was interviewed after leaving a California Check Cashing store on the corner of Kearny and Geary streets. He said he had just purchased a money order and could imagine using a payday loan to get needed cash: “I would consider the bank, but it would be much easier to go here.”

Others may see no place else to turn. Robert Mitchell, who had just completed a Western Union transaction in a Money Mart store on Market Street, said he might take out a payday loan if he faced a deadline to pay rent or a car note, or needed money for a special occasion: “I’m willing to bite the bullet if I have to and pay a little something for that.”

‘Convenience’ for customers Industry spokesman Larsen said consumers, when allowed a choice among a range of financial options, “will always find the credit that is the most cost effective.”

But industry documents acknowledge that price may be secondary to the immediate need for money. DFC’s annual report, in the dry language of Wall Street, says that for its customers, “the pricing of products and services is a secondary consideration.”

Payday lending began in the mid-1990s, fueled by promises of fast and easy money. “Ultimately, convenience, hours of operations, accessibility and other aspects of customer service are the principal factors influencing customers’ selection of a financial services company in our industry,” DFC’s most recent annual report says.

Consumer advocates say payday loans are dangerous financial products that can easily trap

borrowers in a debt spiral, forcing them to take out round after round of high-interest loans to repay earlier ones.

“Payday loans are very expensive, and they are targeted at people who can least afford to pay them back,” said Liana Molina, the payday campaign organizer for the California Reinvestment Coalition, which advocates for the right to equal access to banking and other financial services for low-income people and minority communities.

“If someone is treading financial water, a payday loan is an anchor that’s going to sink them.”

But industry supporters say that payday loans provide a vital source of cash to strapped borrowers, and that costs are justified by the risks lenders take on by making the unsecured loans.

A payday loan is a “convenient, short-term financial option” that provides “a fix for families faced with the prospect of bouncing checks, shutting off utilities or worse, skimping on basic needs such as medical emergencies,” according to written comments submitted by the California Hispanic Chambers of Commerce to the state Senate’s Judiciary Committee.

A profitable business Payday lending is also big business. In 2010, about 1.6 million Californians borrowed $3.12 billion from the state’s more than 2,100 payday loan outlets, according to a report compiled from the industry’s unaudited disclosures to regulators. Each borrower took out an average of 7.5 loans, for an average period of 17 days. The average loan carried an APR of 414 percent.

Larsen noted that the number of payday loan stores in California had declined by 400 or 500 in recent years. The industry, he said, has reached a “maturity level, has stabilized, and now is contracting to some degree.”

Although the state does not require payday lenders to publicly disclose their revenue, the industry data translate to statewide annual fee revenue of about $600 million for the industry. And while the default rate is high — $71 million last year in California — the business is still lucrative.

Larsen declined to comment on those figures.

DFC, which operates Money Mart stores, said its customer base comprises mostly “service sector and self-employed individuals” looking for “cash necessary for living and other episodic expenses.” DFC’s 1,269 retail stores originated payday loans with a face value of $2.2 billion in the last fiscal year. DFC’s 312 stores in the United States, including 99 in California, originated loans with a face value of $481 million, and pocketed $61.6 million in revenue.

In October, DFC agreed to settle a lawsuit that alleged it had violated California law by making payday loans over the $300 limit. Without admitting it violated the law, DFC agreed to pay $7.5 million in restitution to consumers, forgive up to $8 million in unpaid balances on other outstanding loans and pay San Francisco’s city attorney $875,000 to cover investigation and litigation costs. California customers of Money Mart who took out payday loans between January and July 2005 or installment loans between July 2005 and March 2007 may be eligible for restitution. More information about the settlement is available on the city attorney’s website, www.sfcityattorney.org.

DFC spokeswoman Julie Prozeller declined to comment on the lawsuit and settlement.

The District of Columbia and 12 states ban payday loans, according to a tally in February by the National Conference of State Legislatures.

Laws or court rulings in five other states effectively prevent payday lending, according to the Consumer Federation of America. California’s payday lending limit is lower than that of all but

one of the states that allow such lending. Montana also limits each loan to $300.

Some legislators want to raise the limit. Assembly Bill 1158, sponsored by Majority Leader Charles Calderon, D-Montebello, would allow payday loans of up to $500. The existing ceiling has remained unchanged since passage of a 1996 law, also sponsored by Calderon, which legalized payday loans in the state.

The bill passed the state Assembly 49 to 16 in June. In the Senate, the bill was passed by the Banking and Financial Institutions Committee on June 30 and sent to the Judiciary Committee, which has not yet acted on the legislation.

Liana Molina of the California Reinvestment Coalition, which opposes the bill, said there is still a chance it may emerge from the Judiciary Committee. Opponents have proposed amending the bill to require that payday loans not be due for repayment in less than 30 days, limit borrowers to no more than six loans annually and make lenders responsible for underwriting each loan by assessing a borrower’s ability to repay it.

But even with those amendments, consumer advocates still would not line up behind AB1158 and its increase in the payday loan limit, Molina said.

Larsen, the spokesman for the payday lenders, declined to comment on the amendments proposed by the bill’s opponents, but said that the bill is receiving careful consideration.

ven as the Occupy San Francisco encampment at the base of Market Street expressed outrage at big banks and high finance, it remained business as usual at some of the city’s less glamorous financial establishments.

High-interest, unsecured “payday” loans are readily available at 32 establishments along Market Street and Story: in low-income comRick Jurgens // Public Press munities around the city. Most people with bank accounts qualify.

These stark storefronts — where hardpressed consumers line up to speak with clerks behind Plexiglas windows and apply for high-cost payday loans — may seem unconnected to Wall Street.

But while their names and brands are nowhere to be seen, banks and rich investors based here or in distant financial enclaves like Manhattan or Zurich provide funds to or own stakes in some of San Francisco’s largest payday lenders. These include Money Mart, with eight stores, and California Check Cashing Co., with five.

In March, Wells Fargo & Co., the largest bank based in San Francisco, acted as the administrative agent of a bank syndicate that provided DFC Global Corp., the owner of Money Mart, with a $200 million revolving credit, according to SEC filings. Essentially a giant credit card with a March 2015 expiration date, this deal provided DFC with money to lend and pay expenses, and a war chest to fund possible acquisitions of other companies.

Added scrutiny Gabriel Boehmer, a Wells Fargo spokesman, said the bank would not share details about the loan. “Because of the customer relationship with Money Mart, I can’t comment on that at all,” he said.

DFC spokeswoman Julie Prozeller also declined to comment on the terms of the loan.

Boehmer said Wells Fargo does “provide credit to a variety of responsible

financial services industry companies,” including some payday lenders.

The bank is “really selective” in such lending, and its “total commitments to these customers represent a small percentage of Wells Fargo’s commercial lending portfolio,” Boehmer said. “Our philosophy is that every responsible business that complies with the law has equal access to consideration for credit at Wells Fargo.”

Boehmer stressed that payday lenders and check cashers that seek loans from Wells Fargo receive “an additional level of scrutiny,” including on-site visits to review their compliance with laws and regulations and their credit health.

The due diligence occurs, he said, “because these companies are so highly regulated.” big margin A look at the terms of the revolving credit Wells Fargo provides to DFC, a Berwyn, Pennsylvania-based company that investors recently valued at about $850 million, shows why the payday lending business can be so profitable.

DFC’s credit line, which can be raised to $250 million, carries an adjustable interest rate set 4 percent above the London Interbank Offered Rate. In the current market, that means DFC pays about 5 percent interest to borrow some of the money it then lends to customers at nearly 400 percent.

Wells Fargo, in addition to being a lender, has at least a small stake in DFC’s high-margin lending operation.

A proxy statement filed by DFC before its 2010 shareholder meeting disclosed that Wells Fargo and its affiliates held 2.7 million (about 11 percent) of the shares outstanding. A filing in August

by Wells Fargo showed it had cut its ownership stake in DFC to 1.1 million shares. While that stake was recently worth about $21 million, it constitutes only a tiny sliver of the $147 billion portfolio controlled by the bank and its affiliates. Wells Fargo was not represented on DFC’s board and was no longer one of its largest shareholders, according to DFC’s 2011 proxy statement.

Boehmer said he had no comment on Wells Fargo’s ownership interest in DFC. Other banks Another large bank has provided key financial backing to San Francisco’s largest payday lender. Credit Suisse, an investment bank based in Zurich, acted as the lead underwriter for a public offering of shares in DFC. The payday lender raised $117.7 million in that transaction, according to securities filings.

Credit Suisse pocketed $6.8 million.

Credit Suisse is also the lead underwriter of a pending initial public offering of shares in Community Choice Financial Inc. The company was created in April, when Ohio payday lender CheckSmart merged with California Check Cashing Stores, which has five storefronts in San Francisco and 141 statewide.

Credit Suisse also led a group of banks that provided a $40 million line of credit to Community Choice, which will operate a chain of 433 payday loan stores that collectively posted revenue of $310 million in 2010. Community Choice hopes to raise $230 million from its initial public offering, Dow Jones Newswires reported in August.

Golden Gate Capital, a San Francisco investment management company with an office on the 39th floor of the Embarcadero Center, received a $16.7 million dividend from the April merger and will remain a major shareholder in Community Choice, according to a preliminary prospectus filed with securities regulators.

Representatives of Community Choice, Credit Suisse and Golden Gate Capital did not respond to requests for comments.

The Mission District is a locus of payday lending.

Jason Winshell // Public Press

A4 SF Public Press

Winter 2011 // sfpublicpress.org

EDUCATION JUVENILE JUSTICE

Tony Litwak, second from right, the director of the Peer Courts program in San Francisco, has recruited more than 20 students from schools across the city to work with misbehaving students and keep them in class. With him are, left to right, 11th grader Breonna Frierson, 10th grader Ramon Gomez and current City College student Lona Kwon. They met recently near San Francisco City Hall to discuss a letter of apology from a “respondent” — their term for an offender. Jason Winshell // SF Public Press

Bucking a Punitive Trend, San Francisco Lets Students Own Up to Misdeeds Instead of Getting Kicked Out of School How one big-city district cut suspensions and expulsions — and why they may rise again

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nstead of being kicked out for fighting, stealing, talking back or other disruptive behavior, public school students in San Francisco are being asked to listen to each other, write letters of apology, work out solutions with the help of parents and educators or engage in community service. All these practices fall unStory: der the umbrella Jeremy Adam of “restorative Smith // SF Public justice” — asking Press wrongdoers to // Center for make amends bePublic Integrity fore resorting to punishment.

The program launched in 2009 when the Board of Education asked schools to find alternatives to suspension and expulsion. In the previous seven years, suspensions in San Francisco spiked by 152 percent, to a total of 4,341 — mostly African Americans, who despite being one-tenth of the district made up half of suspensions and more than half of expulsions. This disparity fed larger social inequalities: two decades of national studies have found that expelled or suspended students are vastly more likely to drop out of school or end up in jail than those who face other kinds of consequences for their actions.

“My first act as a school board mem-

”

Restorative justice recognizes the crime hurts everyone — victim, offender and community — and creates an obligation to make things right.

“

Sunny Schwartz, founder of an early restorative justice program in San Francisco County Jail

ber was to push a student out of his school,” recalled Jane Kim, a former community organizer who as a member of Board of Education needed to approve all expulsions.

“That’s not what I expected to do,” she said, especially when it seemed to exacerbate the social inequalities she had pledged to fight in her position.

Board colleague Sandra Lee Fewer said, “Sixty percent of inmates in the San Francisco county jail have been students in the San Francisco public school system, and the majority of them are people of color. We just knew we had to somehow stop this schoolhouse-to-jailhouse pipeline.”

Fewer and Kim, along with colleague Kim–Shree Maufas, led the three-year process for the board to officially adopt restorative justice.

Though the task force charged with implementing the policy received only modest funding, expulsions have fallen 28 percent since its inception. Less serious cases have shown even more success. Non-mandatory referrals for expulsion (those not involving drugs, violence or sexual assault) have plunged 60 percent, and

suspensions are down by 35 percent.

Board members and many educators say restorative practices have kept students in school and out of the criminal justice system. “We’re holding kids more accountable than we did before,” said Kim, who now serves on the city’s Board of Supervisors. “In restorative justice, you have to actually have the offender and the victim sit down and discuss what happened and how the offender can make it better.”

But the data — along with interviews with parents, students and educators — reveal that progress so far is halting and uneven. Critics say that’s because the transition from punitive to restorative justice is underfunded and haphazardly evaluated. Suspensions and expulsions are actually rising in some schools that have yet to embrace restorative practices, often in low-income, high-crime neighborhoods. At one, Thurgood Marshall High School, suspensions have almost tripled since 2007. The resulting picture is a school-by-school patchwork, at best an unfinished project to reform the traditional juvenile disci-

Center for Public Integrity // publicintegrity.org

These articles were produced through a reporting collaboration between the Center for Public Integrity and the San Francisco Public Press.

pline paradigm.

One school’s quick turnaround “In the past, we defaulted to the most expedient thing,” said Kevin Kerr, principal of Balboa High School in San Francisco. “Student behavior is incorrect, student gets suspended — not really fully thinking through the process and asking whether this is a good educational decision for this particular student.”

The tide began to turn in 2009, the same year Kerr took over as Balboa’s principal. That is when the San Francisco Board of Education dissolved the district’s discipline task force and

created a new task force charged with implementing restorative justice.

“The biggest question anyone can ask in public education is, ‘Why? Why do you keep doing that?’” Kerr said. At Balboa, the policy change triggered an intense school-wide discussion among staff about how to deal with student misbehavior. Within two years, the school cut expulsions and suspensions in half as it turned from punishing misbehavior to embracing restorative practices.

Though he faces severe budget constraints and rising academic demands, Kerr concluded that restorative justice “may solve all the other problems, by creating a disciplinary policy where students feel that they always have a voice in the process, whether they committed a crime or were the victim of a crime.”

His faith in the new approach is based in part on the results documented in a growing number of school districts across the country. In 1994 the Minnesota Department of Education was the first to embrace restorative justice. At least two rigorous evaluations — one published by the department in 2001, and another this year at the University of Minnesota — found that these practices increased both the safety and academic performance of schools.

In the Bay Area, three researchers at the University of California-Berkeley’s School of Law studied the impact of restorative practices at Cole Middle School, a predominantly minority and low-income school in West Oakland. Their December 2010 study found that suspensions dropped 87 percent. Both students and teachers reported that the program made the school “more peaceful, with fewer fights among students and better behavior in the classroom, relative to earlier years.”

San Francisco’s efforts may be the most ambitious yet — and the immediate results especially promising, given the district’s deep budget cuts and the complexities of operating in one of the nation’s biggest, most diverse cities. They stem from a local culture that has already embraced restorative justice in law enforcement.

“Restorative justice recognizes the crime hurts everyone — victim, offender and community — and creates an obligation to make things right,” said Sunny Schwartz, who in 1997 founded an influential restorative justice program for violent offenders in the San Francisco County Jail, one of the first in the nation. According to an independent evaluation published in 2001, Schwartz’s program virtually eliminated in-jail violence and cut re-arrests for violence by 83 percent.

When the San Francisco Board of Education considered adopting restorative justice in the schools, it sought her expertise.

Today, Kevin Kerr has pinned to his bulletin board a list of five “restorative questions” to ask students in trouble.

The last and most important one asks, “What do you think needs to be done to make things as right as possible?”

It’s a question educators like Kerr are asking themselves as they struggle to reverse what they see as a decade of damage from punitive school policies.

Difficult in practice Only the most serious discipline cases ever reach Kerr. Day-to-day discipline is handled by his dean of students, Kathleen Rodriguez.

Rodriguez first encountered restorative justice three years ago while

working at George Washington High School, when trying to resolve a problem between a teacher and three boys who became increasingly disrespectful and defiant in class.

For help, she looked to Peer Courts, a city-funded restorative justice program that trains students to run hearings for offenders — or “respondents,” in restorative justice parlance — who have committed misconduct that ranges from chronic defiance to theft to fighting.

As coordinator Tony Litwak hastened to say, the Peer Courts do not judge guilt or innocence. Instead, he said, they try to identify who was hurt by the crime and then help respondents to make things right.

“It was quite a process,” Rodriguez said. “It took a lot of time.” Litwak and Rodriguez interviewed the teacher, talked with the boys, met with the parents and recruited a trained peer volunteer to run the hearing. The boys listened to the teacher and at the end of the process were asked to explain, in their own words, the teacher’s responsibilities and the effect of their behavior on the class. They wrote a letter of apology and performed community service with the teacher. Afterward, Litwak and Rodriguez worked with the parents to make sure the students consistently improved their behavior in class.

Other Peer Court cases are more nuanced and involve a combination of punitive and restorative approaches.

In cases of violence or theft involving multiple kids, the perpetrators most responsible might be expelled and go through the juvenile justice system, while more peripheral participants face a court of peers.

When Rodriguez went to John O’Connell Alternative High School, she integrated the program into the life of the school, which faced significant disciplinary problems. Rodriguez was once even physically attacked by a student who refused to stop talking on her cell phone during class.

The main benefit of Peer Courts, Rodriguez said, is that it helps both the volunteers who run the hearings and the kids in trouble to take responsibility for the process. “You could see the volunteers go from not so sure to being amazing, developing their leadership skills,” she said. “The magic of Peer Court is the interaction of peer leaders with the offenders, who respond to their influence and become more aware of the harm done.” This, she said, makes for better outcomes and more lasting impact than simple punishment, or even other restorative programs led by adults instead of kids.

This complex process stands in contrast to the “easy and short punitive system that’s in place now,” Litwak said. He said that students “who do enter the traditional justice system never answer to their peers and are almost always advised by their attorneys to not discuss the incident. They are also denied the ability to apologize and make amends to victims and their family members.” Part of the reason the process takes so long, he said, is that it tries to build the empathy, compassion and community to strengthen the student and the school.

“Nobody is letting anybody off the hook,” Kerr said. “Whenever we have one of these restorative justice sessions, the perpetrator inevitably walks out of the room crying. That’s not our goal, but it’s just natural.

We’re human beings, we’re going to have a sense of compassion for this story continued on following page

THE BAY AREA VIEW

Across San Francisco Region, Expulsion Rates and Attitudes Toward Punishment Vary Widely

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hile there are many aspects of culture and politics that unite the nine counties of the San Francisco Bay Area, a region of more than 7 million people, attitudes toward school discipline do not seem to be among them.

What happens to stuStory: dents when they disrupt T.J. Johnston the classroom or commit // SF Public crimes depends largely on Press // Center for where they live.

Public Integrity That is because approaches to expulsion and suspension vary widely across school districts and across the region. Over the past seven years in the Bay Area, expulsion rates range from among the very lowest in California in San Francisco County, averaging 0.07 percent, to nearly double the state average in Napa and Solano counties to the north, averaging 1.08 percent and 1 percent. San Francisco isn’t the only county that has seen recent declines.

Napa county has seen a sharp per-capita decline.

While reforms such as restorative justice appear to coincide with decreases in expulsion rates across the region in the last year or two, school administrators at the county and local level have a wide range of views on the best ways to preserve order in schools after a student has misbehaved. While some have embraced peer courts and after-school diversion programs, others have given little credence to the trend toward softer disciplinary practices taking off in places like San Francisco.

By their nature, California school districts are independent, and policies on everything from security to dress codes can differ significantly. There is no uniform approach to discipline, as borne out by statistics compiled by the California Department of Education.

The disparities among schoolchildren in low-income and minority communities have been extensively documented. Two recent studies reported that minority students were more likely to be expelled or suspended than their white peers for similar offenses. In Texas, the Council of State Governments reported that African-American students were 31 percent more likely than whites or Hispanics to be suspended or expelled under the discretionary decision-making authority of local school officials.

In North Carolina, 32 percent of black students received out-of-school suspensions for the first instance of possessing a cell phone.

Fewer than 15 percent of white students were suspended for the same offense.

Most recently, a University of California-Los Angeles study suggested that harsh penalties for misbehavior impair student achievement and offer no benefit to other students.

While schools in California have discretion in suspending students, the decision to expel them ultimately belongs to school boards.

(Cases of violence or drug use, though, fall under state laws that require zero-tolerance and removal from schools.) In 1995, the state enacted Assembly Bill 922, authorizing districts to set up community day schools, in hopes of keeping banished students out of the “school-

to-prison pipeline.”

The website kidsdata.org, a project of the Lucile Packard Foundation for Children’s Health, compiled statistics based on figures reported by counties to state education officials.

The data over the last seven years show San Francisco consistently expelling the fewest students yearly, between 13 and 77 students.

In contrast, Alameda and Contra Costa counties each ejected around 400 students per year since the 2004-05 academic year, most coming from Alameda’s Oakland Unified and Contra Costa’s West Contra Costa Unified school districts.

The leaders in the rate of expulsions over this period were Solano and Napa counties, though recently the numbers of expulsions have fallen. Each with more than 1 percent of students kicked out, these two counties flanking San Francisco Bay to the north far exceeded California’s overall rate, which hovered between 0.30 and 0.50 percent between 2005 and 2011. It wasn’t until last year that Napa’s expulsion rate fell to 0.15 percent, below the current state average of 0.35 percent.

Changing attitudes Some school boards stand out as leaders in reducing expulsion rates even as the counties where they reside struggle to find effective means to do so.

Napa County has seen the sharpest decline in the Bay Area. Reintegrating oft-disciplined students into the mainstream of the student population is the goal in Napa County schools,

said Kurt Schultz, a retired Napa High School dean who is now the district’s due process administrator.

“We’ve critically taken a look at the number of expulsions and implemented a strategic intervention,” Schultz said. “We take an overall look at interventions that re-engage students in the classroom.”

Schultz attributed the county’s previous high expulsion numbers to gang activity in the schools, mostly among Hispanic students.

Better cultural understanding and interventions against gang activity led to a significant drop in expulsions. In addition, the district collaborated with law enforcement, social service agencies and community groups to address disciplinary issues.

“All of us working together has made such a nice impact on safety in school campuses,” Schultz said.

Napa is experimenting with other methods to keep kids in school when they act out. Alternatives to expulsion include in-school suspension and having students write apology letters to the people they have wronged.

“My philosophy about discipline is when we talk to families, I have a firm belief those are real opportunities to teach students what it is to be successful young women and men,” Schultz said.

Although school districts are required to report the numbers and causes for expulsion to the state education department, information about a student’s race, ethnicity or socioeconomic status is given on a voluntary basis. A few district administrators did acknowledge

that expulsions against minorities were disproportionate — part of the national pattern.

The West Contra Costa Unified School District, with an expulsion rate of 0.49 percent last year, is working to address the underlying causes of student misbehavior. Since 2006, the district has expelled more than 100 students each year, mostly for drug-related offenses by boys from ethnic minority groups. Last year's rate also reflects a small but growing trend in female expulsions for bullying. Wendell Greer, the associate superintendent of the district’s schools, points to the bleak economy as a source of tension.

“We’re seeing the stresses of poverty, unemployment, homelessness and hunger,” Greer said. “Basic needs are not being met. You see more of this underlying current of being disenfranchised.”

But in the first two months of this school year, only three students were expelled, a significant drop from the 10 to 12 expulsions the district averaged per month last year. Greer credits such methods as restorative justice and peer mediation. Using such techniques, students get involved in the process to defuse conflicts and resolve them peacefully.

“We give them the tools to discuss the consequences of their actions,” he said.

Assessing students’ needs doesn’t necessarily stop after they are expelled. Community day schools, as required by state law, fill that role, he said: “Counseling is 90 percent of what they do in the community schools.”

eduCatiOn a5 sfpublicpress.org // Winter 2011

SF Public Press

REFORM

A Multimillion-Dollar Education Bet

Mission District schools get makeovers to improve performance

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Kevin Kerr became principal of Balboa High School in San Francisco in 2009, when the district approved a policy emphasizing “restorative justice.” In two years, his school cut suspensions and expulsions by half. Now, Kerr said, “students feel that they always have a voice in the process, whether they committed a crime or were the victim of a crime.” Monica Jensen // SF Public Press

Change in expulsion practices helps keep kids in school story coninued from page a4

person that we harmed, once we have a chance to see how our actions made them feel.”

Restorative justice is also implemented directly in classrooms, in the form of “circles” in which students talk through problems before they get out of hand.

“The teacher doesn’t yell or send anyone out of class,” said a student at Everett Middle School, one of the district’s three demonstration schools for the program. “Instead we circle up and everybody gets a say in how to fix it.” He added: “It’s boring, most of the time, but it’s better than everybody being angry. That’s how it is in my house.”

Some kids still get kicked out of school. On the week Kerr and Rodriguez were interviewed for this article, they suspended one student and referred another for expulsion — one who had previously gone through a restorative process, to no effect. The difference for Kerr and Rodriguez is that they now see punishment as the last, not the first, resort.

Every expulsion involves a serious crime, and often the expulsion process works in tandem with a legal one. Once expelled, a student might, depending on the case, be assigned to attend the Civic Center Secondary School, which handles the district's hardest cases, or to attend a courtordered school like Walden House, Woodside Learning Center or Log Cabin Ranch, most of which are operated by the Juvenile Probation Department. The worst-case scenario is that the student drops out and never comes back.

Shawn Taylor is the youth transitional services coordinator for the Seneca Center, which works with kids in court-ordered schools to help them get their lives back on track. He said he believes in “graduated sanctions” for misbehavior, but the problem is that simple expulsion can push them further away from school and towards life on the street.

“There’s no carrot for the kids,” Taylor said. “All they see is the stick.

There’s nothing for them to strive for.

Most of them have never been asked, never been taught by teachers or parents, to be a different type of person.”

Whatever its limitations, he said, restorative justice at least tries to do that.

”

If students continue to make inappropriate choices, then there’s a lot of pressure to fall back on traditional responses like expulsion.

“

Claudia anderson, executive director of student support services for san Francisco unified

dents he did in 2008.

To Lisa Schiff and Tim Lennon, the lack of financial commitment calls into question the district’s ability to deliver on the promise of restorative justice. The two are spouses and longtime leaders in Parents for Public Schools and the parent-teacher associations at the schools their two children attended.

“The trouble is that they have $600,000 to address a $10 million problem,” Lennon said.

Thanks to budget cuts, Schiff added, “There’s been no rigorous analysis to say what kind of impact this program is really having. That’s too bad, because during a time of competing resources, we want to be able to defend programs that are working or change them to be more effective. You can’t do that without good data. And unfortunately, in this case, the lack of analysis and planning means that kids are getting physically hurt,” she argued, because violent offenders are not dealt with effectively.

The district acknowledges the program’s challenges but says it has made progress in two years. In the 2010-2011 school year, it trained 823 employees, including the entire staff at three demonstration schools. This year, said Kerri Berkowitz, San Francisco Unified’s restorative practices coordinator, 35 schools have requested on-site training — something she is hard-pressed to provide.

“Our capacity right now is a challenge,” Berkowitz said. “Our team is made up of myself and a coach, and we’re hiring another full-time coach.

Plus, there’s very little time in the school day — teachers don’t have very many professional development days, and we need funding to hire substitutes so that teachers can leave their classrooms. We have some money, but it’s not enough.”

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Restorative justice is not without enemies in San Francisco. Its deadliest foe is funding. Over the past two years, San Francisco’s school district has been forced to cut $133 million from budget, leaving it with $577 million this year.

As a result, the task force charged with the transition from punitive to restorative justice was allocated $664,763, a modest amount given the size of the system and the ambitious goals of the program. To date, the task force has trained staff at fewer than one-quarter of the district’s 107 schools. In fact, neither Kerr nor most of his teachers have received any formal training in restorative techniques. Instead they have embraced the initiative on their own. A significant portion of the task force budget goes to consultants and paying for substitutes while the teachers are in training.

Budget constraints also apply to independent nonprofits that provide restorative justice services and expertise. After the Board of Education embraced restorative justice in 2009, experienced, successful programs like Peer Courts did not receive additional funds or expand. Peer Courts received $100,000 from the city this school year, which “is basically our total program budget,” Litwak said.

This year, Litwak will work with 50 students, the same number of stu-

Berkowitz has never conducted training at the 769-student Thurgood Marshall Academic High School, which could use her help. Suspensions there jumped from 115 in the 2006-2007 school year to 315 last year, while they were falling across the district.

Thurgood Marshall is located in the Bayview-Hunters Point neighborhood, where 30 percent of families make less than $10,000 a year. Homicide is the leading cause of death for children in the neighborhood, according to the Hunters Point Family social service agency. That statistic hit home when Thurgood Marshall student Andy Zeng was killed and mutilated in April. Two other neighborhood teenagers are accused.

As in many schools throughout the district, poverty and punishment go hand and hand. When Edgar Ulu, a student at Thurgood Marshall, was suspended in 2009 for fighting in the lunch line, he was taken to the principal’s office and suspended for one week. Edgar said there was no effort to discuss the incident or repair any damage done to the other student or the school — he was simply sent home.

In his case, at least, suspension worked. “I learned my lesson,” he said. That week he cut off his abundant Afro, a symbolic step intended to convey his desire to get serious about school. He graduated in 2011 and is now attending San Francisco City Col-

lege.

“Thurgood’s a good school,” said Edgar, who as a linebacker was named to the high-school All-City team. “It’s just that they don’t have a football field, they don’t have enough extracurricular activities. Kids don’t feel connected.”

Administrators at Thurgood Marshall did not respond to requests for interviews.

The Board of Education’s resolution to adopt restorative justice did not force schools to adopt the practices, though rates of expulsion and suspension are now part of how the Board evaluates the performance of principals. Instead, the resolution funded a plan to gradually introduce the concept and train the staffs over a period of many years. In the meantime, deans, principals and teachers still have wide latitude in how they deal with disciplinary issues. District officials said the idea of diverting students from punishment spreads incrementally and varies school by school, social worker by social worker.

“The challenge is that at some schools there are only pockets of belief in restorative practices,” said Claudia Anderson, executive director of Student Support Services for San Francisco Unified. She is the district’s chief expulsion officer and leader of its restorative justice efforts. “If students continue to make inappropriate choices, then there’s a lot of pressure to fall back on traditional responses like expulsion.”

Even when administrators implement restorative practices, the staff sometimes botch the process, and parents sometimes resist.

Two parents, who asked that their names not be used to protect the privacy of their middle-school daughter, said that when their daughter was attacked by two other girls in an assault they described as “life threatening,” they were “pressured” to go through a restorative process that required the girl to face the classmates who assaulted her — a terrifying prospect.

Ultimately, after requesting a more traditional disciplinary response to the attack, the family decided to leave the school, while the offenders remained. The family reported feeling victimized twice: by the attack and by the restorative process, which they said resulted in no consequences for the attackers.

“In restorative justice, the total focus is on re-integrating the perpetrator,” said the father. “But too often it comes at the expense of the victim.”

The district’s Claudia Anderson is not daunted. “There’s always going to be criticism,” she said. “For a decade we went through this zero-tolerance era. And quite frankly it didn’t work.

It didn’t make one bit of difference.”

The results so far suggest that the San Francisco experiment, while just getting started, could bear fruit if given the resources and time the staff need to develop it.

These conversations are happening all across the country. Nancy Riestenberg has coordinated restorative justice efforts in Minnesota public schools since 1994, which gives her a long-term perspective on the challenges facing San Francisco teachers and administrators as they ramp up the program.

“The research said that it takes three to five years to implement anything in schools,” Riestenberg said.

“So everyone in San Francisco should take a deep breath and proceed as calmly as they can. You’re building a new system because the old system wasn’t working. And that’s to be applauded.”

Jeremy Adam Smith is author of “The Daddy Shift,” is co-editor of “Rad Dad: Dispatches from the Frontiers of Fatherhood” and was a 2010-2011 John S. Knight Journalism fellow at Stanford University.

hen some students in the Mission District arrived at school this fall, they may have noticed a few changes — new equipment, new after-school programs, and new faces among tutors and teaching coaches.

It’s all part of a multimillion dollar challenge: Can grants that average $1.6 million a year, for three years, vastly improve the education and outcomes at six struggling district schools?

The setup for the wager began in 2009, when the state announced a Story: lisette Mejia list of more than 100 low-perform// Mission Local ing schools and demanded change.

The lure from the federal government: cash with a catch.

To get the Student Improvement Grant money, the districts had to agree to close schools, turn them into charter schools or opt for one of two options: a turnaround or transformation model.

A turnaround model meant replacing the principal, evaluating the staff and rehiring no more than half the teachers. With the transformation model, principals who had been in place for less than two years could remain.

In both situations, the plan was to improve the school through such strategies as comprehensive curriculum reform, professional development and extending learning time.

The demands were not always constructive, said Guadalupe Guerrero, assistant superintendent for the school district’s Mission Zone. ”It was certainly destructive in a lot of communities that were forced to make decisions about getting rid of teachers and, in some cases, principals.”

In the Mission, four schools underwent the transformation model, two the more drastic turnaround model.

The district made changes as well. San Francisco established one special superintendent zone to oversee the district’s 15 worst schools. (One of the schools, Willie L. Brown Jr. College Preparatory Academy in the Bayview, has since closed, bringing the number to 14.)

This zone was divided into two area teams: One in the Mission, which operates out of Mission High School and is run by Guerrero, and the Bayview Zone, led by Assistant Superintendent Patricia Gray, which operates out of the Metropolitan Arts and Technology High School in the Bayview.

The Mission Zone includes six schools: Bryant Elementary, Cesar Chavez Elementary, Everett Middle School, Horace Mann (now Buena Vista Horace Mann K-8), John O’Connell High School of Technology and Mission High.

Guerrero also supervises John Muir Elementary in the Western Addition and Leonard R. Flynn Elementary in Bernal Heights, because they too are classified as underperforming schools, even though Flynn receives no grant money.

The Bayview Zone includes five schools in that district: Bret Harte Elementary, Dr. Charles Drew Elementary, Dr. George Washington Carver Elementary, Malcolm X Elementary and Thurgood Marshall Academic High. Paul Revere College Preparatory School K-8, another under Gray’s supervision, is in Bernal Heights. Of these, only Dr. George Washington Carver and Paul Revere are receiving the grant.

Mission local // missionlocal.org

The first distribution of the award money was given midway through last school year and, if progress is made, two more waves of money will arrive over the next two years: the second this December and the third in December of 2012.

The framework for the Mission’s overhaul is based on a strategic plan of five factors, including improving family and community ties, professional capacity and instructional guidance and coherence.

“A few key elements needed to be focused on — for example, paying attention to leadership, how you create school communities where teacher leadership is supported and cultivated,” said Guerrero. “It’s no surprise that with failing schools, sometimes they don’t have a clear academic agenda.”

The solution was to integrate a common core curriculum, using national and state standards for what students should know and be able to do. This will provide a set of guidelines to teachers who lacked instructional direction.

The district’s application for the grant money promised “intensive coaching in data-driven instructional planning.”

As for family and community involvement, the district said that schools were committed, but lacked the resources to follow through.

Part of the solution: Hiring community school coordinators for each school to act as liaisons between the community, including parents, and schools.

The position entails arranging partnerships with the city’s community-based organizations to provide services to students and their families, coordinating school “climate” surveys, and convening an advisory committee of partners and community members to provide input on school support services.

For Guerrero, these issues aren’t new. “Some of these schools have received quite a bit of money in the past that hasn’t been used effectively.”

So what will be different this time around?

An area team observing every investment made by the schools, said Guerrero. Principals who want to take the same approach in their leadership, such as hiring instructional coaches.

“When you move as a cohort in a tight, similar fashion, you can make your dollars go a lot farther, and that’s more impactful. We know we have to provide immediate relief right now, but it’s also about the long term.”

Part of that will come through reform plans across the seven schools, including federal monitoring visits, coming up with strategies to address truancy, providing mental health services for students and partnering with professional development services for teacher training in literacy, math and dual immersion.

“I think this year is going to be our year when we see the biggest dent in those achievement gaps,” said Guerrero.

INNOVATION

Stanford’s Institute of Design: School for World Changers

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his school doesn’t really have classrooms. In fact, Stanford University’s Institute of Design in California isn’t really a “school,” jokes Jim Patell. Instead of classrooms, there are clusters of discussion and activity. Instead of blackboards, its walls come covStory: esha Chabbra ered in massive // Christian sheets of white Science Monitor paper, design sketches, and countless PostIt notes. Instead of relying on final exams alone, the program measures success by how its students improve lives in the developing world.

Stanford’s Institute of Design, more commonly referred to as d.school, specializes in pooling students from all different areas of study. Here, public-policy wonks mix with computer scientists, engineers, and medical students. Despite its quirks, or rather because of them, students compete for seats in d.school classes — compete for a chance to step outside academia and start changing the real world.

“There’s a lot of brilliant students at Stanford,” says Sunny Jeon, a Ph.D. candidate at the university. “So, when you put them all together in a class that pushes them to innovate and develop practical solutions to the world’s problems, you get some really interesting ideas and feel like your work can make a difference in somebody’s life.”

Jeon recently returned from Kenya, where he worked on his d.school project before the new semester begins this month.

He’s developing a crowdsourcing system with two classmates — policy-focused Katharine Hoffman and computer scientist Anuraag Chigurupati — that will enable people in Kibera to locate clean sources of water using mobile phones.

The school identifies problems and solutions by examining the intersection of human values, technology, and business. Jeon’s project reflects this approach: a community focus, looking at underserved areas, taking advantage of mobile phones (the most common computer in many parts of the world), and aiming for low-cost solutions.

Patell drills that last point home in his “Entrepreneurial Design for

Extreme Affordability” class, one of d.school’s original courses. This year, he’s had 90 applicants competing for 40 spots. Patell, one of the institute’s seven cofounders, has been teaching students how to build products for underserved markets for eight years.

In the process, students have traveled to Ethiopia, Cambodia, Indonesia, Nepal and Rwanda for research and development.

Such explorations have led to products like a low-cost infant warmer to decrease the number of newborn deaths, solar devices for the poor in rural India and Africa, and irrigation systems for small-plot farmers.

To find the right blend of students each year, Patell says he selects candidates with the skills to tackle that year's focus — be it agriculture, health, or environmental technology. But the most important attribute, he says, is a “strong desire to make things.”

Patell doesn’t just look for the right students, but also the right partners outside Stanford. “Eventually, we work hard because we become so attached to our partners,” he says. “We very much want them to succeed.”

Nonprofit entrepreneurs Jim Taylor and Debbie Aung Din, in particular, have become popular collaborators for the students in Patell's course. The husband-wife team runs Proximity Designs, which works with rural Burmese farmers.

Patell's students have designed several products for the organization, such as low-cost, tripod irrigation pumps in 2006. When the pump launched in Myanmar (Burma), Proximity sold nearly 5,000 pumps in the first six months. That success led to future collaborations.

And now, when Taylor and Din visit the Bay Area, they regularly stay with Patell and discuss upcoming projects with his students.

Bringing together students with nonprofit collaborators, says Stanford political science professor Joshua Cohen, is what helps his classroom thrive. Even though these students are crafting prototypes for business, many of them do not have a business background. Rather, the emphasis is on “empathy-driven” research, requiring students to understand the individuals they’re design-

// csmonitor.com

ing for.

Cohen, who teaches “Designing Liberation Techniques” with computer science professor Terry Winograd, works closely with students to develop mobile-based solutions.

Their latest project, M-Maji, is what sent Jeon to Kenya. He and his fellow students worked with the Nokia Africa Research Center; the University of Nairobi’s computer science department; and the Umande Trust, a nonprofit addressing water and sanitation issues in Kenya.

Working in small, interdisciplinary teams, students designed mobile-based programs similar to MMaji in an intensive 10-week course led by Cohen and Dr. Winograd this past school year.

The result: six different ideas, ranging from a text-message-based system for prenatal care to digitizing data collected by health workers in Kenya.

But putting these ideas on paper isn’t enough. Cohen emphasizes that the course is about “trying, not talking.”

Teaching frugal innovation is not limited to the d.school. Silicon Valley’s startup spirit has created similar courses at nearby Santa Clara University and University of California-Berkeley.

Tapan Parikh, a professor at UCBerkeley’s School of Information, has been teaching an interdisciplinary course on information communication technology for social enterprise for the past two years.

He attributes the emergence of these workshop-style courses to a growing interest in new markets, fresh technologies, and a blending of the two with a social mission.

“There’s definitely more demand than the course can afford,” says Parikh. “But, yes, this is definitely associated with the growing interest in social enterprise. What students are realizing is that they can work full time on work that’s fulfilling, socially rewarding, and aligned with their values. And they can do it in firms and with job titles and salaries that are very comparable to their peers’.”

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Winter 2011 // sfpublicpress.org

CIVICS HUMAN TRAFFICKING

Q&A: SEX SLAVERY

A Global Nightmare in Our Own Backyard

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n estimated 30 million people or more worldwide live as slaves today — working against their will for someone else. And every year, some 17,500 are trafficked into the United States. Many of these people don’t have allies, but here in the Bay Area, there’s one non-profit that’s standing with them.

Not For Sale has a self-described simple and collective challenge: “Stand with those who are enslaved, work together to free them, and empower them in their freedom to break the cycle of vulnerInterview: ability.”

Ben Trefny // KALW President and co-founder David Batstone spoke with KALW’s Ben Trefny about the organization’s work.

BEN TREFNY: David, share a story of something you’ve seen while investigating sex slavery.

Capt. Antonio Parra, commander of the Special Victims Unit (left), appeared in October with Police Chief Greg Suhr (at podium), Mayor Edwin Lee (right) and other officials at the opening of the reorganized Special Victims Unit at its new location on the fifth floor of the San Francisco Hall of Justice. Jason Winshell // Public Press

After Anti-Trafficking Team Shifted Focus to Prostitution Arrests, Police Retool Investigations Special victims unit to take a new victim-centered approach to human rights violations

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he little-noticed use of San Francisco’s human trafficking task force to arrest street prostitutes over the summer underscores a sharp nationwide debate on how local law enforcement can help rescue victims of economic and sexual slavery.

Until October, the city’s anti-trafficking team operated out of the San Francisco Police Department’s vice crimes unit.

With the help of a federal-state grant, the team racked up more than 15 investigations of suspected traffickers. But in the spring it altered its tactics, making large-scale arrests of dozens of prostitutes in the Polk Gulch neighborhood, in response to complaints from neighbors.

While 60 percent of the prostitutes Story: were “assessed” for evidence of human Jason Winshell // Public Press trafficking, according to arrest reports, the operations otherwise looked like typical street sweeps in problem areas leading to misdemeanor charges, said experts inside and out of the department.

One victim was identified and referred to a social service agency, while several suspected victims did not come forward, and were booked.

The vice crimes unit’s tactics have vacillated in the last year as high turnover of anti-trafficking team leadership slowed investigative progress. Last April, less than a year into the grant, the department told the state it would prefer to use the money to perform “aggressive street enforcement of a more general nature.”

The original grant, federal funds awarded by the California Emergency Management Agency, was initially intended for undercover human trafficking investigations and permit inquiries into suspect businesses.

But in an email correspondence and phone conversations, the state grant administrator quickly approved the change.

Then, in May and June, the police conducted a sweep of at least 41 prostitutes.

In October the department announced it was shifting the human trafficking work to a newly overhauled special victims unit. Police officials repeatedly said the new office, which is to include more than 50 investigators, at least three of whom will specialize in human trafficking, would put renewed focus in that area.

The reorganization came just before the department was to hear whether the San Francisco police and a local victim service provider, Asian Pacific Islander Legal Outreach, would each receive federal grants totaling $500,000 over two years from the Bureau of Justice Assistance and Office of Victims of Crime.

But the move did not come in time. The San Francisco Police Department was not awarded the grant. Instead it was awarded on Oct. 1 to the San Jose Police Department. The primary reason given for the denial was insufficient description of how the police would work with their nonprofit partner.

Although grant evaluators considered the department’s proposal comprehensive, one wrote that the human trafficking investigations were run out the vice crimes unit at the time that the application was filed.

This runs counter to a recent federal directive requiring that future grants no longer be run out of vice units — and that they pay equal attention to the wider problem of labor trafficking beyond cases of sexual exploitation.

Victim centered Some criminal justice experts say San Francisco’s recent approach of finding victims through arrests runs counter to rescue and support for victims and catching traffickers.

”

If your objective is to primarily identify human trafficking victims and address their needs, contacting them through the arrest

“

process is the least effective way of doing it.

Sgt. Arlin Vanderbilt

Identifying human trafficking victims by arresting street prostitutes “just drives them underground,” said Dina Haynes, a professor at New England Law in Boston. Haynes, who does yearly human trafficking training for more than 5,000 members of the Department of Justice and Homeland Security, also said that victims who are undocumented immigrants risk deportation by talking to police.

U.S. officials also warn against looking for victims of sex trafficking through arrests. The federal government’s human trafficking training materials for local enforcement warn that “victims will have been coached to anticipate the arrival of attorneys, and their cooperation with law enforcement may be delayed or nonexistent. In other instances, trafficker accomplices who are known to the victim may be posing as victims.”

The San Francisco Police Department’s own human trafficking expert, Sgt. Arlin Vanderbilt, said he thought the operation had not been the best use of department resources.

“If your objective is to primarily identify human trafficking victims and address their needs, contacting them through the arrest process is the least effective way of doing it,” Vanderbilt said. “It’s counterproductive.”

Vanderbilt was the lead investigator on the team at the time of the prostitution sweep. He said he transferred to other duties in the department over concerns about the change in the anti-trafficking team’s approach.

“I wasn’t happy with the direction that the vice crimes unit was going,” he said. “I didn’t feel that there was a strong enough support for investigations.”

Change in state grant Capt. Antonio Parra, commander of the newly reconstituted special victims unit, defended the use of state Emergency Management Agency grant funds for the sweeps on and around Polk Street. Staff racked up more than 350 hours of overtime to conduct at least nine sweeps between mid-May and the end of June, according to a quarterly report to state officials. Based on billable overtime rates in the original grant request, this would total more than $29,700.

“This change in direction and enforcement to the street level was proposed to Cal EMA and it was approved through the proper process,” he said.

Tina Walker, a spokeswoman for the agency, said the Police Department’s use of funds was consistent with the spirit of the grant. She said local law enforcement has the discretion to use funds to address changing local needs.

San Francisco Police Lt. Jason Fox, now leader of the human trafficking task force, concurred with Vanderbilt that finding human trafficking victims by arresting them was ineffective, but with qualifications: “I think on its face I agree with him. But it certainly has its place. It certainly is an instrument in which we can contact potential victims through the arrest procedures as they commit crimes or as they are being victimized.”

Beyond sex cases The vice crimes unit made some progress in sex trafficking cases using the state grant. In 2010 it referred nine sex trafficking cases to the District Attorney’s Office for prosecution.

One suspected trafficker was criminally charged. In the first quarter of this year, six cases have been referred to prosecutors, and three have been charged.

Most of these cases involved investigating sex trafficking.

Cindy Liou, staff attorney Asian Pacific Islander Legal Outreach, the leading local service provider for trafficking victims, said the problem of human trafficking, however, is even bigger than sex abuse, and so far the police have made little progress in this area.

“The vast majority of our cases in the last three years have been labor cases,” she said.

As of mid-September the police had not referred any labor trafficking cases to the District Attorney’s Office during the calendar year.

Police Chief Greg Suhr said he now wants the department to move beyond sex trafficking and prostitution investigations.

Fox explained the rationale: “Prostitution is a very highprofile part of human trafficking. It’s one that’s very tangible. People understand sex and all of that plays into it. It’s a lot bigger than that. And the chief wants our enforcement to be a lot bigger than that.”

Federal changes This year, federal authorities are working to get local law enforcement agencies to abandon their practice of using vice crimes units to address human trafficking. Haynes and Homeland Security Investigations officials both said officers with sex crimes training may lack the expertise to recognize and investigate other human rights violations, including labor trafficking.

Since 2004 the federal Bureau of Justice Assistance and the Office of Victims of Crime have funded 42 human trafficking task forces within law enforcement agencies.

Last year the Bureau of Justice Assistance undertook a comprehensive review of the grant process, looking at past performance and comments from law enforcement and victimsupport nonprofits.

The review led to the creation of a new “Enhanced Collaborative Model to Combat Human Trafficking,” which requires funded agencies collaborate with federal agencies and focus on both sex and labor trafficking.

Although the police department will not be able to count on the Bureau of Justice Assistance grant, human trafficking will remain a priority.

“We don’t need this money to do the right thing,” Fox said.

“The chief is going to reprioritize how he spends the money.

His management priorities are to make sure that human trafficking is staffed to the level that he believes is sufficient to raise awareness, combat the problem, and help the prosecutions.”

Vanderbilt said the department will move forward with intensive human trafficking investigations and abandon its past emphasis on unproductive enforcement activities such as arresting pimps and prostitutes.

He said that for the remainder of the California Emergency Management grant, which expires in September 2012, human trafficking investigations will take a victim-centered approach and adhere to the spirt of the department’s original grant proposal.

DAVID BATSTONE: One of the most startling early experiences I had was to visit undercover in Cambodia, in Phnom Penh, a group of young girls who were in a situation that they couldn’t get out of. They were young, 11- and 12-year-old girls. I had gone to Phnom Penh to explore, really to investigate: How does trafficking happen? This was very early on in my experience.

Even in Cambodia to traffic or to sell a young 11- or 12-year-old girl is something that might get you in trouble. Sell an older woman, older meaning 18 or 19 years old, and no one cares. But 11 or 12, you still might get in trouble.

So the contact took us up the back stairs and we went inside a second story living room. In there were about 15 girls of this age, 11 or 12 years old. I was pretending to be a “John,” someone who was there looking for young girls to buy.

I was with an Australian intelligence officer who fortunately was much more experienced than I was. He had a cool demeanor, pretended to play David Batstone the part, whereas as soon as I saw these little girls and they were told to flirt with me … oh my gosh, I lost my cool, I lost my demeanor. But I struggled along, got through it, and we were offered to buy two young girls each. I think it was about $12.

So I remember seeing those girls, looking at them, and walking out that night. Our exit plan was we’d come back later (we had a hidden camera; we got all this on camera), but it took another three months to close that place down. But I remember not being able to sleep for a week, just thinking about those young girls and what they were going through each night.

TREFNY: So 11- and 12-year-old girls in Cambodia; 15- and 16-year-old girls in Oakland. The sex trade is a very dark, mysterious industry.

How much of that is the result of human trafficking? How many people do you think are involved in that against their own will?

BATSTONE: I would say inside the United States we probably have between 150,000 and 200,000 people living in sex slavery.

The average age of a girl who goes into what we call prostitution is 13 to 14 years old.

Here in Oakland, young girls every day are being brought into the sex trade and they can’t get out. This is the distinction: Maybe they were convinced, because of money or some short-term opportunity, that if they sold their body it wouldn’t be so bad. But you’ll notice that these young girls have someone managing them, a pimp, who won’t let them leave and will use violence against them. This is really a problem.

When I drive down International Boulevard in Oakland, and I see a group of 14- or 15-yearold girls, I think, “Terrible! How can they make those choices? How could they ever put themselves in that situation?”

What we often don’t see is 100 yards away there will be someone, usually a man, controlling them, managing them, and not letting them leave. This really is the story of human trafficking.

TREFNY: These girls who are on the streets of Oakland, a lot of whom come from disadvantaged backgrounds, see the opportunity for quick money and then they get stuck in it because of whoever’s running the show for them. They’re obviously Americans. Is there a much larger trade of international people coming into the country who are part of the sex trade than people who are born in the U.S.?

BATSTONE: Yeah, very much so. You have regions. In, say, Oakland, mostly East Oakland, West Oakland, and then up to Vallejo in the East Bay, you have a lot of local, domestic girls who are trafficked, U.S.-based.

A lot of what people think of when they think of sex trafficking is the movie “Taken” with Liam Neeson. That is less dramatic.

Usually you don’t have someone going into a home and kidnapping a young girl. That still happens, but it’s rare. It’s more likely that someone is drawn into it and can’t leave. In all of the thousands of interviews I’ve done with trafficking survivors and my relationships with them, in almost every case, someone in a uniform was contributing to their trafficking.

CIVICS

sfpublicpress.org // Winter 2011 MUNI REFORM

Transit Effectiveness Was Focus Of Mayoral Candidates — Now What?

Work-rule changes, bus stop, consolidation, rapid buses

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f there was consensus among San Francisco mayoral candidates this fall on improving Muni service and reliability, it was that the city should fully implement its long-term, long-delayed blueprint for overhauling the transit system.

The Transit Effectiveness Project sees the transformation of part of Muni into a “bus rapid transit” Story: network — a kind of Jerold Chinn rail system on tires. // Public Press Other recommendations include eliminating bus stops and consolidating lines to make Muni run faster and more reliably.

The project also would change city streets to make is easier for buses to maneuver and passengers to quickly board vehicles.

The recommendations made their debut in 2008 at San Francisco State University by then-Mayor Gavin Newsom and then-Muni chief Nathaniel Ford. Newsom said “drastic changes” were necessary for Muni to improve its perennially dismal on-time performance.

That was three years ago, and the project is far from being fully implemented, though some recommendations such as the elimination of bus stops have taken effect on some of Muni’s worst-performing lines. The project as a whole is still in the environmental review phase. The total price tag is estimated at $167 million.

Muni’s parent department, the San Francisco Municipal Transportation Agency, is pondering ways to increase revenues — from fare hikes to more parking meters to a parcel tax — to help fund the cash-strapped agency.

ONLINE HIGHLIGHTS: Many of San Francisco’s mayoral candidates this fall said in video interviews with the Public Press that the project needs to be fully implemented as soon as possible.  View the video

interviews online @ sfpr.es/mayor-muni

ON THE RECORD: Mayor Ed Lee’s campaign spokesman Tony Winnicker told San Francisco Streetsblog that ”in the next four years, Mayor Lee will partner with Ed Reiskin and the San Francisco Municipal Transportation Agency to boost Muni’s ontime performance and run it more efficiently with work rule reforms, new technologies and our Transit Effectiveness Project.”

David Chiu: ”I am a big believer in many aspects of the research we’ve known about and what we need to do to change Muni. Whether it be consolidating the number of bus stops we have ... in fact in my city block that I happen live in, I’ve got two bus stops. While that may be immediately convenient for folks like me, I think for the reliability and speed of the system we have to consolidate some of our bus stops.”

Bevan Dufty: ”We really have to move thoughtfully and really engage people. I was on the Board of Supervisors when there was an effort to eliminate some Geary stops in the downtown area. You can’t focus on that area.

There are a lot of people who are very frail and fragile that live in that area that can get to that stop, but maybe feel as though they can’t to the stop further away. So whatever we do, we have to balance ... but I definitely want to see TEP move forward.”

Terry Baum: ”There are so many little changes that can be made. There’s the Transit Effectiveness Project ... and all those proposals need to be taken forward ... both all-door loading and timed traffic lights. Those are a whole group of things that can be done right now.”

Dennis Herrera: ”I think it’s kind of telling in that on the campaign trail when you listen to what other candidates have to say, everybody is talking about the importance of implementing the Transit Effectiveness plan. So there is a certain consensus forming on the importance of implementing the strategic plan that was done on behalf of Muni.”

This multimedia project was supported by donations online from readers via Spot.Us

Q&A: CAMPAIGN FINANCE

A

What Will It Take to Limit the Role of Money in Politics?

City Ignores Illegal In-Law Apartments weekend drive through parts of Visitacion Valley is akin to a tourist visit to crazy parking land: double-parked cars and vehicles left in the median or on sidewalks. The parking mayhem may be partially the result of a steady expansion in the number of “secondary units” — in-law apartments — in southside San Francisco.

In-laws are built into basements and over garages as Story: rental additions that have Katrina Schwartz // The Potrero separate entrances. Many View of them are illegal, either via Neighorhood because they are located Newspaper on blocks zoned for singleAssociation family homes or do not meet building code requirements. In wealthier communities — Dogpatch and Potrero Hill — these units are now often left vacant or deployed as vacation rentals. In Bayview, Portola, Visitacion Valley and elsewhere, they are used to house large extended families or leased to strangers.

Some affordable housing advocates believe that this underground market provides a critical source of affordable housing in a pricey city and generates extra income for hard-pressed families to stay in their homes or avoid foreclosure. Southside San Francisco — particularly Districts 9 and 10 — have the highest foreclosure rates in the city.

The San Francisco Planning Department has not conducted a comprehensive census of illegal in-laws. A 1996 report — issued by the San Francisco Planning and Urban Research Association — estimated that there were 25,000 illegal in-law apartments in the city. Based on San Francisco Tenants Union estimates, rentals house 2.1 people per unit on average, which means 50,000 San Francisans may be living in illegal in-law apartments. Those apartments are still subject to rent control. According to the Tenants Union, secondary units may represent more than one out of every 10 rent-controlled units in the City.

While the illegal units may pose hazards to occupants, including inadequate fire exits, lack of ventilation or windows and code-busting plumbing and electrical service, they provide affordable housing in an expensive city. This dichotomy has led to what SPUR calls a “don’t ask, don’t tell attitude” towards in-law apartments.

These units are “definitely hard to track,” said Bill Strawn, Department of Building Inspections legislative and public affairs manager.

The only way the city knows about them is if a neighbor calls in a complaint, triggering an inspector to stumble across an illegal unit. Or, after a property is sold, if the new owner brings in inspectors to sign off on renovation work.

Thousands of San Francisco properties with rental units attached to them have been underassessed, likely resulting in the loss of millions of dollars in tax revenue for the city. On the oth-

er hand, the city and private developers invest tens of millions of dollars subsidizing affordable housing, the demand for which could grow without the availability of in-law units.

There have been various attempts to legalize in-law apartments and foster their development over the years. In the late-1990s, then-Supervisor Tom Ammiano advocated for full amnesty for inlaw apartments that didn’t comply with zoning codes. In 2002, then-Supervisor Aaron Peskin worked on legislation to allow zoning variances near transit hubs to encourage creation of secondary units. None of these initiatives was even granted a legislative hearing because of strong opposition by neighborhood groups, particularly those in the city’s western districts.

“We have an Eisenhower-era planning code with a ‘Leave It to Beaver’ idea of housing. But now it may be time to move on from that,” said Tom Radulovich, executive director of Livable City, a planning advocacy group.

Much of San Francisco is zoned for RH-1, which means single-family homes. Livable City argues that this type of zoning isn’t a good use of space, especially if public transit is nearby.

The Asian Law Caucus, a legal and civil rights organization, has been conducting a housing survey, including gathering data on in-law apartments in the Excelsior and Ingleside neighborhoods. The initial surveys of 234 single-family homes found that almost 40 percent had an inlaw apartment. Seventy percent of the surveyed renters took public transit to school or work. All of the surveyed homeowners who had in-law apartments said that they relied on the rent to help pay their mortgage.

“Tenants groups have had mixed feelings about legalizing in-law units. We want tenants to have legal recourse, but these units are more affordable,” said Ted Gullicksen, the Tenants Union’s director.

If a tenant reports landlord abuse in an illegal unit they risk losing their home. If a unit doesn’t have heat, for example, a complaint to DBI could trigger condemnation of the unit, though the renter could petition the San Francisco Rent Board for a rent reduction.

According to Gullicksen, while it might seem like a situation rife with abuse, an overall balance is maintained because the renter has something on the landlord as well.

If a renter is unfairly evicted or leaves disgruntled, she can report the illegal unit; an incentive for both parties to get along.

Some housing advocates have pressed the city to grant building and zoning code amnesty to existing secondary units as long as they don’t pose egregious health and safety violations.

However, the Coalition of San Francisco Neighborhoods has opposed such policies, chiefly because of concerns about parking congestion.

In the meantime, the number of illegal units in the city steadily grows.

Social Justice Groups Engage Occupy Movement Local nonprofits defend legal rights, encourage conversation and give in-kind donations

S

Christopher D. Cook // Public Press

SF Public Press

HOUSING

ORGANIZING

BEHIND-THE-SCENES PROTESTS: Activists in the Occupy movement are picketing and camping outdoors every day. But they are also finding support from local social justice nonprofit organizations.

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ocial justice organizations in the Bay Area are joining forces with the Occupy movements in Oakland and San Francisco.

Local nonprofits that have been advocating for the eradication of economic inequities in various sectors of society for years are finding that the Occupy movements are presenting Story: a unique opening to engage Ambika in dialogue across socioecoKandasamy // New America nomic lines on the wideMedia spread wealth disparity in the country.

“Organizations like ours that have been doing basebuilding work and community organizing work have a lot in common with those protestors,” said María Poblet, executive director of Causa Justa, which works to promote low-income tenants’ rights in Oakland and San Francisco.

“In fact, some of us are those protestors,” she added. “So there’s a great opportunity there to get even more concrete on what we’re asking for and use our collective strength to win some gains for our community, ’cause we want both to build a long-term movement and transform our society.”

Poblet said her organization was one of those behind the Nov. 2 general strike in Oakland. The relationship forming between the Occupiers and community groups, however, seems to be symbiotic.

Poblet said members of Occupy Oakland and Occupy San Francisco have supported Causa Justa’s 3-year-old campaign against Wells Fargo.

“We found a lot of the protestors have joined us in demanding from Wells Fargo a few key things,” she said. Those key demands on Wells Fargo, she added, include a moratorium on foreclosures, reinvestment in poor communities and an end to predatory lending practices including payday loans.

Community-based organizations are also participating in the Occupy movements by defending the First Amendment rights of the movement’s members.

“There was a police raid about two weeks ago and we saw that as a threat to First Amendment speech, so we actually came out with a strong statement in support of the encampment,” said Timmy Lu, an operations coordinator for Asian Pacific Environmental Network, a nonprofit in Oakland that advocates for environmental justice in low-income communities.

Lu, who has been involved with the organization’s participation in Occupy Oakland, said that staff from his organization has been going to the streets to support the encampment and the marches.

“We’ve also been involved with working with other community organizations in the Oakland area, particularly with our labor and faith al-

lies as well in trying to create more dialogue between these groups and the Occupy encampment and then also making statements in support of the encampment through City Council,” Lu said.

Some organizations, like the Chinese Progressive Association, which works for low-income immigrants’ rights in San Francisco, are reaching out to their own members to raise awareness about the Occupy movement by integrating it in their advocacy work.

“We actually already have ongoing work on the very things that Occupy is touching on.

We just finished a six-week phone bank project where we were identifying Chinese immigrant voters who were supportive of a millionaire’s tax, and this is something we’ve planned a while back to prepare for next year’s elections,” said Shaw San Liu, a lead organizer at the Chinese Progressive Association in San Francisco.

Shaw said her association developed fliers explaining how Chinese immigrants are part of the 99 percent and hosted an event in Portsmouth Square in San Francisco a few weeks ago called “We are the 99 percent — from Wall Street to Chinatown” with street theater performances and speakers from Occupy San Francisco.

The involvement of civil and economic rights groups transcends solidarity support — certain organizations are providing in-kind donations to the protestors.

“Whenever we have an event and there’s extra food, we’ll take it down to the Occupy Oakland,” said Jakada Imani, executive director of the Ella Baker Center for Human Rights in Oakland. “One of the issues is that they can’t cook out there and there’s also not a lot of food all the time, so we want to make sure that they had food.”

Imani said that staff at the Ella Baker Center has also been taking part in the general assembly in Oakland.

Although various local organizations have been offering support to the members of Occupy encampments and finding support from them, their leaders point out that their organizations are constituents in a larger movement impacting not just the communities they serve, but also everyone suffering from fiscal inequalities.

“Movements are bigger than organizations, and they are bigger than individuals,” said Imani.

“So there are organizations participating in Oakland, San Francisco, New York, Atlanta, Colorado, but it’s not about those organizations.

You’re not hearing their names. There are labor unions involved in this process and you’re not hearing their names — it’s not local X, Y and Z — because that’s actually not what’s important,” he said. “What’s important is the broader message and the broader work.”

T

he corrupting role of big money in political campaigns is the subject of a new book by Lawrence Lessig, a professor of law and director of the Edmond J. Safra Center for Ethics at Harvard. To discuss the path toward ending the influence of money in Congress, Rose Aguilar, host of the daily call-in show “Your Call,” sat down with Lessig to discuss the book, “ReInterview: public, Lost: How Rose Aguilar Money Corrupts // ”Your Call” Congress — and KALW Public a Plan to Stop It.” Radio This is an edited transcript.

Lessig: There are two separate issues.

One is, what would the right system look like? The second is how do we build a political movement?

Congress is responsive to the funders of their campaigns because they spend 30 to 60 percent of their time raising money for their campaigns. The solution is to make sure that when they’re being responsive to funders, the funders are not a tiny selection of America but instead are all of us.

The way to do that is to set up a system of funding campaigns where we, the people, are the funders.

That’s the easy problem. The hard problem is, if you know this is the answer, what could we possibly do to get the political will to bring it about?

The key change we need is to publicly fund public elections. The second set of changes we need are ways to make sure independent expenditures don’t dominate the political process. Then we could have an order to this problem that could bring about some effective solutions.

The one issue that 99 percent of us could actually agree about is the corruptive, corrosive influence of money in politics. You may or may not believe in capitalism. Nobody in America believes in crony capitalism. We’ve got to think about the change that could make it possible for democracy to regain the trust of Americans — not the change that we on the left want versus the change that people on the right want.

If we could, tomorrow, pass a constitutional amendment, what should it have?

One, it should mandate publicly funded public elections.

Two, it should limit contributions to any campaign to a very small amount — $100. It’s good to have people giving money into campaigns; it gets them committed. But it should just be at a number where nobody could ever wonder whether the money is driving a result.

Three, Congress should have the power to limit, but not to ban, the independent expenditures by corporations or individuals or anybody.

But Congress is not going to give us either of the first two without a very strong grassroots fight. A large number of them believe that their future is as a lobbyist, and they’re going to make all this money as a lobbyist. If all you do is convince people the system is deeply influenced by money, most people will then say, “There’s no reason for me to hang around in this system, because the system is not something that listens to me.”

Aguilar: How do you feel that these publicly funded campaigns are playing out at the state level? So far, they’ve been passed in Arizona, Maine and Connecticut.

Lessig: I think people in those states are extraordinarily happy, not necessarily with who gets elected, but because it’s democracy. You see different kinds of people who are able to run, because they don’t have to run the gauntlet of fundraising in order to be a credible candidate.

That’s the kind of change we need to see at the federal level.

It’s important to make sure we have a change that isn’t just an incumbent protection act. Though incumbency is not erased as an advantage, it’s a much weaker advantage than it was before each of those states implemented those changes.

Aguilar: Let’s tackle this issue of bridging the Tea Party and the Occupy movement.

Lessig: If the movement is ever going to have anything more than a passing significance, it’s got to find a way to bridge the gap between the 21 percent of Americans who call themselves liberal and the 41 percent who call themselves conservative.

You should invite Tea Party supporters to the Occupy protests and sit down and talk to them. They have many of the same concerns that we on the left do.

A8 SF Public Press

CIVICS Winter 2011 // sfpublicpress.org Q&A: THE CAMPERS

Occupy SF: In Their Own Words

Q

uestions abound over what the demands, goals and ethos of the Occupy movement are.

Among those directly involved there is an understanding that there is no one unifying philosophy or motivation behind it. We Story and photos: decided to talk to Zach Vasquez the people occupy// The Creosote ing downtown San Journal Francisco’s Justin Herman Plaza to get a sampling of what is motivating the individuals to partake in this massive movement.

CLINT

24, Student

In my mind — and I could be wrong — we’re Americans, we’re patriots. We care about our country. And that’s what makes everybody here, every last person, a patriot. They’re being active, they’re doing the best they can to save their country. I think that’s something to be admired and respected, and needs to be documented.

OAKLAND RAN WITH IT: Encampments developed distinct cultures. East Bay activists drew national attention when police aggressively moved to evict them from near City Hall, and when protesters then briefly shut down the Port of Oakland in a Nov. 2 “general strike.” Oakland Local (Oaklandlocal.com) has continuous coverage. Christopher D. Cook // Public Press

Behind the Protest Signs: Voices of Occupy San Francisco Bankers, bluegrass fans, baristas find common cause in pluralistic movement to challenge status quo

I

think we’re witnessing possibly the biggest left populist rebellion since the populist movement of the 1890s.” On a warm early morning in downtown San Francisco, veteran organizer David Solnit uttered those hopeful words amid a boisterous crowd of about 400 marching through the Financial District demanding banks pay for the economic and Story: human costs of the home Christopher D. foreclosure crisis.

Cook The Oct. 12 protest tem// Public Press porarily shut down Wells Fargo headquarters on Montgomery Street, leading to 11 arrests as demonstrators from a coalition of labor and community-based groups, including affordable housing and immigrants’ rights movements and the Occupy San Francisco movement spent five hours rallying to “foreclose on Wall Street West.”

A few weeks later, more than 10,000 people flooded Oakland’s streets and shut down its port — the fifth busiest in the nation — in a “General Strike” focused largely on corporate commerce and capitalism. A huge banner hung across a downtown intersection, urging: “death to capitalism.” Other signs and flyers called for a range of reforms: Tax Wall Street and the wealthy, boycott big banks, create a “maximum wage,” community-led redistribution of land and food-growing, and much more.

Beyond the slogans and chants, what is this Occupation movement about and why is it catching like wildfire? What do the growing ranks of Occupy Wall Street, San Francisco and other enclaves hope comes of this tempest of progressivism?

Since a handful of protesters “occupied” Wall Street in mid-September to protest corporate power and economic inequalities, an international movement of sorts has risen up, with marches and encampments in hundreds of U.S. cities and towns and protests across the globe.

On Oct. 15, protesters in more than 900 cities throughout Europe, Africa and Asia rallied in sympathy with their counterparts in the U.S. “I’ve never seen anything like this in my life,” said Canadian author and social activist Naomi Klein in an interview at the Wells Fargo rally in San Francisco. “People are so excited to have a new tent in which to meet, and the possibility of it expanding limitlessly. Political courage is so contagious.”

Of course, not everyone is on board. At the bank protest, employees stood on the fringes waiting to get inside to work. Some expressed resentment that their entrance was being blocked. A couple of employees whispered their support for the message, if not the occupation of their workplace. Another said the protesters were “misinformed” about the economy and should “just get a job.” Some media critics have

“The mainstream media keeps asking us for our list of demands, but that’s kind of trapping the movement in a corner,” said Desean Ricardo (left), a rap musician from Pinole who protested with his family at Occupy San Francisco. Christopher D. Cook // Public Press be heard.

“It’s leaderless, it’s spontaneous — that’s what There’s not some board of I love about it,” said protester Robyn Kralique, who said she wanted to help create a “sacred, directors or paid staff person safe open space where we can discuss the possibilities together and actually have a say and running everything. There is a democracy, even if it’s just a bloc of people having free discussion and say about their politics. process of direct democracy in the In America the average person doesn’t get their say, because it’s controlled by money.” face of a failed democracy.

Charmz Valentino, 26, who came to the city David Solnit, political organizer for the Hardly Strictly Bluegrass festival and had since hunkered down with her dog at Ocdecried a lack of focus or coordination to the cupy San Francisco, said she would be there “invaried protests. definitely”: “It’s so amazing that there is such a large range of ages, occupations and views, Culture of consensus and we are all coming together to support our consensus.”

But at the core of the Occupy movement, parJeff Weiss, a 33-year-old cafe worker who ticipants said, lies a democratic culture of lives in San Francisco on “minimum wage, plus consensus that is as important as any list of tips,” said he was inspired by “people coming demands. together, communicating face to face, sharing Solnit, who helped mobilize protests against ideas, ironing out those ideas and deciding colthe World Trade Organization in Seattle in lectively what’s in the best interests of all of us 1999, said the movement is “very horizontal for the best possible intentions.” and open, and they have created a space where huge numbers of people feel comfortable and Grievances — and proposals have ownership.”

Numerous Occupy San Francisco backers What are those intentions? There is no single said they were drawn by the chance to create list of demands, but protesters have plenty of a culture in which everyone could speak and ideas about what is propelling the movement,

”

“

and what they want changed.

The clarion call of “We are the 99 percent” has driven home a blaring message about what protesters argue is a host of inequalities — of wealth, income, education, housing, economic opportunity, political clout and access to decent food and health care. Some protesters want to see corporate economic and political power reined in and others call for capitalism to be reformed, transformed or replaced. Proposals include enforcing existing regulations on corporate finance, breaking up corporate bank chains, creating a city-run municipal bank or expanding off-the-grid barter economies and alternative currencies.

“A lot of things could be fixed if we provided free housing at every level, free education at every level, free health care for every level,” said Valentino, whose puppy sported an “Occupy SF” button. “I am not comfortable with the fact that the Federal Reserve is owned by a private corporation. I would like to see that turned around as well.”

Ken Tray, a teacher and union leader with United Educators of San Francisco, said, “If there is a clear message here, it’s that there is a radical redistribution of wealth upward, and it’s beginning to hurt people on the ground.”

Asked what drew him into the streets, 52 year-old Francis Walsh, an assistant special education teacher from Daly City, said: “It’s right here in the sign — end the wars, tax the rich, care for the people and protect the environment. Four simple ideas, not easy to do, but the simplicity of it and the message behind it is what brought me out here.”

‘Something completely new’ Many of the protesters called for something beyond reform. “The issue goes beyond our government is messed up,” said Lauren Phillips, a 23-year-old City College of San Francisco student who was taking time off from her studies because “there is traveling to be done, and revolution to make.”

Phillips, who has been camping and protesting for weeks, said it’s about more than just the economy: “If we don’t have an environment to prosper in, there is certainly not going to be prosperity anymore — there won’t be any people left to prosper if there is no environment in which to have health. That’s why this thing is so big and so hard to define, why we don’t necessarily have the answer of what to call it.

I think it needs to be something completely new.”

Desean Ricardo, a dread-haired rap musician who came from Pinole to protest along with his wife and baby daughter, resisted calls from mainstream media for a list of demands.

“That’s kind of trapping the movement in a corner. They want to hear our fixes to the system, but the system can’t be fixed.”

Some California Members of Congress Among Richest 1%

T

he Occupy Wall Street movement has focused the national discourse on wealth inequality and, specifically, the split between the richest 1 percent and the 99 percent that’s left. While most Story: Californians, by Will Evans definition, are // California not members of Watch the wealthiest 1 percent, it turns out that many of us are represented in Congress by those who have attained that elite status.

The cutoff for the top 1 percent of

American households, in terms of net worth, is about $9 million, according to New York University economics professor Edward Wolff. His estimate is based on the Federal Reserve Board’s Survey of Consumer Finances, which put the figure at $8.2 million in 2007, he said.

That puts many members of Congress squarely within the 1 percent, including prominent members of California's delegation, such as Democratic Sen. Dianne Feinstein; Rep. Nancy Pelosi, also a Democrat; and House Oversight and Government Reform Committee Chairman Darrell Issa, a Republican.

Exact numbers are hard to come by because politicians report their wealth within wide ranges. A real estate asset, for example, might be worth somewhere between $5 million and $25 million. The Center for Responsive Politics compiled the numbers from 2009 as a range between minimum and maximum wealth.

Issa, worth between $156 million and $451 million, is California's wealthiest representative in Washington, based on the center’s 2009 statistics. Issa doesn’t appear to be an Occupy supporter, calling for an investigation into whether union

members’ money was inappropriately funneled to fund the protesters.

An Issa spokesman did not respond to questions.

Feinstein is next, with between $46 million and $108 million. Democratic Sen. Barbara Boxer, on the other hand, doesn’t make the 1 percent cut, with assets between $1.2 million and $5.6 million.

A Feinstein representative pointed out that she supported President Barack Obama’s jobs bill, which included increased taxes on the wealthy.

“This would have been paid for by asking America’s millionaires and

ANTONIO

32, Unemployed Musician & Journalist

I think right now, we really need to focus on economic policy, because we have so many people out here with so many different goals and beliefs and opinions and visions. Our goals are so lofty, and our agenda, for lack of a better word, is so varied, that you have to take it in stages. I’m afraid that if we go too far and try to spread out to everything, it kind of waters it down, takes away the focus from the original core idea of what we’re trying to go after, which started in New York with Occupy Wall Street.

BETH

30s, Unemployed

I was at the Federal Reserve bank for at least two weeks, and then I went back to the East Coast for a few weeks to spend a few days at Occupy Wall Street. I just got back yesterday.

There’s a little bit of a different vibe in Zuccoti Square. New York is a little bit more business-oriented and focused. San Francisco has more of a hippie vibe, a ’60s vibe.

BRETT

20s, Artist

I am a Republican.

I am voting for Ron Paul for President of the United States of America.

I have not brought that up in my three weeks of being here more than a handful of times. For somebody to come here and represent themselves politically … they already have political aims, they’re not coming here and shedding that skin.

LUCIEN

77, Retired

It’s important to resist the people that have their thumbs on everybody else. Even though each individual resistance doesn’t necessarily succeed, people need to resist those in power who are willing to subdue everybody else. Throughout history, a little bit of resistance might be the only thing that’s kept them from overwhelming us.

BUFF

billionaires — those who have benefited from this economy while so many others have suffered — to contribute a little more,” Feinstein said after Senate Republicans blocked consideration of the bill.

GOP Rep. Gary Miller, who sits on the committee overseeing the banking industry, is worth between $19 million and $84 million.

Pelosi reported a lot of liabilities, so her total is somewhere between negative $7 million and a maximum of $124 million, for an average of $58 million. Pelosi, however, has been supportive of the Occupy Wall Street movement.

“I support the message to the establishment, whether it’s Wall Street or the political establishment and the rest, that change has to happen,” she said on ABC’s “This Week.”

67, Editor

I hope this is the beginning of the end of capitalism.

I think capitalism is a brutal, carnivorous system that eats people’s lives, steals their resources. Noam Chomsky calls it the “ongoing holocaust of capitalism.” We don’t see it in this country nearly as much as it impacts the rest of the world. There are people who are literally ground up and spit out by the capitalist apparatus. I don’t know what shape this movement will ultimately take, but my hope is that people begin to see that capitalism is the problem. It’s not individual rich people, it’s not individual politicians, it’s the system itself.

sfpublicpress.org // Winter 2011

green b4 media b7 streetscape b8

NEW FISCAL YEAR olice and firefighter unions will pay more out of pocket toward their pensions. Disease prevention programs and street beautification will be scaled back. At least $37 million in capital projects will be added to a growing deferred maintenance backlog.

Hundreds of millions of dollars in cuts approved in July forestalled a fiscal day of reckoning for San Francisco, a city that for three years has, like hundreds of local governments across the country, struggled to stay solvent in response to a fluctuating tax base and rising labor costs. City staff estimate that costs are rising three times faster than tax revenues.

This summer, local leaders dug deep to erase a $380 million deficit for the 2011-2012 fiscal year. It was a moving target, growing from an initial projection of $306 million in March, which made the final budget cut decisions extremely painful.

The total budget added up to $6.83 billion — an increase from last year’s $6.48 billion, but difficult nonetheless because nearly half was locked up in earmarked, but ever-rising, costs.

In an attempt to be more engaging than his predecessor, Mayor Ed Lee conducted 10 town hall meetings across the city between March and May. The added participation of district supervisors gave the public a chance to hear their priorities

P

four years ago, san francisco launched a grand experiment, becoming the first city in the nation to offer comprehensive health care to its growing ranks of uninsured.

stitching together two-dozen neighborhood health clinics and an array of hospitals, the city bet that two reforms — emphasis on primary care and a common electronic enrollment system — could improve outcomes and buffer the city against soaring health care costs.

Healthy sf: who pays? continued on page b2

SF Public Press

MORE INSIDE

HEALTHY SF: WHO PAYS?

By many measures, San Francisco’s effort to provide universal health care has been a huge success and has won national accolades. The initiative, Healthy San Francisco, has over time treated more than 100,000 city residents. Many who went for years without health insurance now receive the kind of preventive and specialty care usually associated with private insurance.

But the city’s grand plan has not solved the central problem dogging health care across the country: figuring out who pays for it.

While the Department of Public Health has kept its own spending on the program at under $100 million a year — about the same amount it spent on indigent care before Healthy San Francisco’s 2007 launch — it has spread an additional $78 million in costs to businesses, patients, the federal government and the health care Story: providers themselves. barbara grady The program relies on ample, but not per// Public Press petual, federal grants for health innovation, tied to preparing for President Obama’s health initiatives that may be derailed by the U.S. Supreme Court next spring or a Republican administration after 2012. As national political and economic winds change, the city may not see the soft landing it expected from the federal reforms in the next few years.

With low payments from patients and declining dollars from employers under a new health care spending requirement, the plan’s local financing remains a challenge. Especially when the city has faced deficits of more than $300 million for each of the last three years.

Participating nonprofit community clinics in the network have been shouldering part of the financial burden. That may be a problem in an economy where health care costs are rising twice as fast as inflation. Some clinics say they are tapped out, and the $114 per-patient per-year reimbursement they get from Healthy San Francisco doesn’t come anywhere close to covering costs.

b1

Tenderloin’s Dream Toilet: Free, Green, Compostable before the proposed budget was released in June. The meetings also provided special interest groups a chance to plead for clemency for their programs.

“The goal was to have a situation that was not like we’ve had in the past,” said Rick Wilson, the mayor’s budget director. After the mayor proposes his budget on June 1, the community and supervisors have had little say until budget hearings, which generated a “scramble” to restore cut funds. “They’re kind of surprised, and maybe taken off guard, when they see the budget.”

But, by and large, the mayor’s budget was the final budget. A few ideas directly from the sessions made it into his revised proposal: the mayor restored a nutrition program for seniors when proponents voiced concerns at the early meetings. The mayor made more than $26 million in changes — accounting for less than one-half of one percent of the total — before submitting his proposed budget to the board June 1. Those changes were based on conversations with social service providers, labor and business groups, said Christine Falvey, the mayor’s spokeswoman.

The year-by-year scramble to cut funds, brought on largely by plummeting tax receipts in the wake of the recession, have harmed the city’s ability to plan projects

that take more than a year to carry out. Lee, who will seek his first full term as mayor in November’s election, proposed the city move toward a five-year planning cycle, a seven-part plan he unveiled in May that includes new taxes and employee benefits.

“This is a significantly different budget process, one that I feel has been depoliticized but has been looking at the greater good of a balanced way of doing our work,” said another mayoral candidate, District 11 Supervisor John Avalos.

Yet even as the ink dried on the reconciled city budget Lee signed on July 26, the city controller’s office predicted shortfalls as far as the eye could see. The office calculated that the deficit would double in the next two fiscal years: a $408 million shortfall for 2012-2013, and $642 million the following year.

A report jointly published in April by various city budget agencies including the mayor’s and the supervisors’ offices, said costs would continue to outpace revenues unless structural reform was enacted. The long-term deficit threat led several rivals for mayor to propose such reforms on the November ballot.

Any real savings come through stiff labor concessions. The city’s unions spent months working with Lee to develop his pension reform ballot measure for November, which

advocates estimated would save San Francisco $1 billion over 10 years.

The proposed charter amendment would raise the retirement age for city workers and limit their pension benefits, while forcing them to pay more toward health and retirement plans.

That idea is at odds with another pension reform measure proposed

by Public Defender Jeff Adachi, which would require large pension contributions. Adachi said his plan could save the city up to $50 million a year. Adachi, whose Proposition B pension reform initiative failed last November, is naming this ballot measure “Son of B.” saVings add up Before even proposing his budget, Lee convinced police and fire unions to agree to lower take-home pay. Firefighters, for instance, got a 3 percent salary raise, instead of a scheduled 4 percent, and they must contribute an additional 3 percent into their pension fund. The net result was no raise. The deals will save the city $31 million over two years — vital to avoiding public safety layoffs, an unthinkable move in a mayoral election year.

Most of the savings this year came from a combination of one-time and ongoing departmental cuts, consolidations and increased efficiency.

tecHnoLogY

medicaL records supporting san francisco’s uniVersaL care add miLLions to officiaL cost

Public Press San Francisco California

San Francisco’s Universal Health Care Experiment The California Endowment Health Journalism Fellowships at USC Annenberg sponsored this reporting project by the San Francisco Public Press to take a closer look at whether local health care reform ideas are working in one major metropolis. More than 40 individuals also donated to this project via Spot.Us. Reporting, photography and research for this project were contributed by Barbara Grady, Angela Hart, Kyung Jin Lee, Cindy Chew, Jason Winshell, Monica Jensen, Tom Guffey and Frank Bass.

for more news and updates go online to:

sfpublicpress.org/news/healthy-sf

above: Dr. Mitchell Psotka, right, sees patient Stephen Price for a checkup exam at the San Francisco General Hospital outpatient clinic, which serves people enrolled in Healthy San Francisco. cindy chew // Public Press

T

he San Francisco Department of Public Health says it is ahead of the curve in rolling out databases that keep tabs on tens of thousands of patients across a citywide network of clinics and hospitals. The rollout is needed not just to make a local form of “universal health care” work, but also to meet a 2014 deadline under national health reform.

And the city says it spent just $3.4 million on new patient-tracking technology. Not bad for an unprecedented charity care initiative whose total budget has grown to $177 million just this past year.

But while clinics and hospitals across the city are now linked up to a common intake tool that eliminates overbilling and Story: angela Hart duplicated medical appointments, // Public Press that is only the first step in making the Healthy San Francisco program successful, directors of local health centers and technology experts say.

A separate and much more complex piece of technology — electronic health records — is proving difficult and expensive. Knitting together incompatible computer systems across the 35 medical sites so they can easily share detailed patient medical records could costs the city millions beyond what is included in the official price tag.

An incomplete survey of technology costs borne by the clinics themselves this year reveals spending of at least $15 million in addition to what was budgeted for the whole program, adding at least 8.5 percent to the total cost. But that sum is likely millions higher, since eight clinics could not or would not say how much they spent or were planning to spend integrating their patient records.

The Department of Public Health claims that Healthy San Francisco costs just $276 per patient per year — a real story continued on following page

b2 SF Public Press

Winter 2011 // sfpublicpress.org

Making Healthy SF

work

96,000 = UNINSURED IN S.F.* 90,200 = OF ABOVE ELIGIBLE FOR HEALTHY S.F. who’s uninsured in san francisco?

33% OF UNEMPLOYED 12.4% OF FULL-TIME EMPLOYED 25.4% OF LATINOS 11.6% OF ASIANS 11.4% OF AFRICAN

monthly Health care costs

National Overall Cost Per Capita $628

Healthy SF vs. Average private insurance (U.S.)

PRIVATE INSURANCE

U.S.

2009-10

$163

million

2008-09

EXPENSES

Healthy sf

”

delivery but not for payment.

“

non-dpH

Money spent by clinics and hospitals outside of the Department of Public Health

Cost of care at Department of Public Health clinics, San Francisco General, and UCSF

$45.9

mentaL HeaLtH

$28.1 million

million

$20.4 million

(see inset below)

th

ef

irs

federaL funding Health Care Coverage Initiative

t tw

oy

ea

rs

no

n-d

pH

fun

$27.4 million

citY and countY subsidY $99.7 din

gw

REVENUE

Healthy San Francisco is a model for health care

JAPAN

program start 2007-08

In 2006, the San Francisco million Board of Supervisors voted in the San Francisco Health Care Security Ordinance, creating Healthy San Francisco. Since it began enrollment in 2007, the program's costs have increased to $177 million a year to providing health care to more than 54,000 people, roughly two-thirds of San Francisco's uninsured.

The future of the program depends in part on if independent nonprofit community clinics can continue to shoulder part of the increased burden for paying for medical care, in a sector in which costs are rising twice as fast as inflation.

In reality some clinics say they are tapped out, and the $114 per-patient per-year reimbursement they get from Healthy San Francisco does not come close to covering costs.

U.K.

cLinics and HospitaL care $106

11% OF CAUCASIANS

nonprofits paying for care

$227

2010-11

2009-10

$124

$261

CANADA GERMANY

2010-11 $177 million

2008-09

*Numbers from Census Bureau, other estimates range widely.

NORWAY

$311

Japan data is from 2007, all other country data from 2008. Source: Kaiser Family Foundation, OECD Health Data.

million

AMERICANS

$340

$402

$276 HSF

$417

ere

Funding given by San Francisco million

not

rep

orte

d

patient care from clinics and hospitals outside of the Department of Public Health

$28.1 million

stephen shortell, dean of uc-berkeley’s school of public Health

Healthy sf: who pays?

overview of Healthy san francisco participants

continued from page b1

“The program is very, very important,” said Karen Hill, administrative director of Glide Health Services, a large, busy nonprofit community health clinic in the Tenderloin whose base of 3,000 patients includes 1,500 Healthy San Francisco members. “But I think we should recognize that it does not pay for the care of the population.”

At last count, Healthy San Francisco covers 54,348 patients, about two-thirds of the estimated 82,000 San Francisco adults who lack insurance, according to a September report from Mathematica Policy Research of Princeton, New Jersey. (Estimates range widely from 64,000 to 90,000 uninsured adults aged 18 to 64.)

In a survey of patient satisfaction, 94 percent said they were satisfied with the medical care they received through the program.

But clinic directors say that while the program has been great for patients, the clinics themselves struggle to deliver care to ever-growing numbers of people. Some clinics have seen their patient base grow by a third since 2007.

Healthy San Francisco has laudable goals, said Ricardo Alvarez, medical director of the Mission Neighborhood Health Center, and “has expanded care to a vulnerable underserved population.”

But for clinics to make it work, Alvarez said, “it is challenging financially.”

Several clinics, such as Lyon-Martin Health Services in Hayes Valley, have stopped taking more Healthy San Francisco patients. The center was already under financial stress this year, and announced earlier this year it had been on the brink of bankruptcy.

So as the Obama administration prepares to roll out federal health reform by 2014, cities and states look to San Francisco for proof of concept: They’re finding the plan here offers ingredients for success, but not a complete answer.

“Healthy San Francisco is a model for health care delivery but not for payment,” said Stephen Shortell, the Dean of the University of California-Berkeley’s School of Public Health.

But Alvarez, of the Mission clinic, said San Francisco had little choice but to innovate.

“I think the fact that Healthy San Francisco exists is, in part, a local response to a complex problem,” he said.

“The fact that we don’t have a comprehensive national healthcare program means certain localities will attempt to find their own solutions.” aHead of tHe curVe Healthy San Francisco has scored some nationally recognized successes. In drawing two-thirds of the city’s uninsured into its care, it has shrunk the number of people without some form of health care to 3 percent of the city’s population.

The program is built around a “patient-centered” primary care model that is in vogue in medical reform circles. New enrollees are primarily very poor, though any city resident making less than 500 percent of the poverty level and without proper insurance for three months can apply.

Participants choose one of 35 health clinics around the city as their “medical home.” At the clinic, they are assigned a team of providers: a doctor, a nurse practitioner and assistants who handle their visits and coordinate referrals to specialists or for hospitalization.

The theory is that by offering patients a regular doctor or medical team who might get to know them, in a place that is familiar, they will seek care before problems become acute. Numerous studies have shown that preventive care such as mammograms and cholesterol checks can detect early signs of disease before they become more difficult and costly to treat. Uninsured patients often put off tests and preventive care to avoid out-of-pocket expenses.

Shifting to the patient-centered model has also dramatically cut the use of city emergency rooms for routine care by the program’s participants. Proponents say that in the long run emergency room “diversion” — catching continued on page b3

INCOME LEVEL*

AGE 9%

55-64

26% 42% 23%

RACE/ETHNICITY

41%

2%

18-24

45-54

19% 24%

101% to 200% Poverty Level 66% Under Federal Poverty Level

24%

25-44

Asian/Pacific Islander 9% Other 7% AfricanAmerican

Over 300% Poverty Level 8% 201% to 300% Poverty Level

Future federal funding will depend on whether the Affordable Care Act will be implemented — despite Republican vows to dismantle it — and that county health grants from the federal government to prepare for reform will keep flowing. Healthy San Francisco’s budget got a huge boost by a just expired innovation grant of $27.4 million.

reimbursement bY dpH to outside cLinics, HospitaLs and speciaLists

$14.4

enroLLment, administration and information tecH

$7.84

* indiViduaL fees empLoYer contributions

PRIMARY LANGUAGE 51%

Cantonese /Mandarin

27%

Caucasian

Latino

English

18% 4%

Spanish

Other

million million

$5.8

million

$12.9 million

inset (from above)

$3.56 million

transfer of unused medical reimbursement account funds from employers (2010-11 only)

Businesses in San Francisco will either insure their own employees or pay into a fund that supports Healthy San Francisco. The amount of business funding for the program is smaller than predicted, at $12.9 million or 7 percent of the total cost, and has been shrinking year to year.

Data compiled from Healthy San Francisco's Annual Report, the San Francisco Controller's office, U.S. Census Bureau, and the Kaiser Family Foundation. tom guffey, barbara grady, angela Hart // Public Press

*The federal poverty level depends on the number of people in family. For example, it is $10,890 per year for a single person family, and $ 18,530 for a three-person family.

UNINTENDED CONSEQUENCES

Some Employers Drop Private Health Plans For San Francisco’s Subsidized Public Option

A

San Francisco requirement that businesses pay for their employees’ health needs has led to more workers having some form of health care. But after businesses initially stepped up to buy private health insurance for more of their workers, there has been a steady retreat.

Since 2008, a growing percentage of employers have ditched private insurance for a cheaper way of meeting the law’s requirements: city-engineered reimbursement accounts, Story: barbara grady which cost companies half or less // Public Press what they previously paid for traditional insurance.

The percentage of employers covering workers with private health insurance dropped from 84 percent to 80 percent in the three years since the ordinance came into force. In its place they are contributing to medical reimbursement accounts, an option according to San Francisco’s Health Care Security Ordinance of 2006.

At the same time an equivalent number were setting up reimbursement accounts for workers. The city’s Labor Standards Enforcement office said the rise in popularity of reimbursement accounts, from 9 percent to 13 percent, corresponded to the drop in employers’ insurance coverage.

This change, the office concluded recently, “raises public policy concerns” because with too little money in these accounts to cover some health costs, workers were getting worse care.

The shift away from insurance also increases the cost of the city-run Healthy San Francisco universal health care program, which is another option for employers. Because business contributions to either the reimbursement accounts or Healthy San Francisco are low — about $4,000 for a full-time employee, compared with $8,000 for a typical insurance plan — the city picks up more of the tab. figHt oVer unused funds As has been reported widely, businesses using these reimbursement accounts collectively took back four-fifths of the money they had stashed in the accounts for their

workers at the end of each year.

So goes the law of unintended consequences.

When San Francisco passed the 2006 ordinance, which also set up Healthy San Francisco, the law required medium and large businesses to either buy health insurance, contribute to Healthy San Francisco as the health provider of their workers or set up reimbursement accounts.

Any business with 20 or more employees, or nonprofit with 50 or more, falls under the program. This law covers 5,600 businesses and includes any company registered to do business here, city records show.

Employers now have to spend at least $1.37 per employee per hour worked even for just eight hours of work a week. Employers with more than 100 employees pay more. That works out to $2,849 per year for a full-time employees for small businesses, and $4,285 for large ones.

An outside study by Dartmouth Medical School researcher Carrie Colla and University of California researcher William Dow found that while most employers subject to the mandate already offered private health insurance before the ordinance was enacted, three-quarters of them had to expand their insurance offerings to meet the law’s requirement to cover part-time employees.

But then, according to the Labor Standards office, over time certain firms — disproportionately restaurants and hotels — discovered they could set up reimbursement accounts and empty them at year’s end. What followed was a steady climb in the number of employers choosing this plan. poLiticaL scHism Not only has that hurt workers who lost the health benefits the law promised, but it did two other things. It made an uneven playing field among businesses, and it cost the city money, by putting the workers into the city safety-net system when their reimbursement accounts went dry.

“I was hearing from workers about not being able to use the money,” said David Campos, a member of the Board of Supervisors, who tried to close this “loophole” by introducing legislation to amend the ordinance to disallow employers from recouping unspent money.

The full Board of Supervisors approved it in a 5-4 vote

”

When I wrote this legislation five years ago, it never occurred to me that some restaurants would be so obvious in their attempts to game the system. tom ammiano, state assemblyman

“

in October, but Mayor Ed Lee vetoed it. The unresolved issue is sure to produce a showdown early in Lee’s new term and could affect the future fortunes of the city’s universal care ambitions.

“Healthy San Francisco has been a tremendous success and the vast majority of businesses are doing the right thing,” Campos said. “With any law there are tweaks that have to be made.”

State Assemblyman Tom Ammiano, D-San Francisco, who wrote the ordinance when he was a city supervisor, said those recouping money from the reimbursement accounts are violating the spirit of the law.

“When I wrote this legislation five years ago, it never occurred to me that some restaurants would be so obvious in their attempts to game the system,” Ammiano said in an email. “I find it unconscionable that there are restaurants charging customers a health surcharge and then keeping the money for profit. Healthy San Francisco is about providing health care, not creating profit, and I am looking into legal options to put a stop to this larceny.”

But Steve Falk, president of the San Francisco Chamber of Commerce, suggested a compromise: leave at least a year’s worth of funds in the accounts for each worker, but not all the funds.

“I think most businesses would say it is the right thing to do to provide health care to employees,” Falk said.

“What irritates business owners is the unpredictability of the process.”

To leave all the funds in the accounts each year, he said, “takes $50 million out of circulation that could be creating jobs.”

sfpublicpress.org // Winter 2011

B3 SF Public Press

Healthy SF: Who Pays?

CONTINUED FROM PAGE B2

illness before it becomes acute — has the potential to save the city millions of dollars a year because emergency care is inevitably more expensive.

Keeping better track

Chrystal Powell, 30, consults with volunteer Andy Eggleston at Lyon-Martin Health Services on Market Street. Powell says Healthy San Francisco provides medical care such as a regular doctor rather than having to go to urgent care at San Francisco General Hospital. Monica Jensen // Public Press PRIMARY CARE

Participants Appreciate Safety-Net Health Access Program, but Note Gaps

H

ealthy San Francisco participant April Fredrick, an unemployed human resource professional, values the peace of mind the program provides.

“If I have a serious health problem, knowing that I do have a doctor for treatment and prescription if I need them is the biggest benefit,” she said.

Most participants in Healthy San Francisco, the city’s 2007 initiative to expand care to more than 50,000 uninsured patients, appreciate the overall access to preventative care and treatStory: Kyung Jin Lee ment for chronic health conditions. // Public Press A 2009 survey showed that more than nine in 10 are “very” or “somewhat” satisfied with the program. Patients cite the affordability of the program and the quality of care they receive from the health care practitioners.

“I mainly see it as emergency service,” said Alan Hyland, a 34 year-old unemployed construction worker from Nob Hill. “Health care is costly and the program is a good safety net.”

But program participants and medical care providers also note the inconsistency in the services they receive under Healthy San Francisco.

“There’s a real gap in the way participants of Healthy San Francisco are treated from an administrative perspective coming into the clinics and the hospital,” said Fredrick.

Claire Horton, a doctor who is medical director for San Francisco General Hospital Medical Clinic, said more resources are needed to keep up with the increase in patient load. While medical personnel are working hard covering for each other, short staffing causes real problems for patients.

“We had one person call in sick,” she said. “We had someone who was answering patient phone calls and we had to pull them to staff the front desk. That means less phone access for our patients, more people who might not get to the medicine refill in time, or find out their cardiology appointment is that afternoon for an important test they’ve needed for a long time.”

Ingleside resident and part-time saleswoman Anne Chen made it to her “mid-40s” never having had private insurance. She said Healthy San Francisco helped her become more conscientious about taking preventive measures, and appreciates the care she has gotten. But she also sees the holes in the program.

“Customer service is a big problem,” she said. “Calling for making appointments they never pick up. Even if I leave a message, they don’t call me back.”

Fredrick went to the emergency room at San Francisco General when she thought a cold had developed into pneumonia last year. Her primary medical home had advised her to go there after informing her that they could not provide an appointment for six weeks.

“It was such a negative experience, I left and decided it wasn’t worth waiting to try to get treated,” she said. “You feel like you’re cattle being herded through a system, as opposed to a person who’s sick and there for treatment.”

Fredrick said she sees much bigger demand for services than supply of health care under Healthy San Francisco.

But she also recognizes the high quality care when she does get treated.

“The care I received from my doctor, nurse practitioners at my clinic and the doctor that administered my test at San Francisco General and the other nurses, it’s been excellent,” Fredrick said. “When I was with the health care providers receiving care, I did not feel I was receiving care that was not the best possible care they could offer me.

But for some participants, the difficulties are all worth the access to care they would not otherwise have.

“There’s nothing I don’t like about the program,” said 27-year old Dagima Ganbold, a student from Tenderloin and part-time saleswoman at Marshalls. “I love it.”

Ganbold, a Mongolian immigrant, said she does not mind waiting because of the affordability and access to quality care.

“I would recommend it to everybody,” she said. “It’s perfect for people who have low income.”

One 59-year-old Filipina elderly caregiver — an undocumented immigrant who spoke on the condition that her name be withheld — agreed. She said she was able to see specialists and get lab tests done on her kidneys when blood was detected in her urine.

“Everything is OK now,” she said. “I was relieved. They took care of me. That’s why I love it.”

Healthy San Francisco dramatically improves patient tracking by using a citywide database. Each patient’s enrollment and eligibility status is entered into one place visible to the entire network of providers. Now, a patient does not need to be re-enrolled if she needs hospitalization or to see a specialist elsewhere. If she shows up at a different clinic, she will be redirected to her home clinic.

Administrators say this cuts down on duplicative care and wasted time. Patients used to hop from clinic to clinic, often carrying their own eligibility documents with them.

“We do believe it is a model,” said Tangerine Brigham, director of Healthy San Francisco and a deputy director of the Department of Health. “The medical home, the use of one standardized eligibility and enrollment system, getting all providers that are caring for this population to focus on one network, are things that should happen.”

Roland Pickens, the chief operating officer of San Francisco General Hospital — the county hospital where three-quarters of Healthy San Francisco patients go if they need hospitalization — said the program “has been a good change,” bolstering primary care, resulting in 30 percent fewer visits to the emergency room by uninsured adults and reducing the time and money spent on administrative tasks.

Alvarez relates the story of a woman named Isabel (he could not provide her last name due to medical privacy issues) who came to Mission Neighborhood Health Center with a psychotic disorder, uncontrolled diabetes and eye trouble. A behavioral health specialist calmed her down, and a physician tested her blood sugars, prescribed diabetes medication and gave her an appointment to see an ophthalmologist.

Because she was enrolled in Healthy San Francisco, all this cost the clinic a few hundred dollars, of which the city was billed $114. Had she gone to the emergency room, as many uninsured people did for routine problems before, it would have cost about $1,800, clinic officials estimated.

“Patients know this is their home, providers know this is our patient. It improves health outcomes,” said Albert Yu, medical director of Chinatown Public Health Center, the first Healthy San Francisco participating clinic.

“Previously, patients would go from center to center, or the medical facility might not recognize that she is our patient. She is just coming in for a cold and therefore I can ignore the mammogram referral.”

For patients, it is often a godsend.

“It gives you the option to have medical care and everybody deserves that," said Carol Graham, who lost her job of 17 years, and with it private health insurance, before signing up for Healthy San Francisco. “Oakland doesn’t have this.” She noted that her sister, who lives across the bay, does not have access to a similar program. “I was surprised by how life can be different just by crossing the bridge.”

For Megan Alyse, signing up for Healthy San Francisco allowed her to continue to write her doctoral thesis when she was no longer connected with a school and thus without insurance. “I paid hardly anything and was able to see a doctor,” she said.

Assessing Newsomcare

Darren Barrett, right, gets his blood pressure taken by medical assistant Joyce Chong-Grogg at the San Francisco General Hospital outpatient clinic which serves people enrolled in Healthy San Francisco. Cindy Chew // Public Press

Faces of Healthy San Francisco Interviewed by: Kyung Jin Lee // Public Press

April Fredrick

George McCrae

36 years old Unemployed human resources specialist Neighborhood: Richmond Enrolled: 1 years Primary medical home: Castro-Mission Health Center Loves: Access to quality health care Doesn’t love: Administrative system, long wait times Recognizes the value of the safety-net health services, but wants more consistency with the program’s patient administration.

Brandon Hill 28 years old Bartender and freelance illustrator Neighborhood: Sunset Enrolled: 1 year Primary medical home: Glide Health Services in the Tenderloin Loves: Overall health care service Doesn’t love: Administrative system, long wait time Appreciates Healthy San Francisco, but is thinking about switching back to private insurance for fuller coverage.

Mo Moussa

Dagmina Ganbold

37 years old Freelance illustrator Neighborhood: Mission Currently trying to enroll Loves: Security of having health care access Doesn’t love: Coverage only in San Francisco Loves the freelance lifestyle but would give it up for a full-time position with health care benefits.

27 years old Student and part-time saleswoman Neighborhood: Tenderloin Enrolled: 1 year Primary medical home: San Francisco General Hospital Medical Center in Potrero Hill Loves: Access to and quality of care Doesn’t love: Nothing Appreciates the low-cost access to health care services. Says long wait times are worth it for care she receives.

55 years old Unemployed mortgage broker Neighborhood: Union Square Enrolled: 2 ½ years Primary medical home: Castro-Mission Health Center Loves: Ability to see doctors and specialists regularly Doesn’t love: Lack of coverage for some prescription drugs Goes regularly to his primary medical home and pain specialist, appreciates the program overall.

Anne Chen Mid 40s Part-time saleswoman Neighborhood: Ingleside Enrolled: 4 years Primary medical home: San Francisco General Hospital Medical Center in Portreo Hill Loves: Access to care for low-income people Doesn’t love: Administrative system

Anonymous Undocumented Filipina Immigrant 59 years old Part-time caregiver Neighborhood: Bayshore Enrolled: A few months Primary medical home: Glide Health Services in the Tenderloin Loves: Access to and quality of care Doesn’t love: Nothing Appreciates the safety-net program. Very happy with the services she has received.

In 2006, then-Mayor Gavin Newsom announced a plan hatched by then-Public Health Director Mitch Katz and then-Supervisor Tom Ammiano to cover the uninsured, albeit only within city limits. The left-leaning Board of Supervisors rallied in unanimous approval.

What existed before was a safety-net system of scattered clinics and emergency rooms that cared for whoever walked in the door. They typically treated people for whatever episode brought them in, patched them up and sent them on their way. Emergency rooms were a chaotic jumble of the sick and not-so-sick. Many people didn’t get the care they needed because they didn’t know where to go.

City leaders needed a way to make the plan work economically. And they needed to prevent employers from seeing it as a chance to cut costs by dropping private health insurance and making the city pick up the tab. In part, that meant shifting some responsibility to employers — an idea that if not uniquely popular in San Francisco is certainly not shared nationwide, as the political climate turns toward austerity.

The city coupled Healthy San Francisco with an ordinance requiring employers to spend a minimum of $1.37 per hour per worker on employee health care. Businesses can do one of three things to meet the requirement: buy private insurance for their employees, contribute to Healthy San Francisco, or pay into a medical reimbursement account for employees who live outside the city or earn too much to qualify.

The Health Care Security Ordinance requires businesses with 20 or more workers and nonprofits with 50 or more employees to spend at least $2,849 per year for a full-time employee on health care. For larger employers the rate is $4,285.

Eighty percent of employers have chosen to satisfy the requirement by buying private insurance. The rest use the “city option” — Healthy San Francisco or the reimbursement accounts. But in the last three years, the contributions to Healthy San Francisco have been shrinking, making employer support of the program uncertain. (See related story, page B1.)

It adds up, for now While the total cost of the program has stayed within the Newsom administration’s $200-million-a-year forecast, where that money comes from does not look like the projections. A plan that was supposed to be financed in large part by employers and participants is not seeing that money.

The employer contribution raised relatively modest revenues. Of Healthy San Francisco’s total $177 million budget in the last fiscal year, businesses covered just $12.9 million, or about 7 percent. When city officials created the program they envisioned businesses covering $30 million to $40 million, or at least 15 percent of the cost.

The city’s General Fund picked up nearly eight times that amount — $99.7 million. The contributions of individuals opting to buy Healthy San Francisco for themselves contribute just $5.9 million or a bit more than 3 percent of total costs.

A big chunk of the program is covered by the federal government through a $27.4 million annual grant awarded in 2007 for local health care initiatives that expired in July.

Another $11 million of that charity care was expended by hospitals not owned by the county. The independent nonprofit community clinics — many of them barebones operations where volunteers do some of the administraCONTINUED ON PAGE B6

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SF Public Press

Winter 2011 // sfpublicpress.org

AGRICULTURE

Your Dinner Across Nine Counties

Local food sources key to building healthy communities and protecting environment

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icture the geography of the Bay Area: the sweep of the bay from the Delta to the Golden Gate; the rolling hills, rugged mountains and intimate valleys; all the open spaces that frame our communities.

The urban landscapes of iconic bridges and landmark buildings, the cities and towns where we live and work, densely packed around the bay and then radiating into a suburban patchStory: work beyond.

Sibella Kraus Now try to put farmland into this // Bay Nature picture. That might not be so easy.

Map: Many people think of farmlands priLouis Jaffé marily as passive landscapes — part of & Ben Pease non-urban open space — rather than // Greeninfo as active working landscapes that contribute directly to local economies, healthy diets and sense of place. But Bay Area farms and rangelands cover 1.87 million acres, comprising around 40 percent of the region's total land area, and produce almost enough food to feed all Bay Area residents. In farmers’ markets now spread throughout the region, dazzling arrays of farm products bring a taste of the countryside right into our communities. But the standard measure of “localness” in food is more often a conceptual mileage number than a real connection with the places and people at the core of our incredibly productive local foodshed.

Bay Nature // baynature.org

Versions of these articles originally appeared as part of “Urban Farms to Open Range,” a special publication produced by Bay Nature magazine and SAGE, with funding from the California Coastal Conservancy, Greenbelt Alliance, Union Bank Foundation, and The San Francisco Foundation. Learn more at baynature.org/ foodlandscapes and calagalmanac.com.

For more than a century, the Bay Area has been at the forefront of the conservation movement, and for several decades it has been a leader in the local food movement.

Now these movements are coming together, with conservationists including agriculture in their vision of regional sustainability and farm advocates adding habitat value and farm tourism to their vision of agriculture’s economic vitality.

“Bay Area Food Landscapes” is born of that evolving alliance and reveals local agriculture as integral to both building healthy communities and protecting our environment. The familiar vistas of oak-dotted hills are revealed as part of a million-plus acres of land — both private and public — grazed by beef cattle, dairy cows and sheep and yielding food products valued at approximately $300 million annually. These lands also provide habitat protection,

water conservation and carbon sequestration critical for confronting climate change.

In a few large expanses and many smaller properties, Bay Area farmers tend almost half a million acres of irrigated row crops, orchards, vineyards and pasture, producing fruits, nuts, vegetables, wine grapes, forage and field crops worth around $1.6 billion annually. Some of these areas are well known: the Napa Valley’s vineyards, West Marin’s dairies, Brentwood’s intensively farmed delta soils. Dozens of others are less familiar: the cool valleys along the San Mateo coast, or hidden gems such as Solano’s Wooden Valley, or the extensive wheat-safflower-tomato crop rotations of the Dixon plain masked by commercial development along the Interstate 80 corridor.

After decades of losing ground to such development, local agriculture is persisting, shedding its hidden-in-plainsight vulnerability, and re-emerging as more people discover its places and flavors, and as more farmers reach out to engage the public. Place-based agriculture — where the community at large values the landmark features, unique culture, and even the characteristic taste (“terroir”) of a particular place — is proving more resilient and more appealing than agriculture dependent solely on commodity prices. Entrepreneurial producers are diversifying with onfarm activities, integrated animal-crop systems, renewable energy projects and value-added processing. And urban agriculture is once again expanding farming opportuni-

ECOLOGY

Bay Area Songbirds Growing Bigger as Climate Changes

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cientists have discovered an unexpected consequence of climate change in the Bay Area: bigger songbirds.

The researchers found that the weight and wingspan of thousands of small birds — including finches, robins, swallows and hummingbirds — Story: increased a small John Upton amount almost // Bay Citizen every year during the past three decades, according to a recent study in the journal Global Change Biology.

The discovery contrasts with findings from another region in the country, highlighting the haphazard and sometimes unpredictable consequences of global warming.

“We were very much surprised,” said Point Reyes Bird Observatory Research Director Nat Seavy, one of the scientists who analyzed 40 years of bird measurements from Point Reyes National Seashore and 27 years of data from Milpitas.

The research concluded that the 73 bird species studied increased in size by 0.02 percent to 0.10 percent annu-

Climate change is causing Audubon’s Warblers and other songbirds in the Bay Area to increase in size. John Son // Creative Commons ally, according to Seavy. The scientists detected the growth in both migratory birds and birds that live in California their whole lives.

A similar study in Pennsylvania found that songbirds there are decreasing in size annually as the climate changes.

“One of the things that makes climate change difficult is that the way it changes ecosystems is going to be very different throughout the world,” Seavy said. “It’s going to manifest it-

self in different ways.”

Ecologists generally expect animals to become thinner and smaller as temperatures rise. According to Bergmann's rule, a theory developed in the 19th century, warm-blooded animals in cold climates will be larger than their cousins in warmer zones, because bigger animals are better at retaining body heat.

Seavy and his team expected the birds would decrease in size in order to stay cool as temperatures around

the globe increased. But the counterintuitive findings suggest that global warming is affecting animals’ body sizes in different ways.

While climate change brings warmer overall temperatures, it also increases the frequency of storms, droughts, wildfires and other conditions that sometimes force animals to endure extended food shortages.

The scientists who conducted the California study think birds could be evolving to be bigger in order to increase fat and muscle reserves to help them survive during those difficult periods.

“Organisms, and birds in particular, need to have some reserves to hold themselves through bad times,” said San Francisco State University ecology professor Gretchen LeBuhn.

“The frequency of bad patches is predicted to increase — and seems to be increasing.”

An alternative theory suggests that the birds are growing because lush, wet conditions associated with climate change on the West Coast have increased the plants, insects and other food available to them.

“It’s getting warmer and wetter here,” said Jill Demers, executive director of the San Francisco Bay Bird Observatory, which was also involved with the study.

ties in cities. Urban gardens are producing food — and inspiring new food growers — at multiple scales, from backyard bean plots and rooftop beehives to blossoming ag zones in Richmond, Oakland and San Jose.

Bay Area food landscapes have a long history: from bountiful foodshed for the indigenous people, to the nation's fruit basket only a century ago, to battlefields between development and agriculture. Today, our farms and ranches face ongoing threats — speculative land values, low financial returns, increased costs, pressure from agricultural consolidation, dismantled infrastructure and cumbersome regulations, not to mention climate-change-induced weather extremes. Yet many people at all levels, from neighborhood groups to regional nonprofits and agencies, are promoting reinvestment in agriculture as a key connection between resilient human and natural communities and are forging the relationships that are at the heart of healthy local foodsheds.

Sibella Kraus founded Sustainable Agriculture Education (SAGE, sagecenter. org), dedicated to supporting multifunctional agriculture at the metropolitan edge, in 2001 and directed UC Berkeley’s Agriculture in Metropolitan Regions program from 2006 to 2009. Science writer Jacoba Charles grew up tending sheep on her family’s Sonoma County ranch.

ONLINE

Citizen environmentalists: crowdsourcing the city streetscape The San Francisco Department of the Environment knows a lot, but it also knows that there are unknowns. So in April, it opened a social media site — ideas4sf.org — where residents, even anonymous ones, can offer their top pet peeves and environmental brainstorms. The department’s InSight Project monitors all comments and responds to some. Users are given 10 votes each to promote their favorite ideas. Log on, and vote wisely. ”I would love to see Columbus Avenue in North Beach closed off to traffic for some periods of time. Evenings, weekends and then eventually full time. Like 16th Street in Denver. Perhaps this could be part of a tourist circuit. This would help promote the local businesses.”

— Anonymous, Oct. 24, 2011 ”In European cities you usually find many downtown areas closed off to traffic to create pleasant pedestrian zones. These zones are great for outdoor cafes, shopping and socializing. Why doesn’t S.F. have anything like this? Castro Street, Union Street and Union Square would be great places to start.”

— James, July 15, 2011 ”Please close off most of the Presidio to car traffic. There are plenty of different routes to the Golden Gate Bridge or adjacent destinations.”

— Anonymous, July 13, 2011 Compiled by: Hyemi Choi and T.J. Johnston// Public Press

GREEN

sfpublicpress.org // Winter 2011

B5 SF Public Press

Cartography: Louis Jaffé Ben Pease Data Processing: John Kelly Maegan Leslie Torres Concept: Dan Rademacher

BAYER FARM

Stephen Joseph // stephenjosephphoto.com

MCCORMACK RANCH

Stephen Joseph // stephenjosephphoto.com

SUNOL WATER TEMPLE AGPARK

Jacoba Charles // Bay Nature

SONOMA COUNTY

SOLANO COUNTY

ALAMEDA COUNTY

On most afternoons, 20 or 30 people come to this organic farm and community garden surrounded by apartment buildings and small, closely built houses in the Roseland district of Santa Rosa. Founded four years ago, the farm transformed part of a 6-acre vacant lot into a community hub in an area badly lacking in public green spaces. Individuals and families tend 36 private plots, and more people are on the waiting list. And there’s a public garden, where anyone can volunteer and go home with fresh vegetables. But the farm offers more than a place to grow things. Each summer, about 70 children come for a free-lunch program; the rest of the year, the farm is an outdoor classroom, where kids learn about food, nature and science. And Bayer Farm is about to expand, using a $5 million grant from a state fund for parks in underserved areas. Soon, the rest of the 6-acre lot surrounding the gardens will become a community park, planned largely by people in the neighborhood.

— Jacoba Charles

Al Medvitz and his wife, Jeanne McCormack, run a 3,700-acre ranch on the outskirts of Rio Vista — land that’s been in McCormack’s family for more than a century. There they grow wheat and alfalfa, and have recently added a new 50-acre vineyard overlooking the river.

They also raise pasture-fed sheep and Boer goats. The couple met in graduate school at Harvard and got involved in international aid work often related to agriculture: Medvitz wrote for a New Guinea farming guide, and McCormack worked with women's microenterprise in Kenya. They decided to return to the ranch when McCormack’s parents grew older.

Over the last three decades, the couple developed a business combining the McCormack family’s farming traditions with their own commitment to land stewardship. They market lamb to Niman Ranch and also sell pasture-raised goat to high-end restaurants, such as Cafe Rouge in Berkeley and Prospect in San Francisco. Their wheat and wool go to wholesalers, and soon their vineyard will produce wine grapes to sell to Gallo. — Jacoba Charles

Fred Hempel runs Baia Nicchia Farms at the Sunol AgPark, where he grows dozens of varieties of tomatoes and other crops specially adapted to the local climate. The 18-acre AgPark east of Fremont is the brainchild of the nonprofit organization SAGE (Sustainable Agriculture Education). The goal of the project is to support community-benefit farming, natural resource stewardship, and public education. SAGE leases the land from the San Francisco Public Utilities Commission, then subleases parcels to farmers who get infrastructure, community and support in exchange for participating in public education programs that SAGE conducts on the farm. Hempel’s Baia Nicchia is the largest of the four farms on the property. Others include Terra Bella, which grows produce for its community-supported agriculture business; Iu-Mien Village Farms, a collective of Laotian immigrants whose organic strawberries are sold at places like Monterey Market in Berkeley; and Fico, a small heirloom fig enterprise.

— Jacoba Charles

RECYCLING

Mushrooms Grown on Coffee Waste Inspire Innovation

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s the world economy increasingly collides with the limits of linear, “cradle-to-grave” production, more eyes are turning toward resource synergies, upcycling and improved efficiencies to relieve some economic pressure and get more value with less waste.

Take coffee. For every pound of coffee beans harvested (of which Story: there were 17 Brian Scoles // Earth Island billion in 2010, Journal according to the International Coffee Organization), 4 pounds of pulp must be collected, and it is generally considered a waste product that is left in heaps to rot. But some companies, such as Equator Coffees & Teas and Thanksgiving Coffee, are supporting efforts to train farmers in Zimbabwe and Tanzania how to use coffee pulp as a substrate for growing oyster mushrooms. As a double bonus, growing mushrooms in it turns the coffee pulp into an excellent animal feed, and sends the nutrients along to become rich manure, and

meat and dairy products. These innovations are helping rural villagers (especially women, whom most of the programs focus on) to diversify their income, establish food sovereignty, and cut back on agricultural waste.

Now let’s tune in to the California version. Mushrooms can also be grown in used coffee grounds, which coffee shops throw away in great quantity. When a business ethics professor at University of CaliforniaBerkeley mentioned this, two students started experimenting. Alexandro Velez and Nikhil Arora grew their first crop of oyster mushrooms in a 5 gallon bucket in a frat house kitchen, and before long they had eschewed their offers from a consulting firm and an investment bank, and founded Back to the Roots Ventures. Their company now collects 10 tons per week of used coffee grounds from Peet’s Coffee & Tea locations in the Bay Area, inoculates the stuff with pearl oyster mushroom mycelium, and sells it packaged as grow-your-own-mushroom kits. Whole Foods now carries them in stores nationwide, and the kits are also available online.

When I had Arora on the phone, he excitedly rattled off other ways that his company is looking to capture value from the waste stream. They are now experimenting with used hops from a brewery and soy castings from a tofu company. They snag pallets from loading docks and use them to build display shelves for their products. When they grow mushrooms in bulk, they resell the used mushroom substrate as a premium soil amendment — notice a pattern here?

Many of these innovations create win-win exchanges: Peet’s pays Back to the Roots to haul away its coffee grounds, and puts a coffee coupon in each mushroom-growing kit to ensure the cycle continues. “We were taught that you must constantly innovate in order to maximize your own value,” says Velez in a TEDx talk. “But what we’ve learned through Back to the Roots, is that you have to constantly innovate to maximize your partner’s value. … This is business 3.0.”

Back to the Roots resembles its own product: Like a mushroom, it extracts nutrients from someone else’s garbage, and creates more value

and more opportunities. And true to their own roots as business school students, Velez and Arora are well on their way to building a profitable company. Their scavenging brilliance permits tremendous savings on material inputs, and their novel business model (and wide smiles) have won them a wide swath of free publicity, and some generous grants and loans.

Given all these savings, I had to raise an eyebrow at the mushroom kit’s price: $15 and up in stores, and $19.95 online. When I asked, Arora gave a classic business-school response. The price is justified by the market; $15 for up to 1.5 pounds of pearl oyster mushrooms is very competitive with the price you might pay for such mushrooms in stores, and the homegrown ones are considerably fresher, with the added fun of watching your little fungal caps grow. Perhaps more importantly, Whole Foods shoppers already have a demonstrated willingness to pay a premium.

When describing his company’s philosophy, Arora invoked Apple, and the comparison is apt. He praises Apple’s aesthetics and user-friendly

design, and wants to bring the same experience to your kitchen. “We want to make it easy as possible for people to grow food at home,” he says. The kits certainly accomplish that goal, making it a perfect gift, conversationstarter or a science experiment for kids. Home gardening can be an intimidating or frustrating prospect, but with most of the variables removed, anyone who can operate a mister bottle can now cultivate premium mushrooms. You may remember one of Apple’s marketing slogans: “It just works.” Back to the Roots also mirrors Apple’s unapologetically high prices.

There are many upcycling companies, and many artists on Etsy, which re-purpose discarded materials into jewelry, backpacks and other products. Back to the Roots goes one better by actually upcyling nutrients, keeping them in production cycles and out of landfills. But I would be happier if some of the resource synergies translated into savings for the customer, rather than the company and its bottom line. This would make the benefits of their innovations more visible and more accessible to a wider

audience. Tom Szaky, the founder of large upcycling company Terracycle, believes in selling his backpacks, purses and other products as cheaply as possible. He told the New York Times in an interview, “People who shop at boutiques already buy green, so you’re not making an incremental change.” I wonder how Arora and Velez would respond.

On the Back to the Roots website, a “replacement bag” of mycelium-inoculated coffee grounds is $8.99, versus $19.95 for the whole kit. This means they’re charging $10.96 for the cardboard box, mister bottle and recipe sheet. That’s not upcycling — that’s upselling. Nonetheless, the company deserves enormous credit for capturing both materials and nutrients from the waste stream, and minting them into a product cute enough to sell at high-end stores. It’s a big step toward starting conversations about nutrient cycles and economic synergies, and this will inevitably direct more attention and action to where it’s needed most: in the lands and lives of the farmers who feed the global demand for coffee beans.

B6 SF Public Press

Winter 2011 // sfpublicpress.org

Healthy SF: Who Pays?

CONTINUED FROM PAGE B3

tive work and constant fundraising is the name of the game — contributed $16 million, mostly from federal grants for taking care of the indigent.

Without that extra $55.4 million, mostly from federal sources, the program would be hard to sustain.

U.S. subsidies uncertain At some point, federal funding to Healthy San Francisco could disappear altogether as federal health reform is fully implemented — or if it is scrapped by a future Republican administration.

“They will have to rethink where the money is coming from,” said Dylan Roby, a research scientist and assistant professor at the University of California-Los Angeles’ Center for Health Policy Research. “They won’t have federal dollars anymore.”

But city officials said the plan all along was that the need for Healthy San Francisco would diminish later this decade with the phase-in of national health care reforms passed in 2010.

Under the Obama reforms, more of the currently uninsured population will get access to insurance through two programs: an expansion of Medicaid and the Health Insurance Exchanges, through which individuals and small businesses can buy insurance more easily. Brigham, the Healthy San Francisco director, said she expects thousands of patients to leave the system with these reforms.

“We don’t think it’s a bad thing that we’ll be serving fewer people,” Brigham said. “We’ve always said from the

”

We’ve always said from the beginning that insurance is preferable to Healthy San Francisco. HSF is not insurance, it’s access.

“

Tangerine Brigham, director of Healthy San Francisco

beginning that insurance is preferable to Healthy San Francisco. HSF is not insurance, it’s access.”

She estimated that 60 percent of Healthy San Francisco’s enrollees would eventually leave under the federal plan. In the meantime, she is not that concerned that nonprofit community clinics are footing more of the bill for treating Healthy San Francisco patients because they are getting federal grants. Before the city program, they got little if any local government money, she said.

Less from business, patients What does concern some city officials, particularly at the Office of Labor Standards Enforcement, is the shrinking financial support by businesses.

The amount collected from employers choosing Healthy San Francisco for some of their employees is small, and gradually falling. The $12.9 million employer contributions last year were down from $13.9 the year before, and off by almost one-third from two years earlier, when employers contributed $18.2 million.

Healthy San Francisco’s budget also is not getting much help from individuals paying into the system. Revenue from individuals choosing Healthy San Francisco as an alternative to insurance in the 2010-2011 fiscal year was only $5.7 million, up $5 million from the year before and $3.2 million the year before that.

By and large, people enrolling in Healthy San Francisco are poor. Even though the city extended the program to uninsured people who make up to 500 percent of federal poverty level — a gross income of $50,450 for an individual, at which level they are asked to contribute a modest $150 a month, plus co-pays — the program has almost no participants in that bracket. Two-thirds of enrollees live at or below the poverty level and pay nothing. Another 26 percent are within 200 percent of poverty, and pay $20 a month — far below the cost of a doctor’s visit.

Experiments nationwide At least one local government, Broward County in Maryland, has decided to replicate Healthy San Francisco exactly, while many other localities are studying it.

Massachusetts and Vermont also have created their own permutations of “universal” health care.

In California the tab for safety-net care falls to counties, which run hospitals largely to take care of the poor and under- or uninsured. (San Francisco is both a city and a county.) The uninsured often go to the nearest hospital’s emergency room, which cannot legally turn anyone away for lack of funds.

The need surely has not gone away. U.S. Census Bureau statistics indicate that the number of uninsured people has climbed during the recession, in San Francisco and nationwide. It estimates 96,107 San Franciscans, including children and the elderly, lack insurance — about 12 percent of the city’s population. So unless and until national reforms take effect, Healthy San Francisco should expect more people seeking help, especially if the economy continues to sputter.

Nationwide 49.7 million people are uninsured — one in every six people. Spending on health care continues to far outpace inflation. U.S. health care spending grew 4 percent in 2009, to $2.5 trillion, or about $8,000 for each person, according to the Department of Health and Human Services. The growth is believed to be accelerating and is projected to average 6 percent a year between 2010 and 2019. Health care expenditures now account for 17 percent of gross domestic product, a measure of spending on all goods and services in the country.

“The U.S. has the most expensive health care system in the world, with health status indicators that are, at best, only average in comparison with the less costly health systems of other countries,” said Shortell of U.C. Berkeley’s School of Public Health, in a recent paper published in the journal Public Health Reviews. “Thus the pressure to provide more cost-effective care is particularly intense.”

Shortell said the advent of patient-centered medical homes could provide more cost-effective delivery of health care, especially if combined with payments that reward health providers for outcomes, rather than charge fees for services rendered. This is what Healthy San Francisco is trying to achieve.

“Studies show medical homes are associated with higher quality at the same or lower costs,” he said. “There’s been half a dozen studies showing that. And the federal government is encouraging medical homes.”

Shortell said Healthy San Francisco seems to be successful in addressing national concerns about costs on a local level by coordinating clinics and hospitals. But he said the city’s reliance on the federal government for much of its money, either directly or through subsidized clinics, was not a big deal. That is to be expected as local governments struggle to figure out the new mix of who pays for the uninsured.

Moving away from paper record keeping story coninued from page B1

bargain compared with the average for private insurance — at $402. But building something that looks like insurance on top of an established public-private safety net can mask the technology requirements and other hidden costs of reform.

The current patchwork of at least 11 different computer systems across the network do not easily talk with one another.

As of the fall of 2011, at least 23 clinics were stuck in the 20th century, relying on large storerooms of paper records not easily shared with specialists or emergency room doctors.

This incompatibility of recordkeeping sometimes causes delays, repeated tests, unnecessary procedures and gaps in care as patients move from doctor to doctor.

Ideally, say technology planners, there ought to be just one system citywide. But that is unlikely to happen soon.

The 16 health centers in the network that are operated by the health department, plus San Francisco General Hospital, will get the most comprehensive database upgrades. The process started last January and will continue through the end of 2013. The system, called eClinicalWorks, will cost $11.1 million for software, computers, office equipment, training and extra staff to manage all the data, and roughly $5 million a year thereafter to maintain.

But among the 17 other clinics, private health providers and hospitals currently developing their own transition to electronic health records, many are fundraising on their own to stay ahead of the curve.

Medical directors from the Sunset to the Mission to Chinatown have reported steep costs for upgrading technology, purchasing equipment and staffing the rollout of these systems.

“It’s rather urgent that things start moving toward electronic-based medical recordkeeping,” said Jonathan Howell, the information systems manager for the Community Clinic Consortium, which includes about half of the safety-net clinics citywide. “It could save untold millions, and huge amounts of staff time.”

Money is not the only impediment.

Some medical staff are reluctant to change entrenched work habits. And many clinics have already invested in obsolete systems and are waiting until they need to upgrade.

They can’t wait too long. Health care providers across the country are facing a 2014 federal health care reform deadline for moving patient records online.

Experts say electronic records, a key to President Obama’s Affordable Care Act, could reduce medical errors by improving the accuracy and clarity of medical information. The initiative promises to give doctors the ability to improve care, cut costs and target preventive care to specific populations such as diabetics or AIDS patients.

Cutting-edge software and infrastructure is expensive. The 14 nonprofit clinics in the Community Care Consortium network are struggling and competing for federal funding to catch up.

One already financially stressed clinic, Lyon-Martin Health Services in Hayes Valley, which caters to the gay, lesbian and transgender communities, said buying a new electronic records system might break the bank.

Prevention needs information One of the first things Healthy San Francisco accomplished in 2007 was to deploy a citywide patient enrollment system, One-e-App. For the first time, patients knew they would not have to sit through interviews to re-enroll in each clinic. Also for the first time, the city knew how many people were using the system, when and where.

Healthy San Francisco’s director, Tangerine Brigham, said before deploying One-e-App, the enrollment system was “confusing” and resulted in wasted time for staff and people seeking care.

“It has been invaluable for us,” she said.

“It has allowed us to have one system of records for our population in terms of their enrollment, their disenrollment, demographics, and our hospitals now have access to find out who is eligible for other charity care programs.”

But One-e-App contains no medical data. And in fall 2011, at least 23 clinics still relied on paper records. When doctors want to refer a patient to a specialist elsewhere, their charts must be scanned, faxed, mailed or retyped. Eliminating this clerical work could save the network millions of dollars each year and reduce chances for error.

Brigham said the city is far ahead of others in the ramp-up to nationally mandated health reform.

The medical records system the city chose, eClinicalWorks, was deployed at the first city-run clinic in August. It also is coming to San Francisco General and will allow some online records-sharing. Still, there are speed bumps. While the clinics can see General’s medical files, they cannot currently add to them.

While Brigham said improving electronic health records is not strictly necessary for cheaper, coordinated and more efficient care, she acknowledged that improved recordkeeping could help Healthy San Francisco achieve those goals.

A medical error can add up to millions of dollars in extra expenses, both for the

Patient medical records, above, are still kept on paper at the Chinatown Public Health Clinic.

Dawn Harbatkin, left, is director of Lyon-Martin Health Services. Jason Winshell // Public Press

city and the sick.

One patient living on $100 a month was sent to the emergency room because of a cardiac arrest, said J.P. Perino, administrative manager at Glide Health Services in the Tenderloin. The patient was charged $2,200 for the ambulance ride, plus the cost of the expensive emergency room visit. She didn’t know precisely how much the emergency room visit cost, but according to standard rates treating a heart attack can cost between $13,000 and $18,000. Perino said the debt went to collection, until the clinic redirected the bill back to the city.

“This was a Healthy San Francisco patient,” she said. “These costs weren’t billed correctly, largely as a result of the inability to share patient records.”

Electronic information sharing is not the only way to make Healthy San Francisco more efficient. The program also gives each patient a “medical home” — one clinic or hospital that is the first place for patients to go with a health problem.

Brigham said the medical homes model creates a stable enrollment base.

”

Duplicated procedures, extra labs ordered or X-rays possibly. And because people

can’t exchange information quickly, the insult is to the taxpayer.

“

J.P. Perino, administrative manager at Glide Health Services in the Tenderloin

More than 73 percent of participants in Healthy San Francisco are continuously enrolled, “which is pretty good for an uninsured population who didn’t before have that kind of access to care.”

That shifts the burden from emergency to preventive care, which is far less expensive. Providers can call a patient when she is due for a mammogram or a flu shot, for example. It also reduces unnecessary cost by allowing providers to track a patient’s health over time.

Brigham said medical homes dramatically reduce the per-patient cost of care.

But the total burden on the General Fund has increased because there are more patients using the services.

Nonprofit clinics scrape by Some non-city run clinics still operate with old-fashioned paper medical charts kept in gargantuan filing cabinets or rooms of shelves filled with rainbowcolored tabs. Clinics across the country are now competing for limited federal grant money to purchase new electronic health record platforms. Many are taking on much of the startup costs themselves by scraping together money from other federal and state funding and from philanthropy.

“These systems are incredibly expensive,” Howell said. “You could pay up to $10,000 for up-front costs, but then there’s ongoing costs — the initial software purchase, training and licensing

and technological refreshes. Those costs can easily outpace the purchase price.”

He compared it to a cell phone: “You buy your fancy new phone, for say $700, and that sounds expensive, but then you look at the ongoing bills: $100 a month, $120 a month. It adds up.”

As a result, San Francisco clinics are operating on a variety of technology systems, most of which don’t talk to each other. That causes problems when a patient moves from one medical home to the other. The end result is more expensive care.

“Interoperability is a big problem in terms of setting the same standards system-wide, while keeping patient confidentiality through encryption,” said Stephen Shortell, dean of the School of Public Health at the University CaliforniaBerkeley. “But these are big challenges that are mounting nationally — they’re not unique to Healthy San Francisco.”

According to the school’s research, last year 18 percent of Medicare patients nationwide were re-admitted to the hospital because of miscommunication, wasting $12 billion.

“These are tools that are supposed to improve patient care and coordination and reduce repeat procedures,” he said.

“This shows us the cost for preventable re-hospitalization — meaning if they were properly treated on an outpatient basis, they wouldn’t have been readmitted.”

Duplicated procedures Doctors at some clinics have significant problems in taking on new patients because they cannot easily absorb electronic files patients bring from other medical centers.

On a recent day outside the Lyon-Martin offices on Market Street and Octavia Boulevard, Dawn Harbatkin, the center’s medical director, described a persistent problem: “Often, I’ll send a patient to a specialty clinic, and I’ll have important lab results and imaging that was done elsewhere but the specialist doesn’t have access to any of that care because they can’t retrieve it from our system. What happens is repeat tests and duplication of expensive procedures, because they can’t get ahold of our information.”

In interviews with the Public Press, a dozen clinic medical directors underscored the same problem. They agreed that the advent of medical homes makes care cheaper in the long term. But as clinics adopt incompatible records systems, appointments can get duplicated and some services can go unbilled because staff cannot figure out the proper medical codes.

“We, as a city, are far from being able to share data between clinics,” said Albert Yu, the medical director at Chinatown Public Health Center. “That’s a problem, because say I have a patient, and they were transferred to California Pacific Medical Center for chest pain, but their medical home is here. Those providers don’t track contextual elements in terms of this patient’s past. Patient history, medications, lab data, diagnostic workup data, allergies, and that’s not even mentioning if they don’t speak English.”

The resulting miscommunication could lead to unnecessary or even harmful treatments or tests, if the patient has, for example, an unrecorded allergy to a medicine.

“There are real problems,” Perino said. “Duplicated procedures, extra labs ordered or X-rays possibly. And because people can’t exchange information quickly, the insult is to the taxpayer.”

Centers fund own upgrades Kenneth Tai is the medical director for North East Medical Services, one of eight nonprofit medical homes in the city.

His clinic, also in Chinatown, sees about 50,000 patients annually, 60 percent of whom are uninsured.

Anticipating the federal move toward electronic health records, Tai got together in 2007 with Mission Neighborhood Health Center and South of Market Health Center to apply for a grant to build

one computer system for all three.

The $2.5 million system, called NextGen, was fired up at North East Medical Services two years ago. The Mission clinic planned to roll it out by December, followed by South of Market in 2012.

Tai said the most useful part of the new system is the ability to audit the patient population to improve services to those needing similar care.

“Instead of before, pulling 100 charts at random to get patient data, now we can just check a box and it generates a list of, say, all of my patients with high blood pressure, or patients with diabetes, or women who are due for a pap smear,” Tai said. “It allows us to reach out to more patients and be more proactive in targeting care.”

However the process hasn’t been easy.

Tai has seen training problems with the shift from paper to digital. Patient privacy is more easily compromised by hackers or human error.

Howell said keeping records secure when sharing information is something a citywide information technology committee is currently grappling with.

“We take this very seriously,” he said.

“But there are vulnerabilities.”

Tai couldn’t estimate how much the clinic had paid beyond the $2.5 million grant, but he did know that it was “a lot.”

The clinic needed at least 300 new computers, to implement NextGen, adding hundreds of thousands of dollars in cost.

Ricardo Alvarez, the medical director at Mission Neighborhood Health Center, said his clinic needs 30 new computers which, coupled with staff training and other software, could cost an additional $500,000. The clinic sees about 13,000 patients annually, only about one-quarter of whom are Healthy San Francisco enrollees. Across the network, that means the cost of upgrading all the clinics could run in the millions.

“This is going to be fundamental for medical homes in the future,” Alvarez said.

Still using fax Ocean Park Health Center, a health department-run clinic, launched eClinicalWorks in August. The clinic is small — just six medical personnel and 3,400 patients. It used to be smaller, but uninsured patients there have tripled since Healthy San Francisco began. The clinic needed a laundry list of additional equipment, which it paid for itself, said medical director Lisa Golden.

Golden said she purchased six computers, five printers, two webcams, two keyboards and a fax machine. A half-dozen people were hired for testing, training and troubleshooting. Doctors, nurses, assistants and technicians who worked part time were bumped up to 40-hour workweeks.

When all health department clinics are finally up and using the system, providers will be able to look at records simultaneously. But Golden is already seeing efficiencies emerge: a reduction in simple handwriting mistakes and more coordinated care.

Before digital records, she said, “medication refills would come in as a fax. That required pulling of paper charts and sorting through information, then reviewing the prescription and faxing it back. But now refills are electronically transmitted.

They come in and get sent back immediately.”

And yet in other ways, Golden said the move away from paper charts has actually slowed productivity. Before eClinicalWorks, a patient visit averaged about an hour of work for clinic staff. Now it is 15 to 30 minutes longer because the workflow of medical staff has not caught up with the technology.

“It takes time to transfer information from the paper record into the electronic format,” Golden said. “We’re reviewing charts longer and deciding what to scan and what to type in as a summary. And it’s also just understanding where to click. It’s not second nature yet.”

sfpublicpress.org // Winter 2011

B7 SF Public Press

MEDIA

Dissecting a Newspaper’s Claim of Anti-Panhandling ‘Clamor’

A

ggressive panhandling” made Page One of the San Francisco Chronicle again recently. But the report, like so many others before it in newspapers, magazines, TV and websites, left readers with more questions than answers about whether the trend indicated by the paper reStory: ally existed.

T.J. Johnston In a story oc// Public Press cupying more than one-third of the front page earlier this month,“Clamor for change is growing” (Web headline: “Aggressive S.F. panhandlers, tourist complaints up”), the Chronicle reported an increase in complaints from tourists and the local hospitality industry about the presence of panhandlers who won’t take no for an answer.

While it quoted hoteliers and travelers opining on the city’s homelessness problem, some vital information was missing from the story: •When they say aggressive panhandling, what activities precisely are they complaining about?

•How do they know the panhandling problem is growing — are there any statistics?

•If there is more desperate poverty on the street, what are the causes?

The story was short on the kinds of details local government, social service organizations and neighborhood groups need to assess the scope and nature of people living in poverty on San Francisco’s streets.

Asked whether the story answered the relevant questions about whether a trend existed, Chronicle writer Heather Knight said: “Everything you asked is in our original story. I think you’d get a great story by talking directly to tourists, hotel owners, business owners, etc., instead of trying to re-interpret our story.”

WHAT IS ‘AGGRESSIVE’?

One question is how city law defines “aggressive panhandling.” According to the San Francisco police code, panhandling is specifically prohibited in any public place, roadway and public transportation vehicle or within 20 feet of an ATM. However, “aggressiveness” appears to have a broad definition. That could include any behavior that causes a person to fear for his or her physical safety. But it could also apply to any repeated requests after the panhandlee says no.

IS IT REALLY A TREND? A front-page report on a social trend in a major metro newspaper typically cites statistics backing up the claim or providing caveats. The only

statistic cited in the story, however, was a mention of tourism having increased 40 percent since last year.

If that’s the case, then it’s the complainers — represented by members of the San Francisco Travel Association, formerly the Convention and Visitors Bureau — who are increasing, not necessarily the panhandlers.

How many cases of aggressive panhandling move through the legal system? Since the Tenderloinbased Community Justice Center started operating in March 2009, it processed 30 citations specific to aggressive panhandling, mostly combined with other charges, such as “illegal lodging,” or sleeping on the street.

But the complaint-driven process results in few prosecutions. “The most difficult thing is having no civilian witnesses,” center coordinator Tomiquia Moss said.

From such low numbers, it’s hard to derive a trend, which is something newspapers typically acknowledge when citing strong opinions about trends. The story cited Tim Falvey of the Union Square Business Improvement District saying there had been “a marked increase in people’s observations of people panhandling, sitting and lying on the street, acting strangely, public urination and public defecation — the whole litany of behaviors that has become really problematic.”

ECONOMICALLY STRUGGLING While the Chronicle focused on inconvenienced out-of-towners in their interactions with homeless locals, the story was short on explanations of factors that might lead to panhandling or homelessness, especially economic.

There are some statistics on that.

The 2010 U.S. census estimates that 15.1 percent of the population — or 1 in 6 people — lives in poverty, the highest rate in 18 years. The rate and number of people defined as living “in deep poverty” — below half of the poverty level — hit a record high.

The current economic climate makes getting by difficult for this subset, anti-poverty activists say.

“The cost of living is going up, but general assistance hasn’t gone up in years,” said Gary Lewis, executive director of the General Assistance Advocacy Project. “All are feeling the pinch.”

And the city’s policy has taken cash out of the pockets of many of the homeless. The maximum monthly allowance San Franciscans can get in general assistance welfare benefits is $422. But those enrolled in the Care Not Cash program are left with $59 if they are offered a hotel room with supportive services or a bed in a homeless shelter.

This might be an indicator that over the decade, panhandling could be an increasing way to supplement low income.

But the city’s Human Services Agency surveyed over 1,000 people in the shelter system earlier this year. Almost 80 percent of respondents asked if they had to ask people for money or spare change replied “no.” Just how much would the average panhandler rake in? Out of the remainder, a little more than half said they take in less than $50 per month.

In recent years of budget trimming, the city’s indigents have lost drop-in programs and social service facilities such as the McMillan Dropin Center, the 150 Otis St. resource center, Caduceus Outreach Services and Buster’s Place.

Homeless policy director Dariush Kayhan, was quick to point out that panhandling and homelessness are very different phenomena — many homeless people have never begged, and many beggars have homes.

Kayhan told the Chronicle that “75 percent of aggressive panhandlers are housed,” though he declined to comment further.

Lewis said the Chronicle story left him with a one-sided feeling: “They didn’t really further any understanding. We see this kind of reporting all the time, with symptoms but not causes, using anecdotes to support a position.”

Staff writers Dhyana Levey and C. Nellie Nelson contributed to this report.

Q&A WITH EDDIE COLLA

Graphic Design and The 99:1 Movement

N

The numbers 99:1 also appear in your artwork, on sidewalks and on the mask images. What is their significance?

I think they’re pretty good odds, aren’t they? I’d make a bet on something that’s 99:1. I think what’s encouraging about those numbers is that the people who have this disproportionate amount of power only have

Crossword answers from Page B8

J

ournalist Juan González holds that the American media have molded public sentiment about race. In a new book co-written with media reform activist Joseph Torres, González argues that newspapers, radio and television have helped perpetuate certain racist views among the general population. González discussed his book on Interview: the KQED program Dave Iverson “Forum” with host // KQED ”Forum” Dave Iverson. Following are excerpts: Iverson: Your basic premise is that newspapers, radio and television have played a pivotal role in perpetuating certain racist views.

So it’s not just that the media is influenced; your central thesis is that it’s really perpetuated certain racist connotations that we hold in this country. Give us an example of how that began very early on in this country.

González: My co-author and I take it back to the very beginning of the press in America, to … the first newspaper on what would be American soil in 1690. The bulk of the articles were centered around intelligence to the settlers as to what “the savage Indians,” were up to. During the colonial period we found increasing intention also paid to African Americans, to the slaves, to slave rebellions and also to “violence” by free blacks or slaves against their masters. We discovered that not only did the press instigate a white racial narrative, but newspaper publishers and editors fomented or justified violence against various racial groups.

González: There are examples of white journalists who stood up and said, “No, this is not what our journalism should be about,” but, unfortunately, they were few and far between. For every one of those, you had newspaper publishers and editors that used their papers to sow hatred and bigotry.

We talk about the Zoot Suit riots that happened in 1933 in Los Angeles, where hundreds of servicemen from the Navy rampaged through the Latino neighborhoods, beating up “pachucos.” The front page of the L.A. Times ... had “Servicemen Teach Pachucos a Lesson.” This is not just an issue of one or two publishers or a chain or a broadcast station. This has been a recurring theme throughout American history.

What drew you into the Occupy Wall Street movement?

Interview: Zaineb I think there are a lot Mohammed of common concerns // New America -— not just the financial Media structure of this country and the widening gap between the rich and the middle class, but also a lot of concern about how much control corporations exercise over the political system. That sort of inequity is what drew me to it initially.

I put the flag on the mask because I feel like there’s a certain grassroots nature about this that is more democratic than a lot of what goes on in this country. A lot of people don’t like the use of flags because they think it shows patriotism or complicity with government, but that’s not why I used it. I used it to create this idea of an American Revolution.

Links Between Racism And U.S. Media Run Deep, Says Author

Iverson: You quote an example from Mark Twain. Twain describes this incident where he sees a Chinese individual who’s beaten. He says, “This incident sticks in my memory with a more malevolent tenacity, perhaps, on account of the fact that I was in the employ of a San Francisco journal at the time and was not allowed to publish it because it might offend some of the peculiar element that subscribed for the paper.”

ew Jersey native Eddie Colla is a Bay Area based artist whose creations have become some of the most popular artistic images to emerge from the Occupy Wall St. movement. New America Media’s Zaineb Mohammed spoke with Colla on the inspiration for the images, as well as their deeper meaning for the growing movement. Colla’s work can be seen via his Wordpress blog at http://eddiecolla. wordpress.com.

And what made you use this mask in your artwork for the movement? What inspired you?

They are Guy Fawkes masks — in the 1600s he was part of a plot to try and assassinate the king of England. The mask was worn in the 2006 film “V for Vendetta.” When the protesters were first down there in Lower Manhattan, they were wearing these masks, and that became a symbol of who was at Occupy Wall Street.

Q&A WITH JUAN GONZÁLEZ

Iverson: We live in a time where the power of the press has declined, and anyone can publish over the Internet, anyone can blog, anyone can be a reporter. Is that a source of encouragement? that power if everybody just rolls over and doesn’t do anything about it. To put it in simple terms, 99:1 is pretty hopeful — it’s a way to encourage people. There are so many more of us than them.

How did it all get started? How did the image expand to include multiple cities?

I put the mask and the 99:1 image up online and then a friend in L.A. called me and said, they’re putting this together in L.A., so maybe you should make one for Occupy L.A., and then I did one for San Francisco.

And after that, people would send me messages, and just say, “I’m in Miami, can you do one for Miami?” There’s probably like 20 or something. If somebody sends me an email, I’ll make them a version.

We had about 2,000 stickers made and they were gone in three days. We’re sending them out all over the country and the world.

People can contact me through Facebook, or through my WordPress blog.

Why do you think this mask, this icon with the numbers 99:1 is resonating with people?

It’s a way for people to represent their solidarity with the movement. I think it’s important for people to have a way to do that — it’s good when artists can create things that give people who are not necessarily visual artists a way to express something.

It’s also an image that is specific to this particular event, that hasn’t been used before — there’s certain imagery out there that gets used for anything slightly revolutionary, like a raised fist, that sort of thing. But I felt like the mask was specific to what’s going on in Lower Manhattan.

Subversive art can go viral when protest movements seize hold.

What other images have you seen out there?

There’s quite a bit of stuff with the mask, as well as text pieces that simply say 99 percent. I’ve seen a lot of things that are sort of local, because these things are all happening on a city basis — landmark images. People have a connection to their city, so when that’s included in the logo, that gives them a

Eddie Colla // http://eddiecolla.wordpress.com

closer connection to the movement.

It’s good to have a bunch of images. If you theoretically have a movement that represents 99 percent, there’s going be a huge amount of diversity in that population, so there needs to be a huge diversity in how people can express themselves.

González: It’s definitely a source of encouragement, but we’ve been down this route before. In early newspapers, almost anyone could print a paper. Every time a new technology develops in our communication system, it upsets the existing order.

It forces the government to come in and establish new rules of operation for how that media system will operate and how the citizens will get information. We’re going through that with the Internet right now: What’s going to happen with public access and cable? What’s going to happen with net neutrality? Will minority ownership of media companies be preserved in this issue of greater concentration of ownership?

It’s not enough to complain about the problems in the media. You have to look at government media policy and what kind of policy promotes the greatest possible diversity of viewpoints and ideas, so that people can be exposed to all kinds of perspectives and therefore become better citizens.

Our main concern in writing this book was over the issue of ownership of media companies. The ultimate form of job advancement for any journalist is not just to work in a media company, but to own a media company. The reality is that minority ownership is declining.

Ultimately, it’s the owner and the boss who decide how your company is going to approach news. Therefore it’s imperative to have a media system that is owned by a diversity of people.

B8 SF Public Press

Winter 2011 // sfpublicpress.org

STREETSCAPE PUBLIC HEALTH

Tenderloin’s Dream Toilet: Free, Green, Compostable

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n its campaign to provide free public bathrooms and eliminate human waste on the streets, the North of Market/Tenderloin Community Benefit District has invested $20,000 in an Oakland company to design a prototype public toilet that, if it can really recycle waste, could end up serving the rest of the city and beyond.

The seed money would start Hyphae Story: Design LaboratoTom Carter ries on its way to go // Central City where no one has Extra successfully gone before in making a durable, compostable public loo.

“We’ll need to attract more money,” Hyphae founder Brent Bucknum told the Tenderloin Futures Collaborative on Oct. 19. The company’s contract with the district shows it needs $94,000 for development. Key to development of the Tenderloin toilet is public input to hear what type of W.C. people want, Bucknum said.

The community benefit district is concerned because the neighborhood each month experiences “700 to 800 incidents” of human feces in the streets, sidewalks and alleys, said Dina Hilliard, the group’s executive director. In the district’s initial effort to address the issue in early 2011, it contracted with Rescue Mission on Turk Street to open its bathroom weekdays for the public.

In May, despite a usage report showing a $5-a-flush average cost over three months, the district extended the pilot six months.

Hyphae is a 4-year-old company that consults, researches and designs ecosystems. With a San Francisco Arts Commission grant, it created the 2.2-acre living roof on the California Academy of Sciences. And in the mid-Market Street area it created the Luggage Store gallery’s living wall and the green roof at the Glide social service center, and helped with the Tenderloin National Forest, a garden on Cohen Alley off Ellis Street.

Hyphae’s finished product, if it comes up with the development cash, could be ready sometime next year and would need a half-dozen city permits. Each toilet would sell for between $40,000 and $50,000, Bucknum said.

The waste would be picked up and

CITY VIEW

Urban Crossroads

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an Francisco photographer Jason Winshell set out to capture the experience of social navigation in “Urban Crossroads,” a collection of photographs to be published in spring 2012.

In crowded urban environments, where diversity collides with density, the social communication system is put under stress and tested.

People are pushed together, squeezed through bottlenecks, walk and wait in groups, stand in lines and navigate around physical and human obstacles.

Photos: He chose to use still photography to capture his Jason Winshell // Public Press images because it is a near-perfect medium because it freezes people’s instinctual behaviors, reactions, and my own perspective. “I used the camera as a substitute for my eyes — making eye contact through lens, scanning the people standing with me as if I was looking through a periscope. The result is an intense distillation of social dynamics.”

All photographs in the collection were taken from 2010 to 2011 in downtown San Francisco. A selection can be found on the Web: www.jasonwinshell.com/content/galleries/urban-crossroads

Women in headscarves cross O’Farrell Street.

Men with hats make their way up Stockton Street at Union Square.

SF Public Press Crossword // Andrea Carla Michaels

Too Hot to Hoot

ACROSS 1. 1965 Beatles film 5. Hippodrome events 10. ”Harry’s Law” members, for short 14. Lily-livered 19. Insidious 20. ”That’s ___” (Dean Martin classic) 21. Fancy shooters 22. Ammonia compound 23. Minotaur’s home 24. Incorrect presidential spelling advice?

26. ”A man, ___, a canal, Panama” 27. ”Highway to Hell” rock band 29. Award in the ad biz 30. How Ph.D. theses are defended 31. ”Cosby” costar would not digest minty herb 37. Artist Max 38. Gymnast Korbut 39. Flies in the face of 40. Bro’s sib 41. Japanese beer 43. Part of FDIC 47. DJ’s desire?

51. Frat letters 53. ___ florentine 51. On fire 54. Lake Titicaca backdrop 55. British Nobelist Paul 57. Jackie of ”Shanghai Noon” 58. Suburb of Minneapolis 60. ”Fool’s Gold” 62. Recovery Act of 2009 initials 63. ”Dude, don’t you get you see before you royalty, like the Prince of Prussia?”

68. Morse or man 69. Mogadishu men 70. ”Shazam” and ”Damn!”

71. SFO info 72. Bullets 73. Ghana’s capital 75. 180-degree turn, slangily 76. Nutritional figs.

77. Alex … meet Roger 83. ”Survivor” or 12-step 86. Running tracks 87. Ming of the Rockets 88. Brand again

91. Short time, for short 92. Kind of whale 94. Mad Akita on the loose in a Buddhist tower?

99. Give a pep talk to or admonish 100. Squeeze (in) 101. ”He’s Just Not That ___ You” 102. Ecological community 103. ”Oh, supermodel Campbell ... (sigh!)”

107. Flabbergast 111. Acting Christian family members?

112. Fly-by-nighters?

113. 1,000 kilograms 114. Given the ax, with ”off” 115. Rosebuds, e.g.

116. ”Put a tiger in your tank” brand 117. Betty Ford forte 118. Glimpse DOWN 1. It can go up when the economy goes down 2. A sister of Zsa Zsa 3. Richard’s ex, twice

4. Pretty follower 5. Funky musical genre, for short 6. Rival of 116A 7. ”Cougar Town” star 8. ”___tu”: Verdi aria 9. Capitol V.I.P.: Abbr.

10. Askew 11. Prepared to take off 12. Countdown finish 13. Two-dash ID 14. Like a beauty queen 15. Catch-22 situation 16. Vanilli’s lip-syncing partner 17. Collectively 18. Refudiate, to Palin 25. Final Four gp.

28. Javelin or Fit 30. ”Village Voice” awards 31. ‘70s teen idol Garrett 32. Answer to ”Who’s there?”

33. Webster and Wyle 34. Grades 1-12, for short 35. End of week cry 36. Civil servant 37. Greek letter that looks like a trident 41. Gomez or Morticia 42. Manuscript enc.

44. Gung-ho 45. Bells and whistles?

46. Hawaii’s Pineapple Island 48. Alaskan army base 49. 1963 Beatles song subtitled ”Go to Him” 50. Pastoral poet 51. “Holier than thou” type 52. ”Don't you just ___ it when … ?”

56. CPAs’ recommendations 57. Harvard student, informally 58. Ham 59. Cool cat 60. ___ Alto 61. Art class garb 63. Freeze over 64. Glove compartment item 65. 1816 Jane Austen novel 66. Pinup’s pride, perhaps 67. Bern river 73. Bananalike plant 74. ”Shrek” frame 76. Blitzed 78. ”Eboli” director Francesco 79. 50-50 80. Gazed at 81. ”Avis” adjective 82. First name in Cruises?

84. Pampered 93D, e.g.

85. Backslide 89. Showy parrots 90. Matriculates 91. Nero’s 1,901 92. ”___ Pepper’s Lonely Hearts Club Band” 93. see 84D 94. Along the line of rotation 95. Wild Asian dog 96. ”You are not!” retort 97. Upright, e.g.

98. Tacked-on wing 99. Subsides 103. San Francisco valley 104. ”___ be an honor” 105. Bartender Szyslak on “The Simpsons” 106. Neighbor of Que. 108. Hawaiian lavas 109. Pizzazz 110. ”Grand” ice cream maker

Answers appear on Page B7.

Don’t cheat.

trucked away for treatment. A security and safety feature puts a push-button “water station” on an outside wall, instead of having an inside washbasin.

San Francisco’s 25 highly automated JCDecaux public toilets cost around $300,000 each, Bucknum said, and require costly maintenance because they are breakdown-prone. He visited six one day, and half were broken and shut, he said. A fully automated model costs $6,000 to $20,000 a year for water and sewer.

Hyphae’s concept would not use city water and sewers and would turn the loo’s human waste into fertilizer for inedible plants to pay for the cost of the toilet — a tall order. One of the best examples of public toilets Bucknum studied is a new prototype, similar in shape to a JCDecaux toilet, developed in Portland, Oregon. But that city fell short in its desire to create a compostable waste system, and its four loos in operation are hooked up to the city’s water and sewer system.

Hilliard spoke to Water Department spokeswoman Anne Hill about the loos.

Hill told her a green toilet was “impossible.” Hill told Central City Extra that Portland had looked everywhere for a durable ecological toilet, but couldn’t find one and couldn’t invent one. “That was our only roadblock, a durable, compostable toilet.”

A public toilet must be able to withstand the blows of a baseball bat, Hill said, and for that reason Portland toilets have heavy “penitentiary gray” commodes.

“That’s our urban toilet,” she said.

“But they must be visible. If not, they won’t be used and the old problems come back.”

Portland’s toilets have impressive features. The Americans With Disabilities Act-compliant, stainless steel portables hook up to water and sewer and are big enough to bring a bicycle inside. Their solar-powered lighting brightens when the bathroom is used, then dims. Ventilation slats at the top, and angled slats all the way around the bottom show how many feet are inside. A button-operated washing station is outside. The toilets are open 24/7.

Security, safety and privacy are key issues, Bucknum said. With JC Decaux toilets, “no one knows what’s going on inside.”

SUSTAINABILITY

Big Changes for Great Highway Near Ocean Beach As Planners Grapple With Rising Sea Level Threat

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ave you heard about the Ocean Beach Master Plan? The San Francisco Planning and Urban Research Association, or SPUR, is facilitating a “sustainable long-range plan” for San Francisco’s shoreline because erosion of the beach and anticipated rising sea levels may necessitate major changes in the infrastructure that serves the area.

In September, economist Story: Molly Samuel Philip King of San Francisco // KQED State University unveiled a News Fix blog study aimed at putting estimated price tags on potential economic losses from sea-level rise, a study in which San Francisco’s Ocean Beach emerged as a major potential loser.

KQED’s Molly Samuel talked about the Master Plan with Tom Prete, the editor and publisher-inchief of the Ocean Beach Bulletin, a KQED News associate. (Note: Prete did some work for SPUR previously.)

Following is an excerpt from Samuel’s interview: Molly Samuel: What led up to this plan?

Tom Prete: This project goes back many years through multiple task forces and projects under several mayors. There have been people who are concerned that no single agency is responsible for Ocean Beach.

A lot of people who care about Ocean Beach have been trying to get everyone on the same page and create a way forward, something everyone can live with, even if they don’t get everything they want.

Samuel: Explain what agencies are involved.

Prete: The beach itself is part of Golden Gate National Recreation Area, from the O’Shaughnessy Seawall in the north, opposite the Beach Chalet that you walk up to to get to the Cliff House. Everything to the west, the sand side, is GGNRA, down to the wet sand of the beach. On the other side of that seawall is the parking, which is city property. But if you go down those steps, you’re on federal property.

The California Public Utilities Comission has a great deal of infrastructure at or near the beach. A major sewage transport tunnel under the Great Highway feeds the oceanside water pollution control plant at the south end of Ocean Beach. That’s city property operated by the San Francisco Public Utilities Commission, but maintaining the road and the oceanside water pollution control plant is all done by the Department of Public Works.

Samuel: What are some concerns being addressed in the Master Plan?

Prete: One of the big challenges for Ocean Beach is what will happen if sea levels rise?

We’re seeing some erosion, especially on the south end of Ocean Beach, that could be attributable simply to singular storms. Those have caused some major problems, including the closure for several months of the southern extension of the Great Highway.

But in addition to those singular events, there is the likelihood that the sea level is going to rise, and when we get large storm surges, they’re going to have a greater impact. Are we going to have a nice sandy beach, or to protect the Great Highway and the sewer transport tunnel and the water pollution control plant, are we going to have to install large seawalls?

Samuel: These are big infrastructure suggestions. How do people in the neighborhoods around there feel about them?

Prete: In spite of the fact that potentially there will be some major changes, a lot of people aren’t paying a lot of attention to the plan, or if they are, it’s not coming through in terms of the voicing of opinions. That in part is due to the scope and scale of the plan. It’s so large, it encompasses the beach from north to south and it plans for several decades, so it’s hard for people to get their minds around.

But I have heard from some readers concerned about the Great Highway. I got an email from a reader who wondered if there’s ever a need for emergency transportation out of S.F., where are the residents of Richmond and Sunset going to go? How do they get out of the city if they’re not going north over the Golden Gate Bridge or east across the city? If they need to go south, how do they get there? The surface roads we have there are not designed to handle a great pulse of traffic like that. The Great Highway is, in this reader’s opinion, a necessary artery out of the city.

But can we maintain the Great Highway there no matter what? Is the ocean going to make a decision for us if we don’t make one through the master plan now?

Samuel: What are the next steps?

Prete: SPUR is gathering public input on their draft proposals. They will come back with a revision, with the goal of having a completed plan in February 2012.