Top Story: Health

Thinking big about a weighty issue

The county workforce is expanding—and not in a good way.

When Kaiser, the largest provider of health care to Los Angeles County workers, took a comprehensive look at employees’ vital statistics a few years back, it set off a big wakeup call at the Hall of Administration.

“The numbers were staggering to me,” said Lisa Garrett, the county’s director of personnel.

No wonder. Kaiser found that 76.7% of county employees enrolled in its plan were overweight or obese (compared to the national average of 69.2%.) What’s more, 37.3% had borderline or high cholesterol, 12.3% had high blood pressure and 7.9% were diabetic. Alarmingly, they also seemed to be passing the problem on to their kids, with 40% of enrolled employees’ children weighing in as overweight or obese as well.

“We’ve got to get ahead of it,” Garrett thought. And thus—in a partnership between Human Resources and Parks and Recreation—the Countywide Fitness Challenge was born in 2010.

As the 2013 Challenge rolls out starting this month, Garrett is adding a personal—and very public—dimension to the initiative.

At Tuesday’s Board of Supervisors meeting, she noted the large percentage of overweight county employees and declared: “I have to admit that I’m in that number. But just wait till after this year’s Countywide Fitness Challenge.”

Garrett’s UCLA cheerleading days may be a thing of the past, but she’s not afraid to get a little rah-rah when it comes to promoting fitness. And if that means going public with her intentions, so be it.

“I am coming out to say, ‘I am going to do it and you keep me honest about it,’ ”Garrett said in an interview afterward.

“I would love to get back to my college weight. I used to be a cheerleader in college. I said I’ll never see that uniform again, but I have it hanging in my closet,” she said, laughing.

Beyond that kind of motivation, there’s another powerful force at work.

“In my own family, obesity is an issue,” Garrett said. “I had a sister who had breast cancer and she passed away. My mother’s had cancer, my sister’s had a stroke. And the common thread with all three is that they were obese. So if I’m going to change that from happening to me, I’ve got to watch my weight.”

She already watches what she eats, so “I know the bottom line is going to be getting more active.”

For Garrett, like many employees, that will mean carving out time in a busy schedule.

“My day starts early and I’m here late,” she said. So she’s trying to schedule “walk and talk” late afternoon meetings that can be conducted while moving through Grand Park.

She’s also a big believer in taking advantage of all the free health testing available at Fitness Challenge events, which are held on weekends in all five supervisorial districts and are for employees, families and even pets. (Kickoff events are scheduled for May 18 at Whittier Narrows Recreation Area and May 21 at Grand Park, with other activities scheduled around the county in coming months.)

“For myself, it was at one of these events that I learned that my cholesterol range was going up,” Garrett said.

Free screenings offered include tests for glucose, blood pressure, body mass index and many others, along with fitness activities ranging from extreme boot camp to yoga, from power walking to hula hooping to Zumba.

Then there are the healthy cooking demonstrations.

“People are amazed at how delicious the food is,” Garrett said, recalling a tasty salad she sampled at one such event in Marina del Rey. “It had watermelon, fennel, mint and red onions, and it was absolutely delicious,” she said. “It has become a staple at our house because it is refreshing and healthy.”

In addition, the year-long Challenge features wellness newsletters, health fairs co-sponsored by county departments and labor groups, and the county’s popular Biggest Loser contest.

Amid all the challenges, there are some positive indicators—including the number of employees completing health assessments, in which they learn and begin tracking measurements like weight, blood pressure and cholesterol. The number of employees completing the assessments has gone from 1,502 in 2010 to 15,267 last year.

That kind of knowledge is power when it comes to preventing disease, she said.

“The bottom line is the Fitness Challenge is not a panacea for what ails us, but it will hopefully put the spotlight on the issue and the need to get more healthy as a county community. We could sit back and do nothing, but that’s not acceptable.”

Posted 5/2/13

These co-workers go the distance

Among the thousands of runners at the start of the L.A. Marathon in 2011 was a nervous but excited band of sisters. It was their first marathon, and at their side was their “mother hen,” veteran runner Sachi Hamai, more commonly known by her official title—executive officer of the Los Angeles County Board of Supervisors.

Three of the women were on Hamai’s staff. The fourth worked for Supervisor Gloria Molina. For months, Hamai would lead them on pre-dawn runs of gradually increasing distances. Before they’d even hit the streets, she’d drive the route and strategically stash water bottles so the women wouldn’t have to carry them.

After one of their sessions edged above 13 miles, Hamai, who oversees the Board of Supervisors’ agenda, came clean with an agenda of her own. “We’re going to do a marathon,” she decreed. At the close of those morning training sessions, she began urging them to visualize what it would be like to cross the finish line into the joyous and proud embrace of family and friends

Hamai was so persistent that before the starting gun was fired on the morning of the 2011 marathon, Maria Duron of the executive office remembers thinking: “What am I doing here? Did I ever say yes?”  In the end, she’s forever grateful she never said no. “When we started training, I couldn’t even run a mile,” she says. “When we finished, I said, ‘We did it!’”

All five women did, in fact, finish the race, one of the most grueling in L.A. Marathon history, with rain coming down so hard that the streets were sometimes shin-deep in cold water. “I felt so horrible,” Hamai recalls. “I thought they’d never run with me again.”

She was happily wrong. Since then, the co-workers have logged countless more miles together in a ritual that the women say has created not only strong bodies, but strong bonds. “There’s a lot of chatter during our runs, but it’s not about work,” says Hamai, whose running shoes are always within arm’s reach, even when she’s at her desk. “We listen to each other about our personal lives. We push each other. If one of us says, ‘Let’s just get some coffee this morning,’ someone else will say, ‘Let’s get it after the run.’ ”

Come Sunday, 26,000 runners will once again lace up for the L.A. Marathon, a 26.2 mile journey of sweat and blisters from Dodger Stadium to Santa Monica. This time, though, the coach will be on the sidelines. “My mind is willing but my body isn’t,” Hamai says. Instead, she’ll be rooting for the sole member of the team to brave this year’s race—Avianna Uribe, operations director for Molina. “They’ll be there in spirit,” Uribe says of her training partners in the board’s executive office.

Still, Uribe will have company from a few other county colleagues along the route, including Ryan Alsop, assistant chief executive officer for intergovernmental and external affairs. This will be his fifth L.A. Marathon. But unlike the county women, he runs solo. “I’m an intense trainer and I like to be in my own head,” says the 42-year-old Alsop, whose fastest marathon time is 3 hours and 16 minutes.  Although the fleet-footed exec will be running alone—heavy metal music pulsing through his ear buds—he says he’ll be joined at the starting line by a first-timer, the county’s Sacramento lobbyist, Alan Fernandes, whom Alsop convinced to give it a shot.

Fernandes, a long time cyclist and modest runner, says he thought the L.A. Marathon would be a perfect way to get a street-level view of the county he represents.  “I’m using it as a sightseeing tour,” says the Northern California native. Fernandes is hoping he’ll be able to make that tour all the way from stadium to sea. His longest training run a few weeks back was 20 miles, he says, and that one “really kicked my butt.  Going another six miles is going to be pretty tough stuff.”

“I’m kind of nervous,” he admits, “but I’m going to try to be calm.”

Meanwhile, Hamai is going to try to stay optimistic about her future on the roads. “It’s sad because I almost feel like I might not be able to run that far again,” she says. Last year, she and Uribe ran two marathons—Los Angeles and Chicago—and a dozen half-marathons, all of which took a toll on her body. “I just need to back off,” she says.

But, apparently, not for too long.

The other morning, Hamai and her business-attired running crew—Uribe, Duron, Salene Giron and Ernestina Rhind—gathered in her office in the Hall of Administration to display their bounty of gleaming race medals for a county photographer. Hamai noted that the sign-up for the St. George Marathon in Utah—where she ran her first marathon in 1997—was beginning on April 1.

“You can bet I’ll be trying to get into that one,” she said, and then added with a sly smile: “And I’m going to get the other girls to sign-up, too.”

(To watch the race, consider taking Metro, which has nine stations along the course. And if you’re driving, watch out for street closures.)

Updated: Avianna Uribe and Ryan Alsop finished the marathon in fine form. But Alan Fernandes, after months of training, was unable to make the trip to L.A. from Sacramento because he was sick. Hats off also to two other marathon finishers from the county workforce: Andrew Veis, assistant press deputy to Supervisor Don Knabe, and Mark Pestrella of the Department of Public Works.

 

Smokers got you down? Light up a line.

So the neighbor is polluting your place with cigarette smoke. Who you gonna call?

For a growing number of Southern Californians, it’s the Los Angeles County Department of Public Health.

For years, the department’s Tobacco Control and Prevention Program has manned a phone line for complaints about those who flouted state laws against smoking, and for years, those calls mostly involved bars, restaurants and workplaces.

Lately, however, secondhand smoke wafting into apartments, condos and nursing home units has kept the line buzzing, says Tobacco Control deputy director Monty Messex. In the last six months alone, he says, 88 such complaints have come in via the Tobacco Control complaint line, far more than in past years. Forty-two percent, he added, came from the City of Los Angeles.

“It’s possible that people are smoking more in their apartments now because there are fewer and fewer places anymore to smoke in public,” Messex says, “but I think it’s more about awareness. People are realizing they have a choice.”

Smoke-free housing has become the latest frontier in the tobacco control movement, as health advocates and apartment dwellers have sought to stop secondhand smoke from drifting out of patios, balconies and neighboring units into non-smokers’ homes.

Despite arguments from some smokers and civil libertarians who view the push as an inconvenience and intrusion, California has led the charge in clearing smoke from shared living spaces. The state Department of Public Health has aired popular TV ads depicting secondhand smoke rising from vents to threaten small children, and more than two dozen jurisdictions including Santa Monica and Calabasas have adopted ordinances that restrict smoking in multi-unit housing. Last year a state law went into effect giving landlords permission to manage smoking in rental properties. 

Next month, the Los Angeles County Housing Authority, which manages and owns 3,258 public and affordable housing units, is expected to seek approval on lease changes that would ban smoking within 20 feet of its buildings. Maria Badrakhan, director of the Housing Authority’s housing management division, says the move will affect some 7,000 renters from West Hollywood and Marina Del Rey to East Los Angeles and Long Beach, but so far, residents’ reactions have been overwhelmingly positive.

“We have a lot of seniors, a lot of families and people whose children have asthma, and we receive a lot of complaints from people who don’t want smoking in their buildings,” says Badrakhan, adding that the Department of Public Health has been working with the authority to help tenants quit smoking. 

“We’re trying to create a better quality of life.”

The Tobacco Control complaint line—which essentially rings during business hours into the Tobacco Control and Prevention Office at 213-351-7890—is just a small part of the county’s effort to connect victims of secondhand smoke with agencies and authorities who can help.

The DPH’s Messex says it’s a challenging assignment, given the 88 separate jurisdictions and the patchwork of municipal smoking ordinances in the county. Sometimes, he says, the response is as simple as sending a letter to the property manager or owner and referring the caller to the appropriate fire department or code enforcement unit. Often, however, the county also will send callers to organizations such as S.A.F.E. (Smokefree Air For Everyone), a Granada Hills-based advocacy organization that operates an online, smokefree apartment registry.

“More and more people have come to us from the county,” says S.A.F.E.’s associate director, Marlene Gomez. “We’re getting 5 to 10 calls a week, and email in droves.”

Some of the complaints are heart-wrenching, says Gomez. “I had one case where a mother called from a rent control apartment in Wilmington with three kids—a 4-year-old, a 5-year-old and a 4-month-old baby—and the 5-year-old has asthma and smokers had moved in downstairs.”

In that case, she says, she was able to persuade the landlord to move the family to a different apartment and to let him know that he could keep smokers away in the future by specifying units as non-smoking as they became vacant.

But for many of those who complain, Messex says, recourse is limited because restrictions have yet to be enacted by the state or by most of the municipalities in the county, including the City of Los Angeles, and the bans that do exist vary from jurisdiction to jurisdiction.

“There’s not a lot we can do,” he says. “And in some cases, the situation is pretty severe.”

Apartment dwellers like Cris Borgnine say comprehensive restrictions would make a difference. Borgnine, a 46-year-old cameraman and photographer with two little boys at home, aged 3 and 7, says he started searching for help after smokers moved in not only next door, but also around the corner and downstairs from his North Hollywood apartment.

“It’s been really frustrating,” Borgnine says. “The smoke comes up through the kitchen fans and the heating ducts. When the onshore breeze blows, it comes in through our bedroom window. When you’re having dinner, it’s awful.”

In addition to his concern for his family’s health and the impact on his quality of life, Borgnine adds, his irritation had a personal angle: His father, the late actor Ernest Borgnine, had to have throat surgery at one point in his life because of complications from smoking. So when calls to the apartment manager failed to persuade his neighbors, he started dialing.  

Eventually, he says, he got through to the county’s complaint line, only to learn that little could be done in his jurisdiction, other than sending his property manager a letter.

“We really need to do something about this,” he says. “Fortunately, my family and I have the resources to move to a new place, but the next person to move in is still going to have to deal with it.”

Posted 2/14/13

A passage to India

Vishal Makhija is going home.

He journeyed to Los Angeles in 2009 with dreams of becoming an accountant. Instead, he spent the past nine months at Los Angeles County+USC Medical Center—his body broken, his brain permanently damaged from a hit-and-run driver who mowed him down during an evening walk. On Wednesday morning, Makhija’s stay came to an end as he was gently lifted into a special medical transport jet bound for Mumbai, India, where his family will give him the constant care he now needs.

The $19,200 trip is being underwritten by Los Angeles County.

“Our family is middle class by Indian standards but, for us, the cost was out of the question,” says Kiran Makhija, who has lined up a nurse, a physical therapist and a specialized hospital bed in India for her 32-year-old brother. “This is a huge relief, and we are very grateful. I am 100 percent sure that Vishal will heal better and faster with family and friends who love him here.”

Makhija’s case represents an innovative effort by top county health officials to reduce hospital costs while improving patient outcomes for large numbers of hard-to-place indigent patients who are taking up public hospital beds longer than medically necessary.

Dr. Mitchell Katz, director of the county’s Department of Health Services, says he hopes to create a special fund in his budget for “creative discharges” like Makhija’s that, with some imagination, could be solved in ways that do right both by the individual patient and by the county’s limited pool of health care resources.

“Of course, each case is different,” Katz says. “There isn’t a cookie-cutter solution.” Housing and special placements have their own price tags, he notes, and sometimes the circumstances and the medical needs will make the hospital the most cost-effective decision.

“You have to look at each person and figure out what they need,” he says. “But once you’ve figured that out, if there’s a solution that’s substantially less expensive, you should be able to move on it.”

Dr. Christina Ghaly, LAC+USC’s interim chief executive, says that on any given day, approximately 10% of the hospital’s acute care medical beds, and about half of its acute care psychiatric beds, have been occupied for weeks or months by patients who should be in a lower level of care but have no provider willing to take them.

Because LAC+USC is a hospital of last resort for the impoverished, homeless and poorly insured, its rate of hard-to-place patients is far higher than that of private medical centers. At any given time, there are as many as 60 patients like Makhija, who not only increase the public hospital’s costs but also crowd out patients in need of acute beds. Some have remained hospitalized for so long that they’ve lost their housing. The county’s other three public hospitals fare little better, says Ghaly: “There’s a patient at Olive View whom we’ve been trying to place now for two years.”

Katz says he has been concerned about Los Angeles County’s high numbers of hard-to-place patients since he arrived here from San Francisco two years ago. Aside from the financial issues, he says, overlong hospitalizations can have serious medical and psychological downsides for patients, including risk of infection, atrophy and disorientation.

“When I would ask about why we weren’t sending someone to supportive housing or a board and care, or why we weren’t sending people home to be reunified with family, I was told, ‘Well, the county is in the midst of a fiscal crisis and we don’t have the budget.’ But that has never made any sense to me, because, of course, the most expensive thing to do is to keep people in the hospital.”

So the county has begun exploring alternatives, from “respite” beds where homeless convalescents can recuperate in their own bedrooms like more fortunate patients to providing financial incentives to skilled nursing facilities for taking difficult or poorly insured patients. Katz estimates that broadening the options for lower levels of care could save the county “tens of millions of dollars” while improving patient care.

The push is especially important in the wake of the federal Affordable Care Act, which promises to change the business model for health care providers by, among other things, accelerating the trend toward lump sum allotments for patients and procedures, rather than reimbursement for days in a hospital bed or fees for a medical service.

“But it’s not just about money. It’s about finding the right place for the person,” Katz says.

Finding a place for Makhija was especially frustrating because, unlike many indigent patients, his relatives were ready and willing to care for him, says interim CEO Ghaly. “The problem,” she says, “was mainly logistical.”

In fact, Makhija was planning to return to India, according to his sister. “Nothing was going right for him there,” says Kiran Makhija, an account manager for a public relations firm in Dubai.

“He used to dream, talk, visualize, live and breathe U.S.A.,” she says. “He was the biggest fan of Oprah Winfrey and would lay awake late at night watching U.S. destinations on the Travel channel.” But after spending four years in New Jersey on a visa to work and study accounting, she says, he was laid off during the 2008 financial crash and never recovered.

He moved to Los Angeles, hoping to find work, but couldn’t muster more than low-paying jobs in retail, according to Sahib Dudani, a family friend in Laguna Hills to whom Makhija had reached out. Dudani says the young man was living in a rented room in the Boyle Heights apartment, a few blocks from the site of the April 18, 2012, accident.

Hospital records show that paramedics rushed Makhija to the emergency room at 4:25 a.m. after a passerby saw him lying unconscious in an intersection near Soto Street and the I-10 Freeway. His legs were broken, his brain was traumatically injured and his body was marked with tire tracks, but no witnesses came forward and no arrests were made.

“He was coming to me [on the week of the accident] so I could advise him on his next step, including possibly going back to India,” says Dudani, a computer scientist who had known Vishal’s aunt in Mumbai. “When we didn’t hear from him for a couple of days, we got very concerned and went to his address.”

Kiran Makhija says family members were frantic when they learned what had happened, but their applications for emergency visas repeatedly denied. “They said he was in the U.S. illegally, so no one in the family could come for him. But he had a valid green card.”

When her brother emerged from intensive care after a month, the family began brainstorming ways to get him back to India. Kiran, who had been working in Mumbai, took a higher-paying job in the United Arab Emirates, realizing her semi-retired parents would need the extra money.

But as months passed, it became clear that Vishal would never be able to get on a commercial airplane. Although he begged to come home, his injuries had left him impulsive and unable to sit up for more than three hours at one time. He was incontinent and could not move without a specialized stretcher and wheelchair. An international air ambulance would cost tens of thousands, if not hundreds of thousands, of dollars—an impossible sum either way for the family.

Meanwhile, hospital social workers also were running out of options. Makhija had Medi-Cal coverage, but it would only reimburse for hospitalization that was a medical necessity.

By now it was November and the hospital’s unreimbursed costs were approaching $300,000. Every day, social workers were calling ten or more nursing facilities throughout the state, but none would take him. Such facilities, which typically care for elderly patients, resist taking younger, more labor-intensive clients, particularly those with permanent brain injuries and public insurance, such as Medi-Cal, that reimburses far less than private policies, Ghaly says.

“Finally, we exhausted all other efforts and started thinking outside the box,” says Cecil Clark, an associate hospital administrator at LAC+USC.

Clark says that as he cast about for ideas from his team, Sandy Correa, who had come on board the month before as an assistant hospital administrator for medical services, piped up with a question: If Makhija wanted to go home, and his family couldn’t come and retrieve him, why couldn’t the hospital take him to them?

The specialized transport she eventually found, Florida-based Commercial Medical Escorts, Inc., was substantially cheaper than an air ambulance—and less than half the monthly cost of Makhija’s bed at LAC+USC. He’ll be able to lie flat as much as necessary during his journey and will be accompanied by a nurse from Los Angeles to Mumbai, where he is scheduled to land early Friday.

Although such escorts are often used by other hospitals, health services director Katz says they are a departure for Los Angeles County. He says it took more than a month to get all the necessary approvals inside the bureaucracy but the alternative was for the county to foot the bill for Makhija to spend the rest of his life in an institution.

“It is not right to spend all that time in a hospital doing nothing,” says Kiran Makhija. She and her parents are now counting the days until Vishal’s challenging homecoming. “We are not the kind of family that would leave my brother alone.”

Lying in his hospital bed on a recent afternoon under the watchful eye of a nursing attendant, Makhija says he has no memory of the accident that maimed him, but confirms that he wants to return to Mumbai.

“I don’t want to live here,” he says. “I don’t have a job here. I want to go home.” He says he has spoken to his sister about the arrangements and that he’s “very excited.” Asked what he remembers about Mumbai, he replies simply: “It is beautiful.”

Posted 1/16/13

This Thanksgiving, less can be more

So your belt buckle is loosened, your appetite is whetted and your fat pants are pressed and ready to go. But for all you pilgrims who yearn for a Turkey Day that, just once, could go easier on your waistline, Los Angeles County’s director of public health has a gentle suggestion:

“Choose less,” says Dr. Jonathan E. Fielding. “Thanksgiving isn’t just about the meal.”

Fielding’s advice echoes the motto of the recent Department of Public Health campaign to educate Southern Californians about portion control.  Most adults only need 2,000 calories a day to remain healthy, and most children require even fewer. But many Americans bust that caloric budget and then some on Thanksgiving, typically packing 2,000 to 5,000 calories into a single meal, says Fielding.

“This is a day when it’s not surprising to see somebody go a little crazy,” he says. “There are, however, a couple of things you can do that may be palatable.”

Try to have an active morning. “Do a little extra exercise,” Fielding suggests. A 30-minute jog (about three miles) will work off about six ounces of turkey. Sixty sets of 10 Burpees, and it will be as if you never ate that cup of mashed potatoes and gravy. And if you get really ambitious, 20 minutes on the stairs or Stairmaster will dispense with a slice of pumpkin pie.

Don’t hit the table on an empty stomach. “Eat a piece of fruit or a handful of nuts before heading out to your gathering,” Fielding says. “Or drink a couple of glasses of water to give yourself that feeling of fullness.” Being less hungry will help you avoid overeating when you sit down to the main meal.

Set the table with smaller dishes. Use plates that are 8-10 inches for adults and 6-8 inches for kids, Fielding says. It helps your guests control their portions, and acknowledges the tendency of most people to clean their plates, even if they already feel full.

Take the serving dishes off the table. “When food is in front of us, we tend to eat it,” says Fielding. “So put the serving dishes on another table, or in another room, where you’re not looking at them.”

Start with small portions. “Just serve yourself two to four bites of whatever looks good,” Fielding suggests. “Eat slowly, and give your body a chance to enjoy what you’ve swallowed. Give yourself 20 minutes, and then, if you’re still hungry, go back.” Remember that standard portions of most foods are much smaller than the super-sized menus doled out in restaurants, and an ideal plate should be half vegetables and fruit. (Click here for a good primer.) A standard serving of poultry is 3 ounces, about the size of a deck of cards; a standard serving of mashed potatoes should be about the size of a tennis ball.

Hydrate. Water is one of the best beverages around, Fielding notes, and, for a Thanksgiving dinner, sparkling water couldn’t be more elegant. Even if you’re serving wine or cider, make sure it’s on the table as an alternative.

Please don’t serve sugary sodas, especially not to the kids. Q: What has the equivalent of 22 packets of sugar in it, and more calories than a second helping of stuffing? A: A 20-ounce bottle of regular Coke. Fielding says that, of all the efforts Americans make to keep their weight down, just three simple changes would make a world of difference. “Choose less, increase physical activity and reduce your intake of sugar sweetened beverages.” A single serving a day of sugar-sweetened beverages increases a child’s risk of obesity by 60 percent.

Embrace leftovers—but not for too long. Leftovers, of course, are one of the best things about Thanksgiving dinner. They’re also a good way to talk yourself out of overeating. Have your guests bring their own takeaway containers. Or, if you’re a guest, think about setting aside part of your meal to take home and eat later.  Just remember that food shouldn’t sit out for more than two hours, says Fielding. Unlike fat pants, “leftovers don’t have an infinite life.”

Posted 11/15/12

Condom measure heads to the ballot

An initiative to mandate condom use in adult film production moved this week to the November ballot, despite predictions that it could expose the county to lawsuits and leave taxpayers picking up the tab for some of the program’s costs.

The measure also raises potential free speech questions; compelling filmmakers to put condoms in their movies could be construed as an infringement of the First Amendment.

Acknowledging concerns about the measure, the Board of Supervisors voted to 3-1-1 Tuesday to place it on the ballot, after supporters gathered enough signatures to easily qualify it earlier this month.  Supervisor Gloria Molina voted no and Supervisor Mark Ridley-Thomas abstained.

“We’re all in favor of porno stars using condoms,” Molina said, “but the issue is liability for the county.” Molina noted that existing law requires the state, not the counties, to enforce workplace safety, and said that the county already pays out more than $100 million a year in liability claims.

Backed by Los Angeles AIDS activists, the ballot measure would require the county to issue and enforce public health and film permits for porn producers, whose performers would have to use condoms on their sets. Violators could be fined and/or charged with misdemeanors.

The initiative addresses longstanding concerns about unsafe sex in the San Fernando Valley’s burgeoning porn industry, and qualified for the ballot with more than 370,000 signatures.

It has been dogged, however, by concerns about jurisdiction and enforcement.  Workplace safety in California is currently regulated by federal and state law and enforced by Cal/OSHA. And most adult films are shot quickly and without permits, often in private homes and garages, which makes it hard to police them.

Those concerns were echoed in reports from the Department of Public Health and County Counsel. The Public Health analysis noted that, unlike, say, catering truck owners, adult film producers rarely disclose their locations in advance, and their competitors rarely know enough about their procedures to notify the county of suspected violations. Thus, even with laws in place, it would be difficult to protect many if not most adult film performers.

Meanwhile, County Counsel John Krattli noted that if the initiative passes, the county would be vulnerable to lawsuits, not only from the measure’s backer, AIDS Healthcare Foundation, which could sue if enforcement fails, but also from the adult industry, whose lawyers confirmed the threat on Tuesday.

“This is an unconstitutional and unwise attempt to fix a nonexistent problem,” said Allan Gelbard, a First Amendment lawyer.  “What’s it going to cost the county if you enact it and you are sued and lose? . . . I believe the county would be on the hook.”

Although the measure would require the adult film industry to foot the bill for the enforcement, the Public Health analysis found “significant” startup costs attached to the measure that are unlikely to be covered by the permitting fees built into the initiative because so few adult film producers bother to apply for permits.

Among other things, the report noted, the county would have to set up training programs for producers, create a permitting and review process, maintain an industry database, conduct regular inspections and spot checks, staff a complaint line, assess fines and administer appeals.

The establishment of an Adult Film Public Health Permit Office would cost at least $291,466 a year, not including the costs of confiscation, law enforcement and evidence warehousing, the report said.

“If 10 public health permits were issued, the two-year costs translate into a fee of $58,294 per permit,” the report noted. Even if 50 adult film producers were to apply for permits, the per-permit fee would still be more than $11,000.

Advocates for the measure insisted, however, that it is necessary for porn performers to be ensured of a safe workplace.

Posted 7/24/12

Will new condom law make porn safer?

Few health issues are as obvious—or as guaranteed to generate headlines—as unsafe sex in L.A.’s booming adult film industry. But as an initiative requiring the use of condoms during porn shoots moves closer to the November ballot, it has become equally clear that, if it passes, the county would face a daunting challenge.

“This will be very difficult to enforce,” said the director of the county Department of Public Health, Dr. Jonathan E. Fielding. “If it passes, we’re going to do the best we can, and get the best ideas from everywhere, but there are some serious issues involved in this.”

Members of the Board of Supervisors on Tuesday delayed certifying the initiative for the November ballot until July 24. They asked for a report on the impact on the county, which would be required to enforce the law if enacted.

Backed by Los Angeles AIDS activists, the measure aims to address a chronic health hazard in the nation’s porn capital, where adult entertainment actors fear losing their audiences or jobs if they refuse to perform without condoms. At least three highly publicized industry HIV outbreaks have occurred since the late 1990s.

But the initiative also resurrects quandaries that have long vexed health advocates: How do you regulate a workplace that largely operates under the radar? And how much of the county’s limited health resources should go to a niche that generates only about 1.5% of all its sexually transmitted diseases?

“The nature of the industry is elusive,” said Mario Perez, director of the public health department’s Division of HIV and STD Programs. “Film shoots happen in folks’ living rooms and backyards. They’re scattered throughout the county, without fixed addresses.”

A 2009 report to the Board of Supervisors estimated that Los Angeles County had some 200 porn production companies, with about 1,200 workers engaging in direct, work-related sexual contact, mostly on unpermitted shoots that lasted only a few hours. And, health officials point out, unlike, say, a restaurant, where a kitchen either is sanitary or it isn’t, every act is a fresh opportunity for infection.

“In the most robust sense,” Perez said, “this initiative could mean that we would have to observe every sex scene in every adult film produced in Los Angeles County.”

During Tuesday’s meeting, Supervisor Zev Yaroslavsky echoed those concerns, saying that an unenforceable law would be “a mockery from the starter’s gate.”

“We need to figure out a way to make this stick,” he said, “and not just be a chapter in the municipal code that sits there as a symbol.”

L.A. porn has been both an economic engine and an intractable frustration. State and federal laws require employers to protect workers from potentially infectious bodily fluids, and Cal/OSHA has jurisdiction over workplace hazards—as the county has long argued. The state contends, however, that its resources are tight and employment complaints rarely arise from porn sets, where most performers are hired as independent contractors, not employees.

For years, the industry said it was policing itself through a screening database maintained by a nonprofit industry clinic, but HIV outbreaks in 1998, 2004 and 2009 fueled fears. In 2010, amid complaints and litigation from the AIDS Healthcare Foundation, which backed the current initiative, the county shut down the clinic for operating without a license, heightening awareness but eliminating one of the few checks on the industry.

The county has called for tougher state laws and reported suspected violations to Cal/OSHA. But local health officials have maintained that they have neither the resources nor the jurisdiction to become Los Angeles’ porn police.

Though the industry has generated thousands of STD and HIV cases over the years, the porn problem is dwarfed by other at-risk populations. The adult film industry has accounted for fewer than 20 of the more than 20,000 cases of HIV reported since 2004 in the county, for example. HIV afflicts an estimated 30% of the county’s black gay men.

“Every resident of the county matters to us,” said Perez, “but there are many other groups we also have to serve with scarce resources.”

The measure would force the county to create and administer a new permitting and enforcement bureaucracy. DPH could conduct random spot checks and, if necessary, revoke permits. Violators would be fined and/or charged with misdemeanors.

Advocates say the measure would be no less workable than the county’s systems for inspecting tattoo shops and food trucks. However, Fielding noted that most porn producers don’t tweet their location or hang out a shingle. Moreover, he notes, it is unclear whether industry fees imposed by the initiative would cover its full costs.

“Say you have a permit for 24 hours. Are we going have to have somebody monitoring all that time?” asked Fielding. “Or could it be a [less costly] complaint-driven system?”

AHF President Michael Weinstein countered on Tuesday that “all the health permits the county issues have spot inspections. That’s what we’re looking for.”

Legal questions also abound about the proposed measure’s geographic jurisdiction and constitutionality. Industry lobbyists charge that the measure threatens their free speech. If the law is enacted and found unconstitutional, the county would be legally liable.  But if enforcement fails to meet the standards of the initiative’s backers, they, too, could sue.

The Los Angeles City Council is still struggling to enforce a similar, though much narrower ordinance enacted there in January. Support for the county initiative seems to be strong, however: It easily qualified for the ballot, and an AHF spokesman testified that 63% of county registered voters had voiced approval of it in a March poll.

Posted 7/10/12

County braces for a wave of L.A. ink

Since 1998, Roger “Rabb!t” Rodriguez has been a professional body artist. Piercing, tattooing, branding—he’s seen it all. But in all his time in Greater Los Angeles, in studios from West Hollywood to Pasadena, there’s one thing he has yet to encounter: A health inspection.

That’s about to change this summer.

Starting July 1, California counties will begin enforcing comprehensive state standards for tattooing, body piercing and permanent cosmetics. The Safe Body Art Act, passed in October, is expected to finally bring some uniformity to a municipal patchwork that for decades has hindered widespread regulation of the burgeoning body art industry.

Public health officials applaud the measure, as do most established artists because unsafe practices in piercing and tattooing can lead to HIV and hepatitis. But the new law also promises to dramatically ramp up enforcement, and at the Department of Public Health, the county’s tiny Body Art Unit is braced for big changes.

“This is probably going to quadruple our workload,” says Cole Landowski, head of the county’s environmental hygiene program.

Once a sign of rebellion, tattoos and piercings have increasingly become mainstream, adorning bodies of all ages. Celebrities have taken the industry upscale, and even reality TV has gotten into the act, chronicling the exploits of high profile artists such Los Angeles’ Kat Von D. 

Oversight has struggled to keep pace, however. Until this year, California law mandated only that body art businesses register with their respective counties and receive a copy of sterilization and sanitation guidelines.

Counties were free to impose ordinances that went further, but most didn’t. Riverside County, for instance, didn’t regulate body artists until last year, after its lack of enforcement was taken up by a grand jury. Meanwhile, efforts to legislate minimum statewide standards repeatedly failed amid arguments that such regulation would drive away businesses.

Assemblywoman Fiona Ma (D-San Francisco), who helped push through the new law, noted after it passed that manicurists “need 400 hours of training before they can cut your nails, yet until [now], tattooists and piercers have had no training requirements to stick a needle in you.”

Los Angeles County was, for many years, one of the few to regulate piercing and tattoo parlors. “We’ve recognized this as a public health issue for a long time,” says Terri Williams, assistant director of the Environmental Health Division of the Department of Public Health.

The county passed an ordinance in 1999 requiring practitioners to not only register, but also obtain a county health permit and receive blood-borne pathogen training.  Facility owners also had to obtain health permits and adhere to standards of design, maintenance and sanitation.

But the county ordinance only extended to unincorporated areas and the 14 smaller cities that opted into the county requirements. The rest of the county’s 88 cities, including the City of Los Angeles, had little, if any regulation beyond business licenses and zoning restrictions.

“I’ve been doing this for 14 years professionally and at no time do I ever recall being inspected,” says Rodriguez, a nationally known piercing artist whose current shop, Ancient Adornments, is a West Hollywood fixture.

Rodriguez’ various workplaces were outside the county’s jurisdiction, but even within it, enforcement was a challenge. At last count, some 480 facilities were licensed in the unincorporated county and contract cities, Williams says, and those are just the ones operating in the open. Rodriguez and others note that many more body artists work underground, setting up un-permitted shop in homes and barrooms.

The three environmental hygienists doing body art regulation must squeeze between 10 and 25 inspections a month into their other duties, which range from noise and odor complaints to asbestos and mold inspections.

“Our hands are pretty full—actually, they’re really full, ” says Francis Pierce, who does most of the county’s body art inspections. (For the record, Pierce has no tattoos or piercings, although he jokes that “several hundred people have offered to do it, for free, even, but what can I say? I’m 53 years old and I have no tats.”)

Now comes the new law, which will require body artists from throughout the county not only to obtain health permits by July 1, but also to renew them annually instead of every three years.

County public health officials know they’ve got a huge challenge ahead of them, given the size of the Body Art Unit and the mounting numbers of establishments that will require inspections. The unit will be responsible for every city except Pasadena, Long Beach and Vernon, which have their own health departments. That means the unit could see its caseload quadruple to as many as 2,000 establishments covered by the new law.

“We suspect that we’ve just been hitting the tip of the iceberg, as it is,” says Landowski. “Who knows what we’re going to run into in the cities? Some of those parlors in Hollywood are the size of postage stamps. Then there’s Venice. . .”

Still, Williams says she’s confident her squad, which she expects to grow by five staffers, can handle the job. Already, the department has been assembling a database, putting together registration packets for establishments and artists, hosting training sessions and doing outreach. 

“We’re going to do this well, and be organized in what we do,” she says. Admittedly, it will take time (“They may not all show up saying, ‘Yoo-hoo! We’re here for our health inspection!’”), and everything might not get done before July 1. 

But, she says, “we’re looking forward to a positive working relationship. In my experience, it’s a very cooperative industry.”

Rodriguez, the body artist, says he welcomes the scrutiny.

As a member of professional organizations and a former emergency medical technician, he has made scrupulous sanitation his hallmark, but resents being undercut by competitors who endanger the public with careless work and subpar jewelry.

“A lot of artists have no clue,” he says. “They’re just Joe Schmoe, working at a tattoo shop. Putting the public first—that’s what the benefit of this law is going to be.”

Posted 5/24/12

Calling all condom designers

There are a million free condoms in the naked city, and the Los Angeles County Department of Public Health sees a branding opportunity in that.

In an effort to help curb sexually transmitted diseases, the department’s Division of HIV and STD Programs this month will announce a contest to design an official L.A. condom wrapper to help brand the free prophylactics the county distributes to local businesses, social services and healthcare providers. Ads will invite county residents to come up with “L.A.’s Next Sex Symbol.”

“Our tagline is going to be ‘Show Me Your Package’,” says Project Manager True Ann Beck.

The lighthearted derby is part of a serious push in Los Angeles County to consolidate public health outreach on sexually transmitted diseases. An estimated 2,000 new HIV infections occur annually in L.A. County.  Last year, the department reported more than 47,500 new cases of chlamydia, more than 9,500 new cases of gonorrhea and nearly 1,800 new cases of syphilis.

Each year, grant money is distributed by the county to local health care providers to purchase and distribute free condoms, which help prevent sexually transmitted diseases. (About 250,000 have been handed out so far this year, at a wholesale price of about six cents apiece, Beck says.) The contest is a small part of a larger centralization of STD prevention that has already merged three county programs.

The design contest, which will run from May 21 to June 17, will be facilitated by KCBS Marketing with help from the county’s condom wholesaler, Boston-based One Condoms, Beck says. Entrants must be Los Angeles County residents over the age of 18.

Rules will be posted on the contest web site (LASexSymbol.com), but generally, entries cannot be trademarked, copyrighted or sexually explicit. The winner and nine runners-up will receive prizes and gift cards, plus bragging rights to a package design that will be distributed countywide and featured in future condom promotions.  All ten will be produced and distributed.

“We want to circulate more than one design so people can collect them all,” Beck says, adding that the initial plan is “to start with a million and one condoms.”

Updated 6/14/12: Learn more about the contest at the Downtown L.A. Art Walk tonight. Check out the 40-foot RV parked at 24 Main Street.

Public health officials note that contests are only one way among many to raise awareness and improve Southern California’s health. Still, New York’s 2010 contest attracted nearly 600 entries, persuaded New Yorkers to cast more than 15,000 online ballots and conferred momentary celebrity on the graphic artist who submitted the winning wrapper design—a graphic representation of a high-tech power button.

Beck says the hope is that the entries will be so smart and lively that the public won’t think of the free condoms as a government program.

“It’s going to be very light and sexy and fun. We’ll probably get all sorts of comments, but the point is to get people talking, and to get them to practice safer sex,” she says.

Posted 5/17/12

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