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Those who physically attack doctors, nurses and other emergency department workers in California face harsher penalties in 2025 thanks to a new law.

In September, Gov. Gavin Newsom signed Assembly Bill 977, which increased penalties from six months to a year in jail for those convicted of assaulting California’s hospital emergency room workers.

The bill’s author was Assemblymember Freddie Rodriguez, who spent 30 years as an emergency medical technician in the San Gabriel Valley. 

Rodriguez, a Democrat whose term ended in 2024, said he was compelled to introduce the legislation after seeing too many of his friends and former colleagues attacked on the job. He felt that there needed to be tougher penalties to discourage future attacks. 

As he made his case to lawmakers this year, he testified that his daughter, Desirae, a respiratory technician, was recently assaulted on the job. Other health care workers testified that they too had been attacked. 

Recent polling shows they’re hardly alone. A poll from the American College of Emergency Physicians found that more than 90% of ER doctors said they’d been attacked within the last year.

Though the bill ended up passing overwhelmingly, some progressive Democrats either voted against or didn’t vote for the proposal which counts the same as a “no” vote. They, along with prison reform advocates and the California Public Defenders Association, argued that increasing penalties doesn’t deter crime and that many of those assaulting ER workers are mentally ill. They noted that laws on the books already prohibited assault.

Former Gov. Jerry Brown, who faced a U.S. Supreme Court order to shrink the state’s prison population, had vetoed an identical bill from Rodriguez in 2015.

The California Medical Association, the lobbying group for California’s physicians, was glad Newsom didn’t do the same.

“Thank you Governor Newsom, Assemblymember Rodriguez, and the Legislature for having the backs of health care workers across the state,” the association’s president, Dr. Tanya Spirtos, said in a statement after Newsom signed the bill.

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California voters made several major health care decisions at the ballot box in 2024.

By a narrow margin in March voters approved Proposition 1, one of Gov. Gavin Newsom’s marquee efforts to expand and change the state’s behavioral health system. This ballot measure included a $6.4 billion bond to build more treatment beds and permanent housing for people with mental health and addiction disorders. Additionally, it required counties to redirect some of their existing mental health funding from community services to housing homeless people. The idea is that creating more treatment facilities and housing will keep people with serious mental illness off the streets and out of jails. The governor’s office has already released some funding from the measure and it has promised transparency and progress reports to the public.

Then in November, voters passed Proposition 35, which required that revenue generated from an existing tax on health insurance plans be reserved specifically for health care purposes rather than to offset the state’s general fund spending. The tax revenue — an estimated $35 billion over the next four years — is in part to be used to increase what Medi-Cal reimburses doctors, who for years have protested that the pay they receive to see low-income patients is not sustainable. 

Meanwhile lawmakers pushed through some new protections and benefits for Californians, including an incoming law that prohibits medical debt from showing up on people’s credit reports. This should make it easier for people with a medical balance to rent a home or buy a car starting next year. A second law will require certain health insurance plans to cover in vitro fertilization for the first time, providing some financial relief to families looking to start a family with the help of this treatment. In response to a growing number of California hospitals shutting down their maternity wards lawmakers also passed a law that requires hospitals to increase their public notice window to 120 days before shutting down perinatal services.

The Newsom administration saw a significant departure from its health team this year. Dr. Mark Ghaly, who was instrumental in California’s COVID-19 pandemic response as the state’s Health and Human Services secretary, stepped down in September. Kim Johnson, who formerly led the California Department of Social Services, is the new secretary. Johnson steps into this role at a critical time. Health officials are currently monitoring the H5N1 bird flu virus that some experts say is one mutation away from spreading to humans and creating perhaps yet another pandemic.

2025 outlook

California is already in defense mode as it prepares for a second Trump administration. Democrats are developing new plans to strengthen the state’s abortion protections, and public health experts are warning about a potential wave of vaccine and medical disinformation if  Robert F. Kennedy Jr. is confirmed as secretary of the U.S. Department of Health and Human Services. Some experts worry that key insurance programs such as the Affordable Care Act and Medicaid, also known as Medi-Cal in California, could come under attack. Federal actions this coming year are almost certainly to result in litigation and pushback from the Golden State.

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‘Everyday people across the country skip medical care because of cost. Those who do seek medical help may end up with a balance they can’t pay off. That debt can hurt people’s credit scores, resulting in long-term financial burdens.

Starting Jan. 1, a new state law will prohibit health providers and debt collectors from reporting medical debt information to credit agencies. That means unpaid medical bills should no longer show up on people’s credit reports, which consumer advocacy groups say is a boon for patients with debt.

Here’s why: While the law will not forgive someone’s debt, by keeping it off credit reports, it might provide some reassurance that a hospital stay or trip to urgent care won’t later affect their credit standing. Lower credit scores usually result in higher interest rates and make it harder for people to qualify for a home rental, a car loan or even employment.

During legislative hearings, the law’s author, Sen. Monique Limón, a Democrat from Santa Barbara, contended that because people don’t choose to have a medical emergency or illness, this type of debt should not count against them. Supporters also argued that medical debt is more prone to inaccuracies because of billing mistakes by health providers and insurers.

The main three credit bureaus – TransUnion, Equifax and Experian — stopped reporting medical debt under $500 in 2023. But most people with medical debt owe far more than that. The national average for medical balance is $3,100, according to the Consumer Financial Protection Bureau. In California, an estimated 38% of residents carry some type of medical debt; that figure climbs to more than half for low-income residents, according to the California Health Care Foundation. 

One key caveat is that patients can only take advantage of this law if the debt is owed directly to a medical provider or collection agency, but not when the debt is charged on a medical credit card or a general credit card. 

This new law follows similar ones enacted in a handful of other states, including New York and Colorado. It also mirrors a proposal put forth by the Biden administration to do the same nationwide. However, with a new administration taking over in January, it is unclear whether the federal proposal will go anywhere. 

Limón’s office explained that under the law patients have the right to sue a debt collector or provider who reports a medical debt to a credit bureau. Consumers may also choose to file a complaint with the state’s Department of Financial Protection and Innovation, which has authority over debt collectors. Consumers can also file a complaint with the California Attorney General’s office. 

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

Ezekiel Koontz recalls being a Kaiser Permanente patient “forever, for as long as I can remember” — first as a child and now as a working adult receiving gender-affirming treatment.

But while battling severe depression and experiencing suicidal episodes for the last several years, the 26-year-old teacher struggled to find a therapist with whom they felt comfortable.

“I went jumping from therapist to therapist to therapist,” said Koontz. “I think the last time I tallied it up, it was like 10 different therapists.”

Then after almost two years of sessions, their preferred therapist went on strike, and Koontz found themself back without a consistent person to talk to about their depression and suicidal ideations.

“They keep on offering scab therapists,” said Koontz. “It’s the same issue that I had before, but worse now. It feels scummy in a way, because it’s like they are trying to pity us while shaming and trying to make an example of them — and offering nobody a solution in the process.”

Their predicament reflects the strain on patients and providers as a consequence of the second long-running mental health strike at Kaiser Permanente in the past three years. Approximately 2,400 Kaiser therapists, clinicians and other National Union of Healthcare Workers members went on strike Oct. 21 in Southern California, calling for more time and resources of their workday to be allocated toward critical patient care duties; restored pension benefits; and cost-of-living wage increases. A handful of nonproductive bargaining sessions ended in standstill by Oct. 28, with no further meetings scheduled.

In a recent statement, Kaiser Permanente called the strike “unnecessary.” It claimed the union proposal — which mandates seven hours a week of non-therapy session time for therapists — would “decrease the time therapists see patients to nearly 50% of their week, reducing critically needed patient appointments by 15,000 every month.”

Top Democratic lawmakers this week began pressuring the company to end the strike on the union’s terms. California Senate President Mike McGuire and Assembly Speaker Robert Rivas joined forces on Dec. 12 to petition Kaiser Permanente Chief Executive Officer Greg Adams to do more to resolve the strike.

“My undersigned colleagues and I urge you to resume good faith negotiations with NUHW as soon as possible, and to agree to the union’s reasonable contract proposals to ensure the delivery of timely and appropriate behavioral health services to your patients,” McGuire and Rivas each wrote in identical letters signed by 20 fellow senators and 40 Assembly members.

In 2022, Northern California Kaiser mental health workers went on strike over similar contract disputes. After 10 weeks, Sacramento Mayor Darrell Steinberg stepped in to mediate negotiations, and Kaiser ultimately agreed to a package of wage increases and staffing commitments similar to what  Southern California workers now fight to acquire for themselves.

Kaiser further paid a $200 million settlement to the state of California in late 2023 for failing to provide mental health patients appropriate and timely access to treatment. The deal included a $50 million fine, along with the promise of investing $150 million over a five-year span to improve its behavioral health care response protocols.

“Especially with Southern California Kaiser, I think the mental health system is even more broken,” said psychiatric social worker Linda Cortes, a strike captain at organized union picketing events throughout the southland. “There’s only 2,400 of us for the whole entire Southern California region. Kaiser deemed us essential workers during COVID. They even gave us a little card stating we were essential workers. But now all of a sudden, they don’t see us as that.”

The mother of two has worked for Kaiser almost 10 years and worries about her family’s future as the strike drags on. “It’s been difficult, a lot of emotions. How am I gonna make ends meet every week? I have gone to food banks for the first time as an adult. We all went and got a turkey for Thanksgiving to help us get by.”

Kaiser has said its last offer for the next four-year union contract provides a 5% wage increase each of the next two years, with a 4% bump each of the following two years after that. The strikers, however, also seek additional adjustments to recompense for the lack of any cost-of-living increases in 2018 and 2019, as well as only 2%  bumps in 2022 and 2023.

Kaiser asserts itself as “a leader in pay and benefits” — noting that it also offers a fully subsidized retiree medical plan.

But the disparities between Kaiser employees who receive defined pension plans and the ones who don’t is a sticking point for the Southern California mental health workers.  

“I feel like I’m less valued as an employee at Kaiser,” said Jade Rosado, a Kaiser employee who does not receive a pension. “Especially when you look around and everybody has the pension, everybody from food service workers to janitors. As a mental health care worker, am I less?”

David Zelen, a social worker within Kaiser for the last 37 years who will retire in 2025 with a full pension, pickets alongside Cortes and Rosado. “Everyone should have the pension,” he said. “It’s one of the benefits of working here at Kaiser, and working so hard. In a 40-hour work week, we’re scheduled to see about 35 patients.”

Kaiser strike puts pressure on providers, and patients

Cortes, Rosado and Zelen all worry about the patients who were previously under their caseloads. “I’m scared for them,” said Cortes. “I know during the holidays, suicide rates go up. Divorce rates go up. Violence goes up, unfortunately. So why doesn’t Kaiser care?”

Like most patients affected by the Kaiser strike, Koontz has been offered outsourced access to therapists, including online services like Rula. Koontz gets texts and emails from Kaiser about every two weeks to remind them that these resources are still available.

But so far, Koontz has simply been relying on happenstance to try and remain mentally stable and positive. “I assure you, if anything goes wrong here, I have no safety net. I’m just doing okay, but that is pure dumb luck.”

Another patient, Erin Hartman, also shared her frustrations about Kaiser’s response to the strike. In July, the 42-year-old San Diego mom started receiving one-on-one sessions to help cope with the loss of her father and the added stressors of parenting a kindergartner while also looking for employment. She credits her therapist with helping her navigate grief and manage her anxiety.

“Even in a short amount of time, I can see a huge difference from July to October,” said Hartman. “And then when she told me about the strike, my anxiety immediately bubbled back up because I didn’t know when I was going to see her again.”

Although Kaiser offered to provide Hartman with replacement therapists, she declined. “I won’t be doing that,” she said, instead opting to wait for her therapist  to return after the strike. “We have that rapport, which is so important. Therapy is kind of like dating. I got really lucky.”

She describes herself as one of those patients whose level of treatment can withstand waiting for weeks between sessions or, even, until the strike ends. “I understand why they’re striking, and I totally empathize with them,” she said. “Where it gets scary is that there are people out there with mental health issues who can’t wait. What if you really needed your person and they’re not available?”

Two weeks ago, Hartman thought the strike was over when she found out her therapist had returned to work and was available to resume sessions. “I got a call from Kaiser, and was really excited to meet with her again,” said Hartman. “She said she weighed how long she could remain on strike, and she just couldn’t do it anymore for financial reasons. So now, she’s working alongside scabs.”

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Bobbie Sage thought nursing would be her salvation. She was trapped in an abusive relationship with four kids and looking for a steady income. The day she graduated vocational nursing school, she took the kids and left their father.

Five years later, a DUI ruined her carefully crafted stability. Sage was waiting for a taxi outside a bar with another partner when he began hitting her, she said. She fled in her own car. A mistake with enduring consequences. 

Sage was charged with a misdemeanor for driving under the influence of alcohol in 2014. She paid a fine and completed three years of criminal probation without incident, according to court documents. She thought that tumultuous period of her life was over until her state licensing board ordered her to complete an additional probation program for health professionals with substance use problems. 

Sage couldn’t afford the drug tests at $300 a month or a fine of $3,140. She dropped out. She surrendered her vocational nursing license in 2019 and blames the program for ending her career.

Now, Sage is among dozens of health care workers who allege they’ve been mistreated under a California law governing workers with addiction and mental health problems. They say state regulations are needlessly punitive, overly bureaucratic and based on faulty addiction science. They call it a trap that prevents them from working and leaves many of them with thousands of dollars of debt.

“One misdemeanor is costing my entire life,” Sage said. “Punish me for something with my (nursing) license that I’ve done with my license.”

The 2008 law was supposed to protect patients after a series of audits and legislative hearings suggested licensing boards were doing a poor job of keeping impaired health workers off the job. It created uniform regulations for each board to follow that stipulate exactly how to deal with these workers, including extensive drug testing, travel restrictions and psychiatric evaluations meant to catch anyone who relapsed. 

Some boards created recovery programs as an alternative to discipline. Workers could volunteer to join as a step toward their recovery, or be asked to join by their licensing board as a substitute for public punishment. Others, including Sage, were ordered into a parallel probation program after an incident such as a DUI or other licensing violation. 

Nurses say those provisions have become so burdensome and expensive that health care workers avoid the recovery program outright unless a licensing board asks them to join. As a result, the state is monitoring fewer workers than ever. Fewer than 400 people are enrolled, down from a peak of more than 900 in 2010.

The recovery program has never included doctors, whose lobby resisted it because members believed it was too punitive, according to Gail Jara, executive director of California Public Protection and Physician Health, an organization dedicated to creating a new recovery program for doctors. The California Medical Board, which licenses most doctors, plans to push for an alternative program in the Legislature in the coming year. 

“It’s living hell,” said an emergency room nurse interviewed by CalMatters who joined voluntarily. The nurse asked for confidentiality because she could lose her license for speaking out under the terms of her contract. 

The nurse has been unable to find a job that meets the program’s strict work limitations for nearly two years despite clean tests. She has spent more than $8,000 on drug tests, according to receipts, several thousand more on medical and psychological evaluations, and more than $20,000 paying for health insurance because she lost her work insurance. 

Dentists, physical therapists, veterinarians and other health workers whose professional licensing boards are overseen by the California Department of Consumer Affairs are subject to the state law. Nurses make up the majority of the participants, and complaints about the program have erupted at recent Board of Registered Nurses meetings.

Many say they’ve followed all the rules and still see no way out even after years of demonstrated sobriety.

Officials at those meetings faulted minor changes they made to increase oversight, suggesting they went too far. Participants and addiction experts interviewed by CalMatters, however, say the law itself is the root of the issue.

“We’ve built systems that are completely onerous and agnostic of the value of a human life,” said Amanda Choflet, dean of nursing at Northeastern University in Boston and an expert in nursing addiction programs. “It’s not even that the systems themselves are actively trying to keep people from being able to recover. It’s that the systems aren’t built for humans. They’re built in order to enact legislation.” 

A group of consumer advocates that pushed for the law argues that it is doing exactly what it is meant to do — impose consequences on workers who can’t stay sober. Michele Monserratt-Ramos, a patient advocate with Consumer Watchdog, said licensing boards’ first duty is to protect the public, not shield health workers with substance use or mental health disorders. 

Many of the requirements that nurses and other workers say are intolerable such as work prohibitions were designed to protect patients, said Monserratt-Ramos, whose fiance died after an operation with a doctor who had a history of substance abuse. If health workers know addictive behaviors and other impairments will be scrutinized by their licensing boards, they’ll be less likely to do something harmful, she said.

“The safety net now is the consequences,” Monserratt-Ramos said.

The Department of Consumer Affairs did not make anyone available for an interview, stating that the regulations governing the program were written by a committee years ago and no experts were available. In a statement, the department said each health care board is independently responsible for implementing the program, and eight boards contract with an outside vendor, Maximus Inc., to do so.

The Board of Registered Nursing refused several times to make executive staff or board members available for an interview to address participants’ complaints. Individual board members also failed to return calls or emails from CalMatters. In a statement to CalMatters, board staff said they have already addressed such complaints and are working to address more.

Maximus, a publicly traded company worth $4.5 billion, did not respond to several interview requests. The vendor’s $12.4 million state contract expires at the end of December. The company did not bid for a new contract, and the Department of Consumer Affairs did not provide a reason why.

Sage says she worked hard to transform her life and move on from past abuse. She’s a licensed esthetician now and runs a successful studio in the Bay Area. Family and colleagues describe her as a hard worker, a natural caregiver and someone who doesn’t complain.

She admits she made a mistake, but says she never had an addiction problem. CalMatters reviewed a letter Sage provided from a doctor confirming that she did not meet the criteria for alcoholism and has never been diagnosed as an alcoholic. Under state law, any medical professional with a DUI is presumed to have a substance abuse problem even if it is a one-time offense. The Department of Consumer Affairs said the Board of Vocational Nursing and Psychiatric Technicians, which oversees Sage’s license, does not offer a recovery program, only a disciplinary track.

“I haven’t been a perfect person in my life, but I’ve been a good person,” Sage said. “I’ve taken full responsibility, and I don’t believe we should keep punishing someone for a misdemeanor that happened 10 years ago.”

Nurse demand changes at board meetings

CalMatters spoke with six nurses in the recovery program, all of whom asked not to be named for fear of retaliation from their case managers and the Board of Registered Nursing, which authorizes their licenses. The nurses said while some of the policies they regarded as arbitrary have been rolled back — including a requirement to administer narcotics to patients — many of the problems are longstanding and systemic.

The nurses provided documents that supported their descriptions, including their contract agreements, medical records, and recordings of individual meetings with enforcement committees.

Common problems outlined by interviewed nurses include:

• Moving goal posts — All of the nurses interviewed by CalMatters said the requirements to complete the program kept changing, including work requirements and the need for clinical evaluations that could take months for the board to review, prolonging their time in the program. “I felt like I was going to be in this program indefinitely,” said a former acute care nurse who dropped out with what she says were five years of sobriety.

• Retaliation — Nurses said they felt like they were constantly in trouble and forced to stay silent for fear of losing their licenses. They were not allowed to travel to see family or attend their children’s sports games without approval from case managers. They would be held liable if no testing centers were open even on holidays and weekends, and the inability to pay for a drug test counted as a positive result. “I felt so small. I didn’t feel supported. Every time I saw my case manager calling me, I felt like I was going to throw up,” a second nurse interviewed by CalMatters said.

• Forced attendance at religious recovery meetings — A third nurse who started using drugs after escaping a religious cult said her case manager made her go to a faith-based 12-step meeting despite state law prohibiting such a requirement. “I go. I sit on a church pew. I feel like I’m back in my church, and I have palpitations,” she said. 

• Interference with personal medical decisions — A fourth nurse who was admitted to the program for alcohol and mental health struggles said she was prohibited from taking prescribed medication for attention-deficit disorder despite demonstrated sobriety and a medical evaluation showing her cognitive performance improved with medication. Another who was prescribed suboxone, a drug commonly used to treat people with opioid dependency, said she was forced to stop by program officials against the advice of her doctor.

• “Cookie-cutter” requirements — A sixth nurse who was addicted to opiates said it took two-and-a-half years for a complaint about her drug use to be processed by the nursing board. In the meantime, she put herself through rehab and stayed sober. The board told her to “voluntarily” join the recovery program or be stripped of her license despite letters from her addiction specialist, the nurse said. According to documents reviewed by CalMatters, the frequency of her random drug testing and other restrictions were substantially similar to requirements imposed on nurses who were not sober at the time of joining the program.

In May, when nurses began flooding board meetings with sweeping allegations of mistreatment, Executive Director Loretta Melby said “What you heard from Maximus today is there’s, you know, about 250 participants in that program. We don’t have 250 people in public comment.”

But as more nurses called in to raise issues, other board members registered concern. “It sounds like collectively, we the board made, and this program made some errors,” board member Alison Cormack said during a June meeting. In August, the nursing board voted to rescind program changes made by Melby and chief enforcement officer Shannon Johnson, including a requirement that nurses work directly with patients and administer narcotics.

In response to what nurses told CalMatters about ongoing problems with enforcement committees and employees of Maximus, the board’s staff sent this unsigned statement: “Board staff actively works with the vendor to address all concerns that are brought forth by participants.”

The statement added that “each participant is individually evaluated on a case-by-case basis” to determine the requirements of their recovery contracts, however the unsigned statement also acknowledged that previous participant contracts may not have accounted for an individual’s case history. Case managers and enforcement committee members must now examine each individual participant’s compliance with the program before making changes to their contracts, the statement said.

During a board meeting, Maximus, the program vendor, denied that its staff forced participants to attend religiously based meetings, an objection raised by several people during public comment. In a statement to CalMatters, board staff also denied there was such a requirement.

However, the nursing board’s own website denotes “12-Step Group Attendance” as a program requirement. The 12-step structure was created by Alcoholics Anonymous, and several steps reference God. Recovery agreements provided to CalMatters by participants say they can attend groups other than Alcoholics Anonymous, but program participants say they can’t find non-religious or non-spiritual alternatives that meet the board’s requirements, which also include finding a sponsor, another Alcoholics Anonymous rule.

Program regulations also stipulate that positive drug tests are not dismissed even if they are the result of a valid prescription. Regulations mandate that an approved physician submit monitoring plans for participants to take prescription medication even for chronic conditions such as high blood pressure and diabetes. Some nurses said they avoid medical care outright because of the bureaucratic hoops they are required to jump through.

Workers with addiction avoid program

The majority of recovery program participants, 250, are nurses, Maximus Director of Clinical Services Ginny Matthews testified during a recent nursing board meeting. That means the state nursing board is monitoring less than 0.05% of its roughly 537,000 nurses. Other licensing boards are tracking far less.

The state does not track how many health professionals are disciplined and ordered to probation like Sage because of a drug or mental health impairment, but only 0.1% of the health care workforce is disciplined annually for any reason. Research shows between 10% to 12% of medical professionals will develop a substance use disorder during their lifetime.

That means the vast majority of health workers with addictions are flying under the radar, multiple addiction experts interviewed by CalMatters said.

“Where are all of the people who we know should be getting into these programs, and why aren’t they turning to our programs for help?” said Chloflet, the Northeastern dean of nursing.  “That’s the thing that should be the most concerning to these state boards.”

Dr. Karen Miotto, a long-time specialist in substance use disorders and treatment for physicians, said protecting patients should be everyone’s primary concern, but programs that lean heavily on punishment rather than recovery tend to discourage participation. When that happens, regulators are left in the dark.

“If you create it so that no one will come…then you can’t argue we’re doing the safest thing,” Miotto said.

In a 2018 presentation to the nursing board, Matthews of Maximus attributed the decline in participation, which began in 2010, to a drastic drop in self-referrals after the state implemented the current law designed to increase oversight of professionals struggling with addiction or mental health issues.

In a statement to CalMatters, Board of Registered Nursing staff said it “cannot speculate as to the reason(s) that enrollment is low” but some nurses “may not want to participate in this specific program because it is overseen by their licensing agency, entails worksite monitoring, and there are costs associated with it.”

Nurses say the reason why numbers are dropping is obvious — the program is so intolerable that current participants tell their colleagues with addiction to stay invisible.

“We’re only the tip of the iceberg. When you become an addict you recognize other people,” a nurse who spent three years in the program told CalMatters.

What does evidence-based recovery look like?

Rigorous monitoring and drug testing can be effective even if they are intrusive and inconvenient, experts on health care worker addiction told CalMatters.

Research shows that daily check-ins, random drug tests, attending recovery meetings, and years of monitoring all help health workers stay sober and care for patients safely. Requiring a professional to adhere to these conditions in exchange for keeping their license is known as leveraged treatment — the point being to balance recovery with public safety.

“Leveraged treatment, we know, is enormously successful,” Miotto said.

Some studies suggest more than 90% of health workers who complete recovery and monitoring programs are sober and working five years later. In comparison, about 75% of the general population will recover from addiction. Success among health workers corresponds with random drug tests and lengthier program requirements.

But there are limits to what is effective.

Participants are the most successful with daily check-ins, weekly group meetings such as those held by Alcoholics Anonymous, twice monthly drug testing and nurse support meetings, and at least three years of monitoring, according to the only study to assess nurse monitoring program characteristics.

Requiring nurses to do more did not yield better results, according to the study, which assessed 14 state programs, not including California. 

In comparison, California’s requirements are far more stringent. 

State law requires all health care professionals to be tested once per week the first year in the program. Minimum test requirements drop in ensuing years but still average three times per month. 

Regulations allow an average annual maximum of two tests per week, and many nurses interviewed by CalMatters said they had been subject to two or three tests within a 10-day period despite spending years in the program without violations.

Recovery agreements reviewed by CalMatters also showed that they required nurses to attend chemical dependency support groups several times per week, as often as daily, even after years of proven sobriety.

‘One paycheck away from disaster’

Shortly after receiving the terms of her probation, which included random drug testing and daily check-ins, Sage was injured in a car accident that prevented her from working for a year. She had three kids at home, and her disability checks didn’t stretch far enough to cover the drug tests. In an email to her probation officer, Sage wrote that she wanted to comply and asked if there were other options available. 

“It’s either put a roof over my head or pee for a drug test for something that happened four years ago,” Sage wrote to her probation officer in 2018. 

It didn’t matter.

“Failure to submit biological fluid testing will be considered the same as a positive test and will be a violation of probation. There are no other options,” the probation officer responded via email. 

Sage testified under oath at an administrative hearing that her probation officer verbally told her to give up her house and live in her car if that was the only way to pay for the terms of her probation. During the eight months she was in the program, Sage said she became suicidal. 

“I called my own family and wanted them to take my kids because I didn’t feel like I could take care of them,” she said. “I felt so horribly defeated and desperate by how I was treated.”

Her probation officer listed 148 failures to check in and 15 missed drug tests as part of the reason to revoke Sage’s license. Emails show that all of the violations on Sage’s record happened after she notified her probation officer that she couldn’t afford the costs.

“Most American families are one paycheck away from disaster. The board was perfectly fine to tell me to live out of my car, which I find disgusting,” Sage said.

This year, Sage petitioned to have her license reinstated. During a reinstatement hearing, Sage testified that she did not have a pattern of substance abuse, and instead the 2014 DUI represented the worst of two very difficult years of her life as she tried to escape an abusive relationship.

“I just want to say that I have spent my life trying to change since that day,” Sage testified.

On Monday, the Board of Vocational Nursing and Psychiatric Technicians notified Sage that her license could be reinstated only if she resumed probation for three years and paid an additional $600 processing fee.

“I wish that somebody who has the ability to make a change will look at the whole program and say it’s time to revisit this and make some changes,” Sage said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

California doctors struggling with addiction often don’t want anyone to find out, especially the state board that has the power to revoke their medical license. 

“Doctors are afraid of the medical board,” said Dr. Greg Skipper, a Southern California addiction specialist. “The board is a blunt instrument. It’s basically lawyers and cops.”

When doctors are afraid, they hide, which experts and regulators say is dangerous. That’s why, in the coming year, the California Medical Board plans to ask lawmakers to allow it to create an alternative recovery program that’s disconnected from its disciplinary power. 

Current law already lets state licensing boards create recovery programs for health workers, but the medical board hasn’t made one for more than a decade. Doctors call the existing law poorly written, ineffective and harmful. 

They point to the experience of nurses enrolled in a version of the program currently allowed by state law who say they feel trapped by it. Some nurses regard the programs as too punitive. Doctors want a program that prioritizes early intervention and treatment of substance use disorders or mental illness over punishment. 

They could face opposition to their proposal. The patient advocates who lobbied for the current law are opposed to the approach the doctors want. They favor the transparency and discipline in the existing programs. 

Both sides say they want to protect patient safety.

The doctors’ proposed program would run independently from the licensing board and grant confidentiality to doctors who remain sober and do not endanger patients. It would be required to report to the board noncompliant doctors or those whom it believes cannot practice safely. It would also require other licensed doctors to report if they suspect a colleague of impairment. Doctors who are suspected of harming patients would not be exempt from discipline. 

Other health workers, such as dentists and nurses, are not included in the medical board’s proposed legislation.

“At its most basic level, we hope that it will cause physicians…to get into treatment sooner rather than later, so that treatment happens before any patient harm would occur in our system,” Medical Board President Kristina Lawson said.

Without a recovery program, the medical board can only investigate reports of patient harm after they have happened, a process which sometimes takes years.

California is one of few states without a recovery program — commonly called physician health programs — that offers doctors the chance to seek treatment and help while monitoring them for sobriety. Between 10% to 12% of health care workers will struggle with substance abuse throughout their career, research shows.

Experts with experience running programs in other states say confidentiality and recognition of addiction as a chronic illness are crucial to getting doctors to admit when they’re struggling.

“The single most important thing physician health programs offer is a safe harbor,” said Dr. Paul Earley, former medical director of Georgia’s physician health program, who testified during a recent California Medical Board meeting. “I can tie up to this dock and get some care, and I’m not going to get hammered.”

In other states, programs are typically administered by an independent nonprofit organization that is responsible for evaluating doctors suspected of impairment, managing their treatment and monitoring them for five years.

Patient advocates say this approach is unsafe. They argue that California’s medical community has tried this before and failed. In 2008, the board ended a similar program after a series of audits suggested doctors evaded drug testing and worksite monitoring. Patient advocates also argue that confidentiality only lets dangerous doctors hide from consequences.

“Whatever transparency that the public has had will disappear,” said Michele Monserratt-Ramos, a patient advocate with Consumer Watchdog. Monserratt-Ramos, whose fiance died in 2003 after an operation from a doctor with a history of substance abuse, was one of the advocates who lobbied for the medical board to abolish the program in 2008.

Monserratt-Ramos believes the state’s current laws and regulations, which require strict oversight of doctors with addictions and penalties for relapse, are working as intended.

“We feel there were standards set in place that protected everybody, and the board is willing to dispose of them,” Monserratt-Ramos said.

Lawson said the board acknowledges skepticism of this new approach because of the previous program’s spotty track record. However, Lawson said plenty of evidence from other states shows that programs such as the one it is proposing are effective.

“My belief, and I think that the board shares the belief that not having a program puts patients at greater risk,” she said.

Complaints about other addiction recovery programs

Previous attempts to create a program for California doctors under the current law — such as those that already exist for nurses, dentists, and other health professionals — have stalled. Those recovery programs are supposed to be a voluntary alternative to permanent and public discipline, but they still must adhere to the same regulations that govern disciplinary proceedings for rule-breaking workers. Doctors say that defeats the purpose. 

Many of the criticisms raised by doctors’ groups have been expressed by nurses during recent Board of Registered Nursing meetings.

Nurses say they’ve been saddled with thousands of dollars of debt, prohibited from working for months on end despite documented sobriety and caught in a cycle of constantly changing program requirements.

California’s regulations have a “draconian reputation” among other states, Georgia addiction specialist Earley said. During his time leading Georgia’s physician health program, Earley said he counseled doctors on multiple occasions that they should not accept training opportunities or jobs in California because of their involvement in a recovery program.

That kind of system leads to doctors and other health professionals hiding their problems from authorities, which is dangerous for patients, said California addiction specialist Skipper.

Medical board can suspend doctors

Only 141 physicians are on probation for abusing substances, according to the medical board.

“They ought to have like 2,000 people in monitoring. They’re missing a lot of cases,” based on the number of doctors in California, said Skipper, who ran Alabama’s physician health program for more than a decade.

Ramos, with Consumer Watchdog, said it’s hard to say whether the state is catching enough impaired health workers, but the law should stand as-is. Doctors who cause patient harm due to substance abuse or mental illness should face consequences, Ramos said.

“If we look at a comparison when someone is harmed or dies in a car accident, there’s consequences…They continue to come forward with more legislation and increase those consequences and strengthen them because lives have been lost. How is it any different behind the walls of the hospital?” Ramos said. 

But experts say successful programs are not meant to help impaired physicians evade consequences. They are meant to intervene before a doctor harms anyone, said Dr. Chris Bundy, executive medical director of the Washington Physicians Health Program and chief medical officer of the Federation of State Physician Health Programs, who testified during a recent medical board meeting.

Bundy said he meets regularly with his Washington medical board staff to report program results and discuss anonymized cases that may need to be reported for discipline. Washington state law, in contrast to California’s regulations, also gives him more flexibility to exercise his judgement in how participants are monitored and ensure their chronic illness needs are met, Bundy said.

Ninety-two percent of Washington state participants have had clean records over five years and reported feeling burned out less than half as much as the general physician population. To Bundy, that’s success.

“It’s not about getting through this program. It’s about, how does this program change your life in a way that is transformative and that you’re grateful for,” Bundy said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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Beginning Jan. 1, hundreds of state-licensed residential treatment centers for children and youth up to age 21 operating in California must comply with a new law that brings greater transparency — particularly when they use restraints and seclusion rooms. 

After restraining a youth, or putting them in a seclusion room, the facility is required to provide a report to both the youth and to their parent or guardian. The report must include a description of the incident; which staff members were involved; the rationale behind their actions; how long the incident lasted; and other details.

A copy of the report must be provided to the California Department of Social Services within seven days. The department is required to review reported incidents for any health and safety violations and, if needed, investigate the incident.

Another provision of the law, requiring the department to make data about these incidents publicly available on its website, doesn’t take effect until Jan. 1, 2026. Then, parents or guardians weighing the difficult decision to send their children to these facilities can access information about any potential misuse of restraints and seclusion rooms. 

One of the most widely-recognized champions of the bipartisan measure as it advanced through the Legislature was Paris Hilton. In April, the hotel heiress, socialite and media personality visited the state Capitol to advocate on behalf of the legislation, and recount the physical and emotional abuse she experienced while living at youth treatment centers in California and other states. 

A vocal critic of the “troubled teen industry,” Hilton praised the passage of the law in August.

“For too long, these facilities have operated without adequate oversight, leaving vulnerable youth at risk,” Hilton said in a statement. “I hope our state is the standard for transparency and accountability in these facilities moving forward.”

In 2021, California prohibited sending troubled youth, including foster children, to out-of-state, for-profit treatment centers after reports of rampant abuse. As an alternative, youths can be sent to short-term therapeutic facilities licensed by the state’s social services department. A year later, California passed a law to fund crisis residential treatment facilities for children on Medi-Cal.

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As President-elect Donald Trump prepares to take office, California Democrats are developing new plans to strengthen the state’s abortion protections. 

Attorney General Rob Bonta today announced two legislative proposals aimed at safeguarding medication abortion and enforcing the state’s Reproductive Privacy Act, which ensures individuals have the right to make decisions about reproductive care without government interference. 

Both bills, if enacted, would join more than two dozen other laws intended to make California a reproductive health “safe haven” since the Supreme Court’s Dobbs decision three years ago eliminated federal abortion protections.

The move comes as lawmakers meet during a special legislative session to “Trump-proof” the state’s policies. Gov. Gavin Newsom convened the session to request additional money for the state Department of Justice to sue the Trump administration over a variety of policies that could be challenged by a conservative federal government, including climate programs and reproductive health care.

“In California we are not backing down. We are absolutely committed to making sure that all women have access to reproductive freedom,” Bonta said during a press conference Monday. The state Department of Justice is sponsoring both measures.

Trump said previously he will let states decide on abortion, but he takes credit for the overturning of federal abortion protections. The Supreme Court, with three conservative justices appointed by Trump, in 2022 eliminated Roe v. Wade’s long-standing constitutional protections for abortion. 

Assemblymember Rebecca Bauer-Kahan, a Democrat from Orinda, is authoring a bill that would allow the attorney general’s office to fine cities and other local governments that interfere with abortion access under the Reproductive Privacy Act.

The proposal follows moves by several cities recently to restrict the opening of new abortion clinics. Earlier this year Bonta’s office reached a settlement with the city of Beverly Hills, which Department of Justice investigators said inappropriately prevented an abortion clinic from opening. Planned Parenthood is also in the midst of suing the city of Fontana over allegations that officials are illegally blocking the organization from opening a new clinic. 

“What we know is that our laws are only as good as the enforcement mechanisms in them, and so today, we are announcing better teeth to make sure those cities do not stand in the way of those clinic doors opening,” Bauer-Kahan said. 

The California Family Council, which opposes abortion, said in a statement in November that the Beverly Hills settlement will have a chilling effect on local autonomy.

“The battle in Beverly Hills highlights the importance of vigilance and advocacy in the face of relentless pro-abortion legislation,” the statement said.

Maggy Krell, a newly-elected Assemblymember from Sacramento, will author a second bill to protect medication abortion. Krell, a former Planned Parenthood attorney and former assistant attorney general who focused on sex trafficking cases, said the bill aims to protect the abortion pill supply chain.

“We have an incoming federal government that is hostile to women’s rights. We have a Department of Justice incoming that may not even defend the FDA approval of medication abortion drugs. We have a United States Supreme Court that has abrogated the personal liberty interests of women to control their own bodies…That’s what we’re faced with,” Krell said. “But California has done a lot to be ready for this.”

In his second term, many abortion advocates fear that Trump will revive a so-called “zombie law” from the 19th century known as the Comstock Act that prohibits mailing equipment and tools used for abortion and other pregnancy-related care, which could affect abortion pills.

Bonta said one of the newly introduced bills will shield abortion pill manufacturers, distributors and health care providers from civil or criminal liability when “legally transporting, distributing or administering medication” in California.

Bonta was cautious however in revealing too many details, saying “what it will ultimately include is dependent upon what the Trump administration does” and that he did not want to “telegraph” California’s defensive strategy to the conservative administration. The measure is currently a spot bill, or a placeholder for legislation. 

“I will tell you we have a plan. We have a plan that is both legislative and involves litigation. We think it’s a very effective plan, and should we need to unroll it and unveil it, we are ready on day one,” Bonta said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

Many California families want to bring their babies into the world outside of a hospital, but the state isn’t making it easy for them. Half of the state’s birth centers have closed since 2020, leaving only four licensed facilities open.

Birth centers don’t need a state license to operate, but the expensive and onerous process of obtaining one is one of the primary reasons why birth centers are failing. Most insurers and Medi-Cal, the state’s public health insurance program for low-income residents, will only work with licensed facilities.

Compounding the problem is the rapid closure of hospital labor wards, creating maternity care deserts in communities of all sizes.

That’s why Assemblymember Mia Bonta, a Democrat from Oakland and chairperson of the Health Committee, is planning to introduce a bill today to ease birth center licensing requirements.

“Eliminating requirements that are only driving up prices for providers and are irrelevant to patient safety is a much- needed step to ensure our remaining birth centers can stay afloat and lay the groundwork for more facilities to open,” Bonta said.

The bill, Bonta plans to introduce, would delete a requirement that birth centers participate in a specific Medi-Cal benefit known as the comprehensive perinatal services program, which includes services such as nutrition counseling and psychosocial support. Until recently, midwives weren’t allowed to participate in the program, making birth center licensure nearly impossible. 

Advocates say removing the requirement entirely will further streamline the process and actually allow them to serve more low-income clients.

The bill is part of a larger legislative effort by Bonta to protect access to reproductive health care during the coming Trump administration. Bonta’s other planned bills seek to preserve access to abortions at all hospitals, including ones affiliated with religious organizations, in the event of an emergency and to pay for over-the-counter birth control for Medi-Cal patients.

Licensed midwives and certified nurse midwives can provide prenatal and postpartum care as well as low-risk deliveries outside of hospitals. They direct higher-risk pregnancies to hospitals. Birth centers are midwife-run clinics for low-risk births.

In March, the state’s first licensed and accredited birth center closed after three decades of operation. The San Diego facility, which delivered more than 5,600 babies over the years, was unable to keep up with mounting costs. Many others have followed suit. At least 19 birth centers have closed in the past four years, accompanied by the closure of more than 50 hospital maternity wards, according to CalMatters reporting.

The closures disproportionately affect rural communities and people of color, deepening a maternal health care crisis, said Sandra Poole, a lobbyist with the Western Center for Law and Poverty, which is co-sponsoring the bill.

“We have a whole population that is losing access to maternal care, and we’re hearing more and more for various reasons — whether it’s mistrust of hospitals or just wanting the ability to have their births in a more homelike setting — that folks, particularly people of color, would rather have their birth at a birth center,” Poole said. “But they’re just not afforded that opportunity especially if they’re on Medi-Cal.” 

Medi-Cal pays for more than half of the births in California, and 80% of those babies are not white, according to state data. A statewide survey also suggests that people of color want alternative birth support such as midwives and doulas more than any other demographic group. Lack of insurance coverage is the most commonly cited barrier to that care, according to the survey from the California Health Care Foundation.

California is known for having the strictest licensing requirements for birth centers in the country, according to the American Association of Birth Centers. Midwives have previously told CalMatters that they had to leave the state and even the country because it was too difficult to operate in California.

Bethany Sasaki, president of the state chapter of the American Association of Birth Centers, said it’s “heartbreaking” that this legislative effort is coming too late to save the birth centers that have closed already, but it is an important first step. Sasaki closed her Sacramento birth center earlier this year after the state refused to grant her a license.

“This is step one to the long process of improving access to midwives and safe out of hospital birth,” Sasaki said. 

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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If President-elect Donald Trump goes forward with Project 2025, California could lose out on at least $300 million a year in funding for abortions, family planning and contraception for millions of low-income residents.  

Project 2025, a right-wing blueprint for the next president, targeted the state with an ultimatum that would require California to start reporting abortion data to the Centers for Disease Control or risk losing critical Medicaid funding. 

Despite Trump’s attempts to distance himself from the plan during the campaign, at least 140 of his allies produced the report and he’s appointing key figures from the project to his administration. As California leaders rush to shield the state from a Trump agenda, preserving reproductive freedoms stands as a top priority. 

Newsom called a special session for next month to “Trump-proof” California, and he’s hiring lawyers to prepare for Day 1 of the Trump presidency. 

“Whether it be our fundamental civil rights, reproductive freedom, or climate action – we refuse to turn back the clock and allow our values and laws to be attacked,” Newsom said in a statement.

When CalMatters first reported on the ultimatum in September, the California Department of Health Care Services didn’t provide specific figures detailing how much the state receives in federal reimbursements for reproductive healthcare provided through Medi-Cal. The department now says the federal government reimbursed California about $310.7 million for reproductive healthcare last year, according to California Department of Health Care Services figures. In the previous year, the state received $334.5 million. That funding supports Medi-Cal, the single largest payer of maternity care in the country. Medi-Cal covers about 14.2 million Californians.  All told, the federal government reimbursed the state $90.9 billion for Medi-Cal last year.

Under Project 2025, all 50 states would be mandated to report detailed abortion-related data to the federal government, including information such as the reason for the abortion, the fetus’ gestational age, the birthing parent’s state of residence, whether the procedure was surgical or medication-induced, and more.

Currently, California, Maryland, and New Hampshire do not require abortion providers to share patient data with the federal government. Shortly after the overturning of Roe v. Wade, the California Department of Public Health said that it does not report abortion data federally because it is not legally obligated to do so. States that do collect abortion data typically use it for public health analyses, which can help identify gaps in care and improve access to services.

Newsom’s office did not provide details on the projected costs of lawyering up, but said the  governor plans for legislation to give additional resources to the California Department of Justice and other state agencies. 

These resources are intended “to pursue robust affirmative litigation against any unlawful actions by the incoming Trump Administration, as well as defend against federal lawsuits aimed at undermining California’s laws and policies,” the governor’s office said. “The funding will support the ability to immediately file litigation and seek injunctive relief against unlawful federal actions.”

Trump tapped two individuals associated with Project 2025 for roles in his administration. Brendan Carr, who authored Project 2025’s section on the Federal Communications Commission, will lead the agency.  

Tom Homan, an immigration hawk who’s listed in Project 2025’s credits as having assisted in developing and writing the playbook, will serve as the border czar, overseeing immigration policies and implementing mass deportation strategies. The spot is not an official cabinet position.

To lead the Department of Health and Human Services, Trump tapped Robert F. Kennedy Jr., an environmental lawyer who previously fought California over vaccine mandates. . The department controls oversight of Medicaid spending and plays a critical role in abortion reporting by setting federal guidelines and enforcing privacy protections under HIPAA. 

Kennedy does not appear to have endorsed Project 2025. His stance on abortion has been notably inconsistent over time. In May, he expressed support for unrestricted abortion access, stating he opposed any government restrictions, “even if it’s full term.” 

However, he later revised his position, advocating for legal abortion up to the point of fetal viability, the stage at which a fetus can potentially survive outside the womb. 

Roger Severino, who served as the Department of Health and Human Services’ director of the Office for Civil Rights under Trump, authored Project 2025’s abortion surveillance plan. He is now the vice president of domestic policy at the Heritage Foundation, the conservative think tank behind Project 2025. He declined an interview request.

Severino’s vision for remaking the department is a cornerstone of Project 2025’s effort to impose stricter federal oversight on abortion practices, particularly targeting states like California, which offers greater access to abortion services than most other states. 

“Because liberal states have now become sanctuaries for abortion tourism, [the Department of Health and Human Services] should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method,” reads the chapter on abortion reporting. 

The potential fallout isn’t limited to California. Experts have warned that other states with progressive abortion policies may face similar funding threats, amplifying the national debate over reproductive rights under Trump’s second term.

After Election Day, Newsom traveled to Washington, D.C. for meetings with the Biden administration and congressional leaders to “discuss strategies for safeguarding healthcare access,” said Anthony Cava, a spokesperson for the California Department of Health Care Services.

Cava would not elaborate on those strategies. He said the department “cannot speculate on the future of these programs under a new federal administration, but the Newsom administration is working to protect the health and well-being of all Californians.”

California has long positioned itself as a national leader in reproductive rights, actively opposing federal restrictions on abortion access. The state’s proactive policies, such as safeguarding providers who serve out-of-state patients, stand in stark contrast to the goals of Project 2025. As policymakers and advocates brace for how Trump plans to “Make California Great Again,” they’re treating Project 2025 as a looming possibility.

Planned Parenthood, one of California’s leading providers of reproductive healthcare services for low-income communities, said the organization is preparing for “a variety of scenarios.” 

Shelby McMichael, a spokesperson for Planned Parenthood Affiliates of California, said “while specifics remain under wraps,” the group is prioritizing expanding California’s abortion provider workforce, increasing investments in abortion funds and infrastructure as well as analyzing data to “improve abortion care access and education.”