Assembly Standing Committee on Health

Good afternoon, everyone and welcome to the Assembly Health Committee informational hearing on the impacts of wildfires on health and healthcare systems. I first want to welcome our newest Committee Members, Assemblymember Catherine Stefani. Hello. And Assemblymember Maggie Krell, who are with us today.

I want to take a moment to acknowledge the incredible devastation caused by the recent Los Angeles wildfires, as well as other fires up and down the state in recent history, including the Tubbs fire and and the campfire and the wildfires are fueling a public health crisis. They impact both physical health and behavioral health.

There are also impacts to access to care for our workforce, impacts to our health care workforce and public health. Public health healthcare workers and emergency responders work day in and day out to ensure that we are healthy and safe. Climate models predict that wildfires will triple in frequency and severity by the year 2050.

So we must dive into addressing the immediate needs of the recent devastating wildfires while developing a short term, midterm and long term strategy to mitigate the potential harms to public health. Today's hearing will give the Assembly an overview of the impacts of wildfires on public health, the health care system and the health care workforce.

I look forward to hearing from our presenters and all of the stakeholders we have joined. And with that I want to just give an opportunity for our Committee Members to offer any opening remarks. Majority Leader.

Thank you all for being here today. I just would like to get on with the hearing so we can learn as much as we can. So thank you very much for all attending. Thank you.

And with that, we'll call up the first panel which is about public health impacts on wildfires. We have. Please come up to the dais. We have Dr. John Palperio, Professor with the University of California, Los Angeles, David Geffen, school of medicine. Dr.

Elisa Appel, Associate Professor for the University of California, San Francisco, Department of Psychiatry and Behavioral sciences. Genevieve Flores Haro, associate Director for Mixteco India community organization Project Micop and Sam James, co founder and CEO of Altadena Recovery Team.

Please go ahead and begin your presentation and if you have slides, just indicate that you would like to have this slide show start. Go ahead and press the button.

Good afternoon, Chair Bonta. I'm John Belperio from UCLA, Chief Division of Pulmonary Critical Care, Allergy, immunology and sleep. Dr. Belperio has slides? Yes, and the title of the talk will be Physical Health Impacts a Wildfire. Next slide. And really, January 7th, Los Angeles County was hit with wildfires.

It erupted and took out, unfortunately, 29 people and it destroyed thousands of structures. Next slide. It started out in the Palisades the morning of January 7th, and really by the end of it, took out 24,000 acres and, and 7,000 structures later on that morning. Next slide.

That took the Eaton fires and that took out another 15,000 acres as well as 11,000 structures. Next slide. The estimated loss, total economic losses greater than $50 billion. Next slide. And what you can see here with regards to California wildfires, 75% of of the largest wildfires have occurred since 2000.

Essentially, what you're seeing on the Y axis is the amount of forest area burned, and the X axis is the years. And essentially every couple of years you have a doubling of burned acres in Los. In California. Next slide. And really, this probably has to do with hydroclimate whiplash.

And essentially you get these wet extremes where you get lots of vegetation growth, followed by these dry extremes where there's a lot of drying and dying. And you get multiple cycles of this. And then. Next slide. All you need is that one spark, be it human error or be it from lightning.

Then you get the ambers that are lit. And then with the, with the winds that occur, it's very easy. Next slide. For the home to actually catch fire. Next slide. And that leads to total devastation in our area. Next slide. And what this leads to is poor air quality, especially in the surrounding area. Next slide.

And we check it by the air quality index, which really measures ozone. It measures particulate matter, which is extremely important for lung inflammation and systemic inflammation. It also measures nitrogen dioxides. We usually like to live in that green to yellow zone. We can tolerate the Orange Zone.

But when you have wildfires, you get down to that bottom zone, which is the maroon zone. It's very hazardous. Next slide.

What I want to talk about in particular with these wildfires, and especially when they bleed over into structural damages, meaning homes, vehicles, electric vehicles, you get a lot of particulate matter released, which what you're seeing all the way to the right is a slender of hair in blue. You see a slender of salt. Then next slide.

You actually see particulate matter that is about 10 microns in size. That's a little bit bigger than a red blood cell. Next slide. And then what you'll really worry about next slide. Is the purple dot. That purple.is particulate matter 2.5 microns or less.

What happens is when that next slide gets into the lung, it's very hard for the lung to remove it. It leads to inflammation. We call this compartmental inflammation of the lungs. You See the white blood cells there? When that actually happens, it makes people with asthma, copd, interstitial lung disease, and lung transplant patients decompensate.

In addition, you can see. Next slide. Particulate matter getting deep down into the lung. Next slide. And. And then the white blood cells will come in. Next slide. That actually can lead to systemic manifestations. Next slide. When you have those systemic manifestations. Next slide. You can now have non compartmentalized effects.

Means actually it can affect the brain, it can affect your carotid arteries, it can affect your heart, and for pregnant people, it can affect the placenta. In addition, it can be engulfed by white blood cells, leading to white blood cell dysfunction and lots of infections. Next slide.

So what I'm going to show you here is some compartmentalized effects of wildfires and particulate matter. 2.5. You see, there's a girl who actually has an asthma exacerbation due to particulate matter. Usually that's okay because we actually have treatments. You see on the CT scans, that's a patient with chronic obstructive pulmonary disorders or Emphysema leads to inflammation.

We can treat that. But in the next slide, you have someone with interstitial lung disease and lung fibrosis. When they get that extra burden of particulate matter and inflammation, they decompensate. They always wind up in the emergency room into the ICUs, and worst off can die. Next slide. Shows a lung transplant patient.

When they get hit with this particulate matter, it. It causes inflammation and then they reject their new lungs. Next slide. You can actually see engulfment of this particulate matter in white blood cells, leading to more infection. Next slide. The non compartmental effects will be the systemic inflammation causing worsening depression. Next slide. Carotids get hit, plaque rupture. Strokes.

Next slide. It hits the heart. Plaque rupture of a coronary artery leading to more mis. Next slide. And it can tickle the placenta, leading to preterm labor. Next slide. Overall, you can see that wildfires have many health problems leading to short and long term complications. Thank you.

Thank you, Dr. Belperio. And I also just want to acknowledge and welcome Assemblymember Juan Carrillo, a Member of the Health Committee, as well as our guest, Assembly Member John Harabiden from Pasadena, who has been holding down his community as a result of the Eaton fire with incredible grace.

And we're very thankful that you can be here with us today. We'll move on now to Dr. Elisa Epel. Please go ahead and press the button.

Thank you, Chair Bonta. And Members of the Assembly, very honored to speak with you today. I'm a Professor and Vice Chair in the Department of Psychiatry at UCSF. I have been studying stress and the nervous system and mental health disorders for many decades.

I am representing the UC Wide Center for Climate Health and Equity Today at UC Wide center my colleagues across the ucs have joined together and we've developed the Climate Resilience Initiative co led by Jyoti Mishra at UCSD and Philippe golden at UC Davis. We are urgently providing information, awareness and interventions for climate resilience. Dr.

Appel has slides as well. Yes, thank you. First slide. We already know there's a tremendous mental health epidemic here as well as globally and we cannot meet the need we are face. Next slide. Next slide. Next slide.

Climate disasters and climate change amplify the mental health burden leading to exacerbation of people who have these chronic disorders and rapid incidence of new disorders. Next slide. Next slide. We heard about the many systemic health effects. The mental health effects are one of the most present and lingering effects.

If you talk to people victims in La, they are compLaining of new mental health problems. We know that in the acute weeks after the LA wildfires there was a five fold increase in phone calls to the suicide and mental health crisis lines. Next slide. What happens after a disaster?

It is normal to have disruptions to behaviors, to have more substance abuse, to have anxiety, depression, lack of sleep. These subside within days and weeks for many people. The good news is that 80% of people recover and show resilience.

The bad news is that a around 20% of people show lingering chronic mental health conditions six months or more after these disasters. We think this is higher for wildfire victims. Next slide. We know that there is a syndrome called firebrain.

My colleague Jyoti Mishra at UCSD studied the campfire victims and found that six months after exposure and indirect exposure to these fires, which was one of our deadliest fires In California, participants, 35% of participants had climate trauma symptoms of depression, anxiety or ptsd. Their brain function was still not back to normal. They showed impaired concentration attention.

That means they had trouble decision making. These are people trying to rebuild their lives after loss and and so they're left with these cognitive and emotional problems. Next slide. The good news. We can prevent the long term mental health sequela of fires with financial support that can lead to emotional support.

Human support is the biggest protector of stress related mental health disorders. We have a intervention, psychological first aid. This is a refined and manualized intervention that has been shown to prevent the long term sequela. The good news is that we're not relying on Clinicians to deliver this. We can train this in communities.

We can build climate resilient communities by training people to understand trauma and stress, the effects of it and how to be a helper. So we need to mobilize our communities. People want to be helpers. We put out a call for this training with vibrant and nonprofit. 600 of our UC Members signed up.

And this is for acute days and weeks after the trauma. And then there's the longer term mental health needs. Next slide. Who is at most risk? One of our groups we are absolutely most concerned about is our youth and young adults. We know that our young adults have twice the mental health burden of older adults.

We also know that they are the population that is most distressed about the State of the world and climate change. We see this in our UC classrooms. We see students on day one of class with around 30% of meaningful clinical anxiety. This is unacceptable. We've bonded together across UCs.

We've developed a class to teach essential living skills of emotion, regulation of turning distress into action. We evaluated this class and we found that it reduced the mental health burden, anxiety, depression, climate distress, increased hope and promoted action engagement in our local sustainable activities and communities. Even five months later we found these improvements.

We want to offer this California wide to other higher institutions of education, to high schools. This is a dire need right now for our youth. Next slide I want to end with talking about. Okay, so this is our resilience class. I've never seen alignment across all the UCs. We feel like one University.

We know we need to disseminate this Next slide. What do we need to do in communities? We know that we need to build climate resilient communities and the ingredients are no mystery. And I will refer you to a website that lays out what we need to do. And, and it's not just theory.

There are models of climate resilience networks in other states like South Carolina. There's wording for bills to support these. This is bringing together the web, the network of community players that need support, need each other's support, that need to support individuals that need to support policymakers.

So there's some ingredients of climate resilient networks that you can see here. Besides providing support, we we're educating and bringing awareness to what is a trauma informed community across California. We need to be ready for this dramatic fold increase in wildfires and prevent firebrain. So with that I will end and leave you with two links.

One is for these trauma resilient community networks that we need to start building to prevent the mental health sequela and integrate that with climate resilient physical and economic structures. Secondly is our UC Climate Resilience website. We've offered Wildfire seminars on mental and physical health.

In partnership with our UCLA colleagues, we've offered this climate resilience class as well as psychological first aid training. Thank you.

Thank you so much. And I just want to acknowledge that we have had Assembly Members Don Addis join us who spent spent five hours yesterday chairing Assembly Budget Health Committee. We're thankful that she can participate.

Assemblymember Schiavo, who is struggling with a two year old Chiquita Canyon landfill fire that has consumed her community and very thankful for her leadership. Assemblymember Celeste Rodriguez, a Member of our Health Committee and Dr. Jasmeet Baines, who is guesting with us today today thankful for the work that she has done as a first responder for many, many months and thankful to have you all here. We'll move on to the second, the third panelist. Thank you.

Thank you. Good afternoon everyone. Good afternoon, Madam Chair, Committee Members, My name is Genevieve Flores-Haro and I serve as the Associate Director for the Mixteco and the Community Organizing Project. And I'm a co one of the co founders and immediate passport President of 805undocufund.

It is an honor to be here this afternoon to shed light on an issue that often remains invisible, disproportionate suffering of Latina, indigenous and undocumented communities during wildfires. And I also have slides. Next slide. While disasters do not discriminate, our systems do.

Structural inequities make these communities more vulnerable, not just during a crisis, but also before disaster strikes and long after the headlines fade. Next slide, please. Undocumented immigrants and indigenous farmworkers are among the most marginalized in our society. They work in hazardous conditions, often without protective gear, for Low wages and little to no access to health care.

Many, especially indigenous workers, who make up over 60% of California's farm workers, do not speak English or Spanish, only their native language, like Misteco or Zapoteco, making it nearly impossible to access emergency information. Next slide, next slide, next slide and next slide.

During the 2017 Thomas Fire, which at the time was the second largest wildfire in the State of California, emergency alerts were issued only in English in Ventura County, leaving thousands without life saving information, including a boil water advisory that was only made available in English to those living near the base of the fire.

As the smoke thickened, farmworkers continued toiling in the fields, often without masks, while wealthier communities evacuated. They may not have lost their homes, but they lost wages, suffered severe health impacts, and were denied federal disaster relief simply because of their immigration status. Next slide, next slide and next slide.

And this pattern repeats itself most recently during the Eaton, Palisades and Hughes fires, where outdoor workers are forced to labor under hazardous conditions. Next slide and next slide. But these disparities are not just a consequence of disaster. They themselves are a pre existing condition.

Overcrowded housing, lack of health insurance and dangerous work environments are often daily realities for many in our communities. Next slide, next slide. But these disparities are not just a consequence. Even with the medical expansion in California, some farm workers are left uninsured due to income fluctuations that push them just outside federal poverty guidelines during peak harvest seasons.

For those who are familiar with Strawberry, for example, peak season is February through about the end of summer. And this is when they're paid per box. They pick, not hourly. These barriers continue to put them at a higher risk long before disaster strikes. When disaster does come, the harm is amplified. As Dr.

Belpero mentioned, that fine particulate matter from wildfire smoke is more dangerous than car exhaust. Yet these workers have no choice but to breathe it in day after day during wildfires. As one farm worker put it simply, we all got sick. Our throats closed from breathing in too much smoke and our kids couldn't go to school.

We had to buy our own masks, medicine, and even goggles because my eyes burned while I worked. And there's a double edged sword of sending workers home during a disaster, a luxury many literally cannot afford as there are no safety net programs for these workers. So what can we do? We must push for systemic change.

And since the 2017 Thomas fire, I'm proud to share that this body has taken steps to address some of those inequities.

And you can find that in AB 1877, Limon, which ensures language access for emergency information, SB 160, Jackson, which mandates cultural competency and disaster and climate resilience Planning, and then SB56 and AB4 Health for All, which was that earlier medical health expansion that, that I mentioned.

But there's more work to be done to build on these policies that have already passed. So for example, with AB 1877, emergency communications must extend beyond the threshold languages that are outlined in that policy. We need real time, culturally competent interpretation services that include indigenous languages like Misteco and Zapoteco. But true inclusivity goes beyond interpretation.

It means also valuing the lived experiences and knowledge of migrant communities. It means ensuring that indigenous and Latinate organizations have a seat at the table in disaster planning, response and recovery. We also need a permanent statewide disaster Fund for undocumented immigrants who contribute billions in taxes, yet are excluded from federal aid.

And California has taken steps with programs like the 2020 Disaster Relief Assistance for Immigrants programs or DRY or the Storm Assistance for Immigrants, which provide the state funding disaster relief for those affected by the 2022-2023 storms. But these programs, they're still temporary solutions until they are codified and made available to undocumented workers. They deserve permanent protections.

And moving on to occupational and health safety laws. These laws must ensure that farm workers and other essential laborers receive hazard pay, protective equipment, and the legal protections to report unsafe conditions without fear.

All of the photos I showed you are photos that my staff took because they were the ones out there distributing these N95 masks that employers should have been distributing themselves. There's a Cal OSHA regulation that was passed in 2019 that requires employers for outdoor workers to provide these masks once the ASQ goes above 150.

And time and time again, there's about seven different fires in that slideshow from 2017 to 2025 where the employers did not provide that safety equipment for their workers.

And my organization, MyCup, has also signed on this year to 1.25 million dollar budget request to Fund AB 694, which will provide more funds for Cal OSHA workers to be able to do these workplace inspections within and without disasters. And so just to close, you know, we can no longer ignore the most vulnerable among us. Disaster relief must not be a privilege to only those who can afford it. It must be of right for all Californians. Thank you.

Thank you so much. We'll move now to Sam James.

Thank you Madam Chair and Members of the Committee for elevating the importance of this topic and specifically for highlighting our experiences in Altadena with the Eaton fire. As a former staffer myself, I would also like to extend my gratitude to the staff who ensured this hearing could happen today. Thank you.

My name is Samantha James, or Sam as most people know me and Sammy to many in the Altadena community who raised me. I am 25 years old today and I made the trip up here on my birthday to share the unfortunate realities we are facing after the Eaton and Palisades fires in January of this year.

I am a co founder and CEO of the Altadena Recovery Team, or art, formed immediately after the fire where we have provided Direct relief to community Members in Altadena every weekend. I am a current resident of Santa Monica, where I was an evacuee of the Palisades fire.

But Altadena is my home and it was in fact the place I was evacuating to when my dad told me about the Eaton Fire raging towards our home. I grew up in Altadena, California, where I am the sixth generation of my family to live in the area after we originally placed roots there in 1890.

My family has seen the community through its many iterations from when Orange Grove Boulevard was a scene of orange trees, to redlining and De facto segregation, to the beautiful flourishing of black art and culture that is ever present in the community, and now to the devastation we are experiencing as a result of the Eaton fire.

As is the case for many Altadena residents, homes that were in my family for 607080 plus years are wiped out. My grandfather's house that he worked three jobs to pay off and where I spent much of my childhood is nothing but a garage now.

My own childhood home experienced extreme smoke damage as the fire raged in our backyard, burning down our horse stalls and tack room where the tools my dad once used to build those structures now lay charred in heaps on the ground. As longtime Altadena residents, we have faced environmental challenges and pollution related health disparities for decades.

Many of my family Members have asthma and lung diseases that already disproportionately impact impact black and brown communities and are now exacerbated by the wildfires we have experienced in our lifetimes.

I personally have emergency evacuated three times and suffer from a lung disease and breathing disorder that dramatically worsens when I am around smoke of any kind, let alone the thick toxic smoke that hung over Los Angeles and surrounding counties for weeks after the fires.

While we've always understood the risks of living in this area, the severity of these fires has escalated dramatically due to climate change. The fires I experienced as a child pale in comparison to the near apocalyptic destruction caused by the Palisades and Eaton fires, both to our communities and our health still two months after the fires were extinguished.

And it is not just our physical health that is harmed by these wildfires, but our mental health as well. 10 days after the fire, we lost our patriarch, my grandfather, who worked so hard to provide for our family until he was well into his 80s.

When you experience that magnitude of loss, that intensity of grief, as I'm sure many of you in this room have experienced and can relate to, it is the physical reminders that often serve as A life raft. The hat he wore to my softball games. The photos of me sitting in his lap.

The home he took us to after he picked us up from school. What do you do when you don't have any of those anymore? How do you heal from the compound grief of losing your community, your home and your loved ones at the same time?

How does a community move forward with the painful reminders settled in the ashes all around us? As the co founder of the Altadena Recovery Team, I know that my experiences are not unique.

Each week we meet more and more families with their own stories of resilience now struggling to find basic hygiene items, PPE and other supplies to support their overall health and well being. Families who want nothing more than to rebuild. Nothing more than to breathe freely again.

Nothing more than to be treated as a human being and not an expense for insurance companies if they were even lucky enough to afford it in the first place.

Companies that are now trying to push people like my father back into his home that is still standing but are unhealthy to live in and rife with reminders of their trauma.

As the larger donation centers shut down, as people find long term temporary housing cities, counties and even states away, how will the state support community driven efforts like ART that support the well being of our neighbors waiting to rebuild?

How will we ensure that toxic waste will not be dumped in areas where it will harm other communities as is currently happening?

Who is monitoring and protecting the health of residents still in the area as they are regularly exposed to toxic sites and experience the pollution of the never ending lines of trucks that parade throughout Dina removing debris. Never could we have imagined the destruction we currently face in Altadena.

But what I always knew is that we in Altadena would lift each other up. Our neighbors are not just our neighbors, they are our friends and they are our family. Despite this unimaginable loss, our community remains resilient. But we can't do this alone. So I ask you today, how is the state going to show up for us the way we show up for each other? Thank you.

Thank you so much Samantha, very much appreciate that. And happy birthday. Thank you for being here with us and also for honoring in the memory of your your grandfather. I'll open it up for questions from the Committee or comments. Assemblymember Addis.

I'll echo that. Happy Birthday and thank you for sharing your birthday with us. And I'm just so incredibly sorry for your loss.

And I also want to say thank you so much to Genevieve for your work with Micop I represent Morro Bay and San Luis Obispo, Monterey, Santa Cruz and MICOP has just been incredibly important across the central coast over numerous disasters. And for Dr. Epel, really appreciate your comments around climate anxiety.

I've got two kids, one in med school and one who's just a freshman in college, and this is constantly on their minds. Also, thank you, Dr. Belpero, for your work.

My district has just recently experienced not the level of wildfire certainly that L A has encountered, but we just went through six days of fire of lithium, of a lithium ion battery plant.

And one of the questions I had, I just have a couple questions for the panel, but one of the questions that I had is around if any of you have information on how lithium ion batteries will affect affect wildfire smoke or change the characteristics of wildfire smoke.

I had also heard that lithium ion batteries were very difficult to put out in the recent fires that we had in Palisades and Altadena and that they contributed significantly for the challenges with those fires. And so just wonder if anyone has information they might be able to share on that aspect.

Yeah, no. Well, I think these wildfires obviously led also to structural fires, meaning it hit homes, vehicles, and you know, all these areas have a lot of EV vehicles. So all these lithium batteries are burning, as you mentioned, they burn fast and they burn really hot.

And for sustainability amount of time, the way it's combusted with those fires, there's a lot more heavy, there's a lot more metal that is released into the air. So things like lead, magnes, tungsten carbide, all these different types of metals, beryllium, all that can be released.

When you're talking about lithium batteries, and that can have an effect depending on how high the concentrations are, it can lead to more airway injury. And in cases, it can actually lead to granulomatous disease that look very similar to a disease called sarcoidosis. So we do have to watch for that, we have to monitor for that.

I think anyone that has symptoms such as shortness of breath, cough or dyspneon exertion, meaning shortness of breath when walking, they should see, you know, their Doctor, be it a family Doctor, internist. And usually they'll start off with a chest X ray and possibly some pulmonary function tests to decipher it, because these things can be treated.

You know, and I think that's what we're trying to do is find things that can be treated. I think the sooner you do it, and I think that's what we have to outreach to the community is that if they're having these symptoms, see your Doctor.

And what we found even in our own anecdotal finding with the Palisades fire, because UCLA is very close to that, a lot of people thought their shortness of breath and dyspnea were due to the fires itself. But actually a lot of that was infections.

So we told patients, come in if you think, even if you think it's a fire, if you have a change in cough, more shortness of breath, see your Doctor. And we picked up a lot of influenza treatable things.

Now, some of that may be due to the fires itself affecting white blood cells, making you more susceptible to these infections.

And they're also going to have to watch out for that because now if they're bringing in breathing in those heavy smokes, it will change your immune system, at least in the short run, leading you more susceptible to infections. And we are still in the middle of a pretty potent viral season this season.

Is there. Thank you for that's really helpful information. Is there.

And you may or may not have this information, but a way to differentiate if somebody has health effects from smoke as a, you know, typical wildfire smoke, as opposed to wildfire smoke that has had lithium ion batteries, particularly the LMC batteries, the ones you know, with magnesium and cobalt.

I think it's tough to differentiate between the two. I think, you know, when you have, you know, these lithium batteries and if there is more metals, if anything, that can make your cough much more drastic, make your shortness of breath much more pronounced.

But I think it's really going to be up to the physicians taking a look at it. You know, fortunately, the treatments can be quite similar. In both cases, you're just going to have to monitor these patients for the short term as well as for the long term.

And then I just have a couple more questions. One is, if you have a lack of air monitoring, say in the first 12 to 18 hours of a fire, are there, what does that do in terms of a community's ability to understand the health effects effects of a fire?

So, you know, you don't have air quality monitoring, then maybe 18 hours later you do start air quality monitoring and you find that the air quality is relatively okay. And the message to the community is that it's okay. But you never had that initial monitoring.

Yeah, I mean, I think when you. I think that the big thing is to like, learn from all these experience. I think, you know, when, when a fire happens, you smell smoke, you see smoke, or you think the smoke is going to be coming in your area. I mean, what you want to do is stay indoors.

You really want to try to seal up places where you feel giraffes during the winter. Right. You know, they're going to be the leaks in the house where smoke can get in. So, you know, the regular sealants for waterproofing is fine. These tape type of things.

I think it's really staying indoors, you know, and people nowadays, which is great, everybody likes to exercise, you know, when. When there's a wildfire. You do have to watch that. If you are aware there's a lot of particulate matter, which means, you know, those small particles.

But particulate matter concentrations correlate very well with, you know, metal concentrations and all the things that our air quality index doesn't measure. But it correlates very nicely when the air quality is poor. You have to stay inside, do your exercises inside. You can't get to the gym. That's okay.

They have plenty now on your Internet youtubes, because when you're exercising, you really breathe in deep and fast. So that's when air quality really puts patients in a detrimental situation. So these are things to watch where I think it's a matter of educating. And we really got to educate the communities, especially going forward.

I really want to appreciate what you're saying and just for those that are here, that I do think there's a number of bills moving through the Legislature that have to do with lithium ion batteries. And I think the LA fires, the Moss Landing fires, a number of fires across our state.

And I think we're going to see it more and more. And we do need battery energy storage.

And I think that specific health effects of lithium ion, especially when it burns and burns out of control and burns for days at a time, is something we should be really, really thoughtful about when we're exposing communities to that kind of potential situation. Which just leads me to my last question for my cop.

And again, I want to say thank you. Because after that Pahra Levy broke and there's so much concern in the community about exactly what you were talking about, which is cultural competency and primary language support. And our office actually got a request, some folks were saying they just did not have the translation.

And we were able to find someone in the community just by chance that spoke one of the Mixtec dialects that we were able to connect in with. But for communities that do want to do the things you're saying and are having trouble finding the people to do this, where should they turn?

What should they do when they're, you know, they know there's a need for interpretation and translation. Where can folks go to kind of find those resources?

Yeah, I will say, you know, the Thomas fire in 2017 was a lot of things and I think it was definitely a litmus test for the community because that's where that relationship building started, that relationship building between, you know, the community based organizations, between the county and it's the. They call it blue skies. Right.

So it's in the blue skies time where you really have to do that gathering and that meeting so that you know where to go to when it's red skies during disaster. And I Again, the COVID 19 pandemic was also a lot of things.

And in a way I feel like the 2017 Thomas fire helped my community because we were able to spend the next three years forging those relationships, making those connections.

And to your point about the different variants of Misteco as well, I think it's also important to recognize, you know, who can also verify and validate that this is indeed, you know, the variant in our area that needs to be spoken or that it's a Spanish that is able to be understood by folks.

And we tend to try to keep things at about like a fourth grade level because, for example, with indigenous languages, if the word doesn't exist like lithium battery or wildfire, then what the language does is the language has to describe it.

And so we try to keep it as basic of a level as we can as far as that language piece. But yeah, to answer that question, it's doing the work now during Blue Skies so that we are ready for red skies.

Thank you. And thank you, Madam Chair.

Thank you. We'll go to Assemblymember Schiavo.

Thank you. As the chair mentioned, I have the only fire that continues to burn in LA County, which is the Chiquita Canyon landfill fire, which has just tripled in size to 90 acres underground, making our community sick.

One of the challenges that we've seen is that and have been, you know, informed by Department of Public Health is that masks don't work or help there because benzene and, you know, other chemicals that are in the air will go right through it.

What are you seeing in terms of the effectiveness of an N95 mask in what we know is in the air? And then another challenge that we've also seen is that when it comes to air monitoring, it's only as good as whatever it's monitoring for.

And so if it's not testing for benzene, then you're not going to know benzene's in the air, but it can still be in the air.

So you kind of have to know the broad swath of what are the possibilities of, you know, toxins that are in the air that you have to then figure out how to test for. And, and you're kind of, you know, I don't know if you can test for 50 or 100 or a thousand things. Right.

So can you speak to that when it comes to, to smoke in the air and those dangers?

Sure. You know, I think the air quality index, right, it doesn't, it doesn't measure everything. It only measures a certain amount of things. But the nice thing about the air quality index is if that's high, that usually correlates even during fires with high levels of these polyaromatic hydrocarbons. So, you know, benzenes. So there is a correlation.

So I think you can use that correlation very well. And it's a, it's a fairly strong correlation. So you can feel good. If the air quality index is, is good, you're looking good. You know, other things that it doesn't measure are lead metals. It doesn't measure asbestosis. Right. A ton of asbestosis.

When these structures fall, right, they're all older homes. You're going to get those levels. But, but you know, again, high levels. Asbestosis will be there when the air quality index is high. When it's Low, they're, you know, coming down. You gotta hope for rains. Rains kind of push it down.

Yeah, but, but you know, about these certain gases there. You really need kind of special filters, charcoal filters that, that you know, are, are becoming better and better you can get for homes and all. But you know, realistically, what your hope is, stay indoors, seal the house as best as possible.

You know, the N95s are still very good. You know, they're not good for asbestosis, for instance. Right. So if you want to go out, visit after the fire, go visit your home, look for what's left, you know, is there anything left? Have to be very careful there. You really have to use the P100 mask, not the N95.

The P100 mask will protect you from asbestosis. And the big thing to tell your community, it's the mask that have the pink on in the middle. That's how you can distinguish an N95 from a P100. Look for the pink label. That's the mass you want.

It's very easy to identify those if you know, to look for the pink. And you know, that's the best, you know, that we have out there. And they are very protective, especially if you're not exercising and breathing heavy. So, you know, when you're, when you're going into those smokes, you know. Yeah. You have to really be protective.

And the big thing is not to go into that area. Right. Save that for the professionals.

Dr. Baines.

Yeah. Thank you to all the panelists for all the comments. And you know, to Assembly Member Addis's point, I think the Doctor will also agree that we're not going to see the long term impacts of these wildfires. For right now, it's going to take maybe the next 1020 years.

We're going to see a lot of things that are going to start emerging. For example, what we had discussed, my grandmother died from sarcoidosis, like idiopathic pulmonary fibrosis for when she worked in a factory in Cleveland, Ohio. And that didn't manifest until maybe 40-50 years after.

So there's a lot of health impacts that are going to hit not today, but in several years from now and decades from now. And the impacts that are going to happen to the people. And what do we do when people don't have the leisure of staying indoors? People don't have a home to be indoors.

We have a growing homelessness population. Staying indoors is not a reality for a lot of people in California. What about those health impacts? What about the health impacts for people that don't even have access to know what the air quality index is or never heard of a P100 and don't even have access to a P100?

As a Doctor that worked on the front lines of COVID there were times I didn't even have an N95 myself. But that didn't stop me from working. I needed to be there. I needed to be there for my community. They showed up every single day to work.

I worked out in areas of Taft and we had a lot of farm workers from the Cuyama area, a lot of Oaxacan, and I didn't have a translator from his state go out there. It didn't even exist back then. We had to literally find people in the community to help translate what was happening. There's a lot.

The biggest issue in California is we are such a big melting pot. A lot of different languages, a lot of different cultures. Getting access to that information is really important in the same time, making sure it's in all languages and cultures for sure.

But also the research that we need to be doing today to see what the long term impacts are going to be to our air quality and to long term lung manifestations.

As a Doctor in the Central Valley, seeing those impacts today and what it's going to be in 20 years from now, you're not going to see it today by a CT scan. And you guys can agree to that. If a patient comes in today that was at the fires, Connecticut will probably be normal.

You'll see that in maybe 2030 years. And that's the long term impact that I really worry about. What's going to happen from these LA fires. When it comes to the lithium battery, it's new. We don't have the updated research on what's going to be the long term impact.

You know, what is going to be the type of fibrosis that it's going to cause to the lungs of people, people that are breathing that in and people that don't have the leisure to be indoors. So I think that's where we really as a body need to invest in robust research.

If we're going to invest in new technologies, we also must be responsible and invest in the research to see what happens when those technologies go wrong.

Sure. Just one more question. So I had two fires in my district. Fortunately, no homes, you know, were burned. No, no people were injured. But one of them, the Hughes fire, was one of the largest fires during these LA fires. And another one in the, you know, the hills behind Sylmar were right up against a neighborhood.

And so, you know, there's no clearing of this area that's happening to get the ash out or, you know, or anything else. If wind is blowing around, it can blow right through this community. Right.

So can you talk a little bit about what we should be aware of or maybe, you know, warning our community of in wind events or you know, being around or near those areas because we're not getting as much information as maybe other, you know, Eaton and Palisades fires, which obviously there's a lot of people who are going into those spaces.

Yeah, I think again, you really have to lean on, you know, getting the word out to the local community. I think the big thing, if you have a lot of ash in the area, right. Ash is not good. It's, it, you know, it gets on you. It could be very irritating.

But you know, it actually contains a lot of the metals, you know, it'll, you know, doesn't sound like you had a lot of structural damage, which is great. But I think the big thing is really till we get rains that really will help wash that away, you're kind of stuck.

But I think what you have to watch out for is when it's very windy because the wind will cause dust ups. And those dust ups is when we'll start to breathe in that particular matter.

And that's what we have to kind of tell our communities that when it's windy out, you know, you have to really kind of watch. You don't want to be out there, you know, as little as possible. You want to be outdoors when it's windy. And usually the air quality index will go up when there's dust ups.

So that, you know, and I think it's getting the word out there go to, you know, those who have phones, go to the cell phone on the Google.

You just put in AQI near me and that'll give you usually a monitor that is closest to you that'll tell you and you know, you start getting, you know, above 100, that's bad. But it's typically bad for people that have underlying lung diseases. Once it gets above 150, it's bad for all of us.

And you know that the levels are, you know, when you have these fires, well over 300, which is kind of the top maroon color. And you're talking 5006007 hundreds, a thousand, even during the active fires. So we do have to watch that.

I think with all you guys have mentioned, you know, more research definitely has to be done, you know, not only for the lung, but the systemic manifestations. I mean, we always see, you know, many more strokes, heart attacks and arrhythmias during these times.

You know, the ERs get full of that, as well as obviously the respiratory complaints of asthma, copd. And I think, you know, wildfires don't get as much looked at how bad it is for the body because most of the people that are actually studied are normal people.

And like you said, that takes 2030 years to really see that effect. The. The only ones you do see the effect are people with bad lung diseases. You mentioned fibrotic lung diseases. If you have a fibrotic lung disease, you're in trouble already.

But if you're in a wildfire, you know, and you're breathing in that particular matter, you're at high risk of actually dying of your lung disease pretty soon. So, you know, I think part of it is just, you know, we haven't done, you know, the homework are really researching who this affects worse.

But, you know, lung transplant patients, they're all happy they got a new pair of lungs, right? They don't do that great as it is. But you put particulate matter, now they're rejecting their new lungs pretty quickly. So these are devastating effects that have been understudied and that, you know, I totally agree.

We need to study it more, give better evidence that how detrimental this is. And it's not only detrimental in California, these wildfires happen in California. The winds blow it, you know, start blowing it eastward. Everybody's getting hit with that, and they don't even know how bad the effects can be long term.

I just wanted to thank you. Just make sure that we, as we are winding down this panel, have an opportunity to bring the voices of Ms. James and Ms. Flores-Haro and Ms. Epel, Dr. Epel. Into the conversation as well. You all spoke to the kind of the. I think I'm going to just put a sign on my wall. Fires don't discriminate, but systems do.

And I think it's very, very powerful to hear both the experience that you are bringing into the room about the impacts of wildfires and the behavioral health components, mental health components, overlaid with the incidents of systemic bias that our community Members are facing. So I just wanted to give you Some space to just be able to make comment to that as well.

So I think specifically with the Eaton fire in Altadena, we got lumped in a lot with Palisades and often overlooked based between the two fires. And Altadena, especially in west Altadena, has a very large black and Latino population. A lot of working families, middle class families, lower class families who can't afford to move somewhere else.

I've had conversations with people in the Palisades who have just repurchased another home. And there's people in Altadena who are in homeless shelters. And so how do we rectify that? How do we ensure that as we're talking about all this information that's been shared today, this is some of the first time I'm hearing about it.

And I'm there on the ground every day or not every day, every weekend. And so I'm talking to people constantly and they're not getting any sort of contact. We haven't had LA County Department of Health reach out to anybody that I know of to check and see if their health is okay, if their home is okay.

People are getting pushed back into homes if they're still standing. And the health impacts and the mental health impacts of having to drive past just massive devastation. If you haven't been there, it's really hard to describe, but it looks like a bomb was dropped on our community.

And you can see blocks and blocks and blocks of damage from one vantage point. And trying to put that into words, trying to see that every single day as you're supposed to be going to what is your home, when a community is your home, is extremely difficult to describe.

And I also want to say, to echo what you had mentioned as well, is that we have a lot of people because we're a community drive, who are undocumented and monolingual Spanish speakers who come to us because we don't ask for identification in order for them to receive assistance.

And when they go to the larger donation centers so much that they still exist because many of them did shut down, they're turned away because they don't provide those identifying documents because of the overall climate that we're operating within. And there's a lot of fear in the community and we are there to try to dissipate some of that.

But there's only so much that we can do, especially as a crowdfunded organization versus some of these larger donation centers who aren't thinking about the multi generational homes or they're limiting the number of items that people can receive without thinking that they might be supporting 10 people, not just themselves.

And so like limiting people in their ability to retrieve these supplies at a time when they're already hurting and they're already not being trusting of the people that are around them and the government officials that are around them because they haven't seen that support one on one.

I'm nervous that people are going to shut down and they're not going to be open to support when it does come. Because right now it's coming in spurts, it's not coming continuously. And so that's definitely something that we've been concerned about and something that we've been experiencing every weekend that we set up.

I think just one thing to add that maybe we can scale at a state level because I hear about googling your air quality. I just think about how some of our most vulnerable populations don't know how to read or write, but they do have a smartphone.

One thing we were able to pilot in Ventura County and it was a collaboration with the air pollution control district, our county Executive office, our, our Agricultural Commissioner and some community based nonprofits, is a text messaging system.

So instead of the person having to look up the information for themselves automatically when it hits a certain level at the esq, a text message will go out.

The text is in Spanish and then there are hyperlinks to Misteco and Zapoteco with the same information that's in Spanish because those languages are oral and there's no written version of it. And so we saw that happen a lot with the mountain fire that was, this is all like really like chaotic, right?

But the mountain fire in November of 2024, and we saw it with the Hughes Fire in 2025 and the other the Eaton fires, we were releasing that information and that was a joint effort.

And I think that speaks to the power of, you know, when government and the community can come together to support, you know, during red skies. And then I don't have the science necessarily behind it, but when I hear like also like let it rain after the, after, after the fires.

For me like that evokes a trauma because the first time it rained after the Thomas fire, the first thing we smelled was smoke again, because that's the smoke being washed away. Right. And so again I don't have the science behind it, but I really appreciate you being here to also speak to like the trauma that we carry.

And a lot of us, again, I was not impacted, I was not evacuated. But a lot of us who are doing this work in community we are carrying the secondary trauma. Right. And, and I don't think I've ever said that out loud. So thank you.

Thank you Chair Bonta for the opportunity to elaborate. When we think about the dramatic differential health outcomes and health disparities, when we see the physical health effects, but also the social displacement, the social needs not being met, we know there's emotional, a heavy birdie of emotional suffering in these communities.

And I wanted to differentiate between when we talk about mental health, there is the need for helping people who already have mental health challenges, serious ones, severe mental illness, smi, this includes schizophrenia, bipolar. They need professional medical management. But for everyone else, what we need to think of is prevention of these disorders, especially for children.

Climate traumas, climate disasters are ACEs. They are adverse childhood events.

And so when we think about the most vulnerable groups where from pregnant women to young adults, their brains are developmentally impacted in long term ways potentially from, from each climate disaster and the triggering of subsequent disasters, we're living in a time of what we might call cascading disasters or layered disasters.

And so the resilience of the community, the underlying resilience, which is more of the policy related support to a community, is the infrastructure of prevention.

So in addition to helping with psychologists and psychiatrists with SMI and the medical treatments, we have to think of developing a trauma resilient community of awareness of ACEs and of providing support to parents, to teachers who are able to protect kids because these trauma reactions are contagious.

So I'll just end with thinking about the stress response as the mediator here. And, and so when we can help normalize the stress response for each other, for families, schools, communities, neighborhoods, this is a very important medicine. Thank you.

If I may ask you a follow up question. Celeste Rodriguez, I represent the northeast San Fernando Valley where the Hearst fire was, where we had actually lost our entire community in 2008 by the foothills. And when the fire came back, it was very triggering for the entire community because honestly everyone had expected it to happen again.

Thankfully it did not. But I wanted to ask you about what you just talked about, like building in resilience for communities. What impact does it have when we encourage us that have fire prone areas and those that do not, we're all fire prone I think at this point.

But having a preparedness plan like emergency exit routes and building like a go bag, does that help people feel more resilient to the mental health impacts? And I ask also my 5 year old daughter got her bag ready and she grabbed her stuffy because she said it wasn't ready, like she needed her stuffed animal.

But I did notice there was something about her at such a young age already understanding and that giving her some sort of feeling of being prepared. And so I wanted to ask you about that because I think it's a really great takeaway for all of our districts about how we can encourage preparedness for these events.

Yes, Ms. Rodriguez, you hit it on the nail. It is preparedness, physical preparedness, go bag information education is feeding into mental preparedness and preventing the trauma response. And so we need both disaster preparedness in the traditional sense as well as mental preparedness, which is more of an untouched area.

That's why I emphasize we all need psychological first aid training. Now this is. No one even knew what that was. But we are living in a time of recurrent disasters and so the children can feel empowered and that they know what to do. And that absolutely helps.

And then when we talk about mental preparedness, we need to understand what, what, how to calm our body, how to, how to help someone next to us. And these are fundamental skills that even adults don't know, but they are very teachable and not very expensive. But we do need these programs.

Thank you. And I had. zero, do you want to. Go ahead, Sam? And then I had a question for you afterward.

Yeah, if I could just add on to that, that I think also rebuilding trust within the systems themselves will help with just that feeling of dread. Part of the issue in Altadena and the Eaton fire is that only part of Altadena received notification that they should evacuate. And many people evacuated at 3:30 in the morning.

Granted, I don't think that they necessarily thought the fire was going to go as far as it did, but people left in the middle of the night with nothing, not even their IDs.

One of my friends, her dad, left his passport and ID and every single document that he owned in his house because he was trying to get his family out.

And so I think when we talk about trying to make sure that the community's prepared, we need to make sure that everything else is prepared so that when the community does have their go bag ready to go, that they receive a notification in a timely manner so they're actually able to grab it.

Thank you for lifting that up, Sam. In my community, the alert also did not go out. And so the whole community, knowing what had happened, went through the streets honking their horn to wake each other up. And I think there's this feeling when we have communities like ours that are black and brown that don't get the notification.

It does feel like what you had said before. These systems aren't in place for all of us. I did want to ask you, Sam, in that same vein, you talked about people not getting contacted by the Department of Health in LA County, but also the distress with government.

And I wanted to just ask, in your opinion on the ground, what do you think would be helpful? Is it LA County Public Health coming out and reaching out directly, would that provide the level of comfort we're aiming for where people do feel heard and supported and connected to resources?

Is it some other thing like more nonprofits on the ground as trusted messengers just so that we can hear that feedback about, you know, next steps to be supportive of our colleagues who do represent your area?

I think it's a combination of things. I definitely think that having the County Department that is responsible for our health knocking on doors and talking to people or at least doing some level of outreach would be extremely important. Healthcare providers haven't reached out to many of my friends and family who they know live in Burn Zone.

And so when you don't have that level of outreach, there's not that conversation that started and people aren't willing to continue to open their doors to you or continue to open their hearts to you either. So I think that that is definitely part of it.

I also think utilizing community health workers, people who have been on the ground in the community for years prior to an event, who have that established trust with community Members, have that established trust with local non profits and the government agencies that are overseeing it, utilizing them in a safe way, in a way that they're also protected and not going into areas that are going to put them into harm, but providing that outreach and doing it consistently, not just once and then we never see you again.

Because I think that's also part of the issue is if you have that one singular outreach and then nobody talks to you for for years down the line and you hear, zero, we did this number of outreach, we talked to 39000 households. It's like you didn't talk to my household like what are you talking about?

And so that fuels that mistrust and that fuels that anger and resentment that a lot of community Members are feeling right now.

Thank you for letting us know. And I just want to add my thanks for you sharing your day with us today to lift up your community's voice and all of the panelists today. Thank you.

And I want to thank the panelists for such a robust and a lot of very actionable items that you were able to bring to us as you were sharing your stories and experience and expertise. We are going to move on now to our second panel. Really appreciate you all coming to be able to visit with us.

Sam James, Genevieve, Genevieve Flores Haro, Dr. Elise Appel and Dr. John Belperio. We're going to move on now to our second panel of three on health care system impacts and access to care. We have Director Michelle Boss with the Department of Health Care Services. Thank you for being with us.

Director Mary Watanabe with the Department of Managed health care and Dr. Laurie Morgan, President and CEO of Huntington Health and Dr. Adrian Martinez Hollingsworth from the Director of the AltaMed Institute for Health Equity. And thank you Director Bass for being with us today. It's good to see you.

Good afternoon. Michelle Baass, Director of the Department of Healthcare Services I'm going to provide an overview of the Department's emergency response. The health and well being of our Medi Cal Members is the Department's priority.

In response to the State of Emergency Declaration and Executive order issued on January 7, DHCs acted swiftly to maintain access to healthcare services for our population during the States of emergency. We have protocols that we implement on a regular basis to ensure continued access for our Members.

We implement administrative and statutory flexibilities and coordinate with our federal partners, the Centers for Medicare and Medicaid Services, to secure the necessary federal waivers and flexibilities.

Our Medi Cal managed care plans are required to implement emergency preparedness and response protocols during emergencies, and we confirm that our managed care plans in the affected areas activate these protocols and require them to report to the Department on a Daily basis. The daily reports include impacts on facilities and clinics as well as Member impacts.

Emergency protocols also include deploying care management teams to conduct Member outreach, especially for high need populations, waiving prior authorization requirements, working to provide transportation to care, and ensuring Members do not face any out of pocket costs for getting care from out of network providers.

We also work with our managed care plans throughout an emergency for Members to determine eligibility and connect Members with needed resources as it relates to the Department's licensed behavioral health facilities and certified programs.

We offer temporary waivers and flexibilities for licensing and certification requirements, flexibilities for mandated reporting information, and the opportunity for facilities to request a waiver for a reduction in fees due to hardship. We also collaborate with tribal and urban Indian health programs to ensure essential care and support for Native communities affected by emergency.

We also work to quickly update MEDI Cal Members, stakeholders in the media of the impacts and the critical information information. We launched a website specific to the Southern California fires and it was updated throughout the the emergency with the updates on the waivers updated on the federal approval of those waivers.

We have some key behavioral health resources to support impacted Californians, including calhope, which is free crisis counseling and emotional support Saluna, which is a mental health coaching app for youth aged 13 to 25 and bright life Kids mental health coaching for children age 0 to 12 and their caregivers.

Just want to speak a little bit about some of the flexibilities that we requested and received with regard to the fires. We requested 36 separate federal CMS 1135 waivers from the Federal Government and these are specific flexibilities with regard to the Medicaid program and allow for really to prevent any disruptions to care.

We also these includes for our Members extension for timelines for appeals, fair hearings, benefit reinstatements Alternative settings to ensure continuous access to care so preventing facilities to offer services in alternative settings such as Member homes, mobile clinics or temporary locations, particularly when primary facilities have been damaged or are inaccessible.

We have expedited processing for specified dental services and similarly expedited refills for pharmacy and medical equipment for our Medi Cal providers. Some of the streamlined flexibilities include waivers associated with provider enrollment, expediting and streamlining these processes to ensure that more providers can serve in the areas impacted by the disaster.

Flexibility in service delivery Providers receive authorization to offer long term services and supports in alternative destinations and locations including shelters or hotels ensuring continuity of care despite again displacement or facility damage.

With regard to our home and community based waiver specific flexibilities Extension of timelines to deliver delivery of home and community based settings to permit additional timeline to conduct initial evaluations, reassessments and care plan reviews.

Again to minimize disruption and interruptions for individuals receiving home and community based services under the waiver and providing guidance to our Medi Cal managed care plans on waiving prior authorization requirements to permit expedited access to care. In terms of our Medi Cal Members in the Los Angeles County area who resided in the areas impacted by the wildfires.

Those Members who had eligibility redeterminations for the month of February, March and April, we extended their renewal periods for six months to ensure that they had time to go through that renewal process and for the Members who were disenrolled in January 2025, we reinstated them so that they did not have any disruption in care.

Finally, just really just quickly again on the communication as soon as the disaster was declared and as we went through our waivers and approval of really continuing to maintain and update our website to have a central resource and repository of all this information for both our Members, providers, plans and stakeholders. And with that I will happy to answer questions.

Thank you. We will move on to the rest of the panel and then have a round of questions. Director Watanabe thank you.

Good afternoon. The Department's mission is to protect consumers healthcare rights and ensure a stable healthcare delivery system. We license and regulate 140 health plans that provide health coverage to nearly 30 million Californians. We do not administer any programs.

I'll briefly highlight the steps the Department has taken to ensure those impacted by the recent wildfires in Southern California can continue to access healthcare services.

Within 48 hours of a proclaimed State of emergency, health plans are required to file information with the DMHC regarding whether the plan has or expects to have disruption to its operations, how it will communicate with its potentially impacted enrollees, and the actions the plan has taken or will take to ensure its enrollees needs are met.

Following the Governor's proclamation of a State of emergency related to wildfires in Los Angeles and Ventura County, all licensed health plans by the DMHC in those counties responded to the State of emergency filing requirement.

We also have authority to direct plans to take additional actions to ensure enrollees have continued access to medically necessary necessary carry during an emergency.

On January 92025 we issued an all plan letter directing health plans to provide a toll free telephone number for impacted plan Members and providers to call for answers to questions, including questions about the loss of health plan ID cards, access to prescription refills and how to access healthcare services.

They were required to prominently display on the health plan's website information describing how Members can continue to access care care and who to contact for more information. We also required them to suspend prescription refill limitations and permit impacted Members to refill their prescriptions or obtain new prescriptions out of network at ordinary in network cost sharing.

We also required them to allow Members to replace medical equipment or supplies that were lost, allow Members to access care from out of network providers if in network providers were unavailable to the State of emergency or if the Member was required to relocate outside of the service area and again, they would only have to pay the normal in network cost sharing amount.

We also required them to reduce or remove unnecessary barriers to efficient admission transfer discharge at hospitals that may be impacted by the State of emergency and we encouraged health plans to shorten timeframes for prior approval, pre certification referrals for care, and to extend the time for such approvals, pre certification or referral.

We also created what we call a resource guide which has been posted on our website. This was for health plan Members and providers and included links to health plan websites and phone numbers for the health plans that are operating in these counties.

It was posted on our website, it was shared through social media, posted on the various web source various resource websites and shared with those that were on the ground. We also have a natural disaster fact sheet that we were posting quite regularly on all of our social media channels.

I will just note we had since January 7th of 2025 we had about 18 people that have contacted our help center. 14 of those were under our jurisdiction.

I will be careful that I don't get to identify any enrollees, but the majority of those seeking help were related to prescription refills or asking for assistance in deferring their healthcare premium payments as a result of being displaced.

I will just note, I think the Committee had a number of questions about whether we needed additional flexibilities, additional authority. I will say over the years the Department generally has been given pretty broad authority to direct health plans to respond during a State of emergency. We also have very broad enforcement authority.

So if health plans are not complying with our all plan letters or other guidance, we can take enforcement action which could include issuing cease and desist orders or financial penalties as well. And I think there was also a question just about how health plans are communicating with their Members.

The law is not specific about the method that the plans have to use to communicate and this can vary by depending on the State of emergency. I know we're focused on fires, but earthquakes or other national floods or other natural disasters. I think for the most part mail is not a good idea.

So a lot of Member communication is happening through email text messages. We know from the filings that a number of health plans are identifying high risk Members and they're doing direct outreach to those individuals. And again, we really encourage folks to go to the health plan's websites.

I will just note that we have a help center that is available to assist anyone with their health insurance needs or issues with their health plan. We generally recommend that enrollees go to their health plan first, but if there's an urgent need or they're not getting help, we're happy to help as well. So that's it for me. Thank you.

Thank you so much. We'll move on to Dr. Morgan.

Yes, chair Bonta, Assembly Members, colleagues, thank you for the opportunity to share our experience during the Eaton Fire. I'm Dr. Lori Morgan, President CEO of Huntington Health and a currently displaced Altadena resident and you sent me some questions, so I'm going to try to answer those.

What are the short term and potential long term impacts on hospital and health systems? We saw an immediate impact to patient care. There was a significant increase in emergency room volumes due to medically vulnerable seniors evacuated from skilled nursing facilities and patients presenting with high severity and mental health issues.

We had elevated respiratory and cardiac admissions due to the poor air quality. We had a critical condition of end stage renal disease patients due to missed dialysis sessions and the loss of several dialysis centers in the fire. We had to cancel or delay scheduled surgeries and procedures due to the surge in patient volume in the hospital.

Our outpatient surgery center was closed for several days due to smoke impact as well as staffing shortages. Primary care, specialty care and urgent care locations were closed due to the effects of the fire evacuations, power outages, smoke and a shortage of staff which put additional pressure on the hospital.

Operations had to shift and were pressured by the impact of staffing from the fire. Within 24 hours, more than 50% of our 4,000 employees were evacuated from their homes. This had a significant effect on our ability to provide care and strained our resources significantly, creating a lot of disruption as well as provider fatigue.

We had to activate temporary patient care units to accommodate increased patient volume and patient needs. We did immediately activate our hospital incident command system and emergency triage to manage the crisis. That was really critical for us. We had an immediate need for temporary housing for displaced staff.

We did establish some overnight rooms that people could sleep in, but obviously if we had 2,000 staff that were affected, that was a little beyond our capacity to manage. There are significant financial impacts from this. We had a loss of revenue from canceled surgeries.

We had increased pay for staffing due to reduced availability of our staff and needing additional labor which increased our labor costs. We have a loss of compensation for long term hospital stays. We certainly had increased dialysis costs.

We have increased costs for HVAC filter replacement, HEPA filter realtors, cleanups and other related expenses directly due to the fire. We have expenses related to opening interim care spaces and a command center monitoring. One of the things that happened was when multiple nursing homes burned after these patients were evacuated across the street to the 7:11.

A number of them came to the hospital. They weren't inpatients, they didn't require inpatient care. We ended up setting up a temporary location in our auditorium, but we're not a nursing home, so we provide care for those patients for weeks. But they weren't inpatients so we can't Bill for them.

And we are in a nursing home so we couldn't Bill for them. So we just took care of them. What worked and what could have been improved in terms of the emergency response? What worked I think was the swift response and dedication of our hospital staff to maintain patient care.

Very quick action in the presence of first responders in our community. We established temporary on site housing for our staff and a food pantry for our displaced staff which we have been unable to close and continue to operate today because of the ongoing displacement of our staff. We created wards and repurposed non licensed spaces.

I'm hesitant to say that in this group, but created used non licensed space basis for patient care. We had to provide emergency dialysis around the clock. Coordination with our local public health Department allowed us to send physicians to the disaster center at the convention center that was set up by the Red Cross.

I will tell you the very first thing I said to our team is get the COVID playbook out. That was very useful. Certainly the large sense of community and collaboration amongst our staff and leaders. And I think the Red Cross disaster center that was stood up fairly rapidly was effective.

But I do have some particular comments about elderly patients. There were not great accommodations for the elderly in terms of a high percentage of patients that are diabetic. There were a lot of Gatorade and things like that which have a lot of sugar in them. And so some of the fluids were difficult. Diapers.

We were sending tons of diapers to the Red Cross center because they needed them to take care of those patients. I think things that could be improved is sort of better coordination. Identification of displaced patients. Those nursing home patients that came to us came without medications, without medication lists. Many of them did not know who they were.

It took us in some cases weeks to relocate them with their family Members. So we had just unknown patients in our hospital patients, unknown nursing home patients. We could have used enhanced staffing levels to prevent fatigue and stress. More effective coordination to support patients mental health needs. I know you spent a lot of time on that.

And the last thing, I cannot tell you how that has gone. Up to two weeks ago we were holding 18 patients who needed to be admitted to mental health care that had no place to go that we held in our emergency room for an entire weekend.

Securing emergency housing for staff would be critical and having an ability to do that. Didn't see a lot of regional help to be quite honest. And in terms of staff and resources that would have been very useful. Also I think very focused attention to elderly needs from a disaster planning standpoint.

There needs to be some really pinpointed work to be done on that. I think some of our lessons learned for us the importance of having an emergency incident command system in place. We really have a need for flexible and adaptable care spaces to accommodate surgeons and patient volume.

I think this is increasingly going to be a problem for us. Some of our HCI rules are very restrictive about where we can and cannot take care of patients and somehow there needs to be. When that disaster button gets pushed some of those roles really need to be released.

We absolutely need better provision of mental health resources for patients and for our staff. A little bit better communication among staff, first responders and the healthcare departments. Establishing temporary housing and support system for displaced staff to maintain workforce stability is I think really important. I think a couple other things is I'm going to say this very gently.

Faster release from some of those restrictions that we have to apply for and if there's any way to pre plan those in terms of being able to say this is where we're going to take care of patients in a disaster, you just go ahead and do it.

Now the honest answer is we, we did just go ahead and do it but we wrung our hands about it. Can we really put patients in our auditorium? And at some point I just said we don't really have a choice put them in the auditorium. I think strengthening care transition programs to prevent avoidable readmissions.

We really had a problem with the number of patients that we had. The displacement from the nursing homes was really a difficult, difficult for us. We lost 250 beds in the Eaton fire.

That continues to present a challenge to us for discharging patients and the cross county admission of patients we really need, we really need help with because that's a problem pending on either Medicare or Medi Cal insurance.

I think one of the other things that's going to be a little bit odd but and I know you guys are probably tired of hearing this but sometimes seismic relief at this point for us is going to be really critical. We really need construction to be very focused on rebuilding Altadena and the Pacific Palisades.

There's an increased cost of materials and construction crews and I don't know a way to make all of that construction happen.

At the same time we also need support for employee housing construction for us as Sammy was sharing that some of our lowest paid workers all lived in North Lake and North Altadena, the two areas that were hardest hit that are displaced and still don't have homes to go to.

I think also just understanding overall that, you know, dollars are finite and many of our expenses really aren't in our control. Labor costs, pharmaceutical costs, inflation, all increasing far more than the upcoming OKA limits.

And for many organizations, the ability to meet those limits can only really be borne by either decreasing services or decreasing access, which is exactly what we need to not be doing. Thank you again for the opportunity. I'm happy to ask answer any questions.

If we were able to just complete 1/10 of that opportunity list, I would feel like we were doing better. Thank you so much for sharing that. We'll go on to the next one.

Good afternoon, chair and Members. My name is Dr. Adrienne Martinez Hollingsworth and I serve as the Director of Research at the Ultamed Institute for Health Equity. I'm a Latina registered nurse, a scientist and a local girl.

I'm from the area most impacted by the Eaton Wildfire in Southern California, and I served as one of the Incident Command clinical leaders at the Pasadena Convention Center Wildfire evacuation site. So I'm here today to speak about that experience and I'd like to thank you for the opportunity to testify on this important topic.

Every year, AltaMed cares for nearly half a million patients, more than 80% Latinos, through 2 million visits at our clinics throughout LA and Orange County in Southern California. About 73% of our patients rely on Medicaid. Another 14% are uninsured. We employ about 5,500 individuals in the state, majority Latino employees, including over 400 medical providers.

We're also the largest healthcare provider in Southeast Los Angeles, the area of the Eaton fire devastation. I have slides to accompany my talk.

Perfect. Magic words. Thank you. So the Eaton fire destroyed AltaMed's East Pasadena clinic and it forced the temporary closure of five other clinics in the area, which disrupted care for about 6,000 patients in that immediate service area. Next slide, please.

During this time, our patients faced limited access to medical care, including chronic disease management and prescription refills and. And hundreds of AltaMed employees were displaced. 17 lost their homes, yet they remained committed to providing care, many at the evacuation center itself. Next slide, please.

So in addition to the approximately 6,000 diverted visits, AltaMed was one of the first on scene at the evacuation site to directly deliver care. Next slide, please. And so, across one month, we had about 230 volunteers that served 650 to 850 patients. Our mobilevan treated 50 additional patients, including 10 daily wound care cases.

24% of the patients were seniors 65 and older and 2% were children under 5. We also had several postpartum patients, highlighting the vulnerability of the population.

And in partnership with Kaiser Permanente, AltaMed initiated infection control strategies, including quarantine zones and infection surveillance, which addressed outbreaks of COVID 19, norovirus and Giardia influenza A and B and prevented the spread to the local communities.

Our on site care diverted at least 80 patients that we know of from local ERs, including Huntington Hospital, which reduced the overcrowding and resulted in an estimated savings of approximately $60,000 to the local evacuees. Next slide, please. But it was the bilingual and culturally tailored care that mattered.

88.5% of patients at the evacuation site had at least one concern that required culturally competent healthcare solutions. Our bilingual staff and translation devices ensured evacuees received timely and accurate care in their first language. And it went beyond clinical. Our community organizing and research engagement team provided evacuees with medication, hygiene, supplies, food, food, showers, housing, resources.

Overall, 230 AltaMed personnel deployed to the evacuation center at a staffing cost of approximately $2 million, which underscores a substantial investment in disaster response. Next slide, please. Community health centers are essential, especially in dire times and are providing and are proving critical in disaster resilience.

Long term resilience and equitable recovery means doctors, nurses and support staff who look like and come from the communities we serve, speaking Spanish and other threshold languages that represent the communities across our state. Legislative support for sustained and expanded medical funding is crucial for sustaining this community recovery.

And increasing funding for behavioral health, as we've heard across many of the panelists, is similarly necessary. In this time and given that we want to take a moment to thank Speaker Robert Rivas and Assembly Member John Harabedian for authoring AB 1032.

AB 1032 would increase access to behavioral health services by requiring health care insurers to cover 12 annual visits per year with a licensed behavioral health provider to residents affected by wildfires. The state must also support community health centers by also increasing funding for workforce development and loan repayment programs for our diverse providers.

In closing, AltaMed's wildfire response highlights the essential role of community health centers in disaster resilience. Legislative action is required to strengthen funding, address systemic inequities, and prioritize culturally competent care and future disaster response. We appreciate the continued commitment from Chair Miyabanta to protect the medical program and value based care.

With the legislators ongoing support to the safety net and its health care workforce, we can ensure long term resilience and equitable recovery for fire impacted communities.

Thank you again for the opportunity to testify and share our journey at AltaMed and also personally for the ability to hear the stories and testimonies of colleagues and the community Members here today. We look forward to working with you to identify solutions to address healthcare workforce challenges and the emerging threats to community health. Thank you.

Thank you so much. I will open it up to our Committee for questions. Majority Leader

Good Afternoon. Thank you all for being here today. You know, as my fellow colleagues are aware, Northern California has suffered some of the most devastating fires in the nation's history, let alone California's, including the tubbs fire in 2017, the Camp Fire in 2018.

I'd like to ask DHCS and DMHC to share about how they have used some of those lessons that we have learned from past wildfires to better prepare us for future disasters. I just remember so well during these fires how terrible they were. I can still smell burning flesh. I can still remember seeing cars up in trees.

I can still remember parents and people wailing when they saw their loved ones gone. And I don't want to have that happen again. And so I keep thinking to myself, how can we do better? And so it's frustrating to hear how we weren't really prepared throughout the state. And I'm not just going to pinpoint just La.

It's all through the state. How can we do better? Because we cannot continue to do this. And the City of paradise was gone and we kind of turn our backs to some of our rural areas like they'll take care of themselves. We figured it out. We have not figured it out yet.

We've been there for eight years with homes still not built. So I'm just asking you, what can we do better as we reflect? And I know that you don't have all the answers, but I'll tell you, it really hit me hard, and it still does when I can remember that so vividly.

So just the Department of Health Care service, our oversight and inability is really with regard to the Medi Cal program. And so some of the lessons that we learned from previous disasters is some of the requests that we made to the Federal Government for flexibilities.

We built in from prior, prior times, kind of the ability to move forward with these already approved by the Federal Government instead of having to ask. I mentioned that we already secured 36 other 1135 waivers from the Federal Government for the Southern California fires.

But there were some waivers that we preemptively had built into our process so that we could move forward. For example, those eligibility determinations and pushing out the renewal dates for individuals who were impacted in those zip codes.

And so as we move forward and we develop our protocols, anything that we can do to be really just day one ready, we are doing so. But many of the things that we do are contingent on federal approval because of the Medi Cal program. And then also with regard just to the.

The facility flexibilities, we only have oversight and the ability to waive for behavioral health facilities. So hospital facility flexibilities is not within our purview.

Yeah. And I'll just add, I mean, I think we all have lived through various fires, have those same vivid images when you say we dust off the COVID toolkit. I think that has been my reaction every time, like, zero, my gosh, we've done this before. We know what to do. I think we've gotten better at it.

Covid taught us a lot of lessons. So similar to Director Boss, we don't administer programs, but my job is to make sure that the health plans are responding quickly in these instances. And I will say I think the health plans have gotten better at having their processes of, okay, we've got to get the website up and running.

We've got to make sure our call center staff know how to respond. In the instance, many of our health plans have their headquarters in Southern California, very similar. Their staff were impacted, evacuated. So part of it for us is making sure they are moving quickly. Prescriptions tends to be the first thing where there's challenges.

I will just say, I think hearing the testimony today, I appreciate the opportunity to hear, hear what's happening on the ground. I think an opportunity for us is to make sure Those community organizations that are embedded in the communities that speak the language, have that trusted relationship, know who the DMHC is.

I think many people don't know who we are. They don't know we have a help center because it really helps us to know what those issues are on the ground. But again, I think we've learned a lot. We've gotten better. As Director Boss said, it's moving quickly and we'll continue to just refine how we react. Thank you.

I have one other question. There's something that kind of came to the surface through all this about childcare, the issue of childcare during the fires.

And we've been a lot of time through the fires here in California and yet most of the recent fires in La, many providers experience deLays in payments and difficulties opening alternate sites in the event of an emergency. It affects our families. Ability to find care for their children prevents parents from being able to get to work.

What actions has the Administration or any of you have taken to ensure our state is prepared to support families and providers in the event of these future disasters?

So neither Department of Health Care Services or the Department of Managed Healthcare have any role in childcare. I mean, we can take your question back to the Department of Social Services and circle back with information on that response.

May I comment on that? So serving at the evacuation center was, I would say at the very beginning, best of intentions, but really building the plane as it's flying. And one of the immediate concerns was recognition that we were mashing a variety of different populations into a location that is meant to host trade shows. Right.

It's not meant to help families. The establishment of a separate hall for families with small children. We did have an incident where there was a child that we couldn't immediately locate. Not just altamed kind of the community center at large.

And really understanding that that was a wake up call that immediately we need to strategize on how we going to do rounding as a clinical staff checking in to make sure that we're not just looking at the clinical needs, but also the, the needs of the whole family.

And then how are we going to take kids who are displaced from their schools, displaced from their normal schedule, and provide a conducive environment for their dampening some of the potential trauma. Right. So making it feel normal in some way.

And I would like to say that across many of the agencies that were at the evacuation center, recognizing that it's not just the evacuees and the survivors, it is lots of niche populations, some of whom spoke, you know languages other than English, some of whom had severe chronic illness or were on dialysis, some of whom were postpartum.

And really recognizing how we can work together and use the embedded community health workers, promotores, nursing staff who know these populations well, I felt like that was a success and I hope we can leverage some of those lessons in the future.

Thank you. I really appreciate that. A lot of the nonprofits are really the glue that keep us together and you all did a really fine job. But you know, ultimately I still worry about my childcare people. I really worried about the affordability of the childcare and trying to lift all those people up. So thank you very much. Thank you all of you today.

Assemblymember Schiavo.

Thank you to the whole panel for your insights today. I just wanted to follow up with Dr. Morgan. One of the things that you mentioned that really caught my attention was your discussion around staffing and especially since so many of your staff were impacted needing help with staffing.

I for 13 years worked with nurses, deployed nurses to disaster areas for a chunk of that time. I know that there's. We had nurses during COVID who were like ready and willing to get the call and never even got the call right.

And so I know sometimes there can be a disconnect between the people who need help and the people who are willing to help and somehow not getting connected in the middle. And I wonder if you have feedback on kind of where that would live, how that would happen, who pulls that trigger? Is that a county DPH kind of thing that should happen or how does that, how does that move?

Yeah, I think there's a two issues with that. One of which is certainly in this disaster, which was a little bit different than Covid there would. And were traveling nurses available, they're just incredibly expensive. And when you're hiring traveling nurses for patients that you can't Bill for, it's really a financial burden.

So I think that was a little bit different. But I do think during COVID it really happened at the state level that they, that you could request nurses to be deployed. It is one of the things that we ended up doing to do that.

I will just say that all of the those traveler nurses or day nurses sort of come at a pretty significant premium in terms of the cost. And so which just adds to the overall burden of organizations that are already in a crisis.

And so I do think there is something of having sort of a ready made pool of nurses to pull from, particularly if they could work at whatever our standard wages are would be really useful for any organization that would need to pull them in the event of a disaster because it always becomes this double edged sword.

You need more staff. We always want staffing waivers. Those don't come very easily, even in a disaster. We actually did request that and were denied staffing waivers.

And so again, I think these are some of the disaster things that would be really useful and to have them pre planned so that in the middle of a crisis you don't have people sort of making applications and trying to get them and figure out who to send them to would be very helpful.

Thank you. Yeah. So I imagine in an ish, in a situation like this, where I understand why Covid, during COVID a statewide national international health crisis, that the, that the state may step in, but for this feeling a little bit more local, it seems like it, it might make more sense for it to live at the county.

Well, we're still at the state. It could, but do you want it to live in 58 counties? I guess that's the point. In, in a state vulnerable as California is whether it's wildfires or potential.

I don't even want to say that other word that we always worry about from a natural disaster because I'm really tired of natural disasters. But if there are earthquakes or things like that, we're so vulnerable across the state, you sort of never know where that crisis is going to come.

If, you know, the way I, the way I think about it is if the, you know, if LA County were to have a pretty big earthquake, there would be so many hospitals affected. If it were a county level sort of nursing pod, they're probably not going to be able to activate.

So if it were a statewide process, you could pull people from Northern California and send them south or Southern California and send them north in a vulnerable state. To me that makes more sense.

Right. Thank you. Yeah. And I agree. I mean, I know travelers are incredibly expensive. You know, we had nurses who were willing to volunteer, but certainly, you know, as time goes on, you can only volunteer for so long.

So maybe kind of a tiered list of volunteers of people who would work at the, you know, rate of the hospitals and then kind of as a last option, the travelers. Thank you.

Dr Bains.

I love seeing this conversation because I have a solution for you guys. The California Medical Assistance Team. I'm the CMO for the Central Valley. That's what you just described. So that's a state EMSA response that deploys out based upon the needs.

We were there during COVID I was out at The Westwood Shelter, myself working alongside the American Red Cross. It was a very eye opening experience for me out there.

We had influenza A outbreak, we had RSB outbreak, we had a norovirus outbreak and I got all three and I was home for two weeks after I came back from my demo from that deployment.

There's a lot of work that we need to do together, but the biggest thing is the breakdown of communication, of utilizing the resources at the state that's already there. Like Calmat with EMSA, we have a roster of exactly what you guys just described.

It's a roster of people all across the state in all different areas, and they are ready to go at a moment's notice. I think the biggest problem is how to create that communication out to clinics that this option is there to be utilized and it would be through the Department of Public Health.

They deployed me out to the LA shelter, so I spent some time out there as well. So I think connecting you with the options, with the Public Health Department, with Calmat is something that already exists and we can utilize a little bit better.

I'm just kind of reflecting on the first panel and some of the opportunities for improvement and description of need that we've heard in this panel as well, particularly from Drs. Adrienne Martinez-Hollingsworth and Dr. Lori Morgan is there now, are you all, this is a very basic question.

Are you all as a group, as an interdisciplinary group, city, county, state agencies, frontline organizations, are you all in contact with each other right now to be able to both understand where there are existing gaps that need to be addressed for the immediate relief, but then also the kind of the midterm, ongoing needs that are coming for the communities?

I would like to say that we have a lot of gratitude for the LA County Department of Public Health. I know Dr. Mahajan is here and he's going to be speaking later and working with the county team to do a county wide assessment, because Eaton is not Palisades has allowed us to broaden the scope of what potentially we might need to address in the future.

And potentially maybe the west side too is feeling that way about what it's like over on the east side of La.

But through that connection we have made important contacts, I believe across the county and then also at a lot of connected academic institutions that are doing some of the soil testing and other things that are outside the purview of a health system. But I will say there could always be more.

It would be better if there were more because almost immediately after we had convened, we heard about wildfires on the East Coast. And we know we have real lessons that we could be sharing, not just across our teams, but nationally, potentially globally, because things are different now.

Even if we do have robust literature on wildfires, the world is different. And so being able to have that emergent data really influence how we address these situations together, I think would be truly beneficial.

You sound like me.

I mean, you know, the communication. I think that communication could always be better. You know, I think part of the issue is zero, by the way, in the meantime we're taking care of a whole bunch of like we have our daily work to do. Right.

Which is, which is pretty overwhelming in health care, in healthcare right now, the acuity of patients post Covid is higher than ever. The ratio of inpatient hospitalizations is higher than ever. And so you know, we're just honestly kind of, I almost said we're racing to put out fires, but kind of we are.

And so I think sometimes, and by the way, the agencies are all doing the same thing. So I think sometimes in our day to day sort of taking that step back and making sure that we really try to attack those lessons learned maybe is becomes not the highest priority.

I think the if the ideal is moving to a place where we do have those disaster preplanned infrastructure components that you alluded to in place to be able to quickly understand what kind of cross county movement would be like or what specific waivers are needed or what, you know, what needs to be in an all plan letter.

Those are all pieces that require time and capacity so that we are not moving from one disaster to the next disaster in a very reactive mode. And I just want to recognize and acknowledge that you are already kind of at capacity because you're dealing with the, with the moment before you that has unprecedented components to it. And also sadly there will be something else.

So I kind of offer it to our Committee to really think about how we are creating the infrastructure that allows for these rock star people in all of their jobs and functions to be able to have that space, to be able to come together and thread, thread and weave the necessary supports that we need to in this moment in time, something to think about. I don't know that I have any more questions.

Yes, I appreciate the input that Dr. Assemblymember Bains pointed out about her work on the fires. And I also look at what CAL FIRE does in sending people for those emergency situations. And I think there is a model here that we can somehow put together.

Not today, maybe not tomorrow, but we can certainly put our heads around this and find a best path forward. Because I agree with you, Assemblymember Banta. Chair Bonta, this is going to keep happening and I think we need to be prepared for the next one.

We don't know what that disaster is necessarily going to look like or where it's going to be, but it's going to keep happening. It might be another outbreak, it might be another natural disaster. It's going to happen. And I appreciate all the testimony that you all provided today.

I know I'm running in between different hearings, so I'm catching bits and pieces of it. But appreciate you being here. Thank you.

Thank you. And I know that it's been a long, long day for all of you. So thank you so much for participating. And we will move on to our next panel panel which is around healthcare workforce. We have Dr. Anish Mahajan from the Chief Deputy Director for Los Angeles County Department of Public Health here, Cynthia White, the Los Angeles Department of Public Health data conversion equipment operator and SEIU721 with us. Raffy my apologies. Fire Engineer Station 34 Alpha and President of the Pasadena Firefighters Local 809. We'll start with Dr. Mahajan.

Good afternoon. I'm Dr. Anish Mahajan, the Chief Deputy Director for LA County Public Health. I want to thank the chair and the Committee for inviting us to participate in this panel discussion. Louisiana County Public Health participated along with our sister departments and emergency management structure and responding to the extensive January 2025 wildfires.

We are absolutely grateful to the heroic first responders, our firefighters, our staff delighted that Cynthia White is here from our labor partners, seiu. As you'll hear directly from a Member of our staff and how they responded selflessly and with courage and in the face of enormous challenges to meet the needs.

We're also really grateful to the state and to the Federal Government for all of the help that's come through and we've learned a lot from our colleagues in Maui and from Northern California counties who faced this before us. I'm going to, I do have some slides. If we could put the slides up.

I'm going to sort of move quickly through some slides. We presented slides that have a lot more information than I'll cover today in the interest of time, but wanted to have you, let you all have that.

I'm going to touch on the health officer orders, speak about our immediate response activities, then go to recovery actions and then finish with ongoing needs. You heard from Dr. Belperio. You know, this was an enormous urban wildfire. Urban urban wildlife wildfire interface. This is the Eaton map here. The red structures are entirely destroyed structures.

The orange, you don't even see many orange, but orange are majorly destroyed. And then there's others as well. You can see that there were over 10,500 structures destroyed in the Eaton fire. Next slide, please. In the Palisades fire, 23,000 acres burned more than 7,800 structures destroyed or damaged. Next slide please.

I'm going to focus on the middle of the slide. The LA County Health Officer orders on January 10, Public Health declared a local health emergency in LA County related to the wildfire and the hazards caused to air quality, ash and debris.

As part of that initial local health order Public Health Order we temporarily banned the use of blowing devices like leaf blowers throughout the county given the risk that blowing the air would cause with the debris aerosolizing.

We partnered with our Public Health Councils program who work with a number of non governmental organizations, community groups that work with workers, day laborers and other kinds of workers on the ground to ensure that they are aware of the protections they need to take to work outside and to also help them understand why using leaf blowers as gardeners is not what we need to do in the immediate aftermath.

On January 15, we issued an order that prohibits the cleanup and removal of fire debris and ash in the burned residential and business areas, including the areas of all of the fire zones, until a hazardous materials inspection at the property is conducted.

This order was deemed necessary to protect the health and safety of the individuals from the wide range of materials that burned, such as ash, burnt building materials. We heard about the dangerous toxins that are released when that occurs, burnt household items. We've heard about lithium ion batteries earlier today and other harmful substances.

We updated that order on March 4th to coincide with the way the cleanup is progressing. As you know, there are two phases to clean up. Phase one cleanup by the EPA to address the hazards and phase two, cleanup led by the Army Corps of Engineers to remove the fire debris. Let's go to the next slide.

Some of the immediate response actions. There were a number of these here on the slide. I'm going to only touch on a couple of them. Public communication was first and foremost the most important thing to do right away. And that was us trying to get the word out in every channel that we could.

Town halls, virtual town halls, the media on our website to provide health protection guidance, develop FAQs, ensure that smoke advisories were out in the immediate aftermath of the fire. There was a lot of wind right after the fire that was blowing debris around and we wanted to make sure people understood the wind advisories and ocean water safety.

We also immediately moved into preparing PPE and having PPE distributed as widely as we could to especially the impacted areas by the fire. Let's go to the next slide please. Here you'll see some of the early data on some of the early work that we did in the response section. Here I'm going to focus on assessments first.

Our environmental health division conducted shelter assessments and communicated information to establishments that are public health permittees, such as food establishments. Our environmental health staff also assisted with repopulation efforts and reopening of facilities that were closed due to fire or loss of power. We also worked at the disaster resource centers.

You'll see that under client services Public health staff. I'm sure Cynthia was one of them. She was there offering critical information, guidance and support to the residents by the wildfires. Our staff there answered questions about health risks, cleanup safety, provided available resources and FAQs to residents who were impacted by the fire.

We provided PPE and fire safety toolkits. We also attended as many community meetings as we could in the immediate aftermath, as well as town halls that were stood up by the cities, by the county, and by the mayor of Los Angeles. To help educate the public about the risks.

We hosted numerous town halls and press conferences of our own as well. Let's go to the next slide, please. Here you'll see some more data on the disaster resource centers. We sent some of our Clinicians, nurses and a physician on site to provide immediate assistance at the disaster resource centers to clients.

We also had our telehealth service set up so that we could answer more detailed questions and clinical issues that residents had. We positioned ourselves at the re entry checkpoints.

As you know, before residents were allowed back into the majorly burned areas, there were checkpoints and residents were allowed back into those areas to begin to look and see what happened at their property. We positioned ourselves and our staff at those checkpoints to ensure that residents were handed Tyvek suits, gloves, masks, goggles, etc.

Let's go to the next slide, please. You'll see a picture of the Tyvek suit and the kinds of re entry kits that were put together that we provided. These kits were provided at the entry checkpoints as well as at the disaster resource centers and other locations.

Once the checkpoints were taken down and people were allowed to freely enter these zones, we established public health distribution points also at various intersections of entryways into the burn scar areas, where we provided information, our staff provided information and PPE. We distributed air purifiers, nearly 4,000 of those, to various entities that were in need.

Let's go to the next slide. This is our website link here. I put it here so that you all can take a look at this when you have an opportunity. We have intended this website to really be the clearinghouse of health protection information for the public, information about ocean water advisories, water advisories, air advisories and the like.

Let's go to the next slide please. We developed FAQs. It's a little smaller read. We developed FAQs because we had so many different kinds of questions from residents and we developed different categories of FAQs. We understood that people needed FAQs for if their property or if they lived in a burned area.

People needed FAQs if they lived just outside of the burned area with slightly different information and then FAQs for places that were indirectly impacted a little further away from the burn areas. You can find this website at publichealth.lacounty.gov go to the next slide please. So moving to recovery.

A lot of good information coming from this hearing, so I really appreciate being here as well and hearing the speakers that came before. The County of Los Angeles, along with its city partners, have stood up a set of nine or 10 recovery task forces across a range of topics.

These task forces include state and federal partners as well as local agencies and local entities. One of those task forces is the Health and Social Services Recovery Task Force. We in the LA County Public Health are leading this task force.

This is a convening of government agencies, partner institutions, community and faith based organizations intended to really address the immediate, intermediate and long term impacts health and social services impacts of the fire. We've we stood up a number of subcommittees around specific topics to address that.

An example Subcommitee is one related to the environmental health impacts of the fire and this Subcommitee is bringing together the state, federal, academic partners and other partners who are doing testing of the soil, air and water to ensure that we are understanding the impact of the ash and debris and presenting that to the public.

We've created a LA County Post Fire Air, Soil and Water Assessment Plan that's viewable by the public on our website at the link in the slide there you'll see a listing of all the different entities that are performing testing either on air, water or soil and they've indicated where they're testing, how often they're testing and they've committed to posting their results.

We heard earlier today about questions about the heavy metals in the air and what do we know about that? We know that our partners in the Air Quality Management District are doing mobile and stationary air testing in both the Palisades and Eaton areas and they're posting those results as they get them.

They are testing a whole range of metals that and they're posting those online and we are working on helping them Convey and interpret those results for the public. Let's go to the next slide, please. This is just an example of one of our partners in that Subcommitee.

This is a conglomeration of a number of academic institutions, including some local ones at UCLA and usc, who are launching several sets of studies that include soil sampling includes longitudinally following residents on their health, so including testing, potentially testing their biological characteristics at this time. And going forward, they're a key partner in our effort here.

Let's go to the next slide. One of the biggest questions, as you may have heard, relates to the safety of the soil.

There are a number of reasonable questions being asked by people whose structures have survived the fire and are now being asked by their insurance company to return to their homes, as well as people who are going to, who are going to see their entire property be cleaned through phase one and phase two.

There are questions about whether the soil is going to be cleared completely of the fire debris, toxins. So there's a number of different groups doing soil sampling that is listed in our assessment plan on the website. We at Public Health have also decided to do a set of representative soil sampling to test for chemicals.

And we are testing selected parcels in Eaton in the Palisades area that would end up covering the whole region. But we're sampling different parcels that are either destroyed or have minor, minor damage, no damage, or were adjacent to the fire areas.

And we will be presenting the results of what we find as another data point for the public to understand what's the current risks and chemicals that we're seeing in the soil. Let's go to the next slide, please. So in terms of critical needs, there are so many needs, as we've heard today.

I will add a few to that list. One of the key needs is assessment. Even as we are sort of crowdsourcing the various entities that are performing the testing of air, water and soil, there are still gaps. We are also aware that the Army Corps has made the decision not to do post phase two testing of soil.

And so there are legitimate questions being raised about that. And so that is one of the gaps that we see that is that sort of a good sense of funding and commitment to ensuring that we fully understand the environmental impacts with the testing that we need across the board.

A second area of need are those residents whose properties weren't entirely destroyed, whose houses or buildings are still standing. They are struggling with feeling like being neglected. Their sense is that they are being asked to return often to places, and their biggest concern is about whether they're going to be able to clean up safely. Dr.

Adrian Martinez Hollingsworth mentioned the health task force that she's also a Member on with us. At the LA County Task force, we deployed a rapid needs assessment which is now closed. We received about 1400 participants from the Eaton area, about 800 participants from the Palisades area.

They answered a 10 question survey that we developed in partnership with on the task force. The 10 minute question. The 10 minute survey included questions about what people perceived as their greatest needs. From the health side, mental health was this most significant need.

We understood that 75% to 80% of respondents indicated their mental health worsened and another 35% indicated they weren't sure where they would go to get their mental health services needs met. And so that's a key focus of the task force.

But one of the other big findings was that people felt they didn't have enough resource and support in knowing whether they're cleaning up safely or not. Finally, I just want to thank this body and this Committee for your support of the public health infrastructure funding.

This funding is crucial for us to be able to carry out the activities I just mentioned. As discussed, most of these activities are in addition to other work that our staff are doing at the same time.

But without the public health infrastructure funding that the state provides us, we wouldn't have the expertise or the staffing to perform the work that we do. I'm going to stop there and turn to my colleagues. Thank you.

Thank you. Please go ahead. You have to press the button.

Good afternoon Chair and Member. My name is Cynthia White. I am a Data Conversion Equipment Operator 1 in the Los Angeles County Department of Public Health. I am a public health transformation advocate in partnership with the county and our union. I've worked in public health since 1997 nearly 30 years.

I am a proud Member of SEIU Local 721 and I am grateful for the opportunity to be here today on behalf of SEIU Local 721.

I am one of over 3,440 public health employees and one of the estimate 23,400 employees united in SEIU as a data conversion equipment operator 1 I work in Administration between my supervisor, myself and my other co worker. We oversee 141 staff. We three care of and we care of anything that comes up.

We care for anything that come. We handle. I'm sorry we. We three take care of anything that comes up from time cards, special events and meetings. Sometimes we have special assignments. We onboard staff, we make sure that the program staff have everything basically I wear a lot of hats in public health Administration.

You might not think someone in my position like mine would be involved in wildfires that took so much from so many people in Los Angeles. Not directly, but these fires were a serious emergency. So we were all deployed in frontline staff to help our brothers and sisters get the resources and. And services they needed to survive.

Just as we did during COVID 19. Pandemic pandemic. When disaster strikes, all public health workers become disaster workers. I was deployed to help out at our west location, West LA location. We had resource. We had a resource center which Mayor Bass helped set up. We, we. We was supposed to be. We were supposed to be for.

We was supposed to be for a couple of weeks. We were supposed to be there for a couple of weeks, but then we extended it. Anyone was, anyone who was affected by the fires could come to the center and get access to resources. We had our public health nurses and doctors there on site for an example.

It was someone. If someone was on medication and they weren't able to find it or it was destroyed in a fire, we were able to get them at least 30 days supply of their medication. We even had mental health services available. There are so many details that people need to know that can be.

At that time, it can be very hard dealing with such a loss. That's why it's critical to make it as easy and seamless as possible for them to get everything they need without needing to travel all over the county to get services. Especially while in fires, while the fires were still burning.

We had a resource for everything that was a part of the county. Not just county, but we had city, state and even federal services like FEMA right there for people. In all my years in public health, I don't recall encountering that approach. To me it was historic.

We cared for their physical health and their mental health to help them get back on their feet on the road to recovery. Another important role of Department of our Department of Public Health and Wildfires is to track air quality. We advised on the air quality at an impact property that impacted property and neighborhoods.

At what kind, at what kind of person, at what kind of personnel, protected equipment, you need to just breathe. These things are really vital to your life and to your health after a fire. So we had staff help with that as well.

Our public health environmental specialist team played a very big role in giving people good information and resources. For instance, they talk to folks about how to clean up from a fire. There are a lot of important do's and don'ts like you absolutely cannot use a vacuum cleaner or fire to clean up fire debris.

People with septic tanks, learn how to safely mark them. Alert emergency workers. While the work is rewarding, it is really challenging for us. Even before the fires, we were short of staff and the fires exaggerate, exaggerated that we still had to do our normal work, but not on the same day.

It was a challenge to cover both our disaster related supported activities and our normal duties. It is important. It's really important and proud. I was really proud that the way the Department did so much for so many people, especially with our being short of staff. This reflection of consideration and passion our staff for those who were hurting.

Like so many others in Los Angeles during this time, the fires directly affected our workplace. Around 20 of my co workers and their families lost everything even as they were helping others in that same position.

As you can imagine, the Los Angeles is going to be processing the damage and losses, especially the the lives that were lost for a very long time. But when I think back on my own experience of working with these individuals and family during that time, I am very humble and moved.

I'll never forget the beautiful and good spirit folks I met in the resource center. They lost so much, but they were never upset with us. They always seemed glad to see where we were there.

One thing that made me proud of the work that we do in public health is that we promote, we protect and we educate the public. This situation was a prime example of that. In this action, it's a big deal because so many people trust the Department of Public Health.

They see that we were here and it makes them feel good. This means a lot in a disaster situation. We all wish for a future that is emergency free. Take it from me and my decades of experience in public health. We have to accept that emergencies can continue to happen.

There will be other wildfires, other disasters that could happen at any time. But with careful planning and investment in public health, workforce and infractions, we may minimize the suffering Countless Californians. Thank you.

Thank you so much, Ms. White. Please go ahead.

Good afternoon. Thank you. Chair Bonta and Members of the Assembly Health Committee. My name is Raffy Bitchakdijan and I'm the President for Pasadena firefighters local 809. I've served the City of Pasadena for a little over 17 years and I proudly serve him as an engineer. The engineer position is pretty much the apparatus driver.

May be an engine or a ladder truck making sure that that apparatus is ready to go that day, all the tools, equipment are working properly and making sure that my firefighters at the end of the hose line have the adequate water and pressure to fight that fire. I was amongst the first firefighters on scene at Eaton fire.

It was a busy day and we ran many calls for service before the fire broke out. When we received the call for a brush fire, our engine immediately moved to the area. As the engineer, I am responsible for assessing our surroundings including ingress and egress in case we need to quickly evacuate the area.

Not only that, I'm also responsible for securing a water supply and making sure that my firefighters have adequate water for the situation that they are given. With the winds at 50 mph and gusting to 100, sometimes sustaining 100, controlling the fire was going to be difficult at first.

We were moving as quickly as we could to put out spot fires and get people to safety. After several hours on the fire, we were able to lay a hose line and engage in some direct fire attack.

We were able to finally anchor in place, hold our ground and put some effort into protecting as many homes, lives and the environment around us. Even on after the days, on my days off, whenever we were done or on my days off when I was going off duty, I ended up going down to the convention center.

I pride myself and so do my Members who also went down there to volunteer at the convention center. These are. This is our community. We live in that city as well. And we felt that we wanted to be able to connect with our community.

Being Armenian and Latino and being trilingual, I knew that it was gonna help CAL FIRE Foundation when we're going down there to help people give out these gift cards that we were passing out.

So I just felt had a sense of being able to connect with my community, Having to answer questions directly from Members that were impacted to be able to answer anything that they that any questions that they might have had.

I want to talk a little about January 7th and the following days before talking about the health impacts to help frame the difficult and challenging nature of the eat fire.

When there's a major wildfire brush fire urban interface conflagration like the Eaton fire, Firefighters in the public in the immediate vicinity are exposed to smoke and toxins of anything burning in the area. And while working to find a solution is ongoing.

Firefighters do not have breathing protection and fires like these as air purifying respirators like N1 hundreds restrict breathing too much and self containing breathing apparatus like those we wear in the structure fires would not work in the environment. It is absolutely very difficult, especially in wildfires to be able to have any kind of breathing protection on.

I challenge anybody to try to wear a nice N100 or P100, even an N95 and take a few flights of stairs. It makes it really, really difficult. We do have breathing apparatus.

The challenging part about a breathing apparatus that is limited in air, we only get about 30 minutes of work and refilling and replacing those air bottles will make it very, very difficult and the weight of it on its own will make it very, very difficult as well.

We wear brush packs with fire shelters just in case if we're overrun with fire to protect ourselves. And again, wearing a respirator on top of a pack with all the appliances, tools and everything we carry makes it almost impossible.

With all this in mind, I would like to raise three health issues that I believe we could collaborate on to improve firefighter health and safety and community health and safety. The first issue is cancer, a leading cause of death in the fire service.

The International Agency for Research in Cancer classifies firefighting as a Group 1 carcinogenic in the same category as other cancer causing agents. This is due to the increased incident of cancer among firefighters and the multiple carcinogenic exposures that we endure daily in the line of duty.

In 2023, the Legislator passed AB 700 establishing the California Firefighter Cancer Prevention and Research Program which funds community engaged participatory research between University of California researchers and the California Fire Service.

This was a huge leap forward in the effort to reduce cancer risk amongst firefighters and we are hopeful that more funding can be provided to expand this research. Efforts to reduce the cure of firefighter cancer will also support broader community health and we look forward to achieving that goal.

The second issue I would like to discuss is behavioral health. Thanks to the work of the Legislator, significant process progress has been made on improving behavioral health amongst firefighter.

I'm very proud to say that Pasadena Fire Department has been on the cutting edge of implementing strategies such as peer support to help our firefighters who often see horrible things in effort in their efforts to protect the public.

While steps have been made, we need to expand access to care for firefighters and increase the number of culturally competent behavioral health Clinicians available for firefighters. Finally, in our efforts to support community health, we need to continue to promote efforts to strengthen fire based emergency medical services.

This Committee has supported many fire based EMS innovations and we greatly appreciate that we need to continue to expand services to our residents and strengthening the fire service will help protect residents every day including events like the Eaton Fire.

Pasadena Fire Department is an EMS provider and we take great pride in supporting Our residents with when they need EMS services, that type of fire and EMS collaboration strengths, our all risk response to any incident, whether it be as large as the Eaton fire or smaller incidents involving a single resident. I love my job.

I love serving the citizens of Pasadena. I don't take the oath I took lightly, nor do all my Members. And knowing that the risks and consequences that come with the job, I never hesitate and I would never change my mind. And I am hopeful that we can work together to reduce health risks for firefighters and the public.

Before closing, I would like to say that my heart is out with the residents for Altadena, Pasadena, Pacific Palisades and anyone affected by these impacted by these fires. Honestly, the resilience of our community Members is amazing and I look forward to helping our communities rebuild. Thank you for your time and I'm happy to answer any questions.

Thank you so much for being here and for your dedication and for giving us even just a small window into the amount of commitment and care that you have for your community. Very much appreciate it and open it up for any questions. Assemblymember Harabedian.

Thank you, Madam Chair. First of all, I just wanted to thank you for doing this and for the whole Committee for doing this, just how impactful and educational it is. So thank you. And I think that every panel was so helpful and educational, including this one. So let me just say to Dr. Mahajan, Ms.

White, my friend, Mr. Boccaccian, it's good to see you. Thank you for everything that you guys have done and continue to do. And you know, Mr. Bitchakdijan was there the day after the fire on the front lines handing out cards to the victims alongside with his fellow firefighters, many of whom lost their homes and still fought the fire. So it was incredible. And to all the Members of the force, I just want to say thank you.

I have one question and I think there's been excellent questions and I've learned a lot. But Dr. Mahadrin, can we address this point that you brought up?

The families that have are still lucky enough to have homes are kind of stuck in this middle ground of not knowing whether it's safe to move back or not and getting pressure from a lot of different sources to move back. Is it safe for them to move back?

And if it is, how do we actually get information to the community to convince them or show them that they and their children and their parents and grandparents aren't going to sustain long term health effects by moving back at this time or in the short term?

Thank you for your question. Assemblymember It's a great question. I'll start with the easiest answer first, and that is that if one's property is damaged or destroyed and there is fire debris on your property, the public health recommendation is that you shouldn't go there. You shouldn't even try to sift it yourself. As Dr.

Belperio said earlier, leave it to the professionals. It's dangerous. And so that's our first advisory. And especially if you're elderly or you're young or you're vulnerable in some other way, you really want to avoid it.

Now, if you're in a property that backs up onto other properties that were destroyed and damaged, but your property is relatively preserved and it's still standing, that's the question you're asking, and that's what the residents are saying, well, is it safe for me to, to go home?

You know, we recommend, and we support the insurance Commissioner's suggestions that residents first work with their home insurer or their insurance company to really ensure that there is an evaluation of whether it's safe or not.

We have also at the Public Health Department put out an advisory that being within 250 yards of fire debris, there is evidence that if you are exposed to fire debris, if you're exposed to it, it could increase your risk to adverse health outcomes that we've heard about earlier today. But it varies.

It depends on which way the wind is blowing, right? If you're near an area that's got a lot of fire debris and there's a lot of gusting wind and that fire debris is still there and it's aerosolizing, you got to take steps to protect yourself. These are tough questions to answer because it varies by location.

And one of our goals is to really try and provide the best available data that we can about water testing, soil testing, air testing, and put it publicly and have it be discussed in town halls.

So we at Public health have held already 2 environmental health impact, 3 environmental health impact virtual town halls attended by over by hundreds of people. The last one last week, over 700 people attended. We had experts from the universities, from the federal and state partners answering people's questions and presenting the data that they do have.

We're waiting for more data to help answer these questions, but I think it's not an easy answer. You know, we really need phase one and phase two to be completed, and once that's completed, then the fire debris will be gone. But till then, it's a matter of taking the right precautions, depending on where exactly you are.

Doctor Bains?

Yes. You know, my heart goes out to all the work that our first responders have been doing. I was out there at both Eaton and Palisades deployed with Calmat in addition to the LA shelters as well.

One of the biggest things that we're still missing when it comes to the healthcare impacts of wildfires is our impact to first responders. I mean, we have someone sitting here, right here telling us about the increased cancer risk of what's happening.

If we want to know what the health care impact of these wildfires is, it's already in front of us. Look at what's happening to our firefighters that are responding. I mean, it's been happening for years. Look at what happened post 911. We had people coming down with asbestosis. A lot of firefighters lost their lives.

And these are people that put their life on the line to protect all of us. They don't. When they get the call for a fire, they're out there. What are we doing to protect their health care impacts? What are we doing to better make sure that that hazard, that workplace hazard that they're experiencing is being addressed?

Now I'll give you an example. In 2018, I had firefighters show up to the Ridgecrest earthquakes that were happening right outside my district. That time I wasn't elected. I was just a Doctor that was seeing first responders in my clinic come down with valley fever.

And I called our local public health Department and I said, what are we doing to protect first responders that respond to an area that has valley fever? And when you respond to an earthquake, you'll have increased exposure to valley fever.

And I was told by Public Health Department, zero, we don't think valley fever is a problem out there. I didn't give up. I got into my truck, I went out there and I took 14 dirt samples and I published a research paper that showed valley fever is a problem out there.

And I published a research paper one year before the pandemic saying that we don't have enough N95 masks to cover not just our first responders. What would happen if we had a pandemic. So our public health Department is running 10 years behind on what it is.

And the biggest example right now is we should be studying the impacts of what's happening in our first responders because that is the answer of what's going to happen to all of us when it comes to the long term health care impacts of these wildfires.

Thank you, Assembly Member Bains, Assembly Member Schiavo.

It was encouraging and I want to thank you, Ms. White for being here. You know, one of the things you said was about the trust that is created. I'm sorry, I'm going to cry when LACDP shows up in this way. And in my community we have not seen that.

We haven't seen it when it comes to the Chiquita Canyon landfill fire. And there's incredible mistrust because of that. It is so frustrating to see everything that happens when an emergency is declared.

And I am told over and over and over by the Board of Supervisor who represents our area that we don't need to declare an emergency, that we don't need any more actions taken. Thank you. And we have just heard at our legislative tour in the last week that the size of the fire has tripled.

It's not just going to be one decade, but multiple decades that it's going to be burning. People are sick. People spoke at our press conference who had cancer, who have rare cancers, children are getting bloody noses and even got one in the middle of our press conference.

And for a year the response from LACDPH has been when one mother would almost daily or weekly email the address they were given at LACDPH about what the issues, the health issues that they were experiencing were. And the response was we'll put it in the log for a year.

And then finally they promised to do a health study. And we thought it was going to be like a comprehensive door to door, robust study. We had volunteers ready to go to help and it ended up being an email that was sent out to people to talk about what their daily symptoms and smelling the odor was.

And so, you know, when I see all of these slides that you're putting up here about everything that's done in an emergency, all of the responses that are done in an emergency, a website dedicated to informing the public. I just went on LACDPH's website and searched Chiquita Canyon landfill.

And I don't there's no dedicated website to it that I can find for sure there, you know, there's a couple one offs on things that were done over the last few years. And so, you know, I don't want to take away from the robust response to the fires and certainly there's lessons to be learned.

I know short staffing is a challenge. I've been hearing about short staffing and you know, in DPH and all of our public sector, fire law enforcement everywhere since I got here over two years ago. And that certainly hamstrings our ability to respond.

But we need in my community so much more, so much more than what LACDPH is doing right now. And I have asked, I have sent letters, I have met with Dr. Ferrer and Muntu Davis and others. Dr. Quick. And our community is getting sicker and sicker as time goes on. And now it's been years.

It's been years that these toxic fumes have been blowing into the community. The fire training center was shut down for a while because of the impacts of that. And so I have to. I don't want to derail the conversation, but I have to at every opportunity I have say that we need to declare a State of emergency.

And if we are not, because the county, as the lea, for some reason seems determined not to, and saying that they have everything they need and they're doing everything they need, then we are going to provide a very long list of the things that we do not have currently that should be provided.

And I don't want it to take five months to hear back about what's happening. We can't. Our community cannot wait any longer. We need an emergency response. We need an emergency response.

And I'm grateful to my colleagues who have been stepping up and supporting this effort as well, because I have not been able to get that to move by myself. Our community, who has been screaming for years, has not been able to get that kind of response.

We're going to be continuing to build and get louder until we get the kind of emergency response that we see as possible. We see it. We see everything you have done, which is great, great. And the community deserves that. Our community deserves it, too.

Thank you. Assemblymember Schiavo. I don't have any additional questions for the panelists. I just want to. Or comments directly. I just want to thank you all for coming Here, in particular, Ms.

White, for being able to share a moment of great resilience in how you, as somebody who didn't need to kind of stepped in, into your role as a community Member and as a first responder. And of course, to our, to our friends,

Mr Bitchakdijan, for just bringing the, bringing the realities of what our first responders have been fighting for and just always being able to go towards danger and not only continue to go towards danger, but do so knowingly and with such a commitment and care that puts your lives at risk.

I want to thank you for being here in that and certainly to all of our panelists for just kind of being able to give some. Give some real heart to the moments that we're facing here.

What we heard from our panelists were we heard survivors who have been dealing with their own displacement, with their own response to living with having to be able to support our communities in need while also experiencing the same health factors, the same level of trauma, the same level of concern, displacements, loss of property that so many have been devastated by with these.

With these fires. I just wanted to just acknowledge that we had the blessing of having our colleagues here on the Committee who are coming from those same experiences and who have been incredible advocates supporting how the Legislature approaches what we need to do in this moment in time. Assemblymember Schiavo, Mr. Harabedian,

Dr Bains, especially Celeste Rodriguez, who spoke to their own experience and the majority leader in dealing with these catastrophes and the fires and the impacts that they continue to have at Dawn Addis on our communities. So we wanted to just be able to shed some light on an area that hasn't been able to have quite enough attention.

We were kind of in the emergency response mode for a moment, and now we need to turn our attention to the impacts of both the public health crisis that we are experiencing as a result of these climate change and the wildfires in particular, and then what the ongoing impacts of that are.

We have an opportunity to hear just the nuts and bolts of the impacts of the air quality, what that means in terms of impacts on trauma, what the generational trauma is for our communities, and what we need to do to be able to embed support systems ongoingly.

We've heard that we need to make sure that we are aware of the full impacts of that, not just in this moment, but in the moments to come that we are still contending with.

And I also want us all to know, and I'm sure we are all cognizant of the fact that these natural disasters are happening within the context of already existing systems, Bias, disparities and differences in life circumstances that make a catastrophe hit some harder than others.

And we just have to kind of own that, whether you are a frontline worker, whether you are somebody who is homeless, whether you are someone who is privileged. But we are all really challenged by this moment. And some of us have the ability to rebound and be resilient. Others of us, many of us, all of us, need the support of our communities in order to be able to do that together.

We also heard about the need for an opportunity for the state to play a role in continued role in supporting, scaling, notice and response, and also to be able to be deliberate about being targeted about our notice and response and support and recognizing the disparities that exist and Also the assets that exist in our communities.

How are we taking advantage of our community health workers, our people who are just superheroes and say, I'm going to step into this, how are we taking advantage of our frontline nonprofit organizations? How are we making sure that we are supporting our workers who continue to just show up for us every single day?

We also heard that we needed to make sure that we trust our neighbors in a moment of crisis. People should not be asked to demonstrate need, should not have to have a barrier of status or eligibility to keep them from getting the care that they need. I heard that loud and clear.

And we also know that and heard that we need to be able to rebuild our communities by ensuring that we have trust as the center of that.

And when that trust is violated because we haven't shown up with consistency and, and with dedication, and when we have just allowed some parts of our communities to fall through, fall through the gap, that we need to be able to acknowledge that and refocus our efforts.

We heard a lot about how our systems, our agencies, our county level efforts, our hospital facilities, our frontline workers and our staff Members, our clinics need to be able to have a level of flexibility as well in being able to address this more fully. We heard about flexibilities, we heard about the fiscal impacts to our health organizations as they tried to step in to be able to address the needs that we had.

We also heard that we need to take a much more anticipatory approach that is collaborative and connected and that involves all the people who are stakeholders in our community and who are responders so that we can make sure that we're having an opportunity to be able to move forward together.

Of course, we heard the role and importance of our public health workforce and our first responders and the support and need that they have right now in this moment. And I want to thank Dr. Baines for always kind of bringing us back to that moment of really thinking about what that means, whether it's addressing, as Mr.

Bhatchachan raised, the cancer risk for our first responders, behavioral health supports ongoingly, or creating fire based emergency medical services as a critical thing that we need to do.

And ultimately we heard that we have a lot of things that we've learned and a lot of things that we still need to learn because we know that there's just going to be something else that we have to deal with.

And in this moment right now, there is something else that we need to deal with in order to be able to ensure not only that we have ongoing public health, but that we have a mind towards being able to rebuild with wellness at the Center for our community. So I want to thank all of you for participating in in this hearing.

I'm sure all of your minds are just bursting with different things that we still need to do as legislators and I'm certainly committed as Health Chair to ensure that we are focusing on rebuilding our communities so that we can have the healthiest California even in times of crisis. Thank you for participating. zero, I didn't do that.

We're going to have some public comment, but the panelists are free to free to go to their seats. And just as a reminder for public comment, if you could keep your public comment to one minute, please indicate your affiliation. That would be very helpful.

Is it on? Oh, thanks. Thank you Chair and Members Kassidy Heckmann on behalf of ATA Action, the advocacy branch for the American Telemedicine Association, we just wanted to thank Committee for having this hearing today and also highlight the benefits of telemedicine and connecting displaced persons to care following a natural disaster.