Berkeley City Council
November 19, 2024

14

Contract: NEMA Construction for CONSENT CALENDAR
FY 2023 Street Light Maintenance Project November 19, 2024

Nema Construction of Albany, California, was the lowest responsive and responsible bidder, with a bid of $369,100, and their references were satisfactory. This project includes a 15% contingency, which brings the total contract amount up to the requested $424,465. Staff recommends that a contract for this project be awarded to Nema Construction.

The FY 2023 Street Light Maintenance Project is a Strategic Plan Priority Project, advancing our goal of providing state-of-the-art, well-maintained infrastructure, amenities, and facilities.

BACKGROUND
In 2017, the Department of Public Works hired a consulting firm to evaluate the condition of Berkeley's 3,105 metal street light poles. The firm developed a custom survey for field staff to compete for each pole. The survey data was used to determine which poles were experiencing chronic rust or corrosion and how these issues should be addressed.

The data was further reviewed, and an estimated remaining helpful pole life was determined for each street light pole. The remaining pole life was estimated based on pole type and the level of damage (if any) observed in the field. The data was also mapped to allow the City to visualize where various issues are occurring.

This data was used to select the most needed replacement street light poles. A subset of those poles was chosen to be replaced as part of this project.

The plans and specifications are on file in the Public Works Department. In accordance with the California Environmental Quality Act (CEQA) requirements, this project has been determined to be categorically exempt because it consists of maintenance of existing street light poles and does not expand their use beyond existing conditions.

According to City policy, the Living Wage Ordinance does not apply to this project since Public Works construction contracts are subject to state prevailing wage laws. The contractor has submitted a Certification of Compliance with the Equal Benefits Ordinance.

The Community Workforce Agreement (CWA) does not apply because the engineer’s estimate of $425,000 was below the $500,000 contract amount threshold for CWA eligibility.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
Improved street lighting is consistent with the City’s efforts to improve the efficiency and safety of the movement of people and vehicles throughout the City’s roadway network.

Street lighting can also advance opportunities for people to safely walk, bike, and take public transit, therefore working to reduce greenhouse gases and pollutants that impact air quality.

RATIONALE FOR RECOMMENDATION
This street light maintenance project is part of the City’s ongoing efforts to maintain and rehabilitate public work infrastructure. The work requires contracted services, as the City

Contract: NEMA Construction for CONSENT CALENDAR
FY 2023 Street Light Maintenance Project November 19, 2024

does not possess the in-house labor or equipment resources necessary to complete the project.

ALTERNATIVE ACTIONS CONSIDERED
The City council can choose not to award a contract, but the street light infrastructure would continue deteriorating, reducing night visibility and public safety.

CONTACT PERSON
Wahid Amiri, Deputy Public Works Director, (510) 981-6396 Ronald A. Nevels, Manager of Engineering, (510) 981-6439 Srinivas Muktevi, Supervising Civil Engineer, (510) 981-6402 Attachments:
1: Resolution
2: Location Map
3: Abstract of Bids

RESOLUTION NO. ##,###-N.S.

CONTRACT: NEMA CONSTRUCTION FOR FY 2023 STREET LIGHT

MAINTAINENCE PROJECT
WHEREAS, the FY 2023 Street Light Maintenance Project is part of the City’s ongoing efforts to maintain and rehabilitate public works infrastructure throughout the City; and WHEREAS, the City has neither the labor nor the equipment necessary to undertake this FY 2023 Street Light Maintenance Project; and
WHEREAS, an invitation for bids was duly advertised on September 5, 2024, bids were opened on September 19, 2024; and
WHEREAS, NEMA Construction was determined to be the lowest responsive and responsible bidder; and
WHEREAS, funding is available in the current year budget for the FY 2023 Street Light Maintenance Project Funds (Fund 142).

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that the Plans and Specification No. 24-11668-C for the FY 2023 Street Light Maintenance Project are approved.

BE IT FURTHER RESOLVED that the construction contract is awarded to Nema Construction as the lowest responsive and responsible bidder.

BE IT FURTHER RESOLVED that the Council of the City of Berkeley authorizes the City Manager to execute a contract and any amendments, extensions or change orders, until completion of the project in accordance with the approved plans and specifications with Nema Construction for the FY 2023 Street Light Maintenance Project, in an amount not to exceed $424,465, which includes a 15% contingency for unforeseen circumstances. A record signature copy of said agreement and any amendments to be on file in the Office of the City Clerk.

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Office of the City Manager
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov/

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Paul Buddenhagen, City Manager
Submitted by: Terrance Davis, Director, Department of Public Works Subject: Contract: Sposeto Engineering, Inc. for Southwest Berkeley Bikeway and Bus Stop Improvements Project

RECOMMENDATION
Adopt a Resolution, as a condition of receiving grant funding from the State of California Affordable Housing and Sustainable Communities (AHSC) program:

1. Approving plans and specifications for the Southwest Berkeley Bikeway and Bus Stop Improvements Project (“Project”), Specification Nos. 24-11640-C & 24-11666-C;

2. Accepting the bid of Sposeto Engineering, Inc., the lowest responsive and responsible bidder; and

3. Authorizing the City Manager to execute a contract with Sposeto Engineering, Inc., and any amendments, extensions, and/or change orders until completion of the Project in accordance with the approved plans and specifications, in an amount not to exceed $2,390,000, which includes a 10 percent contingency for unforeseen circumstances.

SUMMARY
In 2019, the City partnered with Satellite Affordable Housing Associates (SAHA), the developer of the Grinnell Apartments (formerly known as Blake Apartments) affordable housing residences at 2527 San Pablo Avenue, to design and construct pedestrian, bicycle, and bus transit transportation improvements as a condition of receiving grant funding from the State of California Affordable Housing and Sustainable Communities (AHSC) program for both SAHA’s and the City’s work.

In early 2020, the City and SAHA entered into an agreement, which defined the City’s work that was formalized as the following two projects:
 Parker Street to Addison Street Bikeway
 University West Bus Stop Improvements
This agreement allows the City to obtain grant funds for its work via a reimbursement process, as grant funds from the AHSC program must be passed directly to the housing

15

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

developer (SAHA) and would then reach the City via the agreement between the City and SAHA. SAHA’s grant from the AHSC program is $11.7 million and the City’s grant is $1.422 million, of which $1.069 million is budgeted for construction of the Parker Street to Addison Street Bikeway and University West Bus Stop Improvements projects.

The City’s work and receipt of final grant reimbursement monies must be complete by June 30, 2026, or the City will be liable for the grant costs and risk loss of grant funding for SAHA’s and the City’s work.

The Parker Street to Addison Street Bikeway fills a key gap in the existing Citywide bicycle network by connecting San Pablo Park to Strawberry Creek Park and the adjacent West Street Pathway and begins a new bikeway along Parker Street toward the existing Ninth Street Bicycle Boulevard, as per the Berkeley Bicycle Plan.

The University West Bus Stop Improvements makes improvements at the University Avenue/Bonar Street and University Avenue/Acton Street intersections to create safer pedestrian crossings as per the Berkeley Pedestrian Plan and to improve bus stop amenities and service reliability as per the City General Plan.

City Staff engaged engineering and design consultant teams to assist in several key tasks: developing design concepts, conducting public outreach, reviewing and evaluating public feedback, and finalizing the design with plans and specifications.

Additionally, the teams evaluated the proposed transportation improvements to assist staff in determining the appropriate California Environmental Quality Act (CEQA) compliance pathway.

The City’s design team expended considerable effort in (a) preparing various initial and revised design concepts and (b) advertising and conducting three public engagement meetings to explain the concepts and receive public input to balance such input and the project goals in a synthesized and comprehensive design.

The Parker Street to Addison Street Bikeway and University West Bus Stop Improvements projects were merged into a single construction bid package, titled Southwest Berkeley Bikeway and Bus Stop Improvements Project (Project), so that City staff could more easily administer and oversee the construction contract and to streamline the grant reimbursement process.

The Project construction was bid via an open competitive bid process. Bids were opened on October 22, 2024, and Sposeto Engineering, Inc. was found to be the lowest bidder, with a bid of $2,165,360.80, which is within the Project budget.

To keep the Project on schedule, the City should enter into a construction contract and begin construction in early 2025.

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

FISCAL IMPACTS OF RECOMMENDATION
The construction budget for the Southwest Berkeley Bikeway and Bus Stops Improvement Project is $2,947,823, including contingency. The construction contract for this Project consists of two individual projects that are funded in part by a California Affordable Housing and Sustainable Communities (“AHSC”) infrastructure pass-through grant via Satellite Affordable Housing Associates’ (“SAHA”) Grinnell Apartments, located at 2527 San Pablo Avenue. Funds are available in the FY 2025 budget in the funding sources indicated below.

Project
AHSC
Capital
Grant-State
(Fund 306)
Alameda
County
Measure BB
Local
Streets &
Roads
(Fund 134)
Alameda
County
Measure BB
Bicycle and
Pedestrian
(Fund 135)
State
Transportati
on Tax
(Fund 127)
Parker Street to Addison Street
Bikeway, Specification No. 24-
11640-C
$880,814 $269,786 -- --
University West Bus Stop
Improvements, Specification
No. 24-11666-C
$188,651 $497,072 $161,500 $950,000
Total funding for Project
construction: $2,947,823
$1,069,465 $766,858 $161,500 $950,000
Low Bid by Sposeto Engineering, Inc. $2,165,360.80
10% Contingency $224,639.20
Total Not-To-Exceed Construction Cost $ 2,390,000.00

CURRENT SITUATION AND ITS EFFECTS
On October 22, 2024, four bids were opened for the Project, with bids ranging from $2,165,360.80 to $2,576,678.00. The determination of the lowest responsive and responsible bidder was based on the total bid price, as described in the bid documents.

The lowest bidder is Sposeto Engineering, Inc., with a bid of $2,165,360.80. Staff have identified funding to cover the total bid price of the low bidder, plus a 10 percent contingency, as indicated above. Staff have verified that Sposeto Engineering, Inc. is the lowest responsive and responsible bidder.

The Living Wage Ordinance does not apply to this Project as Department of Public Works construction contracts are, pursuant to City policy, subject to State prevailing wage laws. Sposeto Engineering, Inc. has submitted a Certification of Compliance with the Equal Benefits Ordinance. The Community Workforce Agreement applies to this

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

project because the estimated construction cost exceeds $500,000. As a result, the successful bidder and all subcontractors will be required to sign an agreement to be bound by the terms of the Community Work Force Agreement.

The Southwest Berkeley Bikeway and Bus Stop Improvements Project is a Strategic Plan Priority Project, advancing our goals to provide state-of-the-art, well-maintained infrastructure, amenities, and facilities via construction of the Parker Street to Addison Street Bikeway and the University West Bus Stop Improvements, and creating affordable housing and housing support service for our most vulnerable community members via SAHA’s Grinnell Apartments affordable housing development.

BACKGROUND
Project Origins and Scope & Grant Funding
On December 10, 2019, via Resolution No. 69,231-N.S., Approval of the 2019 Housing Trust Fund Request for Proposals Reservations, Council reserved City funds to support four affordable housing developments, including SAHA’s Grinnell Apartments, located at 2527 San Pablo Avenue. The Grinnell Apartments is funded in part by the State of California’s AHSC program, which has a goal of reducing greenhouse gas emissions and requires associated transportation improvements as a condition of funding. The transportation improvements would focus on sustainable forms of transportation, such as biking, walking, and mass transit. SAHA requested that the City partner with them, as the City has a history of successfully delivering such projects. The following two transportation improvement projects are now ready for approval:
 Parker Street to Addison Street Bikeway. This project originated in the 2017 Berkeley Bicycle Plan (Bicycle Plan), which envisions a Citywide network of low- stress bikeways along particular streets which were specifically chosen in large part to connect major destinations. A primary goal in designing low stress bikeways is for all portions, including intersections, to have consistently low levels of traffic stress as perceived by bicyclists in order to improve safety and encourage more people to bike.

The Parker Street to Addison Street Bikeway will construct a new north-south Bicycle Boulevard connecting San Pablo Park to Strawberry Creek Park and the adjacent West Street Pathway via Mabel Street (between Ward Street and Dwight Way), Dwight Way (between Mabel Street and Bonar Street), and Bonar Street (between Dwight Way and Addison Street), in addition to beginning a new east-west Bicycle Boulevard on Parker Street (between Mabel Street and San Pablo Avenue), which would eventually be extended westward as part of a separate, yet-to-be funded future Bicycle Plan project to connect into the existing Ninth Street Bicycle Boulevard. Bicycle Boulevards would include standard bicycle boulevard signage and pavement markings and wayfinding signage.

New bicycle access improvements at Strawberry Creek Park would also be constructed, including improved curb ramps and a new bicycle ramp onto West

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

Street. This project would fill an important gap in the existing Citywide bicycle network.

In addition, this project will also construct new sidewalks where none currently exist on the east side of Acton Street, between Parker Street and Carleton Street, as supported by the Berkeley Pedestrian Plan, which aims to maintain an accessible path of travel for all pedestrians at all times.

The work of the Parker Street to Addison Street Bikeway is within the public right of way.
 University West Bus Stop Improvements, aim to improve pedestrian crossings and bus stops at the University Avenue/Bonar Street and University Avenue/Acton Street intersections. These two intersections were identified in the 2021 Berkeley Pedestrian Plan as needing pedestrian crossing safety improvements. Improving the pedestrian crossings also provides opportunities to improve the four bus stops along University Avenue at these two intersections, as efficiencies in sidewalk widening also provide space for new bus shelters and associated amenities.

Specifically, pedestrian improvements at the two intersections will consist of:
a. sidewalk bulbouts, which would shorten crossing distances across University Avenue, Bonar Street, and Acton Street,
b. new accessible directional curb ramps with adjacent pedestrian push buttons and improved traffic signal infrastructure, and c. repaved intersections with new crosswalk markings.

Bus stop improvements at the two intersections will include constructing:
a. new bus bulbs which would allow buses to stop in the vehicle lane rather than pulling out of the lane, thereby increasing efficiency and reliability of bus service,
b. concrete bus pads, and
c. bus shelters and associated benches and trash receptacles.

Bus shelters will be solar-powered where feasible, depending on the amount of sunlight that can reach the bus shelter beneath tree canopies.

The bus stop improvements follow City General Plan Policy T-2 which calls on the City to “implement improvements to make transit more convenient, dependable, and attractive”, and General Plan Policy T-4 which establishes the City’s Transit-First Policy concerning identified Primary and Secondary Transit Routes.

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

The work of the University West Bus Stop Improvements project is within the public right of way.

These two projects were submitted to the State’s AHSC program as part of SAHA’s grant funding application for the Grinnell Apartments affordable housing development in 2019. SAHA’s application was successful, and the Grinnell Apartments project received housing funds for approximately $11.7 million. As part of the AHSC’s funding, the City will receive $1.422 million for the Parker Street to Addison Street Bikeway and University West Bus Stop Improvements projects via a side agreement with SAHA in order to receive AHSC funding that would be passed through the Grinnell Apartments project to these City projects.

The side agreement compels the City to complete the Parker Street to Addison Street Bikeway and University West Bus Stop Improvements projects by the end of January 2026. Completion of the transportation projects in a timely way will be necessary for the Grinnell Apartments developments to receive AHSC housing funds; the City’s default would mean the loss of AHSC funds for the Grinnell Apartments. For that reason, the City will need to prioritize completion of those projects or it will expose the City to liability for those losses.

On January 21, 2020, via Resolution No. 69,252-N.S., California Affordable Housing and sustainable Communities Infrastructure Grant Applications and Agreements with Proposed Blake Apartments and Maudelle Miller Shirek Community Projects, Council authorized the City Manager to negotiate, enter into, and cause the City to perform its obligations under an agreement with SAHA relating to its grant agreement with the AHSC program for the Grinnell Apartments (formerly known as Blake Apartments) project-related transportation and infrastructure improvements, and to accept and perform grants if awarded.

On January 29, 2020, the City executed a contract with SAHA not to exceed $1.422 million for transportation infrastructure improvements related to the Grinnell Apartments development.

Public Outreach
City staff conducted three public outreach meetings for the Southwest Berkeley Bikeway and Bus Stop Improvements Project, which were intended to provide information to and solicit input from the public. The meetings were advertised and conducted as per the Department of Public Works’ Public Participation Policy.  December 1, 2022 – First meeting for Parker Street to Addison Street Bikeway. Initial design concepts were presented. Public input was received during and after this meeting, which necessitated refined/revised concepts for the proposed bikeway on Dwight Way, leading to a second meeting.

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

 April 13, 2023 - University West Bus Stop Improvements. Initial design concepts were presented, and no significant public input was received during or after this meeting. The design was subsequently refined and finalized after this meeting.
 November 9, 2023 – Second meeting for Parker Street to Addison Street Bikeway. A refined concept and a new concept were presented for the proposed bikeway on Dwight Way, which considered public comments from the first meeting. Additional comments were received during and after this meeting, which guided the City staff’s decision to proceed with finalizing the design of a two-way cycletrack along the north side of Dwight Way.

At the conclusion of the public outreach process, the design team reviewed comments from the public including residents and businesses, Staff reviewers, and external stakeholders including AC Transit and utility companies, and evaluated these comments in the context of project goals, grant funding obligations, Citywide goals and policies, engineering design practice, management of the public right of way, safety, and cost.

Detailed design documents were prepared by the design team in accordance with these factors. City staff believes the Project design documents consisting of engineering plans and specifications best achieves these objectives.

Design Options and Considerations
Following staff turnover and staffing shortages in the Public Works Department, in late 2021, the City solicited proposals from design consultants under its on-call engineering services contracts. Separate consultant teams were procured for the Parker Street to Addison Street Bikeway and University West Bus Stop Improvements work to obtain needed expertise and distribute work to different on-call consultants. Selected consultants were issued work authorizations and began preparing conceptual design options in spring 2022. During the course of preparing and evaluating different conceptual design options, a few scope items were addressed in detail:

1. Traffic calming on Bonar Street, between Allston Way and Addison Street.

In response to a neighborhood petition requesting traffic calming measures on this block, the City gathered and evaluated traffic data and will include two speed tables as part of the Parker Street to Addison Street Bikeway project. The speed tables contribute to the overall efficacy of a new Bike Boulevard by slowing vehicles on a route where bicycles would share the roadway with vehicles.

2. Traffic circles at the Parker Street/Ninth Street and Bonar Street/Channing Way intersections. These locations are at the intersections of future and existing Bicycle Boulevards and, in keeping with City design practice for such intersections, traffic circles will be installed as part of the Parker Street to Addison Street Bikeway project. Traffic circles are a secondary measure at these intersections, which will remain all-way stop controlled, to keep vehicle

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

speeds low, and also reduce the number of potential conflict points between vehicles and bicycles thereby improving the overall safety.

3. New sidewalk along east side of Acton Street, between Parker Street and Carleton Street. The Parker Street to Addison Street Bikeway project includes installation of approximately 200 feet of new sidewalk along the east side of Acton Street, immediately south of Parker Street, where no sidewalk currently exists. This work includes the necessary removal of a Monterey Pine tree that has been evaluated by the City’s Urban Forestry Division of the Parks, Recreation, and Waterfront Department and found to be in poor condition, with fungus and beetle infestations. The new sidewalk will include tree wells for planting six new trees.

4. Offset Intersection at Dwight Way, between Mabel Street and Bonar Street.

The scope of work for the Parker Street to Addison Street Bikeway project, as described in the agreement between the City and SAHA, includes pedestrian and bicycle crossing improvements at the Dwight Way/Mabel Street intersection consisting of a roadway median and an associated rectangular rapid flashing beacon (RRFB). However, based on a detailed survey and review of existing site conditions, a roadway median on Dwight Way was deemed infeasible due to insufficient roadway width and a desire to maintain vehicle circulation patterns and on-street parking. An RRFB was considered at this intersection, but based on engineering judgment, staff believes all-way stop controls at this intersection would result in a safer crossing for pedestrians and bicycles.

The Parker-Addison Bikeway project would connect San Pablo Park to Strawberry Creek Park and the West Street Pathway via a new north-south bicycle boulevard on Mabel Street and Bonar Street, which have relatively low vehicle volumes. Because these streets are discontinuous at Dwight Way, offset by about 100 feet, they would be joined by constructing a low-stress bikeway on a street with high vehicle volumes (Dwight Way) with associated traffic controls, including an all-way stop at the Dwight Way/Mabel Street intersection.

In order to provide maximum roadway space for potential options, City staff coordinated with AC Transit, which runs regular bus service on Dwight Way, to remove the existing eastbound bus stop at the Dwight Way/Mabel Street intersection, resulting in bus stop spacing that would be closer to (but less than) the ideal spacing of 1,000 feet outside of downtown areas, as per AC Transit’s Multimodal Corridor Guidelines.

City staff considered several options for the bikeway connector on Dwight Way, which included different kinds/sizes of bikeways on the north, south, or both sides of the roadway and varying traffic controls at the Dwight Way/Mabel Street and/or Dwight Way/Bonar Street intersections, in an effort to reduce the potential

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

loss of on-street parking and changes to curbside planter areas (which were expressed concerns from the public during the public outreach process, described below), as well as improving safety for bicyclists, pedestrians, and vehicles. Based on detailed analyses, which included consideration of public comments, City staff recommends the bikeway option with a two-way cycletrack along the north side of Dwight Way.

This recommendation includes the following:

1. Two-way cycletrack. In accordance with the Berkeley Bicycle Plan, “A cycletrack connector is proposed for offset major intersection crossings along the Bicycle Boulevard network. This treatment provides a protected, low- stress crossing on the bikeway approach, and a low stress two-way facility on the cross-street parallel to the bikeway approach.” As a result of the Bicycle Plan’s focus on two-way cycletracks at offset intersection crossings, City staff carefully studied the two options as described below. Both options would provide protection for bicyclists via a concrete buffer between the cycletrack and the adjacent vehicle lane. On-street parking would need to be removed to provide space for a cycletrack.
 Along north side of Dwight Way. An approximately 55-foot long,

8.5-foot wide two-way cycletrack, with a one-foot wide concrete buffer, would be installed along the north side of Dwight Way. All way stop controls would be implemented at the Dwight Way/Mabel Street intersection to provide a safer crossing for pedestrians at the existing crosswalk across Dwight Way and for bicycles traversing to/from the cycletrack and Mabel Street. Hardened centerlines consisting of low- profile mountable rubber, would be installed on Dwight Way at the uncontrolled intersection (Bonar Street) to reduce vehicle turning speeds to/from Bonar Street.

This option utilizes the existing sidewalk bulbout, on the north side of Dwight Way at Mabel Street, to protect the cycletrack from approaching westbound vehicles; this configuration also reduces shifting of lanes on Dwight Way. It preserves the curbside planter area alongside the north side of Dwight Way, which the adjacent homeowner expressed interest in maintaining, and retains on-street parking to the extent feasible along the south side of Dwight Way by paving over its curbside planter area and installing a rolled curb and adding an additional on-street parking space via the removal of the AC Transit bus stop. Net on-street parking change: -1 (-2 along north side, +1 along south side).

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

The path of travel for northbound bicycles would be approximately colinear with the driveway for a residence along the north side of Dwight Way at the intersection of Mabel Street. This path of travel would need to be kept clear, meaning the residents would be able to use their driveway but would not be able to park a passenger vehicle on the roadway. City staff explored various alternatives to enable a passenger vehicle to park at this location, including one-way bicycle lanes and a shared roadway (described below), as well as shortening the proposed cycletrack. The latter alternative is problematic from a safety standpoint, as eastbound bicycle riders in a shortened cycletrack would enter the Dwight Way/Mabel Street intersection outside of the eastbound drivers’ direct line of sight, thereby increasing the risk of a collision between vehicles and bicycles. Also, northbound bicycle riders on Mabel Street would enter the shortened cycletrack at a skewed angle, which would introduce a risk of collision with a parked vehicle and a difficult entry into the cycletrack; this would also make the cycletrack vulnerable to closure if a larger or improperly parked vehicle is too close to the eastern end of the cycletrack.

A roadway diverter could be analyzed at a later date after traffic patterns have been established, which would prohibit vehicles from entering Bonar Street from Dwight Way and would enhance bicyclist safety when entering and existing the two-way cycletrack at Bonar Street.

City staff recognize that this is the best bikeway option for improving safety, providing a key link in the Citywide bicycle network that is in accordance with the intent of the Bicycle Plan, and balancing the roadway needs and desires of residents, vehicular travelers, pedestrians, and bicycles.
 Along south side of Dwight Way. In contrast, cycletrack on the south side of Dwight Way would necessitate all-way stop controls at the Dwight Way/Bonar Street intersection, instead of the Dwight Way/Mabel Street intersection, to allow bikes to cross Dwight Way more safely to/from the cycletrack. This would involve construction of new curb ramps, a crosswalk, and a bicycle crossing at this intersection. However, potential crosswalk locations appear to conflict with or would be too close in proximity to existing driveways, which would likely result in detailed and costly crosswalk design and construction.

A cycletrack on the south side of Dwight Way would also shift lanes on Dwight Way toward the north, likely requiring removal of the existing

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

sidewalk bulbout on the north side of Dwight, and remove and pave over the curbside planter area along the north side of Dwight Way in order to maintain on-street parking along this side of the roadway. Net on-street parking change: -1 (0 along north side, -1 along south side).

2. One-way bicycle lanes. This concept would install five-feet wide, one-way bicycle lanes along the north and south sides of Dwight Way. For equitable distribution of traffic controls, westbound traffic on Dwight Way would stop at Mabel Street, whereas eastbound traffic on Dwight Way would stop at Bonar Street. This would leave one uncontrolled direction of traffic on Dwight Way at each of the intersections’ bikeway crossings and at the existing crosswalk, which would remain, which could result in collisions between vehicles and pedestrians/bicycles, as the latter may not realize that both directions of traffic along Dwight Way would not be stop controlled. This option would also eliminate almost all of the on-street parking along both the north and south sides of Dwight Way, which is prohibitive to the residents’ parking needs.

City staff attempted to develop this option to allow on-street parking at (a) the eastern end of the westbound bicycle lane, in front of the driveway for the residence along the north side of Dwight Way) and (b) the western end of the eastbound bicycle lane along the south side of Dwight Way. Analysis indicates that preserving these on-street areas is possible, but would result in a skewed approach angle for bicycles into the cycletrack, which would lead bicycles to make a longer angled crossing across Dwight Way and expose bicyclists to increased risk of collision with a moving vehicle, as well as a risk of collision with a parked vehicle, especially if the vehicle is parked too close to the bike lane.

Two variations of this option were considered:
 Protected via a concrete buffer. The bicycle lanes would be separated from the vehicle lanes via approximately 1.5-foot wide concrete buffers. This would provide protection for bicycles in the lanes but would leave insufficient width to allow the City’s mechanical street sweepers from cleaning the gutters, thereby increasing the risk of clogged storm drains and associated maintenance issues. Net on- street parking change: -1 to -2, depending on length of bike lanes and turn movements of bicycles (-2 along north side, 0 to -1 along south side).
 Unprotected via pavement markings. To allow street sweepers to clean the gutters, the bicycle lanes could be constructed without concrete buffers and instead implement pavement markings as visual buffers. This would introduce real and perceived safety issues to

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

bicyclists, as vehicle speeds on Dwight Way are significantly higher than bicycle speeds, and an unprotected bikeway runs counter to the Bicycle Plan’s goal to provide low-stress bikeway crossings. Net on- street parking change: -1 to -2, depending on length of bike lanes and turn movements of bicycles (-2 along north side, 0 to -1 along south side).

3. Shared roadway. This option would require bicycle and vehicles to share the existing lanes on Dwight Way, and the roadway would be signed and marked with arrows to emphasize the shared use. The same distribution of traffic controls as the previous option for one-way bicycle lanes would apply:
westbound traffic on Dwight Way would stop at Mabel Street, whereas eastbound traffic on Dwight Way would stop at Bonar Street. It follows that bicycles and pedestrians crossing Dwight Way would encounter similar challenges as described above (namely, real and perceived safety issues to bicyclists), although these challenges may be greater because bicycles would not have a dedicated lane on Dwight Way to separate them from faster- moving vehicles. On-street parking would increase under this option, as the existing parking would remain and the existing eastbound bus stop would be removed. Net on-street parking change: +1 (0 along north side, +1 along south side).

All of the studied options were found to be in compliance with the operational requirements for the Berkeley Fire Department.

Construction Documents
City staff combined the separate design packages for the Parker Street to Addison Street Bikeway and University West Bus Stop Improvements work into a single construction bid package, titled Southwest Berkeley Bikeway and Bus Stop Improvements Project, to more easily administer and oversee the construction contract and to streamline the grant reimbursement process, especially since the work of both packages is funded by one AHSC grant under a single set of schedule deadlines.

Environmental Documentation
City staff have determined that the Project is statutorily exempt from the California Environmental Quality Act (CEQA), as per the State of California Public Resources Code, Division 13 Environmental Quality, Chapter 2.6 General, §21080.25, under the following exemptions:
 (b)(1) Pedestrian and bicycle facilities that improve safety, access, or mobility, including new facilities, within the public right-of-way,  (b)(2) Projects that improve customer information and wayfinding for transit riders, bicyclists, or pedestrians within the public right-of-way, and

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

 (b)(3) Transit prioritization projects.
“Transit prioritization projects” include signal and sign changes and transit stop access and safety improvements including the installation of transit bulbs. Public Resources Code §21080.25(a)(11)(A & E).

Upon Council’s adoption of a resolution approving this Project, City staff will file a Notice of Exemption with the Office of Planning and Research and the Alameda County Clerk as per California Public Resources Code §21080.25(h).

Project Schedule
The City’s agreement with SAHA stipulates that the City must be reimbursed for all grant-funded expenditures by June 30, 2026. Because the Project closeout and grant reimbursement process typically takes several months, the City estimates that construction activities should be complete by the end of January 2026 to meet the deadline. The Project construction includes the purchase of items that typically have relatively long manufacturing times, including traffic signal poles and equipment and bus shelters, which can take approximately ½ year to procure.

Project construction is estimated to have an 8-month duration, which is scheduled to begin in spring 2025 after a construction contract is executed and conclude in late 2025/early 2026.

For this reason, it is imperative that Council issue a resolution covering the items in this report during the November 19, 2024 Council meeting.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
The purpose of the AHSC program is to reduce greenhouse gas emissions in California, and all of the projects identified for the funding will help accomplish that goal. Increasing cycling and walking in the City would help the City achieve the Berkeley Climate Action Plan greenhouse gas emission reduction targets of 80% below year 2000 levels by 2050.

The Climate Action Plan states that, in order to meet these targets, “Transportation modes such as public transit, walking and bicycling must become the primary means of fulfilling our mobility needs.”

RATIONALE FOR RECOMMENDATION
Approving the plans and specifications, accepting the bid of Sposeto Engineering, Inc. as the lowest responsive and responsible bidder, and authorizing the City Manager to execute a contract with Sposeto Engineering, Inc., all for the Southwest Berkeley Bikeway and Bus Stop Improvements Project, will keep the Project on schedule in accordance with the grant funding agreement.

Contract: Sposeto Engineering, Inc.for CONSENT CALENDAR Southwest Berkeley Bikeway and Bus Stop Improvements Project November 19, 2024

ALTERNATIVE ACTIONS CONSIDERED
If City Council chose not to take the proposed actions at this time and instead defer the item to a future Council agenda, such an action could increase the risk of the City defaulting on its obligations to deliver this Project and liability for a potential loss of grant funding for SAHA’s Grinnell Apartments affordable housing development if the Project is not completed on time.

CONTACT PERSON
Wahid Amiri, Deputy Director, Public Works, 510-981-6396 Hamid Mostowfi, Transportation Manager, 510-981-6403
Kenneth Jung, Supervising Civil Engineer, Public Works, 510-981-7028 Attachments:
1: Resolution
2: Site Map
3: Abstract of Bids
4: Project Plans: Parker Street to Addison Street Bikeway (Specification No. 24-11640- C) & University West Bus Stop Improvements (Specification No. 24-11666-C)

RESOLUTION NO. ##,###-N.S.

CONTRACT: SPOSETO ENGINEERING, INC., FOR SOUTHWEST BERKELEY

BIKEWAY AND BUS STOP IMPROVEMENTS PROJECT
WHEREAS, the Southwest Berkeley Bikeway and Bus Stop Improvements Project consists of two subprojects:
 Parker Street to Addison Street Bikeway (Specification No. 24-11640-C) and  University West Bus Stop Improvements (Specification No. 24-11666-C); and WHEREAS, the work of the Parker Street to Addison Street Bikeway fills a key gap in the existing Citywide bicycle network by connecting San Pablo Park to Strawberry Creek Park and the adjacent West Street Pathway and begins a new bikeway along Parker Street toward the existing Ninth Street Bicycle Boulevard, as per the Berkeley Bicycle Plan; and
WHEREAS, the work of the University West Bus Stop Improvements makes improvements at the University Avenue/Bonar Street and University Avenue/Acton Street intersections to create safer pedestrian crossings as per the Berkeley Pedestrian Plan and to improve bus stop amenities and service reliability as per the City General Plan; and
WHEREAS, the City has received $1.422 million in grant funding for these transportation improvements from the State of California Affordable Housing and Sustainability Communities program through a side agreement with Satellite Affordable Housing Associates, the developer of the Grinnell Apartments affordable housing development at 2527 San Pablo Avenue, which stipulates that the City must complete these transportation improvements and receive final grant reimbursement by June 30, 2026 or be liable for the loss of funding for the City’s work and the $11.7 million grant funding for the Grinnell Apartments; and
WHEREAS, with the support of an engineering and design consultant team, City staff identified conceptual design options, obtained public input on, and analyzed the conceptual design options; selected recommended conceptual designs that balanced comments and concerns from the public with project goals; completed the final design documents in the form of plans and specifications for the Project which were prepared in substantial conformance with the selected conceptual designs; and WHEREAS, with the support of an environmental consultant, City staff have determined that the Project is statutorily exempt from the California Environmental Quality Act (CEQA), pursuant to the State of California Public Resources Code, Division 13 Environmental Quality, Chapter 2.6 General, §21080.25(b)(1), (b)(2), and (b)(3); and

WHEREAS, the Cit y has neither the staff nor the equ ipment needed to undertake the construction of this Project; and
WHEREAS, on September 12, 202 4, the Cit y released an Invitatio n for Bids (Specification Nos. 24-11640-C & 24-11666-C) for the work of this Project; and WHEREAS, Sposeto Engine ering, Inc., was fou nd to be the low est responsi ve and responsible bidder; and
WHEREAS, funds are available in the FY 2025 and planned FY 2026 budgets in the State Capital Grants (Fund 306), Alameda County Measure BB Local Streets & Roads (Fund 134), Alameda County Measure BB Bicycle and Pedestrian (Fund 135), and State Transportation Tax (Fund 127); and
WHEREAS, no other fun ding is requ ired, and no oth er project from the Publ ic Works Department will be delayed due to this expenditure.

NOW THEREFORE, BE IT RESOLVED by
the Council of the City of Berke ley that
Plans and Specificati ons for the Southwest Be rkeley Bikeway and Bus Stop Improvements Project (Specification Nos. 24-11640-C & 24-11666-C) are approved.

BE IT FURTHER RESOLVED that the Council of the City of Berkeley accepts the bid of Contractor as the lowest responsive and responsible bidder.

BE IT FURTHER RESOLVED that the Council of the City of Berkeley authorizes the City Manager to execute a contract and any amendments, extensions, and/or change orders until completion of the Project in accordance with the approved Plans and Specifications with Sposeto Engineering, Inc., in an amount not to exceed $2,390,000, which includes a 10 percent contingency for unforeseen circumstances. A record signature copy of said agreement and any amendments will be on file in the Office of the City Clerk.

ATTACHMENT 2

SITE MAP

SOUTHWEST BERKELEY BIKEWAY AND BUS STOP IMPROVEMENTS

Office of the City Manager
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Paul Buddenhagen, City Manager
Submitted by: Terrance Davis, Director, Public Works Department Subject: Contract: Telegraph-Channing Parking Garage Restroom Renovation & Elevator Improvements Project

RECOMMENDATION
Adopt a Resolution:

1. Approving plans and specifications for Telegraph-Channing Parking Garage Restroom Renovation & Elevator Improvements Project (Project), Specification No. 22-11535-C; and

2. Accepting the bid of W.E. Lyons Construction Co. as the lowest, responsive and responsible bidder; and

3. Authorizing the City Manager to execute a contract and any amendments, extensions, or other change orders until the Project is completed in accordance with the approved plans and specifications for an amount not to exceed $2,413,689, which includes a contingency of $314,829.

FISCAL IMPACTS OF RECOMMENDATION
Funding for this project is available in the Fiscal Year 2025 budget in the Capital Improvement, Off-Street Parking, and Measure T1 Funds.

Low bid by W.E. Lyons................................................................$2,098,860 20% Contingency $419,772
Total Construction Cost NTE $2,518,632
Fiscal Year 2025 Funding:
 Capital Improvement Fund: …………………………… $2,143,260
 Off-Street Parking Fund …………………………………. $155,372
 Measure T1 Phase 2 Fund:..………………………….… $220,000

16

Contract: W.E. Lyons Construction Co. CONSENT CALENDAR
for Telegraph-Channing Parking Garage November 19, 2024 Restroom Improvements & Elevators Project

CURRENT SITUATION AND ITS EFFECTS
The Project was advertised for bids on July 9, 2024, and opened on August 15, 2024.

The City received four (4) bids ranging from $2,006,880 to $3,200,000, not including bid alternates. The lowest responsive and responsible bidder was determined to be W.E.

Lyons Construction Co. Staff recommends that a construction contract for the Project be awarded to W.E. Lyons Construction Co.

The Telegraph-Channing Parking Garage is located between Durant Ave and Channing Way, adjacent to Telegraph Avenue. It consists of ground-floor retail space and five (5) parking decks above. Two public restrooms and two tenant restrooms are located on the ground floor, and two elevators service the parking levels.

The restroom finishes are at the end of their useful life, and the public-facing restrooms are regularly subject to vandalism. The existing elevators and related equipment were evaluated and recommended for extensive modernization and replacement. Additional lighting, signage, and path of travel upgrades are required to comply with current building and accessibility codes.

The Project will consist of a complete renovation of four restrooms, including new vandal- resistant fixtures, finishes, accessories, LED lighting, hardware, and signage; modernizing two elevators by installing new control systems, motors, platforms, cabs, doors, cables, safety features, and other related equipment; improvements to elevator landings including new LED lighting, bollards, and paint; and accessibility improvements to the pedestrian entrance at Channing Street.

The Project is a Strategic Plan Priority Project, advancing our goal to provide state-of- the-art, well-maintained infrastructure, amenities, and facilities.

BACKGROUND
The Telegraph-Channing Parking Garage (originally the Sather Gate Garage) was constructed in 1970 to serve the commercial and campus parking needs in the area south of UC Berkeley’s Sather Gate.

Public Works engaged the services of an architectural consultant to begin the design of improvements to the elevator and associated electrical and mechanical equipment at the Telegraph-Channing Parking Garage in May 2020. The elevator improvements project was originally to be funded by the Off-Street Parking Fund. The design for the elevator project was placed on hold in April 2021 following decreased off-street parking revenue during the COVID-19 pandemic.

Separately, Staff engaged the architectural consultant to provide design for the renovation of the public and tenant restrooms in October 2021. The restroom renovation project is a Measure T1 Phase 2 project.

Contract: W.E. Lyons Construction Co. CONSENT CALENDAR
for Telegraph-Channing Parking Garage November 19, 2024 Restroom Improvements & Elevators Project

Capital Improvement Funding was later identified for the elevator modernization project.

As the timelines of the two projects were now in sync, the decision was made to combine the elevator improvements and restroom renovations into one project. Strategically combining the projects reduces costs by streamlining project management, minimizing scheduling conflicts, and leads to greater efficiency and competitive pricing during construction by consolidating resources. The design of the combined project was authorized to continue in October 2022, and construction documents were completed and advertised for public bid in July 2024.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
New plumbing fixtures in the restrooms will reduce water use, and new LED lighting fixtures will reduce energy use and increase energy efficiency. There are no anticipated negative environmental effects of this action.

RATIONALE FOR RECOMMENDATION
Contracted services are required for this project as the City does not have the in-house expertise to complete this specialized work.

ALTERNATIVE ACTIONS CONSIDERED
None. The City can elect not to construct the project; however, deferring the work will lead to continued deterioration of the restroom facilities and elevators.

CONTACT PERSON
Wahid Amiri, Deputy Director, Department of Public Works (510) 981-6396 Ronald Nevels, Manager of Engineering, Department of Public Works (510) 981-6439 Elmar Kapfer, Supervising Civil Engineer, Department of Public Works (510) 981-6435 Attachments:
1: Resolution
2: Abstract of Bids

RESOLUTION NO. ##,###-N.S.

CONTRACT: W.E. LYONS CONSTRUCTION CO. FOR THE TELEGRAPH-

CHANNING PARKING GARAGE RESTROOM RENOVATION AND ELEVATOR

IMPROVEMENTS PROJECT
WHEREAS, the project consists of restroom renovations, elevator modernization, and accessibility improvements; and
WHEREAS, the City has neither the staff labor nor the equipment necessary to undertake this project; and
WHEREAS, an invitation for bids (Plans and Specifications No. 22-11535-C) was duly advertised, and W.E. Lyons Construction Co. was determined to be the lowest responsive and responsible bidder; and
WHEREAS, funds are programmed in the FY 2025 budget through Capital Improvement, Off-Street Parking, and Measure T1 Phase 2 Funds.

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that Plans and Specifications No. 21-11535-C for the Telegraph-Channing Parking Garage Restroom Renovation and Elevator Improvements Project are approved, and W.E. Lyons Construction Co. is determined to be the lowest responsive and responsible bidder.

BE IT FURTHER RESOLVED that the Council of the City of Berkeley authorizes the City Manager to execute a contract and any amendments, extensions or change orders until completion of the project in accordance with the approved plans and specifications with W.E. Lyons Construction Co. for the Telegraph-Channing Parking Garage Restroom Renovation and Elevator Improvements Project at 2431 Channing Way, in an amount not to exceed $2,518,632, which includes a contingency of $419,772. A record signature copy of the agreement and any amendments will be on file in the Office of the City Clerk.

Office of the City Manager
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov/

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Paul Buddenhagen, City Manager
Submitted by: Terrance Davis, Director, Public Works
Subject: Contract No. 10413C Amendment: LAZ Parking LLC for Managing City- Owned Off-Street Parking Facilities

RECOMMENDATION
Adopt a Resolution authorizing the City Manager to execute an amendment to Contract No. 10413C with LAZ Parking, LLC, a parking management company, to provide management services for the Telegraph Channing, Oxford, and Center Street garages, extending the term to December 31, 2026 and increasing the contract amount by $6,073,974 for a total not-to-exceed amount of $22,326,349.

FISCAL IMPACTS OF RECOMMENDATION
Funding for the duration of the contract amendment is available in the FY 2025 Parking program budget and programmed into baseline budgets for FY 2025 and FY 2026.

Funding in FY 2025 and FY 2026 for this contract is subject to appropriation in each fiscal year in the Off-Street Parking Fund (Fund 627).

Current contract amount $16,252,375
Amendment amount......................................................................... $6,073,974 Total NTE $22,326,349
Amendment Costs by Facility
Parking Facility
Total
Amendment
Cost
FY 2025 Cost
(6-months)
FY 2026 Cost
(12-months)
FY 2027 Cost
(6-months)
Average
Monthly Cost
Center Street Garage $3,373,024 $818,308 $1,686,512 $868,204 $140,542.66 Oxford Garage $589,945 $143,412 $294,973 $151,561 $24,581.04 Telegraph Channing
Garage $2,111,005 $512,269 $1,055,503 $543,234 $87,958.54

CURRENT SITUATION AND ITS EFFECTS
LAZ Parking provides management, custodial, security, and limited maintenance services for the Center Street, Oxford and Telegraph Channing parking garages.

These activities include all aspects of the day-to-day operation of the three facilities

17

Contract No. 10413C Amendment: LAZ Parking LLC for Managing CONSENT CALENDAR City-Owned Off-Street Parking Facilities November 19, 2024

including hiring staff to operate the garages for up to 17-hours per day, opening and closing the garages, conducting bookkeeping and record keeping, facilitating purchases of essential supplies like paper tickets as well as other replacement parts such as gate arms and hiring security and janitorial staff. The most recent contract amendment with LAZ was authorized on November 15, 2022, extending the term to the current end date of December 31, 2024. Additionally, funding was provided to continue parking garage operations at limited capacity during the pandemic and to ramp up to full capacity as the economy reopened.

The recommended contract amendment is necessary to continue daily operations, including several projects related to the aging Telegraph Channing Garage, such as pigeon mitigation and stairwell upgrades. (The Telegraph Channing Garage is now older than the Center Street Garage when it was demolished.) Additionally, the amendment allows sufficient time and resources for staff to issue a Request for Proposals (RFP) for the next multi-year parking management contract.

Managing City-owned off-street parking facilities is a Strategic Plan Priority Project, advancing our goals to provide state-of-the-art, well-maintained infrastructure, amenities, and to facilities and foster a dynamic, sustainable, and locally-based economy.

BACKGROUND
In September 2016, after a competitive Request for Proposals process, the City entered into a five-year contract with LAZ Parking, LLC to provide parking management, operations, and associated services for the City’s three off-street parking facilities and the Berkeley Way Lot while the Center Street Garage was being reconstructed. The City is amending this contract because the Parking Services Manager position, which oversees garage operations, has been vacant since July 2023; the City is recruiting to fill this position by spring 2025. When the new Parking Services Manager is hired, the City will initiate a new RFP process for contracting with a vendor to manage City-owned off-street parking facilities (garages). Staff expects this process to start in fall 2025 and conclude before June 2026, allowing for a transition in line with the conclusion of this contract amendment on December 31, 2026.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
As part of the goBerkeley demand-responsive parking program, the City’s three parking garages play an important role in improving parking availability and reducing congestion in the Downtown Berkeley and Southside/Telegraph areas. Garages also serve as a City hub for Electric Vehicle (EV) charging stations, with 69 charging ports across the three garages.

RATIONALE FOR RECOMMENDATION
As the City of Berkeley ended its pandemic emergency declaration, the parking garages have seen increasing demand. Additional funding is necessary to continue

Contract No. 10413C Amendment: LAZ Parking LLC for Managing CONSENT CALENDAR City-Owned Off-Street Parking Facilities November 19, 2024

facility operations until a successor garage management company can be identified.

Staff will prepare a new RFP that reflects post-pandemic garage operation trends.

Typically, this task takes at least a year including contracting procedures.

LAZ Parking has performed well as the City’s parking garage management company. In an industry with few large parking garage operating companies, LAZ Parking was the lowest bidder in the previous solicitations for garage management services in Berkeley.

ALTERNATIVE ACTIONS CONSIDERED
If this contract amendment is not approved, funding will be unavailable for operating the City’s parking garages beginning in January 2025. The City is unable to conduct daily operations on its own. Closing these facilities would result in loss of revenue, risking the fiscal health of programs and bond payments reliant on this funding. Putting the bond payments at fiscal risk would jeopardize the financial stability of Berkeley’s government.

CONTACT PERSON
Wahid Amiri, Deputy Director, Public Works, 510-981-6396 Hamid Mostowfi, Transportation Manager, Public Works, 510-981-6403 Noah Budnick, Acting Parking Services Manager, Public Works, 510-981-7069 Attachments:
1: Resolution

RESOLUTION NO. ##,###-N.S.

CONTRACT NO. 10413C AMENDMENT: LAZ PARKING LLC FOR MANAGING CITY-

OWNED OFF-STREET PARKING FACILITIES
WHEREAS, the City of Berkeley owns and operates three off-street public parking facilities; and
WHEREAS, the City of Berkeley is currently under contract with LAZ Parking, LLC to operate and maintain these facilities under an “all inclusive” scope of services; and WHEREAS, Contract No. 10413 was executed October 1, 2016 as authorized by Resolution No. 67,689-N.S., was amended on August 1, 2017 to include additional Payment Card Industry (PCI) Compliance information, and amended again on November 15, 2022 to add budget for continued operations and extend the term to December 31, 2024; and
WHEREAS, extending the contract term until December 31, 2026 will allow the City adequate time and funding for LAZ Parking to continue to operate the City’s off-street parking facilities, and for staff to conduct an RFP process for a possible successor management company; and
WHEREAS, funding for the duration of the contract amendment is available in the FY 2025 Parking program budget and programmed into baseline budgets for FY 2025 and FY 2026. Funding in FY 2025 and FY 2026 for this contract is subject to appropriation in each fiscal year in the Off-Street Parking Fund (Fund 627).

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that the City Manager is authorized to execute an amendment to Contract No. 10413C with LAZ Parking, LLC to provide management services for Center Street Garage, Oxford Garage and Telegraph Channing Garage, increasing the contract amount by $6,073,974, for a total not-to-exceed of $22,326,349, and extending the contract term to December 31, 2026.

Office of the City Manager
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov/

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Paul Buddenhagen, City Manager
Submitted by: Terrance Davis, Director, Department of Public Works Subject: Contract No. 31900036 Amendment: On-Call Civil Engineering Services, Bellecci & Associates, Inc.

RECOMMENDATION
Adopt a Resolution authorizing the City Manager to execute an amendment to Contract No. 31900036 with Bellecci & Associates, Inc. for on-call civil engineering services, increasing the contract amount by $750,000 for a total not-to-exceed the amount of $1,750,000 and extending the term of the contract to June 30, 2026.

FISCAL IMPACTS OF RECOMMENDATION
Funding for this contract amendment is subject to appropriation in the Fiscal Year (FY) 2025 Capital Improvement Fund (501) and the Sanitary Sewer Fund (611) budgets.

Funding for FY 2026 is subject to appropriation in the future capital budgets based on the department’s needs for civil engineering services.

CURRENT SITUATION AND ITS EFFECTS
The City requires additional civil engineering support to advance capital improvement programs and establish current City design standards. These services are crucial for designing streets, storm drains, green infrastructure, sidewalks, retaining walls, and managing construction for these projects.

The contract with Bellecci & Associates, Inc., was established in FY 2019 with an original amount of $1,000,000 and a current term through December 31, 2024. Approximately 97% of the contract funds have been utilized for design, bidding, and construction support for sanitary sewer and retaining wall projects and a preliminary evaluation of the City of Berkeley's Standard Details.

The proposed amendment would increase the contract by $750,000, bringing the new total not-to-exceed amount to $1,750,000, and extend the term through June 30, 2026.

This contract supports the Strategic Plan goal of providing state-of-the-art, well- maintained infrastructure, amenities, and facilities.

18

Contract Amendments: Contract No. 31900036 CONSENT CALENDAR Bellecci & Associates, Inc. for On-Call Civil Engineering Services November 19, 2024

BACKGROUND
The Engineering Division of the Public Works Department is experiencing significantly increased workloads resulting from staff vacancies, deferred maintenance, ongoing capital projects, T1 projects, and a ramp-up in the City's paving program. To address these challenges, the City engages civil engineering consultants to supplement City staff on project design and management, provide expertise for specialized projects, and offer on-call professional services without the need for additional permanent staff.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
There are no negative environmental effects of this action. This contract will help ensure the successful completion of capital improvement projects, including complete street projects that facilitate walking and cycling as alternatives to driving and green infrastructure projects. These projects will contribute to reducing peak storm runoff flows, removing pollutants from storm runoff, increasing green space, and reducing the urban heat island effect.

RATIONALE FOR RECOMMENDATION
Bellecci & Associates, Inc. has expertise in civil engineering and can support the City in various capital projects. Staff are working on multiple projects, and regulatory agency permits under strict timelines. This contract amendment will enable timely progress on critical infrastructure improvements.

ALTERNATIVE ACTIONS CONSIDERED
The council could choose not to amend this contract, which would delay the progress of planned capital improvement projects and reduce the department’s level of service.

CONTACT PERSON
Wahid Amiri, Deputy Director, (510) 981-6396
Ronald A. Nevels, Manager of Engineering, (510) 981-6439 Attachments:
1: Resolution – Amendment to Contract with Bellecci & Associates, Inc.

RESOLUTION NO. ##,###-N.S.

CONTRACT NO. 31900036 AMENDMENT: BELLECCI & ASSOCIATES INC. FOR ON-

CALL CIVIL ENGINEERING SERVICES
WHEREAS, on July 24, 2018, by Resolution No. 68,559-N.S., the City Council authorized Contract No. 31900036 with Bellecci & Associates, Inc. for on-call civil engineering services, in an amount not to exceed $1,000,000 for a three-year period expiring June 30, 2021; and
WHEREAS, the contract term is extended through December 31, 2024; and WHEREAS, the City lacks sufficient in-house resources to meet the current volume of civil engineering service needs; and
WHEREAS, the City requires ongoing on-call civil engineering services for various Public Works projects, including multiple projects generated by the passage of the Measure T1 Infrastructure & Facilities GO Bond; and
WHEREAS, funding is available in the FY 2025 budget in the Sanitary Sewer Fund and Capital Improvement Fund, with future funding to be appropriated as needed.

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that the City Manager is authorized to execute an amendment to Contract No. 31900036 with Bellecci & Associates, Inc. for on-call civil engineering services, increasing the amount by $750,000 for a total not to exceed $1,750,000 and extending the term of the contract to June 30, 2026. A record signature copy of said contract and any amendments will be on file in the Office of the City Clerk.

Office of the City Manager
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov/

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Paul Buddenhagen, City Manager
Submitted by: Terrance Davis, Director, Public Works
Subject: Contract No. 31900162 Amendment: Pride Industries, Inc. Contract for Custodial Services

RECOMMENDATION
Adopt a Resolution authorizing the City Manager to execute an amendment to Contract No. 31900162 with Pride Industries, Inc. for citywide custodial services to: Approve additional appropriations related for performance of this contract and coverage of the Living Wage Ordinance in the amount of $1,100,000 for a total not-to-exceed amount of $6,225,735 which includes updated service rates for Year 6 of the agreement.

FISCAL IMPACTS OF RECOMMENDATION
Funds are available in individual departmental budgets. The increase in the not-to- exceed amount is required to complete the current contract year due to an additional year of service being added to the agreement, an additional annual Living Wage Ordinance increase and increases in service rates by the contractor. Funding from Public Works is available in Funds 636 and 673 for FY2025 via appropriation through the FY2025 Annual Appropriations Ordinance.

CURRENT SITUATION AND ITS EFFECTS
Pride Industries, Inc. provides citywide custodial services to multiple City departments.

These departments include Public Works; Parks, Recreation and Waterfront; Planning and Development; Health, Housing and Community Services; Police; and Fire. Services are currently performed at approximately 21 City-owned and leased locations.

Departments each pay for these services through their own funds.

The original Pride contract was set to expire on June 30, 2024, but was extended to June 30, 2025 to allow City staff to complete a Request for Proposals (RFP) for citywide custodial services, that will be released this Fall. To ensure that there are no delays or interruptions in service, an amendment is needed so departments can pay for custodial services until the RFP can be completed and a new custodial agreement can be executed before the end of FY2025.

19

Contract No. 31900162 Amendment: Pride Industries Contract for Custodial Services CONSENT CALENDAR November 19, 2024

This supports the City’s Strategic Plan Goal to provide state-of-the-art, well-maintained infrastructure, amenities, and facilities.

BACKGROUND
Pride has been servicing the City since July 1st, 2019. They provide routine daily and weekly custodial services at several locations. Pride also provides special one-time and emergency custodial services as requested by City Departments.

On September 14, 2018 the City released Request for Proposal number 18-11213-C for citywide custodial services. The solicitation was released for 53 days and five proposals were submitted and received. Upon review by City staff, Pride Industries, Inc. was selected as having the most responsive proposal to meet the specifications of the RFP and was thusly awarded Contract No. 31900162. Pride also currently provides custodial services for the City’s Library under Contract No. 31900159.

On March 12, 2019 Council approved Resolution 68,789-N.S. for the execution of a contract with Pride for citywide custodial services with a not-to-exceed amount of $6,414,880 for the total lifetime of the agreement. The initial three-year contract, Contract No. 31900162, was executed with a not-to-exceed amount of $3,725,735.

Contract No. 31900162 included two optional extension years beyond the three-year contract term and the City excised those options. The contract specifies service rates for each location served under the full five years of the agreement. However, the contract did not specify rates for any year past Year 5. Over the years, the locations serviced by Pride and level of custodial services has changed due to Departments’ needs changing, Departments moving staff and services to new locations, and the COVID-19 pandemic necessitating changes in service.

In March, 26, 2024 Council approved an amendment to Contract No. 31900162 to increase the not-to-exceed amount to $5,125,735. The increase was requested to provide adequate funding to complete the fifth year of the contract and to cover increases in costs due to changes to services after ramping back up post-pandemic, annual Living Wage Ordinance increases and inflation.

Management of Contract No. 31900162 was originally performed by the City’s Finance Department, but management was transferred to Public Works in June 2024. Public Works staff assessed the potential timeframe for the City to complete a solicitation for citywide custodial services and found that due the complexity of custodial services needed within the City, a solicitation could not be completed until the second half of FY2025. As such, the City formally extended the agreement to June 30, 2025.

As part of this contract amendment, Year 6 rates will be formally adopted as they were not originally specified in the contract. Additional funding is also needed to cover increased costs due to increases in the City’s Living Wage Ordinance, which were not originally built into the contract. After negotiations with Pride and discussions with the

Contract No. 31900162 Amendment: Pride Industries Contract for Custodial Services CONSENT CALENDAR November 19, 2024

Finance Department and City Attorney’s Office, Public Works accepted updated services rates for Year 6 and payment for the estimated $162,000 in Living Wage Ordinance costs not previously factored into the contract.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
Pride Industries complies with the City’s environmental requirements and uses cleaning chemicals that are the least toxic on the market, and/or rated as environmentally friendly, where feasible. The paper products supplied by Pride meet or exceed the recycled content percentage required by the City.

RATIONALE FOR RECOMMENDATION
Authorizing this amendment will allow the City to continue receiving custodial services without interruption. Pride services many City-owned and leased locations across multiple Departments. To provide the City adequate time to complete a formal solicitation for custodial services, a vendor for custodial services is needed in the interim. Pride has a current contract with the City and has familiarity with facilities.

ALTERNATIVE ACTIONS CONSIDERED
If not amended, the City will be unable to pay for custodial services through its current agreement with Pride for FY2025. Service delays and interruptions would occur. This would negatively impact not only the health and morale of staff working at those facilities, but also residents who visit and use these facilities. Bringing in another contractor on a temporary basis would lead to increased costs for the City, both in terms of service costs, and time spent by Departments to transitioning to a different vendor.

CONTACT PERSON
Tucker Brofft, Senior Management Analyst, Public Works, 510-981-5375 Peni Basalusalu, Deputy Director, Public Works, 510-981-6485 Joy Brown, Operations Manager, Public Works, 510-981-6629 Attachment:
1: Resolution

RESOLUTION NO. ##,###-N.S.

CONTRACT NO. 31900162 AMENDMENT: PRIDE INDUSTRIES, INC. CONTRACT

FOR CUSTODIAL SERVICES
WHEREAS, City Council approved Resolution 68,789-N.S. on March 12, 2019 approving the contract for custodial services with Pride Industries, as a result of Request for Proposals #18-11213-C; and
WHEREAS, City departments require ongoing custodial services without a significant interruption in services, and have departmental budgets to fund these services; and WHEREAS, the pandemic led to dramatic changes in scopes of services at several city locations, many of which will continue as revised; and
WHEREAS, the original contract with Pride did not specify services for any year of service past five years; and
WHEREAS, City Council approved Resolution 71,248-N.S. on March 26, 2024 approving amendment to the contract to amend the contract with Pride Industries in the amount of $1,400,000 for a not-to-exceed amount of $5,125,735; and WHEREAS, funds are available within individual departmental budgets, including Funds 636 and 673 for Public Works for FY2025 via appropriation through the FY2025 Annual Appropriations Ordinance.

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley authorizing the City Manager to execute an amendment to Contract No. 31900162 with Pride Industries, Inc. for citywide custodial services to adopt service rates for Year 6 of the contractual agreement and additional appropriations related to performance of this contract and coverage of the Living Wage Ordinance costs in the amount of $1,100,000 for a total not-to-exceed amount of $6,225,735.

Office of the City Manager
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov/

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Paul Buddenhagen, City Manager
Submitted by: Terrance Davis, Director, Public Works
Subject: Contract No. 32000179 Amendment: Allied Universal Security Service for Citywide Unarmed Security Services

RECOMMENDATION
Adopt a Resolution authorizing the City Manager to execute an amendment to Contract No. 32000179 with Allied Universal Security Service (formerly First Alarm Security & Patrol, Inc.) for citywide unarmed security services in the amount of $900,000 for a new total not to exceed $4,450,000 and extend the contract through February 28, 2026.

FISCAL IMPACTS OF RECOMMENDATION
Funds are available in individual departmental budgets. The increase in the not-to- exceed amount is required to complete an additional year of service being added to the agreement and increases in service rates for this additional year. Additional spending authority in the amount of $900,000 is estimated as needed to cover anticipated expenditures.

CURRENT SITUATION AND ITS EFFECTS
Allied Universal Security Service provides citywide unarmed security services throughout the City at several facilities. Allied Universal has security guards stationed at City Hall located at 2180 Milvia, the Corporation Yard located at 1326 Allston Way, the Transfer Station located at 1201 2nd Street, at 1947 Center Street, the Adult Mental Health Clinic located at 2640 Martin Luther King Jr. Way, and at several other locations with the City. Allied Universal’s work protects both City staff and residents at these locations. Departments each pay for these services through their own funds.

The City’s current contract with Allied Universal is set to expire on February 28, 2025.

However, to allow City staff time to complete a proper solicitation for security services, the contract needs to be extended into FY2026. The increase in the not to exceed amount is also needed to cover this additional year of service and anticipated increases.

This supports the City’s Strategic Plan Goal to create a resilient, safe, connected, and prepared City.

20

Contract Amendment: Allied Universal Security CONSENT CALENDAR Service for Citywide Unarmed Security Services November 19, 2024

BACKGROUND
Unarmed security guard services are contracted by the City to perform routine patrol and access control duties at various City facilities on a regularly scheduled basis and occasionally on an ad-hoc basis.

On April 4, 2019, General Services released RFP Specification No. 19-11316-C; of which ultimately a contract did not result due to unexpected staff turnover at the time of the solicitation and the extended time that elapsed before interim staffing was assigned.

A second solicitation was released as RFP Specification No. 19-11316-C-Reissued on July 22, 2019. The reissued solicitation closed on August 29, 2019, and garnered six proposal responses. At the conclusion of this process, Allied Universal Security Service (formerly First Alarm Security & Patrol, Inc.) was selected as the most responsive respondent with the highest level of qualification and best value to meet the City’s needs and was awarded a Contract No. 32000179 with a total not to exceed of $3,550,000. The Library, while a co-participant in the RFP, entered into a separate contract with Allied for their facilities.

Management of Contract No. 31900162 was originally performed by the City’s Finance Department, but management was transferred to Public Works in June 2024.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
There are no identifiable environmental effects or opportunities.

RATIONALE FOR RECOMMENDATION
Allied Universal is the City’s current contractor for citywide unarmed security services.

Extending the City’s current agreement is the most cost-efficient method to ensure there are no security service interruptions. This extension will also allow staff time to complete the solicitation process for security services by the end of 2025.

ALTERNATIVE ACTIONS CONSIDERED
None. The City does not have trained staff to perform security services where such services are required; therefore funding service under the existing contract is needed.

CONTACT PERSON
Peni Basalusalu, Deputy Director, Public Works, 510-981-6485 Joy Brown, Operations Manager, Public Works, 510-981-6629 Tucker Brofft, Senior Management Analyst, Public Works, 510-981-5375 Attachment:
1: Resolution

RESOLUTION NO. ##,###-N.S.

CONTRACT AMENDMENT: ALLIED UNIVERSAL SECURITY SERVICE FOR

CITYWIDE UNARMED SECURITY SERVICES
WHEREAS, unarmed security guard services are contracted by the City to perform routine patrol and access control duties at several City locations on a regularly scheduled basis and occasionally on an ad-hoc basis; and
WHEREAS, the City does not have qualified available staff to perform security services; and
WHEREAS, on July 22, 2019, the City released RFP Specification No. 19-11316-C- Reissued for unarmed security services. At the conclusion of this process, Allied Universal Security Service (formerly First Alarm Security & Patrol, Inc.) was selected as the most responsive proposer with the highest level of qualification and best value to meet the City’s needs and was awarded Contract No. 32000179; and WHEREAS, Contract No. 32000179 is set to expire on February 28, 2025; and WHEREAS, to accommodate the contract’s extension and before a new solicitation is completed, additional spending authority in the amount of $900,000 is needed to cover anticipated expenditures; and
WHEREAS, funds are available within individual departmental budgets for the extended contractual term.

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that the City Manager is authorized to amend Contract No. 32000179 with Allied Universal Security Service (formerly First Alarm Security & Patrol, Inc.) for citywide unarmed security services in the amount of $900,000 for a new total not-to-exceed amount of $4,450,000 and extend the contract through February 28, 2026.

Office of the City Manager
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov/

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Paul Buddenhagen, City Manager
Submitted by: Terrance Davis, Director of Public Works
Subject: Contract No. 32300177 Amendment: Baker Tilly for On-Call Professional Development services

RECOMMENDATION
Adopt a Resolution authorizing the City Manager to execute an amendment to Contract No. 32300177 with Baker Tilly, increasing the contract by $100,000 for consulting services in a total amount not to exceed $125,000, with a contract end date of December 31, 2027.

FISCAL IMPACTS OF RECOMMENDATION
The initial resources for the contract are available in the FY2025 baseline budget as follows:

Clean Storm $50,000
Parking Meter $5,000
Zero Waste $20,000
Equipment
Maintenance
$20,000
Streetlight $5,000
Additional funding will be appropriated in future years. This is an on-call contract and costs will be incurred when services are performed.

CURRENT SITUATION AND ITS EFFECTS
The Public Works Department has continued to experienced high vacancy rates over the last several years. While increased hiring has lowered the vacancy rate in some Divisions, the Transportation Division is still working to expand staffing capacity and lower its vacancy rate to manage workload. In line with the Employer of Choice Initiative, Public Works remains focused on retaining staff, expanding internal leadership, team building capacity, and ensuring existing staff have the resources needed to deliver programs, projects and services.

21

PW-Baker Tilley Contract Amendment CONSENT CALENDAR
November 19, 2024

To address these needs, the Department has a contract with Baker Tilly for On-Call Professional Development Services. These services include:
 Interviewing and coaching staff
 Providing interactive executive and professional development coaching  Creating work plan drafts with goals and timelines for staff to finalize with their supervisors.

Expanding this agreement to include organizational assessment services will ensure that adequate training and professional development continues and enables staff to focus on service delivery for Berkeley residents.

BACKGROUND
Baker Tilly entered into a contract with the City’s Public Works Department on May 25, 2023 in the amount of $25,000 for On-Call Professional services. The services provided under this agreement are key tools to assist with the retention of current and future staff.

The original contract amount was below the procurement threshold, and did not require an RFP or Council approval. However, Baker Tilly was selected through the California Multiple Award Schedule (CMAS) bid procedure. This allows the City to procure a contractor that was previously selected through the State of California bidding process.

All pricing, products and/or services offered to the State of California through this system are made available to the City. Making use of this process meets City procurement requirements, results in cost savings and expedites contractor selection.

With the addition of the $100,000 requested in this amendment, this contract now requires Council approval to continue work.

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
None.

RATIONALE FOR RECOMMENDATION
Additional training and support of current staff will assist with retention and ensure effective service delivery for Berkeley residents.

ALTERNATIVE ACTIONS CONSIDERED
None. Consistent staff is the most cost-effective solution to maintaining a regular workflow and completion of projects for the City in a timely manner.

CONTACT PERSON
Wahid Amiri, Deputy Director of Public Works, (510) 981-6396 Attachments:
1: Resolution

RESOLUTION NO. ##,###-N.S.

CONTRACT: BAKER TILLY CONTRACT AMENDMENT FOR ON-CALL

PROFESSIONAL DEVELOPMENT COACHING SERVICES
WHEREAS, there has been an ongoing need for professional development support services to address vacancies, retain staff and further develop staff leadership in the Department of Public Works,
WHEREAS, due to the staffing support needs, the City previously contracted Baker Tilly for On-Call Professional Development Services in the amount of $25,000 executed on May 25, 2023 to expire on December 31, 2024 contract #32300177.; and WHEREAS, the California Multiple Award Schedule (CMAS) is available to state and local governments; and
WHEREAS, The California Department of General Service Procurement Cooperative Division determined Baker Tilly’s bid pricing to be fair and reasonable and awarded CMAS Contract No.PS20375.

WHEREAS, due to Baker Tilly’s critical support, the Department of Public Works would like to extend these same On-Call services and increase this contract by an additional $100,000 and extend the expiration date to December 31, 2027.

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that the City Manager is authorized to amend Contract No. 32300177 with Baker Tilly to be increased to add up to a total not to exceed $125,000 and extend the contract to December 31, 2027.

BE IT FURTHER RESOLVED the City Manager, or their designee, is hereby authorized to execute all original or amended documents or agreements to effectuate this action; a signed copy of said documents, agreements and any amendments will be kept on file in the Office of City Clerk.

Mental Health Commission
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: [email protected] Website: https://berkeleyca.gov/

CONSENT CALENDAR
November 19, 2024
To: Honorable Mayor and Members of the City Council
From: Mental Health Commission
Submitted by: Monica Jones, Chairperson, Mental Health Commission Subject: Appointment of Maria Sol and Ashley (Jiahao) Gu to the Mental Health Commission

RECOMMENDATION
Adopt two resolutions approving the recommendation for appointment of Maria Sol and Ashley (Jiahao) Gu to the Mental Health Commission both as representatives of the Special Interest Category, Consumer. Maria Sol’s 3-year term will begin on November 20, 2024 and end on November 19, 2027. Ashley Gu’s 3-year term will begin on November 20, 2024 and end on November 19, 2027.

FISCAL IMPACTS OF RECOMMENDATION
None.

CURRENT SITUATION AND ITS EFFECTS
The Mental Health Commission is authorized to be composed of thirteen members.

However, there are presently seven vacancies on the Commission. The Mental Health Commission is actively seeking candidates with the ability to fulfill the state law duties for Commissioners, including reviewing and evaluating the community’s needs, services, facilities, and special problems.

Approval of the recommended action will fill two of the existing vacancies and allow the Commission to move one step closer to having a full and diverse complement of commissioners to review and evaluate the community’s mental health needs, resources, and programs.

BACKGROUND
California State law requires that appointments to the Mental Health Commission meet specific categories, who may serve up to nine years consecutively. Maria Sol meets the category of special interest, consumer. The general public interest category may include anyone who has an interest in and some knowledge of mental health services. The special public interest category includes direct consumers of public mental health services and family members of consumers, which together must constitute at least fifty

22

Appointment of Maria Sol and Ashley Gu to the MHC CONSENT CALENDAR November 19, 2024

percent or nine of the commission seats. Direct consumers and family members shall each constitute at least 20% of the commission membership.

The Mental Health Commission recommends Maria Sol as a representative of the special interest category, consumer appointment on the Mental Health Commission for the city of Berkeley for a three-year term. Maria has studied and majored in psychology and sociology providing services in the community, actively involved in human welfare, homeless prevention, mitigation and advocacy. Based on her opinion, the most important mental health issues in Berkeley are neglect, lack of support, prejudice and disparagement, alienation and trauma. She wants to help people see their potential and value, and connect with them by listening and providing real support.

Maria shares that she has personal direct lived experience. She has engaged with folks from coast to coast and has worked in state hospitals, shelters, programs for battered women, and focuses on advocacy for “maximum health and well-being.” The Mental Health Commission passed the following motions at the September 26, 2024 meeting:

Interview and vote on nomination of Maria Sol to the Mental Health Commission:

M/S/C (Prichett, Opton) Motion that we move to recommend Maria Sol to the city council for the mental health commission.

PASSED
Ayes: Jones, Krishnan, Prichett, Opton, Turner Noes: None; Abstentions:

None; Absent: Lunaparra
The Mental Health Commission recommends Ashley (Jiahao) Gu as a representative of the special interest category, consumer appointment on the Mental Health Commission for the city of Berkeley for a three-year term. Ashley is a first-generation Chinese immigrant who has witnessed and experienced the process of not only seeking mental health services but also overcoming her community’s sociocultural stigma around the subject. She is currently enrolled at UC Berkeley and has been a chapter leader and advisory board member for Bring Change 2 Mind, a nonprofit focused on youth mental health stigmatization, and a counselor for the California Youth Crisis Hotline, and she hopes to continue participating in this work through supporting the efforts of the Commission.

From Ashley’s perspective, the most important mental health issue in Berkeley is serving the unique needs of everyone on the broad socioeconomic and cultural spectrum. Another important issue she shared is that, within mental health services in the City of Berkeley, there is an apparent lack of streamlined access to urgent non-emergency mental health care. At UC Berkeley, for example, many students

Appointment of Maria Sol and Ashley Gu to the MHC CONSENT CALENDAR November 19, 2024

report that it’s difficult to book same day or next day appointments, an obstacle that once again discourages community members from seeking help.

Ashley’s recommendation about what to do about issue in Berkeley is to start conducting data analysis and field studies within the city to identify different demographic groups, their levels of access to mental health services, their attitudes towards these services, and their preferred method of support in times of crisis. This would allow the city to create tailored advertisements towards these groups and to implement culturally sensitive tools and related training. Additionally, data points like these can help the city in pinpointing the specific issues hindering each socioeconomic group’s access to care, from which the process for accessing care can be streamlined and resources to explain the process can be created.

Interview and vote on nomination of Ashley (Jiahao) Gu to the Mental Health Commission
M/S/C (Prichett, Turner) Motion that we move to recommend Ashley (Jiahao) Gu to the city council for the mental health commission.

PASSED
Ayes: Jones, Krishnan, Prichett, Opton, Turner Noes: None; Abstentions:

None; Absent: Lunaparra

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
There are no identifiable environmental effects or opportunities associated with the subject of this report.

RATIONALE FOR RECOMMENDATION
Approval of the recommended action will allow the Mental Health Commission to move one step closer to having a full and diverse complement of commissioners to review and evaluate the community’s mental health needs, resources, and programs.

ALTERNATIVE ACTIONS CONSIDERED
None.

CITY MANAGER
The City Manager concurs with the content and recommendations of the Commission’s Report.

CONTACT PERSON
Jamie Works-Wright, Commission Secretary, HHCS, 510-981-7721 Attachments:
1: Resolution – Appointing Maria Sol
2: Resolution – Appointing Ashley (Jiahao) Gu

RESOLUTION NO. ##,###-N.S.

APPOINTMENT OF MARIA SOL TO THE MENTAL HEALTH COMMISSION WHEREAS, membership of the Mental Health Commission is composed of thirteen appointments by the City Council as a whole, including one appointment by the Mayor (or designee), six special public interest appointments, and four general public interest appointments; and
WHEREAS, with the ongoing implementation of the Mental Health Services Act, the City of Berkeley will need to have a full complement of diverse appointees to the Commission to review and evaluate the community's mental health needs, resources, and programs and to fulfill its mandate; and
WHEREAS, Maria Sol has
studied and majored in psychology and sociology providing services in the community offering her lived experience; and WHEREAS, The Mental Health Commission at its September 26, 2024 meeting recommended the appointment of Maria Sol.

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that the Council appoints Maria Sol as a representative of the Special Interest category, to complete her first term ending November 18, 2027.

RESOLUTION NO. ##,###-N.S.

APPOINTMENT OF ASHLEY GU TO THE MENTAL HEALTH COMMISSION WHEREAS, membership of the Mental Health Commission is composed of thirteen appointments by the City Council as a whole, including one appointment by the Mayor (or designee), six special public interest appointments, and four general public interest appointments; and
WHEREAS, with the ongoing implementation of the Mental Health Services Act, the City of Berkeley will need to have a full complement of diverse appointees to the Commission to review and evaluate the community's mental health needs, resources, and programs and to fulfill its mandate; and
WHEREAS, Ashley Gu
is a first-generation Chinese immigrant who has lived
experienced as a consumer and currently enrolled at UC Berkeley; and WHEREAS, The Mental Health Commission at its September 26, 2024 meeting recommended the appointment of Ashley Gu.

NOW THEREFORE, BE IT RESOLVED by the Council of the City of Berkeley that the Council appoints Maria Sol as a representative of the Special Interest category, to complete her first term ending November 18, 2027.

Office of the Mayor
2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7100 ● TDD: (510) 981-6903 ● Fax: (510) 981-7199 E-Mail: [email protected]

CONSENT CALENDAR
November 19, 2024
To: Honorable Members of the Berkeley City Council
From: Mayor Jesse Arreguín and Councilmember Sophie Hahn (Authors) Subject: Exploring the Formation of Joint Powers Authority (JPA) or other entity to Publicly Finance the Development of a Hospital to Meet Regional Healthcare Needs

RECOMMENDATION

1. Direct the City Manager and City Attorney to explore establishing legal and financial structures, such as a Joint Powers Authority (JPA) or Hospital District, with relevant East Bay jurisdictions, to facilitate public financing for a full service public acute and emergency care hospital serving Berkeley and the greater East Bay.

2. Authorize the City Manager and City Attorney to engage staff or consultants as needed, and submit further budget requests if additional resources are required.

BACKGROUND
In 2016, Sutter Health announced its intention to close Alta Bates hospital, the only full- service acute and emergency care hospital between Berkeley and the northernmost communities of Contra Costa County, by 2030. Alta Bates has a capacity of 347 beds, and is the third largest general acute care facility in the region. Its service area includes almost 850,000 residents, of whom 44% are people of color and 36% are below 200% of the federal poverty level.

On July 12, 2016, City Council passed Resolution No, 67,615–N.S, opposing Sutter’s plans to close the hospital. The Resolution further resolved that the Mayor, City Council and City Departments pledged to cooperate fully to facilitate this process (Attachment 1). The Mayor’s Office convened the Alta Bates Regional Task Force composed of officials from Alameda and Contra Costa Counties, and the cities of Alameda, Albany, El Cerrito, Emeryville, Oakland, San Pablo and Richmond, as a venue to share information and explore policy alternatives.

Subsequently, a formal request was sent to Sutter Health on February 7, 2019

23

2 requesting that Sutter provide a plan, in writing, for the retrofitting/rebuild of Alta Bates Hospital or share their future plans for the property. To date, Sutter has not provided such a plan to the City Council or the public and has not indicated in any forum that it plans to continue operating Alta Bates as a full service acute and emergency care hospital after the 2030 deadline.

According to the City’s 2018 Health Status Report, significant health disparities persist in Berkeley, particularly impacting the African American community. Despite comprising only 8% of the population, African Americans accounted for nearly 30% of the Years of Potential Life Lost (YPLL), indicating a higher rate of premature death compared to other racial/ethnic groups. This disparity extends to various health conditions: African Americans were 2.3 times more likely to die prematurely from any condition compared to Whites and faced inequitably high rates of hospitalization due to uncontrolled diabetes and its long-term complications. Moreover, the rate of hospitalization due to hypertension among African Americans sharply increased, being over five times that of the total population.

These troubling health trends, coupled with the potential closure of Alta Bates hospital, could further strain the healthcare system, exacerbating the challenges faced by vulnerable populations in Berkeley and intensifying the need for comprehensive and accessible healthcare solutions across the city.

In December 2018, a Rapid Health Impact Assessment Report (RHIA) was commissioned by the Task Force and delivered by a research team at the UC Berkeley Institute of Urban and Regional Development, led by professor Jason Corburn. The RHIA report identified potential health impacts of the closure of Alta Bates. With the hospital serving as a regional hub for pregnancy and birthing, there will be reduced high quality prenatal, birthing & neonatal care accessible to Berkeley and other East Bay residents. Closure will disproportionately impact people of color and low-income/ uninsured residents, many of whom are already at a higher risk of having health complications. Emergency departments in hospitals throughout the region will see increased crowding, leading to longer wait times, longer travel times, and placing additional strains on ambulances, negatively impacting both the Berkeley Fire and Police Departments. Closure also places the entire I-80 corridor at additional risk in the event of a disaster such as an earthquake, wildfire - or pandemic, with victims having less access to emergency services.

In addition to these disparate impacts across the region, the report identified a particularly acute impact to Berkeley’s elderly and student populations. Approximately, 13% of the population in the Alta Bates Hospital Service Area is over the age of 65, with an additional 12% between the ages of 55-64. Notably, in three Berkeley ZIP codes (94705, 94707, and 94708), the elderly population (over 65) constitutes 20-30% of the

3 residents, indicating a significant portion of the population that might require more healthcare services, particularly in the context of emergency services and age-related health issues. Moreover, UC Berkeley students rely heavily on Alta Bates services, with an estimated 4,000 emergency visits per day. Student health and mental health would be impacted by the loss of Alta Bates, where between 2,500-3,000 students per year are referred to from the student health center (Tang Center).

While securing the healthcare needs of Berkeley residents and understanding and addressing the impacts of closure of Alta Bates have been topics of interest and concern to the City Council for many years, evidenced by resolutions, letters, and studies, the COVID pandemic paused progress at a critical moment - and put enormous stress on health care facilities region-wide, including Alta Bates, which heroically cared for (and continues to care for) victims of this unprecedented pandemic. With the Pandemic now largely under control - and 2030 just six years away - the need to pick up the pace to understand and explore options for the people of Berkeley - and in neighboring communities - to have their healthcare needs met is more urgent than ever.

This year, the Mayor and City Council continued their advocacy to ensure healthcare needs are met. Mayor Arreguín and Councilmember Hahn presented the findings of the 2018 Rapid Health Impact Assessment Report at meetings of the City Councils of Richmond and Albany and did outreach to other nearby jurisdictions to ensure neighboring jurisdictions are educated and aware of the potential impacts of Alta Bates’ closure. Each of these jurisdictions expressed their enthusiastic support and appreciation for Berkeley’s advocacy efforts, as well as an interest in joining together in future efforts to retain or otherwise obtain access to a full service acute and emergency care hospital serving our communities.

In February 2024, the City Council allocated $300,000 to support the City Attorney's office in engaging technical and legal experts to develop strategies to meet the healthcare needs of Berkeley and the region in the event of Alta Bates' closure. Initial research identified the potential for Berkeley to collaborate with neighboring jurisdictions to publicly finance the construction of a new public hospital to serve the East Bay. (See Attachment 4).

The purpose of this item is to direct staff to continue this work, conducting the necessary financial, technical and other relevant analyses to assess the viability of this approach, or to consider other approaches. This action will provide explicit Council direction for the City Attorney and City Manager to work together on an accelerated schedule to bring this exploration to the next step. Any further formal action, such as authorizing additional funding or formally establishing a partnership of any kind, would still require Council approval.

4 FINANCIAL IMPLICATIONS
Staff Time

ENVIRONMENTAL SUSTAINABILITY AND CLIMATE IMPACTS
Not Applicable

CONTACT PERSON
Mayor Jesse Arreguín 510-981-7100
Councilmember Sophie Hahn 510-981-7150
Attachments:

1. Resolution 67,615

2. City of Berkeley 2018 Health Status Summary Report

3. 2018 Rapid Health Impact Assessment: Proposed Closure of Alta Bates Campus

4. Memorandum of Findings: Briefing on Berkeley Hospital Financing Options, Manatt (August 23, 2024)

Report
2018
Health
Status
City of Berkeley

SUMMARY

ACKNOWLEDGEMENTS
We wish to acknowledge the many persons who contributed their time, expertise, and wisdom to inform this report.

The assistance has been invaluable. We thank the City Manager, Dee Williams-Ridley, the City Council, Health Housing and Community Services (HHCS) Director Paul Buddenhagen, and HHCS staff for their support and dedication to the City’s health.

This report was produced by the City of Berkeley
Public Health Div ision:

Lisa B. Hernandez, MD, MPH, Health Officer
J
osé A. Ducos, MD, MPH, Manager Vital Statistics
and Epidemiology
Alv
an Quamina, JD, PhD, MPH, Health Services Supervisor
Rebecca L. Fisher, MPH, MA, Epidemiologist
Public Health Division Students and Interns:

Michael Huynh, MPH
Heather Jones, MPH
Victoria Le
Victoria Mercado, MPH
Catherine Nguyen, MPH
J
ennifer Tan
Key Contributors:

Laura Schroeder, MPP
Essence Fisher-Hobson, MS
Reviewers and Contributors:

Alison Roberts, Ana Weidenfeld, Ann Song, Cheryl Ford,
Dechen Tsering, Essence Fisher-Hobson, JoAnn Evangelista, Jocelyn De Sena, Josie Emunah, Katherine Brown,
Kelly Wallace, Kim Cardoso, Laura Schroeder, Lisa Sterner, Marcia Brown-Machen, Marty Lynch, Patrice Paul,
Rikki Moreno, Robert Benjamin, Sandra Hunter, Suzanne Ridel, T
anya Bustamante, Vicki Alexander, Victoria Lopez
T o obtain additional copies of this report, or to make suggestions, please contact:

City of Berkeley Public Health Division
1947 Center Street, 2nd Floor
Berkeley, CA 94704
Phone: 510-981-5300; TTY: 981-6903
Website: http://www.ci.berkeley.ca.us/publichealth/reports/reports.html Email: [email protected]

CITY OF BERKELEY LEADERSHIP
City of Berkeley City Council
City Mayor, Jesse Arreguin,
Councilmember Linda Maio, District 1
Councilmember Cheryl Davila, District 2
Councilmember Ben Bartlett, District 3
Councilmember Kate Harrison, District 4
Councilmember Sophie Hahn, District 5
Councilmember Susan Wengraf, District 6
Councilmember Kriss Worthington, District 7
Councilmember Lori Droste, District 8
Berkeley City Manager, Dee Williams-Ridley
Health, Housing & Community Services
Leadership
Paul Buddenhagen, Department Director
Kelly Wallace, Deputy Director
Tanya Bustamante, Aging Services
Manuel Ramirez, Environmental Health
Kristen Lee, Housing and Community Services
Steve Grolnic-McClurg, Mental Health
Leah Talley, Public Health
Lisa B. Hernandez, Public Health
Cover photos: Berkeley Unified School District,
Nancy Rubin-Berkeleyside, Annie Burke
T oomey Design

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
1 INTRODUCTION
The City of Berkeley is a prosperous, innovative, and thriving community. Our city has considerable wealth, high levels of educational attainment, and a rich culture that all contribute to a healthy community. Despite overall good health,
Berkeley is not a city where all people are living long and healthy lives and are achieving the highest possible level of health. In Berkeley, African Americans and other people of color die prematurely and are more likely than White people to experience a wide variety of adverse health conditions throughout their lives.

Achieving optimal health for all requires that everyone has access to resources and environments that support
health and wellness. Higher incidence of disease is linked to neighborhoods that have been historically under-
resourced and overexposed to unhealthy conditions. These neighborhoods have more people living in poverty and more people of color than surrounding neighborhoods. A truly healthy Berkeley depends on achieving and maintaining
optimal health and wellness for all people regardless of an individual’s or group’s position in society. Health inequities among racial and ethnic groups are striking and extend across a number of indicators. These health inequities are neither new nor unique to Berkeley—nevertheless, they are unjust and unacceptable. The conditions in which we are born, grow, live, work and age, broadly known as the social determinants of health, greatly influence how well and how long we live. T o aggressively address the health disparities we see in this report requires that we also address the underlying social, economic, and environmental inequities that perpetuate them.

Berkeley is well positioned to realize greater health equity.

Our community is known for its political and social activism.

Our residents are passionate about creating healthier
communities. Our leaders have a long standing commitment to achieving health equity and have been at the forefront of innovative health programs and policies. We are one of three cities in the state of California that has its own Public Health Jurisdiction. This distinction enables public health services to be focused on and dedicated to a discreet population. While the challenges we face should not be underestimated, through strategic collaboration, a unified vision, and broad community engagement we can achieve our mission of optimal health and wellness for all.

The Health Status Report is written by the Public Health Division of the Department of Health, Housing and Community Services and is released periodically to provide a picture of the health status of people who live in Berkeley. The report has three key objectives:
•
Monitor health concerns impacting the City with a focus on health disparities and social determinants of health; •
Show trends and changes in health over time;
• Guide our Public Health work and support community
partners in shaping and responding to policy and other
factors influencing Berkeley’s health and quality of life.

This report will help the Public Health Division define goals and objectives for improving Berkeley’s health. It is also designed to spark community conversations, spur collaboration and inform decision making throughout Berkeley.

PUBLIC HEALTH

VISION AND MISSION
Vision: Healthy people in healthy communities.

Mission: T o achieve and maintain optimal health
and well-being for all people in Berkeley. We do
this by working in partnership with our diverse
communities to: promote healthy behaviors and
environments, prevent illness and injury, protect
against disease and other emerging health threats,
eliminate health inequities, and advocate for social
and environmental justice.

DEPARTMENT OF HEALTH,

HOUSING, & COMMUNITY SERVICES

MISSION AND VISION
Vision: A vibrant and healthy Berkeley for all
Mission: The Department of Health, Housing,
& Community Services’ mission is to enhance
community life and support health and wellness for
all. We are committed to social and environmental
justice and to promoting equity in health, housing,
and economic opportunity. We collaborate with
community partners to build a vibrant and healthy
Berkeley.

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
2 SOCIAL DETERMINANTS OF HEALTH
Addressing the social determinants of health continues to be a key objective of the Public Health Division. Research has shown that health is dependent largely on conditions that are not related to medical care. In fact, about 80% of our health is influenced by the environments around us which include social, economic factors, and every day behaviors. Conditions such as poverty, homelessness, shifting federal and local policies, changing City demographics, gentrification, and the subsequent rise in the cost of housing all have profound impacts on community health. In many of these areas, the Public Health Division works collaboratively with other departments, and with divisions in the City of Berkeley’s Department of Health, Housing and Community Services. For example, Public Health staff are working on a multi-departmental group formulating the regulatory environment for newly legal adult use marijuana, which has serious public health impacts.

An important, continuing trend seen in the 2018 Health
Status Report is the steady and significant shift in the City’s demographics. Compared to the 2010 Census, the African American population has decreased from approximately 10% to 7% of the population, while other racial/ethnic groups have remained relatively stable. The phenomenon is not unique to Berkeley, but is a regional trend that is evidence of displacement caused by gentrification. Displacement disrupts access to education, employment, health care, and healthy neighborhood resources. Residents forced to move may face longer commutes to work or school, leading to increased stress, loss of income, job loss or greater school dropout rates. Displaced residents may have trouble obtaining medical records, prescriptions, and affordable health care services. Displacement can also mean relocation to neighborhoods with fewer health-promoting resources, such as high quality jobs, healthy food options, accessible public transit, and safe and walkable streets.

Socioeconomic status is one of the most powerful predictors of disease, injury, and mortality. In Berkeley, African Americans have lower income than any other ethnic/racial group. For every dollar a white family earns, an African American family earns 28 cents. This income inequality paired with unemployment or under employment can increase stress levels, make it difficult to find safe and affordable housing, and lower educational prospects. Research demonstrates that poverty is the single greatest threat to children’s well-being. Children living in poverty are at significantly higher risk for poor health and development.

In Berkeley, 10% of all children under the age of 18 live in poverty.

Notably, 29% of African American children live in poverty, which is seven times the poverty rate for white children, and two to three times the rate of any other racial group.

Additionally, homelessness impacts the health of the entire community. Berkeley has the second highest number of
homeless people among all Alameda County cities, second only to Oakland. Berkeley’s homeless population accounts for 17% of the homeless people in Alameda County. Given that Berkeley makes up only 7% of the population of Alameda County, it is home to a disproportionate number of people experiencing homelessness. Poor health conditions among people who are homeless are frequently co-occurring with a mix of psychiatric, substance use, and social challenges.

Exposure to high stress, unhealthy or dangerous environments, and food insecurity worsens overall health and often results in visits to emergency rooms and hospitalization. Nationally, individuals experiencing homelessness are three to four times more likely to die prematurely than their housed counterparts, and experience an average life expectancy as low as 41 years. Far too often, those experiencing homelessness are people of color.

African Americans make up less than 8% of Berkeley’s general population, but are 50% of the homeless population.

Berkeley Unified School District

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
3 KEY THEMES IN 2018 HEALTH STATUS REPORT
KEY THEMES IN 2018 HEALTH STATUS REPORT
Three key themes can be found in the Health Status Report and will continue to guide the work of the Public Health Division:
• Inequities in Health. Sinc
e 1999, the Berkeley Public Health Division has been
at the forefront of breaking down data to uncover hidden inequities in health. It is only through examining data by characteristics such as race, ethnicity, gender, age, income, neighborhood, immigration status and other qualities that we can see a true and full picture of health. The Berkeley Public Health Division is committed to monitoring health indicators by relevant, available demographic characteristics and investigating the status of health equity in our community. We will be thoughtful, intentional, and strategic in the development of programing to address these inequalities.
•
Importance of Prevention. P
revention is a continuum and extends from deterring
diseases and behaviors that foster disease to slowing the onset and severity of illness when it does arise. A focus on prevention includes focusing on upstream factors those that are largely outside of an individual’s control and promoting conditions that support good health.
•
Emerging Health Threats. The health landsc
ape in Berkeley is not static but
evolves, and new threats can emerge on both a global and local scale. Infectious disease such as tuberculosis, sexually transmitted infections, and diseases once considered under control such as pertussis, continue to be a significant source of illness in Berkeley. These threats require constant monitoring and a responsive public health system. New health threats can emerge from a variety of directions:
from the rise in antibiotic resistant bacteria, to new risks from climate change and global connectedness, to the health impacts caused by changing federal and local policies. Additionally, public health systems across the country are responding in various ways to the complex and inter-related social, economic and environmental inequities that are connected to poor health.

Nancy Rubin, Berkeleyside Berkeleyside Nancy Rubin, Berkeleyside Berkeley Unified School District

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
4 HEALTH INEQUITIES IN BERKELEY
Chapter 1:

Sociodemographic
Characteristics &
Social Determinants
of Health
Chapter 2:

Pregnancy & Birth
Chapter 3:

Child & Adolescent
Health
Chapter 4:

Adult Health
Chapter 5:

Life Expectancy
& Mortality
Families headed by a
Whit
e householder
earn 3.4 times
more than African
American families,

1.9 times more than
Latino families, and

1.4 times more than
Asian families.

The risk of an
African American
mother having a
LBW baby is 2.5
times higher than
the risk for White
mothers.

African American
children (under 18)
are 7 times more
likely, Latino children
are 5 times more
likely, and Asian
children are 2 times
more likely than
White children to
live in poverty.

African Americans
are 3 times more
likely than Whites to
be hospitalized due
to coronary heart
disease.

African Americans
are 2.3 times more
likely to die in a
given year from any
condition compared
to Whites.

The proportion of
families living in
poverty is 8 times
higher among
African American
families, 5 times
higher among Latino
families and 3 times
higher among Asian
families, compared
to White families.

The risk of an
African American
mother having a
premature baby is
2 times higher than
the risk for White
mothers.

African American
high school students
are 1.4 times more
likely than White
students to drop out
of high school.

African Americans
are 34 times more
likely than Whites to
be hospitalized due
to hypertension.

African Americans
are 2.0 times more
likely than Whites to
die of cardiovascular
disease.

African Americans
are 2.8 times less
likely, Latinos are 1.6
times less likely and
Asian children are 1.1
times less likely than
Whites to have a
bachelor’s degree or
higher.

The teen birth rate
among African
Americans is 9 times
higher, and among
Latinas is 3 times
higher than the rate
among White teens.

The asthma
hospitalization
rates for children
under 5 for African
American children is
10 times higher, and
for Latino children
is 2.8 times higher
than the rate among
White children.

African American
women are 1.5
times more likely
than Whites to be
diagnosed with
breast cancer.

African Americans
are 1.8 times more
likely than Whites to
die of cancer.

HEALTH INEQUITIES IN BERKELEY

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
5 HOW TO READ THIS REPORT

HOW TO READ THIS REPORT
ORGANIZATION: This report is organized along the life course, from conception thr
ough death. Health throughout the stages of life is influenced by an individual’s social and physical environment, health and experience in the prior stage. The report begins with a description of Berkeley’s population. Subsequent chapters give information about health in Berkeley during the major life stages which include pregnancy and birth, childhood and adolescence, adulthood, and finally the end of life. Each chapter starts with a description of the significance of that life stage, a list of key findings, the importance of the health indicator and its current status in Berkeley.

COMPARISONS: O
ne way to evaluate the health of our City is to compare ourselves to others. Each time Berkeley meets one of the Healthy People 2020 (HP2020) goals, that goal is reported. By doing this, it allows us to compare the data on how Berkeley is doing relative to national health benchmarks. We also compare Berkeley with Alameda County and the State. We report how different groups of Berkeley residents compare with each other: by age, gender, income, race/ethnicity, education, and place of residence. Finally, we show how health indicators in Berkeley have changed over time. Such comparisons allow us to assess how Berkeley is faring relative to national goals, our past, and our neighbors.

PROGRAM HIGHLIGHTS: The City’s Public Health Division works with partners to improve health in Berkeley. Each chapter contains program highlights, describing how the City is addressing issues raised by the data in that chapter. More information about these programs is available on the City’s website: https://www.cityofberkeley.info/Health_ Human_Services/Public_Health/A_to_Z_Public_Health_Services.aspx FROM THE COMMUNITY: This report contains quotes and summaries from a series of community engagement events. These events were held in 2014 and were organized in order to hear from Berkeley residents and community members about what they see as priority areas for reducing health inequities.

DATA: This report contains quantitative data about the health of the Berkeley c
ommunity. The data is as objective as possible — there may be biases related to reporting errors, incompleteness or limited by small samples. In our effort to understand what the data tell us about health in Berkeley, we look at correlations; what characteristics go along with better health or worse health? Public health programs and interventions are designed to address the likely “causal pathways” of adverse health outcomes, and are based on available evidence and best practices.

We use the latest year of data available at the time of analysis. For hospitalization and emergency department visit data, changes in the coding system were implemented in the last quarter of 2015 which made the previous years not comparable with current data. The last full year of data under the prior coding system was 2014, thus data on hospitalization and emergency department visits are only presented through 2014.

TECHNICAL NOTES:

Data Sources and Definition of Key T erms: this information is provided at the end of the report. Those interested in additional technical details are invited to contact the Public Health Division Epidemiology and Vital Statistics Unit at [email protected].

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
6 SOc IODEMO g RAPHI c cHARA c TERIS TIc S AND SOc IAL DETERMINANTS Of H EAL TH 1 CHAPTER 1: SOCIODEMOGRAPHIC

CHARACTERISTICS AND SOCIAL

DETERMINANTS OF HEALTH
The social and physical environments in which we live,
work and play greatly influence our overall health. Experts agree that health is in part determined by access to social and economic opportunities; the cleanliness of our water, food and air; availability of preventative health care and wellness programs; the nature of our social interactions and relationships; and the resources and supports
available in our schools, homes and neighborhoods. These conditions are broadly known as the social determinants of health, which this chapter explores in detail.

According to the 2011–2015 American Community
Survey, the city’s residents are 56% White, 20% Asian,
10% Latino and 7% African American. Compared to
the 2010 census, the African American population has
decreased from approximately 10% to 7%, while other
racial/ethnic groups have remained relatively stable.
1 f igure 1.2  P OPULATION DISTRIBUTION BY RACE/ETHNICITY  Berkeley, 2000–2015 Source: City of Berkeley Public Health Division, Office of Epidemiology and Vital Statistics, U.S. Census Bureau, 2000-2015

UPDATED FIGURE
Population Distribution by Race/Ethnicity, Berkeley 2000-2015 0 10
20 30
40 50
60 2000 2005 2010 2015
Percentage
White Latino API African American Other
Asian/PI
Afr. Amer.

White
Latino
Other
Source: City of Berkeley Public Health Division, Office of Epidemiology and Vital Statistics, U.S. Census Bureau, 2000–2015
non-White households are more likely to be low income.

All families and households have experienced an increase in median income during the last decade, except for
African Americans who experienced a slight decrease.

Approximately 7% of Berkeley families live below the federal poverty level. Poverty rates vary drastically by race/ ethnicity.

Compared to White families, the proportion of families living in poverty is 8 times higher among African American families, 5 times higher among Latino families and 3 times higher among Asian families. At the individual level, about 20% of all Berkeley residents live below the federal poverty level, which is strongly influenced by the large university student population in Berkeley. f igure 1.11  PER CENT OF FAMILIES AND INDIVIDUALS BELOW FEDERAL POVERTY LEVEL IN THE PAST 12 MONTHS BY RACE/ETHNICITY IN BERKELEY  2011–2015
0 5
10 15
20 25
30 35
40 Families Individuals
Percent
African American Asian Latino White Total
REPLACEMENT FIGURE Percent of Families and Individuals
below Federal Poverty Level in the Past 12 months by
Race/Ethnicity in Berkeley, 2011-2015
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2011-2015Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2011–2015 f igure 1.9  MEDIAN F AMILY AND HOUSEHOLD INCOME IN PAST 12 MONTHS (IN 2015 INFLATION-ADJUSTED DOLLARS) BY RACE/ETHNICITY IN BERKELEY  2011–2015
$-
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
Median Family Income Median Household Income
African American Asian Latino White Total
REPLACEMENT FIGURE Median Family and Household Income
in Past 12 months (in 2015 inflation-adjusted dollars) by Race/Ethnicity in Berkeley, 2011-2015
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2011-2015Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2011–2015 In Berkeley the median family income is $118,190. The
median household income is $66,237, which is influenced by the large population of low-income university students living in Berkeley. Families with a White head of household are more likely to be higher income while those headed by f igure 1.1  P OPULATION DISTRIBUTION BY RACE/ETHNICITY  Berkeley, 2000–2015 f igure 1.2  MEDIAN F AMILY AND HOUSEHOLD INCOME IN PAST 12 MONTHS (IN 2015 INFLATION-ADJUSTED DOLLARS) BY RACE/ETHNICITY IN BERKELEY  2011–2015 f igure 1.3  PER CENT OF FAMILIES AND INDIVIDUALS BELOW FEDERAL POVERTY LEVEL IN THE PAST 12 MONTHS BY RACE/ETHNICITY IN BERKELEY  2011–2015

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
7 SOc IODEMO g RAPHI c cHARA c TERIS TIc S AND SOc IAL DETERMINANTS Of H EAL TH 1 Berkeley has the second highest number of homeless
among all Alameda County cities, second only to Oakland.

Berkeley’s homeless population accounts for 17% of the
5,629 homeless people in Alameda County. Given Berkeley makes up only 7% of the population of Alameda County,
it is home to a disproportionate number of homeless.
0% 10% 20% 30% 40% 50%
Piedmont
Pleasanton
Dublin
Emeryville
Union City
Albany
Newark
San Leandro
Alameda
Unincorporated
Livermore
Hayward
Fremont
Berkeley
Oakland
% of Homeless in Alameda County
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Alameda County 2017 Homeless Point-In-Time Count
Alameda County Homeless Population Percent by City, 2017 UPDATED FIGURE 1.13
f igure 1.13  ALAMED A COUNTY HOMELESS POPULATION PERCENT BY CITY , 2017 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Alameda County 2017 Homeless Point-In-Time Count
Approximately 84% of Berkeley residents ages 25 and over attended at least some college. Over 70% of residents
have a bachelor, graduate, or professional degree,
compared with 43% in Alameda County and 31% in
California. Berkeley’s levels of education attainment are not evenly distributed. Whites and Asians have the highest rates of higher education. Latinos are the least likely to graduate from high school, and African Americans have
the lowest rate of college and professional degrees.
0 10
20 30
40 50
60 70
80 90
African American Asian Latino White
Percent
Less than high school diploma High school graduate, GED, or alternative Some college or associate's degree Bachelor's degree or higher UPDATED FIGURE Educational Attainment of Population Aged 25 Years and Older by Race/Ethnicity, Berkeley, 2011-2015 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2011-2015 f igure 1.22  EDUCA TIONAL ATTAINMENT OF POPULATION AGED 25 AND OLDER BY RACE/ETHNICITY  Berkeley, 2011–2015
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2011–2015 Berkeley Unified School DistrictNatalie Orenstein, Berkeleyside

FROM THE COMMUNITY
African American respondents noted that African
American communities and families are being
displaced because of a lack of jobs, housing and
community investments. Others noted that health
inequities are rooted in poverty, racism, inadequate
access to culturally relevant and high quality health
services, and a lack of community and economic
development in their communities.
f igure 1.4  ALAMED A COUNTY HOMELESS POPULATION PERCENT BY CITY , 2017 f igure 1.5  EDUCA TIONAL ATTAINMENT OF POPULATION AGED 25 AND OLDER BY RACE/ETHNICITY  Berkeley, 2011–2015

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
8 PRE g NAN c Y AND BIRTH2
2 Pregnancy and childbirth mark the beginning of an individual’s journey along the life course. The health conditions of pregnancy, birth, and early infancy have a profound impact on health and well-being throughout life. It is important to pay particular attention to this critical life stage when assessing the overall health status of a community.

Berkeley has excellent overall health indicators related to pregnancy and birth, and meets most HP2020 goals in these areas. There have been substantial improvements in health outcomes related to pregnancy and birth, including low birth weight (LBW), prenatal care, and teen birth. Almost 94% of pregnant Berkeley mothers of all racial/ethnic groups receive prenatal care in the first trimester, which is higher than Alameda County and California. Berkeley meets the HP2020 goal and there is no racial disparity in this indicator.

CHAPTER 2: PREGNANCY AND BIRTH
African American babies, for the first time ever recorded, met the HP2020 objective for LBW in 2008-2010 and for
prematurity in 2014–2016. However, a disparity still persists as African American babies are 2.5 times more likely to be LBW as compared to Whites and twice as likely to be born prematurely as White, Latino, or Asian babies.

Robin Kempster
f igure 2.3  PER CENT OF PREGNANT MOTHERS RECEIVING PRENATAL CARE IN 1ST TRIMESTER  Berkeley, 1990–2016
50 60
70 80
90 1001st Trimester Prenatal Care Percent
Latino
API
White
HP2020: 77.9%
African American
HP2020: 77.9%
Berkeley (2014-2016): 93.8%
Alameda County (2013): 90.6%
California (2013): 83.6%

UPDATED FIGURE
Percent of Pregnant Mothers Receiving Prenatal Care in 1st Trimester in Berkeley, 1990-2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Birth Records, 1990-2016 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Birth Records 1990–2016

BERKELEY BLACK INFANT HEALTH (BBIH)

PROGRAM
Berkeley’s BIH program aims to improve birth outcomes
and reduce health disparities affecting African American women and their babies. Through culturally affirming
group education and complementary case management,
the program works to empower African-American
mothers and their families. BBIH helps to build social
support, develop parenting and life skills, learn stress management tools, promote healthy behaviors and
relationships, and support a healthy pregnancy. In addi- tion, BBIH provides resource linkages to assist
participants in connecting with the community, social,
and health services to meet their needs.
f igure 2.1  PER CENT OF PREGNANT MOTHERS RECEIVING PRENATAL CARE IN 1ST TRIMESTER  Berkeley, 1990–2016

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
9 PRE g NAN c Y AND BIRTH 2
f igure 2.4  L OW BIRTH WEIGHT BY RACE/ETHNICITY (EXCLUDES MULTIPLE BIRTHS)  Berkeley, 1990–2016 (3-year-intervals)
0 5
10 15
20 1990-92 1993-95 1996-98 1999-01 2002-04 2005-07 2008-10 2011-13 2014-16 Percent of Low Birth Weight
White African American API Latina

UPDATED FIGURE
Low Birth Weight by Race/Ethnicity (excludes
multiple births), Berkeley, 1990-2016 (3-year intervals) HP2020: 7.8%
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Birth Records, 1990-2016 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Birth Records 1990–2016 Berkeley’s teen birth rate has been decreasing in all racial/ethnic groups over the past decade and it is at its lowest ever recorded.

Berkeley has the lowest teen birth rate of any health jurisdiction in the state. From 2004–2006 to 2014–2016, the overall teen birth rate decreased by 82%. For African Americans, the rate decreased by 76% during the same time period. In spite of this decrease, the birth rate among African American young women is higher than all other racial/ethnic groups.

Robin Kempster
Annie Burke
Robin Kempster

FROM THE COMMUNITY
“I was born and raised in Berkeley. [Berkeley Black Infant Health] has been a big impact in a lot of our lives, helping us navigate our lives.”
0 5
10 15
20 25
30 35
40 White African
American
API Latina Overall
Birth Rate per 1,000 females
2004-2006 2009-2011 2014-2016

UPDATED FIGURE
Birth Rates in Females 15 to 19 Years Old by Race/Ethnicity, Berkeley, 2004-2006, 2009-2011, 2014-2016 (3-year intervals) Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Birth Records, 1990-2016 2014-2016
Alameda County 9.6/1,000
California 17.6/1,000
f igure 2.7  BIR TH RATES IN FEMALES 15 TO 19 YEARS OLD BY RACE/ETHNICITY  Berkeley, 2004–2006, 2009–2011, 2014–2016 (3-year intervals)
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Birth Records 1990–2016 f igure 2.2  L OW BIRTH WEIGHT BY RACE/ETHNICITY (EXCLUDES MULTIPLE BIRTHS)  Berkeley, 1990–2016 (3-year-intervals)
f igure 2.3  BIR TH RATES IN FEMALES 15 TO 19 YEARS OLD BY RACE/ ETHNICITY  Berkeley, 2004–2006, 2009–2011, 2014–2016 (3-year intervals)

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
10 PRE g NAN c Y AND BIRTH2
Nancy Rubin, Berkeleyside

PUBLIC HEALTH NURSING FIELD SERVICES
Public Health Nurses (PHNs) provide quality,
confidential, community-based case management
services for families and individuals, primarily
during home visits. The focus of the program
is on Berkeley residents at highest risk for poor
health outcomes, often those with special
needs or limited access to care. These include
pregnant women, new parents and their
infants, school-aged mothers, children, elders,
disabled, and people who are homeless.

Case management services include nursing
assessments of health status and need for
medical care and other services; counseling on
diverse health related topics and supporting
healthy lifestyle choices; advocating for
better use of health care systems while linking
families to other health and social services;
assisting with enrollment in low cost medical
and dental plans; and helping families support
children’s growth and development.

FROM THE COMMUNITY
“All around, we need to care about the health and
safety for the moms in the family and especially single moms. Single moms sometimes are down and out;
they need more care. They are caring for a whole
community. You take care of her, then you are reaching
a lot of people. If she doesn’t feel safe, then a whole family will fall down.”

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
11 c HILD AND ADOLES c ENT HEALTH 3
Childhood and adolescence are important developmental
periods in the life course and health in early life is the basis for continued health over the life span. Educational foundations are established during this time, influencing future learning and employment opportunities. Personal habits of physical activity, diet, and social connections are also formed. This chapter summarizes the state of health of children and adolescents in Berkeley: practices and behaviors, use of alcohol, tobacco and other drugs, overweight and obesity, childhood immunizations, and specific health outcomes including mental health, asthma hospitalizations, injuries, and sexually transmitted diseases.

Half of the children in Berkeley belong to non-White racial and ethnic groups; the largest proportion of these is Latino. In the last decade, the percentage of children living below the poverty level has decreased for the overall Berkeley population and every racial/ethnic group except Latinos. Children in poverty are concentrated in South and West Berkeley.

The Berkeley Unified School District (BUSD) four-year high school dropout rate fell from 15.5% in the 2010–2011 school year to 10.7% for the 2015–2016 school year. Despite a decrease from

18.8% to 13.5% since 2010–2011, African Americans still have the highest drop-out rate in Berkeley.
3 CHAPTER 3: CHILD AND ADOLESCENT
HEALTH
0 5
10 15
20 25
30 35
40 All Races/
Ethnicities
African
American
Asian Latino White
Percent

2006-2010 2011-2015
Children Living Below the Poverty Level
2006-2010: N=1,745
2011-2015: N=1,425
Percent of Children 17 Years and Younger Living Below the Poverty Level by Race/Ethnicity, Berkeley, 2006-2015
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2006-2015 f igure 3.3  PER CENT OF CHILDREN 17 YEARS AND YOUNGER LIVING BELOW THE POVERTY LEVEL BY RRACE/ ETHNICITY  Berkeley, 2006–2015
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; U.S. Census, ACS 2006–2015 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Department of Education
0 5
10 15
20 25
African
Am.

Asian Latino White Overall Alameda CA
Drop Out Rate (Percentage)
2010-2011 2015-2016
Drop Out Rates, Overall and by Race/Ethnicity, Berkeley Unified School District, Alameda County, and California, 2010-2016 BUSD
f igure 3.11  DR OPOUT RATES, OVERALL AND BY RACE/ETHNICITY Berkeley Unified School District, Alameda County, and California, 2010–2016 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Department of Education 2020 VISION
Berkeley’s 2020 Vision is a city-wide collective
impact effort to achieve equity in education for
all Berkeley children from “cradle to career”. The
Berkeley community collaborates on six areas of
systemic focus to end racial disparities in education,
especially for Berkeley’s African American and Latino
children. Berkeley’s 2020 Vision strives to “move the
needle” on the following key indicators of educational
equity: Kindergarten Readiness, Third Grade Reading
Proficiency, Ninth Grade Math Proficiency, Attendance,
College and Career Readiness, and Community
Engagement. Berkeley’s 2020 Vision also includes the
Berkeley Promise, a college scholarship initiative.

FROM THE COMMUNITY
“It’s been an amazing experience to be born and raised
here in Berkeley, grow up in Berkeley Unified School
District, and to be able to work with the people that
I’ve grown up with. We’ve had children together, been
pregnant together.”
f igure 3.1  PER CENT OF CHILDREN 17 YEARS AND YOUNGER LIVING BELOW THE POVERTY LEVEL BY RACE/ETHNICITY  Berkeley, 2006–2015
f igure 3.2  DR OPOUT RATES, OVERALL AND BY RACE/ETHNICITY Berkeley Unified School District, Alameda County, and California, 2010–2016

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
12 c HILD AND ADOLES c ENT HEALTH3
Berkeley Unified School District
Over a quarter of Berkeley’s 5th and 7th grade students are overweight or obese. Berkeley has a lower proportion of 5th and 7th grade children who are overweight and obese (29.4%) compared to children in Alameda County (35.3%) but has a higher proportion compared to California (26.8%). A higher proportion of African American children are overweight
and obese in Berkeley compared to in Alameda County and California.
0 5
10 15
20 25
30 35
40 45
50 55
African Am. Asian Latino White Overall
Percentage
Berkeley Alameda Co. California
UPDATED FIGURE Percentage of Overweight and Obese Children in 5th and 7th grades by Race/Ethnicity, BUSD, Alameda County and California School Districts, 2015-2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Department of Education, FITNESSGRAM 2015-2016
f igure 3.16  PER CENTAGE OF OVERWEIGHT AND OBESE CHILDREN IN 5TH AND 7TH GRADES BY RACE/ETHNICITY  BUSD, Alameda County, and California School Districts, 2015–2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Department of Education, FITNESSGRAM 2015–2016

FROM THE COMMUNITY
“One day your kid gets bigger and you worry. Is my child healthy or is she obese?”

FROM THE COMMUNITY
“It’s really hard for kids of color (Latinas); you know, this is a predominantly white school—the white kids,
they have all kinds of privilege; their parents have been paying for tutoring for years; they have been reading
to them for years; they have so much more to start
with. I don’t understand my homework, I can’t go to my
parents for help. My mom didn’t graduate from high
school; that is why it is really frustrating when it comes to going to college, getting ahead.”

HEALTHY BERKELEY PROGRAM
Initiated in 2015, this program stemmed from
Berkeley’s historic passing of an excise tax (1
cent/oz.) on the distribution of sugar-sweetened
beverages (SSB). The program goal is to reduce the
consumption of SSB as a pathway for decreasing
the rates of T ype 2 diabetes, obesity, and tooth
decay in Berkeley. The Healthy Berkeley program
offers multi-year community agency grants for
programs designed to reduce SSB consumption
and promote healthy beverages such as tap water
in low-income communities, particularly children
and youth targeted by the beverage industry;
the Sugar-Sweetened Beverage Product Panel
of Experts (SSBPPE) Commission makes agency
funding recommendations to the City Council. The
Healthy Berkeley program collaborates with the Bay
Area Nutrition and Physical Activity Collaborative
(BANPAC), Healthy Food America, University
of California in Berkeley, and the Public Health
Institute.
f igure 3.3  PER CENTAGE OF OVERWEIGHT AND OBESE CHILDREN IN 5TH AND 7TH GRADES BY RACE/ETHNICITY  BUSD, Alameda County, and California School Districts, 2015–2016

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
13 c HILD AND ADOLES c ENT HEALTH 3
Alcohol is the most commonly used substance among BUSD
students, followed by marijuana. The use of alcohol and marijuana have remained relatively unchanged among 11th graders. Cigarette smoking, already at comparatively low levels, has continued to drop for 7th and 9th graders but fluctuated for 11th graders. There has been a drop in e-cigarette use for students at all grade levels. The percentage of BUSD students who have been drunk or high on school property has steadily decreased for all grade levels over the past six years. 0 5
10 15
20 25
30 35
40 45
50 2010 2012 2014 2016 2010 2012 2014 2016 2010 2012 2014 2016 2014 2016 Percentage
Grade 7
Grade 9
Grade 11
Smoke Marijuana Smoke Cigarette Use E-cigaretteDrink Alcohol (Full Glass) Cigarette, Alcohol, and Marijuana Use in Past 30 Days: 7th, 9th, and 11th Graders, Berkeley Unified School District (BUSD) 2010-2016 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Healthy Kids Survey (CHKS) 2010-2016
f igure 3.20  AL COHOL, TOBACCO, AND MARIJUANA USE IN PAST 30 DAYS: 7TH, 9TH, AND 11TH GRADERS  Berkeley Unified School District (BUSD), 2010–2016 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Healthy Kids Survey (CHKS) 2010–2016
The asthma hospitalization rates for children under 5 in all racial/ ethnic groups have declined. Compared to the HP2020 goal, the rate for African American children is 12 times higher, for Latino children is 3.3 times higher and for White children is

1.2 times higher. The number of hospitalizations among Asian children under 5 are too small to calculate a reliable rate and are therefore not presented.
0 500
1000
1500
2000
2500
3000
3500
2000-2002 2003-2005 2006-2008 2009-2011 2012-2014
Age-Specific Rate per 100,000
White African American Latino Total HP2020
UPDATED FIGURE Age-Specific Asthma Hospitalization
Rate of Children Under 5 Years of Age by Race/Ethnicity, Berkeley, 2000-2014
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Office of Statewide Health Planning and Development, 2000-2014
f igure 3.18  A GE-SPECIFIC ASTHMA HOSPITALIZATION RATE OF CHILDREN UNDER 5 YEARS OF AGE BY RACE/ETHNICITY  Berkeley, 2000–2014 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Office of Statewide Health Planning and Development, 2000–2014
Berkeley Unified School District

TOBACCO PREVENTION PROGRAM
The T obacco Prevention Program provides community-based tobacco education programs and services to the community.

Berkeley community members receive education about federal, state, and local tobacco control laws including ordinances relating to City of Berkeley’s tobacco control related ordinances such as Smoke-Free Multi-Unit Housing, 600 ft. flavored tobacco buffer zone near schools K–12, tobacco free pharmacies and commercial zones ordinances. The Smoke-Free Multi- Unit Housing ordinance prohibits smoking in 100% of multi-unit housing with two or more units (i.e. apartments, co-ops, condominiums, common interest developments, etc.) and common areas. Free cessation classes are available to anyone interested in planning and sustaining a smoke-free lifestyle. T obacco program staff also collaborate with Berkeley T obacco Prevention Coalition members in the community, retailers, and policy makers in the City to develop policy aimed at reducing community members’ exposure to tobacco smoke and tobacco products — including electronic nicotine delivery systems. f igure 3.4  AL COHOL, TOBACCO, AND MARIJUANA USE IN PAST 30 DAYS: 7TH, 9TH, AND 11TH GRADERS  Berkeley Unified School District (BUSD), 2010–2016 f igure 3.5  A GE-SPECIFIC ASTHMA HOSPITALIZATION RATE OF CHILDREN UNDER 5 YEARS OF AGE BY RACE/ETHNICITY  Berkeley, 2000–2014

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
14 c HILD AND ADOLES c ENT HEALTH3

BREATHMOBILE
The Breathmobile, a project of the Prescott-Joseph
Center for Community Excellence (PJCCE), is
partnering with Berkeley Unified School District and
the City of Berkeley Public Health Division to bring
asthma care to BUSD students. This free mobile
asthma clinic provides diagnosis, education, and
treatment for children with asthma. For the first year
of this partnership, two BUSD elementary schools
(Malcolm X and Rosa Parks) and one preschool
(King Child Development Center) were selected
based on the high asthma prevalence at these sites.

In its fourth year (2016–2017) of partnership, the
Breathmobile has expanded services to include all
three BUSD preschools. PJCCE and school staff
work closely with the City of Berkeley Public Health
Division to identify students with asthma who
could benefit from this community resource. The
partnership is an example of community agencies
working together to address health inequities
and the achievement gap. Improving childhood
asthma management improves health and improves
educational success.

Percent of Kindergarten Children with All Required Immunizations Berkeley, Alameda County, and California, 2007 to 2016
50 55
60 65
70 75
80 85
90 95
100
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Percentage
California
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Department of Public Health, Immunization Branch Berkeley
Alameda Co.
f igure 3.39  PER CENT OF KINDERGARTEN CHILDREN WITH ALL REQUIRED IMMUNIZATIONS  Berkeley, Alameda County, and California, 2007–2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; California Department of Public Health, Immunization Branch
For the past decade, the proportion of Kindergarten children immunized against the nine diseases for which childhood immunizations are required has been consistently lower in Berkeley compared to both Alameda County and California.

Berkeley’s immunization rate has also experienced some
fluctuations with a recent peak of an 85% immunization rate in 2016, the highest percentage ever recorded. Required immunizations include polio, measles, mumps, rubella,
diphtheria, tetanus, pertussis, hepatitis B, and varicella vaccines.

Berkeley Unified School District

IMMUNIZATION PROGRAM
The Public Health Immunization Program works to
increase immunization rates for all Berkeley residents
across the life span. Special efforts are targeted at
African American and Latino children less than
two years of age by collaborating with WIC; public
and private preschools; licensed family childcare
homes; medical providers; and through community
outreach, education and encouraging participation in
the immunization registry among medical providers.

Immunization services are provided to the community
in several venues including at the Public Health Clinic.

The program also focuses on pertussis vaccination for
teens and adults and seasonal influenza vaccine for all ages. In addition, the Public Health Clinic expands its service by providing varicella vaccines to adults who
are uninsured or underinsured.
f igure 3.6  PER CENT OF KINDERGARTEN CHILDREN WITH ALL REQUIRED IMMUNIZATIONS  Berkeley, Alameda County, and California, 2007–2016

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
15 ADULT HEALTH 4
This is the stage of life when chronic diseases, including cancer, are most likely to develop and affect adults’ well-being.

Mental health conditions, injuries, and communicable diseases continue to have major roles as well. This is the period of life in which one is most likely to work, accumulate wealth, have partners, and hold responsibilities for other family members.

Approximately 7.6% of Berkeley residents were smokers in 2014, which was a substantial decrease from 11.5% in 2012. 4 CHAPTER 4: ADULT HEALTH
% 3% 6% 9% 12% 15% 18%
California
Alameda County
Berkeley
2012 2014
0 Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, California Health Interview Survey (CHIS), 2012, 2014
UPDATED FIGURE Adults Who Are Current Smokers,
Berkeley, Alameda County, CA, 2012, 2014
f igure 4.4  ADUL TS WHO ARE CURRENT SMOKERS
Berkeley, Alameda County, CA, 2012, 2014
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, California Health Interview Survey (CHIS), 2012, 2014
The proportion of Berkeley adults categorized as obese based on BMI increased from 13.1% in 2012 to 15.7% in 2014. In Berkeley, African Americans and Latinos are more likely to be obese. % 10% 20% 30% 40%
California
Alameda County
Berkeley
White
Latino
African American
Female
Male
UPDATED FIGURE Obesity in Adults Based on Body Mass Index (BMI) of 30 and Greater, Berkeley, Alameda County, CA, 2014
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, California Health Interview Survey (CHIS), 2014
0 f igure 4.1  OBESITY IN ADUL TS BASED ON BODY MASS INDEX (BMI) OF 30 AND GREATER  Berkeley, Alameda County, CA, 2014
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, California Health Interview Survey (CHIS), 2014
Nancy Rubin, Berkeleyside
Annie Burke

FROM THE COMMUNITY
“It’s really overwhelming when you go to a store, and
even when you think it’s healthy, you don’t know how
much sugar there is in it. Juice has sugar and you don’t realize it. “
f igure 4.1  ADUL TS WHO ARE CURRENT SMOKERS
Berkeley, Alameda County, CA, 2012, 2014
f igure 4.2  OBESITY IN ADUL TS BASED ON BODY MASS INDEX (BMI) OF 30 AND GREATER  Berkeley, Alameda County, CA, 2014

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
16 ADULT HEALTH4
0 20
40 60
80 100
120
140
2000-2002 2003-2005 2006-2008 2009-2011 2012-2014
Age Adjusted Rate per 100,000
White African American API Latino Total
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, Office of Statewide Health Planning and Development, 2000-2014 UPDATED FIGURE Hospitalization Rates due to Hypertension by Race/Ethnicity and Year of Hospitalization, Berkeley, 2000-2014 f igure 4.9  HOSPIT ALIZATION RATES DUE TO HYPERTENSION BY RACE/ETHNICITY AND YEAR OF HOSPITALIZATION  Berkeley, 2000–2014
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, Office of Statewide Health Planning and Development, 2000–2014
Berkeley’s adult African American population experiences inequitably high rates of hospitalization due to both
uncontrolled diabetes and long-term complications, such as kidney, eye, neurological and circulatory complications.

However, the hospitalization rate among African Americans for lower-extremity amputation has substantially decreased between 2006 and 2014. For Latinos, hospitalizations
for lower-extremity amputations dropped dramatically
from 29.3 per 100,000 in 2000–2002 to 5.9 per 100,000
in 2003– 2005. The Latino rate has continued downward
with no reported amputations in 2012–2014.

The rate of hospitalization due to hypertension among
Berkeley’s African American population has sharply increased, and is now over five times that of the total population.

However, hypertensive heart disease hospitalizations, a severe complication from hypertension, have decreased among all racial/ethnic groups over the past decade. The most dramatic decrease was among African Americans—from 170 per
100,000 in 2000–2002 to 51 per 100,000 in 2012–2014.

HEART-2-HEART & BERKELEY HYPERTENSION

PREVENTION
Heart 2 Heart (H2H) uses a holistic, community-
based approach to addressing health inequities in
Berkeley. The program focuses on preventing high
blood pressure and heart disease in South Berkeley;
additionally, healthy eating and physical activity are also encouraged. The program provides increased access
to hypertension screening and treatment, and trains
Community Health Advocates in a program focused
on outreach, education, and intensive counseling and
support. H2H serves to bridge community, programs,
resources, and services that are necessary to address
the needs of community members.

A highlight of the program is the weekly drop-in
Hypertension Clinic that provides free blood pressure
screenings and education for anyone, and provides
treatment for uninsured residents with hypertension.

Attendance at the drop-in Hypertension Clinic is
correlated with lowered blood pressure in residents
who attend the clinic consistently.
f igure 4.3  HOSPIT ALIZATION RATES DUE TO HYPERTENSION BY RACE/ETHNICITY AND YEAR OF HOSPITALIZATION  Berkeley, 2000–2014

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
17 ADULT HEALTH 4
The annual number of cases and rates of chlamydia, gonorrhea, and syphilis in Berkeley adults has increased in the last decade. These changes in rates may reflect either changes in Sexually Transmitted Infections screening or reporting, as well as actual changes in higher disease incidence. The most dramatic rise has been in chlamydia as the number of cases more than doubled from 420 in 2010 to 898 in 2017.

Due to better treatment, people with HIV are living longer, and the overall number of people living with HIV is increasing.

Berkeley has a higher rate of persons living with HIV than Alameda County and California. African Americans and
Latinos experience disproportionately high rates of HIV/ AIDS. The proportion of persons living with HIV who are in care and who are virally suppressed is higher in Berkeley than both Alameda County and California. Berkeley
does not yet meet the 2021 California Integrated Plan
Objectives of 90% in care and 80% virally suppressed.
0 100
200
300
400
500
600
700
800
900
1000
Number of Cases
Chlamydia Gonorrhea
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, California Department of Public Health, STD Control Branch, 2000-2017 UPDATED FIGURE Chlamydia and Gonorrhea Infections by Year of Report, Berkeley, 2000-2017
f igure 4.50  CHLAM YDIA AND GONORRHEA INFECTIONS BY YEAR OF REPORT  Berkeley, 2000–2017 Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, California Department of Public Health, STD Control Branch, 2000–2017
NEW FIGURE Continuum of HIV Care for Persons Living with Diagnosed HIV Infection, Berkeley, Alameda County, CA, 2016
0 10
20 30
40 50
60 70
80 90
100
In HIV Care Virally Supressed
Percent
Berkeley Alameda CA 2021 California Integrated Plan
Objective
In HIV Care: 90%
Virally Suppressed: 80%
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, Cancer Prevention Institute of California, 2016
f igure 4.66  C ONTINUUM OF HIV CARE FOR PERSONS LIVING WITH DIAGNOSED HIV INFECTION  Berkeley, Alameda County, CA, 2016
Source: City of Berkeley Public Health Division, Epidemiology and Vital Statistics, CDPH, Office of AIDS, 2016 PUBLIC HEALTH CLINIC’S REPRODUCTIVE AND SEXUAL HEALTH SERVICES:

Berkeley’s Public Health Clinic offers confidential testing, diagnosis, treatment, and prevention education to residents who think they may have a sexually transmitted infection, including HIV. Clinic staff follows up with clients who have sexually transmitted infection to ensure that they and their partners receive appropriate treatment. The program also provides free condoms and lubricant to both clients and non-clients on a drop-in basis. The Clinic offers comprehensive family planning services including nearly all types of birth control, reproductive life counseling, Pap smears (cervical cancer prevention), Hepatitis A, B and HPV vaccines, and referrals to local and low-cost breast screening/mammography services. Assistance is offered to survivors of intimate partner violence. The Clinic offers reproductive and sexual health services to people of all genders. The Public Health Clinic accepts Medi-Cal and FPACT (state funded payment programs). Others may qualify for reduced rates based on income. Some clients may even qualify for free services. No one is turned away because of inability to pay. Clinic clients are linked to a wide range of community and health services. Community outreach and presentations are provided on family planning methods, clinic services, sexually transmitted illnesses , HIV and sexually transmitted ill- nesses/HIV prevention. In 2012 over 2,300 individuals were seen at the clinic, many for more than one visit. f igure 4.4  CHLAM YDIA AND GONORRHEA INFECTIONS BY YEAR OF REPORT  Berkeley, 2000–2017
f igure 4.5  C ONTINUUM OF HIV CARE FOR PERSONS LIVING WITH DIAGNOSED HIV INFECTION  Berkeley, Alameda County, CA, 2016

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
18 5
5 CHAPTER 5: LIFE EXPECTANCY AND

MORTALITY
The number of years a person is expected to live, and the leading causes of death in Berkeley are important indicators of population health and guide Public Health Division program priorities.

In the last decade, the mortality rate in Berkeley has decreased steadily and life expectancy has increased for both men and women. Life expectancy in Berkeley is 86.7 years for women and 83 years for men in 2016. Mortality rates in Berkeley are lower than those of surrounding Alameda County and California— reflecting the city’s long life expectancy.
72 75
78 81
84 87
90 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 Age in Years
Total Female Male
Life Expectancy at Birth by Gender
Berkeley, 1994-2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 1994-2016, US Census Bureau
f igure 5.1  LIFE EXPE CTANCY AT BIRTH BY GENDER  Berkeley, 1994–2016 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 1994–2016, US Census Bureau
The overall age-adjusted mortality rate in Berkeley has decreased steadily throughout the last decade. The mortality rate for African Americans has reached the lowest ever
reported. In spite of this marked decrease, the age-adjusted mortality rate for African Americans is twice as high as the mortality rate of Whites and is higher than the population overall. This disparity has remained unchanged throughout these years.
0 200
400
600
800
1,000
1,200
1,400
2005-2007 2008-2010 2011-2013 2014-2016
Age Adjusted Rate per 100,000
White African Am. API Latino Total
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2005-2016
f igure 5.2  M ORTALITY RATES BY RACE/ETHNICITY AND YEAR OF DEATH Berkeley, 2005–2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2005–2016 Mortality rates from cardiovascular disease and cancer have decreased for all groups over the last decade. Cancer is the leading cause of death in the population as a whole, followed by heart disease. However, among African Americans in Berkeley, heart disease is the leading cause of death, followed by cancer.

Breast and lung cancer are the top leading causes of cancer death for women, while lung and pancreatic cancer are the top leading causes of cancer death for men. Women who are Latina, Asian, or Pacific Islander have the lowest mortality rates from breast cancer in Berkeley. Only African American women do not meet the HP2020 goal for breast cancer deaths.

Rank White Black Latino Asian/Pacific Islander
1 Cancer Heart Disease Cancer Cancer
2 Heart Disease Cancer Heart Disease Heart Disease
3 Stroke Alzheimer’s Stroke Stroke
4 Alzheimer’s Stroke Unintentional Injury Alzheimer’s
5 Chronic Lower Respiratory
Disease Organic Dementia Alzheimer’s Organic Dementia
6 Unintentional Injury Chronic Lower Respiratory
Disease Organic Dementia Diabetes
7 Organic Dementia Diabetes Diabetes Pneumonia & Influenza 8 Intentional Injury Nephritis & Nephrotic Syndrome Pneumonia & Influenza Parkinson’s 9 Parkinson’s Unintentional Injury Intentional Injury Intentional Injury 10 Metabolic Disorders Pneumonia & Influenza Chronic Liver Disease & Cirrhosis
Chronic Liver Disease &
Cirrhosis
NOTE: Color boxes denote causes of death that are leading in all racial/ethnic groups UPDATED FIGURE Top 10 Causes of Death By Race/Ethnicity, Berkeley, 2014-2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2014-2016
f igure 5.7  T OP 10 CAUSES OF DEATH BY RACE/ETHNICITY  Berkeley, 2014–2016 Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2014–2016 LIf E Ex PEc TANc Y AND MORTALITY
f igure 5.2  M ORTALITY RATES BY RACE/ETHNICITY AND YEAR OF DEATH Berkeley, 2005–2016
f igure 5.3  T OP 10 CAUSES OF DEATH BY RACE/ETHNICITY  Berkeley, 2014–2016 f igure 5.1  LIFE EXPE CTANCY AT BIRTH BY GENDER  Berkeley, 1994–2016

Even though the Berkeley population as a whole is living longer healthy lives, there are racial/ethnic variations and disparities in causes of death, mortality rates, and years of potential life lost, as there are differences in health status throughout the life course. Shortened lives and premature mortality are the cumulative results of health inequities that span the life course from conception to old age.
0 50
100
150
200
250
300
350
2005-2007 2008-2010 2011-2013 2014-2016
Age Adjusted Rate per 100,000
White African American API Latino Total
UPDATED FIGURE All Cardiovascular Disease Mortality Rates by Race/Ethnicity, Berkeley, 2005-2014
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2005-2016
f igure 5.13  ALL CARDIO VASCULAR DISEASE MORTALITY RATES BY RACE/ETHNICITY  Berkeley, 2005–2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2005–2016 0 10
20 30
40 50
60 White African American API Latino
Percent of Total YPLL or Population
YPLL Population
Years of Potential Life Lost (YPLL) by Race/Ethnicity
Berkeley, 2014-2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2014-2016 f igure 5.25  YEARS OF P OTENTIAL LIFE LOST (YPLL) BY RACE/ETHNICITY Berkeley, 2014–2016
Source: City of Berkeley Public Health Division, Epidemiology & Vital Statistics; Death Certificates 2014–2016 19 City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
5 LIf E Ex PEc TANc Y AND MORTALITY
Annie Burke

CITY OF BERKELEY VITAL STATISTICS OFFICE
The City’s Vital Statistics unit registers every birth
and death in Berkeley, and receives information
about births and deaths of Berkeley residents
outside of the City. The Vital Records Office
plays an important role in the analysis of birth
and death records. The California State Office of
Vital Records has acknowledged the excellence of
Berkeley’s Vital Statistics performance with annual
awards since 2005.
f igure 5.4  ALL CARDIO VASCULAR DISEASE MORTALITY RATES BY RACE/ETHNICITY  Berkeley, 2005–2016
f igure 5.5  YEARS OF P OTENTIAL LIFE LOST (YPLL) BY RACE/ETHNICITY Berkeley, 2014–2016

SUMMARY

KEY AREAS
Based on the 2018 Berkeley Health Status Report, the Public Health Division has identified four key areas that are important to monitor and develop interventions for:
•
Obesity in both children and adults. Sinc
e While the
overall childhood obesity rate in Berkeley is lower than in Alameda and California, the proportion of African
American children who are overweight and obese in
Berkeley is higher than Alameda County and California.

In 2014, 16% of Berkeley adults were categorized as obese based on Body Mass Index (BMI), which is an increase
from 2012. Additionally, among children and adults,
African Americans and Latinos experience higher rates of obesity than Whites and Asians.
•
Hypertension is increasing in all people in Berkeley.

Hospitalization rates due to high blood pressure for the o
verall population is 20/100,000, the highest in a decade.

The hospitalization rate for African Americans has sharply increased and is 120/100,000, over five times that of the total population.
•
Sexually transmitted disease rates are at epidemic levels.

H
istorically, chlamydia rates in Berkeley were lower
than the State, but in 2015, Berkeley’s rate increased
substantially, surpassing both Alameda County and
California. From 2011 to 2017, Berkeley’s chlamydia
rate has increased from 349.7 per 100,000 to 738.2 per
100,000. Gonorrhea rates in Berkeley are also consistently higher than those of Alameda County and California.

From 2011 to 2017, Berkeley’s gonorrhea rate has increased from 94.8 per 100,000 to 301.7 per 100,000.
•
African Americans are more likely to die prematurely
than any other racial/ethnic group in Berkeley. Years
o
f Potential Life Lost (YPLL), a measure of premature
death, demonstrates the significance. Although African
Americans comprise 8% of the population; they account
for almost 30% of the YPLL.

SUMMARY
This report presents a snapshot of the health of the Berkeley community. It describes how health changes over time, how we compare to our County, the State, and to the National Healthy People 2020 goals. It also shows how groups within Berkeley compare with each other and geographically.

An additional emerging key area of interest that we will be monitoring is in demographic shifts in breast cancer incidence.

For the first time, African American women have surpassed White women in the rate of breast cancer diagnosis. As we monitor this notable change, we will also seek to understand what is driving this trend.

Berkeley’s health is characterized by an overall excellent health status with striking health inequities. These patterns of health inequities are neither new nor unique to Berkeley nevertheless, they are unjust and unacceptable. The underlying causes and their solutions lie in the environments and neighborhoods in which people are born, grow, live, work, and age. Truly addressing the root causes of health inequities requires focused, consistent, comprehensive, and sustained effort on many fronts.

Through strategic collaboration, a unified vision, and broad community engagement we can achieve our mission of optimal health and wellness for all.

Annie Burke
City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
20

RUNNIN g HEAD

SUMMARY
Essential Service Berkeley Examples

1. Monitor health st atus to identify and
solve community health problems.
• Communicable Disease surveillance (including TB, STIs, HIV/AIDS) • Registration of births and deaths (Vital Statistics)

2. Diagnose and
investigate health
problems and health hazards in the
community
• Communicable disease outbreaks
• Health inequities in cardiovascular disease, low birth weight, diabetes, and asthma

3. Inform,
educate and empower people
about health issues
• Berkeley High School Health Center and Berkeley T echnology Academy Clinic • School Linked Health Services

4. Mobilize c
ommunity partnerships
and action to identify and
solve health problems
•
Berkeley Healthcare Preparedness Coalition/Hub
• Comprehensive Perinatal Services Provider Roundtables

5. Develop policies and plans tha
t support
individual and community health efforts
• T obacco ordinances
• Sugar Sweetened Beverage Tax and Healthy Berkeley Program

6. Enforce la
ws and regulations that
protect health and ensure safety
• Immunization requirements for school entry
• Public Health Emergency Preparedness Program

7. Link people t
o needed personal health
services and assure the provision of
health care when otherwise unavailable
•
Nursing Targeted Case Management (TCM)
• Partnerships with LifeLong Medical Care and Alameda County Public Health

8. Assure a c
ompetent public and
personal health care workforce
• YouthWorks and AmeriCorps Programs
• Training site for students interested in health (high school, college, graduate, and clinical)

9. Evaluate eff
ectiveness, accessibility,
and quality of personal and population-
based health services
•
Member of the local Fetal and Infant Mortality Review Board • Participation in Alta Bates Hospital Infection Control Committee

10. Research f
or new insights and
innovative solutions to health problems
• Contribute our experience to the scientific literature and to professional and academic venues • Evaluation of impact of Sugar Sweetened Beverage Tax
HOW BERKELEY PROVIDES THE 10 ESSENTIAL SERVICES OF PUBLIC HEALTH Berkeley’s Public Health Division is responsible for fulfilling the 10 Essential Services of Public Health as defined by the Centers for Disease Control and Prevention (CDC). The examples below demonstrate how Berkeley’s public health activi- ties address these essential services. This is not a comprehensive account of Public Health activities.

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
21

City of Berkeley HEALTH STATUS SUMMARY REPORT 2018
22 RUNNIN g HEAD

LOOKING AHEAD
The c ity of Berkeley Health Status Report 2018 is the
groundwork from which the Public Health Division, the
Department of Health, Housing and c ommunity Servic
es,
the c ity
, and the Berkeley community will identify
priorities, develop a strategic plan, and implement tailored interventions to improve community health. This path to better health is not one we can take alone. It is the charge of the entire community to create a healthy Berkeley. As a community member, you make choices that impact not only your own personal health, but the health of your families and neighbors.
c ommunity leaders in our c ity go
vernment,
community based organizations, faith institutions, and local businesses, in addition to providers and residents all have a role to play in creating a healthier community.
c ollectiv
ely,
we can achieve a better quality of life for all who live in Berkeley. We look forward to working with you.

Annie Burke

December 2018
Final Report

RAPID HEALTH IMPACT ASSESSMENT
Proposed Closure of Alta Bates Campus Berkeley, CA

EMERGENC Y

AL TA BAT ES HOSPIT AL

EMERGENC Y

AL TA BAT ES HOSPIT AL

2 5 EXECUTIVE SUMMARY
8 INTRODUCTION
8 Proposed Closing of Sutter Alta Bates Campus, Berkeley, CA 9 Overview Of Potential Health Issues from an Urban Hospital Closing 11 What is Health Impact Assessment (HIA)?
12 Scope of this Rapid HIA (RHIA)
12 Key RHIA Focal Areas
13 Hypothesized Impact Pathways
17 Rapid HIA Methodology
18 OVERVIEW OF ALTA BATES HOSPITAL
19 Alta Bates Campus Patient Utilization
20 Emergency Department
20 Hospital Service Area
26 SUMMIT CAMPUS IMPACTS
26 Campus Utilization & Capacity to Absorb Alta Bates Campus Patients 28 Sutter Health Plans for Summit Campus expansion
30 IMPACT ON VULNERABLE POPULATIONS
31 Pregnant Women & Newborn Babies
32 People of Color
34 People with Disabilities
34 Uninsured & Publicly Insured Patients
35 The Aging and Elderly
36 Mental Health & Suicide Prevention
36 Homeless People
37 Adverse Impacts on Vulnerable Communities in the Alta Bates Hospital Service Area 42 IMPACTS ON UC BERKELEY STUDENT HEALTH CARE
46 IMPACT ON EMERGENCY SERVICES
47 Alta Bates Emergency Department (ED) Utilization
47 Analyses of Travel Times to Alta Bates vs Summit Campus Emergency Departments 50 Impacts on Ambulance Travel Times
53 Ambulance Diversion
53 Regional Emergency Department impacts
56 DISASTER EVENT IMPACTS
58 Potential Impact from Chevron Refinery Fire
60 ECONOMIC IMPACTS
61 Alta Bates Campus as an Economic Base Multiplier
63 APPENDIX
66 REFERENCES
Table of Contents
Authors:

Jason Corburn, PhD
Amanda Fukutome
Marisa
Ruiz Asari
Jennifer Jarin
Vaughn Villaverde
Research Assistants:

Laura Atukunda
Riya Desai
Cindy Ochieng
Report design:

Marisa Ruiz Asari
Institute of Urban and
Regional Development
University of California Berkeley
2018

RAPID HEALTH IMPACT

ASSESSMENT

Proposed Closure of Alta Bates
Campus, Berkeley, CA

Page

3 Figures
5 Figure 1. HIA Key Findings Overview
7 Figure 2: Likely Health Impacts from the Closing of Alta Bates Medical Center, Berkeley, CA 10 Figure 3. Alta Bates Closure key milestones time line 11 Figure 4. Health Impact Assessment process
12 Figure 5. Rapid Health Impact Assessment guiding research questions 14 Figure 6. Hypothesized Impacts from Alta Bates Campus birthing center closing 14 Figure 7. Hypothesized Impacts from Alta Bates Campus Emergency Department (ED) closing 15 Figure 8. Hypothesized Impacts of Alta Bates Campus ED closing on Emergency Medical Services 15 Figure 9. Hypothesized Impacts of a Regional Disaster on ED access without Alta Bates Campus 16 Figure 10. Hypothesized Impacts from Alta Bates Closing on Local & Regional Economy 17 Figure 11. Examples of inputs to Rapid HIA
19 Figure 12. Alta Bates Campus ED patient discharges (2016) from cities impacted by the DMC hospital closure 19 Figure 11. Alta Bates Campus utilization overview 2016 22 Figure 13. Increased Alta Bates Campus discharges from Contra Costa County & regional zip-codes 22 Figure 14. Alta Bates Campus Hospital Service Areas: RHIA & CHNA defined 24 Figure 15. ED Visits by Cause: Comparing the RHIA Defined Alta Bates Campus HSA to State and County Rates 31 Figure 16. Outcomes for largest birthing centers in Alameda & Contra Costa Counties, 2016 32 Figure 17. Number of live births across regional birthing centers 2016 33 Figure 18. Percent race/ethnicity in the HSA compared to county and state rates 34 Figure 19. Alta Bates Campus expected payer source 2016 37 Figure 20. Total Homeless patients at select East Bay hospitals 2016 - 20176 38 Figure 21. Alta Bates Summit Medical Center CHNA Communities of Concern 40 Figure 22. High Health Care Need Communities in the RHIA defined HSA 41 Figure 23. Heart Disease ED visits per 10,000 residents for all ZIP Codes in the RHIA defined Alta Bates Campus HSA 41 Figure 24. Select ZIP Codes - Asthma and Diabetes ED visits per 10,000 residents 43 Figure 25. Student vs Alta Bates Campus mental health care utilization 48 Figure 26. Travel times to Alta Bates & Summit Campuses from ZIP Codes in the HSA 52 Figure 27. Emergency response time line
54 Figure 28. Additional ED visits/year hospitals can absorb before exceeding (ACEP) standard 55 Figure 29. Alta Bates & Summit ED utilization & American College of Emergency Physicians’ recommended capacity 59 Figure 30. Emergency Department patient surge volume after Chevron refinery fire, Richmond, CA, 2012 62 Figure 31. How hospitals contribute to regional economies Page

4 9 Map 1. Alta Bates Campus & Regional Hospital Network 18 Map 2. Alta Bates Campus and affected buildings
21 Map 3. Rapid Health Impact Assessment defined Hospital Service Area (HSA) 23 Map 4. Large volume increases in Alta Bates Campus ED discharges from West Contra Costa County 2013 - 2016 25 Map 5. Comparing RHIA & CHNA defined Hospital Service Areas 27 Map 6. Summit Campus and affected buildings
38 Map 7: 2016 CHNA defined service area CHVI scores
39 Map 8: Percent Uninsured across Census Tracts in the RHIA defined Service Area 39 Map 9: Percent of Families (with Children) in Poverty across Census Tracts in the RHIA defined Service Area 44 Map 10. Population density in ZIP Codes surrounding UC Berkeley, Alta Bates Campus, and Summit Campus 49 Map 11. Projected Heart Disease ED Visits & Travel Times to Summit Campus for ZIP Codes North of Alta Bates Campus 50 Map 12. Travel times to Alta Bates vs. Summit Campus at 5:30pm from select ZIP Codes in the Alta Bates HSA 57 Map 13. Surge event: Earthquake along the Hayward Fault

EMERGENC Y

AL TA BAT ES HOSPIT AL
Maps
Page

5 EXECUTIVE SUMMARY
Sutter Health has proposed to close Alta
Bates Campus in Berkeley, California, by 2030.

Alta Ba
tes Hospital serves the City of Berkeley
and the entire East Bay with 347 beds,
22 Emergency Department treatment stations,
about 50,000 Emergency Department (ED)
patients, and over 5,000 births in 2017. In 2016,
the hospital billed almost $2 Billion in patient
revenue.
2-4 Sutter Health has determined that
state-mandated earthquake safety upgrades
would be too costly to keep the major functions
of the hospital open. Sutter Health stated in 2016
that they plan to relocate most inpatient care and
emergency services from the Alta Bates Campus
site in Berkeley to an expanded Summit Medical
Campus in Oakland approximately three miles
from the Berkeley campus.

Proposed closure of Alta Bates Summit Medical Center - Alta Bates Campus Vulnerable
populations

HIA FOCUS AREA
Emergency
Department
access
Regional
economy
Figure 1. HIA Key Findings Overview
• Likely decreased access to urgent and chronic care for vulnerable populations.
• Likely increase in Bay Area elderly population will increase hospital care needs.
• Uncertainty regarding replication of high-performing birthing center and related maternal & newborn care
currently at Alta Bates.
• Increase in homeless patients at East Bay hospitals & this population will likely delay or avoid care.
• Increase in private vehicle travel times to hospital emergency department for West Contra Costa County
patients.
• Likely increased burden on regional emergency medical services, including emergency department over-crowding
& an increase in ambulance diversions.
• Lack of a coordinated disaster preparedness plan for Bay Area regional health care providers that includes UC Berkeley.
• Likely loss of living-wage jobs for entry-level hospital workers & some skilled positions, such as nurses.
• Limited information on proposed Sutter relocation &
construction plans made some projections difficult.

People with disabilities
Uninsured
People of color
Elderly
Pregnant Women
Homeless
Wait times & capacity
Travel times
On call times for EMS
Capacity for surge event
Wages
Employment
Municipal costs
Select Key Findings

6 This Rapid Health Impact Assessment (RHIA)
was commissioned by the City of Berkeley’s, Alta
Bates Regional Task Force and highlights some
of the likely health impacts from the closure of
Alta Bates hospital. More specifically, the Rapid
HIA focuses on the health impacts to: (1) already
vulnerable populations, such as the elderly, the
uninsured, and people of color; (2) University
of California, Berkeley, students; (3) emergency
medical services, including travel times to the
emergency room and regional emergency room
capacity in the case of a disaster, and; (4) the local
economy.

Alta Bates Campus has served as a regional
community health asset since its founding in 1905
by nurse Alta Alice Miner Bates. Alta Bates has
the greatest number of hospital-births out of all
hospitals in the East Bay. Further, Sutter Health’s
own 2016 Community Health Needs Assessment
(CHNA) report noted that the Alta Bates Summit
Medical Center Service Area currently serves
a large percentage of the region’s vulnerable
communities with high chronic health care needs.

Alta Bates Campus also has one of the highest
volume emergency departments (ED) in the East
Bay. The ED has experienced a sharp increase
in patients from West Contra Costa County,
many of whom were likely served by Doctors
Medical Center (DMC) in San Pablo, which closed
in 2015. In 2017 the Alta Bates Campus ED
was operating at about 6,000 visits above the
capacity recommended by the American College
of Emergency Physicians.
4 Research from across California and the United
States has found that hospital closures in urban
areas can displace patients, particularly those
already vulnerable, from familiar and usual
sources of care, and overburden the hospitals
that remain open. More specifically, Emergency
Department (ED) closures can adversely impact
regional morbidity and mortality.

Overall, we found that the closing of Alta Bates
Campus will have potentially significant adverse
health impacts related to: birthing/obstetrics;
ED care for the elderly, uninsured, homeless and
people of color; private vehicle travel times for
certain areas of the East Bay, particularly Western
Contra Costa County; disaster response capacity,
and; some UC Berkeley student health care
needs. We also found that the closing of the Alta
Bates campus will adversely impact employment
for low-wage workers, reduce spending in the
local economy and potentially reduce community-
based health promotion investments.

A summary of the likely impacts appears in
Figure 2. We describe the key impact, the likely
magnitude of impact on a scale of 1-3 stars, with 3
being the greatest impact, and offer examples of
key data for each impact.

This RHIA utilized a detailed review of the
scientific literature, existing provider data, and
interviews with select professionals to estimate
likely impacts. However, the projected impact
analyses and some conclusions were limited
due to the fact that Sutter Health did not provide
detailed relocation and re-construction plans for
either the Summit or Alta Bates campuses. The
findings here are based on available hospital
and public health data. Despite these limits, we
find that the closing of the Alta Bates hospital
campus in Berkeley, CA, will likely have significant
adverse public health impacts on populations
along the corridor from Berkeley to San Pablo
unless specific actions are taken to increase ER
and inpatient care access for already vulnerable
populations, increase existing hospital emergency
department capacities and increase 24-hour
urgent care facilities, especially those serving
West Contra Costa County.

7 Figure 2: Likely Health Impacts from the Closing of Alta Bates Medical Center, Berkeley, CA (Magnitude: 1 = less likely to 3 = highly likely)
Key Issue Likely Health Impact Magnitude
of impact Examples of Supportive Data
Birthing/
obstetrics
Reduced access to high quality
prenatal, birthing & neonatal care *** Over 5,000 births per year at Alta Bates - highest in the region Current birthing center has excellent maternal & infant outcomes Elderly care
Delayed care, increased severity
of disease & likely avoidable
hospitalizations
*
Already high % Medicare serving facility; senior population increasing Hospital closures have resulted in delayed care & increased mortality for elderly
Uninsured &
homeless
Delayed care, increased unnecessary
hospitalizations, increased care costs
& potential spread of infections
**
About 41% of patients in 2016 were Medi-Cal or uninsured 600% increase in homeless patients at Alta Bates between 2016 - 2017
People of
color
Delayed care, increased unnecessary
hospitalizations, increased care costs
& some increase in unnecessary
deaths
***
Over 63% of patients at Alta Bates were people of color (PoC) in 2016 West Contra Costa County has high % PoC utilizing Alta Bates & will experience greatest increased travel times to reach Summit campus People with
Disabilities
Accessibility barriers due to
increased distance and unfamiliarity
with relocated services
**
12% of the population in the HSA are living with a disability, of which at least 61% are racial/ethnic minorities
UC Berkeley
Students
Loss of familiar ED & in-patient care;
loss of some emergency mental
health & suicide prevention
**
Estimated 4,000 UCB student visits to Alta Bates ED per year About 2 ambulance transfer per day from Tang Health Ctr. to Alta Bates Loss of familiarity & proximity of care may adversely impact students Emergency
Department
Increased crowding at EDs across
the region, increasing wait times;
Increase travel times to ED for some;
Increased ‘time-on-task’ for many
regional EMS providers.
***
Loss of 22 ED treatment stations at Alta Bates
Increase private vehicle travel times to Summit hospital during PM peak rush hour, with some areas needing over 50 minutes to reach ED.

Summit will need to double current ED capacity to accommodate all Alta Bates patients
Berkeley EMS reports 10-12 min. increase in transport times to Summit compared to Alta Bates, which would add on average 2 extra hours of EMS ‘time-on-task’ per day if Alta Bates closes Disaster
preparedness
Loss of ED capacity to treat
earthquake & fire victims, potential
increase in avoidable deaths &
hospitalizations; likely increased
cost of
long-term care.
***
Est. 900 people needing ED care in first days of HayWired scenario earthquake & 1,000-1,200 from a major fire at Chevron in Richmond w/out Alta Bates.

Regional ED capacity in an emergency/disaster will be significantly compromised without Alta Bates
Concentrating ED capacity in fewer locations may limit access during a disaster if
roadway network to those facilities is compromised.

Economics
Local government EMS spending
increase; low wage workers
disproportionately lose jobs; Nurses
may also be adversely impacted;
local service economy suffers
*
Potential increased cost to local governments to provide additional EMS services due to longer time on task
Potential loss of nurses out of region, increasing shortage of skilled practitioners
Estimated loss of $20M to local economy from annual hospital contracting & services

8 Sutter Health announced in 2016 that it will
close its Alta Bates Campus in Berkeley and
consolidate its current inpatient and emergency
services approximately three miles away at its
Summit Campus in Oakland, CA. Sutter Health
has stated that the closure of the Berkeley
hospital campus is expected to occur gradually,
with full closure occurring by 2030 (Sutter
Health, 2018). Some services have already been
relocated from Alta Bates Campus to Summit
Campus, such as the cardiac catheterization lab,
which began to close as early as 2010.

Alta Bates Campus was established in 1905 by
a nurse named Alta Alice Miner Bates. In 1906
the facility became the emergency hospital for
many in the East Bay, especially as hundreds
of San Franciscans fled to Berkeley after the
Earthquake and Fire of 1906. Between 1910 and
1912, the hospital built two wings and had about
40 beds. In 1928 a new hospital was opened on
the same site with 112 beds. In 1985, the 1928
building was replaced with a 300 bed, three story
structure, that exists today (Sutter Health, 2018).

Alta Bates Campus currently serves the City
of Berkeley and the entire East Bay with 347
beds and 22 Emergency Department stations,
generating approximately $1.89 billion in total
patient revenue in 2016.
1,4 Alta Bates Campus
is one of the only hospitals serving the East Bay
corridor from approximately San Pablo in Contra
Costa County to Berkeley in Alameda County (see
regional hospital network Map 1). Without access
to Alta Bates Campus, West Contra Costa County
residents will likely rely on Kaiser-Richmond,
which has limited capacity, and hospitals located
18-25 miles east, such as Contra Costa Regional
Medical Center and John Muir Hospital (Alta
Bates averages 9 miles from most West Contra
Costa County origins).

In response to the announcement of the
proposed closure of the Alta Bates Campus, the
Mayor’s Office of the City of Berkeley convened
the Alta Bates Regional Task Force to explore
ways to prevent this closure and keep Berkeley’s
only acute and emergency care hospital open.

The Berkeley City Council voted in 2016 to work
to keep the hospital open, and the Task Force
is one venue where information and policy
alternatives are being explored. The Task Force
is comprised of officials from Alameda and
Contra Costa Counties, and the cities of Alameda,
Albany, Berkeley, El Cerrito, Emeryville, Oakland,
San Pablo, and Richmond, California. The task
force also includes stakeholders from labor
unions, non-profit organizations, the University of
California Berkeley, and members of the public.

The Task Force commissioned this Rapid Health
Impact Assessment (RHIA) in the Spring of 2018,
to better understand the potential impacts of the
hospital closure on health care utilization and
access to emergency medical services (EMS).

Research on hospital closures suggests that the
events can displace patients from usual sources
of care and force them to access facilities that
may lack their prior medical records. Emergency
Department (ED) closures can adversely impact
morbidity and mortality in a region. The closure
of an ED can have a significant impact on a
region as patients may have to travel farther
to obtain care and the remaining EDs have to
Proposed Closing of Sutter Alta Bates Campus, Berkeley, CA

INTRODUCTION

9 bear the extra patient volume, especially for
patients experiencing time-sensitive illnesses
requiring prompt intervention. EDs provide care
not only for the critically ill, but also for those
unable to access care by other means, and are
seeing a rising trend in patient volume in both
the US and California. Significant increases in ED
volume create a strain on existing emergency
care capacity and emergency medical service
providers, and can adversely impact patient
health outcomes.

Overview of Potential Health Issues from an
Urban Hospital Closing
Research in the public health, medical and health
care services literatures suggests that urban
hospital closures can have adverse impacts on
population health, access to care and patient
outcomes. However, research also suggests that
whether or not a hospital closure will adversely
impact access and/or patient outcomes can
Map 1. Alta Bates
Campus & Regional
Hospital Network

10 depend on a host of factors, such as if there
are other high-performing institutions in close
proximity, if these institutions are accessible to
the poor, and if these same institutions can serve
additional patients, particularly in the ED (Hsia
& Shen 2011; Joynt et al., 2015; Liu et al., 2014).

Urban hospital closures have seen an increase
in both California and the US. Most recently and
related to this trend, Doctors Medical Center
(DMC) in San Pablo, California, closed in April
2015. Since that time, as we will highlight in
more detail below, residents living in Northwest
Alameda County and West Contra Costa County
have become increasingly reliant on the Alta
Bates campus for emergency and inpatient care.

Hospital closures can have a significant impact
on emergency department (ED) access. A
2015 national survey by the American College
of Emergency Physicians titled “Review of
the Evidence on the Use of the Emergency
Department by Medicaid Patients and the
Evolving Role of Emergency Medicine Physicians,”
revealed that patients in crowded EDs have a
greater likelihood of experiencing long wait
times, leaving without being seen by a physician,
feeling unsatisfied with their care, and having
worse medical outcomes including delays in
diagnosing myocardial infarction and increased
mortality rates. Horwitz, et al., (2010) reported
that only 67% of acutely ill ED patients were seen
within the recommended times in the US. In
2009, Pines, et al., reported on the complication
rate of patients with acute coronary syndrome
(ACS) as a function of crowded versus non-
crowded EDs, and found a significant increase in
serious complications (approximately 6% vs. 3%
incidence of death, cardiac arrest, heart failure,
late myocardial infarction, arrhythmias, stroke, or
hypotension) in those patients presenting during
overcrowded EDs.

ED overcrowding may also reduce the quality
of care and increases medical errors, as the
emergency staff may have to continually focus
on new patients. ED closure can also eliminate
hospital capacity for accommodating critical
incidents such as infectious disease epidemics
and disasters, another issue we explore in more
detail below.

The locations of urban hospital closures do not
seem to be randomly patterned, as Sager (2013)
and Ko et al. (2014) found that racially segregated
communities and especially predominantly
African-American neighborhoods are more
likely to experience a hospital closing than
predominantly white, Latino or Asian-American
majority neighborhoods. Nationally, one in three
urban African-Americans receive their primary
and other care at a hospital while for whites this in
about one in six.

A 2014 investigation by the Pittsburgh Post-
Gazette/Milwaukee Journal Sentinel revealed
that people in poor, urban neighborhoods are
Hospital
Seismic Safety
Law Updated
Sutter Health
Announces
Closure
Systematic
Transfer of
Service Lines
Alta Bates
Campus
Proposed
Closure
1994 2016 2016-’30 203020152008
Extensions
granted
Doctor’s Medical
Center Closes
Figure 3. Alta Bates Closure key milestones time line

11 less healthy than their more affluent neighbors,
but more likely to live in areas with physician
shor
tages and closed hospitals (Thomas, 2014).

A more detailed review of the medical literature is
included in each section below, and suggests that
urban hospital closings can have adverse impacts
that disproportionately impact already vulnerable
populations - such as the elderly, people of
color, and the homeless - emergency department
access, regional emergency management
systems, and the local economy.

What is Health Impact Assessment (HIA)?
Health Impact Assessment (HIA) uses a
combination of procedures, methods and tools to
analyze the potential, and sometimes unintended,
effects of a policy, plan, program or project on
the health of a population and the distribution of
those effects across population groups. HIA is a
process that aims to create healthier communities
by providing decision-makers with an
understanding of the potential health impacts of
a proposed project, and makes recommendations
that could reduce adverse impacts. Importantly,
HIA does not endorse or oppose a project or
policy; rather, the purpose of conducting an HIA
is to inform stakeholders and decision-makers
about the population health implications of
proposed actions, to identify and examine trade-
offs, and to encourage the exploration of health
promoting alternatives.

A Rapid or sometimes called a “desktop HIA” ,
does not include the extensive community and
stakeholder input of a typical HIA or original
data collection, such as surveys. Instead, the
Rapid HIA (RHIA) utilizes existing data and
limited stakeholder engagement to generate
analyses that can inform ongoing policy debates
and identify areas for additional study. The
key stages of the HIA process are highlighted
in Figure 4, and this RHIA includes the first
three major steps of screening, scoping and
assessment. While there is no single best
approach to HIA, each HIA
process should reflect the
needs of its particular context.

This Rapid HIA aims to extend
the knowledge and awareness
for communities and decision-
makers about select health
equity issues raised by the
proposed closing of Alta Bates
hospital in Berkeley, California.

Health
Impact
Assessment
Screening
Scoping
Assessment
Recommendations
Reporting
Sharing results and
recommendations with
decision makers
Measuring and
evaluating progress on
HIA recommendations
Determining if and why
the HIA is necessary
Identifying the health
impacts and scope of
the HIA
Evaluating the health
effects and impacts
Identifying actions and
risk mitigation strategies
to improve health
Monitoring
& Evaluation
Figure 4. Health Impact
Assessment process
*Figure adapted from Mecklenburg County

12 Figure 5. Rapid Health Impact Assessment guiding research questions Vulnerable
populations
Emergency
Department
Access
Regional
economy
How might the proposed closure impact already vulnerable populations such as those who are low-income, people of color, the elderly, the uninsured, UC Berkeley students, and expecting mothers? How might the proposed closure influence access to emergency department care for Bay Area residents, particularly travel times & in the event of a major disaster, such as an earthquake or fire? How might the proposed closure impact local jobs and the regional economy, such as from reduced hospital spending?
Rapid HIA research questions:

Scope of this Rapid HIA
On July 27, 2017, the City of Berkeley, California’s
Community Health Commission voted to
authorize a scope of work for a Health Impact
Assessment analyzing select impacts from the
proposed closing of Alta Bates Campus. After
reviewing this preliminary scope, a revised scope
of work was developed by Professor Jason
Corburn and University of California, Berkeley
(UCB) researchers at the Institute of Urban and
Regional Development (IURD), in consultation
with the Health Commission and other City of
Berkeley stakeholders. A Rapid HIA screening
and scoping document was produced by
UCB in December 2017. City of Berkeley staff
commented on and suggested revisions to the
initial draft scope of work (SOW). A final SOW
was developed by Professor Corburn based on
feedback and a preliminary review of availability
data.

Since a detailed closing plan, including specific
time frames and services, was not provided by
Sut
ter Health, this RHIA was not able to offer
detailed analyses of potential impacts from the
removal and/or relocation of inpatient services.

The RHIA analyses are based on the best and
most up-to-date information we were able to
obtain from Sutter Health on the closing and
relocation of services from Sutter’s website
and the Sutter Vision for 2030: https://rebuild.
altabatessummit.org.

Key RHIA Focal Areas
Based on consultation with the Alta Bates
Regional Task Force and key stakeholders, we
refined this RHIA to focus on the following areas:

1. Impacts on vulnerable populations, including
but not limited to low-income, under and
uninsured populations, people of color,
elderly, pregnant women, and those with

13 limited transportation options;

2. Impacts on health care and emergency
department services for University of
California, Berkeley students;

3. Impacts on Emergency Department access
and regional ED capacity;

4. Impacts on Emergency Medical Services
(EMS), specifically to paramedic ‘time-on-task;’

5. Impacts on regional hospitals’ disaster
response ED capacity, particularly in the case
of an earthquake and fire, and;

6. Impacts on local employment and the regional
economy.

Hypothesized Impact Pathways
Based on the six agreed upon focal areas
described above and the three key RHIA
research questions (Figure 5), the research team
performed a preliminary review of the scientific
literature on hospital closures, ED closures in
urban areas and previous studies of the impacts
of hospital closures, specifically the report on
the closure of Doctors Medical Center. The
authors of this RHIA hypothesize at least five
potential pathways between the closure of Alta
Bates Campus and population health outcomes,
informed by a preliminary research review.

These hypothetical scenarios are highlighted in
the Figures 6-10 and described below. In each
pathway diagram, a up arrow indicates a likely
increase while a down arrow indicates a likely
decrease. The hypothetical scenarios helped to
further refine our review of the literature and data
analysis. The hypothesized pathways of potential
impacts from the closing of Alta Bates hospital
included:

Scenario A: Birthing center closes (Figure 6)
In this scenario, we hypothesized that the Alta
Bates Campus birthing center & related prenatal
and postpartum care, including the NICU, close
and there is some replication of these exact
services in any one location in the region.

Scenario B: Emergency Department closes
(Figure 7)
In this scenario, the Alta Bates Campus ED closes
and some additional capacity is provided for at
Summit in Oakland.

Scenario C: ED closes & regional ED patients
increase (Figure 8)
In this scenario, we hypothesized the Alta
Bates Campus ED closes & the remaining open
hospitals in the region experience increased ED
patients.

Scenario D: Disaster & ED access (Figure 9)
In this scenario, we hypothesized potential
impacts to ED access during a disaster in the
absence of Alta Bates Campus.

Scenario E: Economic Impacts (Figure 10)
In this scenario, we hypothesized potential
economic impacts to jobs and the local economy
from the closure of Alta Bates Campus.

14 Birthing
Center
Closure
Scenario A:

Multi-service
labor & deliver
unit closes
(approx. 6,000
births/yr.)
Prenatal care and access
within hospital for low
income women of color
NICU capacity and
services (55 beds and approx.
1,000 patients/yr.)
Multi cultural & multi-
lingual labor & delivery care
Crowding at regional
birth centers
High risk C-sections &
episiotomy procedures
High-level expert
birthing care Maternal health
Low birth weight &
preterm babies
VBAC and exclusive
breast feeding before
discharge
Maternal morbidity,
especially for women of
color
Emergency
newborn care
Knowledge
about birth plan &
postpartum options
Access to options
for midwifery & doula
services
Emergency
Department
Closure
Scenario B:
+

Alta Bates ED closes
(Loss of 22 ED
treatment stations
& redistribute
approx. 50,000
patients /yr.

Urgent and non-urgent
care access for people of
color
Urgent and non-urgent
care for uninsured,
elderly, homeless & other
frequent users of ED
Emergency room
screening for mental health &
suicide prevention services
Urgent and non-urgent
care access for UCB students Avoidable
hospitalizations
Delayed treatment
for some infectious &
chronic diseases
Immune function &
other stress-related physical/
mental health outcomes
Severity of illness
due to delayed or lack of
treatment
Infectious disease
contagion
Mental illness &
suicides
Cost of future disease
management & mental
health services
Familiarity with new
urgent care locations
Stress about where
to go & decreased
quality of urgent care
Referrals for mental
health care, esp. for
homeless & students
Figure 6. Hypothesized Impacts from Alta Bates Campus birthing center closing Figure 7. Hypothesized Impacts from Alta Bates Campus Emergency Department (ED) closing

15 Alta Bates
Emergency
Department
closes
Acces
s to urgent &
chronic care for vulnerable
populations across region
Ambulance travel
times
Travel times by private
vehicle & transit to
regional EDs, especially for
Contra Costa County residents
Patient volume at other
EDs
Severity of illness
Ambulance diversions
Cost to local
government to
provide more EMS services
Stress for already
vulnerable
populations regarding
where to get care
Immune function &
other stress-related health
outcomes
Delayed care
Morbidity
Avoidable
hospitalizations
Crowding at all
regional EDs
Wait times for
urgent & non-urgent
care within ED
Need for costly air
ambulance services
EMS time-on-task
Earthquake along
Hayward Fault (i.e.,
HayWir
ed scenario)
Fire at Chevron
Richmond Refinery
Est. 14,000 people
require out-of-home
medical car
e in
Alameda & Contra
Costa Counties
Estimated 1,460
patients to ED @Kaiser
Richmond from West
Contra Costa County
Est. 3,800 patients to
ED within the first 3
days
Est. 700
patients
would have
used Alta
Bates ED in
first day
Delayed care
Severity of
unat
tended injuries
Mortality
Avoidable
hospitalizations
Costs of treatment
from delayed care
Est. 1,400
patients
would have
used Alta
Bates ED
Figure 8. Hypothesized Impacts of Alta Bates Campus ED closing on Emergency Medical Services Figure 9. Hypothesized Impacts of a Regional Disaster on ED access without Alta Bates Campus ED Closure:

Regional
Impacts
Scenario C:
+
Disaster
Events
Scenario D:

Overcrowding
& long wait
times at
remaining
regional EDs
Access to EMS
& chronic care
physicians

16 Figure 10. Hypothesized Impacts from Alta Bates Closing on Local & Regional Economy Alta Bates
Campus
closes
Clinical staff
Some Drs. and nurses go
to other hospitals in region
Some Drs. and nurses
leave the region
Layoffs - nurses and low
wage workers
$ to local economy
Spending on food,
flowers, transit, lodging, etc.

Nurses
Low wage service
work
ers
Local purchases &
spending
Hospital visitors to
local area
Poverty
Economic inequality
Nursing shortage
Low-wage worker
displacement due to
unemployment & reduced
incomes
Physicians
Local tax base
Regional economy
ED Closure:

Regional
Impacts
Scenario E:
$
Local business closures

17 Rapid HIA Methodology
A mixed set of methods were used to complete
this RHIA. As mentioned above, a detailed
review of the scientific literature related to
hospital closing was conduced to develop the
hypothesized pathway diagrams and support data
collection. We analyzed hospital and patient data
using the California Office of Statewide Health
Planning and Development (OSHPD). The RHIA
also includes detailed reviews of reports by local
hospital systems, emergency medical providers,
and county health departments, which helped
us obtain existing utilization information. Key
findings from existing reports and analyses were
summarized and incorporated into our analyses.

Data for multiple years and for multiple hospitals
in the region, including Alta Bates Campus,
were obtained from OSHPD. OSHPD conducts
an annual, standardized survey required of all
hospitals and health services in the state. Each
facility is required to report data on patient
capacity, inpatient utilization, ED utilization, and
expenditures. We generated summary statistics
on hospital and patient utilization for Alta Bates
and Summit Campuses, as well as select hospitals
in the East Bay region. Where possible, we
utilized data from 2017, and otherwise reference
complete OSHPD datasets from 2016. Five year
estimates from the 2016 US Census, American
Community Survey data were gathered to define
ZIP Code populations and other community-scale
demographics in the region.

Previously published health outcome data from
the Alameda and Contra Costa County Health
Departments were summarized by ZIP Code.

In addition, ZIP Code level hospitalization data
(2011) was accessed through the Sutter Health
“Health Needs Maps” website (http://www.
healthneedsmap.com). All these data are publicly
available and as such this assessment was exempt
from review by the human subjects’ protection
office of the University of California, Berkeley.

Meetings with Sutter Health, City of Berkeley and
UC Berkeley’s Tang Health Care providers also
informed the analyses and provided qualitative
data. A list of interviewees & reviewers of a first
draft of this report appears in the appendix.

A summary of the inputs used appear in Figure

11. A full list of references appears at the end of
this document.

Scientific Literature Reports Existing data
• CA Health Inter-
view Survey (CHIS)
• OSHPD
• City of Berkeley &
County EMS
• US Census
• Alta Bates CHNA
• Haywired
• Doctors Medical
Center Closure
• County Health De-
partment Surveil-
lance Reports
Interviews
• Regional stake-
holders
• UC Tang center
providers
• Sutter Health
• UCB students
• PubMed & Google
Scholar
• Ovid, Proquest &
Ebscohost
• Web of Science &
Science Direct
Figure 11. Examples of inputs to Rapid HIA

18 *map is not drawn to scale

OVERVIEW OF ALTA BATES
Map 2. Alta Bates
campus and affected
buildings
Alta Bates Campus is one of the most utilized hospitals and birthing centers in Alameda and Contra Costa Counties, with a total of 66,268 patients in 2016. The hospital service area, in which 75% of patients reside, encompasses 9 cities across the East Bay. The hospital has recently seen a large increase in patients from West Contra Costa County after the closure of Doctor’s Medical Center in 2015.

The Alta Bates campus of Alta Bates Summit
Medical Center is a 347-bed acute care hospital,
loca
ted in the city of Berkeley, in North Alameda
County, California. Alta Bates was purchased by
Sutter Health Corporation and integrated with
Summit Medical Center in Oakland and Herrick
Hospital in Berkeley to form Alta Bates Medical
Center in the year 2000. Aside from providing
emergency, acute and specialty care services, Alta
Bates campus is also a major regional birthing
center.

The Alta Bates Campus currently has 5 buildings
that are out of compliance with the Hospital
Seismic Safety Law, and must be retrofitted
by 2030 or stop providing all inpatient and
emergency services.
10 These buildings, depicted
in Map 2 below, include parts of the general
hospital and all of the emergency department.

EMERGENC Y

AL TA BAT ES HOSPIT AL
Source: OSHPD, 2018

19 We detail Sutter’s response to the seismic
upgrade on page 28 below.

Alta Bates Patient Utilization
Alta Bates Campus is one of the most utilized
hospitals in Alameda County, and is the 3rd
largest general acute facility in the region. Of its
347 beds, the facility currently has 146 general
acute beds, 16 in intensive care, 116 perinatal,
55 in intensive newborn nursery, and 14
coronary care beds.
4 In 2016, Alta Bates Campus discharged 66,268
patients, more than any other non-Kaiser
hospital in Alameda County except Highland
Hospital at 81,500. Of the 66,268 patients that
were seen at Alta Bates Berkeley, 19,887 were
hospitalized, including 5,930 patients admitted
from the emergency department. Of the 19,887
hospitalized patients, 30% were admitted for a
birth-related diagnosis and 33% were admitted
with a pregnancy-related diagnosis, for a total
of 63% of all hospitalized patients. In 2016, Alta
Bates Berkeley delivered 5,863 babies, more than
any hospital in Contra Costa County or Alameda
County, making it the region’s largest birthing
center. After birthing and pregnancy patients,
the third highest patient diagnosis was infection-
related, which made up only 6% of hospital
admissions.
8 Alta Bates also operates an ambulatory surgery
center, which conducted 6,975 surgeries and
medical procedures in 2016. The most common
principal diagnoses from the ambulatory surgery
center were: eye disorders (22%), other reasons
347 beds
3rd largest
gener
al acute
care facility in
the region
66,268 patient
discharges, 2nd highest
of non-Kaiser hospitals
in Alameda County
2016
45,900
ER visits
in 2016 - 7%
increase since
2013
61% of ER visits
were Medi-Cal
and Medicare in
2016
7% of ER visits
were uninsured
patients in 2016
5,863 live
births in 2016
- highest in the
region
16,494
discharges from
Contra Costa
County in 2016
- 31% increase
since 2013

EMERGENC Y

AL TA BAT ES HOSPIT AL
Figure 11. AB utilization
overview 2016
Figure 12. Alta Bates Campus ED patient discharges (2016) from cities impacted by the DMC hospital closure
0 3000
6000
9000
12000
15000
Berkeley Albany El Cerrito Richmond San Pablo
City
Patient discharges
Source: OSHPD, 2016

20 (15%), digestive system (14%), cancer (12%),
and genitourinary system (11%). Of the 6,699
sur
geries that were performed at the ambulatory
surgery center in 2016, 60% were related to
either eye and ocular surgeries (25%) or digestive
surgeries (35%).
8 Emergency Department
The Alta Bates Campus has one of the largest
emergency department (ED) patient volumes
in the region, operating over capacity by
approximately 6,000 visits per year in 2017. That
year the ED had 22 emergency treatment stations,
down 3 stations from 2016.
3,4
In 2017 Alta Bates Campus documented 50,414
emergency department visits, an additional
4,524 visits than 2016, despite having three
less treatment stations. 63% of emergency
department visits not resulting in admission
were classified as severe, with 27% being life-
threateningly severe and 36% being non-life-
threateningly severe. Of the remaining visits,
27% classified as moderate, 9% were classified as
low/moderate, and 1% were classified as minor.
4 Based on our review of the literature it is unlikely
that the ‘severe’ visits – comprising over 60% of
total visits – could be treated in an urgent care
facility or primary care setting.

Given the high volume of ED patient traffic, Alta
Bates Campus reported 57 hours of ambulance
diversion in 2016, and 13 in 2017.
3,4 During these
hours the hospital closed its ED to incoming
ambulances, resulting in those ambulances being
diverted to other hospitals. High ambulance
diversion rates can be an indicator of ED
overcrowding, and is associated with poorer
health outcomes for patients as well as lost
revenue for hospitals. A more detailed discussion
on ED access and impact of an Alta Bates Campus
closure on the regional emergency medical
services network can be found in the section
below on EMS.

Hospital Service Area
For this RHIA, we calculated the Alta Bates
Campus hospital service area (HSA) using the
latest available OSHPD (2016) patient origin data.

This HSA best reflects the geographic area from
which patients are coming from to receive care
at Alta Bates Campus. As we describe below,
the RHIA defined HSA is slightly larger than the
area Sutter Health defines as the HSA for Alta
Bates Summit Medical Center (which includes
Alta Bates, Summit, and Herrick campuses) in
their 2016 Community Health Needs Assessment
(CHNA) report, since we aimed to capture the
recent increase in patients coming from West
Contra Costa County.

Using all 2016 inpatient and ED origin data,
this RHIA defines the Alta Bates campus HSA to
include the 32 ZIP Codes in the region where
approximately 75% of patients lived. The HSA
spans across 9 cities in Alameda and Contra
Costa Counties: Oakland, Alameda, Emeryville,
Berkeley, Albany, El Cerrito, Richmond, San
Pablo, and El Sobrante (Map 3). While 75% of
patients in 2016 came from these 32 ZIP Codes,
66% of all patients that year came from Alameda
County, and 25% from Contra Costa County, for a
total of 91% of all patients.
6 According to the US Census, the RHIA HSA
includes 839,299 residents, 44% of which are
people of color and 18% of which lived below the
poverty line in 2016 (ACS 2012-2016). Roughly
18% of the population in the service area are
African American and 25% are Hispanic/Latinx.

In the HSA 25% of the population receives
Medicaid coverage and 11% are uninsured.

Since people with Medicaid and the uninsured
may utilize a hospital for primary care more than
those with other health insurance, there are
approximately 301,146 people in the HSA that

21 Source: OSHPD POMS, 2016
ZIP Code Community
94806 San Pablo
94803 El Sobrante
Richmond
94805 East Richmond
94804 South Richmond
94801 Richmond - North, Iron
Triangle, Point Richmond
94530 El Cerrito
94706 Albany
Berkeley
94720 UC Berkeley Campus
94710 West Berkeley / Marina
94709 Northside Berkeley
94708 Tilden/Berkeley Hills
94707 North Berkeley / Kensington
94705 Claremont / Elmwood
94704 Berkeley Downtown / South
of Campus
94703 Northwest Berkeley
94702 Northwest Berkeley
94608
Emeryville
Oakland
94621 East Oakland / Coliseum
94619 Oakland Hills / Laurel
94618 Rockridge
94613 Mills Campus
94612 Downtown Oakland
94611 Piedmont / Oakland Montclair
94610 Oakland Grand Lake /
Lakeshore
94609 Oakland MLK
94607 West Oakland / Jack London
94606 Oakand / Cleveland Heights
94605 Oakand Hills / Eastmont
94603
East Oakland / Brookefield
94602 Oakland / Glenview
94601 East Oakland / F
ruitvale
94501 Alameda
Map 3. Rapid Health Impact Assessment
defined Hospital Service
Area (HSA)
32 ZIP Codes from which 75% of all Alta
Bates Campus patients came from in 2016
0 1.5 3mi
N

22 may seek non-urgent care at Alta Bates Campus.

Health outcome data also suggests that residents
in the Alta Bates Campus HSA experience health
inequities and disproportionate rates of illness
and injury including asthma, diabetes, assault,
unintentional injury, and substance abuse
compared to the State of California and both
Alameda and Contra Costa Counties (Figure 15)
(Sutter Health, 2013).

According to Sutter Health’s 2016 Community
Health Needs Assessment (CHNA) report, the
HSA defined for all three campuses (Alta Bates,
Herrick, and Summit) included 24 ZIP codes in
Oakland, Berkeley, and Emeryville, what they
call their “core market.” Approximately 20% of
this population lives below the poverty line and
about 59% are People of Color. We highlight the
differences in the Sutter CHNA defined service
area and the RHIA defined service area in Figure
14 and Map 5. Rather than include patients from
all three campuses in the Alta Bates Summit
Medical Center, the RHIA defines the HSA solely
for the Alta Bates Campus, in order to identify
specific needs of the Alta Bates Campus patient
population and evaluate impacts of the proposed
campus closure.
0 10000
20000
Contra Costa County 94530, 94801, 94803,
94804, 94805 and 94806
2016
2013
Figure 13. Increased Alta Bates discharges from
Contra Costa County & regional zip-codes
RHIA defined
service area
CHNA
defined
service area
Population 839,299 557,296
Number of Cities 9 3
Number of Zip
Codes 32 24
Figure 14. Alta Bates Hospital Service Areas:

RHIA & CHNA defined
Source: ACS 2012-2016 estimates
32 ZIP codes
RHIA defined
Alta Bates
Campus
hospital
service area
839,299
residents
36% of population
below 200% of the
federal poverty level
18% of population below
100% of the federal poverty level
44% People of Color
Area
Patient discharges
Source: OSHPD, 2013 & 2016

23 Map 4. Large volume
increases in Alta Bates
ED discharges from West
Contra Costa County 2013
- 2016
Alta Bates campus
H
We determined that the larger number of
residents from West Contra Costa County
utilizing Alta Bates Campus in recent years
demanded that we expand the HSA to include
these communities in our analyses (Figure 13).

The increase in patients from West Contra Costa
County can be partly attributed to the closure
of Doctor’s Medical Center (DMC) in the city
of San Pablo, California in 2015. Of the 66,268
patients that visited Alta Bates Campus in 2016,
approximately 18% were from 6 zip codes in
Richmond, San Pablo, El Cerrito, and El Sobrante
(94530, 94801, 94803, 94804, 94805 and 94806)
located in West Contra Costa County (Map
4). From 2013 through 2016, there was a 24%
increase in patients visiting Alta Bates Campus
from Contra Costa County and a 39% increase in
patients visiting Alta Bates Campus from the six
zip codes above.
5,6
Since these communities are in close proximity
to Kaiser Richmond (which has limited ED
capacity and primarily serves Kaiser members)
the closure of Alta Bates Campus is likely to
West Contra Costa
County in the RHIA
defined service area
Additional Cities in
the HSA
Source: OSHPD, 2013 & 2016

24 have a significant adverse impact on access
to ED and hospital care for residents of West
Contra Costa County. These same communities
are also some of the most vulnerable in terms of
having the largest African-American populations,
having preexisting health conditions and being
uninsured.

For example, according to Contra Costa Health
Services 2010 Community Health Indicators
Report:
• African Americans in Contra Costa had a
shorter life expectancy (73 years) than any
other racial/ethnic group in the county.
• African Americans also experienced higher
rates of new cases of colorectal, lung and
prostate cancer, new cases of HIV and AIDS,
hospitalization for non-fatal assault and self-
inflicted injuries, low birth weight infants and
teen births, and a higher percent overweight
and obese fifth-graders.
• The communities of Richmond and San Pablo
had the highest health risks and death rates
(particularly for African American men) from
heart disease, all cancers, diabetes, stroke and
homicides.
• African Americans in Richmond had 254
asthma hospitalizations and ED visits per
10,000 people, compared to 105 for all racial/
ethnic groups.
• The rates of sexually transmitted infections
and people living with HIV/AIDS are
significantly higher in Richmond than in
Contra Costa County.
• A larger percentage of Hispanic students
in Richmond high schools reported
contemplating suicide than other students,
according to the 2011 California Healthy Kids
Survey, Grades 9-11.

The RHIA addresses potential impacts of the
proposed hospital closure on vulnerable
populations served by Alta Bates on page 30 of
this report.

Figure 15. ED Visits by Cause: Comparing the RHIA defined Alta Bates Campus HSA to State and County Rates Asthma Type II Diabetes Assault Unintentional
Injury
Substance
Abuse
0 200
400
600
800
1000
HSA 75%
State of CA
Alameda County
Contra Costa County
Cause for visit
ED visits per 10,000 residents
Source: Sutter Health Needs Maps, 2013

25 Map 5. Comparing RHIA & CHNA defined
Hospital Service Areas
Alta Bates
Campus
2016 CHNA defined Alta
Bates Summit Medical
Center HSA
RHIA defined Alta Bates
Campus HSA
H
Source: OSHPD POMS, 2016 & Alta Bates Summit
Medical Center CHNA, 2016

26 Campus Utilization & Capacity to Absorb Alta Bates Patients The Summit Campus hospital on Hawthorne
Avenue in Oakland includes an emergency
department (ED) and a new patient pavilion
that was renovated in 2014. Despite the recent
renovation and a current emergency department
expansion underway, 9 buildings at the Summit
Campus do not currently meet seismic standards,
and must be retrofitted or stop all inpatient and
ED services by 2030 (Map 6).
10 In 2017, Summit Campus saw a total of 60,038
patients, both hospitalized and from the ED.
47,117 patients were seen in the ED, of which
25% were admitted to the same hospital. In 2017,
Summit had 25 ED treatment stations, down from
32 stations the year prior.
4 Of the approximate 47,000 ED patients in 2017
(including those later admitted to the hospital),
35% were classified as severe and life threatening,
33% were classified as severe but not life
threatening, 25% were moderate, 6% were low/
moderate, and 1% was minor.
4 Since the closure of the Alta Bates Campus
catheterization lab, the Summit campus has
become the central heart attack and ST-
Elevation Myocardial Infarction (STEMI) patient
receiving location. The hospital performed 345
cardiovascular surgery operations in 2016, and
saw 2,531 cardiac catheterization patients (1,106
diagnostic 1,425 therapeutic), which resulted in
3,426 catheterization procedures in total.
8 The Summit Campus includes an emergency room and hospital with 403 licensed beds in 2017. Sutter has indicated that all inpatient and emergency care capacity at Alta Bates Campus will be relocated to the Summit Campus by 2030. However key details about the expansion as well as the capacity for the Summit Campus to absorb an additional 40,000 ED patients remains in question.

SUMMIT CAMPUS IMPACTS

27 *map is not drawn to scale
Total Emergency
Department Patients
47,117 403 147,095 60,038 29 025
Licensed
Beds
Licensed Bed Days
per year
Total patients Diversion
Hours
Summit Campus at a glance in 2017
Total
Live
Births
EMS Treatment
Stations
Map 6. Summit Campus
and affected buildings
Source: OSHPD, 2018
The Summit Campus does not currently have the
capacity to serve the volume of patients seen at
the Alta Bates Campus, particularly for birthing
and emergency care.

Summit currently does not operate a birthing
center, and relocating services to Summit would
require that a new birthing facility be built at the
Oakland campus, with the capacity to deliver
nearly 6,000 babies per year.

To replace Alta Bates Campus emergency
department, Summit
Campus would need
to expand its capacity
by an additional
50,000 emergency
department visits per
year (the number of
ED patients seen at
Alta Bates campus
in 2017), for an
approximate total
of 100,000 visits
annually.

In the case of a relocation of all ED services from
Alta Bates Campus to Summit, the total patient
volume at Summit Campus would exceed any
Emergency Department in the East Bay or San
Francisco, including SF General, the highest traffic
ED in the broader region which had 72,716 ED
encounters in 2016.
8

28 Sutter Health Plans for Summit Campus Expansion
Sutter Health is proposing to relocate all East
Bay inpatient and emergency services to its
Summit C
ampus in Oakland. The Sutter website
dedicated to the proposed closure of Alta
Bates Campus (https://rebuild.altabatessummit.
org), indicates that Sutter plans to build a new
acute care medical center and ED at the Summit
location by the year 2030.

The following section outlines select Frequently
Asked Questions (FAQs) and responses from
Sutter regarding the hospital closure, along with
the RHIA’s relevant key findings.

What services will Sutter Health continue to
provide in Berkeley?
Sutter response:

W
e are committed to making future investments
in Berkeley and see it as a primary location to
provide outpatient care. Our Herrick Campus on
Dwight Way has been identified by the city as a
prime location to deliver medical services. We
plan to expand Herrick’s services, which include
our Comprehensive Cancer Center and Behavioral
Health program. In addition, we currently have
three large care centers, including our newest one
near the Herrick Campus on Milvia Street, where
people can also visit our urgent care center.

RHIA analysis:

Since we did not have details from Sutter on what
services will remain at Alta Bates Campus, we
focused on impacts to the birthing center and ED.

Will the new facility in Oakland be able to
provide enough emergency care?
Sutter response:

W
e plan to enlarge, upgrade and strengthen the
current Summit Emergency Room so that we have
the capacity to handle more than 90,000 ER visits
a year. By the year 2030, we plan to completely
rebuild our ER within a second critical care tower
to be constructed at the Summit Campus.

RHIA analysis:

We detail the ED impacts throughout this report.

A key finding is that the new Summit Campus ED
will need a capacity of approximately 100,000
visits per year, but plans to serve 90,000.
4 This
exceeds the number of visits seen by any ED in
the East Bay or San Francisco.

Oakland is farther away than Berkeley from
wher
e I live. What if I’m having a heart attack or a
stroke and need to call 9-1-1?
Sutter response:

Any non-K
aiser patient in the Alta Bates Summit
service area calling 9-1-1 today for a heart attack
or stroke is already transported to our Oakland
campus, where we have one of the most advanced
heart centers in California. Additionally, the
Summit Campus ER is located next to two major
freeways (I-580 and I-980) in Oakland. It’s actually
faster for most patients in the East Bay – including
those from West Contra Costa County – to get
to our Oakland campus than it is for them to get
to our Berkeley campus, especially during an
emergency.

29 RHIA analysis:

We offer a detailed travel time analyses in the
Emer
gency Services section, on page 43. We
found that private vehicle and transit travel times
will increase for some communities. Where travel
time increases exceed 30 minutes, the literature
suggest patients will experience adverse health
outcomes.

What will happen to the Summit Campus?
Sutter response:

In
August 2014, the new 238-bed patient care
tower opened at the Summit Campus in Oakland.

This new tower meets the state’s 2030 seismic
regulations and is equipped with the latest
technology, ensuring the highest level of medical
care and patient safety. We plan to create a
modern footprint at this campus that will allow us
to build another building – a second pavilion – that
will include new operating rooms, intensive care
units, a modern, expanded Emergency Room and
space for our Women and Infants Birthing Center
and Newborn Intensive Care Unit. It is our plan
to relocate inpatient and emergency hospital
services, including all staff and doctors, from
Berkeley to Oakland by 2030.

RHIA analysis:

As noted above, needs at an expanded Summit
Campus would include a comprehensive birthing
center and significantly increased capacity in
the ED. The Summit Campus is located less than
3 blocks away from the Kaiser Oakland ED.

Although Kaiser Oakland is not accessible to all
patients, its ED has the capacity to see 96,000
visits per year, and was operating 32,313 visits
below capacity in 2017.

Summit currently has the
capacity to see 50,000 ED visits per year, but was
operating under capacity by
2,883 visits in 2017.4
This suggests that while patients currently have
the option to utilize Summit Campus or other EDs
with more capacity, many are choosing to utilize
the Alta Bates Campus ED which was operating
above capacity by over 6,000 visits in 2017.

What happens next?
Sutter response:

Planning a pr
oject of this scale takes years and
must be thoroughly vetted and collaboratively
developed. We will keep our community
informed with accurate and timely information.

This transition must be planned far in advance to
ensure the community’s ongoing health needs are
met without interruption. Please visit this site for
updates or use the information on the Contact Us
page to reach out to us.

RHIA analysis:

Our review of the literature suggests that the
timing of events is crucial to prevent adverse
impacts to those seeking both chronic and urgent
care. A more detailed plan would be necessary,
including public awareness and engagement,
to ensure treatment options are clearly
communicated to current Alta Bates patients and
those seeking urgent care in the region.
*All Sutter Health website text referenced reflects updates as of June 7th 2018

EMERGENC Y

AL TA BAT ES HOSPIT AL

30 IMPACT ON VULNERABLE

POPULATIONS
Vulnerable populations are more likely to be impacted by the proposed closure of Alta Bates Campus, this includes low-income and people of color, Medi-Cal and Medicare patients, pregnant women, and the homeless.

The Alta Bates Campus and ED provide key
medical services to a high volume of patients from
vulner
able populations in the Bay Area region which
include but are not limited to: pregnant women,
People of Color, low-income, uninsured and Medi-
Cal patients, the elderly, and people living with
disabilities. While people of color make up 44% of
the Alta Bates campus Hospital Service Area (HSA),
they represented 63% of hospitalized patients and
56% of ED patients in 2016. An additional 41% of
patients in 2016 were Medi-Cal recipients or self
pay/uninsured, and 23% of hospitalized patients
were over 60.
8 A wealth of evidence suggests that vulnerable
populations may be more severely impacted
by hospital closures, and should be taken into
special consideration in the context of Alta
Bates and the capacity of the East Bay regional
healthcare network. Chen et al (2015) found
that vulnerable populations, particularly African
American and Medicaid patients, have higher
measures of non-urgent ED scores, and are more
Excess burden on already vulnerable people
Increased health inequities
Increased morbidity
Increased mortality
Vulnerable
populations
Uninsured
People of color
Elderly
Pregnant women
Homeless
Delayed critical care
56% of ED patients and 63% of
hospitalized patients were people of color

ALTA BATES PATIENT
DEMOGRAPHICS 2016
41% of patients are uninsured/self
pay or are Medi-Cal recipients
68% of inpatient discharges were
women
23% of hospitalized patients are elderly

31 frequent users of the ED for both non-urgent
and urgent reasons. A 2011 study looking at
major medical services such as outpatient care,
specialty care, marker conditions, births, and
mental health and substance abuse services
found that urban hospital closures led to
disproportionate disruptions in accessing care,
especially for uninsured African-Americans and
Latinx populations, and all women on Medicaid
hospitalized for births (Hsia & Shen, 2011).

The ED visit rate to Alta Bates Campus for
patients living in low-income ZIP Codes (i.e.,
the lowest quartile), increased 23% from 2006
to 2014. There was no change in ED visits for
patients living in higher-median-income ZIP
Codes over this same period. This is not a surprise
finding, but it does suggest that the Alta Bates
Campus ED currently serves an increasingly
number of low-income residents in the Bay Area.

Pregnant Women & Newborn Babies
As noted above, Alta Bates Campus is one of the
region’s premier birthing centers. The age and
gender distribution of hospitalized Alta Bates
Campus patients reflects the high utilization of
its birthing and pregnancy-related services: in
2016, 68% (13,564) of inpatient discharges were
female, and 32% (6,322) of inpatient discharges
were male. 30% (6,018) of inpatient discharges
were for patients under 1 year old, reflecting high
utilization of birthing and the NICU.
8 In 2016, Alta
Bates Campus had 2,145 more births than Kaiser
San Leandro, the second largest birthing center in
the region that year (Figure 17).
3 While being one of the most highly utilized
birthing centers in the region, Alta Bates Campus
has some of the best health outcomes for birthing
services when compared to other regional
birthing centers and CA state averages (Cal
Hospital Compare, 2018). As depicted in Figure
% C-Section in Low-risk
pregnancies % Episiotomy Ex
clusive breastfeeding
before discharge %
% Vaginal birth after
C-Section (VBAC)
Alta Bates Campus 19.4 2.8 86.5 33.2
John Muir - Walnut
Cr
eek 23 7.2 73.7 20.8
Kaiser - San
L
eandro 20.2 6.9 80.7 21.8
State of CA Average 25 9.1 68.5 12.3
Figure 16. Outcomes for Largest birthing centers in Alameda & Contra Costa Counties, 2016 *numbers are reported as percentages (Adapted from CA Health Care Foundation & CHART 2014) Lower is better Higher is better

32 16, Alta Bates Campus reports the
lowest regional rates for C-Section
in low-risk pregnancies and
episiotomy procedures, which
can put mothers at risk for post
surgical complications. Alta Bates
Campus also has the highest rates
for exclusive breastfeeding before
discharge and vaginal birth after
C-section (VBAC) which are both
positive birth indicators for mothers
and newborns.

Alta Bates Campus also has an
active 55-bed, level III newborn
intensive care unit, operated by a
200-person healthcare team (Sutter
Health, 2018). Compared to other
birthing centers in the region, the
Alta Bates Campus NICU has experienced a
consistently high occupancy rate and discharged
a high volume of newborns. In 2016, the NICU
was at nearly 60% occupancy and discharged 964
patients, 350 more than John Muir Walnut Creek,
which had the second highest number of live
births for a non-Kaiser hospital. That year, John
Muir Walnut Creek had a NICU occupancy rate of
27% with 614 patient discharges.
3 Lorch et al (2013) found that when hospital
obstetric units in Philadelphia closed, neonatal
and fetal mortality increased almost 50% in the
first three years after the closure compare to
surrounding counties where hospitals did not
close. This study also found that low income
women tended to receive their prenatal care at
the hospital, not a doctor’s office, and this may
have also had an impact on birth outcomes.

Given the comprehensive prenatal, labor and
delivery, postpartum and specialty newborn care
provided at the Alta Bates Campus as well as
the high volume of births, we determined that
the hospital closure will likely have an adverse
impact on maternal and newborn health in the
region, particularly in the short term. While Sutter
plans to open a new regional birthing center at
the Summit campus in Oakland, the timing and
specific services that will be offered have not been
disclosed.

People of Color
Alta Bates Campus serves diverse communities in
terms of race, ethnicity, and socioeconomic status,
and hospital and emergency department patients
have consistently included a high proportion of
low-income and people of color.

In 2016, 63% of inpatient discharges and 56%
of emergency department discharges were for
people of color (African American, Hispanic/
Latino, Asian/Pacific Islander or Native American).

Of the 63% of inpatient discharges for people
of color, 22% were African American, 25%
were Hispanic/Latino, 16% were Asian/Pacific
Islander. White patients made up 32% of all 2016
discharges. For the ED, 56% of discharges were
people of color, including 38% African American,
14% Hispanic/Latino, and 10% Asian/Pacific
Islander. White patients made up 38% of 2016 ED
Figure 17. Number of live births across regional birthing centers 2016 0 1000
2000
3000
4000
5000
6000
Alta Bates
Berkeley
Kaiser San
Leandro
(not open in
2013)
Kaiser
Walnut Creek
Kaiser
Oakland
John Muir
Walnut
Creek
Contra Costa

Regional
Medical Center
Hospital/Birthing Center
Live Births
Source: OSHPD, 2016

33 discharges.8 African American people in particular
were overrepresented in both inpatient and ED
discharges from Alta Bates in 2016, making up
only 18% of the population in the RHIA defined
Alta Bates Hospital Service Area (HSA).

Within the Alta Bates HSA, an estimated 20% of
the population has limited English proficiency;
this figure is higher than both Alameda (18%) and
Contra Costa Counties (14%) (ACS 2012-2016).

Limited English proficiency can create language
barriers between patients and providers, but
can also contribute to decreased healthcare
utilization particularly when a patient must access
a relocated or unfamiliar facility.

Fishman et al (2018) studied ED and clinic usage
in Chicago and found that patients living in
medically under-served areas (MUAs) and areas
with lower spatial access to primary care clinics
had higher odds of preventable ED use. Analyzing
data from the National Hospital Ambulatory
Care Survey, Johnson et al. (2012) observed
higher preventable ED use among those who
were female, non-Hispanic black or Hispanic,
older, or publicly insured, and that areas with
large concentrations of ethnic and racial minority
populations have been shown to have high rates
of preventable use of EDs. While a significant
portion of preventable ED use can be addressed
by improved access to primary care, EDs still serve
as an essential care provider for those unable to
access care by other means. Chen et al. (2015)
found that lower-income vulnerable populations,
particularly African Americans and Medicaid
patients, more frequently utilized the ED for both
non-urgent and urgent reasons, and these same
populations tended to utilize the hospital ED for
medical conditions that could be addressed in a
primary care setting.

With high rates of ED and hospital service
utilization, and representing large percentage
of the population in the HSA, people of color
will be disproportionately burdened by the
closure of Alta Bates Campus. We are especially
concerned with access for both urgent and non-
urgent conditions, and the continuity of care
for people of color that are already relying on
Alta Bates’ ED for regular care. Related to the
closure of Alta Bates Campus, we would expect
short term (first 1-3 years) delays in seeking
treatment, increased severity of some diseases,
increased hospitalizations due to delays in
seeking care, increased costs of treatment (i.e.,
medications, doctor visits, etc.) and potentially
increased morbidity and mortality (especially from
conditions already disproportionately burdening
Figure 18. Percent race/
ethnicity in the HSA
compared to county and
state rates
0 10
20 30
40 50
60 HSA 75%
Alameda County
Contra Costa County
African American Hispanic/Latinx Asian White
Race/Ethnicity
Percent
Source: ACS 2012-2016

34 people of color such as diabetes, heart disease
and asthma) for people of color in the region.

T
he high utilization of the ED for both urgent
and non-urgent conditions raises an opportunity
in the Bay Area for increased coordination and
communication between primary, urgent, and
emergency care providers. While the region
has a network of urgent care facilities that may
be able to absorb some of the preventable ED
patient traffic, urgent care hours of operation and
insurance plans accepted may still pose barriers
to low-income and people of color.

People with Disabilities
According to the US Census, 95,840 people or
11% of the population in the HSA are living with
a disability, of which at least 61% are racial/
ethnic minorities. White people represent 44%
of the population in the HSA, however they make
up only 9% of people living with disabilities.

Conversely, the Native American and Pacific
Islander populations, which combined constitute
less than 2% of the total HSA population,
represent 31% of people living with disabilities in
the area.

While this RHIA does not frame disability as a
medical condition, we recognize that people
living with disabilities may be adversely impacted
by the closure of Alta Bates Campus due to
transportation barriers and increased distance,
unfamiliarity with relocated services, and other
accessibility challenges.

Uninsured & Publicly Insured Patients
As discussed above, Alta Bates Campus serves
a large number of low-income patients. In the
HSA, over 18% of the population lives below the
federal poverty level, and 36% of the population
live below 200% of the federal poverty level. This
has a large impact on children and young people,
as 61% of public school students are eligible for
free/reduced price lunch, compared to 44% in
Alameda County and 40% in Contra Costa County.

This is consistent with the high rate of Medi-Cal
covered patients (25%) and uninsured patients
(11%) in the hospital service area (ACS 2012-
2016).

Alta Bates Campus’ 2016 expected payer sources
(Figure 19) for emergency department patients
highlights that a large percentage of Alta Bates
patients are from vulnerable populations, as
68% of Alta Bates ED patients were expected to
pay via either Medicare, Medi-Cal or were self-
pay/uninsured.
8 Medicare serves populations
over 65 and also serves people with disabilities.

People utilizing Medicare represent vulnerable
populations, such as the aging/elderly,
socioeconomically vulnerable and people with
disabilities. Medi-Cal serves socioeconomically
vulnerable populations, by qualifying people/
families that are at 138% of the federal poverty
level or below (i.e. $28,677 annually for a family
of 3), which is very low-income for California and
especially the Bay Area (DHCS, 2018).

Uninsured patients are also extremely vulnerable,
as uninsured patients can include patients that
are low-income, homeless and/or undocumented
immigrants. Hsia et al (2013), found that between
2005-2010 in California, ED visits by Medicaid
beneficiaries increased by 14%, significantly
higher than privately insured patients. According
to the 2006 California Health Care Foundation
34% 26%
7%2%
31%
Medicare
Medi-cal
P
rivate insurance
Self-pay/uninsured
Unknown
Figure 19. Alta Bates
Campus expected payer
source 2016
Source: OSHPD, 2016

35 report, Overuse of
Emer
gency Departments
Among Insured
Californians,
even insured
patients can be more
frequent ED users than
uninsured patients,
particularly those with
Medicaid coverage,
which still leaves them
with difficulties in
accessing primary care.

The Aging & Elderly
Aging people and the elderly (60+ years old)
account for a disproportionately high percentage
of inpatient discharges and emergency
department visits at both Alta Bates and Summit
Campuses. Despite representing only 18% of
the population in the RHIA defined HSA In 2016,
the 60+ year old population accounted for
approximately 23% of inpatient discharges and
over 30% of emergency department visits at the
Alta Bates Campus. That same year, the 60+ year
old population accounted for approximately
65% of inpatient visits and 39% of emergency
department visits at the Summit Campus.
8 The aging and elderly population is expected to
increase in the coming decades. According to
the Public Policy Institute of California, the 65+
year old population is expected to grow 87%
from 2012 to 2030, and the California Health
Care Foundation has similar findings, noting that
California’s 65+ year old population is projected
to more than double from 2000 to 2030, growing
to 8.8 million.

In 2012, the RHIA defined HSA had a 65+ year
old population of 93,537, and with an 87%
growth projection, will reach 174,914 in 2030
(ACS 2008 - 2012). This growing population is
critical to consider because this age group is
among the highest users of both emergency
and inpatient care. The California Health Care
Foundation noted that due to seniors’ high rate
of hospitalizations, acute care hospital days are
projected to increase by 76% from 2000-2030,
and by 2030, the 65+ group is projected to use
over half of the state’s acute care days, despite
representing only 18% of the population.

The CA Health Care Foundation suggests that
by 2030 there will be an insufficient number of
acute care beds in the SF Bay Area due to the
increasing numbers of hospitalized elderly. And,
considering the high utilization of the emergency
department by the 60+ year old population and
the quick growth rate of that demographic, it is
unlikely that a new emergency facility designed
to meet current capacity would be able to
accommodate the combined growth of the elderly
and regional population, which could impact
timely care for all patients needing to access
emergency treatment.

A study that included focus groups with seniors
two years after the closing of a Pittsburgh hospital
(Countouris et al 2014) found that seniors’ health
was adversely impacted from a combination of
feelings of sadness and loss, fear of finding a new,
unfamiliar facility, and powerlessness. Elderly in
this study also expressed concerns about having
to navigate a new facility/location, uncertainty
about transportation that resulted in canceled
doctor’s appointments, and higher parking
costs at the new facility. Bindman et al (1990)
found that hospital closures resulted in delayed
treatment for the uninsured and elderly because
“I know seniors that don’t drive and used to regularly use DMC (Doctor’s Medical Center, San Pablo) for speciality and emergency situations. Now that DMC is closed, some have to travel 2 hours by public transportation to see speciality doctors.

That has a huge impact on whether or not they receive care.”

- Local government official, Bay Area

36 of inconveniences and difficulties in finding new
providers.

Buchmueller et al (2006) r
evealed that hospital
closures in the Los Angeles area increased travel
distances to ED and ancillary care and contributed
to an increase in heart attack deaths, most notably
for the region’s elderly population.

This RHIA suggests that the elderly and uninsured
will be adversely impacted from the closure of
Alta Bates Campus, both due to ED and chronic
care needs. The elderly living in the HSA may be
most adversely impacted if an adequate number
of beds are not provided (such as at the Summit
campus), due to their increasing numbers and
inpatient needs. The uninsured and publicly
insured will be adversely impacted from the lack
of access to a familiar ED for both chronic and
urgent medical needs. W
e expect, especially
in the short term, interruptions and delays in
seeking care, increased severity of disease,
potential greater spread of infections, increased
need for costly future care and potentially
increased hospitalizations. We are less confident
in the possibility of increased mortality, but this is
a possibility especially for the elderly.

Mental health & Suicide Prevention
While the Sutter Herrick Campus in Berkeley
is a designated site for mental health care, the
Alta Bates Campus ED plays a significant role in
treating and identifying mental health patients
that may first be seen through emergency care. In
2018, the Lancet Public Health journal published,
“Suicide in the USA: A Public Health Emergency”
noting that the rate of mental health/ substance
abuse-related ED visits increased 44% from 2006
to 2014, with suicidal ideation growing 415% over
this period.

The Alta Bates Campus ED acts as a first-
responder to screen for, intervene and refer for
mental health care and suicide prevention. In
2016, almost 4% of ED patients were transferred
to psychiatric care.
8 Since the hospital ED is often
associated with traumatic events, it is the ideal
environment to perform suicide risk assessments.

Individuals in a suicidal crisis often seek help at
a hospital ED. EDs also frequently provide care
for people with other risk factors for suicide,
such as serious mental illness, substance use
disorders and chronic pain. The ED visit is an
important window of opportunity, however brief,
to intervene and save lives (Ahmedani et al 2014).

EDs can reduce suicide attempts among high-
risk patients by delivering a combination of
interventions that includes suicide risk screening,
discharge resources, and other interventions (Betz
et al 2016; Larkin & Beautrais, 2010). A multi-site
study found that when compared to treatment as
usual, a combined set of interventions starting in
the ED resulted in a 5% decrease in the proportion
of patients who attempted suicide in the 52 weeks
after their initial ED visit and an overall 30% drop
in the total suicide attempts (Miller et al 2017).

The presence of the Herrick Campus, with its
comprehensive mental health services, may be
able to accommodate any potential delays in care
for those currently utilizing Alta Bates Campus.

Significant impacts on mental health for the
population in the HSA from the closing of Alta
Bates Campus may be difficult to quantify.

Homeless People
Homeless people and families, some with mental
health care needs, tend to rely on the ED for
care (Karaca et al 2013). Nearly three out of four
inpatient stays by homeless individuals began
in the ED, compared with half of stays for non-
homeless patients. Due to multiple barriers in
accessing care, including lack of insurance and
transportation as well as poor continuity of care,
homeless people frequently use EDs as their
primary or only source of health care.

37 A 2002 study by Kushel et al. examined the
factors associated with emergency room visits
among 2,578 homeless and marginally housed
persons. They found that 40.4% of the 2,578
visited an emergency room one time or more
during the previous year, and that less-stable
housing, chronic illness and victimization were
associated with emergency department use
among homeless and marginally housed persons.

The study also suggests that emergency care is
a primary option for homeless and marginally
housed persons due to convenience and 24-hour
operation, and because they face challenges
in addressing medical needs outside of an
emergency setting.

In 2017, many Bay Area hospitals reported
increases in homeless patients from the prior year.

Figure 20 shows the total number of homeless
patients that visited the Alta Bates Campus and
5 other major East Bay regional hospitals in
2017, and the volume increase in patients
from 2016. Kaiser Richmond and Kaiser
Oakland combine hospital data, and are
represented as one site in the analysis.

The figure highlights that all six hospitals
saw a significant increase in the number
of patients from 2016 to 2017, with
the Alta Bates Campus seeing nearly
a 600% increase in homeless patients,
rising from 60 to 409. Highland Hospital
had the smallest percentage increase
in homeless patients but served 1,118
homeless patients in 2017. Importantly,
aside from Highland and the Herrick
Campus, at least 89% of homeless
patients seen were either emergency
department patients or inpatient from the
emergency department, underscoring
how essential emergency room care is for
the homeless and marginally housed.
6 While the cause behind the increases
in annual reported homeless patients
across Bay Area hospitals is unclear, a
recent quicknotes memo published by OSHPD
suggests that the number of homeless patients
has been historically underreported (OSHPD,
2018).

We find that the loss of Alta Bates Campus and
its critical emergency and mental health care
services may have an impact on the surrounding
area’s homeless population, particularly if the
increasing trends in homeless patients seeking
emergency care continue.

Adverse Impacts on Vulnerable Communities in
the Alta Bates Hospital Service Area
Alta Bates Campus currently serves some of the
most vulnerable communities in the Bay Area,
such as those mentioned above in West Contra
Costa County as well as many communities in
Alta Bates
Campus
Kaiser
Oakland/
Richmond
Herrick
Campus
Summit
Campus
HighlandContra Costa
Regional
Medical Center
Figure 20. Total Homeless patients at select East Bay hospitals 2016 - 20176

38 Oakland and other parts of Alameda County.

Community vulnerability includes not just current-
day utiliza
tion of hospital care, but the likelihood
of future needs based on health-influencing
risks, such as poverty, low education, housing
displacement, exposure to pollution and violence.

These same communities are also vulnerable
since a large percentage of the populations living
there have preexisting health conditions that
require chronic care.

The 2016 Alta Bates Summit Medical Center
Community Health Needs Assessment (CHNA)
recognized these vulnerable communities as
the medical center’s “communities of concern.”
The 2016 CHNA identified 13 ‘vulnerable
community’ ZIP Codes that represented 65% of
the population served by all three campuses in
the Alta Bates Summit Medical Center.

Figure 21. Alta Bates Summit Medical Center CHNA
Communities of Concern
Source: Alta Bates Summit Medical Center CHNA, 2016
ZIP Code Community
94601 East Oakland/Fruitvale
94602 Oakland/Glenview
94603 East Oakland/Brookefield
94605 East Hills/Oakland Zoo
94606 Oakland/Cleveland Heights
94607 W
est Oakland/Jack London
94608 Emeryville
94609 Oakland/MLK
94612 Downtown Oakland
94621 East Oakland
94702 Northwest Berkeley
94703 Northwest Berkeley
94710 West Berkeley/Marina
To identify communities of concern in the 2016
CHNA defined hospital service area, the CHNA
authors identified significant health needs and
developed what the report calls the ‘Community
Health Vulnerability Index’ (CHVI), which
combines the following indicators of community
vulnerability into one CHVI index value (Map 7):
• Percent Minority
• Population 5 Years or Older Who Speak
Limited English
• Percent 25 or Older Without a High School
Diploma
• Percent Unemployed
• Percent Families with Children in Poverty
• Percent Households 65 years or Older in
Poverty
• Percent Single Female-Headed Households in
Poverty
• Percent Renter-Occupied Households
• Percent Uninsured
For this report we were not able to calculate CHVI
scores for the additional ZIP Codes included in
the RHIA defined HSA using the 2016 CHNA
Map 7: 2016 CHNA defined service area CHVI scores
Oakland
Berkeley
Emeryville
Source: Alta Bates Summit Medical
Center CHNA, 2016

39 Map 9: Percent of Families (with Children) in Poverty across Census Tracts in the RHIA defined Service Area
Source: Community Commons, 2018
Map 8: Percent Uninsured across Census Tracts in the RHIA defined Service Area
Source: Community Commons, 2018
methodology. However, we reviewed each of
the CHVI indicators to assess the vulnerability of
the additional ZIP C
odes (primarily communities
in West Contra Costa County) using ACS 2012-
2016 estimates. This review indicated that many
communities in West Contra County likely meet
the same standard of vulnerability as the 13
communities of concern in the 2016 CHNA, which
did not include any ZIP Codes outside of Alameda
County.

The vulnerable communities from West
Contra Costa County include ZIP Codes within
Richmond, San Pablo, El Cerrito, and El Sobrante;
cities for which Alta Bates Campus saw a 39%
increase in discharges between 2014-2016.

Maps 8 & 9 highlight select CHVI indicators for
communities in the RHIA defined HSA. As both
maps indicate, communities in West Contra Costa
show high levels of vulnerability at comparable
rates to those in Oakland, Emeryville, and parts
of Berkeley, in Alameda County. In addition to
the review of CHVI indicators, we reviewed data
compiled by Sutter Health on their interactive
Health Needs Maps website. The website
provides 2011 data on hospitalization and ED visit
rates by condition, reported per 10,000 residents
and aggregated by ZIP Code. We compared
the following 11 available reported causes
(conditions) for ED visits and hospitalizations
across all ZIP Codes in the RHIA defined hospital
service area (HSA):

1. Asthma

2. COPD

3. Diabetes

4. Heart disease

5. Hypertension

6. Mental health
0 1.5mi 0 1.5mi

40 7. Assault

8. Self-inflicted injury

9. Unintentional injury

10. Stroke

11. Substance abuse
From this data, we identified high need ZIP Codes
that fell within the top quartile relative to all zip
codes in the HSA for each condition. We then
ranked the top10 ZIP Codes in order of highest
need (those that fell within the top quartile most
often for the 11 conditions).

Figure 22. High Health Care Need Communities in the RHIA defined HSA
ZIP Code Community
94801 Richmond/Ir
on Triangle
94804 South Richmond
94806 San Pablo
94621 East Oakland
94612 Downtown Oakland
94609 Oakland/MLK
94608 Emeryville
94607 West Oakland/Jack London
94605 East Hills/Oakland Zoo
94603 East Oakland/Brookefield
Figure 22 lists the top 10 high health care need
ZIP Codes in the RHIA defined HSA from highest
to lowest need.

ZIP Codes that overlap with the
2016 CHNA communities of concern (listed in
Figure 20) are highlighted in yellow.

Consistent with our review of CHVI indicators
in the RHIA defined HSA, we found that West
Contra Costa County ZIP Codes are particularly
vulnerable.

Zip Code 94801 in Richmond,
which includes unincorporated North Richmond,
the Iron Triangle neighborhood, and relatively
wealthy Point Richmond, ranks first out of all zip
codes in the HSA for ED visits for all 11 conditions,
and is 1st for stroke, 2nd for diabetes and heart
disease, 3rd for asthma and 4th for injury-assault.

The 94804 South Richmond ZIP Code ranked
1st in heart disease-related ED visits, and the
94806 San Pablo and 94804 Richmond Iron
Triangle ZIP Codes were ranked 3rd and 4th for
highest incidence of diabetes-related inpatient
hospitalization. As highlighted in Figures 23 and
24, many of the high health care need ZIP Codes
experienced ED visit rates greatly exceeding
those of both Alameda and Contra Costa
Counties as well as the state of California in 2011.

While there are many vulnerable communities in
the RHIA defined HSA that fall outside of West
Contra Costa County (primarily in Oakland and
Emeryville), these communities are currently
served by existing services at the Summit
Campus, as well as Highland Hospital and Kaiser
Oakland, and are likely to be less adversely
impacted by a closure of Alta Bates Campus.

As noted above, we predict a disproportionate
adverse impact on access to chronic and urgent
care for the communities of West Contra Costa
County, particularly Central and North Richmond,
from a closure of Alta Bates Campus. Access
to care in these communities has already been
adversely impacted by the closure of Doctors
Medical Center and the limited capacity of Kaiser
Richmond.

41 Figure 24. Select ZIP Codes - Asthma and Diabetes ED visits per 10,000 residents Asthma Diabetes
Richmond & Iron Triangle
Emeryville
San Pablo
Alameda County
Contra Costa County
0 100
200
300
400
500
600
Visits per 10,000 residents
Source: Sutter Health, Health Needs Maps, 2011
Tilden/Berkeley Hills - 94708
Northside Berkeley - 94709
Berkeley Hills / Kensington - 94707
Berkeley Claremont / Elmwood - 94705
Albany - 94706
Oakland Rockridge - 94618
El Cerrito - 94530
Piedmont / Oakland Montclair - 94611
Berkeley Downtown / South of Campus - 94704
Oakland Grand Lake / Lakeshore - 94610
Alameda - 94501
Central Oakland - 94606
Oakland Dimond - 94602
El Sobrante - 94803
Oakland Hills / Laurel - 94619
Berkeley Sacramento Cooridor - 94703
West Berkeley - 94710
Berkeley San Pablo Cooridor - 94702
East Richmond - 94805
Oakland Fruitvale - 94601
Oakland Temesal / Bushrod / Pill Hill - 94609
West Oakland - 94607
Oakland Uptown - 94612
East Oakland / Coliseum - 94621
Oakand Hills / Eastmont - 94605
San Pablo - 94806
Emeryville - 94608
East Oakland / Elmhurst - 94603
North Richmond, Iron Triangle, Point Richmond - 94801
South Richmond - 94804
0 50 100 150 200 250 300
California
Alameda County
Contra Costa County
Figure 23. Heart Disease ED visits per 10,000 residents for all ZIP Codes in the RHIA defined Alta Bates HSA Visits per 10,000 residents

42 In the 2017-18 academic year, the University of
California Berkeley had 30,574 undergraduate
students, 11,336 graduate students, and
approximately 12,000 staff (UC Berkeley Office
of the Vice Chancellor of Finance, 2017). Since
we did not have complete information on
staff health insurance, this RHIA focuses on
the potential impacts of the closing of Alta
Bates Campus on student health care access.

Roughly half of UCB students are enrolled in
the Student Health Insurance Plan (SHIP), with
the remainder enrolled either in alternative
private insurance plans or through Medi-Cal.

SHIP covers medical, counseling, prescription,
vision and dental services. In interviews with
Tang Center staff including Executive Director
of University Health Services, Claudia Covello,
and Medical Director Dr. Anna Harte, we learned
that a larger proportion of graduate students
are likely enrolled in SHIP . This is due in part to
undergraduates being able to remain on their
parents’ insurance plans until
age 26. Regardless of insurance
enrollment, all students have
access to the on-campus Tang
Health Care Center.

The University Health Service
Tang Center is a fully-accredited
outpatient center designed
to address most medical, mental health and
health education issues. The Tang Center
employs about 300 physicians, registered
nurses, nurse practitioners, medical assistants,
physical therapists, pharmacists, nutritionists, lab/
radiology/pharmacy technicians, social workers,
licensed psychologists and psychiatrists, and
health educators. An urgent care facility is open
seven days a week but limited to working hours,
with reduced hours on weekends.

While the Tang Center is a student health asset,
it is not a licensed hospital and therefore relies
heavily on Alta Bates Campus for timely referrals
of acutely ill patients for conditions including
appendicitis, ectopic pregnancies, blood clots,
and head injuries requiring scans. According
to the Tang Center, they refer approximately
2,500-3,000 students per year to the ED, 21% for
surgery and 41% for emergency care alone (not
all, but most, go to ABMC). Approximately 1-2
students per day require ambulance transport to
the hospital. An additional 2 students per week
may require hospitalization for psychiatric care
from Tang.

There can be daily communication between
Tang practitioners and Alta Bates and this close
relationship enables students to receive referrals
for potentially serious illnesses. In addition

IMPACTS ON UC BERKELEY

STUDENT HEALTH CARE
Cal
The UC Berkeley student population may be adversely impacted by increased travel times to the Summit campus. The campus can generate about 4,000 student ED visits per academic year, and the UC Tang Center alone estimates about 1,500 student ED r
eferrals per year. While the Tang Center can meet the majority of urgent care student needs, it is not open 24 hours and does not perform imaging, surgery, and some emergency services make the UC Berkeley student population particularly reliant on Alta Bates Campus.