Science
California Health and Human Services chief Dr. Mark Ghaly to step down
Dr. Mark Ghaly is stepping down as head of the California Health and Human Services Agency after an eventful tenure that included the eruption of the COVID-19 pandemic, Gov. Gavin Newsom announced Friday.
Newsom called Ghaly “a driving force for transformative changes to make healthcare more affordable and accessible,” whose leadership during the pandemic “saved countless lives and set the stage for our state’s strong recovery.” The governor’s office also credited Ghaly with reimagining Medi-Cal, the California Medicaid program; overhauling the state behavioral health system; and launching efforts to make crucial medications more affordable, among other initiatives.
Ghaly was appointed in 2019 to lead the state agency, which oversees a slew of California departments and offices that handle public health, mental health, assistance to people with developmental disabilities and a range of other health and social services.
Ghaly will stay at the agency through the end of the month. Newsom is appointing California Department of Social Services Director Kim Johnson to replace Ghaly in October. The Times talked to Ghaly this week about his tenure.
This conversation has been edited for length and clarity.
What were the three biggest challenges you faced at Health and Human Services, and what are the three biggest challenges facing your successor?
One of the big ones was navigating, under the governor’s leadership, this state through our COVID response — that obviously is a huge one. The second one, I think, is really addressing a comprehensive overhaul of our safety net …. And then the third piece has been, how do we make sure that for all Californians, we’re making progress to keep these basic necessities affordable, like healthcare … ?
The successor will certainly need to continue implementing the really thoughtful policy agenda that has stitched together … this real tapestry of programs and services that, when implemented successfully, I think really changed the arc of the lives of a lot of Californians, in particular the most vulnerable.
The focus on the principles of equity … I have no doubt that will continue to be a focal point. And then just on the last point, there’s a lot of pundits and detractors on the affordability agenda: Can we make thoughtful policy decisions and implement them to make things more affordable for Californians?
Having started a year before the pandemic, if you knew then what you know now, is there anything that you would do differently, in terms of the COVID response in California?
If you had told me that we had to successfully navigate California — the largest state in the nation — with one of the lowest end death rates from the disease, with a very thoughtful path to economic recovery, and while achieving that, build up and grow the California Health and Human Services Agency’s investment by nearly 50% over these six years, I would have said, ‘Sign me up for that job any day of the week. What a privilege.’
But of course, there are things that happened during the pandemic, that as it goes on and you think through it, you hope you may do something different in the future. And I would say No. 1 on the list for me … is how we supported young people with learning and school.
You’ll remember early on, the question about how to handle … schools as places where people become infected and go home and infect other vulnerable people — we were learning more about this sneaky airborne virus that mutated as it went along. And we made decisions in this state to have kids stay home, [to] really lean into virtual distance learning, and it stuck much longer than I think people had hoped …. And the governor put together a number of programs that supported their education in all sorts of forms.
But I think knowing what we know now about both the virus, the length of the pandemic — some of that information would have been helpful in those early days, weeks, months, around how we supported kids in schools.
During your time at the agency, we’ve seen some major changes in how California handles severe mental illness: the opening of CARE Court and Senate Bill 43, which broadened the definition of grave disability for involuntary treatment …. Do you think it is bringing about the change that was hoped for?
When I say the full transformation of the safety net, I can think of no better issue, single issue to focus on than behavioral health. Under Gov. Newsom’s leadership, we have changed from a focus on mental health to behavioral health, to include the very real need to focus on addiction and substance use disorders, its connection to things like housing instability and homelessness, its connection to incarceration.
When I came into this job, in my actual interview with the governor before I was appointed, we talked about how much we wanted to change the trajectory of people with serious mental health and behavioral health conditions, because in so many ways, the often ending place for individuals was jail, incarceration, prison ….
[With CARE Court] our goal was not just to get people in the line, but to get people in the front of the service line that so often are left outside to decompensate … until they do something that gets them arrested, and then suddenly we start to wrap around some of the care that they need, but often in the worst environment possible.
I do think the governor’s many programs that focus on behavioral health … when you take a step back and look at it all together, it’s essentially giving Californians and local government tools that they never had to be able to dream differently and put together a program that, I think, really gives us a credible shot to catch people much earlier in their trajectories with the challenges of behavioral health conditions, rather than what we so frequently do ….
I think we’re going to see these programs really pay off as they become more deeply seated [and] we work through some of the obvious operational challenges.
California has been expanding Medi-Cal, its Medicaid program, to cover many more people, but there’s been concern from healthcare providers that it doesn’t pay them adequately, which results in a shortage of providers willing to accept Medi-Cal patients. How should California fix that problem?
A: I often tell the governor, ‘Look, there’s four basic things when you talk about health services. You think about benefits, you think about access, you think about quality, you think about eligibility.’ And I think the governor has addressed all of those areas ….
We made pretty big investments in some of what I’ll call the bread-and-butter rates in Medicaid, bringing them either to 100% or close to 100% of what Medicare pays in this part of the country. Because of some budget challenges, we had to back off some other planned investments for this coming year, but as that budget starts to hopefully turn around … I know those will be an ongoing place of focus.
Mind you, Medicaid has a lot of different ways for providers and plans to receive payment …. I think as you look at that in totality, the opportunities to recruit providers to take care of the Medicaid population is stronger than it was when Gov. Newsom took office six years ago.
That all said, this has to be an ongoing sort of balance and conversation about how we continue to support this program, because one in three Californians now depend on Medicaid. So many kids — more than 33%, closer to 50% of kids — are dependent on Medicaid. When you have that vital a safety net program, we must continue to keep our eye on all four of those elements: quality, access, eligibility and benefits.
Earlier this year, the Office of Health Care Affordability announced a target of 3% annual growth in healthcare spending, to be phased in over time. How do you anticipate that healthcare providers will reach that target, given the kinds of pressures that have ramped up costs in the past — things like labor costs and inflation?
I think it’s going to require some real movement away from our traditional views on how you operate healthcare. We’re going to really have to make some decisions about moving more things upstream — promoting prioritizing things like preventative care and primary care, helping support other access points for people where access is challenging, and frankly speaking, really looking at some of the benefits of each of the different entities in the whole healthcare delivery system ….
We don’t expect everyone in California to always be there. There will be some conditions that legitimately push the markets in a different direction.
But as a whole, if we don’t chase a target that is both aggressive and achievable, that affordability problem that so many Californians face won’t just not get better — it is likely to get worse.
Reporters who cover the Capitol have raised concerns about interviews like this becoming rare. I know for me, personally, it’s been unusual to get anyone from the Department of Public Health on the phone. Why aren’t these departments routinely speaking directly to the media, instead of sending written statements?
Frankly, it is less about a lack of interest in speaking directly to the media — often, the interviews allow directors and leaders to very clearly convey nuance and important points.
My experience has been, so often the questions that reporters want answers to have some ability to be answered very clearly in a written form. And so we’ve used that frequently — not to sort of hide behind something or avoid the live interview — but because it seems and has been adequate in many of those conversations or requests.
One of the things I know you’ve been working on lately is this state plan on services for Californians with developmental disabilities. In California, these services have long been coordinated through a system of nonprofits called regional centers, which contract with the state. Do you believe that system is working for Californians and their families, and if not, what do you think needs to change?
One of the most important themes that got amplified during COVID was this notion of building trust through transparency …. And in my time and experience, I have heard loud and clear [from consumers and their families] that this system is not as transparent as it can be or that it should be, and I agree with that.
So part of the work of this new strategic plan … is recognizing that Gov. Newsom did something unprecedented. He took a rate study from before he came into office and implemented it …. We’re on a trajectory to fully implement that soon [Ghaly is referring to increases in rates paid to regional center vendors that provide services to people with disabilities] …. To say it plainly, we — given the level of investment — should become a lot more of a system that’s able to say “yes” to consumers, rather than “no” or delay.
Science
Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind
The American Cancer Society’s 2026 Cancer Statistics report, released Tuesday, marks a major milestone for U.S. cancer survival rates. For the first time, the annual report shows that 70% of Americans diagnosed with cancer can expect to live at least five years, compared with just 49% in the mid-1970s.
The new findings, based on data from national cancer records and death statistics from 2015 to 2021, also show promising progress in survival rates for people with the deadliest, most advanced and hardest-to-treat cancers when compared with rates from the mid-1990s. The five-year survival rate for myeloma, for example, nearly doubled (from 32% to 62%). The survival rate for liver cancer tripled (from 7% to 22%), for late-stage lung cancer nearly doubled (from 20% to 37%), and for both melanoma and rectal cancer more than doubled (from 16% to 35% and from 8% to 18%, respectively).
For all cancers, the five-year survival rate more than doubled since the mid-1990s, rising from 17% to 35%.
This also signals a 34% drop in cancer mortality since 1991, translating to an estimated 4.8 million fewer cancer deaths between 1991 and 2023. These significant public health advances result from years of public investment in research, early detection and prevention, and improved cancer treatment, according to the report.
“This stunning victory is largely the result of decades of cancer research that provided clinicians with the tools to treat the disease more effectively, turning many cancers from a death sentence into a chronic disease,” said Rebecca Siegel, senior scientific director at the American Cancer Society and lead author of the report.
As more people survive cancer, there is also a growing focus on the quality of life after treatment. Patients, families and caregivers face physical, financial and emotional challenges. Dr. William Dahut, the American Cancer Society’s chief scientific officer, said that ongoing innovation must go hand in hand with better support services and policies, so all survivors — not just the privileged — can have “not only more days, but better days.”
Indeed, the report also shows that not everyone has benefited equally from the advances of the last few decades. American Indian and Alaska Native people now have the highest cancer death rates in the country, with deaths from kidney, liver, stomach and cervical cancers about double that of white Americans.
Additionally, Black women are more likely to die from breast and uterine cancers than non-Black women — and Black men have the highest cancer rates of any American demographic. The report connects these disparities in survival to long-standing issues such as income inequity and the effects of past discrimination, such as redlining, affecting where people live — forcing historically marginalized populations to be disproportionately exposed to environmental carcinogens.
Dr. René Javier Sotelo, a urologic oncologist at Keck Medicine of USC, notes that the fight against cancer in Southern California, amid long-standing disparities facing vulnerable communities, is very much about overcoming educational, cultural and socioeconomic barriers.
While access to care and insurance options in Los Angeles are relatively robust, many disparities persist because community members often lack crucial information about risk factors, screening and early warning signs. “We need to insist on the importance of education and screening,” Sotelo said. He emphasized that making resources, helplines and culturally tailored materials readily available to everyone is crucial.
He cites penile cancer as a stark example: rates are higher among Latino men in L.A., not necessarily due to lack of access, but because of gaps in awareness and education around HPV vaccination and hygiene.
Despite these persisting inequities, the dramatic nationwide improvement in cancer survival is unquestionably good news, bringing renewed hope to many individuals and families. However, the report also gives a clear warning: Proposed federal cuts to cancer research and health insurance could stop or even undo these important gains.
“We can’t stop now,” warned Shane Jacobson, the American Cancer Society’s chief executive.
“We need to understand that we are not yet there,” Sotelo concurred. ”Cancer is still an issue.”
Science
Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations
As the state continues multiyear marathon discussions on rules for what residents in wildfire hazard zones must do to make the first five feet from their houses — an area dubbed “Zone Zero” — ember-resistant, the Los Angeles City Council voted Tuesday to start creating its own version of the regulations that is more lenient than most proposals currently favored in Sacramento.
Critics of Zone Zero, who are worried about the financial burden and labor required to comply as well as the detrimental impacts to urban ecosystems, have been particularly vocal in Los Angeles. However, wildfire safety advocates worry the measures endorsed by L.A.’s City Council will do little to prevent homes from burning.
“My motion is to get advice from local experts, from the Fire Department, to actually put something in place that makes sense, that’s rooted in science,” said City Councilmember John Lee, who put forth the motion. “Sacramento, unfortunately, doesn’t consult with the largest city in the state — the largest area that deals with wildfires — and so, this is our way of sending a message.”
Tony Andersen — executive officer of the state’s Board of Forestry and Fire Protection, which is in charge of creating the regulations — has repeatedly stressed the board’s commitment to incorporating L.A.’s feedback. Over the last year, the board hosted a contentious public meeting in Pasadena, walking tours with L.A. residents and numerous virtual workshops and hearings.
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Some L.A. residents are championing a proposed fire-safety rule, referred to as “Zone Zero,” requiring the clearance of flammable material within the first five feet of homes. Others are skeptical of its value.
With the state long past its original Jan. 1, 2023, deadline to complete the regulations, several cities around the state have taken the matter into their own hands and adopted regulations ahead of the state, including Berkeley and San Diego.
“With the lack of guidance from the State Board of Forestry and Fire Protection, the City is left in a precarious position as it strives to protect residents, property, and the landscape that creates the City of Los Angeles,” the L.A. City Council motion states.
However, unlike San Diego and Berkeley, whose regulations more or less match the strictest options the state Board of Forestry is considering, Los Angeles is pushing for a more lenient approach.
The statewide regulations, once adopted, are expected to override any local versions that are significantly more lenient.
The Zone Zero regulations apply only to rural areas where the California Department of Forestry and Fire Protection responds to fires and urban areas that Cal Fire has determined have “very high” fire hazard. In L.A., that includes significant portions of Silver Lake, Echo Park, Brentwood and Pacific Palisades.
Fire experts and L.A. residents are generally fine with many of the measures within the state’s Zone Zero draft regulations, such as the requirement that there be no wooden or combustible fences or outbuildings within the first five feet of a home. Then there are some measures already required under previous wildfire regulations — such as removing dead vegetation like twigs and leaves, from the ground, roof and gutters — that are not under debate.
However, other new measures introduced by the state have generated controversy, especially in Los Angeles. The disputes have mainly centered around what to do about trees and other living vegetation, like shrubs and grass.
The state is considering two options for trees: One would require residents to trim branches within five feet of a house’s walls and roof; the other does not. Both require keeping trees well-maintained and at least 10 feet from chimneys.
On vegetation, the state is considering options for Zone Zero ranging from banning virtually all vegetation beyond small potted plants to just maintaining the regulations already on the books, which allow nearly all healthy vegetation.
Lee’s motion instructs the Los Angeles Fire Department to create regulations in line with the most lenient options that allow healthy vegetation and do not require the removal of tree limbs within five feet of a house. It is unclear whether LAFD will complete the process before the Board of Forestry considers finalized statewide regulations, which it expects to do midyear.
The motion follows a pointed report from LAFD and the city’s Community Forest Advisory Committee that argued the Board of Forestry’s draft regulations stepped beyond the intentions of the 2020 law creating Zone Zero, would undermine the city’s biodiversity goals and could result in the loss of up to 18% of the urban tree canopy in some neighborhoods.
The board has not decided which approach it will adopt statewide, but fire safety advocates worry that the lenient options championed by L.A. do little to protect vulnerable homes from wildfire.
Recent studies into fire mechanics have generally found that the intense heat from wildfire can quickly dry out these plants, making them susceptible to ignition from embers, flames and radiant heat. And anything next to a house that can burn risks taking the house with it.
Another recent study that looked at five major wildfires in California from the last decade, not including the 2025 Eaton and Palisades fires, found that 20% of homes with significant vegetation in Zone Zero survived, compared to 37% of homes that had cleared the vegetation.
Science
At 89, he’s heard six decades of L.A.’s secrets and is ready to talk about what he’s learned
Dr. Arnold Gilberg’s sunny consultation room sits just off Wilshire Boulevard. Natural light spills onto a wooden floor, his houndstooth-upholstered armchair, the low-slung couch draped with a colorful Guatemalan blanket.
The Beverly Hills psychiatrist has been seeing patients for more than 60 years, both in rooms like this and at Cedars-Sinai Medical Center, where he has been an attending physician since the 1960s.
He treats wildly famous celebrities and people with no fame at all. He sees patients without much money and some who could probably buy his whole office building and not miss the cash.
Gilberg, 89, has treated enough people in Hollywood, and advised so many directors and actors on character psychology, that his likeness shows up in films the way people float through one another’s dreams.
The Nancy Meyers film “It’s Complicated” briefly features a psychiatrist character with an Airedale terrier — a doppelganger of Belle, Gilberg’s dog who sat in on sessions until her death in 2018, looking back and forth between doctor and patient like a Wimbledon spectator.
“If you were making a movie, he would be central casting for a Philip Roth‑esque kind of psychiatrist,” said John Burnham, a longtime Hollywood talent agent who was Gilberg’s patient for decades starting in his 20s. “He’s always curious and interested. He gave good advice.”
Since Gilberg opened his practice in 1965, psychiatry and psychotherapy have gone from highly stigmatized secrets to something people acknowledge in award show acceptance speeches. His longtime prescriptions of fresh food, sunshine, regular exercise and meditation are now widely accepted building blocks of health, and are no longer the sole province of ditzy L.A. hippies.
Beverly Hills psychiatrist Dr. Arnold Gilberg, 89, is the last living person to have trained under Franz Alexander, a disciple of Sigmund Freud.
(Robert Gauthier / Los Angeles Times)
He’s watched people, himself included, grow wiser and more accepting of the many ways there are to live. He’s also watched people grow lonelier and more rigid in their political beliefs.
On a recent afternoon, Gilbert sat for a conversation with The Times at the glass-topped desk in his consultation room, framed by a wall full of degrees. At his elbow was a stack of copies of his first book, “The Myth of Aging: A Prescription for Emotional and Physical Well-Being,” which comes out Tuesday.
In just more than 200 pages, the book contains everything Gilberg wishes he could tell the many people who will never make it into his office. After a lifetime of listening, the doctor is ready to talk.
Gilberg moved to Los Angeles in 1961 for an internship at what is now Los Angeles General Medical Center. He did his residency at Mount Sinai Hospital (later Cedars-Sinai) with the famed Hungarian American psychoanalyst Dr. Franz Alexander.
Among his fellow disciples of Sigmund Freud, Alexander was a bit of an outlier. He balked at Freud’s insistence that patients needed years of near-daily sessions on an analyst’s couch, arguing that an hour or two a week in a comfortable chair could do just as much good. He believed patients’ psychological problems stemmed more often from difficulties in their current personal relationships than from dark twists in their sexual development.
Not all of Alexander’s theories have aged well, Gilberg said — repressed emotions do not cause asthma, to name one since-debunked idea. But Gilberg is the last living person to have trained with Alexander directly and has retained some of his mentor’s willingness to go against the herd.
If you walk into Gilberg’s office demanding an antidepressant prescription, for example, he will suggest you go elsewhere. Psychiatric medication is appropriate for some mental conditions, he said, but he prefers that patients first try to fix any depressing situations in their lives.
He has counseled patients to care for their bodies long before “wellness” was a cultural buzzword. It’s not that he forces them to adopt regimens of exercise and healthy eating, exactly, but if they don’t, they’re going to hear about it.
“They know how I feel about all this stuff,” he said.
He tells many new patients to start with a 10-session limit. If they haven’t made any progress after 10 visits, he reasons, there’s a good chance he’s not the right doctor for them. If he is, he’ll see them as long as they need.
One patient first came to see him at 19 and returned regularly until her death a few years ago at the age of 79.
“He’s had patients that he’s taken care of over the span, and families that have come back to him over time,” said Dr. Itai Danovitch, who chairs the psychiatry department at Cedars-Sinai. “It’s one of the benefits of being an incredibly thoughtful clinician.”
Not long after opening his private practice in 1965, Gilberg was contacted by a prominent Beverly Hills couple seeking care for their son. The treatment went well, Gilberg said, and the satisfied family passed his name to several well-connected friends.
As a result, over the years his practice has included many names you’d recognize right away (no, he will not tell you who) alongside people who live quite regular lives.
They all have the same concerns, Gilberg says: Their relationships. Their children. Their purpose in life and their place in the world. Whatever you achieve in life, it appears, your worries remain largely the same.
When it’s appropriate, Gilberg is willing to share that his own life has had bumps and detours.
He was born in Chicago in 1936, the middle of three boys. His mother was a homemaker and his father worked in scrap metal. Money was always tight. Gilberg spent a lot of time with his paternal grandparents, who lived nearby with their adult daughter, Belle.
The house was a formative place for Gilberg. He was especially close to his grandfather — a rabbi in Poland who built a successful career in waste management after immigrating to the U.S. — and to his Aunt Belle.
Disabled after a childhood accident, Belle spent most of her time indoors, radiating a sadness that even at the age of 4 made Gilberg worry for her safety.
“It’s one of the things that brought me into medicine, and then ultimately psychiatry,” Gilberg said. “I felt very, very close to her.”
He and his first wife raised two children in Beverly Hills. Jay Gilberg is now a real estate developer and Dr. Susanne Gilberg-Lenz is an obstetrician-gynecologist (and the other half of the only father-daughter pair of physicians at Cedars-Sinai).
The marriage ended when he was in his 40s, and though the split was painful, he said, it helped him better understand the kind of losses his patients experienced.
He found love again in his 70s with Gloria Lushing-Gilberg. The couple share 16 grandchildren and seven great-grandchildren. They married four years ago, after nearly two decades together.
“As a psychoanalyst or psychiatrist ages, we have the ability, through our own life experiences, to be more understanding and more aware,” he said.
It’s part of what keeps him going. Though he has reduced his hours considerably, he isn’t ready to retire. He has stayed as active as he advises his patients to be, both personally (he was ordained as a rabbi several years ago) and professionally.
For all the strides society has made during the course of his career toward acceptance and inclusivity, he also sees that patients are lonelier than they used to be. They spend less time with friends and family, have a harder time finding partners.
We’re isolated and suffering for it, he said, as individuals and as a society. People still need care.
Unlike a lot of titles on the self-help shelves, Gilberg’s book promises no sly little hack to happiness, no “you’ve-been-thinking-about-this-all-wrong” twist.
After 60 years working with Hollywood stars and regular Angelenos, Gilberg is ready to share what he’s learned with the world.
(Robert Gauthier / Los Angeles Times)
His prescriptions run along deceptively simple lines: Care for your health. Say thank you. Choose to let go of harmless slights and petty conflicts. Find people you belong with, and stop holding yourself and others to impossibly high standards.
“People have the capacity to self-heal, and I have become a firm believer in that. Not everyone needs to be in therapy for 10 years to figure it out,” he said. “A lot of this is inside yourself. You have an opportunity to overcome the things and obstacles that are in you, and you can do it.”
So what is “it”? What does it mean to live a good life?
Gilberg considered the question, hands clasped beneath his chin, the traffic outside humming expectantly.
“It means that the person has been able to look at themselves,” he said, “and feel somewhat happy about their existence.”
The best any of us can hope for is to be … somewhat happy?
Correct, Gilberg said. “A somewhat happy existence, off and on, which is normal. And hopefully, if the person wants to pursue that, some kind of a personal relationship.”
As it turns out, there is no housing in happiness. You can visit, but nobody really lives there. The happiest people know that. They live in OK neighborhoods that are not perfect but could be worse. They try to be nice to the neighbors. The house is a mess a lot of the time. They still let people in.
Somewhat happy, sometimes, with someone else to talk to.
It is that simple. It is that hard.
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