The Brief

Recently, I was working from home in Eagle Rock, hungry, but trying to meet my LAist deadlines. I decided to quickly go get lunch at a sushi place I’d been recommended, Rice and Nori.

Since I’m new to the area and rely on Google Maps for everything, I followed it to an address on Colorado Avenue in Pasadena.

But when I got there, I found myself in front of a liquor store and what looked like a small auto shop. You know, the classic red and black bold lettering with racer stripes along the exterior. Nothing like a restaurant.

But Google Maps insisted that this auto-shop-maybe-it's-a-warehouse was, in fact, where my lunch was being prepared. And on the sign above the door, it said Allied Food To-Go. So I took a deep breath and walked in.

What I found was something like an Amazon locker meets Hot Dog on a Stick. There was no hostess and no tables — no seating at all in fact. Instead, there were white lockers on the left all the way up to the ceiling, and a desk with a tablet on top.

I was confused as to where I was. There was an employee placing food into the lockers, assisted by what seemed to be a robot, but since talking to strangers is on my top 10 list of things I hate to do, I decided to just navigate this one on my own.

Food is picked up via lockers at CloudKitchen locations.

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Lucy Jaffee

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The tablet had 15 restaurant options to choose from, and after scrolling past lots of birria and Mediterranean food, I found Rice and Nori on the last screen and picked what I wanted.

I awkwardly stood by the lockers, middle school flashbacks flooding in, wondering what would happen next.

Two robots at Allied Food To-Go ready to deliver food to the lockers.

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Lucy Jaffee

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LAist

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A few minutes later — a text! Apparently my order was ready in locker D2. I pressed a button on my phone and it opened automatically, like the gates of heaven, and there I found my spicy tuna onigiri and edamame. (I’d been looking in the other direction, but I’m pretty sure one of the robots put it there. Later, I found out they have names, Rosie and Johnny).

By now, the space was filling with delivery drivers hustling to grab orders. Still confused, still hungry, I sped off in my car to process what just happened.

Is this normal for Pasadena? Again, I’m new.

What is a ghost kitchen?

Back at home, I googled Allied Food To-Go and discovered it’s a ghost kitchen, a commercial kitchen where multiple vendors make food that’s ordered online for pickup or delivery. Perfect for the digital age, customers and drivers usually pick up their orders using a tablet — no interaction with an employee is necessary.

Allied Food To-Go is just one location of CloudKitchens, a larger company that operates multi-vendor ghost kitchens in cities like Los Angeles, Miami, and New York (Co-founder of Uber Travis Kalanick invested a few years ago). In L.A. according to its website, CloudKitchens currently operates 11 ghost kitchens in places like Long Beach and Koreatown.

I tried to contact CloudKitchens but they couldn’t be reached. I only got through to one location in Echo Park, who declined to comment.

How does it work?

Ghost kitchens took off due to the pandemic when many restaurant owners shifted to delivery-only operations to reach customers out of public safety concerns. By leaving their storefronts and switching to a less costly ghost kitchen, they could also cut costs — making this new set-up popular post-pandemic too.

I wanted to understand more, so I tracked down George Shenefelt, a partner at Rice and Nori. He told me that they’d initially partnered with CloudKitchens to experiment with other concepts (but haven’t thus far) because their locations had become too busy for the kitchen to make anything besides their staples.

Most ghost kitchens function the same way. Food vendors pay rent to the ghost kitchen operator, whether it be a company like CloudKitchens or an individual, to use the space. The prices vary according to the size of the space, type of equipment and whether additional storage is needed, according to CloudKitchens’ website.

The exterior of DTLA Kitchens, an independent commercial kitchen located in southeast Los Angeles.

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Courtesy of Yuri Amsellem

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Another fee is added for utilities and general operating costs, such as the employees (or robots) needed to transport food from the kitchen to customers.

Vendors are given individual or shared kitchen spaces to prepare and produce their food. Their workstations are usually adjacent to other local vendors renting in the same ghost kitchen.

On a food delivery app, these all show up as different restaurants, but their locations will be the same. The only way to tell if it's from a ghost kitchen is to look up the vendor’s address or drive there.

Since ordering delivery is the reality for most of us at the end of a long day, chances are you’ll never stumble into a ghost kitchen like I did.

Struggling without a storefront

While ghost kitchens can be a good way for restaurants to cut costs, they come with several downsides. Shenefelt says he has found staffing the ghost kitchen to be challenging.

“It kind of feels like a prison,” he said. The space has no windows and is only around 200 square feet, turning off many employees looking for more interactive work experiences.

Another major drawback is that without a storefront, a new restaurant can struggle to find customers. Rice and Nori has been around since 2018, has two locations and an Instagram following. But others are not so well-established.

Janet Kang originally started Pizza Baby as a ghost kitchen but broke her lease last September because sales were too low. Between paying for rent and utility costs, she had no extra money available for marketing to draw in customers.

She said it’s a “matter of money,” whether using a ghost kitchen ultimately turns out to be profitable. “Do you have enough cash reserve to stick around long enough to get noticed?”

The inside of a commercial kitchen for rent at DTLA Kitchens.

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Courtesy of Yuri Amsellem

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Winston Shipp, founder of ¡Quesadilla Mía! shared a similar experience. He started in the pandemic renting a space at a delivery-only CloudKitchen. But few knew of their brand.

“You are at the mercy of people searching on apps looking for food,” said Shipp. He also left CloudKitchen and now rents a kitchen for a limited number of hours per week, rather than having a permanent space in a ghost kitchen.

Shipp sees ghost kitchens as ideal options for already-successful restaurants looking to move delivery away from their brick-and-mortar locations. Kitchen staff can better focus on dine-in customers and prevent long lines and wait times.

However, Yuri Amsellem, owner of DTLA Kitchens, a commercial kitchen that is used as a ghost kitchen and for other ventures like filming in southeast LA, sees ghost kitchens as a “great start” for small businesses. “We are incubators,” he told LAist, where vendors will eventually expand into their own brick-and-mortar locations.

Should I order from one?

If you need a reliable lunch option when hunger strikes, ghost kitchens are the way to go. With no dine-in customers to distract the kitchen, your food will arrive quickly to your doorstep. Or, you can pick it up from an automatic locker.

But if you’re new to a restaurant and need some advice on what to order, opt for a brick-and-mortar. Employees can impart their knowledge about flavor, the level of spice, or whether the dish you want contains traces of gluten, among other preferences.

Five sushi hand rolls from Rice and Nori, with fillings ranging from cucumber to spicy salmon, wrapped in your choice of seaweed or soy paper.

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Courtesy of George Shenefelt

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Plus, it's hard to beat an excellent mealtime ambiance.

So, would I go back to a ghost kitchen?

Maybe.

My Rice and Nori order from Allied Food To-Go was delicious and the food quality was not compromised. It was packed in sealed containers with extra soy sauce and chopsticks.

But at the end of the day, I prefer a meal shared with friends amid a lively restaurant. No ghost kitchen can replace that.

The Los Angeles City Council decided Tuesday to delay voting on proposed reforms to the city’s embattled “mansion tax.”

The tax has staunch defenders, but a number of economic studies have found that it’s slowing housing development at a time when L.A. is grappling with a severe housing shortage.

Instead of sending Measure ULA back to voters with proposed changes, the council decided to refer the idea to their Housing and Homelessness Committee for further debate.

Councilmember Nithya Raman, chair of the committee, introduced a motion last week that sought to put a reform measure on the June ballot. Her proposal would have asked voters to cancel the tax on apartment buildings constructed within the last 15 years, exempt Palisades Fire victims from the tax and change financing terms in city-funded affordable housing projects.

“Voters were sold a mansion tax,” Raman said during Tuesday’s council meeting. “Ignoring the very real impacts on apartment construction — apartments that people want and need and want to move into — doesn’t protect Measure ULA. It weakens it.”

How the ‘mansion tax’ works

Measure ULA was approved by nearly 58% of L.A. voters in 2022. It levies a 4% tax on real estate sales over $5.3 million and a 5.5% tax on properties selling for more than $10.6 million.

The city uses tax revenue to fund tenant aid programs, such as eviction defense and rent relief. And it subsidizes the construction of affordable housing, though most of the funds raised for that purpose have not yet been spent.

Supporters rallied outside City Hall before the Tuesday vote, urging City Council members not to send Measure ULA back to the voters with proposed changes.

“We believe it's working,” said Carla De Paz, a steering committee member of the United to House L.A. coalition. “Every day we hear the stories of the tenants who are staying housed, who are not being evicted, who are getting the services they need.”

De Paz said putting Measure ULA back on the ballot would detract from efforts to better the city’s implementation of affordable housing and tenant aid programs.

“The harm is that we're spending a lot of time trying to amend something that doesn't need fixing,” she said.

Reform would reduce revenues by around 8%

Housing policy researchers contend that the measure does need fixing. They point to a number of studies showing that because the “mansion tax” also applies to new apartment complexes selling for more than $5.3 million, housing development has slowed in the city relative to other parts of L.A. County.

One UCLA and RAND study found that L.A. would likely have more affordable housing units — like those bundled in with many market-rate projects — if the tax did not apply to new apartments. That study also estimated that canceling the tax during the first 15 years of an apartment building’s life would reduce total revenues by 8% because most sales happen in older properties.

Scott Epstein, policy director with Abundant Housing L.A., said he supports keeping ULA in place, but with the proposed reforms.

Epstein said he wants the city to “continue to provide the important revenue that we need for tenant protection, homeless prevention and affordable housing production, while not dissuading needed multi-family housing production from the private sector.”

What happens now? 

Because the L.A. City Council decided not to take action Tuesday, the proposed reform measure will not be ready for the June ballot. If the council approves sending it to voters later on, it could go head-to-head with a separate ballot initiative currently gathering signatures for a November measure to repeal not just Measure ULA, but all such taxes across the state.

Before failing to convince her colleagues to vote on the reform measure Tuesday, Raman said the other ballot initiative, plus the possibility of intervention of state lawmakers, should inspire city leaders to act fast.

“We can head off donors and supporters and promoters of other efforts if we do it the right way and if we do it locally,” she said. “Fixing unintended consequences is how we keep this policy aligned with what voters expected and what the city needs.”

The proposed changes are proving hard to advance for reformers. State lawmakers pursued similar tweaks in a bill that failed to move forward at the end of last year’s legislative session in Sacramento.

One year into President Donald Trump’s second term, Californians who voted for him are mostly happy with how his policies have played out so far.

Trump’s support among California Republicans has slipped to 79%, down from 84% near the start of his term, according to a Public Policy Institute of California poll released last month.

The survey found that Californians name the cost of living and the economy as the most important issues facing the state today. Those concerns also dominated follow-up conversations KQED had with voters first interviewed 100 days into Trump’s second administration. From Southern California and the Central Valley to the North Coast, seven voters offer a mixed review of Trump’s performance.

They weigh in on a range of issues, including sweeping tariffs, immigration raids, National Guard deployments and a redistricting battle. While there is general support for his “America First” platform, they are divided on whether the president’s actions fulfill that mandate. Several also criticized Trump’s rhetoric and tone.

Emerson Green, 26, El Dorado County

Of all of his expectations for Trump’s second term, Emerson Green had been most optimistic that the president would improve the economy. Instead, he said he’s deeply disappointed and believes Trump let him down.

“I wish I never voted for him,” Green said. “It’s not that he lied or he didn’t hold up his promise. It is that he did the exact opposite, with intent, of what he promised he was going to do.”

Since Trump returned to the White House, Green got engaged and is expecting a baby in May. The 26-year-old now works at O’Reilly Auto Parts after changing jobs twice last year. He said he’s noticed the cost of some car parts rising because of tariffs, though not as dramatically as he expected when Trump announced his “Liberation Day” tariffs last April.

Emerson Green sits during a hike in Adams Canyon, Utah, on May 4, 2025.

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Courtesy of Emerson Green

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He’s also noticed everyday expenses like groceries and medication becoming more expensive and has begun to see home ownership as nearly unattainable.

“The idea of owning a house at this point in my life seems like something that is, if I even do it, it might be 30 years out at this point,” Green said. “It’s probably as bleak as it gets for young people these days … and [Trump] has done nothing to improve that.”

Last year, Green’s mom received an offer letter for a job with the Internal Revenue Service, but when Trump issued a government hiring freeze, her offer was rescinded. It took her a couple of months to find another job, and she now works in funeral insurance sales.

“She is really struggling to make ends meet,” Green said.

Beyond his dissatisfaction with the economy, Green is most critical of Trump’s military intervention in Venezuela, which he sees as veering away from the president’s pledge to prioritize America first. On Jan. 3, Trump ordered U.S. forces to seize President Nicolás Maduro in a stunning extraction that resulted in Venezuela’s leader facing federal charges in New York.

“I can’t see a strategic benefit to it at all,” Green said. “I do think he did it as, like, a stunt to boost his approval ratings.”

Green also faults Trump for repeatedly delaying the release of the Epstein files, then issuing heavily redacted documents despite vows on the campaign trail to declassify them.

“You may as well have red hands,” he said.

Ben Pino, 56, Los Angeles County

Following the fatal shooting of 37-year-old Alex Pretti by federal immigration agents in Minneapolis over the weekend, Ben Pino still stands behind the administration’s immigration tactics. The shooting marks the second killing this month of a Minneapolis resident during an operation after 37-year-old Renee Good was fatally shot in her car by a U.S. Immigration and Customs Enforcement officer earlier in January.

Pino believes Pretti and Good were “antagonizing the feds,” echoing statements made by Secretary of Homeland Security Kristi Noem, who said Pretti approached U.S. Border Patrol officers with a 9 mm semiautomatic handgun and claimed, without evidence, that he attacked officers with intent to harm them.

Ben Pino in his neighborhood in Los Angeles County on May 7, 2025.

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Julie Leopo

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Video footage shows Pretti holding a phone, with his concealed gun removed from his waistband by an agent, before he was shot.

“I think the loss of life is tragic. I think that those young people used poor judgment and got themselves killed,” Pino said. “I don’t understand the outrage, to be quite honest with you.”

Pino lives in the Diamond District in Los Angeles and works in Carson. He supported Trump’s decision to deploy thousands of California National Guard troops to Southern California, without the governor’s approval, to quell anti-ICE protests last summer.

“If you ask me, ICE needed some kind of protection because people were going nuts,” he said.

In December, the U.S. Supreme Court upheld a lower-court ruling barring Trump from deploying National Guard troops to Chicago without Illinois Gov. JB Pritzker’s permission.

“I’m a little bit surprised that they can take that kind of power away from the president of the United States. He is the ultimate leader of our country,” Pino said.

While he bristled at limits on the president’s authority at home, Pino praised Trump for exercising that power abroad by ordering a military incursion into Venezuela.

“I’ve never seen a president take an action like going into a foreign country, grabbing its Communist criminal leader and bringing them back to face trial,” Pino said. “It’s one of the most spectacular foreign policy events that I’ve seen any American president make in my lifetime.”

Pino, whose parents immigrated to the U.S. from Cuba, hopes Trump will intervene there, too.

“As a Cuban American, I feel that direct U.S. intervention should happen if you want to protect something that’s that close to your shores,” he said.

One year in, Pino remains fully on board with the administration.

“I approve of everything he’s done so far,” he said. “I’m a bigger fan now than you found me last year.”

Kim Durham, 68, Sacramento County

Kim Durham is thankful to have Trump in office, but wants to see him temper his rhetoric.

“I think he shoots himself in the foot by saying things he doesn’t need to say,” she said. “Decorum could be utilized a little bit in public speaking.”

Immigration ranks among Durham’s top policy concerns, and she supports Trump’s rapid push to secure the southern border as well as his aggressive approach to deportations. Her daughter is a police officer, and Durham believes national media coverage has fueled hostility toward ICE that has spilled over to local law enforcement.

Kim Durham sits outside of an apartment she rents outside of Sacramento on May 6, 2025. 

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Beth LaBerge

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“It’s just infuriating to watch just regular people in uniforms … have to fight through angry mobs of cars,” she said.

In response to the killing of Pretti, Durham repeated Noem’s rhetoric, blaming Minnesota Gov. Tim Walz and Minneapolis Mayor Jacob Frey for not coordinating with ICE.

“If they’ve let ICE do the job that they’ve been called to do, this wouldn’t be happening,” she said.

Durham would not condemn the individual officers involved, saying that a final judgment should come from the courts.

“There’s no guarantee that individually every ICE agent is gonna act perfect,” she said. “So, I don’t believe as a whole ICE is wrong. Or even necessarily overreaching.”

Durham also backs Trump’s decision to deploy the National Guard in Los Angeles, and said she wishes state leaders would cooperate with the president.

“There are some that say he’s a dictator. Well, no, he’s not a dictator — we voted him in,” she said. “I think it would all be a lot better if we didn’t resist the federal government and instead just got together and said, ‘Hey, I’m with you … Let’s sit down, work together and clean it up instead of fight it.’”

On health care, Durham said she’s glad to see the administration target Medicaid fraud. In July, Trump signed into law his sweeping policy bill, including an estimated $1 trillion in Medicaid cuts. Much of that reduction would come from new work requirements and additional paperwork demands that would shrink enrollment.

“I honestly believe if all the fraud could be cut out of Medicaid and Medicare, we would be in a surplus of money,” she said.

Durham also praised Health Secretary Robert F. Kennedy Jr.’s Make America Healthy Again initiatives, especially efforts to remove synthetic dyes from the food supply and curb ultra-processed foods, raising concerns about what her grandchild eats. She’s also in favor of his updated childhood vaccine schedule, calling the previous standard “ridiculous” and saying families need choices.

Cindy Cremona, 66, formerly San Diego County

When Cindy Cremona heard about Proposition 50, the November 2025 ballot measure approved by voters that redraws California’s congressional maps, she felt Republicans would never have a voice in the state.

“I think for many, people just felt that it was going to lock in California as a blue state forever and ever,” she said.

In September, Cremona moved from Encinitas, a coastal city in northern San Diego County, to Wellington, Florida. She had been considering the move since Gov. Gavin Newsom took office in 2019 and was even more compelled to leave during the pandemic, when she felt the state went too far with vaccine and mask mandates and lockdowns.

Cindy Cremona and her 12-year-old Andalusian horse, Durango, in San Marcos, California, on May 8, 2025. 

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Carolyne Corelis

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Last year, she reached her breaking point and decided to move, citing “the politics, the taxes, the over-regulation, the traffic, the overdevelopment.”

Cremona finds Florida’s housing costs and policies preferable to California’s. For instance, she took issue with last year’s passing of SB 79, which makes it easier to build apartment buildings near major public transit stops.

She’s optimistic about Trump’s housing proposals, including a recent pledge to target institutional investors who buy up single-family homes. Newsom echoed a similar stance toward corporate landlords in his State of the State address, a rare instance of political overlap between the Democratic governor and the president.

Looking ahead, Cremona expressed confidence in the president’s ability to deliver on other economic promises, like lower food and energy costs.

“I think 2026 is the year where we’ll see some of those policies borne out,” she said.

Debbie Pope, 60, Long Beach

Debbie Pope is deeply disillusioned with Trump’s first year back in office. At the beginning of 2025, she welcomed what she described as Trump’s “guns-a-blazing” return. But her view shifted in the second half of the year, following the assassination of conservative activist Charlie Kirk and repeated delays in releasing the Epstein files.

“I saw a whole different view of Trump after that for some reason,” she said. “The biggest disappointment is the Epstein files. It’s just like, Trump, you’re in them. You’re in it.”

Debbie Pope in her Long Beach home on May 10, 2024.

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 (Courtesy of Debbie Pope)

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Pope voted for Trump in 2016, 2020 and 2024, but before that, she was a Democrat and voted for Barack Obama in 2008 and 2012. Her party switch was driven by a distaste for Hillary Clinton and Trump’s hardline stance on immigration, one of her top policy concerns.

The daughter of a Nicaraguan immigrant, Pope supports stricter border enforcement — and thinks Trump has failed to deliver on promises of mass deportations.

She wants to see the president focus on domestic issues, like ramping up deportations even more, rather than foreign military interventions in Venezuela and Iran.

“He’s veered off the America First train, I think,” she said. “So yeah, I’m a little disappointed in him.”

These days, Pope sees Trump as prioritizing the interests of billionaires over those of his constituents. She also points to his massive ballroom renovations and putting his name on the Kennedy Center as diversions from America First.

“Dude, we know you’re a narcissist, but really, you’re getting carried away,” she said.

Ron Dawson, 68, Eureka

Ron Dawson said he would give Trump’s performance in 2025 a B+. He feels his cost of living has improved since Trump took office, noting lower grocery and fuel prices. He still wants to see the president lower the federal deficit.

Dawson voted for Trump in 2024, but his preferred presidential candidate was Nikki Haley. He still favors the president over Kamala Harris.

Once a Democrat like his parents, Dawson said the last time he voted blue was for Bill Clinton in 1996. Since then, he’s felt like the Democratic Party has become elitist, prioritizing identity politics and social justice issues, which he said have “nothing to do with running a country.”

Before settling in Eureka six years ago, Dawson spent almost five decades in Southern California. He recalls working as a machinist in 1980 and losing the job to an immigrant.

“He could work cheaper than I would accept,” he said. “I have a problem with the system. The system I recognized way back then is really broken.”

Today, Dawson approves of Trump’s secure border platform.

Now living in far Northern California, Dawson is critical of Proposition 50 and the newly redrawn 2nd Congressional District. Previously stretching from Marin County to the Oregon border, the new boundaries push further inland to the Nevada border, pulling in Siskiyou, Modoc and Shasta counties.

“Our congressional representative, Jared Huffman — he already has a very, very large district and a lot of people say, like, you never see him, never hear from him,” Dawson said. “They didn’t stop and think, how does this one guy represent such a large area?”

Those concerns deepened following the recent death of Rep. Doug LaMalfa, a Republican who represented rural Northern California for more than a decade.

Mari Barke, Orange County

Mari Barke, president of the Orange County Board of Education, has mostly positive things to say about the president.

“He puts our country first, which to me is critically important of somebody who is president,” she said.

Mari Barke, photographed at the California Policy Center in Irvine in 2024. 

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(Courtesy of Mari Barke)

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Above all, she aligns with Trump’s education agenda, like his executive order banning transgender athletes from participating in girls’ and women’s sports and his push to eliminate diversity, equity and inclusion programs. The administration has threatened to withhold federal funding from schools with DEI initiatives.

“I think it’s important to get rid of all the biases and just let people enter higher education based on merit,” Barke said, arguing that merit incentivizes students to work hard and reduces the likelihood of academic failure.

Barke is a staunch advocate for parental notification policies, which require school teachers and staff to notify parents if their child identifies as a gender other than what they were assigned at birth.

“I never think it’s a good idea to teach children to lie to their parents,” she said. “I think if a child is going through something like that, nothing is more important than having your parents’ love. I have a gay son who has a husband, and I love him to death, no matter who he is or what he decides.”

Despite her alignment with the administration, Barke occasionally finds fault with Trump’s delivery, suggesting he could behave “more presidential” so as not to offend people.

As AI expands into every facet of society, a California company is testing whether the technology can help improve the health of people living on the streets.

Akido Labs, a Los Angeles-based health care technology company that runs clinics and street medicine teams in California, plans to start using its AI model on homeless and housing insecure patients in the Bay Area next month. The program generates questions for outreach workers to ask patients and then suggests diagnoses, medical tests and even medication, which a human doctor then signs off on remotely. The idea is to save doctors time and allow them to see more patients.

The new model, called Scope AI, is addressing a very real problem: There aren’t nearly enough doctors visiting encampments and shelters. At the same time, homeless Californians are in much poorer health and are dying earlier than the general population.

“There are individuals who haven’t seen doctors for years. There are individuals who haven’t seen a dentist ever,” said Steve Good, president and CEO of Five Keys, which is partnering with Akido to launch the AI technology in its San Francisco homeless shelters. “There just aren’t enough resources to go in there and find out the needs these individuals have.”

Experts who research AI told CalMatters that if done right, the technology has the power to increase access to care for homeless and other marginalized communities. But while many health care providers already are using AI for administrative duties, such as transcribing patient visits, using it to help diagnose people is still a relatively new field. It brings up concerns around data privacy, biases and patient outcomes, which are particularly pressing when the technology is being used on homeless patients and other vulnerable groups.

“We don’t have perfect solutions to a lot of these challenges yet,” said Angel Hsing-Chi Hwang, an assistant professor at USC who researches human-AI interaction.

How Scope uses AI to diagnose homeless patients

Scope AI essentially allows non-medically trained outreach workers to start the intake and diagnosis process before a patient sees a doctor.

An outreach worker goes out into the field with Scope on their tablet or laptop. As they start interviewing a patient, Scope suggests questions the outreach worker should ask. Scope listens to, records and transcribes the interview, and as the interaction progresses, it suggests new questions based on what the patient says.

When it has enough information, Scope suggests diagnoses, prescriptions and follow-up tests. That information is then sent to a human doctor, who reviews it (usually the same day) and either signs off on the prescriptions, makes changes, or, if it’s a more complex case, arranges to see the patient to get additional information. The medical care is paid for by Medi-Cal through its CalAIM expansion into social services.

Dr. Rishi Patel from the Akido street medicine team checks on an unhoused man living in a vineyard in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments.

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Larry Valenzuela

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CalMatters/CatchLight Local

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Dr. Rishi Patel from the Akido street medicine team checks on an unhoused man living in a vineyard in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. Photo by Larry Valenzuela, CalMatters/CatchLight Local In demonstrating the technology to CalMatters, using an imaginary 56-year-old female patient who complained of trouble breathing, Scope asked several follow-up questions to drill down on her symptoms. Then, it made suggestions that included: a diagnosis of COPD or chronic bronchitis, a chest x-ray and spirometry breathing test, and a prescription of an albuterol inhaler.

The Scope AI technology is already being used in a few target areas. Akido’s street medicine teams began using it in homeless encampments in Los Angeles County in 2023, where it has since seen more than 5,000 patients. Akido also uses AI in encampments in Kern County, clinics in California and Rhode Island, and to treat ride-share workers in New York.

Scope lands on the correct diagnoses within its top three suggestions 99% of the time, according to Akido.

Other studies have called into question the reliability of diagnoses made by artificial intelligence. A 2024 study, for example, found that AI was significantly more likely to misdiagnose breast cancer in Black women than in white women.

The infiltration of AI into homeless services has sparked concern from some critics who argue homeless patients, because of their increased vulnerability, need a human health care provider.

“We should not experiment on patients who are unhoused or have low incomes for an AI rollout,” Leah Goodridge, a tenants rights attorney and housing policy expert, and Dr. Oni Blackstock, a physician and executive director of Health Justice, wrote in a recent opinion piece for the Guardian.

Brett Feldman, director of USC Street Medicine, agrees. When someone is homeless, much of their health status is dependent on their living environment, he told CalMatters. For example, he recently treated a patient with scabies. Typically, he would prescribe a shampoo or body wash, but this patient had no access to a shower — a key detail that AI might not know to ask.

Instead, he prescribed an oral medication. The patient needed one dose right away, and another dose in a week. He had to decide whether to give the patient the second dose now and trust that it wouldn’t get lost or stolen, ask the patient to travel to a pharmacy to pick up the second dose, or try to find the patient again in a week to deliver the dose. AI couldn’t make that complex calculation, and neither could a doctor who hadn’t met the patient and seen their living situation, Feldman said.

And any missteps the AI makes could have outsized consequences when a patient is homeless, Feldman said. If the patient has an issue with the medication prescribed, they likely don’t have an easy way to contact the doctor or have a follow-up appointment.

“I would say, in general, that this would not work for this population,” Feldman said.

Akido argues the benefit of AI is clear: better efficiency and improved access to health care.

Before introducing AI, each of Akido’s street medicine doctors in LA and Kern counties could carry a case load of about 200 homeless patients at a time, said Karthik Murali, head of safety net programs for the company. Now, it’s closer to 350 patients per doctor, he said, because doctors spend less time asking routine questions and filling out paperwork.

That means more patients get access to care and medication more quickly, Murali said.

Nearly a quarter of homeless Californians surveyed by the UCSF Benioff Homelessness and Housing Initiative reported needing medical care that they couldn’t get in the six months prior to the study. Only 39% said they had a primary care provider. Nearly half of homeless Californians surveyed reported their health as poor or fair — a rate about four times higher than the general U.S. population.

Good, of Five Keys, hopes the technology also will let clinicians build trust and deeper relationships with their clients. An outreach worker using Scope will have time to form a bond with the patient and better respond to their individual needs, as opposed to a doctor who is rushing through the visit to get to the next patient, he said.

His organization hopes to roll out the technology in some of its San Francisco homeless shelters next month.

Partnerships and access

Akido also plans to work with Reimagine Freedom and the Young Women’s Freedom Center to use the AI technology at four centers — in San Francisco, Oakland, Richmond and San Jose — that serve women and girls who are or have been incarcerated. The clients they serve often had poor access to health care while in jail or prison, or had their medical concerns ignored, said Reimagine Freedom President Jessica Nowlan. Many have no trust in the medical system.

Currently, the centers offer health education. This new AI technology will allow them to provide actual medical care, Nowlan said.

“Our guess is we will see a huge increase in women being able to access health and care for themselves,” she said.

Reimagine Freedom started testing Scope AI at its Los Angeles clinic in November. So far, “it’s going really well,” Nowlan said.

Akido plans to partner with additional homeless service providers who can help it roll out its AI technology in more places throughout the Bay Area. That partnership is being spearheaded by the Future Communities Institute, which is also developing metrics to judge the effectiveness of Akido's program.

If providers who serve vulnerable patients are left out of the AI race, any benefits in the technology will go to wealthy communities instead — further widening the gap between the haves and have-nots, said Stella Tran, who researches AI companies for a California Health Care Foundation investment fund. That’s why social service providers need to be involved in testing this technology and developing the ground rules and safety checks, she said.

But that doesn’t mean Tran doesn’t have concerns. For example, AI works differently on different communities. An algorithm that produced accurate diagnoses for patients in Los Angeles might not work as well in the Bay Area, she said. And while AI has the potential to be less racially biased than human doctors, it all depends on how the algorithm is constructed.

“I think there is a potential to increase access if we do it right,” Tran said, “with the right set of guardrails and being thoughtful about safety, transparency to patients, consent, all of that.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.