The Brief

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.

After copper wire theft left the Sixth Street Bridge in darkness for years, the city of Los Angeles has hired a Pasadena-based engineering firm to restore the lighting, a move aimed at improving safety for Boyle Heights and the surrounding neighborhoods.

City officials contracted Tetra Tech to relight the bridge, which has been plagued by copper wire theft since its opening in 2022. The outages have frustrated residents and commuters who use the bridge to walk, run, bike and drive between downtown LA and the Eastside.

Aging infrastructure, copper wire theft and delayed repairs led to nearly 2,000 streetlight service requests in Boyle Heights in 2024. Nearly seven miles of copper wire have been reported stolen from the Sixth Street Bridge.

Tetra Tech began working on the project’s design in January and is scheduled to restore the wiring to all lights along the bridge, including along roadways, barriers, ramps, stairways and arches before the 2028 Olympic and Paralympic Games come to Los Angeles that summer, according to a Feb. 18 news release from Councilmember Ysabel Jurado’s office.

The firm – which was selected by the city’s Bureau of Engineering – will fortify the pull boxes, service cabinet and conduits to protect against copper wire theft. Tetra Tech will also install a security camera system to deter vandalism and theft.

“When our streets are well-lit, our neighborhoods feel safer and more connected,” Jurado said in the news release. “The Sixth Street Bridge plays a vital role in connecting Angelenos between the Eastside and the heart of the City.”

Jurado – who pledged to look into fixing the Sixth Street Bridge lights when she was elected in 2024 – said the partnership with Tetra Tech “moves us one step closer to restoring one of the City’s most iconic landmarks as a safe, welcoming public space our communities deserve.”

According to officials, the total contract value with Tetra Tech is $5.3 million, which includes work on the Sixth Street Bridge as well as the Sixth Street PARC project, which encompasses 12 acres of recreational space underneath and adjacent to the bridge.

The PARC project will make way for sports fields, fitness equipment, event spaces and a performance stage. PARC’s grand opening is anticipated later this year.

Because the work for the PARC project and the bridge is connected, the Board of Engineers recommended using the existing PARC contract with Tetra Tech to ensure completion ahead of the 2028 Games, officials said.

The cost for the design work on the bridge alone is roughly $1 million.

On Thursday, Jurado announced that her streetlight repair crew had restored lighting and strengthened infrastructure for more than 400 streetlights across her district, including Boyle Heights, Lincoln Heights, and El Sereno. Next, they plan to tackle repairs in downtown L.A.

For the last 70 years, the  27th Street Bakery hasn’t just been the go-to place for people who want to spend less time in the kitchen — it’s become a staple in South Central, providing jobs and security for people living in the neighborhood.

The bakery is Black-owned and in its third generation as a business. It’s co-owned by sisters Denise Cravin-Paschal and Olympic gold-medalist Jeanette Bolden-Pickens, as well as her husband Al Pickens.

“My grandfather employed a lot of people around here as he was growing his business and so have we,” Cravin-Paschal told the LA Local. “They feel that this is a safe place to come. We have the respect of being here for 70 years and so we enjoy it.”

The bakery sits on Central Avenue, the focal point of Black Los Angeles between the 1930s and 1960s. As segregation laws were struck down, Black people in LA began to move elsewhere and took their businesses with them. The bakery, though, is still Black-owned and operating 70 years later.

Today it is considered the largest manufacturer of sweet potato pies on the West Coast, the bakery’s website states. Last year, the city and District 9 Councilmember Curren Price Jr. presented the bakery with a plaque that reads: “A Walk Down Central Avenue — A legacy of community: powered by the people and its places.”

It hangs on the wall in the bakery’s lobby along with several other photos and recognitions they’ve received over the years.

“Our goal is to keep this legacy alive and we’re celebrating 70 years of being here in business. We are so grateful to the community,” Bolden-Pickens said.

In celebration of its anniversary, a sign in the bakery says it is offering one slice of sweet potato pie for 70 cents on Saturdays starting this weekend through Oct. 31.

The bakery was a restaurant at first bringing Southern flavor to LA

The bakery began as a restaurant in the 1930s on Central Avenue founded by Harry and Sadie Patterson, according to the family and Los Angeles Conservancy. Back then, Central Avenue was the epicenter of LA’s Black community and Patterson, who came from Shreveport, Louisiana, decided to bring his Southern recipes to life in Los Angeles.

The restaurant later became a bakery in 1956, according to the bakery’s website. Patterson’s daughter Alberta Cravin and her son Gregory Spann took over the bakery in 1980. After Spann passed away, Cravin’s daughters — the sisters who are current owners — took over the family business. Five other relatives also help them out, Cravin-Paschal said.

These days, the bakery is open Tuesday through Saturday each week and the bulk of their customers are other businesses. They serve nearly 300 vendors including convenience stores like 7-Eleven, Ralphs grocery stores, Smart & Final, ARCO gas stations, restaurants and other mom-and-pop stores. Louisiana Fried Chicken has been a customer since 1980, Cravin-Paschal said.

An average delivery today is usually 45 dozen pies and they also ship orders out of state, Cravin-Paschal said.

She also told The LA Local they have six full time employees and most of them have worked for the bakery at least 25 years.

“I like working here, I like the people,” Maximina “Maxi” Rodriguez, a longtime employee, told The LA Local. After 32 years at the bakery, she said she plans to retire in June. “I’m going to miss it.”

Rodriguez said working at the bakery is a family affair for her, too. Her sister, Guadalupe Garibaldi, has worked at the bakery for over 40 years and her niece, Yoselin Garibaldi, is now a cashier and driver.

Patterson’s lessons inspired 3 generations to keep the business running

For Bolden-Pickens and Cravin-Paschal, running the bakery is a labor of love. Both told The LA Local that their grandfather taught them to stay true to the fresh ingredients they use and not to cut corners.

These lessons helped Bolden-Pickens in her life before taking over the family business. She won a gold medal as part of the U.S. 4×100 meter relay team in track and field during the 1984 Olympics.

“What I learned from being an Olympian is that it takes a lot of hard work. I learned that from my grandfather,” she said.

Bolden-Pickens said it hasn’t been easy running the business, but they’ve been able to stay afloat because of the lessons learned from their grandfather.

“I remember during the pandemic, we actually had to go to the egg farm and stand in line for a couple of hours just to get the eggs that we needed,” Bolden-Pickens said. “We use the best spices. We make our own vanilla.”

Cravin-Paschal said after the death of their brother Gregory Spann, who was the main baker for nearly two decades, they struggled for a few years to keep the recipe and taste consistent. But eventually they figured it out.

“We had a little rough spot because we all know the recipes but you have to put it together (correctly),” Cravin-Paschal said. “Now we’re back to the original taste.”

As marijuana use among teens has grown in the past decade, researchers have been trying to better understand the health risks of the drug. Now, a new longitudinal study finds that cannabis use among adolescents increases risks of being diagnosed with bipolar and psychotic disorders, as well as anxiety and depression, years later.

"This is very, very, very worrying," says psychiatrist Dr. Ryan Sultan at Columbia University, a cannabis researcher who wasn't involved in the new study published in the latest JAMA Health Forum.

Strong study design

Researchers analyzed health data on 460,000 teenagers in the Kaiser Permanente Health System in Northern California. The teens were followed until they were 25 years old. The data included annual screenings for substance use and any mental health diagnoses from the health records. Researchers excluded the adolescents who had symptoms of mental illnesses before using cannabis.

"We looked at kids using cannabis before they had any evidence of these psychiatric conditions and then followed them to understand if they were more likely or less likely to develop them," says Dr. Lynn Silver, a pediatrician and researcher at the Public Health Institute, and an author of the new study.

They found that the teens who reported using cannabis in the past year were at a higher risk of being diagnosed with several mental health conditions a few years later, compared to teens who didn't use cannabis.

Teens who reported using cannabis had twice the risk of developing two serious mental illnesses: bipolar, which manifests as alternating episodes of depression and mania, and psychotic disorders, such as schizophrenia which involve a break with reality.

Now, only a small fraction — nearly 4,000 — of all teens in the study were diagnosed with each of these two disorders. Both bipolar and psychotic disorders are among the most serious and disabling of mental illnesses.

"Those are the scarier conditions that we worry about," says Sultan.

Silver points out these illnesses are expensive to treat and come at a high cost to society. The U.S. cannabis market is an industry with a value in the tens-of-billions — but the societal cost of schizophrenia has been calculated to be $350 billion a year.

"And if we increase the number of people who develop that condition in a way that's preventable, that can wipe out the whole value of the cannabis market," Silver says.

Depression and anxiety too

The new study also found that the risk for more common conditions like depression and anxiety was also higher among cannabis users.

"Depression alone went up by about a third," says Silver, "and anxiety went up by about a quarter."

But the link between cannabis use and depression and anxiety got weaker for teens who were older when they used cannabis. "Which really shows the sensitivity of the younger child's brain to the effects of cannabis," says Silver. "The brain is still developing. The effects of cannabis on the receptors in the brain seem to have a significant impact on their neurological development and the risk for these mental health disorders."

Silver hopes these findings will make teens more cautious about using the drug, which is not as safe as people perceive it to be.

"With legalization, we've had a tremendous wave of this perception of cannabis as a safe, natural product to treat your stress with," she says. "That is simply not true."

The new study is well designed and gets at "the chicken or the egg, order-of-operations question," says Sultan. There have been other past studies that have also found a link between cannabis use and mental health conditions, especially psychosis. But, those studies couldn't tell whether cannabis affected the likelihood of developing mental health symptoms or whether people with existing problems were more likely to use cannabis — perhaps to treat their symptoms.

But by excluding teens who were already showing mental health symptoms, the new study suggests a causal link between cannabis use and later mental health diagnoses. Additional research is needed to understand the link fully.

'Playing with fire'

Sultan, the psychiatrist and researcher at Columbia University, says the study confirms what he's seeing in his clinic — more teens using cannabis who've developed new or worsening mental health symptoms.

"It is most common around anxiety and depression, but it's also showing up in more severe conditions like bipolar disorder and psychosis," he says.

He notes that mental health disorders are complex in origin. A host of risk factors, like genetics, environment, lifestyle and life experiences all play a role. And some young people are more at risk than others.

"When someone has a psychotic episode in the context of cannabis or a manic episode in the context of cannabis, clinicians are going to say, 'Please do not do that again because you're you're you're playing with fire,'" he says.

Because the more they use the drug, he says the more likely that their symptoms will worsen over time, making recovery harder.

"What we're worried about [is if] you sort of get stuck in psychosis, it gets harder and harder to pull the person back," says Sultan. "Psychosis and severe mood disorders, particularly bipolar disorder are like seizures in your brain. They're sort of neurotoxic to your brain, and so it seems to be associated with a more rapid deterioration of the brain."

Some electric bikes in California could soon require license plates under a proposed state bill aiming to address the rise in electric bike related injuries.

AB 1942 or the E-bike Accountability Act, would apply exclusively to Class 2 and Class 3 electric bikes.

Class 2 bikes can be operated without peddling until it reaches the speed of 20 mph.

Class 3 bikes reach a max speed of 28 mph; motor assist could only kick in with peddling.

The bill would also require owners to carry proof of ownership and would direct the Department of Motor Vehicles to establish a registration process. It was introduced by Assemblymember Rebecca Bauer-Kahan of Orinda in Contra Costa County earlier this month.

E-bike injuries spiked 18-fold between 2018 and 2023, according to state traffic data.

The bill may be heard in committee March 16.