Colorful collages line the hallways of Best Start Birth Center in San Diego, the squishy faces of hundreds of newborns carefully cut out and framed. A picture of Executive Director Karen Roslie’s son, born in 2003, hangs among the smiling, crying, and squinting babies.
Thirty years ago, Roslie’s mother, Roberta Frank, opened Best Start after training to become a certified nurse midwife. Since that time, state agencies and national organizations have recognized the birth center as a model for alternative birth practices. The Canadian health ministry even visited in the 1990s as it developed plans to fund midwifery services, Roslie says.
But in March, Best Start closed its doors, unable to keep up with escalating costs. TRICARE, a major military insurer and Best Start’s biggest contractor, wouldn’t pay for licensed midwives—only nurses, who can make much more money in a hospital. In a community where the Navy is a prominent employer, it was a debilitating blow to the birth center. The photos Roslie meticulously framed over the years will most likely have to be destroyed to avoid any medical privacy violations—evidence of more than 5,600 births shredded.
(Left to right) Executive Director Karen Rosalie and Founder Roberta Frank at the Best Start Birthing Center in San Diego. | Photo Credit: Ariana Drehsler for CalMatters
“It feels like I’m mourning a death,” Roslie says, gazing at the pictures. Best Start was the first licensed and accredited birth center in California, and even those credentials couldn’t save it. In fact, they may have hindered the birth center’s survival, requiring expensive renovations that many midwives say aren’t relevant to the care they provide or the safety of their practice. Its closure was one of at least 19 recent birth center shutdowns and reductions in service in the past four years, according to the California chapter of the American Association of Birth Centers (AABC).
Those closures deepen a crisis of declining women’s health services across California. More than 50 labor and delivery wards have closed in California hospitals in the past decade, creating maternity care deserts in rural communities and overburdening the remaining labor wards in cities and suburbs.
Sally K. (left) thirty-eight weeks pregnant, talks to midwife Andrea Bergleen (right), during a check-up. | Photo Credit: Ariana Drehsler for CalMatters
Consumer health and policy experts have pointed to birth centers as a way to expand capacity in communities where hospitals are no longer delivering babies. The midwife-run clinics deliver low-risk births and direct higher-risk pregnancies to hospitals.
But California has some of the toughest licensing requirements in the country, AABC says, and facilities like Best Start have long argued that California’s onerous regulations and an uncooperative Public Health Department prevent them from succeeding.
Only six operating birth centers are licensed in California. Another 26 are unlicensed. Licensure isn’t required, but it enables practices to work with insurance plans and helps them serve lower-income families who can’t cover birthing costs out of pocket.
Increasingly, only wealthy families who pay cash can afford to have a midwife or give birth outside of a hospital.
“The system is just a mess. It’s flawed. It’s set up to prevent providers that can provide really good care from even getting started,” says Best Start founder Frank.
Photo Credit: Ariana Drehsler for CalMatters
While most births in California take place in hospitals, birth centers serve a small but growing number of families. The number of planned out-of-hospital births attended by midwives has doubled over the past decade, even as birth rates overall declined, according to data from the Medical Board of California. And a statewide survey conducted in 2018 by the California Health Care Foundation indicated that more than one-third of pregnant people would be interested in having a midwife for a future birth.
Frequently, those who seek the services of midwives and birth centers cite the desire for more personalized care or poor experiences with previous hospital births. Studies show that for low-risk pregnancies, midwife-led deliveries at birth centers are safe and lead to fewer interventions such as cesarean sections.
“Women deserve this,” Frank says. “Every human deserves to find their own strength, find their place, [and] exercise their initiative.”
But even as demand for out-of-hospital births increases, birth centers across the state are shutting their doors, unable to withstand the joint battering ram of financial and regulatory challenges.
California’s health system was too unfriendly to make ends meet. Another Sacramento birth center is also on the verge of closure because it cannot get a state license. In September, Monterey Birth and Wellness Center will close, citing high costs and poor insurance reimbursement.
The California Department of Public Health refused multiple requests for an interview about the licensure process, responding only to emailed questions. The licensing process sets “minimum standards” for patient care, which include regulations around proper equipment and staff competency, the department said in an unsigned statement.
“We cannot speculate or comment on any reason why providers chose to close these facilities [or] aren’t seeking licensure for new [birth centers], or what could be done to improve the process,” the department statement added.
Executive Director Karen Rosalie | Photo by Ariana Drehsler for CalMatters
Licensing Can Take Years
Nancy Myrick, a co-founder of the San Francisco Birth Center, says it took four-and-a-half years of back-and-forth with the state health department to obtain a license. At one point, Myrick asked for a list of items that an inspector would check and was referred to regulations that had not yet been written.
“In the process of opening, the state bureaucracy was like the Great Wall of China. It was such a horrible barrier,” Myrick says.
It wasn’t until Myrick called her local assemblymember’s office to complain about the inability to get licensed and see Medi-Cal patients that the application was approved, she adds. The birth center was licensed in 2020.
“It literally took calling in the political dogs to get it done,” Myrick says.
Many providers noticed that getting a license became much more difficult after the state centralized the process with the public health department in 2018. Since then, nearly all birth center applications have been rejected, according to data provided by the department.
The department said in a statement the change was necessary to improve “standardization and consistency” in the licensure process for multiple kinds of facilities. Previously, the department’s 14 regional offices processed applications and approved most of them.
Yet midwives and advocates say multiple issues continue to plague the process. It’s slow, often taking years; it’s expensive, costing tens of thousands to retrofit buildings and maintain a license; and the standards are frequently at odds with midwives’ scope of practice. What results is a “de facto ban” on birth center licensure in California, says Sandra Poole, a lobbyist with the Western Center on Law and Poverty.
Without licensing reform, more birth centers will close, warns Bethany Sasaki, president of the state chapter of the American Association of Birth Centers.
A key problem, Sasaki continues, is that birth centers are expected to comply with building standards designed for hospitals. Requirements include negative pressure rooms for infection control and cast-iron plumbing for water supply and drainage.
Many midwives argue the standards don’t make sense because their patients are legally required to be healthy, with low-risk pregnancies. Any condition that would require the additional medical intervention the standards are meant to accommodate, such as surgery, would force the patient to be transferred to a doctor or hospital, Sasaki says.
“There’s no reason to hold a birth center to the same standards as a hospital, because it’s not a hospital, and that’s the whole point,” Sasaki adds.
Photo Credit: Ariana Drehsler for CalMatters
According to the Department of Health Care Access and Information, which sets building codes for health facilities, it would take legislative changes to make exceptions for birth centers. Poole and a number of groups representing midwives and Black maternal health advocates tried to introduce a bill earlier this year that would ease licensing requirements, but they were unable to find a legislator willing to carry it.
Sasaki’s licensure application for Midtown Nurse Midwives in Sacramento was denied in 2020. The holdup is the ventilation system in her building, which doesn’t meet hospital building code.
In March, Sasaki requested an appeal and emergency license after TRICARE, the same insurer that Best Start relied on, stopped contracting with unlicensed facilities. As of mid-July, she has not received a response from the state, though the department told CalMattersit was past the deadline for her to file an appeal.
Sasaki says that, without the TRICARE contract, which made up about 30 percent of her clients, the birth center will close by November.
“We’ve had to turn away so many people that we stopped answering our phone, because I don’t want to listen to another person cry,” Sasaki says.
Birth Centers Must Get Licensed to Accept Medi-Cal
Why is licensure such a stumbling block for birth centers? Medi-Cal, the state’s public insurance program for low- income families, pays for half of all births in the state, and it requires birth centers to be licensed.
“The single biggest thing that will help with sustainability is if birth centers can take Medi-Cal and if Medi-Cal can actually reimburse appropriately,” Sasaki says.
The majority of Medi-Cal births—more than 80 percent—are babies of color. A statewide survey also indicates that people of color, particularly Black women, want alternative birth support such as midwives and doulas the most. White women and those with private insurance were the highest users of midwives, the survey shows, while those who wanted a midwife but didn’t use one most commonly cited lack of insurance coverage as a barrier.
Caroline Cusenza, a midwife and the owner of the Monterey Birth and Wellness Center, says accepting insurance allowed her to serve a more diverse population in the working-class Latino enclave where the birth center is located. She wanted to take Medi-Cal patients but couldn’t. Though Cusenza applied for licensure twice, she was also rejected because the building didn’t meet ventilation standards.
The birth center will close in September after seven years.
“It was a hard decision to walk away, but we really just could see no path forward,” Cusenza says.
Executive Director Karen Rosalie hugs Kendra Wyatt, while Founder Roberta Frank hugs Jolene Wyatt. | Photo Credit: Ariana Drehsler for CalMatters
The Western Center for Law and Poverty has pointed to accreditation as a possible alternative to licensure. The Commission for the Accreditation of Birth Centers is the national organization that sets standards for birth center quality and safety. California regulators have used accreditation to help license other kinds of health facilities, but health department officials see no need to provide birth centers with alternate options. They argue that very few have tried to get a license in the first place. Only 23 birth centers have applied in the past decade.
Holly Smith, a certified nurse midwife and co-lead of Midwifery Access California, contends that the low number of applicants reflects the difficulty of the process. Midwives know licensure is nearly impossible, so they don’t bother applying, Smith argues.
“If [the Department of Public Health] can be much more involved in figuring out solutions to help birth centers exist and be licensed, should they want to be, then we would see a greater proliferation of applications,” Smith says.
Midwifery Access California is working with another state agency to improve access for low-income patients, Smith adds. They hope to convince the Department of Health Care Services to increase Medi-Cal payments to midwives. Right now, a licensed birth center gets about $1,300 per birth, while the midwife gets $400.
Some birth centers say that, at those rates, even Medi-Cal wouldn’t be enough to save them.
“If our birth center were to accept Medi-Cal, we would go bankrupt,” says Trisha Wimbs, owner of the California Birth Center in Rocklin.
Licensed in 2023, Wimbs’ facility was one of only three birth centers to achieve licensure since the public health department took over and tightened building codes. Wimbs says it cost $1 million to build the “hospital-grade facility” to code, including $80,000 to move a fire hydrant two feet closer to the building. The birth center does not take Medi-Cal because it pays too little to recoup expenses. Instead, the birth center caters to cash-pay and commercially insured clients in the affluent Sacramento suburb.
To sustain birth centers, Medi-Cal needs to pay around $8,000 per birth, Smith says. At that price point, delivering at a birth center would still cost less than half as much as a hospital delivery.
Saying Goodbye to Best Start
Eighteen years ago, Ellary Alonso was born at Best Start Birth Center when her mom, a former labor and delivery nurse, sought a more personalized birth experience. Alonso, who was 21 weeks along in March, wanted to deliver her son in the same place, surrounded by midwives she knew, maybe even in a bath. She wanted the emotional support of the team, she says, because her husband is a Marine, and there’s no guarantee he’ll be able to make it to the birth.
But a week before her first prenatal appointment at Best Start, Alonso got a call that the center was closing permanently. There are no other birth centers in Southern California that take her insurance, TRICARE.
“In this time when everything is about choice, you can choose not to have a baby, but you can’t choose how to have your baby,” Alonso says. “Hospitals are the only option.”
Compared to a hospital room, Best Start offered a homey atmosphere and the promise that the midwife attending each birth was familiar to the laboring client. The birthing rooms came with queen-sized beds, floral duvets, and white porcelain tubs for water births. A marble-topped “crash cart” sat in each room. With the doors closed, the cart looked like an end table, matching the décor. Inside, it was filled with medical supplies for conducting emergency resuscitations or stitching up lacerations.
Photo Credit: Ariana Drehsler for CalMatters
Though cozy, the rooms bore the hallmarks of a by-the-book clinic: boxes of nitrile gloves in each room, hazardous waste bins mounted discreetly to the wall. Best Start was the only birth center in the state to have a licensed clinical laboratory to confirm water breakage.
They never lost a mother or baby, Roslie says. Their transfer rate for cesarean sections was 20 percent less than the state average in 2022. In the past five years, they performed no episiotomies, perineum incisions intended to enlarge the vaginal opening during birth. And 96 percent of newborns were exclusively breastfed before leaving Best Start, compared to the statewide hospital rate of 69 percent.
Despite the center’s recognized success, keeping it running was always a labor of love, Roslie says.
“It’s never been a thriving business,” she adds. “Roberta’s gone without pay. I’ve gone with reduced pay. That’s what it takes to run a birth center.”
When Roberta Frank, Roslie’s mother, graduated from UC San Diego with her nursing midwifery degree in 1981, she was told, “San Diego will never accept midwives.”
Sometimes—in the face of Best Start’s closure—it still feels that way.
This story is produced by CalMatters, published jointly with San Diego Magazine.
Kristen Hwang is a reporter for CalMatters covering health care. Prior to joining CalMatters, Kristen earned a master’s degree in journalism from UC Berkeley’s Graduate School of Journalism and a master of public health degree from Berkeley’s School of Public Health.
Before, during, and after the Fourth of July, San Diegans can commemorate America’s 250th anniversary with an abundance of stars, stripes and local celebrations. America The Beautiful: 250 at The Rady Shell and Lamb’s Players Theatre’s revival of American Rhythm will look back at the many songs which define our country. Liberty Station’s Anchored in Freedom celebration and the Independence Day Carnival offer community-centered fun and loads of family-friendly activities. And who can possibly forget the Big Bay Boom, which will resume its reign over San Diego Bay as the state’s biggest fireworks show. Outside of the holiday festivities, this week brings the yearly return of Little Italy’s Summer Sera and the Athenaeum Summer Festival, as well as a slate of championship matches for All Elite Wrestling.
Sip on refreshing beverages and savor a panoramic rooftop view this Friday from 6-8 p.m. during the 21-plus Sunset & Spritz at Margaritaville Hotel San Diego Gaslamp Quarter’s 5 O’Clock Somewhere Bar. There will be a live DJ (until 9 p.m.), appetizers, pool and cabana access, a photo booth, and a cash bar (until 11 p.m.). To accentuate the summer theme, guests are invited to dress in white, pink, and orange attire. Tickets are $29 and come with a welcome aperol spritz.
616 J Street, Gaslamp
The 250 Grand Tasting Menu at Amaya
July 3 & 4
Bring a patriotic palette to the Fairmont Grand Del Mar for The 250 Grand Tasting Menu at Amaya this Friday and Saturday from 5-8:30 p.m. Patrons will be treated to a five-course tasting menu, curated to exhibit a selection of standout regional flavors and culinary concepts that have shaped our country’s distinct food heritage. The meal will also include beverage pairings with each course, such as wine, cocktails, and artisanal drinks. Reservations are $330 per person (with tax and 20% gratuity) on OpenTable.
Don Toliver thrives at being the life of the party (and the “After Party”). His fifth album Octane, released in February, is indicative of his thrill-seeking nature. As with his earlier releases, Octane sees Toliver operating in the space between hip-hop and R&B, with warbling vocals and blaring beats that are best heard at a high volume. This Tuesday at 7:30 p.m., Toliver will play at Pechanga Arena, with rappers SoFaygo, Chase B and SahBabii—who had a guest verse on Octane standout “K9”—as special guests. Tickets start at $156 for this concert.
What makes musicals like Wicked, Cats, Chicago, and Jersey Boys so timeless is the legion of excellent songs that makes fans out of those who’ve never even watched the show. This Friday at 7:30 p.m. during Blockbuster Broadway! at The Rady Shell, conductor Evan Roider, the San Diego Symphony Orchestra, and veteran vocalists Alex Getlin, Jessica Hendy, Scott Coulter, and John Boswell (also on piano) will perform an all-star theater soundtrack. In addition to the shows named above, audiences can expect songs from A Chorus Line, The Phantom of the Opera, Annie,and more. Tickets range from $57 to $129 for this concert.
222 Marina Park Way, Embarcadero
America The Beautiful: 250 at The Rady Shell
July 4
One night after recognizing the brilliance of Broadway, The Rady Shell will ring in the United States’ landmark anniversary with America The Beautiful: 250 this Saturday at 7:30 p.m. Conductor Byron Stripling, joined by a five-performer ensemble and the San Diego Symphony Orchestra, will lead a night of ballads that best resemble the red, white, and blue, including songs sourced from the Great American Songbook. After the show, concertgoers are invited to watch the nearby Big Bay Boom from their seats. Tickets range from $71 to $139 for this concert.
222 Marina Park Way, Embarcadero
Athenaeum Summer Festival at Athenaeum Music & Arts Library
Ryan Hardison is a freelance arts and entertainment writer and recent graduate of San Diego State. When he's not staring at his laptop, he's likely eating an adobada burrito or getting sunburnt at the beach.
“This is insane!” the guy filming it seems to proclaim. “It’s the best fireworks show ever!” a companion confirms, inspiring a debate lasting over a decade.
All told, 7,000 fireworks exploded in the span of 25 seconds over San Diego Bay on July 4, 2012. A Michael Bay amount of unison. $125,000 worth of shells, cakes, Roman candles, and skyrockets had been placed on a barge—enough for 17 minutes of decorative sky flares—and…
Boom.
The sky looked like someone had set a giant Rorschach test on fire. Or as if whatever we all see in our Rorschachs—butterflies, clowns, tongue kissing, dads—was being electrocuted and lifted heavenward, amen. It was shocking how bright it was, how much it sizzled the local cosmos. Could’ve been one of those sci-fi films where a hole is ripped open between warring universes. But angstier, more metal—the work of some methy creator in a sleeveless concert tee.
The sound?
Lou Reed once released an entire album that contained 64 minutes of mindflaying guitar screeches and machine noises. No regular songs, just a fascinating amount of ear distress. His record label reps no doubt heard the melodic outro of their careers, but everyone else was in pain and stumped. That album still sounded better than the bay did that night. The bay sounded like a god who struggled with emotional regulation had blown his speakers and was working through the anger stage of AV grief.
In the left frame of the video, a middle-aged woman is attempting to drag her husband off by the hand. In no way does he want to go, possibly because he had missed the time Roseanne Barr sung the national anthem at a Padres game, simultaneously disemboweling and amusing America through the power of song. He would not willingly abandon an equally worthy San Diego trainwreck.
Another woman in the video appears to have just filled her beer, rushing to sit down for the show. She pauses mid-sit and returns to the full and upright position to properly bear witness. What was supposed to be prolonged entertainment has been so radically shortened that she will have to find another reason to drink. Lucky for her, drinking will be the only way to adequately process.
Locals remember the conspiracy theories. People wondered if the fuses had been tripped by a saboteur who was sympathetic to dogs, fish, or the growing suspicion that late-stage capitalism is a gorgeously branded but impossible dream sustained by remarkably efficient top-tier wealth retention and the soft compliance of fireworks-watchers who can no longer afford a house, a beer, or the personal impacts of human reproduction.
Speaking of being terrified of babies, babies were terrified. The children who witnessed it probably still can’t go near a candle store. But those kids will be tougher, perfectly scarred kids. They’ll write better songs.
That night helped us absolutely dominate the national news cycle. For a hot minute, we became America’s water-skiing squirrel. Now, years later, when you Google “fireworks gone wrong,” San Diego is always a top contender, along with that poor Nebraska family who nearly wiped out a couple generations in their front yard, their minivan somehow turning into a howitzer of recreational TNT.
There is still debate as to whether Big Bay Boom 2012 is the worst or greatest fireworks show of all time. But the advanced parts of civilization arrived at the truth as quickly as the women in the video did. It was undeniably amazing.
First of all, the point of Fourth of July fireworks isn’t “the intricate choreography of sky fire over a guaranteed amount of show time.” It’s about creating a vivid memory shared with some people you like, love, or would like to love.
BBB2012 used large-scale chemical fire to create the ultimate memory.
Sure, some people who iron their jeans subjected their family to a sermon about how San Diego managed to botch America’s birthday like a Disney princess-for-hire who smelled of quite a few Sauvignons.
The rest of us saw how perfectly it nailed the actual feeling of being an American. Because only a miniscule percentage of us bake postcard apple pies where every inch of crust is perfectly laminated like the wood in an Irish bar. Very few of us can paint on par with Picasso. The rest of us—despite truly believing in our America-activated abilities to achieve greatness in almost any field of our choosing—burn pies. We try to paint only to realize it looks like our fine motor skills have entered active death.
That’s why BBB2012 was the most perfectly American fireworks show ever: A wildly ambitious idea galvanized thousands upon thousands of people to both work on it and come to hold a beer and gawk at it, only to have it fail in the most glorious TMZ-level spectacle.
America isn’t about immaculate, storyless wins. It’s about how the framework of a country is solid enough that we can accidentally detonate our entire lives—a few times—and still probably be OK.
No one has America’d quite like San Diego did on that day. It was performance art. Lou Reed’s heart slow-clapped. Any brief municipal embarrassment quickly became a pride of our people. I can only hope the same for the Nebraskan yard family whose Dodge Aerostar became a hyperactive Death Star.
P.S. Local writer Maya Kroth compiled a quite great oral history of that night for Thrillist. The bottom lines for me were—it took nine months to prepare, no one was hurt, and even though the pyrotechnics company tried to zero out the bill, Big Bay Boom founder H. P. “Sandy” Purdon refused and paid them in full. This year will mark the 25th Anniversary of the yearly Big Bay Boom.
Troy Johnson is the magazine’s award-winning food writer and humorist, and a long-standing expert on Food Network. His work has been featured on NatGeo, Travel Channel, NPR, and in Food Matters, a textbook of the best American food writing.
If absence makes hearts (and stomachs) grow fonder, then shuttered restaurants quickly become the hottest tickets in town—something a number of iconic institutions found out after taking very public hiatuses after historically long runs. For instance, following a lengthy (and extremely flip-floppy) closing process after 92 years in business, Las Cuatro Milpas reopened two blocks away in Mercado del Barrio. Similarly, Carlsbad butcher shop Tip Top Meats reopened in the same location (albeit a smaller space) after the death of founder Joachim “Big John” Haedrich in 2023. Finally, after a whopping decade out of business, Sami Ladeki and chef Alfie Szeprethy brought back Roppongi to its original Prospect Street space, where it was the talk of the town in the late ’90s. All came back under the same proprietors, so they weren’t third-party nostalgia-licensing deals. The algorithm may have ravaged our attention spans away from all but the newest and shiniest, but this proves there’s still hope for our collective prefrontal cortex.
Other local eateries honored their pasts by bringing in new perspectives. The Lion’s Share in Embarcadero, Milton’s Deli in Del Mar, Dudley’s Bakery in Santa Ysabel, and J-K’s Greek Cafe in La Mesa handed over the keys to new owners willing to take on a big task: maintain the soul of icons through particularly rough economic circumstances for restaurants, navigate big feelings from longtime regulars (who often don’t take kindly to change), and make some necessary changes to keep going for another few decades. Taking over a project in process can be a lot harder than starting from scratch. But building that feel-good nostalgia doesn’t happen overnight, so it sure helps to have a well-established playbook of success passed down from those who came before.
Courtesy of Sugarfish
The Expansion Class Arrives
It wasn’t just restaurant groups from Los Angeles that decided to put down roots en masse, although San Diego saw plenty of LA transplants recently (Sugarfish, Mr. Charlie’s, For the Win, Katsuya Ko, Bacari). Global brands like Chef Fei, Zuma, and Pepper Lunch have locations of their own on the way, and upscale Canadian eatery Joey joined to the inescapable gravitational pull of Westfield UTC’s culinary cosmos for its first spot in America’s Finest City. Good to see the rest of the world is catching up with what we’ve been seeing the last few years—San Diego is a dining destination already on the rise.
Choosing To Not Choose
Between the never-ending news cycle of doom and perimenopause brain fog, I’m at the stage in life where I’m more than happy to let someone else make a decision for me, especially when it comes to what’s for dinner. And based on the way a lot of menus look right now, I’m not alone. It seems like half the places I visit offer some version of a prix fixe, omakase, or tasting menu. Restaurants are embracing the curated experience to solve the problem of affordability (a fixed menu reduces food and labor costs, guarantees an acceptable check average, etc.) and critical thinking in one fell swoop. Omakase (meaning “I leave it up to you”) is far from a new concept in high-end Japanese sushi culture, but now that it’s popping up everywhere from coffee experiences to grab-and-go sushi and sandwiches, it’s gone from somewhat niche to nearly omnipresent.
Courtesy of Rikka Fika
Local Coffee Hit the World Stage
The world got an up-close look at San Diego’s coffee industry when we hosted the premier specialty coffee expo World of Coffee for the first time this April. San Diego’s long and rich coffee history stretches back to the late 19th century. Things percolated fairly quietly for around a century before really picking up steam. Today, there are nearly 200 specialty roasters and cafes across the county, with many earning national accolades like the Good Food Award (Steady State Roasting, 2020; Bird Rock Coffee Roasters, 2023, 2021, 2019, 2017, 2016), Roaster of the Year by Roast Magazine (Mostra Coffee, 2020; Bird Rock Coffee Roasters, 2012), and the Specialty Coffee Association Coffee Design Award for packaging (Rikka Fika, 2026). Now that we’ve moved past the comically insufferable coffee snob era of the early 2000s, even java newbies can feel comfortable walking into pretty much any coffee shop in San Diego, asking questions, trying a few things, and feeling confident they’re going to get great service and a great beverage.
Beth Demmon is an award-winning writer and podcaster whose work regularly appears in national outlets and San Diego Magazine. Her first book, The Beer Lover's Guide to Cider, is now available. Find out more on bethdemmon.com.
Kelly H. Harfouche, founder of KQ Aesthetic Society, knows firsthand that cosmetic treatments like fillers, neurotoxins, and microneedling, can not only enhance a person’s appearance and restore confidence, they have the power to truly change a person’s life. An expert injector has the ability to tailor treatments to each individual patient’s anatomy and goals for personalized results. Harfouche, a board-certified nurse practitioner, has spent nearly a decade perfecting her craft as an aesthetic injector and integrating her multifaceted artistic skills with precision patient care. Her commitment to continual education and training, plus a passion for helping people look—and feel—their best, set KQ Aesthetic Society apart in a sea of local medspas.
For many people considering nonsurgical treatments, the intent is to look refreshed and refined. KQ Aesthetic Society’s philosophy eschews a cookie cutter approach that bases treatments around units, instead working to understand each person’s unique goals, then curating a treatment plan to fit that vision. Harfouche focuses on “inclusive luxury,” the belief that everyone deserves access to aesthetic treatments, respective of budget restrictions. She develops long-standing trusted relationships with her patients, and works with each one to achieve their aesthetic objectives and address the underlying causes of their concerns.
“For me, forming an honest and open relationship with every patient who walks through the door is essential. This means understanding them on a deeper level and meeting them where they are to define and achieve their individual goals,” she says.
Drawing on her artistic background, which inspired her transition into medical aesthetics, Harfouche sees each client as a “unique canvas.” Rather than relying on standardized procedures, the practitioner’s distinctive approach combines her profound understanding of the physiological and anatomical changes associated with aging with an unwavering commitment to ongoing education about the newest products and their mechanisms of action. Her goal is to make each patient feel beautiful in their own skin and to embrace their individuality.
She has also pioneered a way to combine her talent for aesthetic artistry with her philanthropic nature. Harfouche is one of only a handful of providers using dermal fillers to treat patients with lip asymmetry and scarring resulting from cleft lip surgery. Patients travel from around the country for this transformative treatment, noting increased confidence and a restored identity. She hopes to eventually launch a training program to help fill the void in this space.
“My passion has always been connecting with people and giving back in any capacity that I can,” she says. In the rapidly advancing landscape of aesthetic medicine, you can place your confidence in Harfouche and KQ Aesthetic Society to deliver exceptional care. To learn more or book a consultation, please visit kqaestheticsociety.com.
Summer has officially kicked off, and San Diego is celebrating the sunny season with a myriad of fun events. From San Diego Pride week and a fairytale performance at Civic Theatre to a Santigold concert and Comic-Con, there are dozens of opportunities to make memories worth adding to your scrapbook. Here are all the best things to do in San Diego this July:
Divine inspirations, operatic ballads, and symphonic pop production elevate Rosalía’s Lux to heavenly levels. Hear angelic vocals ascend—in up to 13 languages—during her performance at Pechanga Arena.
Enjoy a night of feel-good indie rock and sing-along anthems at the Cal Coast Credit Union Open Air Theatre courtesy of Young the Giant and special guest Cold War Kids.
29
Santigold collects genres like gold stars: musical accouterments that brighten her uniquely alternative sound. See her live in concert with dancehall producer Troy Baker Sound at Humphreys Concerts by the Bay.
Two male government workers pursue a secret romance amid the Lavender Scare in the San Diego Opera’s production of “Fellow Travelers” at the Balboa Theatre.
Audrey Hepburn. Marlon Brando. Salvador Dalí. What do these icons have in common? Each was the enigmatic focus of a Cecil Beaton portrait. Step inside Cecil Beaton’s Fashionable World, an alluring showcase of 20th-century style at San Diego Museum of Art.
Courtesy of San Diego Pride
More Fun Things to Do in San Diego This Month
1
The Little Italy Mercato will trade morning rays for golden-hour glow through its free Summer Sera, an expansion of the neighborhood’s farmers market with live music, artisanal finds, and a fetching amount of pet activities.
11–19
San Diego Pride week starts with a Dyke March and ends with the two-day “Pride Shines On” festival. The days in between? Run a 5K, march in the parade, visit the rainbow-lit St. Paul’s Episcopal Cathedral, and more.
19
Dress up for a Mediterranean-themed tea time at the Estancia La Jolla, a laid-back yet refined afternoon planned for the resort’s monthly Tea in the Garden series.
23–26
Nerd culture’s biggest gathering returns to the Convention Center. San Diego Comic-Con welcomes fans of everything from comic book cinema to ultra-rare collectibles for panels, exhibits, sneak peeks, and much more.
Ryan Hardison is a freelance arts and entertainment writer and recent graduate of San Diego State. When he's not staring at his laptop, he's likely eating an adobada burrito or getting sunburnt at the beach.
You’re coasting home after a weekend in Rosarito Beach—still riding the high of vitamin D and Baja Med—and then comes a slap back into reality: brakelights and gridlock exhaust.
Small wonder, given that San Ysidro is the busiest land border crossing in the western hemisphere (fourth-busiest in the world). Otay Mesa’s no breeze either; it’s the busiest commercial port in California and second-busiest across the entire southern border. Smart Border Coalition says that each day last year, 41,800 vehicles crossed into the US at San Ysidro; 17,800 crossed at Otay Mesa, along with 1,023,000 commercial trucks.
Diana Pazos, a San Diego resident and adolescent psychiatrist working in Tijuana, says the northbound border wait at the San Ysidro crossing is often three to five hours Saturday through Monday—delays that modern humans and multinational maquiladoras alike aren’t built to endure. At the current Otay crossing, “commercial trucks may be in line for six hours or longer,” she says.
Needing to bake a couple hours of commute into the States doesn’t just affect vacations; tens of thousands of people cross the border each day for doctor’s appointments, work, school, you name it. The clog has personal and commercial ramifications.
But change is coming. Construction has begun on a new border crossing in Otay Mesa, which is expected to significantly reduce wait times across all San Diego border crossings, bolster binational trade, and improve the air pollution levels in the area.
Nikki Tiongco, an 18-year Caltrans veteran who oversees the Otay Mesa East project (aka Otay 2) for the agency, says the new border crossing will also be among the most high-tech, efficient, and secure border crossings in the nation.
“We have already completed the roadway network within the Otay Mesa East region,” says Tiongco. Part of this project included building State Route 11, an extension of SR 905, which has been open to the public since August and will feed traffic to the new entry port. Otay 2 comes with a 21st century upgrade, too. Miles of fiber-optic cables have been installed underground, which gives the port the brainpower to efficiently sort and streamline traffic as cars approach the border. (Unlike the San Ysidro border, where lanes get organized by vehicle type, Otay 2’s lanes will be interchangeable. For example, if the system indicates that a high number of commercial trucks is heading to the border, passenger lanes could be converted to cargo lanes in real time.)
Otay 2, driven by a binational collaboration among government agencies (Caltrans, SANDAG, General Services Administration, and U.S. Customs and Border Protection), receives both federal and state funding, plus hefty contributions from Mexico. So far, funds from the $1.3 billion project have helped build new bridges and roadway interchanges that will guide traffic to the crossing. At this stage in the process, Caltrans is “laser-focused on building the facility itself,” Tiongco says.
Now, to the juicy part: the prospect of a “20-to-30-minute border wait time” at Otay 2, according to Tiongco. Currently, there are three standard ways to cross the border at San Ysidro: Ready Lanes, General Lanes, or SENTRI Lanes. Most travelers use either the Ready or General lanes. SENTRI Lanes require a form of pre-approval from the US federal government plus an additional fee. According to CBP, the average wait time in 2025 at the San Ysidro crossing, was as little as 15 minutes in the SENTRI Lanes, 45 minutes in the Ready Lanes, and 1.5 to 2 hours in the General Lanes. Those are best-case scenarios that vary based on lane type and time of day.
Otay 2 is about 12 miles east of the San Ysidro crossing and 2.5 miles east of Otay 1. Those not wanting to spend that much extra time on the road to drive to the new border crossing, despite the allure of an under-30-minute wait, are still expected to see some benefits. Tiongco says Otay 2 will “provide a relief valve” overall by spreading the burden across the three border crossings. As a result, SANDAG says, wait times at San Ysidro and Otay 1 could be cut in half.
It’s not just your time waiting at the border that matters. Multinational corporations that relocated their manufacturing plants (maquiladoras) to Northern Baja have claimed for years that the long delays at Otay 1 eat away at their profits. More than 600 maquiladoras, used by companies such as Samsung and Panasonic, currently use Otay 1 to transport products to US and international markets. Ambassador Alicia G. Kerber-Palma, the consul general of Mexico in San Diego, says the project will facilitate more than $60 billion in cross-border trade annually.
Previous reports say that Otay 2 also has the capacity for around 12,000 passenger cars and 1,500 commercial trucks daily. A shiny, new element to this port: Commercial and personal vehicles that choose to cross will pay a dynamic toll on both sides of the border. The fee will increase during busy hours and decrease during slower periods, Tiongco says. Caltrans estimates that the toll could range from $4 to $30 for passenger vehicles and higher for commercial trucks. Drivers will be able to see current rates before they reach the actual border crossing.
And, with these changes, there are environmental benefits, too. “With shorter wait times at all three ports, there’s less idling and congestion, which should significantly reduce air pollution on both sides of the border,” says Kerber-Palma. The main factor driving improved air quality would be decreasing dirty emissions from idling diesel trucks. This county’s air could use some sprucing up, anyway. A 2026 report from the American Lung Association named San Diego as the fifth-most particle-polluted county in the US. The bulk of that dirty air comes from the heavy-duty trucks and ships that pass through the area.
Otay 2 is not only expected to curb the acceleration of air pollution in San Diego; if the state’s legislature passes California Senate Bill 10, the border crossing could also restore local water quality. This bill would use a portion of Otay 2 toll revenues to fund ongoing maintenance of the South Bay International Wastewater Treatment Plant. Current media reports say, however, that it’s increasingly unlikely that SB 10 will become law.
Otay 2 has been in the works for over two decades and is finally nearing the finish line. Construction estimates show that it should be up and running in 2029. Tiongco says this border crossing is “a good example of how the state, federal and local governments are working together and with Mexico to advance our mutual goals in the region.”
AVRP Studios’ tradition for Design Excellence and Innovation began in 1976 with Doug Austin, FAIA, in Solana Beach, California. The firm has since grown to complete major projects throughout the United States and Canada. We think of ourselves as a family and we care deeply about people. We want to inspire, help make their lives richer and more complete through our efforts. We believe that architecture is one of the most important art forms because of the impact it can have on the lives of those it touches. We’re delighted to have been recognized with over 150 awards for design excellence.
703 16th Street, Suite 200, San Diego, California 92101 | 619-704-2700 | avrpstudios.com
