The Doctor Will Tweet You Now

In Kaiser Permanente‘s hospital exam rooms, artificial intelligence is listening—and that’s a good thing. “It brings the joy back into… getting to know a patient,” says Assistant Area Medical Director Dr. William Tseng. “It restores the connection between doctor and patient, allowing us to actually see each other during the exam.” AI is now a routine part of patient care at Kaiser’s Southern California facilities, where it’s replacing “COWS,” computers on wheels, that can act as a physical barrier between physicians and their patients. Ambient AI functions as a scribe, listening to the exam room conversation (with patient permission), taking notes, and later transcribing everything to the medical record.

In collaboration with generative AI platform Abridge, Kaiser’s San Diego facilities have rolled out the region’s biggest deployment of “assisted clinical documentation” technology, and Tseng is excited about its potential for the entire healthcare industry.

His AI assistant, he says, “[doesn’t] miss things. It improves quality and efficiency.” AI has applications for diagnosis, as well. For example, “in radiology, we can use it to pick up diseases earlier by analyzing images of potential strokes and [helping doctors prioritize which scans they review,] based on severity,” Tseng explains.

Kaiser Permanente also rolled out two new hospitals in San Diego County in recent years. The latest, San Marcos Medical Center, opened in August of 2023. It has a labor and delivery ward, a neonatal ICU, a 24-hour emergency department, and 206 single-patient rooms.

Like many health systems in the area and the nation, Kaiser Permanente is no stranger to struggles with staffing. In late 2023, San Diego Kaiser workers went on strike as part of walkouts across four states to protest exhausting working conditions related to labor shortages and pay that didn’t cover the current cost of living. The walkouts resulted in a new contract that led to what President Biden called “historic” increases in healthcare worker wages.

Two of Kaiser’s San Diego medical centers nabbed a top-60 spot on US News and World Report’s 2023 list of the best hospitals. The publication named Zion Medical Center in Mission Valley and San Diego Medical Center in Kearny Mesa (both Kaiser facilities) among the best hospitals for maternity care this year. Contrasting a recent trend in maternity ward closures across California, the new San Marcos maternity ward opened shortly after two local facilities shuttered L&D services.

Additionally, the organization’s cancer survival rates consistently beat the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) averages. A study published in 2024 showed Kaiser patients with colorectal, breast, and lung cancers have better survival rates after five years than other patients tracked in SEER data.

Tseng attributes this to Kaiser Permanente’s integrated model, where members have access to preventive care, smoking cessation programs, and cancer screenings—along with a national referral system providing regional Kaiser doctors with a comprehensive database related to cancer treatment, to ensure they’re delivering the most up-to-date and effective therapies.

It’s a big year for Scripps. The healthcare institution is celebrating its 100th birthday, and in its century in SD, it’s racked up its fair share of accolades: US News and World Report has named Scripps in the top 50 hospitals for cardiology and orthopedics for 19 and 11 years running, respectively.

And it’s not letting age slow it down.

At Scripps Clinic’s Shiley Center for Orthopaedic Research and Education (SCORE), scientists are currently in the discovery phase of developing tissue from human stem cells to use in rotator cuff treatment. The eventual goal is to create a biologically engineered tendon to replace or repair the patient’s torn rotator cuff.

“This is a common injury, and as our population ages, there’s a pressing need to find new solutions,” says lead researcher Darryl D’Lima, MD, PhD, and director of orthopedic research for SCORE at Scripps Clinic.

This year also marked 40 years of the Mohs Micrographic Surgery and Dermatologic Oncology Fellowship, led for all four decades by Dr. Hubert Greenway. Dr. Greenway teaches doctors a technique pioneered by his mentor, Dr. Frederic Mohs, who developed a method of removing skin cancer layer by layer, checking for cancer cells along the way and preserving healthy tissue in the process. Dr. Greenway has performed 45,000 Mohs surgeries and trained 68 physicians to disseminate the technique as skin cancer cases increase each year.

Aside from treating formidable health issues, Scripps Health faces a growing, industry-wide challenge: violence against healthcare workers. Workplace violence at all five Scripps hospital campuses jumped by 31 percent in 2023, reaching 2,335 total incidents. Healthcare staff experience demeaning comments, verbal abuse, and assaults on a regular basis.

Scripps Health President & CEO Chris Van Gorder is part of a countywide task force addressing the problem, and the organization recently hired a retired FBI special agent to enhance staff security and safety training.

Next up for Scripps Health? A new, 227,000-square-foot, three-story building that will expand acute care services and increase the number of hospital beds. Lusardi Tower at Scripps Encinitas is scheduled to open in 2025, housing private inpatient rooms, operating facilities, intensive and progressive care units, and a pulmonary institute.

This is part of a three-part series. This is Act III. See Act I and Act II here.

The Future

We’ve been here before.

In 2012, city funding for the arts and culture in San Diego had eroded. As a corrective, the city council unanimously approved “Penny for the Arts”—a promise to dedicate roughly one penny of every dollar spent on hotel rooms (the Transient Occupancy Tax, or TOT).

The logic was fair and sound: Cultural institutions and events help attract visitors. Those visitors pay hotel taxes. So, the people agreed, some of that hotel-tax revenue should go back into maintaining the cultural ecosystem that helps bring those visitors and that money.

Projected as a five-year plan, the measure was supposed to increase funding to $17.9 million by 2017.

It never did. The penny was never guaranteed, so each year the city used part of it for other priorities. By 2023, the money going to arts and culture was up to about a half a penny. Even as TOT revenue has gone up significantly.

In 2019, TOT revenue was $245 million.

In 2025: $325 million.

One fix would be to guarantee the penny. Not simple, given San Diego’s financial woes. But the alternative—eroding the culture that makes San Diego San Diego, give it its identity—also doesn’t feel wise. Plus, even a locked percentage still rises and falls with tourism, which is why culture advocates want a guaranteed floor on top of it.

Another solution would be to give the arts commission actual authority.

“It’s an advisory body,” says arts commissioner Kamaal Martin. “You’d be hard-pressed to find anybody who takes our advice.”

He described the commissioners debating real, consequential questions this year, like whether and how to divide the cuts between funding pools. But those conversations “don’t connect to whoever’s actually deciding,” Martin says. “We haven’t been entrusted with decision-making about relevant things nearly enough.”

Christine Martinez is building political infrastructure through her organization Arts+Culture:San Diego—which is starting a 501(c)(4) lobbying structure not unlike police and fire unions. Martinez is also keeping her community actively engaged. “We won’t be caught off guard next year like we were this year,” she tells me.

Then there’s the evergreen issue of affordability and accessibility. Kiplinger’s most recent report ranks San Diego as the 11th most expensive city in the US, based on cost of living. The average home value is $980,700 (the US median is $540,000), but San Diego’s median household income is only one-third greater than the national level. Rent is also 66 percent higher than the national average ($2,716 vs. $1,636).

This is why San Diego has long suffered from the creative brain drain—creatives leaving for more affordable cities. “Artists are free to live wherever they want, and they will go where the rent is affordable,” says Jennifer de Poyen of Space 4 Art. “When they leave, they take their gifts with them, and their contributions, and their economic impact.”

One saving grace is the presence of Tijuana, where the cost of living is about 60 percent lower than San Diego, per Numbeo. Tijuana has long functioned as an affordable neighborhood for many in San Diego’s creative culture. It’s part of the reason why the binational identity is such a constant in our galleries, music, theater, murals, and culture. While that cross-border blood flow is one of San Diego’s most compelling attributes, few artists living that life would call it convenient or easy. A city is at a disadvantage when its culture creators have to cross a border to go home at night, and cross again the next morning to work.

In May, San Diego County Board of Supervisors approved a $2.75 million arts initiative of its own. It includes an Artist Space Grant Program aimed directly at the affordability crisis, as well as an artist-in-residence program, a dedicated Binational Creative Economy Investment, and a one-time investment in the Black Arts and Culture District in Encanto.

Bob Lehman of San Diego Art Matters has been doing county-level, binational organizing for years; in 2023, he helped get the county’s arts commission reestablished after 30 years of defunctness. That’s important because it gives arts and culture an official seat in county government, advising the County Board of Supervisors on arts and culture policy. He also brought in consultant Laura Zucker, who ran LA County’s arts program for three decades, to build a real regional plan.

“I really believe we’ll have something set up here that other communities come and look at,” he told me. “A national template other cities come to learn from.”

When asked who decides which artists will get the new grant money, county arts commissioner and executive director of the Chicano Park Museum and Cultural Center Monica Delgadillo Hernandez doesn’t hedge.

“That’s part of the infrastructure we’re going to be building,” she says. “What should a panel of reviewers look like? Should it be the commissioners? Should it be other folks? A supervisor?” She was just as candid that the commission itself doesn’t reflect San Diego’s population—Chicano communities are roughly a third of the city, she tells me, “and that’s not represented at the table yet.”

What Other Cities Prove Is Possible

The great news is that none of these solutions have to be invented from scratch. Numerous cities serve as examples of what’s possible—if we have the will.

Jonathon Glus—Prebys Foundation Senior Fellow for Art & Design, the Executive Director of the Art + Design District, and board president for California for the Arts—worked in Houston before coming to San Diego. The Texas city dedicates 74.5 percent of its hotel tax to arts grants by formula, and that support is guaranteed. Washington, DC locked in dedicated arts funding in 2019. Salt Lake City, my hometown, has run a voter-approved arts tax for almost 30 years, most recently reauthorized through 2034. And just this summer, New York City pushed cultural funding to a record $323.8 million, even incorporating an emergency fund.

Denver’s model is interesting because instead of a city-dependent funding model, theirs is a 0.1 percent regional sales tax. In place since 1988 and renewed by voters three times, their Scientific & Cultural Facilities District has distributed between $54 million and $85 million to arts, culture, and scientific orgs—each of the last 12 years.

This is part of a three-part series. This is Act III. See Act I and Act II here.

None of these cities got there by accident. They decided, on purpose, that arts and culture were worth protecting from politics—and, in some cases, worth building an entire identity around.

“That’s how Miami has flipped the switch,” says Glus. “People go to Miami for culture as much as they do the beach.”

San Diego has spent decades selling itself backward: Beach and weather first, culture as an afterthought you might stumble into. Glus would love to see the strategy flipped: Visitors should come for the art, “and then, by the way, you’re on the beach.”

So What Happens From Here?

“I do think it was a wake-up call for the community,” de Poyen says of the budget fight. “People understand that our funding is vulnerable. It was a lesson in how much power people have when they coalesce. But wow, is it painful.”

Glus says he’s genuinely optimistic. “The players have all changed seats, but the work is moving forward.”

“I believe optimism is a moral duty,” says Martin, who’s both power-fist and polite.

In eight months, there will be another budget fight. Everyone I talked to expects it will be worse. But something happened this spring that can’t be undone.

“I hope this rupture has brought us together in a moment of self-realization,” says Leticia Gomez Franco of the Balboa Art Conservation Center. “I hope we stop being so transactional; we begin to see ourselves and each other as partners in this work.”

That’s the whole ask, really. And it’s on all of us.

This is part of a three-part series. This is Act III. See Act I and Act II here.

This is part of a three-part series. This is Act II. See Act I and Act III here.

Without concrete, wildflowers are just weeds. Any honest history of San Diego art and culture is tension and its reckonings. It begins before the name existed, with the Kumeyaay. It must pass through the Panama-California Exposition, one hell of a county fair that conjured Balboa Park as our grand cultural stage. It pays tribute to the lights of La Jolla, where the donor pool helped realize unrealizable things. It should mention names like Marston, Scripps, Ochoa, DeWitt, Lopez, Klauber, Baldessari, Torres… so many.

In short spaces like this, long histories like that become roll calls. So this is more of a walk through pressure points, notes on recurring forces and regional oddities.

Border life is key to understanding the here of here. Art without dialogue is just decoration. At its best, that dialogue should be a tad muddy, emotionally gassed. In other words, it should be in need of art—to widen perspective, parse meaning, see the unseen.

San Diego’s central dialogue—the magic and the stressor—is being flatmates with Mexico’s second-largest city by population. That makes San Diego a swing-gate of shared and vastly different perspectives, both its own place and something larger. And in no other major city in the US do the fresh flow of ideas from two countries—different governments, laws, mores, expressions, arts, cultures, traditions, economies, loves, and resentments—mingle at such a constant daily rate (due respect to El Paso).

That binational steam created Chicano Park, one of the most uniquely San Diegan contributions to national and international culture. When construction of the I-5 and Coronado Bridge divided Logan Heights, neighbors protested by transmuting prejudicial concrete into redwoods of Chicano art. Turning a civic wound into a beautiful and enduring landmark that expressed and preserved a core identity—like East Side Gallery in Berlin or Constitution Hill in Johannesburg—is damn near the core of what art is supposed to do.

Like any city, the underground-overground friction is crucial in San Diego. Our culture is headlined by institutions that lift creative work onto national and international stages: MCASD, The Nat, SDMA, Centro Cultural de la Raza, the Symphony, WorldBeat Center, The Old Globe, La Jolla Playhouse, Mingei, Museum of Us, Stuart Collection, Timken, ICA, Comic-Con, etc. The next mutations grow in the seams: street murals, music dives, tattoo shops, wheatpasted walls, graffiti, lowriders, surf and skate art (though in San Diego, this is mainstream), pop-up shows, backyard shows, beach raves, any place with room for people and a loose relationship with regulations.

Both art and culture get their power from power. They’re fundamentally a conversation with and retort against dominant structures. San Diego’s most pervasive structure is arguably the most rigid form: the military. Its presence is heavy in the southern tip (Border Patrol), the middle (Navy and MCAS Miramar), and northern edge (Camp Pendleton). The military is San Diego’s largest employer, by a long shot.

Within this plus-sized environment of order and hierarchy, it’s understandable that Shepard Fairey’s “OBEY” posters in the late ’90s struck such a potent chord. The most compelling punk rock is often outside a strong governor’s window. (The “OBEY” series featured an ominous, propaganda-style André the Giant wheatpasted on random ugly surfaces across San Diego—launching Fairey’s style that he eventually used for Obama’s “HOPE” poster.)

Armed forces are often viewed as the absence of creative culture—understandably so, since rogue individual expression feels like a pretty sure way to sink a war effort.

But in San Diego, the Navy’s unsuspecting role as art creator—directly or indirectly—is hard to ignore. Tattoos are a dawn-of-time practice of many early cultures, including the Kumeyaay. But Polynesia was a core realm. Sailors were exposed to it on deployment in the Pacific Rim, inking their arms with the names of loved ones and unit insignia. Back in San Diego, they’d flaunt those tats in the beaches and bars of Mission Beach or PB (Marines did the same in Oceanside.) Enlistees were the muscular flesh galleries that helped turn skin art into one of the city’s most widespread modern art forms.

During WWII, the military also trained huge legions of San Diego laborers how to build war machines. Those mechanics, engineers, machinists, welders, painters, and metal fabricators used those skills for creative good in their neighborhoods—especially in custom car culture, which took off in the post-war ’50s and ’60s. Mexican-American vets helped develop the lowrider scene, a deeply rooted part of San Diego creative expression. Galleries on slow-moving wheels.

Tourism is the other mainstream force ripe for creating against. It is both critical to San Diego’s economy, and one of the greatest barriers to deeper, more nuanced expressions of what and who San Diego is. The industry of selling our city to passers-through creates a gigantic tarp of cultural tropes. It reinforces the most obvious charms—cute zoo animal takes in an epic sunset with a giant margarita—and doesn’t yield much airspace to the thrilling micro-cultures that live and breathe where locals live and breathe. Nothing against watercolors of dolphins, but much against the hegemony of watercolors of dolphins.

Maybe because of these dominant forces, San Diegans especially tend to force underground and institutional art into a needless cage match. It’s human instinct to champion the underdog as more worthy, but that has always felt like a form of articide.

It’s like saying the only good food is made by gritty upstarts who crafted their own whisks from discarded shopping carts. Most of those plucky whisk-makers would love to eventually be paid properly, would love a stage, a grant, a building, a donor, a lighting rig, health insurance, maybe even one chair that doesn’t threaten the spine.

That’s what the major institutions do. Both stages—the duct-taped and the donored—serve vital roles and deserve commensurate support if we care about the entire lifespan of creative expression and not just its first exciting steps. Championing the starving artist exclusively just secures an enduring poverty for the creative class at large.

I’ve often theorized it’s harder to create great art and culture in cities like San Diego, where the climate is supernaturally pleasant. In colder/hotter/rainier/less beautiful cities, people are forced indoors to fabricate their own beauty (the grunge music of Seattle, the obscene creative output of Reykjavík). San Diego’s eternally mild sunshine tends to make the human body our art medium of choice. But scratch the surface of that surf poster (and I’ve only scratched a miniscule percent here), and this city’s far from the cultural shallows it gets accused of being.

Addendum: A Personal Agenda. In scouting the route of art and culture across San Diego county through history, two areas come up again and again: La Jolla and Barrio Logan. So I propose a collaboration between two icons of artful concrete—Chicano Park and Salk Institute (one of the world’s great examples of brutalism architecture). Let Barrio Logan’s muralists go nuts on that coastal science fortress, unite the realms for a moment in time.

This is part of a three-part series. This is Act II. See Act I and Act III here.

This is part of a three-part series. This is Act I. See Act II and Act III here.

Every spring, Christine Martinez reaches out to the arts community to explain what’s on the line, hoping they’ll engage with the city’s budget process. Cultural funding, she constantly reminds, is almost always strapped to the guillotine. Especially in a city strapped for cash.

“It’s not an easy ask,” says Martinez, manager of Arts+Culture:San Diego. “Showing up is a real cost for small, volunteer-run groups that can’t spare half a day at City Council without possibly having to close their doors.”

Then, last April—with one day’s notice to arts leaders—Mayor Todd Gloria proposed a budget that didn’t trim arts funding; it eviscerated it, from $13.8 million to $2 million. An 85 percent slash. Other city departments faced cuts of about 7 percent.

The scheduled date of the cuts was just three months away (beginning of the fiscal year). Organizational leaders have to plan months if not years ahead to run their organizations. They had made hires, dedicated spending, and programmed their seasons based on a reasonable expectation that support for the arts would be somewhat in line with previous years. (The City has allotted at least $7 million a year to arts every year for the last 20 years, and the last four years have ranged between $13.8 and $18.2 million.)

The day felt even more existential given the national and international climate around the arts: namely, the federal government’s repeated proposal to eliminate the country’s two biggest cultural foundations (NEA and NEH), and the global trend of AI replacing more costly human creatives.

“It shocked everybody,” says Kamaal Martin, arts commissioner and co-founder of Art Power Equity. “If the message had been, ‘Times are tough, everybody tighten their belts a little,’ it would have landed differently. But there was no vision offered for the future, no parity in the cut. It was just, essentially, ‘Fuck you.’”

Among things I’m good at—sleeping late, low bidding for expensive shoes on Poshmark, parallel parking on either side of the street—budget analysis isn’t among them. In trying to understand how bad the finances were for San Diego to propose this drastic cut, I found myself drowning in numbers, pie charts, and politi-speak.

In his April 27 newsletter, Gloria explained that balancing the budget means “asking hard questions about every single dollar this city spends: Is this a core responsibility of city government, or is it something we do when we can afford to?”

Fair enough—if he were to ask those hard questions about every single dollar this city spends. It also makes his conclusion clear: The City of San Diego does not view supporting arts and culture as a core responsibility.

Which begs more than a few questions: Should the City be responsible? If not, then who? How crucial are arts and culture to a city? And since this is a budget discussion, how much revenue does the arts and culture industry generate for San Diego? What’s the ROI?

The Impact of Arts & Culture

$1.2 billion.

That’s how much economic activity San Diego’s arts and culture nonprofits generated in 2022, according to the City’s latest Arts & Economic Prosperity 6 report. The industry created nearly 17,000 jobs and generated $878 million of personal income for local residents. About 15 percent of the people showing up to arts events in San Diego are tourists, so money was raised through TOT (Transit Occupancy Tax). The activity generated $275.7 million in tax revenue to the city.

In other words, the ROI seems to be ROI-ing.

Still, there have been signs that cuts were coming. In 2025, the City demoted the Department of Cultural Affairs to a division, folding it into the Economic Development Department (EDD). That meant Cultural Affairs no longer had independence, nor its own leader sitting at the same organizational level as departments like parks and recreation, library, police, and fire. It lost institutional leverage and would now have to compete with other EDD priorities—real estate, airport operations, business development, etc.—for budget allocation.

To be clear, few arts administrators and leaders I spoke with are interested in the either/or false choice of funding law enforcement or after-school programs; the fire departments or libraries. They’re sincere in looking for solutions that don’t leave any single group with a greater burden of righting a long-out-of-balance budget.

Jennifer de Poyen, executive director of Space 4 Art, says Gloria had long been a supporter of the arts, which made his attempted Red Wedding especially upsetting.