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GWOT V - Briefing Paper, California Office of the Surgeon General

[By Order Of The Surgeon General - posting required as indicated.]

To all who read this message, greetings.

[pictogram of illegible writing on a poster]

EXPLANATION - IF YOU NEED HELP NOW, SKIP TO THE BOTTOM

[pictogram of person screaming] (arrow skips first section and points to pictograms in that section)

Upon the assertion of national sovereignty by the California Republic, it was immediately realized that the health and safety of all Californians depended on the immediate creation of a robust healthcare system, with no help from Washington or anywhere else for that matter. Also that California was at war with America, crushingly poor, had suffered two nuclear strikes within the last two years (San Francisco and Burlingame), had been invaded directly (by Mexico) and had suffered first a genocidal campaign (Homeland) and then the successful insurgency by the Resistance. Millions of Californians needed long term care for life altering injuries. Hundreds of thousands were dying of cancer. Many had been shot, beaten, tortured and worse. And so-called 'pre existing conditions' from asthma to urinary tract disorders had been horribly worsened by lack of care during the war. Last but not least, children continued being born and needed prenatal and postnatal health care… which even pre-War was supposed to be provided for free.

Therefore, the decision was made to implement a military healthcare system, using elements of military control and discipline in combination with a command economy with respect to healthcare. All existing medical professionals (including enemy POWs!) were essentially drafted 'for the duration.'

California already being divided into counties, the obvious place to seat the final source of healthcare was the County Hospital. These facilities were massively expanded, and in some cases built (and more than once, rebuilt) to each have the pre-war capacity of a major university teaching hospital, equivalent to pre-war Stanford University or UCLA Medical Center, in every county in California. Note that even compared to _pre war_ capabilities, this was a massive increase: in beds, in fungible equipment, in personnel.

Every County Hospital also had associated with it a teaching program, to meet California's suddenly voracious need for every type of healthcare provider, from LVN and EMT through paramedic and nurse up to surgeon and nurse-practitioner. The smaller counties took the vocational training programs; the largest trained doctors, surgeons and particularly battle surgeons.

As the California Republic continues her transition from wartime to a watchful peace, the Office of the Surgeon General continues to be under direct, autocratic military control. There are a number of reasons for this, but most notably to assure quality of care provided.

The Office of the Surgeon General also subsumed the Public Health departments of the various California counties, as well as taking up all of the functions that had been provided by pre-War Federal agencies such as the Food & Drug Administration, Health & Human Services, the VA, the DEA, etc ad nauseum.

The resulting bureaucracy would be mind numbingly complex if it were also required to attempt to make a profit. Exactly the opposite is true - the care that is needed must be provided, and is all to be billed to the California Republic. The sheer magnitude of the needs has required leveraging both the remains of the civilian healthcare system and humanitarian aid societies such as the Red Cross, Red Lion and the Salvation Army. In practical effect, the County Health Officers are a check and balance on the power of the Surgeon General, and the drive to control costs through outsourcing keeps empire building to a manageable level.

Medical billing still exists. But the Draconian requirement that medical care must be provided regardless of ability to pay means that a swirl of electronic files (printing to paper is expensive!) follows around every person in California, as complex as a pre-War credit report and much more detailed for verification of identity, from dental records to blood types. "Outlaw" medical care is nearly impossible to find.

-> Aliases and fake names are cheerfully accepted at point of care and no real-time effort at verification is made. <-

It is notable that the California Republic has not had any insurgency against it in turn, and that both infiltrators and pro-American adherents are immediately and with as much as kindness as feasible shown to the borders.

[pictogram of happy face]

The Office of the Psyche General has been established, reporting to the Surgeon General, to provide morale, psychiatric and mental health services to all Californians, with the same added emphasis on healing the wounds of the wars. The working assumption of the OPG is that all Californians, whether or not diagnosed, suffer from complex Post Traumatic Stress Disorder (C-PTSD), and that therefore treatment services should be offered freely to all Californians without the formality of requiring a diagnosis.

Immigrants are evaluated against the likely future lifetime healthcare costs, on a sliding scale against their individual and/or family productivity, with a considerable fudge factor for humanitarian considerations. This has tended to guarantee that family groups of immigrants, some of whom have major health problems, are much more likely to be admitted to residency visa than individuals with health problems.

[pictogram of dollar sign, yen sign, pound sign, etc]

A frequent question asked by outsiders is "How does California pay for all of this?"

At present the California economy is transitioning back to a market model from a wartime command economy. Taxation of personal income is now approximately 50%, none of which goes to the United States. Due to the costliness of imports of all kinds, native California corporations are strongly encouraged to source internally and there is a punitive luxury tariff of 200% of face value on non-essential imports. There are significant tax breaks surrounding medical costs of all kinds, from individual healthcare costs (reducing personal income tax) to companies providing healthcare not merely for their own employees but for the nearby community.

Visitors to California find that any healthcare provided to them is free of charge for the duration of their visit. This is part of being a tourist destination. This includes applicants for immigration.

[pictogram of person wearing vest] [pictogram of person wearing helmet]

A word on injury prevention. California has been ruthless about implementing certain civil and criminal laws for the purpose of reducing preventable injuries, especially head injuries and suicides. For example, riding a motorcycle without a helmet is a felony resulting in lifetime revocation of motorcycle license for the first offense. Permitting a minor child to ride a bicycle without a helmet is 30 days at hard labor; a second offense may terminate parental rights. Driving a vehicle in which a small child is present, unless the child is in a proper car seat or another life threatening emergency exists, is felony child endangerment and the _first_ offense terminates parental rights. The theft of a firearm from an unoccupied residence, without physical evidence that a safe was defeated or a cable lock cut, causes a one year prohibition on purchasing a firearm and a mandatory inspection of storage practices three times: immediately, at six months, and prior to the purchase prohibition being lifted. All firearms purchasers must pass a background check, firearms safety course (online) and live-fire exercise at point of purchase. The costs of helmets, safes, child seats, training, etc. are subsidized. All counties have public-access driving and riding simulators, 'skid pans,' public firing ranges for both small arms _and medium arms_, etc.

[pictogram of pistol] /SLASH/ [pictogram of pistol within circle and slash] [???]

The relationship between the California Republic and the firearms rights of individuals is deeply convoluted and confusing. The right to "keep and bear" (own or carry) firearms is seen as a community right, for keeping the community safe rather than the individual - remembering that California just fought _three_ wars to kick various invaders out. Rifle ownership is common and totally unregulated. (Most privately owned rifles do not even _have_ serial numbers!) Machine gun ownership requires an easily acquired permit, during which safe storage and certification of training is checked. Pistol ownership requires a simple permit to possess in the home, which explicitly includes a campsite, vehicle trunk or backpack for travelers. (Analogy to Texas 'peaceable journey' laws.)

Carrying a rifle in public is considered 'disturbing the peace' without sufficient cause; but over fifty specific causes are listed in the applicable legislation, so in practice it is a 'stop and question' by police unless the reason is obvious, such as hunting wild boar (still a pest, despite much more commonly being hunted for meat). Pistols can only be carried in public by uniformed persons. However, this can include not only regulated couriers, guards, etc. but ordinary persons who choose to wear a "P" brassard on both arms. There are 'open carry advocates' who insist on their rights in this regard. Only California Republic police officers, soldiers and officers may openly carry a firearm aboard an aircraft or in a 'sterile area' protected by security screening and rapid reaction.

The carrying of a concealed pistol requires much more training and a finding of 'reasonable cause' which explicitly includes self defense. This finding is made by local law enforcement (city or sheriff), and refusals for law abiding persons may be appealed to state police. Concealed pistol permit holders are encouraged to fly armed and are given approval to bypass screening into sterile areas.

There is a rebuttable presumption that a lawfully armed person's actions in defense of self or others were lawful and prudent until proven otherwise. All unusual discharges of a firearm are fully investigated.

This apparent liberalization of firearms laws and regulations comes with significant responsibilities. The negligent discharge of a firearm in public carries an immediate one year suspension of firearms license and purchase; if the subject is a California Republic employee, they are terminated; if a soldier, transferred to a (unarmed) labor battalion; if an officer, dismissed without pension credit. The brandishing of a firearm in an unlawful quarrel can result in not only permit revocation, but loss of firearms rights for ten years. The actual use of a firearm in a violent crime (showing or touching it is sufficient) is charged as attempted murder and carries a minimum penalty of thirty _months_ at hard labor. If the offender is lucky they are permitted to serve this in a labor battalion; if not, they spend the time breaking rocks on a road crew, or are 'allowed' to 'volunteer' for the French Foreign Legion's China Expeditionary Force. Few such volunteers ever return. Rape or murder, with or without a firearm, are literally hanging offenses under both criminal and military law.

[pictogram wearing skirt holding head and weeping] [pictogram lying on floor with knife sticking out of torso] -->> [pictogram of person hanging by neck]

The prevention of suicide by firearm is a major public health objective. Ranges, instructors, firearms shops, ranges are all equally frank … if you need help, go get help… but first lock up your gun(s). A person with a firearms license who voluntarily seeks mental health treatment is legally protected from adverse action against that license, _even if they contemplated self harm_, on the theory that they can be trusted to continue to go get help as needed. A person involuntarily taken to mental health treatment loses their firearms licenses consistent with pre-War practice, i.e. 5150 and 5250, etc. The incentives are consciously set up to encourage responsible firearms ownership by people struggling with mental health concerns.

Explosives regulations are more Draconian and focus on the qualifications of the licensed person(s) and the safe storage requirements. They are applied with reckless disregard for the official status of the entity - a construction company, a police department, power plant security guards and a National Guard armory are held to the same exact standard.

CAL-OSHA workplace safety inspectors are armed peace officers and may inspect any part of any workplace at any time without warrant, except within private homes. CAL-OSHA, like any California peace officer, can issue immediate civil safety violations that carry the force of law. Note that CAL-OSHA now reports to the Surgeon General's office.

DO YOU NEED HELP TODAY?!?
(arrow from top arrives here)

from left to right:

[pictogram of 'hurt' person holding head with bandage]
[pictogram of 'sick' person throwing up, looking ill]
[pictogram of person holding head and screaming]
[pictogram of green cross]
[pictogram of EMS system symbol]
[pictogram of medical cadeus]

You may be seeking medical or psychiatric care for yourself or a loved one. Go to your clearly marked community clinic. Signage is posted for what to do if it is closed, and the location of the next nearest 24 hour emergency room. For any medical emergency that keeps you from getting to a clinic during hours or a 24-hour emergency room, dial 9-1-1 anywhere in the state and help will come to you. All medical care is provided without regard to ability to pay.

-> Aliases and fake names are cheerfully accepted at point of care and no real-time effort at verification is made. <-

[pictogram of person shaking hands with person seated at desk]

You may be seeking employment in the California medical or psychiatric care system. There are literally thousands of jobs open at any given time, not only with the Republic but with contract companies to the Republic. Information on how to apply is available at any community health clinic, any job site, from any Psyche General employee or contractor, and on the California Republic onion site.

You may be seeking related training. The County Office of Education will administer preliminary aptitude testing. If you have will and drive, they will help you map out a career path. California needs thousands of doctors, TODAY. If you speak Spanish, you may be sent to medical school in Cuba under our exchange program with that nation.

[pictogram of person holding head and looking at piece of paper, puzzled]

You may have received an electronic or (rarely) paper bill for medical services received. File it with your taxes (all CR tax filing is now electronic) and don't worry about it.

You may have been cited for a safety violation. These are properly speaking, civil infractions, and the goal of the California Republic is to correct the violation rather than punish the participant(s). Fix your problem. Wear the damn helmet. Keep it in the safe when you are not at home. If you feel you are unable rather than unwilling to address the safety violation, take your violation to the Duty Judge and she or he will discuss it with you and help you come up with a plan. We can give you a helmet or safe, or take your motorcycle or your license(s), more likely some combination that balances your responsibilities with your rights with the opportunity to prove yourself more worthy over time. Freedom comes with responsiblity.

[pictogram of soldier running forward, with rifle]

You may wish to join the Army of the California Republic. Go to the community armory; they will direct you further. To comply with international law, you must be at least fifteen (15) years of age. Your background will be investigated. If we cannot take you, we may refer you to the French Foreign Legion, China Expeditionary Force.

You may wish to apply for a license to possess or carry firearms or explosives. Information about this is on the state Web site and can also be provided at related businesses. You can also talk to the range masters at your county's public range during normal business hours. (This is also a chance to meet Army recruiters.)

[pictogram of person with suitcase and arrow pointing towards outline of California]

You may wish to apply to emigrate to California. You may do so at any time; the application process is four to ten weeks in duration. If your entry to California was unlawful, you must surrender yourself to the nearest peace officer to avoid prejudicing your application. You will be cited and given a date and time to appear before the Immigration Officer, then released and referred to support resources during your stay in California.

[pictogram of circle and slash over unhappy face] [pictogram of hanged man]

Exception: if you are an expelled person, you _cannot_ emigrate and if you are caught in California, you will serve at hard labor or be executed according to the exclusion conditions when you were sentenced for your crimes. Surrender of your own free will _immediately_ and mercy may be possible.


Reader's note: the text of this notice is posted at all California border entry points, in the waiting areas of all California county hospitals and community clinics, at all public injury prevention sites and in all court buildings, in all military recruitment sites and at all airports. It is also posted in Spanish and is made available on request by "point and identify" in over seventy languages.

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