Valley Democrats Cardoza and Costa are key to big health care vote
WASHINGTON – With a Capitol Hill showdown only days away, two San Joaquin Valley congressional Democrats remain crucial and undecided votes on a controversial health care bill.
The pressure is building on Reps. Dennis Cardoza of Atwater and Jim Costa of Fresno. In some ways, they hold the bill's fate in their hands – as well as several political futures: the president's, the party's and their own.
The White House has summoned both in recent days. Television ads and Republican talking points target them.
"I have had good friends who have called me in recent weeks, who have made good arguments on both sides," Cardoza said.
Costa went to the White House on Thursday night. A week ago, it was Cardoza's turn. As a counterweight, corporate opponents of the health care bill have been running television ads urging viewers to tell Cardoza to vote no. Phone bank operators have been deluging both offices, also urging a no vote.
Inevitably, bargaining over one issue blends into another.
Costa said last week that he used some of his time with President Barack Obama to urge more consideration for the valley's water and employment needs. Obama said he understood, Costa reported.
In a memo, Republican leaders identified the two Valley lawmakers as among those who would ultimately determine the success or failure of the legislation. They are both part of the Blue Dog coalition, whose members have more moderate voting records than other Democrats.
In November, Cardoza and Costa joined the majority in approving the initial House bill by a 220-215 margin.
Since then, negotiators have revised the package, but the final bill, well over 1,000 pages, isn't expected to be available for inspection until Monday. The Valley lawmakers say they can't commit until then.
"We've gotten the summaries, but we don't know what the actual language is going to be yet," Cardoza said.
Costa, too, stressed that "I want to see the bill in print, what we're actually voting on," before making a decision.
Costa and Cardoza both support elements in the health care package, including insurance coverage for those with pre-existing conditions and portability of coverage when employees change jobs. The bill's final cost remains a potential concern for both.
Both lawmakers oppose federal funding of abortions, though they are leaving to others the details of how to write the necessary legislative language.
Because of congressional vacancies, House Speaker Nancy Pelosi needs 216 votes. No Republican is expected to vote for the health care package, leaving Democrats to pick their own way.
Politically, legislators see danger everywhere.
Failure to pass the bill would invariably brand Obama and congressional Democrats as weak or inept. That would hurt the party in November's elections. But in conservative-leaning San Joaquin Valley districts, support for Obama and Pelosi could also be costly.
In this environment, even modest clues invite interpretation. Cardoza, for one, seemed to emphasize last week the problems of uninsured San Joaquin Valley residents and the pain of rising insurance costs.
"We have real problems with a lot of my folks not having insurance," Cardoza said.
An estimated 28 percent of the residents of Costa's congressional district in Fresno, Kings and Kern counties lack health insurance, according to the Physicians for a National Health Program.
An estimated 22 percent of the residents of Cardoza's congressional district in San Joaquin, Stanislaus, Merced and Fresno counties are uninsured.
The Valley's uninsured population is much higher than in other parts of the country.
Cardoza and Costa both cited funding for new medical schools in their votes in November. The original House bill authorized $500 million over five years for new medical schools in underserved areas.
The University of California, Merced, was an unnamed but presumed beneficiary.
The health care package to be considered next week omits the medical school funding.
Instead, Cardoza noted, the Obama administration in its fiscal 2011 budget request is seeking $100 million next year for the same purpose.
Cardoza serves on the leadership-controlled House Rules Committee, which will play a crucial behind-the-scenes role in coming days. The panel sets rules for how bills are put together and debated, and often is lambasted by Republicans for cutting off GOP alternatives.
Congressional action is expected to be concluded by next Sunday.
Rules vary for discarding medications in capital region
One woman who called the Don't Flush Your Meds hotline not long ago wanted to know what to do with one of her father's old prescription drugs – which, as it turned out, had expired in 1963.
"She was cleaning out his medicine cabinet," said Sabina Rynas, who manages the Don't Flush Your Meds program for the Sacramento Regional County Sanitation District. "Good thing she held onto the medication, so she could finally dispose of it properly."
With the abuse of prescription medications on the rise, their proper disposal is a growing safety issue. It's also an environmental issue and an ongoing concern for the elderly and their families.
"Usually, the people who call have bags and bags of medicine, everything from over-the-counter cold medicine to morphine," said Rynas.
Water treatment plants can't routinely process discarded and excreted pharmaceuticals out of the water supply. The science is thin, but studies indicate that as a result, the drinking water that reaches 46 million Americans is laced with trace amounts of pharmaceuticals.
"It's not like you drink three glasses of water and feel the OxyContin," said Rynas. "It's more like thousands and thousands of gallons."
Similarly, research has shown that enough excreted birth control medication has leached into the watershed to disrupt the endocrine systems of amphibians and fish in some parts of the country.
"The fish change sex," said Rynas. "Male fish develop female organs, to make it simple. There's no evidence that this will affect humans' health in any way."
The fear is that the intentional dumping of meds down the drain will only exacerbate the amount of drugs in the water supply.
So what should consumers do with expired or unused meds? For years, patients were routinely told to flush them – but now, it depends on several factors.
For most drugs, the Don't Flush Your Meds program and the California State Board of Pharmacy follow current and rather complicated U.S. Food and Drug Administration guidelines.
Consumers should keep most old meds in the original vial, scratch out identifying patient information and mix the meds with water and a tiny amount of something that no one would find palatable, such as kitty litter, cleaning powder or coffee grounds.
"You have to render them unusable," said Paul Lofholm, past president of the California Pharmacists Association.
Then, the instructions continue, the consumer should seal the vial with tape, then further seal the taped vial in a small box or margarine container.
Finally, the consumer should toss the sealed and tainted meds in the trash, having thwarted any possibility that wayward children, marauding pets or druggie-minded scavengers might accidentally overdose on discarded medication.
Exceptions to this process include a list of controlled substances – morphine, Demerol, OxyContin and other drugs. Because of the risk of accidental ingestion, the FDA continues to recommend that they be flushed down the sink or toilet.
Alternatively, Sacramento County residents can turn in most meds – except controlled substances – at county waste management's North Area Recovery Station. West Sacramento and Folsom residents can turn over unused medications to local police.
"They rightfully belong back at pharmacies," said Lofholm. "We're used to the disposal of drugs."
Since 2000, hospitals, pharmacies and nursing homes have been required to contract for the incineration of expired prescription drugs, he said. Yet consumer take-back programs at pharmacies aren't legal in many areas – including Sacramento County, said Rynas.
State law allows unused and unopened prescription medications to be collected from nursing homes for redistribution at low cost to needy Californians in some counties.
LEARN MORE
For more information on the local disposal of unused or expired meds, call (916) 875-7000 or go to www.dontflushyourmeds.com
Sacramento County budget cuts change mental health treatment
Dave Da Vigo meets with a psychiatrist at The Effort, a nonprofit clinic that has been inundated with patients suffering from mental illnesses since Sacramento County reduced services – 1,000 new patients since July. "We have hired three new psychiatrists, but we can't do it fast enough," said Robert Caulk, the clinic's executive director.
Thousands of mentally ill people who have been cut from county programs during the past year are straining the area's health system, with hospitals and private clinics struggling to fill gaps in care.
Psychotic patients are crowding emergency rooms, facing long waits for care and triggering safety concerns, officials said.
County Mental Health Director Mary Ann Bennett said the cuts to county programs have prompted providers and administrators to consider new ways of delivering critical services.
In the future, she said, more patients may get federally funded care or treatment at smaller psychiatric clinics scattered throughout the county.
"We're booked," said Robert Caulk, executive director of The Effort, a nonprofit outpatient health clinic in midtown Sacramento that is getting spillover county mental patients. "We have picked up 1,000 new patients since July. We have hired three new psychiatrists, but we can't do it fast enough."
During the past year, the county has shuttered the crisis unit at its Mental Health Treatment Center on Stockton Boulevard, and closed 50 of the facility's 100 inpatient beds. The center handles the most severe psychiatric patients in the county.
During the same period, the area's four nonprofit "regional support teams," funded by the county to provide outpatient care to people with severe mental illness, each cut their client loads from 2,000 to 900. Administrators referred patients elsewhere but don't know how they are faring, said John Buck, chief executive officer at Turning Point Community Programs.
Some are bouncing back to regional support teams for help, said Buck. "Some, I fear, are running out of medication and ending up in emergency rooms."
"Many have just given up and are out on the streets," said George Ehrlick, 61, a former county patient now getting care for his depression and anxiety at The Effort. He said some patients who had beaten addictions are doing drugs again, and he knows of former county patients suspected of taking their own lives.
Ehrlick himself stopped taking his medications for months after he was cut from the county-funded program he'd been in for seven years. "When I came to The Effort I was a basket case," he said.
Since Sacramento County began cutting services at its mental health center, area emergency departments have seen a 65 percent increase in psychiatric patients, said Scott Seamons of the Hospital Council of Northern and Central California.
"The public should know that they are going to see more people out of control in the ERs," Seamons said. At any given time, emergency rooms are holding 12 to 15 mental patients.
As a result, said Bill Sandberg, executive director of the Sierra Sacramento Valley Medical Society, ERs are beefing up security and psychiatric staffing. "I have never seen emergency department directors so worried," he said.
UC Davis Medical Center, located across the street from the county mental health center, is bearing the biggest load, but all hospitals are being affected, Sandberg said.
"Psychiatric patients experiencing flare-ups used to go to the mental health treatment center. Now they're coming to us, and at first we were not prepared," said Dr. Debra Kahn, a UC Davis psychiatrist.
Only the sickest patients are admitted for inpatient care, she said, and "we are maxing out all of the outpatient resources" to accommodate everyone else.
The Effort is receiving many of them.
The waiting room at the J Street clinic is constantly crowded with former county patients, many "in a state of desperation," said Dr. Brad Briercheck, a psychiatrist.
"They're having suicidal thoughts, they're unstable, they're off of their medications," he said. Those in crisis are sent directly to hospitals.
The Effort is better prepared than most to handle the deluge of new patients because its clinic is a Federally Qualified Health Center, making it eligible for certain grants and boosting its Medicare and Medi-Cal reimbursement.
Jonathan Porteus, The Effort's clinical director, said the county should consider a similar approach. "It would be a great alternative to the county funding mental health," he said.
Officials are pondering the idea, said Bennett. Opening a series of smaller county clinics for patients who qualify for Medi-Cal also is a possibility, she said. One such clinic, with 12 beds, is ready to open in Carmichael, she said.
"Anytime you make reductions of the magnitude that we have made, you're going to have a big impact on services and clients, and that's very sad," Bennett said.
"But all of this has forced some really creative thinking … Maybe some positive things will come out of all of this."
George Ehrlick, who has depression, says he's seen the effect of budget cuts on patients: "Many have just given up."
Psychiatrist Brad Briercheck is seeing more patients who used to be served by the county.
Sacramento mulls plan to cap medical pot dispensaries at 12
Ryan Landers of a medical marijuana advocacy group addresses a meeting Thursday about Sacramento officials' plan to allow no more than 12 medical marijuana dispensaries in the city. "This proposal would kill myself and other patients in similar situations," he said.
Sacramento officials Thursday night presented a plan to cap the number of marijuana dispensaries in the city at a dozen and impose strict requirements for their operations.
Faced with a packed room of pot shop owners and medical marijuana advocates, City Manager Gus Vina asked for measured input on "an emotional issue."
But representatives for marijuana patients and many of the city's 39 registered dispensaries threatened lawsuits. They charged the plan would shutter tax-producing businesses and deny care to hundreds of cannabis patients.
"This proposal would kill myself and other patients in similar situations," complained Ryan Landers, a Sacramento senior adviser for the Compassionate Coalition, a medical marijuana advocacy group. "You're going to close clubs where hundreds of patients get marijuana. This is a huge problem for the sick."
Landers, whose neck was bandaged on both sides from pain shots he takes for shingles, told city officials he was one of the architects of the 1996 Proposition 215 medical marijuana law.
He said the city plan amounted to Sacramento turning its back on people who should be protected under Proposition 215.
But Vina said Sacramento is trying to accommodate patients and communities. "There are a handful of cities that are trying to do something. And we're one of them," Vina said.
Robert Shantz, a lawyer for a dispensary association, the Sacramento Alliance of Collectives, said the city is offering "prohibition masquerading as authorization."
The plan includes a lottery to determine which pot shops could stay in business. It would require dispensaries to maintain security and would ban the hiring of workers with felony convictions.
It also would require pot shops to label their products with a disclaimer saying that the dispensary – not the city – assumes "risk of injury or harm" from any marijuana sold.
Sonny Kumar, co-founder of the El Camino Wellness Center, complained that the ordinance could force virtually every Sacramento pot shop to close.
He cited provisions that would restrict dispensaries to commercial and industrial zones and ban clubs within 300 feet of neighborhoods or 500 feet of churches, parks, schools, youth facilities or substance abuse centers.
"It would result in only three locations where clubs or dispensaries would be left in the total city," Kumar said.
Michelle Heppner, a special project manager working on the dispensary issue, said Sacramento officials studied Oakland, a city with a slightly larger population.
Oakland passed an ordinance allowing only four dispensaries but is considering expanding to 14, Heppner said.
Oakland also passed the nation's first special tax – on top of the state sales tax – for local medical marijuana sales. The Sacramento proposal doesn't include a local taxing plan.
City Councilwoman Lauren Hammond, who chairs a committee that will review the proposed ordinance, said she is concerned about dispensaries clustering disproportionately in a few city areas, including midtown.
She said Sacramento needs to get control of the issue to avoid a scenario similar to Los Angeles, where officials grappled over an ordinance as hundreds of dispensaries kept opening.
"We don't want to wind up like Los Angeles," she said. "We don't want to rush to do this, but we want to be timely."
WHAT'S NEXT?
The Sacramento City Council's Law and Legislation Committee is expected to work on the proposed dispensary ordinance in April and May. If approved by the City Council, the ordinance could go into effect in June or July.
Jason Sterling of Rio Linda stands at a sparsely attended rally at Cesar Chavez Plaza in support of medical marijuana prior to Thursday evening's meeting across the street in City Hall. Sacramento has 39 registered medical marijuana dispensaries.
$62 million UC Davis center puts Sacramento at hub of stem cell research
Jan Nolta, director of the new UC Davis Institute for Regenerative Cures, discusses the state-of-the-art hot-cells device, left, at the new facility housed in a former State Fair exhibit hall on Stockton Boulevard. The device generates radio tracers to locate cancer stem cells before they form a tumor, Nolta said.
A hub for regenerative medical research opens today in Sacramento, putting the University of California, Davis, in the forefront of stem cell research.
UC Davis already is testing dozens of therapies in the laboratory, such as HIV treatments and organ regeneration, and is even using stem cells to repair injuries in horses.
The new $62 million UC Davis Institute for Regenerative Cures will consolidate those efforts, which are scattered in various locations in the region. The center will bring 200 scientists and laboratory personnel together under one roof.
Experts say the new center reflects where medical advances are heading.
"Regenerative medicine will take us into a whole new era of medicine, especially personalized medicine, because we can make a cell line for each patient," said Jan Nolta, director of the UC Davis stem cell institute.
The red brick building a few blocks south of UC Davis Medical Center in Sacramento will be the first of a dozen major laboratories to open in California, funded in part by Proposition 71 of 2004. The initiative, the California Stem Cell Research and Cures Act, authorized $3 billion in bonds.
The new institute, housed in a former California State Fair exhibit hall on Stockton Boulevard, received $20 million from the state's agency in charge of stem cell funding – the California Institute for Regenerative Medicine.
Outside, the 1940s structure has arches and Corinthian columns. Inside, it sports 90,000 square feet of hallways and pure-white state-of-the-art research facilities.
Giant tanks of liquid nitrogen store stem cells, and the researchers will work at rows and rows of laboratory benches.
Powerful filters hum and change the air every minute to discourage contamination. A normal cubic foot of air has 35 million dirt particles. This lab has fewer than 10,000.
"When we start working here in a month, we're going to have to wear all sorts of coverings and masks," said Nolta, one of America's top stem cell researchers with more than 20 years of research experience.
A year ago, President Barack Obama lifted a ban on embryonic stem cell research that was imposed by former President George W. Bush.
But UC Davis now is moving away from using embryonic stem cells, Nolta said. Instead, researchers have found that skin cells have the ability to function much like embryonic stem cells.
Lab designer Gerhard Bauer said skin cells can produce a more favorable outcome.
"With skin cells we can make a personalized stem cell line, so there is no chance the patient would reject the stem cells," he said.
Bauer hopes to get the skin cell technique to clinical trials within five years.
The opening of California's first major center comes as national policy and public acceptance of stem cell research has shifted, observers said Tuesday.
Robert Klein, who conceived, wrote and led the campaign for Prop. 71, said the change has been sweeping. He cited three examples:
• First, the scientific community has identified new therapies it believes will be successful in treating a number of chronic diseases. The therapies are expected to reach human trials within 48 months.
• Second, $270 million in bond funds combined with another $880 million of donor, institutional and matching funds are financing the new stem cell centers, most attached to the UC system.
• Third, he said, there has been a "broad-based global validation" of California's leadership in the field, with more than a half dozen nations seeking collaboration and bilateral funding of some projects.
Judy Roberson, president of the Northern California chapter of the Huntington's Disease Society of America, said stem cell research is more accepted. Her husband died from Huntington's in 2003 at age 51.
"Before, people used to think of stem cells only as embryonic," she said. "Now there are a lot more types of cells. And people are starting to listen."
Acceptance grew, too, with the personal stories of well-known public figures who sought the benefits that stem cell research could bring.
The late Christopher Reeve, who became a quadriplegic after he was thrown from a horse, was perhaps the best known advocate for research to treat spinal injuries.
Actor Michael J. Fox has promoted stem cell research to aid those with Parkinson's disease, a degenerative disorder of the central nervous system.
Lisa Hughes, president of the Coalition for the Advancement of Medical Research in Washington, D.C., said both have been powerful persuaders of public opinion.
She said Obama's decision to reverse Bush's policy on embryonic stem cell research was pivotal.
"Just lifting that policy alone has breathed new life into the research community, and there is a sense they can move forward now, supported by the federal government," Hughes said.
California isn't the only state paying for stem cell research. New York is spending $600 million, said John Robson of the California Institute for Regenerative Medicine.
The California institute reports that it has funded more than 425 discoveries being published in scientific journals, each discovery moving closer to new therapies.
At UC Davis, dozens of therapies are being tested. Nolta, the stem cell institute director, described the process of using bone marrow cells for damaged hearts with a bit of awe.
"We put the stem cells into the bloodstream through an IV bag, and the stem cells find the injured area and repair it," she said. "It's really amazing."
Don Cross climbs up to secure a banner welcoming visitors to today's grand opening of the UC Davis Institute for Regenerative Cures in Sacramento. The facility boasts 90,000 square feet of hallways and state-of-the-art research facilities.
Jose Nunez, of Classic Party Rentals, aligns one of 400 chairs being set up for today's grand opening of the $62 million laboratory for stem cell research, funded in part by 2004's Proposition 71.