The grants were awarded to 48 lead organizations, which will be supported by 226 community partner groups. They will focus on education and outreach to the 5.3 million Californians the exchange seeks to enroll, with an estimated 2.6 million of those people eligible for subsidies to help them afford insurance. Five of the recipients will target their outreach to small businesses.

Californians will be able to shop for insurance on the new marketplace starting Oct. 1, with coverage going into effect on Jan. 1. Most people must have insurance or pay a penalty. In 2014 the penalty is $95 per person or 1 percent of income (whichever is greater), and the penalty rises to $695 or 2.5 percent of income (again, whichever is greater) by 2016. 

Many of the 5.3 million outreach workers will try to reach are currently uninsured or often unfamiliar with insurance as a product. Peter Lee, executive director of Covered California, acknowledged the significant outreach work in front of them. “What it’s going to take on Jan. 1, 2014, is partnership,” he said in a press conference. “It’s a huge task, but it’s a task that’s doable.”

The grant recipients are charged with outreach and education only, not enrolling people into a plan. Actual enrollment will come later. Much of “what we’re doing now is putting fertilizer out there,” Lee said. “We’re starting to till the soil to get people educated, so when it comes to open enrollment we can harvest huge enrollment.”

Community Health Councils, an umbrella advocacy group in Los Angeles, received a $1 million grant. Sonya Vasquez, CHC’s policy director, also acknowledged the “short window of time” that groups have to do outreach, but said her organization is ready to “meet people where they work, play, pray, live and access services. Our goal is to have one-on-one communication” and ensure people know how to enroll.

Enrollment will come later this summer by “assisters,” who will be trained and certified by Covered California to help individuals with the actual sign-up process.

More than 200 organizations that applied for the grants. In a release, Covered California said organizations not chosen can apply to become “Assister Enrollment Entities.”

Lee joked that Californians can expect airwaves to be buzzing with ads this summer as Covered California starts an advertising campaign to inform people about the new insurance marketplace.

Ross, the board member, praised Covered California for being nimble, but then echoed President Obama’s recent remarks to expect “glitches” as full implementation takes place. “We know it’s not going to be perfect on Jan. 1,” Ross said. “We will have bumps; we will have bruises, but we will continue to move forward.”

The U.S. Patent and Trademark Office has been granting parents on human genes for nearly 30 years. This is the first case questioning that premise to reach the Supreme Court. At the heart of the case are two genes associated with breast cancer, BRCA1 and BRCA 2. People with certain mutations in these genes have a significantly higher risk for breast, ovarian and other cancers.

Opponents of patenting human genes say genes are products of nature and therefore cannot be patented. Myriad Genetics, which holds the patent on the genes, say that once genes are isolated from the body and processed they are no longer a product of nature.

The Associated Press captured the back and forth:

Justices attempted to break the argument down to an everyday level by discussing things like chocolate chip cookies, baseball bats and jungle plants.

[Gregory A.] Castanias, the Myriad lawyer, argued that the justices could think about the gene question like a baseball bat. “A baseball bat doesn’t exist until it’s isolated from a tree. But that’s still the product of human invention to decide where to begin the bat and where to end the bat,” he said.

That didn’t work for Chief Justice John Roberts.

“The baseball bat is quite different. You don’t look at a tree and say, well, I’ve cut the branch here and cut it here and all of a sudden I’ve got a baseball bat. You have to invent it, if you will,” Roberts said. “You don’t have to invent the particular segment of the strand. You just have to cut it off.”

The court moved on to body parts. Said Justice Sonia Sotomayor, “If you cut off a piece of the whole in the kidney or liver, you’re saying that’s not patentable, but you take a gene and snip off a piece, that is? What’s the difference between the two?”

Castanias tried again, comparing the company’s patented genes to medicine.

“It’s important to note that molecules have been patented for a very long time. That’s what drugs are. And drugs are often made by taking one molecule and another molecule, both of which are known, reacting them in a test tube,” he said. “Reactions have been around 100 years just like snipping has been, but they make something new and useful and lifesaving from that.”

Roberts still wasn’t convinced. “Well, I don’t understand how this is at all like that, because there you’re obviously combining things and getting something new. Here you’re just snipping, and you don’t have anything new, you have something that is a part of something that has existed previous to your intervention,” he said.

The ACLU filed its lawsuit against Myriad in 2009. According to the AP,  U.S. District Judge Robert Sweet invalidated the patents. But a federal appeals court reversed him in 2011, saying genes are indeed patentable. The Supreme Court first sent the case back to lower courts for rehearing. The federal court again upheld Myriad’s patents last August. And that’s where we are today.

The Supreme Court is expected to issue a decision this summer.

Now, in China, global influenza experts are watching another novel virus, H7N9. So far, nine people are sick, and three are dead. As Helen Branswell at The Canadian Press (and self-described “flu freak“) reports “those first three sick people and the genetic sequences of the flu viruses that infected them were enough to make the hairs on the backs of knowledgeable necks stand on end.”

Branswell also tweeted that case “numbers are a moving target” right now.

She lays out why flu experts are racing to determine if we’re on the brink of the second pandemic in five years in this report:

Influenza scientists always pay attention when animal flu viruses start making people sick. There is a rich soup of flu viruses in nature, most of which human immune systems have never seen. Many of those viruses, at least in theory, have the potential to trigger pandemics.

So when China notified the World Health Organization over the weekend that it had found three cases of infection with H7N9 viruses, there was immediate concern.

While some H7 viruses have infected people in the past — including two poultry workers in a big H7N3 outbreak in British Columbia in 2004 — viruses bearing an H7 hemagglutinin and an N9 neuraminidase in combination had never been previously known to infect humans.

Adding to the alarm: The three people were not linked. That means each caught the virus from an animal, or a person. The first bet would be animals, but so far the virus hasn’t been found in Chinese poultry or pigs, the likely suspects.

And the cases didn’t live close to one another. Two were in Shanghai, China’s largest megacity. But the third was in the nearby province of Anhui. As more cases have emerged, the geographic distance among infections has become greater, making it increasingly clear that there is H7N9 virus spreading, undetected, over hundreds of kilometres in China.

Dr. Keiji Fukuda, the World Health Organization’s top flu expert explains: “It’s possible that we have infected animals. But we still haven’t detected actually what is the infected animal and whether it’s these animals that are spread out and individuals in a widespread area are coming into contact (with them) and becoming ill.”

The other option? “At the same time you have to be thinking about is there any evidence of person-to-person transmission,” Fukuda, the WHO’s assistant director-general for health security and environment, told The Canadian Press in an interview.

——

When people show up in hospitals sick with pneumonia, it can take a while to figure out what bacteria or virus is making them ill. It takes even longer when tests for known culprits come back negative, and laboratories have to start thinking about whether they are dealing with something new.

The first known H7N9 cases started getting sick in late February. And two died in the first part of March. But once the Chinese hospitals got the country’s public health agency — the China CDC — involved and they found the new virus, that organization quickly mapped the genetic sequences of the first three viruses and uploaded them into a database that international flu scientists can access.

That prompt sharing allowed outside experts to start studying the viruses to look for clues to their origin.

All eight genes of each virus were avian, meaning these were bird flu viruses. But all the viruses showed several genetic changes that scientists who study influenza recognize as signals of a virus adapting to spread in mammals, not birds. Those changes mean the virus is learning to attach to the type of cells people have in their upper airways, the type of cells that human flu viruses infect.

Those signs of adaptation ratcheted up the concern.

“We would be paying very close attention to any situation in which you have a novel influenza virus which has caused some cases of infection and caused some deaths,” Fukuda says.

“But I think that the molecular changes also make us pay a lot of attention.”

Richard Webby, a swine flu expert who runs the WHO’s influenza collaborating centre at St. Jude Children’s Research Hospital in Memphis, Tenn., says those genetic changes suggest the virus may no longer be circulating in birds.

He believes it is in mammals. That could mean pigs, which are called mixing bowls of influenza, because they can be infected with both human and bird flu viruses, providing a chance for genes to swap.

Or it could mean the virus is spreading in people.

Typically with influenza, we see a (relatively) small number of deaths, many very sick people and then a large group with such mild symptoms they might not even know they have the flu.

Right now, experts don’t know if that’s the case with this flu or if it’s something much more serious.

Longtime pandemic-watcher and Pulitzer Prize winner Laurie Garrett filed this piece earlier this week for Foreign Policy where she examines whether the recent (and mysterious) mass deaths of pigs and ducks are linked to the flu deaths in people. “Is this a pandemic being born?” the headline asks.

In a one-year contract worth up to $88,000, Consumer Watchdog will supplement the rate review process already done by the insurance department.

From the Los Angeles Times:

California officials and disability rights advocates yesterday announced a settlement of a lawsuit challenging a 20 percent budget trigger cut in In-Home Supportive Services care.

The settlement allows an 8 percent reduction this year and a 7 percent reduction in 2014. It also changes the cuts from permanent to temporary.

The size and timing of the cuts are based, in part, on a current 3.6 percent IHSS cut established in 2009. That reduction will remain in effect, and an additional 4.4 percent cut will be added onto that this year followed by a 3.4 percent additional cut next year, bringing the totals to 8 percent this year and 7 percent next year.

“As a package deal, it’s not as simple as saying it’s 20 percent down to 8 percent,” said Elissa Gershon, attorney for one of the plaintiffs, Disability Rights California. “What we’re looking at is small cuts this year and the following year, and hopefully full restoration of benefits in 2015.”

Michael Weston, spokesperson for the Department of Social Services, which was named in the suit along with the Department of Health Care Services, said the budget included the 20 percent cut over only seven months, so the 8 percent cut over the full 12 months actually achieves budgeted savings, while helping beneficiaries and eliminating a costly lawsuit.

“The agreement still captures budgeted savings, that’s really the gist of it,” Weston said. “And we’re creating stability for IHSS recipients, ensuring that these individuals remain safely in the community.”

IHSS aid allows some recipients to avoid hospitalization or nursing home care, which “would be far more costly than the current IHSS program,” according to Weston.

In addition to settling the issue of the 20 percent trigger cuts, the settlement covers several other key points:

• The agreement resolves earlier cuts based on beneficiaries’ functional index score;
• It ensures IHSS beneficiaries will have the right to request a reassessment based on a change in circumstances. Now they won’t need a medical certification, as is currently required;
• The agreement not only resolves the Oster v. Lightbourne lawsuit (formerly known as V.L. v. Wagner), but it also settles another IHSS case, Dominguez v. Schwarzenegger; and
• The agreement restores the hours lost from the 7% cut as early as the spring of 2015, as long as California is able to obtain federal approval of a provider fee to bring new federal revenue to California, according to advocates.

“The gradual nature of the cuts is less harmful,” Gershon said. “It means the uncertainty of the past four years is gone, and there is hope for full restoration of hours in 2015. People depend on these services to remain in their home. We don’t want to minimize the impact [of these cuts], but under the circumstances, we’re doing it in the hopes that the stability outweighs the harm for the next two years.”

More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to prescription painkillers like Oxycontin and Percocet.

Hospital emergency departments in San Diego are now reevaluating their role in dispensing these medications.

Bobby Stevens, not his real name, first started popping Oxycontin when he was in high school in northern San Diego county. His classmates used to hand it out at parties.

Stevens soon became hooked. At the height of his addiction, he was taking up to 20 Oxycontin pills a day, plus the anti-anxiety drug Xanax and the amphetamine Adderall. He was spending $1500 a week on his habit.

Stevens used to get his a lot of his drugs from hospital emergency rooms. He had a few standard lies he would tell the doctors.

“That I either had lower back pain, or I did something to my knee, running,” Stevens recalls. “It pretty much was the same story every time. I would go to different doctors, I wouldn’t go to the same ER. So I could pretty much use the same story.”

Most of the time, ER doctors would give Stevens a prescription for at least a month’s worth of pills. He said he didn’t have to do much acting.

“I would just explain the pain I had. But they were so busy, it seemed that they took you for your word, and wrote you the prescription,” Stevens said. “I mean I didn’t have to do x-rays, I didn’t have to do an MRI, or any of that type of stuff. They just asked what I was there for, and they wrote me the scrip.”

Sales of prescriptions opiates have skyrocketed in recent years. So have drug-related deaths.

The Centers for Disease Control says hospital emergency departments are the biggest source of these drugs.

Dr. Kevin Kelly, director of the ED at La Mesa’s Alvarado Hospital, said many patients are asking for them.

“I think all the emergency departments are experiencing an incredible influx of opiate requests, and opiate-related emergencies,” he explained.

Dr. Kelly said physicians can’t always tell when someone is really in pain — or just faking it.

“Our goal, first of all, is we want to help,” Kelly explained. “So, each case we look at and we say, ‘How can I help this person?’ and then second, we really want to do no harm. And that’s where a lot of narcotic issues come up; there’s a lot of harm related to the use and misuse of these medications.”

The emergency department at Scripps Mercy Hospital in Hillcrest is one of San Diego’s busiest. More than 57,000 patients were treated there last year.

Scripps’ Dr. Roneet Lev said these days, about one out of five patients in her ED are taking narcotics.

“When you talk about cocaine or heroin, you talk about the drug lords in Columbia,” Dr. Lev said. “But prescription drug abuse and deaths usually are given by well-intentioned, well-meaning physicians, and we need to kind of change the way we practice and get a hold of this epidemic.”

To that end, Dr. Lev is leading an effort to change the way local emergency departments dispense painkillers. With the help of some other ED doctors in San Diego, Lev has come up with a set of guidelines.

Under the new rules, people who come to the ED for chronic pain will be directed to visit their primary care doctor.

“Someone who has pain for more than three months, or needs any long-acting pain medications that last in the body for a long time, those are the people who need to get all there prescriptions coordinated by one prescriber and one pharmacy,” Dr. Lev explained.

These changes will not affect people with acute or sudden pain, from say a broken arm or a kidney stone. The new guidelines will only apply to those complaining of chronic pain.

“That’s the population at risk, who die unintentionally,” Dr. Lev said. “They don’t know that they’re taking all these medicines from different providers, different prescribers. They got something from the ER, something from the psychiatrist, something from the primary care doctor. And people die from that. That’s what we want to get a grasp on and prevent.”

Dr. Michele Lamantia directs the chronic pain program at the San Ysidro Health Center, a network of community clinics in southern San Diego County.

She said there are some non-narcotic prescription drugs that are quite effective for chronic pain. Lamantia thinks doctors who prescribe narcotic painkillers need to be more careful.

“I think sometimes we feel it’s only a percent of people who might have a problem with the drugs and that we as physicians are going to easily be able to pick them up. But that’s really not the case,” she said.

All hospitals in San Diego and Imperial County have tentatively agreed to the new narcotic guidelines. They could be rolled out sometime this spring.

After eight years of abusing narcotics, Bobby Stevens has finally quit. He’s been in recovery now for four months.

Stevens says he wishes those emergency room guidelines had been in place back when he got hooked on painkillers.

“I don’t personally feel like I would be where I’m at today, if they weren’t so easily available,” Stevens lamented.

In 2010, more than 16,000 Americans died from an overdose of prescription narcotics.

Every day in California, nine people die by suicide. Both in California and nationwide, suicide is the 10th leading cause of death. According to a recent study, in 2009, more than a half-million adults in California seriously thought about killing themselves. Last fall, the California Mental Health Services Authority launched a statewide campaign called Know the Signs as part of a larger suicide prevention initiative.

One of the highest risk groups for suicide is people who have previously attempted suicide. In Sacramento, an innovative program seeks to reach that group directly and easily: through the simple phone call.

One of the program’s clients is John, a 29-year-old student at Sacramento’s American River College. Today, he describes himself as happy-go-lucky. But a year ago, he had lost two jobs, was facing bankruptcy and had to move in with friends.

Already feeling “emotionally and mentally stripped,” he was then was diagnosed with HIV. “That took away pretty much the last thing that I had, which I thought was my health,” he recalls.

One day last August, he reached an end. Feeling he was “tired of doing this,” he decided to take his own life.

“In my room, I wrote out my note,” he remembered. “I got all my medication out on my bed and I just started taking it. And … All of a sudden, what I just realized is here I am laying here on my floor. … I think, ‘Oh My God, what am I doing? What am I doing?’”

He called out for help, and his roommates called 9-1-1.

He woke up in downtown Sacramento at Sutter General Hospital’s emergency department with nurses pumping his stomach. He recovered. But before he was discharged, he was visited by a social worker, who told him about a unique program that would match him with a suicide prevention specialist. John signed up. That person would give him a call every few days for a month just to check in.

“Ultimately, I knew that I had a cushion for support,” John said about receiving those calls. “I knew that if I was having a hard time, I absolutely had somebody available there.”

The program is a partnership between Sutter Medical Center and WellSpace Health. Calls are made from a WellSpace Health clinic in South Sacramento. It’s Roop Dhillon’s job to call people like John who have recently been to the ER for thinking about suicide or attempting it.

“A lot of times that [ER] visit alone could be a pretty overwhelming experience,” said Dhillon. “What we’ve heard from a lot of participants is their hardest part of leaving the emergency room was feeling alone once they got home.”

What makes the ED Follow Up Program innovative is that it is proactive. Dhillon calls people who have just gotten been discharged. People who are vulnerable. People who are most likely to try to take their own lives again.

Dhillon calls her clients from the same room where the clinic runs a more traditional 24-hour crisis hotline. The outreach program has served about 300 people so far, and none have died from suicide.

Liseanne Wick, who manages suicide prevention and crisis services at the clinic, was drawn to suicide prevention over a decade ago after her brother took his own life.

“Personally, it will never bring my brother back, but it really brings meaning to that experience knowing that we’ve affected the lives of thousands, literally, over the last 10 years, probably tens of thousands,” she said.

Wick can’t know if a crisis hotline or the Follow Up Program would have helped her brother, but she’s sure the clinic is helping people now. “We know that statistically; we know that anecdotally from our experience,” she says. “I can’t speak for my brother, if he would have called or if he had knowledge of suicide hotlines. I wish he would have, though, because I know that it makes a difference, and we save lives on a daily basis.”

Indeed, John sounds like a convert when talking about how the follow-up program helped him. He said when he would see the number pop-up on his cell phone, it would remind him to pause. To assess how he was doing. And to realize he wasn’t alone in the world.

“So if you’re at a point where it just makes more sense to end it all because it’s not worth bothering anymore,” he said, speaking to those who may be considering hurting themselves. “Just pick up a phone and reach out to somebody for help. Let them tell you why it’s worth the bother.”

A bureaucratic hearing in Sacramento took an emotional Monday morning, as parent after parent told state legislators how their children died from overdosing on prescription drugs.

The parents who testified during the Medical Board of California’s “sunset review” hearing all said the agency should do more to crack down on doctors who abuse their prescription-writing powers.

Tammy Smick, of Downey, says she’s outraged the doctors who gave prescriptions to her drug-addicted son Alex are still practicing medicine. “What has the California Medical Board done about the death of our son? As far as I can tell, absolutely nothing, and that is just shameful,” she told the panel of senators and assembly members.

The hearing was part of a regular oversight process called a “sunset review.” Under this type of review legislators evaluate the effectiveness of a board to determine whether to change its powers, operational scope or mission. Prescription drug abuse has become a flashpoint in this process in part because of a 2012 Los Angeles Times investigation revealing that during a six-year window, 30 southern California patients died from prescription drug overdoses while their doctors were under board investigation.

“From my perspective the Medical Board can be doing a lot more,” testified April Rovero, whose son died from a drug overdose in 2009 after he received hundreds of pills from a doctor who had been under board investigation for three years. “Whether it’s regulations that need to be changed or whatever, we need it to step up to the job. Our families need to be protected.”

Board President Sharon Levine commended the Los Angeles Times investigation during her testimony. She told legislators the panel’s powers are limited, because it can’t investigate doctors without a formal complaint. “Complaints regarding prescription drug-related offenses can be somewhat difficult for the board to obtain. In many instances patients who are receiving prescription drugs in a manner that is not within the standard of practice are not interested in bringing the complaint to the board.”

When asked whether legislators should grant the board the power to proactively investigate doctors, Levine stayed neutral. “I honestly can’t answer that ahead of a policy discussion at the board about what that would look like,” she said.

Levine did endorse a bill giving the agency more information about overdose-related deaths, and said she supports increasing revenue through application fees or other means to help boost the state’s prescription-tracking database.

The Board is being given one month to respond in writing to questions raised during Monday’s hearing. Legislators have until the end of the year to extend of revise the Board’s mission.

Learn more:

Painkiller Abusers Now Overdosing on Heroin: KQED & California Watch

Young Painkiller Addicts Switch to Heroin, Overdose Rates Rise: KQED and California Watch

Prescription Drug Monitoring Program Facing Cuts: KQED