Syringe law creates 'sticky' situation

While on vacation in San Mateo County, a San Francisco Walgreen’s pharmacy manager, Jenny Pan, needed to buy syringes from a pharmacy for her diabetic husband. Even though the county has approved over-the-counter syringe sales, Pan was “hassled” at the pharmacy and forced to present her identification in order to purchase the syringes.

San Mateo County is one of California’s counties that has enacted Senate Bill 1149 authored by Sen. John Vasconcellos, D-Santa Clara, that was passed in 2004 and enacted Jan. 1, 2005, by Gov. Arnold Schwarzenegger. The law allows participating pharmacies to sell up to 10 syringes at a time to anyone over 18 without requiring a prescription or identification.

It was enacted to help prevent the spread of blood-borne illnesses and other health-related risks to those who are and can become exposed to contaminated syringes.

California was one of the last states to require a prescription to purchase syringes. California's program is unique in that each local health jurisdiction must approve over-the-counter syringe sales before pharmacies can opt-in.

Proponents of the law argue that legalized syringe sales and syringe exchange programs increase proper disposal of syringes.

The National Drug Alliance of New Jersey website said the programs “provide injection drug users with referrals to drug treatment, detoxification, social services, and primary health care.”

Syringe exchange programs are different from pharmacies in that they provide syringes on a confidential one-on-one basis, free of cost, and safely dispose of contaminated syringes. Rachel Anderson of Sacramento Area Needle Exchange said her program gives out syringes, disinfectant wipes and condoms.

On the flipside, while syringe exchanges usually operate about 20 hours a week, pharmacies that provide nonprescription syringes are usually open seven days a week and have flexible hours, making access to clean syringes more accommodating.

Unlike most syringe exchanges, pharmacies also offer treatment options and contact information for counseling services at no cost to the patron, but the syringes do come with a 50 cent price tag per syringe.

Ricky Bluthenthal, a senior social scientist with the RAND Corporation and sociology professor at California State University, Dominguez Hills, said the cost of paying for syringes – that would otherwise be free through a syringe exchange program – could inhibit the effectiveness of SB 1159.

“In a study of needle exchange participants statewide, we found half are homeless,” Bluthenthal said. “If you can't pay to have a roof over your head, you're probably not going to pay for syringes.”

SB 1159 has also received some criticism from opponents like the California Narcotics Officers Association for not requiring an even exchange of dirty syringes for clean ones, which they claim puts more syringes on the streets and increases the potential for accidental needle sticks.

According to the Los Angeles County Department of Public Health and Public Health Policy, potential victims of improperly disposed syringes, aside from intravenous drug users, include: waste management workers, law enforcement officials, maintenance personnel and children.

“Even after use, needles and syringes may still puncture the skin and potentially spread germs and diseases, such as hepatitis, HIV, tetanus and syphilis,” the department said on its website.

“‘Needle-stick’ injuries are a preventable health risk,” the department said. “Injuries resulting from improper disposal may demand expensive testing, cause long-term emotional stress and increase the risk of exposure to infectious diseases.”

Researcher Thomas Stopka, who has worked with the California Department of Public Health, Office of AIDS for six years said that, so far, data does not suggest that there has been an increase in improper syringe disposal.

Although the research is still ongoing, Stopka said that in metropolitan cities like San Francisco and Los Angeles, researchers have actually reported a lower number of syringes on the streets since SB 1159's implementation.

An evaluation on the effects of SB 1159 is currently in the process of being prepared by the Department of Public Health and will include an in-depth look at five specific “outcomes” of concern: injection drug use rates, syringe disposal, HIV and hepatitis C rates, the occurrence of accidental needle sticks, and the incidence of crime as a result of the bill's implementation.

The report will be released in January 2010 – the same year the law will either expire or be renewed by the governor.

The California Narcotics Officers Association claims that an increase in crime is one of their major concerns about the legitimacy of SB 1159.

Stopka, who is one of the lead researchers for the law's evaluation, said that although they have yet to conduct systematic analyses the correlation between crime rates and nonprescription syringe sales, “some other states have done analyses and they didn’t see any increase in crime around pharmacies.”

The California Narcotic Officers Association, however, isn't quite as positive about the bill's potential effects.

John Lovell, legal counsel for the California Narcotic Officers Association, said, “There’s no benefit to the bill.”

“Needle programs only work when there is supportive social infrastructure,” Lovell said. “You can’t be stupid about this. You have to have oversight, and you have to have responsibility.”

Lovell said not only is there is no way the law could be improved, but it has also made no impact on the intravenous drug community.

“Nothing's changed. You have the same number of IV drug users you had as before. We would just like to see this bill expire. We think 1159 is beyond repair.”

Keith Hocking, deputy director of the Programs and Services for the San Francisco AIDS Foundation, disagrees.

“Slowly but surely we see the amount of syringes we exchange go down,” Hocking said. “I do know it's had some impact on the amount of syringes we exchange, but there are a number of variables.”

Glen Backes, former director of the Drug Policy Alliance and current freelance researcher studying the implications of SB 1159, said the law doesn’t have a downside. “The opposition is based on belief and not research,” he said.

For now, both sides will have to wait until the comprehensive 2010 evaluation before anything can be proven conclusively.

Parks put on hold

Sacramento State senior Michelle George has mastered a skill not many other students likely have: churning butter.

As the vocational education major sits in the shade of a tree in Sutter's Fort in a Gold-Rush-era burgundy dress, she explains her craft to two wide-eyed fifth-graders.

Her job as an interpreter – a sort of window into the past – at Sutter’s Fort could soon disappear if the proposed budget cuts are approved. The park is one of 48 state parks and beaches that could close as part of Gov. Arnold Schwarzenegger's proposed 2008-2009 budget, which would shave 10 percent from the Department of State Parks and Recreation.

But George doesn't seem worried.

“They always put (Sutter's Fort) on the list, but I don't think they’ll ever close it,” she said as she slowly rotated the churn. “They can't close it. This is Sutter town. ... That's Sutter hospital. ... You know what I'm saying?”

Others have taken a much less casual attitude to the proposed cuts of more than $13 million and about 130 jobs.

“If we start closing down these invaluable places, where will our children go to learn these lessons?” hiker and author Amy Racina asked the crowd April 7 at the Save Our State Parks rally on the West Steps of the State Capitol.

In 2003, Racina fell 60 feet while hiking alone in the Sierra Nevada and broke both of her legs. She was stranded for four days, and doctors said she would never hike again.

Nine months later, she was hiking again. She credits her recovery to the determination and persistence she learned from her life-long experiences with hiking.

She figures she has spent 18 days of the last two months in Armstrong Redwoods State Natural Reserve near Guerneville – one of the parks on the proposed list of closures.



Sen. Abel Maldonado, R-Santa Maria, who also spoke at he rally, said his family took vacations to state parks when he was a child because they couldn't afford more expensive destinations.

“Parks are the lifeblood of the state,” Maldonado told the crowd. He is the only Republican legislator who spoke out against the governor's proposed budget at the rally.

Aaron McLear, spokesman for the governor, said Schwarzenegger is open to other proposals.

“He's been imploring the legislators to come out with their own ideas, and that simply hasn't happened,” McLear said in a phone interview. “He says that at every stop he makes.”

McLear said the parks department is not being unfairly targeted, because every department in the state is being asked to cut 10 percent under the proposed budget.

“We're not protecting a certain group over another – (the cuts are) consistent with everybody,” he said.

Maldonado said the legislature should “put everything on the table and prioritize what's important to California.”

The Legislative Analyst’s Office has suggested alternatives that don’t include any park closures.

It has recommended offsetting the budget cuts by raising park entry fees instead, explaining the fees are still at about the same levels as a decade ago.

“However, if fees per visitor are adjusted for inflation over this time, the department would collect about $25 million more per year,” the office said in its recommendation.

Roy Stearns, a spokesman for the parks department, said it doesn't want to raise fees and “price people out.”

“For a lot of people in the state, (state parks are) their main and only vacation,” he said.

Stearns said the parks on the proposed list of closures are some of the least-visited parks that produce the lowest revenue. The department also had to be sure the parks on the list actually could be closed.

“We're not talking about parks the size of a city block you can just fence off,” he said in a phone interview. “It just isn't feasible to close a 20,000-acre park.”

The idea behind the closure of nearly a quarter of all state parks in California is that it would allow for enough money left over in the budget to pay for the maintenance and observance by peace officers of the closed parks that be would be re-classified under “caretaker” status.

But some worry if the parks are closed, they might deteriorate or be vandalized.

“If they close the fort it won’t be maintained,” said an employee in the Sutter’s Fort trade store who asked he not be named because of possible repercussions from his employer. “If I can insert a little sarcasm here, I can guarantee that homeless people won’t climb the walls and start squatting here.”

The employees within the walls of the fort are dressed in period garb and employed by the Sacramento Historical Sites Association, an association that functions in collaboration with California state parks.


If Sutter’s Fort closes, the Historical Sites Association will have no reason to exist, according to the trade store employee.

The park’s closure would not only affect the people who work there or have for more than 20 years, but also school children and local businesses, said Mona Larian, who has managed the adjacent Blimpie sandwich shop on K and 27th Streets, for 13 years.

“(The governor has) really cut a lot off the education,” Larian said.

And while the closure of Sutter’s Fort and other parks in California could mean a loss of educational experience to the thousands of grade school students who visit them each month, it could also have an impact of local businesses that surround the parks.

“We have all the contracts (to provide lunches to visiting students). We deliver over 10,000 lunches over there in a three-month period,” Larian said. “(The closure of Sutter’s Fort) would really hurt our business. We would have to downsize.”

Larian predicts she could see a 20 to 25 percent decline in business if Sutter’s Fort closes.

Larian is not alone. The area surrounding the Sutter’s Fort Park contains several businesses that might suffer without the incoming students and tourists – who come from as far away as Switzerland to see the fort, George said.

The employees of Sutter's Fort will have to wait at least until the May revision of the state's budget to see if they will keep their jobs, but the employees who have been at the fort for a few years are likely all too familiar with budget cuts.

In 1991, the state parks system faced its first major reduction under the Phoenix Program, which cut more than 500 jobs and cut the number of districts in half. Now some of California's park districts contain more parks than entire states, Stearns said.

“The Angeles district has 15 parks, which is bigger than some other state park agencies altogether,” Stearns said.

The state parks system is also behind on its maintenance – since the late 1980s, funding has lagged behind the need for maintenance by $117 million every year, according to a Parks Department press release. The current backlog of maintenance projects is at $1.2 billion.

“Since the late 1980s, the State Parks maintenance agency has been underfunded,” Stearns said. “In some places the quality has suffered.”



editor's note: the videos posted here do not necessarily reflect the viewpoints of Team El Dorado County

Assemblyman hopes for trans fat transformation

Diana Correa just can't quit doughnuts cold turkey. She used to visit Marie's DO-Nut Shop in Sacramento five days a week before she realized she needed to lose weight and eat better.

Now she and her grandson are “trying to go organic.” But they’re finding that it's not that easy.

“They miss me here,” Correa, 62, said as she held a dozen doughnut holes in an unassuming white paper bag. Although she's well aware of the dangers of trans fats – and the fact that doughnuts are a prime source of them – she splurges occasionally.

“I stay away from trans fats,” she said. “But they taste so good! You gotta have one once in a while.”

Correa's personal choice to limit her trans fat intake could be compared to the national trend away from the fat, which has been condemned by the American Heart Association and the FDA.

California may soon join the campaign against trans fats, but on a much larger scale. Assembly Bill 97, which would reduce the use of artificial trans fats to less than 0.5 grams in California restaurants beginning in July 2009 and baked goods in July 2010, has passed the Assembly and is currently awaiting debate in the Senate. It would also require that restaurants have labels available for any food containing fat, in case consumers want to be sure what they're eating is trans-fat-free.

The bill would still allow pre-packaged foods containing trans fats to be sold in California.

If passed, AB 97, authored by Assemblyman Tony Mendoza, D-Artesia, would be the first statewide trans fat ban in the country. Similar bans have already gone into effect in New York City and Philadelphia. A ban in Boston was passed Monday.

Artificial trans fats, according to the American Heart Association, are industrially processed vegetable oils that have been heated to make them solidify. They can increase the shelf life of products and they give food a “buttery” flavor without using actual butter, which is much pricier.

Although trans fats are in a partially hydrogenated or semi-liquid state when used in cooking, once consumed, they can solidify in the arteries, which can cause blockage, heart attacks, or strokes, experts say.

The American Heart Association recommends no more than 2 to 2.5 grams of trans fat each day, which is roughly 1 percent of a person’s total calorie intake for a 2,000 Calorie a day diet.

According to BanTransFats.com, Inc., a California-based non-profit group dedicated to eliminating trans fats nationwide, a medium order of McDonald’s french fries can contain as much as 8 grams of trans fats, nearly four times the recommended daily amount. When consumed on a regular basis and in large quantities, trans fats can lead to an increase in LDL, or bad, cholesterol levels.

Mendoza, who was originally a teacher, first became interested in the issue after he noticed several children in his elementary school class had diabetes, said Mercedes Flores, Mendoza’s legislative director. After researching diabetes, he realized that a poor diet and too much trans fat can increase the risk of developing the disease. He felt compelled to take action.

Adam Francis, legislative assistant for the California Academy of Family Physicians, said everyone could benefit from eating fewer trans fats.

“By reducing things like trans fats we can reduce incidences of childhood obesity and heart disease,” he said in a phone interview.

Because individual cities and counties in California are prohibited from bans like this, Mendoza took the effort statewide.

Justin Malan is executive director for the California Conference of Directors of Environmental Health, which oversees consumer health issues like hazardous waste, drinking water and waste water. The group also employs about 1,000 restaurant inspectors in California. He said the inspectors are responsible for making sure food is safe, and that unhealthy food can be unsafe in the same way that an undercooked steak can be.

“We’ve come to realize that diet is a very very important public health issue,” he said in a phone interview. He said the inspectors would be the main enforcers of the bill. “Because inspectors are in the restaurants quite regularly checking on food safety, its not a big burden on them to make sure food is labeled correctly.”

But although AB 97 might be a step in the right direction for consumers' health, it could also have a strong impact on small restaurants and bakeries, which would be forced to find substitutes for their frying oils and shortening – essential parts of the cooking process for both types of businesses.

Walter Goetzeler, owner of Freeport Bakery in Sacramento, wonders if an increase in demand for substitute oils will raise prices, but he said it's hard to even make a guess, since all of his supplies have been going up in price recently.

The California Grocer's Association shares this concern.

“What we feel is that it will be difficult for grocery retailers to comply because of the lack of adequate availability of alternative oils,” said Dave Heylen, spokesman for the California Grocer’s Association.

The group believes that it is necessary to wait until farmers have been given adequate time to produce the crops that are necessary to create alternatives like palm or cottonseed oils.

“Our feeling is we should wait and bring in more experts and then study the issue more clearly so that we can be better prepared,” Heylen said. “As these alternatives come online and are available in quantity, then you can tend to make the shift and it would be an effective shift that we think would be a win-win for everyone involved.”

Flores said this argument “does not hold water.”

“We've since (these arguments surfaced) talked to some manufacturers and they said, 'Not a problem. If trans fats are banned, we could switch over within 30 days,' ” she said in a phone interview.

But some question whether it's the government's place to be regulating what people eat.

“We all feel a little bit stepped on our toes by the government telling us what not to use,” Goetzeler said, his German accent showing through.

Goetzeler moved to the United States from Germany in 1982, where smoking in restaurants was banned in 2006. A similar ban has been in effect in California for more than 10 years. He wonders if he would be facing trans fat restrictions at all if he were still living in Germany, since the country was so far behind California in adopting the smoking ban.

Many consumers, like Jeannie Dawkins, 44, share Goetzeler’s concern.

“We still need to have a choice,” she said as she finished a jelly doughnut at Yum Yum Donut Shop in Sacramento. “I don't want people's choices taken from them.”

Dawkins doesn't eat doughnuts very often, so she isn't too concerned about the health risks of trans fats.

“We know it ain't too healthy, but you only live once,” she said.

Goetzeler, who has been asked by customers whether certain items contain the controversial fat, knows that trans fats are continuing to become a national concern.

“For some people it’s just because it’s in the papers, so it’s a concern,” Goetzeler said. “Some people don’t give a hoot.”

For many food producers, however, it has been an issue for some time. In 2003, BanTransFats.com sued Kraft for their use of trans fats in Oreos.

BanTransFats.com withdrew the lawsuit after Kraft conceded to their request to begin eliminating trans fats, and many other companies like Taco Bell, KFC, and Starbucks voluntarily followed suit.

After 200 trials and more than 100,000 hours invested in researching an alternative, Oreos now contains only 1 gram of “unidentified fat” thereby making it trans-fat free according to a 2007 Kraft Foods, Inc. press release.

Some small businesses worry they might have to go through a long series of trials and tests like this, wasting time and money.

“It can only be the government’s place (to ban trans fats) if they can create an alternative that won’t break the bank of small businesses,” said Dennis Finn, an employee of Baker Ben’s Donuts in Sacramento. Finn is one of only two people who work in the shop.

Seeing straight: Assemblyman brings medical experience to the Capitol

When Assemblyman Alan Nakanishi's family was interned during World War II, they lost everything they had. The experience thrust them deep into poverty, and when they were released, Nakanishi decided he wanted to be a doctor.

Nakanishi, 67, said he knew he wanted to be a doctor from the first time a doctor cared for him. He fell ill as a child, and said he’s had a passion for health care since that day.

Now he still wants to keep people healthy – or, rather, he wants to create incentives for people to keep themselves healthy.

Nakanishi, R-Lodi, is a large proponent of Health Savings Accounts (HSAs), which would work similar to Roth IRAs. People would contribute money into an account that would earn interest and grow over time, and could be used to pay for medical costs that aren't covered by insurance companies.

He has authored several bills to introduce HSAs since he began his assembly term in 2002. He has been largely unsuccessful, and blames it on Republicans being the minority in the Assembly.

“What happened is, last year when we had the health message, we had what we wanted to do, but the Democrats were in control, so all of the bills were kicked off the committees and their ideas came forward,” Nakanishi said in a phone interview.

Nakanishi still practices medicine as an opthalmologist – an eye surgeon – for about half of every Friday at the practice he helped found in 1973, Delta Medical Eye Group, Inc. Cindy Daasch, 18-year manager of the practice, said the atmosphere in the office is very different when Nakanishi is working.

“He's a man with a lot of energy,” Daasch said. “He talks fast, moves fast. He likes to be busy.”

Nakanishi’s work as an assemblyman is his way of using his experience as a medical doctor to give back to his community and the public sector, Chief of Staff Jeff Hale said.

“He’s spent his career not just treating ailments, but working within California’s health care system,” Hale said. “He knows what its deficiencies are.”

Nakanishi, who has extensive knowledge of the health care system in California, sits on the Assembly committees of Health and Education. He was also a vocal opponent of Gov. Arnold Schwarzenegger’s health care reform bill, which recently died in the Assembly.

“I voted against it because it’s too costly,” Nakanishi said.

Nakanishi sees three major concepts as the means for incrementally achieving better health care: to find better jobs, where health care is provided by the employer; to seek preventive care and to use HSAs.

This argument isn't always well-received. Nakanishi has received criticism that because policies like this hinge on the ability to be able to afford health care, they exclude the poor.

Randy Bayne, chair for the Amador County Democratic Central Committee, called HSAs “short-sighted.”

“It doesn't cover the people who need it the most,” Bayne said in a phone interview. “If I'm poor and don't have money to put away in a savings account now, what makes Mr. Nakanishi think people will be able to put away money (in an HSA)?”

Bayne's ideal form of health care would be a single-payer system similar to Medicare or Canada's health care, in which taxes pay into a fund that helps pay for anyone's medical expenses. He rebuts people who say the Canadian system produces long lines and high premiums.

“I have talked personally to people from Canada . . . people from Great Britain, and every one of them likes it,” Bayne said. “There are people clamoring to go across the border to buy prescriptions there (because they're cheaper).”

Nakanishi said a system like this would be too costly would create even longer waits and make it more difficult to receive care.

“People in Canada are coming to this country to have surgery,” Nakanishi said.



Listening to constituents

Recently, Nakanishi asked the people in his district, which covers parts of four counties, for their opinions on issuing driver's licenses to undocumented immigrants. He received 8,000 letters, and said he read many of them.

Hale said under normal circumstances, Nakanishi personally reads and responds to many if not all letters sent from constituents in his district.

“He will actually spend hours calling up constituents when they write in and say, ‘vote on AB whatever,’ ” Hale said. “And he will say, ‘yeah, I voted for it,’ or ‘no, I didn’t, and here’s why.’ ”

While he invites comments and opinions from his constituents, he isn't afraid to disagree with some of them.

Long-time Nakanishi supporter Carl Burton is president of the River City Republicans, a volunteer group that has endorsed Nakanishi. He said he doesn't always agree with Nakanishi's policies.

“If I see him someplace I might take him aside and ask him why (he did something I didn't agree with),” he said. “He explains to me the reasons he's reached the conclusions he's reached.”

And while he has reached many of his constituents through these letters and conversations, Burton, 62, questions whether someone from Sacramento, would better represent the district.

“I think it's time we have somebody from Sacramento (to represent District 10),” he said. “Knowing he goes home every night to his wife in Lodi – maybe he’s a little stronger on issues that affect San Joaquin. I feel our next assemblyman should be . . . a little more involved with what’s going on here in Sacramento County.”


For family, for country: Politics could wait

Although the United States took everything his family had during WWII, Nakanishi isn't bitter about it, Daasch said.

“He looks at that very philosophically,” Daasch said. “He's not a person to carry a grudge at all.”

In fact, Nakanishi is quick to point out his patriotism, even as a child.

“I felt we lived in the best country in the world,” Nakanishi said.

And when he was drafted into the Army as a doctor during the Vietnam War, he had no qualms serving his country.

Even now, Nakanishi looks at his country admirably, not for what it has taken from him, but rather for all the luxuries it has afforded him.

Hale characterizes Nakanishi’s life as an eloquent “rags to riches” narrative, in which the “rags” of the assemblyman’s life were the by-product of the federal government; however, with hard work and dedication, so were the “riches.”

“They practically took everything away from him and he is still ended up as a really successful doctor and has achieved and lived the American dream,” Hale said.

But in spite or (or perhaps because of) his strong work ethic, Nakanishi waited until his three children were grown to run for political office.

“If my kids were young right now . . . or if my kids were not in college, I would not be (in politics),” he said.

Now his children work in respectable fields as well: his son, Jon, an attorney; his daughter Jennifer Cooper, a special education teacher; his daughter Pamela Tsuchiya, an eye doctor at the Tracy office of Nakanishi's practice.

His advice to others is similar to the path his life has taken.

“Get involved. Get educated,” he said. “Raise a family and then enter politics.”

Nakanishi has done all that, and his last term ends in November. But he is coy about his plans for the future.

“I’m keeping all my options open,” he said.