WASHINGTON (AP) — It's about to get faster and easier to diagnose food poisoning, but that progress for individual patients comes with a downside: It could hurt the nation's ability to spot and solve dangerous outbreaks.
Next-generation tests that promise to shave a few days off the time needed to tell whether E. coli, salmonella or other foodborne bacteria caused a patient's illness could reach medical laboratories as early as next year. That could allow doctors to treat sometimes deadly diseases much more quickly — an exciting development.
The problem: These new tests can't detect crucial differences between different subtypes of bacteria, as current tests can. And that fingerprint is what states and the federal government use to match sick people to a contaminated food. The older tests might be replaced by the new, more efficient ones.
"It's like a forensics lab. If somebody says a shot was fired, without the bullet you don't know where it came from," explained E. coli expert Dr. Phillip Tarr of Washington University School of Medicine in St. Louis.
The federal Centers for Disease Control and Prevention warns that losing the ability to literally take a germ's fingerprint could hamper efforts to keep food safe, and the agency is searching for solutions. According to CDC estimates, 1 in 6 Americans gets sick from foodborne illnesses each year, and 3,000 die.
"These improved tests for diagnosing patients could have the unintended consequence of reducing our ability to detect and investigate outbreaks, ultimately causing more people to become sick," said Dr. John Besser of the CDC.
That means outbreaks like the salmonella illnesses linked this fall to a variety of Trader Joe's peanut butter might not be identified that quickly — or at all.
It all comes down to what's called a bacterial culture — whether labs grow a sample of a patient's bacteria in an old-fashioned petri dish, or skip that step because the new tests don't require it.
Here's the way it works now: Someone with serious diarrhea visits the doctor, who gets a stool sample and sends it to a private testing laboratory. The lab cultures the sample, growing larger batches of any lurking bacteria to identify what's there. If disease-causing germs such as E. coli O157 or salmonella are found, they may be sent on to a public health laboratory for more sophisticated analysis to uncover their unique DNA patterns — their fingerprints.
Those fingerprints are posted to a national database, called PulseNet, that the CDC and state health officials use to look for food poisoning trends.
There are lots of garden-variety cases of salmonella every year, from runny eggs to a picnic lunch that sat out too long. But if a few people in, say, Baltimore have salmonella with the same molecular signature as some sick people in Cleveland, it's time to investigate, because scientists might be able narrow the outbreak to a particular food or company.
But culture-based testing takes time — as long as two to four days after the sample reaches the lab, which makes for a long wait if you're a sick patient.
What's in the pipeline? Tests that could detect many kinds of germs simultaneously instead of hunting one at a time — and within hours of reaching the lab — without first having to grow a culture. Those tests are expected to be approved as early as next year.
This isn't just a science debate, said Shari Shea, food safety director at the Association of Public Health Laboratories.
If you were the patient, "you'd want to know how you got sick," she said.
PulseNet has greatly improved the ability of regulators and the food industry to solve those mysteries since it was launched in the mid-1990s, helping to spot major outbreaks in ground beef, spinach, eggs and cantaloupe in recent years. Just this fall, PulseNet matched 42 different salmonella illnesses in 20 different states that were eventually traced to a variety of Trader Joe's peanut butter.
Food and Drug Administration officials who visited the plant where the peanut butter was made found salmonella contamination all over the facility, with several of the plant samples matching the fingerprint of the salmonella that made people sick. A New Mexico-based company, Sunland Inc., recalled hundreds of products that were shipped to large retailers all over the country, including Target, Safeway and other large grocery chains.
The source of those illnesses probably would have remained a mystery without the national database, since there weren't very many illnesses in any individual state.
To ensure that kind of crucial detective work isn't lost, the CDC is asking the medical community to send samples to labs to be cultured even when they perform a new, non-culture test.
But it's not clear who would pay for that extra step. Private labs only can perform the tests that a doctor orders, noted Dr. Jay M. Lieberman of Quest Diagnostics, one of the country's largest testing labs.
A few first-generation non-culture tests are already available. When private labs in Wisconsin use them, they frequently ship leftover samples to the state lab, which grows the bacteria itself. But as more private labs switch over after the next-generation rapid tests arrive, the Wisconsin State Laboratory of Hygiene will be hard-pressed to keep up with that extra work before it can do its main job — fingerprinting the bugs, said deputy director Dr. Dave Warshauer.
Stay tuned: Research is beginning to look for solutions that one day might allow rapid and in-depth looks at food poisoning causes in the same test.
"As molecular techniques evolve, you may be able to get the information you want from non-culture techniques," Lieberman said.
___
Follow Mary Clare Jalonick on Twitter at http://twitter.com/mcjalonick
Hours before he played the romantic lead in a community theater play opposite his real-life fiancee, authorities allege Daniel Patrick Wozniak shot and killed his neighbor.
Not long after that evening’s performance, he slipped out of the Costa Mesa apartment he shared with his then-fiancee, Rachel Buffett, 25, and killed a second person , according to police, prosecutors and Buffett's account of events.
Authorities say that when they questioned Buffett, she lied to protect Wozniak, who is now facing double murder charges.
More than two years after the May 2010 crimes, Buffett was charged with being an accessory to murder after the fact. It is a charge she disputes.
"I'm innocent, and he's guilty, and he confessed to that," she told the Daily Pilot in a jailhouse interview. She said Wozniak told her that he confessed to police that he killed the two victims.
She said she's always been honest and forth-coming with police and doesn't understand why she is now facing felony charges and a possible prison sentence of more than three years.
"You go over it in your mind, 'How could I possibly give someone wrong information?' " she said. "I was trying to be helpful and give them every conception in my mind."
Police, however, say their investigation, which included interviews with Buffett and multiple witnesses, indicates she wasn't truthful.
"She told us a story we know not to be true," said Costa Mesa Police Sgt. Ed Everett. "We waited that long basically because we didn't want to prematurely arrest her for accessory and find out she was complicit in the homicides."
Police said Wozniak killed his neighbor Samuel Herr in the theater of the Joint Forces Training Center in Los Alamitos before dismembering his body and leaving his head and hands at the nearby El Dorado Nature Center in Long Beach.
Authorities allege that Wozniak then killed Herr's friend and tutor, Juri "Julie" Kibuishi, 23, in Herr's apartment, then staged the crime to make it look like a sexual assault.
Wozniak reportedly told detectives he was motivated by money. He and Buffett had planned to marry soon. Authorities said Wozniak killed Herr to secure his ATM card. Herr had saved money from his time in the military.
Wozniak remains in Orange County Jail on murder charges. If convicted, he could receive the death penalty.
Buffett faces three felony charges of accessory to murder after the fact. She faces a three-year, eight-month, sentence if convicted.
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WASHINGTON — A new intelligence assessment of global trends projects that China will outstrip the United States as the leading economic power before 2030, but that America will remain an indispensable world leader, bolstered in part by an era of energy independence.
Russia’s clout will wane, as will the economic strength of other countries reliant on oil for revenues, the assessment says.
The product of four years of intelligence-gathering and analysis, the study, by the National Intelligence Council, presents grounds for optimism and pessimism in nearly equal measure. The council reports to the director of national intelligence and has responsibilities for long-term strategic analysis.
One remarkable development it anticipates is a spreading affluence that leads to a larger global middle class that is better educated and has wider access to health care and communications technologies like the Internet and smartphones. The report assesses global trends until 2030.
“The growth of the global middle class constitutes a tectonic shift,” the study says, adding that billions of people will gain new individual power as they climb out of poverty. “For the first time, a majority of the world’s population will not be impoverished, and the middle classes will be the most important social and economic sector in the vast majority of countries around the world.”
At the same time, it warns, half of the world’s population will probably be living in areas that suffer from severe shortages of fresh water, meaning that management of natural resources will be a crucial component of global national security efforts.
But these developments also bring significant risks, allowing radicalized groups to enter world politics on a scale even more violent than that of current terrorist organizations by adopting “lethal and disruptive technologies,” including biological weapons and cyberweapons.
The study warns of the risk that terrorists could mount a computer-network attack in which the casualties would be measured not by the hundreds or thousands killed but by the millions severely affected by damaged infrastructure, like electrical grids being taken down.
“There will not be any hegemonic power,” the 166-page report says. “Power will shift to networks and coalitions in a multipolar world.”
It warns that at least 15 countries are “at high risk of state failure” by 2030, among them Afghanistan and Pakistan, but also, Burundi, Rwanda, Somalia, Uganda and Yemen.
The study acknowledges that the future “is malleable,” and it lists important “game changers” that will most influence the global scene until 2030: a crisis-prone world economy, shortcomings in governance, conflicts within states and between them, the impact of new technologies and whether the United States can “work with new partners to reinvent the international system.”
The best-case situation for global security until 2030, according to the study, would be a growing political partnership between the United States and China. But it could take a crisis to bring Washington and Beijing together — something like a nuclear standoff between India and Pakistan resolved only by bold cooperation between the United States and China.
The worst-case situation envisions a stalling of economic globalization that would preclude any advancement of financial well-being around the world. That would be a likely outcome after an outbreak of a health pandemic that, even if short-lived, would result in closed borders and economic isolationism.
The chief author and manager of the project, Mathew Burrows, who is counselor for the National Intelligence Council, said the findings had been presented in advance in more than 20 nations to groups of academic experts, business leaders and government officials, including local intelligence officers.
In an interview, Mr. Burrows noted that the audiences in China were far more accepting of the American intelligence assessments — both those predicting China’s economic ascendancy and those warning of political dangers if there was no reform of governance in Beijing — than were audiences in Russia.
Shannen Doherty recently called 911 to help save a Twitter follower who was sending messages about wanting to commit suicide.
The former Beverly Hills 90210 star, 41, who was in California, was so concerned by the message from a distraught fan who'd aggressively Tweeted at her before, that she called police in Westhampton, N. J., and asked them for help. TMZ.com, which first reported the story, released the 911 call on Sunday.
"This is going to sound incredibly strange," she told a police dispatcher on the call. "My name is Shannen Doherty and I'm an actress. I am on Twitter, sadly, and there is a girl that is threatening to shoot herself and she lives somewhere over there. I'm completely untrained to deal with somebody threatening to commit suicide, especially via Twitter."
Still, Doherty was smart enough to put the police on the right trail, and even coaxed an address out of the woman.
As Doherty stayed on the line – "I'm sitting here, like, you know, freaking out and held hostage and I can't even do anything," she says on the tape – police found the woman, who was okay.
But not before the dispatcher let Doherty know he was a fan.
"All my co-workers can't believe who I'm on the phone with," the dispatcher told to an appreciative-sounding Doherty. "They all want your Twitter account."
SEATTLE (AP) — The crowds of happy people lighting joints under Seattle's Space Needle early Thursday morning with nary a police officer in sight bespoke the new reality: Marijuana is legal under Washington state law.
Hundreds gathered at Seattle Center for a New Year's Eve-style countdown to 12 a.m., when the legalization measure passed by voters last month took effect. When the clock struck, they cheered and sparked up in unison.
A few dozen people gathered on a sidewalk outside the north Seattle headquarters of the annual Hempfest celebration and did the same, offering joints to reporters and blowing smoke into television news cameras.
"I feel like a kid in a candy store!" shouted Hempfest volunteer Darby Hageman. "It's all becoming real now!"
Washington and Colorado became the first states to vote to decriminalize and regulate the possession of an ounce or less of marijuana by adults over 21. Both measures call for setting up state licensing schemes for pot growers, processors and retail stores. Colorado's law is set to take effect by Jan. 5.
Technically, Washington's new marijuana law still forbids smoking pot in public, which remains punishable by a fine, like drinking in public. But pot fans wanted a party, and Seattle police weren't about to write them any tickets.
In another sweeping change for Washington, Gov. Chris Gregoire on Wednesday signed into law a measure that legalizes same-sex marriage. The state joins several others that allow gay and lesbian couples to wed.
The mood was festive in Seattle as dozens of gay and lesbian couples got in line to pick up marriage licenses at the King County auditor's office early Thursday.
King County and Thurston County announced they would open their auditors' offices shortly after midnight Wednesday to accommodate those who wanted to be among the first to get their licenses.
Kelly Middleton and her partner Amanda Dollente got in line at 4 p.m. Wednesday.
Hours later, as the line grew, volunteers distributed roses and a group of men and women serenaded the waiting line to the tune of "Chapel of Love."
Because the state has a three-day waiting period, the earliest that weddings can take place is Sunday.
In dealing with marijuana, the Seattle Police Department told its 1,300 officers on Wednesday, just before legalization took hold, that until further notice they shall not issue citations for public marijuana use.
Officers will be advising people not to smoke in public, police spokesman Jonah Spangenthal-Lee wrote on the SPD Blotter. "The police department believes that, under state law, you may responsibly get baked, order some pizzas and enjoy a 'Lord of the Rings' marathon in the privacy of your own home, if you want to."
He offered a catchy new directive referring to the film "The Big Lebowski," popular with many marijuana fans: "The Dude abides, and says 'take it inside!'"
"This is a big day because all our lives we've been living under the iron curtain of prohibition," said Hempfest director Vivian McPeak. "The whole world sees that prohibition just took a body blow."
Washington's new law decriminalizes possession of up to an ounce for those over 21, but for now selling marijuana remains illegal. I-502 gives the state a year to come up with a system of state-licensed growers, processors and retail stores, with the marijuana taxed 25 percent at each stage. Analysts have estimated that a legal pot market could bring Washington hundreds of millions of dollars a year in new tax revenue for schools, health care and basic government functions.
But marijuana remains illegal under federal law. That means federal agents can still arrest people for it, and it's banned from federal properties, including military bases and national parks.
The Justice Department has not said whether it will sue to try to block the regulatory schemes in Washington and Colorado from taking effect.
"The department's responsibility to enforce the Controlled Substances Act remains unchanged," said a statement issued Wednesday by the Seattle U.S. attorney's office. "Neither states nor the executive branch can nullify a statute passed by Congress."
The legal question is whether the establishment of a regulated marijuana market would "frustrate the purpose" of the federal pot prohibition, and many constitutional law scholars say it very likely would.
That leaves the political question of whether the administration wants to try to block the regulatory system, even though it would remain legal to possess up to an ounce of marijuana.
Alison Holcomb is the drug policy director of the American Civil Liberties Union of Washington and served as the campaign manager for New Approach Washington, which led the legalization drive. She said the voters clearly showed they're done with marijuana prohibition.
"New Approach Washington sponsors and the ACLU look forward to working with state and federal officials and to ensure the law is fully and fairly implemented," she said.
___
Johnson can be reached at https://twitter.com/GeneAPseattle
Prosecutors say a Stockton man lived with his girlfriend's rotting corpse for months after killing her.
In court last week, prosecutors alleged that the man hit is girlfriend on the head with a a metal table pedestal, raped her and stabbed her 32 times.
Devon Epps was evicted from his apartment in December 2011. The next
day, when the apartment manager stopped by, they found a dead body in
the bathroom.
Epps was arrested and then arraigned a few days later. At an earlier hearing, he yelled at a San Joaquin County judge, according to Fox 40.
Investigators identified the body as Veronica Jones, who was last seen at a family function with Epps in May 2011.
HAVANA — Cuba’s liveliest experiment with capitalism unfolds every night in a dirt lot on the edge of the capital, where Truman-era trucks lugging fresh produce meet up with hundreds of buyers on creaking bicycle carts clutching wads of cash.
“This place, it feeds all of Havana,” said Misael Toledo, 37, who owns three small food stores in the city. “Before, you could only buy or sell in the markets of Fidel.”
The agriculture exchange, which sprang up last year after the Cuban government legalized a broader range of small businesses, is a vivid sign of both how much the country has changed, and of all the political and practical limitations that continue to hold it back.
President Raúl Castro has made agriculture priority No. 1 in his attempt to remake the country. He used his first major presidential address in 2007 to zero in on farming, describing weeds conquering fallow fields and the need to ensure that “anyone who wants can drink a glass of milk.”
No other industry has seen as much liberalization, with a steady rollout of incentives for farmers. And Mr. Castro has been explicit about his reasoning: increasing efficiency and food production to replace imports that cost Cuba hundreds of millions of dollars a year is a matter “of national security.”
Yet at this point, by most measures, the project has failed. Because of waste, poor management, policy constraints, transportation limits, theft and other problems, overall efficiency has dropped: many Cubans are actually seeing less food at private markets. That is the case despite an increase in the number of farmers and production gains for certain items. A recent study from the University of Havana showed that market prices jumped by nearly 20 percent in 2011 alone. And food imports increased to an estimated $1.7 billion last year, up from $1.4 billion in 2006.
“It’s the first instance of Cuba’s leader not being able to get done what he said he would,” said Jorge I. Domínguez, vice provost for international affairs at Harvard, who left Cuba as a boy. “The published statistical results are really very discouraging.”
A major cause: poor transportation, as trucks are in short supply, and the aging ones that exist often break down.
In 2009, hundreds of tons of tomatoes, part of a bumper crop that year, rotted because of a lack of transportation by the government agency charged with bringing food to processing centers.
“It’s worse when it rains,” said Javier González, 27, a farmer in Artemisa Province who described often seeing crops wilt and rot because they were not picked up.
Behind him were the 33 fertile, rent-free acres he had been granted as part of a program Mr. Castro introduced in 2008 to encourage rural residents to work the land. After clearing it himself and planting a variety of crops, Mr. Gonzalez said, he was doing relatively well and earned more last year than his father, who is a doctor, did.
But Cuba’s inefficiencies gnawed at him. Smart, strong, and ambitious, he had expansion plans in mind, even as in his hand he held a wrench. He was repairing a tractor part meant to be grading land. It was broken. Again.
The 1980s Soviet model tractor he bought from another farmer was as about good as it gets in Cuba. The Cuban government maintains a monopoly on selling anything new, and there simply is not enough of anything — fertilizer, or sometimes even machetes — to go around.
Government economists are aware of the problem. “If you give people land and no resources, it doesn’t matter what happens on the land,” said Joaquin Infante of the Havana-based Cuban National Association of Economists.
But Mr. Castro has refused to allow what many farmers and experts see as an obvious solution to the shortages of transportation and equipment: Let people import supplies on their own. “It’s about control,” said Philip Peters, a Cuba analyst with the Lexington Institute, a Virginia-based research group.
Other analysts agree, noting that though the agricultural reforms have gone farther than other changes — like those that allow for self-employment — they remain constrained by politics.
“The government is not ready to let go,” said Ted Henken, a Latin American studies professor at Baruch College. “They are sending the message that they want to let go, or are trying to let go, but what they have is still a mechanism of control.”
For many farmers, that explains why land leases last for 10 years with a chance to renew, not indefinitely or the 99 years offered to foreign developers. It is also why many farmers say they will not build homes on the land they lease, despite a concession this year to allow doing so.
Success, as they say, has many fathers. In the killing of Osama bin Laden, proud papas from President Obama to SEAL Team 6 earned kudos aplenty – and justifiably so, given the monstrosity of bin Laden's crimes. But with all due respect to all those dads, it's time to meet Mom.
Few people know the identity of the real-life female CIA agent who hunted bin Laden, but Oscar-winning director Kathryn Bigelow calls her Maya in Zero Dark Thirty, which stars Jessica Chastain in the role, as well as Kyle Chandler and Jennifer Ehle. You'll recognize Maya before we've even been properly introduced, because she's the only pretty redhead in Pakistan assisting in the waterboarding of a detainee.
It's a warning of sorts: Zero Dark Thirty lives in gray areas, brilliantly juxtaposing the perverse intimacy of torture with the moral imperative to stop terrorism.
This masterful, merciless film (out Dec. 19) also gives Chastain her best shot yet at an Oscar, as she constructs Maya out of vibrating steel, buzzing with determination to catch her quarry.
When May 1, 2011, comes, and the SEAL team heads out to fulfill the mission in the film's terrifically tense final scenes, there's a weird but palpable sense of regret that Maya can't join them. After all, it's her baby.
SEATTLE (AP) — The crowds of happy people lighting joints under Seattle's Space Needle early Thursday morning with nary a police officer in sight bespoke the new reality: Marijuana is legal under Washington state law.
Hundreds gathered at Seattle Center for a New Year's Eve-style countdown to 12 a.m., when the legalization measure passed by voters last month took effect. When the clock struck, they cheered and sparked up in unison.
A few dozen people gathered on a sidewalk outside the north Seattle headquarters of the annual Hempfest celebration and did the same, offering joints to reporters and blowing smoke into television news cameras.
"I feel like a kid in a candy store!" shouted Hempfest volunteer Darby Hageman. "It's all becoming real now!"
Washington and Colorado became the first states to vote to decriminalize and regulate the possession of an ounce or less of marijuana by adults over 21. Both measures call for setting up state licensing schemes for pot growers, processors and retail stores. Colorado's law is set to take effect by Jan. 5.
Technically, Washington's new marijuana law still forbids smoking pot in public, which remains punishable by a fine, like drinking in public. But pot fans wanted a party, and Seattle police weren't about to write them any tickets.
In another sweeping change for Washington, Gov. Chris Gregoire on Wednesday signed into law a measure that legalizes same-sex marriage. The state joins several others that allow gay and lesbian couples to wed.
The mood was festive in Seattle as dozens of gay and lesbian couples got in line to pick up marriage licenses at the King County auditor's office early Thursday.
King County and Thurston County announced they would open their auditors' offices shortly after midnight Wednesday to accommodate those who wanted to be among the first to get their licenses.
Kelly Middleton and her partner Amanda Dollente got in line at 4 p.m. Wednesday.
Hours later, as the line grew, volunteers distributed roses and a group of men and women serenaded the waiting line to the tune of "Chapel of Love."
Because the state has a three-day waiting period, the earliest that weddings can take place is Sunday.
In dealing with marijuana, the Seattle Police Department told its 1,300 officers on Wednesday, just before legalization took hold, that until further notice they shall not issue citations for public marijuana use.
Officers will be advising people not to smoke in public, police spokesman Jonah Spangenthal-Lee wrote on the SPD Blotter. "The police department believes that, under state law, you may responsibly get baked, order some pizzas and enjoy a 'Lord of the Rings' marathon in the privacy of your own home, if you want to."
He offered a catchy new directive referring to the film "The Big Lebowski," popular with many marijuana fans: "The Dude abides, and says 'take it inside!'"
"This is a big day because all our lives we've been living under the iron curtain of prohibition," said Hempfest director Vivian McPeak. "The whole world sees that prohibition just took a body blow."
Washington's new law decriminalizes possession of up to an ounce for those over 21, but for now selling marijuana remains illegal. I-502 gives the state a year to come up with a system of state-licensed growers, processors and retail stores, with the marijuana taxed 25 percent at each stage. Analysts have estimated that a legal pot market could bring Washington hundreds of millions of dollars a year in new tax revenue for schools, health care and basic government functions.
But marijuana remains illegal under federal law. That means federal agents can still arrest people for it, and it's banned from federal properties, including military bases and national parks.
The Justice Department has not said whether it will sue to try to block the regulatory schemes in Washington and Colorado from taking effect.
"The department's responsibility to enforce the Controlled Substances Act remains unchanged," said a statement issued Wednesday by the Seattle U.S. attorney's office. "Neither states nor the executive branch can nullify a statute passed by Congress."
The legal question is whether the establishment of a regulated marijuana market would "frustrate the purpose" of the federal pot prohibition, and many constitutional law scholars say it very likely would.
That leaves the political question of whether the administration wants to try to block the regulatory system, even though it would remain legal to possess up to an ounce of marijuana.
Alison Holcomb is the drug policy director of the American Civil Liberties Union of Washington and served as the campaign manager for New Approach Washington, which led the legalization drive. She said the voters clearly showed they're done with marijuana prohibition.
"New Approach Washington sponsors and the ACLU look forward to working with state and federal officials and to ensure the law is fully and fairly implemented," she said.
___
Johnson can be reached at https://twitter.com/GeneAPseattle
Matthew Stavron, 24 speaking, mother Kelle Stavron
Chaz La Bry, 26 speaking, mother Robin La Bry
William "Skip" Halpin, 51 speaking, brother Jerry Halpin
Doneno "Rick" Polizo, 58 speaking, wife Margaret Polizo
Karl Finnila, 43 speaking, sister Sally Finnila-Sloane
Jennifer Thurber, 22 speaking, father Charles Thurber
Alex Clyburn, 23 speaking, father Ron Clyburn
Larry Carmichael, 51 speaking, son Dan Carmichael
Clifford Dwight Oshier, 60 speaking, brother Ron Oshier
He prescribed powerful painkillers to addicts who had no medical need for them, conducted sham examinations and appeared to be a key supplier for drug dealers, according to court records.
He wrote more prescriptions than the entire staffs of some hospitals and took in more than $1 million a year.
Worse, one of Estiandan's patients had fatally overdosed on drugs he prescribed, a board investigator learned. The investigator said in her report that she confronted the doctor and told him the death was "the inevitable result" of giving narcotics to an addict.
Unknown to the investigator, two other Estiandan patients had suffered fatal overdoses. More deaths would follow.
By the time the medical board stopped Estiandan from prescribing, more than four years after it began investigating, eight of his patients had died of overdoses or related causes, according to coroners' records.
It was not an isolated case of futility by California's medical regulators. The board has repeatedly failed to protect patients from reckless prescribing by doctors, a Los Angeles Times investigation found.
It is board policy to give such cases a high priority. But The Times' examination of board records and county coroners' files from 2005 through 2011 found that:
"Material things are nothing now," said Dr. Carlos Estiandan, who was released from prison in September, after serving roughly half of a five-year sentence. (Liz O. Baylen / Los Angeles Times)
At least 30 patients in Southern California have died of drug overdoses or related causes while their doctors were under investigation for reckless prescribing. The board ultimately sanctioned all but one of those 12 doctors, and some were criminally charged — too late to prevent the deaths.
The board seldom tries to suspend the prescribing privileges of doctors under investigation. The agency can petition a judge for an interim suspension order. It has obtained orders only rarely: 12 times in the last five years in cases of excessive prescribing, in a state with more than 100,000 practicing physicians.
Even when the board sanctions doctors for abusing their prescribing powers, in most cases it allows them to continue practicing and prescribing. In 80% of the 190 cases of improper prescribing filed by the board since 2005, the offending physician was given a reprimand or placed on probation. In most of those cases, the doctor was allowed to continue writing prescriptions with few or no restrictions.
Eight doctors disciplined for excessive prescribing later had patients die of overdoses or related causes. Prescriptions those doctors wrote caused or contributed to 19 deaths.
At the heart of these shortcomings is the board's approach to oversight. It investigates when it receives a complaint of abuse or poor treatment of a specific patient or patients. It generally does not look for evidence of wider problems in a physician's practice.
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For example, in looking into cases of improper prescribing, investigators usually do not search county coroners' files to determine whether — as in Estiandan's case — a doctor's patients are dying of drug overdoses.
Dr. Rick Chavez, a pain management physician in Redondo Beach, serves as an expert for the board in cases of reckless prescribing. He said overprescribing is a pervasive problem, and oversight is inadequate.
"We have doctors out there doing things that no one is monitoring," he said. "It's scary."
The medical board's president, Sharon Levine, a pediatrician who is an executive at Kaiser Permanente, declined to be interviewed, saying it would be "inappropriate" because disciplinary cases are ultimately decided by the board. Executive Director Linda Whitney declined to comment, and staff members said they are barred by policy from speaking with reporters.
Responding by email to written questions, board officials asserted that their "highest priority and primary mission is consumer protection."
In response to The Times' findings, they have asked the Legislature to require county coroners to report all prescription drug deaths to the board.
"If only one physician was found to be overprescribing," the board said in its request to legislators, "this could save numerous lives."
Estiandan, a diminutive man with a cheerful demeanor, had a thriving general practice. He sang tenor in his church choir, played golf once a week with his sons and took his wife ballroom dancing. He was a lieutenant colonel in the U.S. Air Force Reserve and led medical relief missions to the Philippines, where he grew up and attended medical school.
In October 2004, one of his employees reached out anonymously to authorities.
The man told Robin Hollis, a medical board investigator, that Estiandan, then 62, was taking in $3,000 in cash a day selling prescriptions. Drug-addicted patients, the employee said, crowded the lobby of the doctor's clinic west of downtown Los Angeles, one of three he owned.
"Estiandan will give the patients anything they want," he told Hollis, according to her report.
The U.S. Drug Enforcement Administration and the Los Angeles County Sheriff's Department were also investigating Estiandan, and the agencies shared information.
Evidence accumulated quickly. Alleged drug dealers were arrested in Los Angeles carrying bottles of medications prescribed by Estiandan, court records show.
A Costco pharmacist reported that groups of men in their 20s and 30s were showing up at his counter with prescriptions from Estiandan for painkillers, tranquilizers and muscle relaxants — the makings of a drug cocktail that is popular with addicts.
The pharmacist, Edward Wong, told authorities he would call Estiandan to make sure the prescriptions were legitimate, and the doctor would instruct him to fill them. Eventually, Wong stopped calling and simply refused to fill the prescriptions.
In Albuquerque, DEA agents stopped a man who was carrying more than 1,800 pills and several bottles of narcotic cough syrup with a street value of up to $500 each. According to court records, the medication labels identified Estiandan as the prescriber.
In the summer of 2005, about 10 months into the investigation, Leo Martinez checked in at Estiandan's clinic in Reseda. He paid a $120 fee for the office visit and waited a half-hour to see the doctor.
What happened next is detailed in court records.
Estiandan asked Martinez what was wrong.
"Nothing," Martinez said. He explained that he wanted a refill for painkillers he had been prescribed by another doctor whose clinic had since closed.
Estiandan asked him why he was in pain: Had he fallen or been in an accident?
He asked Martinez again if he had hurt his back or been in an accident. This time, Estiandan nodded and raised his eyebrows.
No, Martinez replied.
Estiandan said the other doctor must have had a reason to prescribe painkillers.
Martinez said it was a long time ago and he couldn't remember.
Estiandan told Martinez he couldn't prescribe the drugs unless there was an indication Martinez was in pain.
Then he asked Martinez again if he had hurt his back or been in an accident. This time, Estiandan nodded and raised his eyebrows.
Reading the cue, Martinez said he hurt his back lifting weights.
Estiandan pulled out his prescription pad.
Martinez was an undercover sheriff's narcotics investigator who had been secretly recording the conversation. He left Estiandan's office with prescriptions for the painkiller Vicodin, the muscle relaxant Soma, the anti-anxiety drug Valium and a 16-ounce bottle of narcotic cough syrup.
The medical board and law enforcement agencies were not the only ones interested in Estiandan.
Medi-Cal agents suspected him of fraudulent billing and put him under surveillance. They followed him as he drove home to Northridge in a Lincoln Navigator or Lexus sedan, sometimes stopping at a hospital or to pick up takeout at a Filipino restaurant.
But amid this intense scrutiny of Estiandan's life and medical practice, one thing appears to have escaped attention: what was happening to his patients.
One of them, Pamela Stone, suffered chronic pain from herniated disks. She also struggled with anxiety and had trouble sleeping.
Stone's mother grew concerned when she didn't hear from her daughter for a couple of days and asked the manager of the Reseda apartment building where Stone lived to check on her.
On Nov. 20, 2006, the manager opened the door to the apartment and found Stone's lifeless body on her bed. There was a trace of dried white foam around her nose and mouth.
The coroner determined that Stone died of an accidental overdose of multiple drugs, including an anti-anxiety medication prescribed by Estiandan. She was 54.
Hollis continued with her investigation, unaware of the death.
Hollis is one of about 130 medical board investigators on the front lines of patient protection in California. They look into allegations of physician misconduct ranging from botched surgeries to sexual abuse of patients.
Their ranks have dwindled, even as the number of licensed physicians in the state has risen over the last decade, to 102,000.
There are about 30 fewer investigators today than in 2001. The board opened 1,577 investigations last year, a 40% decline from a decade ago, and investigations now take longer to complete: an average of 347 days, compared with 256 in 2001.
Members of the Medical Board of California meet in Torrance in May. (Liz O. Baylen / Los Angeles Times)
The agency is overseen by a 15-member board appointed by the governor and legislative leaders. By law, eight members must be doctors. The board is funded by physician licensing fees, a revenue stream that was supposed to be immune to California's boom-and-bust budget cycles.
But Govs. Arnold Schwarzenegger and Jerry Brown used the board as a piggy bank, taking $15 million in licensing fees — the equivalent of a quarter of one year's budget — to help fill holes in the state general fund.
Schwarzenegger ordered state employees to take three unpaid furlough days per month, hobbling the board's enforcement efforts. Brown imposed hiring freezes. At one point, 1 in 4 investigator positions were vacant.
The board's staff has warned for years that the cuts were crippling its ability to protect the public. Julianne D'Angelo Fellmeth, a public interest lawyer who has monitored the board for the state Legislature, said the situation is urgent.
"The medical board is regulating the most important profession in terms of irreparable harm," Fellmeth said. "It should not be neutered."
The board's challenges go beyond the financial. Unlike medical regulators in other states, it cannot suspend a doctor's license or prescribing privileges on its own, even to prevent imminent harm.
Instead, the board must petition a state administrative law judge for an interim suspension order. If it obtains an order, the board must file a complaint against the doctor within 15 days — a legal provision for which physician groups lobbied, Fellmeth said.
The 15-day rule means that "an investigation must be nearly complete" before the agency can seek a suspension, board spokeswoman Jennifer Simoes wrote in an email.
If a doctor has been criminally charged, the board can ask a Superior Court judge for a suspension. It has done so a handful of times in recent years in cases of excessive prescribing.
Board officials said they sometimes hold off on seeking suspensions until that point to avoid jeopardizing a criminal investigation.
Steve Opferman, a Los Angeles County sheriff's deputy who runs a task force on healthcare fraud and took part in the Estiandan investigation, questioned that rationale. He said the board should move swiftly to shut down a doctor's prescribing whenever lives are at stake — even if it could affect a criminal prosecution.
The danger in waiting, he said, is that "people are going to die."
Andrew Corless began abusing drugs at the age of 15 and spent at least eight stints in drug treatment. On Aug. 11, 2006, he had a moment of resolve.
He called Estiandan's office at 11:45 a.m. that day and left a message.
He was about to undergo drug detoxification, according to a handwritten note by a receptionist, and he asked that the doctor "please not see him anymore."
Three hours later, Corless called back with a message "to disregard" the earlier call.
Leslie Greenberg lies in the grass at a park after leaving flowers at the nearby grave of her boyfriend Andrew Corless, who died in 2006 of prescription drug and alcohol intoxication. (Liz O. Baylen / Los Angeles Times)
Corless was in Estiandan's office 10 days later, pleading for drugs, court records show. He was back again in December, this time after leaving rehab early.
On Dec. 13, 2006, Corless, 46, was found on the street in front of his house in Northridge, dead of an overdose. Two of the drugs found in his system — hydrocodone and alprazolam — had been prescribed for him by Estiandan.
A month later, authorities searched Estiandan's offices and home. They found hundreds of partially completed prescription forms, some of them already signed, along with $12,300 in cash, court records show.
Looking at patients' records, investigators saw that groups of people from as far as Bakersfield, the Antelope Valley, Victorville and San Bernardino would show up at Estiandan's clinic near downtown Los Angeles on the same day, describe the same symptoms and leave with prescriptions for the same drugs.
Shortly after the raid, Estiandan was back at work — and writing prescriptions at a furious pace.
DEA agents consulted a database on prescriptions for controlled substances, written for patients paying in cash, to see where Estiandan stood. For March 2007, he ranked first in Southern California, Nevada and Hawaii, and fifth in the United States, according to court records.
For Joyce Saldivar, 55, he prescribed hydrocodone.
Saldivar had chronic back pain and was known to abuse her medications, according to coroner's records. She died June 29, 2007. The cause was an overdose of multiple drugs, including hydrocodone.
Estiandan acknowledged that Corless was an alcoholic and an addict and had “begged” him for drugs, according to Hollis' report.
By then, Hollis had learned about Corless' death from his girlfriend, who complained to the medical board about Estiandan, court records show.
Hollis got Corless' medical records and the autopsy report, and summoned Estiandan to an interview at a board office in Glendale on Sept. 12, 2007.
Estiandan acknowledged that Corless was an alcoholic and an addict and had "begged" him for drugs, according to Hollis' report.
Hollis told Estiandan that she couldn't understand how he could "continue to give pain medication to a person who is addicted," according to her report. "I explained that now there was a patient death.... This was the inevitable result. It was just a matter of time."
Hollis later obtained a report from an expert physician stating that Estiandan's treatment of Corless included "extreme departures" from accepted standards and contributed to his death.
Another patient, Wilma Jones, 47, was found dead in an unfurnished one-room apartment in South Los Angeles on Feb. 14, 2008. She had contracted pneumonia, and various drugs had suppressed her breathing to the point of death, coroner's records show.
One of the drugs was hydrocodone, which Estiandan had prescribed for her, records show.
Within a six-week span that summer, three more people died after taking medications prescribed by Estiandan. In all, seven of his patients had died since the medical board began investigating nearly four years earlier.
Estiandan, an early riser, was on the computer, tending to his stock portfolio on the morning of July 23, 2008, when a throng of DEA agents and sheriff's deputies appeared at his doorstep.
The doctor was polite and cooperative as an officer handcuffed him and led him to a police car. He was charged with 13 felony counts of illegally prescribing controlled substances. He was not charged with any of his patients' deaths.
Clint McKinney, center, hugs his mother and wife after scattering the ashes of his father, Bill, who died of cancer, and brother, Byron, who died of prescription drug-related causes. (Liz O. Baylen / Los Angeles Times)
Three weeks later, the medical board asked a Superior Court judge to suspend Estiandan's license, saying it was "the surest way to protect the public" from a doctor who "supplied patients with drugs, not medical care."
While the board waited for a ruling, Estiandan was free on bail and seeing patients.
Byron McKinney, a former pro wrestler, had been seeing Estiandan for eight years and had gotten hooked on the muscle relaxant carisoprodol, the anti-anxiety drug Xanax and a narcotic cough syrup, according to his brother, Clint.
McKinney, 33, died Nov. 18, 2008, of heart disease. The coroner said carisoprodol and hydrocodone were contributing factors. An empty bottle of hydrocodone cough syrup prescribed by Estiandan was found on a coffee table near McKinney's body.
About this story
This is the second in a series of occasional stories on the epidemic of prescription drug deaths. For this article, reporters Lisa Girion and Scott Glover, with help from reporter Hailey Branson-Potts, examined medical board records, coroners' files and court documents, and interviewed doctors, law enforcement officials and relatives of those who died from overdoses.
Times photojournalist Liz O. Baylen created still images and videos, contributed reporting and helped conduct interviews.
Stephanie Ferrell designed the web presentation and Armand Emamdjomeh created the interactivity.
Clint McKinney told a coroner's investigator that he and his brother "were able to regularly obtain prescription painkillers at free will via an unethical doctor who would write them five prescriptions for $120," records show.
In February 2009, six months after the board went to court, a judge barred Estiandan from prescribing painkillers and other addictive drugs. He surrendered his medical license that September. The next year, he was tried and convicted on the criminal charges and sentenced to five years in prison.
He was released in September after serving about half his term. A few days later, he spoke with Times reporters in the spacious home where he now lives on a ridge of the Verdugo Mountains in Burbank.
He referred to his time in state prison as "my vacation" and described how he practiced guitar, tutored inmates, volunteered in the chapel and read the Bible.
By turns defensive and contrite, Estiandan complained of being unfairly targeted by prosecutors for simply doing his job.
He said he warned patients of the dangers of becoming addicted to prescription drugs, telling them: "Eventually you will lose control of yourself."
He recalled that his wife, Gloria, a nurse, had warned that he was headed for trouble. She saw the disheveled people in his waiting room, Estiandan said, and told him: "Just let them go."
Estiandan, now 70, said he was not motivated by greed and never intentionally harmed patients. But he said he realizes he used poor judgment in prescribing drugs.
"Instead of helping them, I might have harmed them," he said of his patients. "I made a mistake."
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