PG&E Says Federal Judge's Safety Plan Is Not Feasible And Too Expensive

With a downed power utility pole in the foreground, residents of Paradise, Calif., examine a burned-out vehicle destroyed by last year’s wildfire.
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Noah Berger/AP
Attorneys for utility giant Pacific Gas and Electric say a federal court proposal to require the company to enact a major fire-prevention program could cost as much as $150 billion dollars and the removal of 100 million trees from Northern California.
Two weeks ago, Judge William Alsup proposed ordering the utility to inspect its entire electric grid — almost 100,000 miles of power lines — to determine the safety of that system and “remove or trim all trees that could fall onto its power lines” to minimize the risk that a dangerous wildfire would be ignited.
In a court filing Wednesday, the attorneys said the company “agrees with the Court that the status quo is unacceptable” and that it is “committed to working aggressively and expeditiously with state and federal officials on system maintenance and upgrades and on wildfire mitigation efforts.”
“But the path forward to mitigating wildfire risk is best designed not through probation conditions, but rather through careful coordination with state and federal regulators, after appropriate consultation with other interested parties, based on the best science and engineering advice, with policy analysis that accounts for the full range of important but often conflicting social goals,” the attorneys argued.
Alsup’s proposed order also would impinge on the authority of the California Public Utilities Commission and the Federal Energy Regulatory Commission which oversee high-power transmission lines, according to the filing.
Instead the attorneys say the company is already working on wildfire safety and “does not object to” working with a court-appointed monitor to review and monitor its progress.
In a separate filing, the U.S. Attorney’s office in San Francisco also expressed doubts about the judge’s proposal.
The judge issued his proposed order as part of his supervision of the company’s probation related to its conviction for violating pipeline safety laws that led to the deadly gas explosion in San Bruno, Calif., in 2010.
PG&E announced last week that it intends to file for bankruptcy protection after determining that it is potentially liable for as much as $30 billion related to the California wildfires of 2017 and 2018.
The judge has scheduled a hearing on his proposals set for Jan. 30.
California Doctors Alarmed As State Links Their Opioid Prescriptions to Deaths

When a former patient died from a lethal combination of methadone and Benadryl, Dr. Ako Jacintho got a letter from the state medical board.
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About a year ago, Dr. Ako Jacintho of San Francisco returned home from traveling to find a letter from the state medical board waiting for him.
The letter explained that a patient he had treated died in 2012 from taking a toxic cocktail of methadone and Benadryl — and Jacintho was the doctor who wrote the patient’s last prescription for methadone. He had two weeks to respond with a written summary of the care he had provided, and a certified copy of the patient’s medical record. He faced fines of $1,000 per day if he didn’t comply.
“I was horrified,” Jacintho says. He hadn’t known that the patient had died. “I became overwrought with sadness. And I was really just surprised that this had happened to this patient.”
The letter was one of more than 500 sent to doctors in recent years throughout the state, all part of the California medical board’s Death Certificate Project. The board typically investigates doctors in response to patient complaints, but with this project, it proactively collected almost 3,000 death certificates of people who died of opioid overdoses, then cross-referenced those with the state’s drug prescription database.
Investigators are going back three years to identify any doctors who may have prescribed the drugs inappropriately, even if it was not the fatal dose, and send them letters. Doctors who are found to have violated state law face public reprimands, probation, or even revocation of their medical licenses.
When Jacintho received his letter, his first reaction was grief. But then he grew afraid, then indignant. The letter seemed to presume he did something wrong — it used words like “complaint” and “allegation.” But when Jacintho reviewed the patient’s medical charts, he was convinced he didn’t.
Dr. Ako Jacintho was horrified to learn that a patient of his had died of an overdose and was surprised when the state started investigating him.
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“This person had intractable pain,” Jacintho says, and at the time, methadone was a preferred treatment. Methadone is long-acting, and was considered to have less potential for addiction than other opioids. In particular, Jacintho says he takes issue with the board’s choice of words in the letter: “over-prescribing,” and “toxic levels.”
“Toxicity is a very subjective word,” he says. “What’s a toxic level for someone may not be a toxic level for someone else.”
It wasn’t until 2016 that the CDC issued guidelines for prescribing opioids, telling doctors to start with low dosages and increase slowly. And when possible, use ibuprofen instead.
But, back in 2012, doctors like Jacintho were being admonished to never leave a patient in pain. The California medical board’s own guidelines from 2013 advised doctors that for certain types of pain, opioids were the cornerstone of treatment and should be pursued vigorously.
“It actually says that no physician will receive disciplinary action for prescribing opioids to patients with intractable pain,” Jacintho says.
But now the medical board is using death certificates from 2012 and 2013 to discipline doctors.
The timing of the investigation really bothers Jacintho, because in the six years since his patient died, he’s totally revamped his practice. As a family doctor, he saw the opioid crisis coming. He had patients asking for more, stronger drugs, even though their pain stayed the same. So he switched gears, went back into training and got certified as an addiction specialist.
“If they’re looking for clinicians who are overprescribing, I’m the wrong doctor,” he says.
The executive director of the medical board, Kim Kirchmeyer says medical investigators take career changes like this into account, and they review medical records according to the standard of care that was in place at the time.
“We understand that just because a patient has overdosed that that doesn’t mean that the care and treatment provided was not appropriate,” she says. But anytime there may have been a violation of the law, she adds, “we do need to look into it.”
The board is only punishing doctors who actually broke the law, she says — those with a clear and repeated pattern of inappropriate prescribing.
“Individuals were prescribing drugs without even performing a history and physical exam,” she says. These doctors never did any kind of testing, they didn’t provide informed consent. “They don’t have a treatment plan or objectives. They just continue to prescribe and prescribe.”
Investigators have so far completed investigations for about half of the 500 doctors originally identified as possibly deviating from the standard of care. The majority were cleared of any wrongdoing, and the board filed formal accusations against 25 doctors.
But there are hundreds of doctors who are still waiting, more than a year later, to learn their fate.
Ultimately, the medical board is a consumer protection agency, Kirchmeyer says, and this is about patient safety, not doctors’ comfort. “If we save one life through this project, that is meeting the mission of the board, and that makes this project so worth it,” she says.
But it’s unclear if the overall effect of the project will be good for patients. Some doctors, including Jacintho, have been so frightened by the letters that they’ve lowered their patients’ opioid doses or cut them off completely. Some doctors are telling their chronic pain patients to find another doctor, according to the California Medical Association. This carries a whole new set of risks.
“It’s like leaving a pair of scissors in an abdomen after surgery,” says Dr. Phillip Coffin, director of substance use research at the San Francisco Department of Public Health. “If you’re just going to discontinue opioids, basically you’re ripping out the scissors and telling the person: ‘Good luck.’ Let them deal with the intestinal perforation on their own.”
The CDC’s 2016 guidelines on how to prescribe opioids are for patients who have never taken them before. But they include virtually no guidance on how to taper down doses for chronic pain patients who have already been taking high doses of opioids for many years.
Preliminary research from the San Francisco Department of Public Health suggests some patients who are weaned off long-term prescription opioids are twice as likely to turn to street drugs. That increases risk of overdose.
“Scaring providers into not prescribing opioids, I think that is not the ethically appropriate way to go forward,” Coffin says of the California Death Certificate Project.
Doctors in North Carolina reacted similarly — refusing to treat chronic pain patients — when the medical board there began proactively investigating doctors who had prescribed high levels of opioids, or who had two patients die of an overdose in the previous year.
A federal prosecutor in Massachusetts also sent letters to doctors who had prescribed opioids within 60 days of a patient’s death. While those letters were intended to be a “warning,” rather than notice of an investigation, they also sparked fear among doctors.
It was never the California medical board’s intention for doctors to simply stop prescribing opioids, Kirchmeyer explains, and it doesn’t want that outcome. She says board members have already learned some lessons on how to improve their approach: They’ve rewritten the letters so they’re less accusatory. And, they know they have to move faster with the investigations.
But the board is committed to the project. Kirchmeyer says after the board finishes examining the 2013 death certificates, it will start working on 2014.
Raging NFL Controversy Over A Blown Referee Call Turns Political
Louisiana’s governor sent the NFL Commissioner a letter complaining about a missed penalty that New Orleans Saints fans say cost their team a chance to play in the Super Bowl.
DAVID GREENE, HOST:
There has been a controversy raging in the NFL since Sunday that has now turned political. Louisiana’s governor, John Bel Edwards, has sent a letter to NFL Commissioner Roger Goodell complaining about a missed penalty that New Orleans Saints fans say cost their team a chance to play in the Super Bowl. This letter follows lawsuits, a petition and just general rage about this now infamous no call by referees in the NFC championship game. And let’s talk about this with NPR sports correspondent Tom Goldman. Hi, Tom.
TOM GOLDMAN, BYLINE: Hi there, David.
GREENE: OK. So for people who were not watching that game, remind us what happened and what is causing all this.
GOLDMAN: Only one of the most obvious cases of pass interference you’ll ever see, and it wasn’t penalized. It happened late in the game between the Saints and the LA Rams. A Rams defender blasted a New Orleans receiver before a pass reached the receiver, and there was no flag. And after the game, the Rams defender acknowledged he interfered. The NFL head of officials admitted they blew the call, which, under NFL rules, wasn’t reviewable, so they couldn’t check replays and see what everyone else in the world saw.
Now, as a result, the Saints lost a chance to run down the clock and kick a short field goal for the win in the final seconds. Instead, they were forced to kick a tiebreaking field goal with over a minute and a half left. That gave the Rams lots of time to get the ball back, drive down the field, kick the tying field goal, which they did, and then they won in overtime.
GREENE: So Saints fans are going to want you to answer yes to this question, but I’m going to ask it. Would they have definitely won the game if this penalty had been called?
GOLDMAN: (Laughter) Highly likely, Saints fans, but not certain, David Greene. This is just between you and me. Even if the Saints had run down the game clock and attempted that very short field goal for the win, the kicker could have missed or it might have been blocked. Even with the botched call, the Saints could have won. Yes, the Rams got the ball with lots of time after the Saints went ahead, but, hey, what about that great Saints defense? They could have stopped the Rams from driving down the field, kicking the tying field goal. And then in overtime, the Saints had the ball first and had a chance to win.
So now that all Saints fans hate me, I will say, yes, the odds were pretty good that had the penalty been called, the Saints would be playing New England in the Super Bowl February 3.
GREENE: All right. Well, sports fans like me, we just suffer and deal with a bad call. It sounds like in Louisiana I guess you could do lots of things like file lawsuits and get your governor involved. So what – tell us – tell me more about the response here.
GOLDMAN: The governor sent that letter to Commissioner Goodell to make rule changes that allow for expanding use of replay. Otherwise, he said, the integrity of the game will be called into question. Edwards also said Louisiana football fans will move on but will not forget. There are these lawsuits by fans. One of them alleges damages of mental anguish and loss of enjoyment of life. I know you’ve felt that as a Pittsburgh Steelers fan.
GREENE: Thanks.
GOLDMAN: (Laughter) Saints fan Matt Bowers has rented billboards in Atlanta, the host city for the Super Bowl, with messages like Saints got robbed. And there’s an online petition asking for a rematch this Sunday. As of early this morning, David, the petition had over 680,000 signatures.
GREENE: OK. There’s not going to be a rematch. I’m going to predict that right now. But what is the NFL going to do here going forward?
GOLDMAN: What should happen and probably will is replay needs to be expanded. That play should have been reviewed and the call corrected. The league has said subjective penalties like pass interference cannot be reviewed. The NFL, you know, worries that too much replay will slow down games. But if you watch the other conference championship game between New England and Kansas City, which I’m sure you did, there were a bunch of replays during a thrilling fourth quarter, and it didn’t take away the excitement at all.
GREENE: NPR sports correspondent Tom Goldman. Thank you, Tom.
GOLDMAN: A pleasure, David.
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