- Sacramento Watch 1
- Sacramento Watch: Dems Plan To Test New Gubernatorial Waters By Resurrecting Bills Vetoed By Outgoing Governor
- National Roundup 2
- Health Spending Growth Slows For Second Year In A Row
- EPA Circulating Proposal To Limit Obama-Era Rule On Water Pollution
- Pharmaceuticals 2
- Drugmaker Actelion Agrees To Pay $360M To Settle Kickback Investigation
- Small Drug Companies Closely Watching Supreme Court Case On Patents
- Around California 1
- Around California: Annual Ceremony Honors Los Angeles' Forgotten People - The Unclaimed Dead
Latest From California Healthline:
KFF Health News Original Stories
No Cash, No Heart. Transplant Centers Require Proof Of Payment.
The case of a Michigan woman who was told to fundraise $10,000 for a heart transplant sparked viral outrage, but experts say such “wallet biopsies” are common. A California mother has raised nearly $24,000 in a GoFundMe campaign to pay for costs related to her adult daughter's second kidney transplant. (JoNel Aleccia, 12/7)
More News From Across The State
Sponsors of the legislative initiatives, which run the gamut of exempting the cost of diapers from taxation to providing health care for undocumented immigrants, hope the newly elected Gavin Newsom will by more supportive. In addition, an aide to Sen. Kamala Harris of California resigned after the state settled a sexual harassment claim against him. The alleged issue took place while Harris was in charge of the California Department of Justice.
The Desert Sun:
California Democrats Introduce Costly, Progressive Bills Post-Midterms
From exempting diapers from taxation to providing undocumented immigrants healthcare, Democratic lawmakers want to give bills previously vetoed by Gov. Jerry Brown another try, hoping they’ll find a more sympathetic audience in incoming Governor Gavin Newsom. In total, legislators proposed more than $40 billion in new spending, which includes increasing the state’s K-12 education budget by $35 billion. Assemblymember Eduardo Garcia, D-Coachella, said the new policies Democratic legislators have introduced—including expanding access to early childhood education, healthcare and housing—could all have a profound effect on the Coachella Valley. (Metz, 12/6)
San Francisco Chronicle:
Kamala Harris Aide Resigns After Sexual Harassment Settlement Surfaces
A senior aide to Sen. Kamala Harris of California has resigned after it was reported that the state paid $400,000 to settle a sexual harassment lawsuit filed against him for his alleged conduct at the California Department of Justice while Harris ran the agency. Harris denied knowing about the alleged harassment or settlement until this week. (Kopan, 12/6)
Covered California & The Health Law
Health Law Sign-Ups Down 11% From Same Period Last Year
In the first five weeks of the enrollment period, 3.2 million Americans signed up for health insurance coverage through healthcare.gov. In the same period last year, 3.6 million enrolled. Enrollment on the federal exchanges close Dec. 15, while Covered California's sign-up period runs through Jan. 15, 2019.
The New York Times:
Why Is Obamacare Enrollment Down?
More than halfway through the sign-up period for Obamacare health plans, fewer people have enrolled in coverage than during the same stretch last year. Enrollment through the federal website Healthcare.gov, which manages insurance marketplaces in 39 states, is down 11 percent compared to 2017, according to government figures released Thursday. Given President Trump’s assault on the law, many people are watching this year’s enrollment closely for clues to its durability. While it is too soon to draw any firm conclusions, there are several reasons sign-ups could be lower — and not all of them spell trouble for the landmark legislation. (Abelson and Sanger-Katz, 12/6)
The Associated Press:
Obama Health Law Sign-Ups Lagging For 2019
With open enrollment ending next week, the government says sign-ups for coverage under former President Barack Obama’s health care law are lagging when compared with last year. Figures released Thursday by the Centers for Medicare and Medicaid Services show that about 3.2 million people have signed up so far for subsidized private insurance, compared with about 3.6 million at the same time last year. Open enrollment ends Dec. 15. Health law supporters are concerned. The number of new customers is down nearly 18 percent. (12/6)
KPBS:
'Big Risk' Dropping Health Coverage After Obamacare Penalty Removal, Official Warns
As the deadline looms for Covered California, the state health insurance exchange, nearly 90,000 new consumers have purchased a health plan since open enrollment began in October, and more than 1 million people have renewed their coverage. But tens of thousands of people are expected to forgo health insurance in 2019. (Murphy, 12/6)
Health Spending Growth Slows For Second Year In A Row
Although the nation spent $3.5 trillion on health last year, federal economists found that the increase in health expenses did not exceed the growth in the overall economy.
The New York Times:
Growth Of Health Care Spending Slowed Last Year
But the rate of increase for the major categories — drugs, doctors and hospitals — was more modest than in recent years. For the first time in several years, health spending grew at about the same rate as the economy as a whole in 2017. So the share of the economy devoted to health care stabilized. By contrast, over the past few decades, health spending has generally grown faster than the economy. (Pear, 12/6)
California Healthline:
Podcast: ‘What The Health?’ Is Health Spending The Next Big Political Issue?
The Republican-led Congress was unable to repeal the Affordable Care Act in 2017, but the Trump administration continues to implement elements of the failed GOP bill using executive authority. The latest change would make it easier for states to waive some major parts of the health law, including allowing subsidies for people to buy insurance plans that don’t meet all the law’s requirements. (12/6)
The Fiscal Times:
Fixing U.S. Health Care: Can States Step Up Where Washington Has Failed?
The midterm elections may have focused extensively on health care, but the results have done little to clarify where health care reform is headed. “The future of U.S. health care reform is muddier now than at any point in the past two decades,” write researchers from the Boston University School of Public Health, University College London and the Milbank Memorial Fund in this week’s New England Journal of Medicine. (Rosenberg, 12/6)
EPA Circulating Proposal To Limit Obama-Era Rule On Water Pollution
The Obama administration's regulation was a target for rural landowners since it could have restricted how much pollution from chemical fertilizers and pesticides could seep into water. In other national news, the surgeon general acknowledges the need for changes in the classification of drugs, the Trump administration requests more funding for immigrant detention efforts and Maine's outgoing governor loses another skirmish in his efforts to stop Medicaid expansion.
The New York Times:
Trump Rule Would Limit E.P.A.’s Control Over Water Pollution
The Trump administration is expected to put forth a proposal on Tuesday that would significantly weaken a major Obama-era regulation on clean water, according to a talking points memo from the Environmental Protection Agency that was distributed to White House allies this week. The Obama rule was designed to limit pollution in about 60 percent of the nation’s bodies of water, protecting sources of drinking water for about a third of the United States. It extended existing federal authority to limit pollution in large bodies of water, like the Chesapeake Bay and Puget Sound, to smaller bodies that drain into them, such as tributaries, streams and wetlands. (Davenport, 12/6)
The Hill:
White House Requests Additional $190M For Housing Detained Migrant Children, Dem Lawmaker Says
The Trump administration has asked for an additional $190 million to operate immigrant detention facilities, according to a top House Democratic appropriator. “The White House has had the audacity to ask Congress for more money, even though we are done” with appropriations for the year, Rep. Rosa DeLauro (D-Conn.) told reporters on a conference call Thursday. “Over my dead body will we provide another nickel for these folks to do what they’re doing." DeLauro is set to become head of the House Appropriations subcommittee with jurisdiction over the Department of Health and Human Services (HHS), starting in January. (Weixel, 12/6)
The Hill:
Maine Judge Denies GOP Governor's Request To Stay Medicaid Expansion Order
The court on Thursday delayed a previous deadline it had set for enrollments in Medicaid expansion to begin from Dec. 5 to Feb. 1, meaning the new administration will be in place when enrollments start. “This is good news in that the court is denying the request for a stay, at the same time the court is extending the deadline for rulemaking and enrollment to February 1st,” said Robyn Merrill, executive director of Maine Equal Justice Partners, the advocacy group suing in favor of implementing Medicaid expansion. (Sullivan, 12/6)
Drugmaker Actelion Agrees To Pay $360M To Settle Kickback Investigation
The Justice Department alleged that Actelion Pharmaceuticals violated federal law by using a foundation fund to funnel kickback payments aimed at inducing patients to buy its drugs. Actelion was bought by Johnson & Johnson in 2017, after the alleged actions took place, and admits no wrongdoing as part of the settlement. And in other pharma news: Walgreens' new delivery service; an EpiPen alternative; and the FDA approves a new lung cancer treatment.
The Associated Press:
Drug Company Actelion To Pay $360M In Kickback Probe
Federal prosecutors say South San Francisco-based Actelion illegally used a purportedly independent charity to cover the co-payments of thousands of Medicare patients taking its pulmonary arterial high blood pressure drugs. Prosecutors say that helped the company convince patients to buy its drugs when the prices it set would have otherwise prevented them from doing so. (12/6)
USA Today:
Walgreens Launching Next-Day Prescription Delivery Service With FedEx
Walgreens is launching a next-day prescription delivery service as pharmacies brace for the possibility of Amazon's entry into their world. The drugstore chain announced Thursday that it is partnering with FedEx to offer drug delivery throughout the nation in a new program called Walgreens Express. The company's move comes after archrival CVS Health recently a very similar delivery service. (Bomey, 12/6)
The Associated Press:
Generic Drugmaker To Sell Alternative To EpiPen Injectors
Generic drugmaker Sandoz announced plans Thursday to start selling an alternative to the EpiPen in the U.S. early next year. The EpiPen injector is used to halt life-threatening allergic reactions to insect bites, nuts and other foods. Brand-name EpiPen, which dominates the market, has been in short supply since spring because of production problems. (Johnson, 12/6)
Reuters:
Roche's Lung Cancer Combo Treatment Wins FDA Approval
Swiss drugmaker Roche Holding AG said on Thursday that its Tecentriq immunotherapy in combination with Avastin and chemotherapy won U.S. Food and Drug Administration approval as a first-line treatment for a type of lung cancer. ... The drug on Wednesday had also won priority review from the U.S. regulator for treating patients with untreated extensive-stage small cell lung cancer. (12/6)
Small Drug Companies Closely Watching Supreme Court Case On Patents
A Swiss drugmaker is challenging a 2011 change to the law that no longer allows a company to patent an invention if it was for sale for more than a year before filing a patent application. Meanwhile, Congress also plans to focus on the issue of pharmaceutical patents and lawmakers continue to question the industry's pricing decisions. And as Capitol Hill gears up for potential action on drug costs, there may be some lessons to be learned from China.
Stat:
Supreme Court To Decide Patent Case With Implications For Small Drug Makers
In a few months, the U.S. Supreme Court will decide a closely watched case that could lead to patents being canceled more easily and, therefore, chill deals that small drug makers may pursue in hopes of finding larger partners to get their medicines to market. The case turns on disputed language in U.S. patent law, which was overhauled in 2011, that prohibits a company from patenting an invention if it was for sale for more than a year before filing a patent application. The court, which heard oral arguments on Tuesday, must decide whether Congress intended the law to apply only to agreements that are publicly known or also encompasses confidential transactions out of the public eye. (Silverman, 12/6)
Stat:
Democrats Are Eyeing A Valuable Pharma Asset: Its Patents
Democrats, newly empowered in D.C. and on the hunt for bigger and bolder ways to lower drug prices, are suddenly taking aim at a far more central part of pharma’s monopoly power: the patents the industry holds on its drugs. For years, lawmakers from both parties have shied away to address the industry’s intellectual property. Muck with a drug company’s government-granted monopoly, the thinking goes, and investments in research and development will disappear. Pharma even helped to scuttle a broad, bipartisan patent reform effort in 2015, in part because the industry worried that even small changes focused on bad actors would open the door to bigger ones. (Facher, 12/7)
The Wall Street Journal:
Congress To Drug Makers: Why Stock Buybacks Over Lowered Drug Prices?
Critics of high drug prices are launching a new line of attack against manufacturers of the medicines, faulting the firms for using savings from the tax overhaul to buy back shares rather than lower prices. The attacks began in October, when more than a dozen Democrats in the House of Representatives sent letters to five big pharmaceutical companies saying they had benefited from recent tax cuts but kept charging high prices. The letters singled out certain drugs whose list prices had increased and asked their manufacturers for details about price changes and the costs of research and advertising. (Loftus, 12/6)
The Wall Street Journal:
Solving China’s Drugs-Price Problem Is Hurting Drugmakers
China’s cure for its health-care problems is causing plenty of pain for drugmakers. Just as in the U.S., expensive prescription drugs have long been a headache in China. Government insurance usually doesn’t cover the full price of drugs for patients, so many have to pay a hefty portion out of their own pockets, especially those with serious diseases. In its latest bid to lower medicine costs, the Chinese government recently asked drugmakers to bid for the right to supply hospitals in 11 major cities, including Shanghai and Beijing. The winners will be those willing to accept the lowest prices. Hospitals are the biggest buyers of drugs in China, accounting for 68% of the $200 billion market, according to health-data company Iqvia. (Wong, 12/7)
Around California: Annual Ceremony Honors Los Angeles' Forgotten People - The Unclaimed Dead
In other news around the state, San Diego's Alzheimer's Response Team increasingly responds to calls about people with dementia and, in the Bay Area, it's the season to beware of toxic mushrooms.
The New York Times:
‘A Witness That They Were Here’: Los Angeles Honors 1,457 Of Its Unclaimed Dead
They are the forgotten people of Los Angeles — 1,457 people, to be exact. Old, poor, homeless, babies born premature and abandoned. They may have died alone, but they were buried together, in a mass grave, and were honored together this week in an interfaith ceremony that has been an annual ritual in Los Angeles for more than a century. (Arango, 12/7)
KPBS:
New Alzheimer's Response Team Helps San Diego Seniors In Crisis
Emergency officials and law enforcement officers are increasingly responding to calls about people with dementia in crisis. The degenerative brain disease can cause disruptive or sometimes violent behaviors. (Murphy, 12/6)
San Francisco Chronicle:
'Tis The Season: 2 Of The World's Most Toxic Mushrooms Sprouting In East Bay
A string of winter storms means it's mushroom season in the Bay Area, and the East Bay Regional Parks District has issued its annual warning to beware of deadly fungi. Death Caps and Western Destroying Angels are two of the world's most toxic mushrooms — they can be lethal to humans and pets if consumed — and they are currently found in moist soil around the Bay Area. (Robertson, 12/6)
For Some Patients, Cancer Fight Turns To DNA
The therapies include risks and work for only a minority of patients. But those successes continue to drive the research forward.
Reuters:
Special Report: After A Child's Dire Diagnosis, Hope And Uncertainty At The Frontiers Of Medicine
Natan was days away from a delicate surgery to remove part of the tumor that doctors had eventually found growing, weed-like, from his spinal cord. ... But even if successful, the surgery would be only a stop-gap measure, a starting point in a process that would propel our family to the forward edges of medical science. There, the genomics revolution, as it’s known, has made it possible to understand and confront what drives some cancers and other diseases. With tissue taken from the tumor, doctors told us, they would determine whether it was caused by a rare genetic mutation, which could radically change the course of his treatment. ... there was a slim chance Natan could beat back the tumor by merely swallowing a pill twice a day, with few, if any, side effects. (Gershberg, 12/6)
Reuters:
Special Report: Learning About Targeted-Therapy Options
When we were told our son had a potentially life-threatening brain tumor, our family was lucky to have world-class doctors and hospitals close to home and health insurance that covered nearly all his medical expenses and prescription drug costs. These resources helped us make a difficult decision regarding treatment, a scenario many more families may face as modern medicine evolves. Here are some questions they may want to consider, based on our experience and interviews with cancer experts. (Gershberg, 12/6)
The Associated Press:
Nobel Laureates: Despite Progress, Cancer Won't Be Wiped Out
The winners of this year’s Nobel Prize for Medicine say they expect substantial advances toward treating cancer in the next several decades, although it is unlikely the disease could be eradicated. “Soon we’ll get close with some cancers,” [James] Allison said, citing progress against some forms including melanoma. But, he said, “the world will never be cancer-free.” (Bzganovic, 12/6)
People Still Getting Sick By E. Coli-Tainted Romaine Lettuce
Nine more recent cases have been reported, according to the Centers for Disease Control and Prevention. Also in public health news today: school lunch nutrition, a cookbook-related study retracted, autism, and suicide.
USA Today:
Romaine Lettuce E. Coli Outbreak: Nine More Sickened, CDC Says
Nine more people have become sick after eating romaine lettuce amid an E. coli outbreak, according to the Centers for Disease Control and Prevention. The total of people infected is now 52 across 15 states, the CDC said Thursday. The highest number of cases have been reported in California and New Jersey, each reporting 11 people sick. Seven people in Michigan, and six each in New Hampshire and New York were reported. Other states affected include: Connecticut, Florida, Illinois, Louisiana, Massachusetts, Maryland, Ohio, Pennsylvania, Rhode Island and Wisconsin. (May, 12/7)
The Associated Press:
School Lunch Rules OK Refined Grains, Low-Fat Chocolate Milk
The U.S. school lunch program is making room on menus again for noodles, biscuits, tortillas and other foods made mostly of refined grains. The Trump administration is scaling back contested school lunch standards implemented under the Obama administration including one that required only whole grains be served. The U.S. Department of Agriculture said Thursday only half the grains served will need to be whole grains, a change it said will do away with the current bureaucracy of requiring schools to obtain special waivers to serve select refined grains foods. (Choi, 12/6)
The Associated Press:
Study That Took Aim At 'Joy Of Cooking' Is Retracted
More work by a prominent food researcher, including a study that took aim at the “Joy of Cooking,” has been retracted because of problems with the data. The Annals of Internal Medicine retracted a study that said the book’s recipes changed with updated editions to include more calories and bigger portions. It said a reanalysis by co-author Brian Wansink resulted in numbers that differed — “many substantially so” — from the published versions. ... The retraction is the latest for Wansink, who resigned from Cornell University in September after a school investigation found he engaged in academic misconduct, including misreporting of data. (12/6)
Bloomberg:
One In 40 U.S. Children On Autism Spectrum: Demographic Trends
An estimated one in 40 American children have been diagnosed with autism spectrum disorder, according a study published in this month’s edition of the journal Pediatrics. ...The prevalence of autism spectrum disorder has increased over the past 30 to 40 years, most likely a result of “broadening diagnostic criteria, increased provider ascertainment at earlier ages, increased parent awareness, and an increase in some risk factors such as births to older parents,” the study said. (Tanzi, 12/6)
USA Today:
Suicide Survivor Answers Questions On How She Prevents Another Attempt
The Centers for Disease Control and Prevention released new numbers last week showing that the nation's suicide rate is up 33% in less than 20 years. Suicide is a growing problem, yet stigma often prevents people from talking openly about it. Shelby Rowe attempted to take her own life almost 10 years ago, but she survived. She is one one of millions of Americans who survive suicide attempts and go on to live full, healthy lives. USA TODAY enterprise reporter Alia Dastagir interviewed Rowe, a leader in the field of suicide prevention, for USA TODAY's Surviving Suicide project. Rowe and Dastagir answered questions about suicide during a Reddit AMA Monday. (Dastagir, 12/6)
Child-Friendly Prison Visits Help Moms Stay Connected, Reduce Trauma Of Separation
States are experimenting with programs that allow low-risk, incarcerated mothers to spend quality time with their children. Women are the fastest-growing prison population, in large part due to the national opioid crisis. In other drug news, supervised injection sites are debated in cities.
The New York Times:
Getting Past The Barriers: When A Mother Is In Prison
Currently, over 200,000 women are imprisoned in the United States, the majority for nonviolent drug or property offenses, which have recently skyrocketed in connection with the opioid crisis. The number of children in foster care or living with relatives has soared as well. According to the Vera Institute of Justice, a nonprofit research organization, women are the country’s fastest-growing prison population, and 80 percent of them are mothers. The overwhelming majority were the primary caregivers of their children. (Valencia, 12/6)
NPR:
Programs Help Incarcerated Moms Bond With Their Babies In Prison
Sonya Alley is the Correctional Unit Supervisor overseeing the Residential Parenting Program at WCCW. She says the program gives women a tangible way to turn their lives around. "It gets them out of their addictive past and co-dependency on drugs, or alcohol or relationships," she says. "It seems oxymoronic but there's some clarity when forced to do a prison sentence and forced to be a parent. It starts to shift the way the women think about themselves, their environments and wanting the best for themselves and their child." (Corley, 12/6)
CQ:
Supervised Injection Site Implementation Faces Uphill Climb
A growing number of cities are seeking to fight the opioid epidemic by providing people with an addiction a place to inject drugs with sterile needles, despite questions about the practice’s legality under federal law. The trend suggests a showdown with the Justice Department may come if one of these cities is able to pass legislation and find funding to open a supervised injection site, which could happen as soon as next year. (Raman, 12/7)
Viewpoints: Drug Legalization, How To Solve Homelessness, And Drug-Pricing Optics
A selection of opinions on health care developments from around the state.
Fresno Bee:
To Limit Drug Use, Make Them Legal
Several countries are solving their opioid overdose problem by dispensing heroin in treating the addicted. These include Switzerland, Holland, Denmark, Germany, England, Spain and Canada. Better formulations of the drug are longer lasting and help to stabilize patients by freeing them from craving and withdrawal so they can hold a job and live healthier lives. (David Finch, 12/6)
Orange County Register:
Closure Of Needle Exchange Has Left A Void In Orange County Harm Reduction Efforts
Since the closure of the Orange County Needle Exchange Program (OCNEP) in January 2018, and a recent court ruling that bars OCNEP from operating for an unknown period of time, the entire weight of harm reduction in Orange County has fallen on a tiny non-profit, devoid of county or state funding, and operated by a handful of volunteers. With no centralized location for providing harm reduction services, focus is placed on trying to reach the most vulnerable community members struggling with substance use disorders, mental health conditions, and homelessness via backpack outreach. (Aimee Dunkle and Elizabeth Copulsky, 12/6)
Los Angeles Times:
L.A.'s Efforts To Solve Homelessness Are Paying Off, One Life At A Time
A few days before Thanksgiving, I hosted a pre-holiday feast at Getty House for a group of men and women who live at El Puente, the city’s first temporary bridge housing site, built on a corner of the El Pueblo historic district downtown. It was a privilege to meet these men and women and to hear them describe their sense of renewed promise. They were thankful because, for the first time in months or even years, they have a place to sleep at night, a place to call home. Nearly every community in Los Angeles has been touched by the profound moral and humanitarian crisis of homelessness. The individuals and families living in tents, cars and on our streets aren’t faceless strangers. They’re our neighbors, and they’re in need of housing, healthcare and, most of all, hope. (Eric Garcetti, 12/2)
San Francisco Chronicle:
Housing Needed To Reduce HIV Infections
Improving housing brings not only public health benefits, but also financial gains for society. The provision of housing reduces public spending on medical costs for homeless individuals, including the number and length of hospitalizations. In fact, San Francisco spends five times as much on medical costs for the sickest homeless people as for those in housing. (Diane Havlir and Joe Hollendoner, 11/29)
Sacramento Bee:
Skipping Background Checks For The People Hired To Care For Detained Migrant Kids? What Could Go Wrong?
The inspector general recommended that the government staff Tornillo as it would a permanent facility. It pointed out that a similar "flux" facility in Homestead, Fla., must adhere to the smaller ratio.Part of the problem is the government's decision to treat Tornillo, a pop-up tent village that opened in June, as a temporary way station for children. But that doesn't absolve the government of ensuring that it is not placing the minors at risk. Unfortunately, the government's failure to properly handle the migrants it insists on detaining is becoming a norm rather than an exception. And that is unacceptable. (Scott Martelle, 11/29)
Los Angeles Times:
In UC's Battle With The World's Largest Scientific Publisher, The Future Of Information Is At Stake
Boiled down to dollars and cents, the battle between the University of California, the nation’s premier producer of academic research, and Reed Elsevier, the world’s leading publisher of academic journals, can seem almost trivial. UC is paying almost $11 million this year for subscriptions to some 1,500 Elsevier journals. That’s not much when measured against the university’s core budget of $9.3 billion. But in fact it’s a very big deal — big enough for the university to consider dropping the subscriptions entirely when its current five-year contract with Elsevier expires on Dec. 31. Scores of town hall meetings for UC faculty to discuss the ongoing negotiations between UC and Elsevier have been scheduled across the system as the deadline approaches. What faculty are likely to hear, in the words of Jeff MacKie-Mason, the university librarian at UC Berkeley, is that “we’re pretty far apart at this point.” (Michael Hiltzik, 12/7)
Los Angeles Times:
The NFL Is The Fox In The Henhouse Of Football-Injury Research
Last month, the NFL announced that it is awarding more than $35 million in grants to fund research on brain injuries. The recipients of the league’s largesse include researchers at prestigious academic institutions such as Boston Children’s Hospital, Harvard Medical School, the University of Pittsburgh and UC San Francisco. Peter Chiarelli, who chaired the scientific advisory board to allocate the NFL’s funds, said the league did not influence the panel in any way: “We were totally independent.” We’ve seen this story line before. (Kathleen Bachynski, 12/3)