Federal appeals court upholds California’s gun show ban on state property

• June 12, 2024

California’s ban on gun shows on state property is constitutional, a federal appeals court said on Tuesday, June 11.

In Orange County, gun shows — including the Crossroads of the West Gun Show that had been held at the  OC Fair & Event Center since 1996 — were banned in 2022 under a state law authored by Sen. Dave Min, D-Irvine. The ban was later expanded to include all state properties, including state-owned fairgrounds.

In October, however, a federal judge blocked those bans, saying California was violating the rights of gun sellers and possible buyers by prohibiting purchases at the fairgrounds of weapons that could be bought legally at standard gun shops. That made it possible for the Crossroads of the West gun show to return to the  OC Fair & Event Center in January after a two-year hiatus.

The federal appeals court’s 3-0 ruling overturns that decision, effectively blocking the gun shows on state-owned fairgrounds, including the OC Fair & Event Center, yet again.

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Crossroads of the West Gun Show returns to Orange County fairgrounds
Ban on gun shows at OC fairgrounds takes effect Jan. 1
Gun shows at OC fairgrounds are likely done unless Newsom vetoes bill

“Today’s a big win for anyone who cares about gun safety,” said Min, who is running for Congress in California’s 47th congressional district. “If you care about gun safety, if you care about preventing gun violence … this is a big win for you.”

The California Rifle and Pistol Association, a pro-gun owners organization that challenged the bans, said it would appeal Tuesday’s decision.

“CRPA will continue to protect the despised gun culture and fight back against an overreaching government that seeks to limit disfavored fundamental rights and discriminate against certain groups of people on state property,” the association said in a statement. “CRPA looks forward to seeing this misguided decision reversed in short order.”

B&L Productions, the group that operates Crossroads of the West gun shows, had also challenged the ban on gun sales on state property, alleging a violation of gun buyers’ constitutional rights, including freedom of speech and the right to keep and bear arms.

Judge Richard Clifton, appointed to the appeals court by former President George W. Bush, wrote in Tuesday’s 25-page decision that gun sales are “nonexpressive conduct” and thus are not protected by the First Amendment.

Min said his legislation prevents gun sellers from selling firearms on state property, not talking about them.

“If Crossroads of the West decided they wanted to do a show about how cool guns are where they spoke about guns, they can do that,” he said. “They just can’t sell them.”

In the ruling, Clifton wrote, A “celebration of America’s ‘gun culture,”’ in the words of one of B&L’s briefs, can still take place on state property, as long as that celebration does not involve contracts for the sale of guns.”

Plus, there are six licensed firearm dealers in the same ZIP code as the fairgrounds, Clifton noted in the ruling, and banning gun sales on state property won’t impair potential buyers from owning firearms.

As it was, a separate state law — not challenged in the ruling — imposes a 10-day waiting period and a background check before a firearms dealer can release the weapon to the buyer, meaning someone who purchased a gun at a show on fairgrounds would not be able to walk away with it that same day, the appeals court noted.

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“Merely eliminating one environment where individuals may purchase guns does not constitute a meaningful constraint on Second Amendment rights when they can acquire the same firearms down the street,” he said.

Tracy Olcott, president of Crossroads of West, said the gun show has always been one of the “biggest financial contributors” to the OC Fair & Event Center. (When reached Tuesday afternoon, Olcott declined to comment on the ruling.)

The total revenue for the Crossroads of the West Gun Show held at the OC Fair & Event Center in January was $226,250, said event center spokesperson Terry Moore, which included parking as well as food and beverage commissions in addition to the rental fee.

The OC Fair & Event Center is waiting to hear from its attorney on the next possible steps, said Moore.

Attorney General Rob Bonta and Gov. Gavin Newsom, both Democrats, applauded Tuesday’s ruling. Bonta, who defended the bans in court, said the ruling is “another victory in the battle against gun violence in our state and country.”

“If other states followed our policies, thousands of lives would be saved — we won’t stop defending our laws from the right’s radical lawsuits,” said Newsom.

Between 2016 and 2021, the Crossroads of the West gun show brought the fairgrounds about $2.6 million in rental revenue, and according to estimates from 2021, gun shows raked in more than $7 million over the last 25 years for the fairgrounds.

​ Orange County Register 

Angels’ Michael Stefanic looks to pick up where he left off last season

• June 12, 2024

PHOENIX — Michael Stefanic finished last season on a high note.

Unfortunately for him and the Angels, a strained quadriceps didn’t allow him to show if he could pick up where last season ended.

“Definitely frustrating,” said Stefanic, who has been back in the majors since Saturday. “I knew right when I pulled my quad that it wasn’t good. I had one before. I knew it’s a long process, not always a linear process. Some days you wake up and you feel really good and can do stuff and other days you wake up sore and can’t do much. Unfortunately I had a couple setbacks, but here we are in June. I’m happy to be back.”

Stefanic was at the top of the lineup on Tuesday, with the Angels facing a left-hander. Against right-handed pitchers, Luis Guillorme is more likely to get the opportunity at second base.

Stefanic, 28, is a feel-good story simply from making the majors. A non-drafted free agent out of Westmont College in Santa Barbara, Stefanic hit .326 in the minors to force his way to the big leagues.

At the end of last season, he hit .400 with a .933 OPS in his final 38 plate appearances, ending his season with a .290 batting average and a .735 OPS in 71 plate appearances.

“I feel like September was something I can really build off,” Stefanic said. “It gave me a lot of confidence going into this year. I’m excited to be at the top of the order and getting a lot of at-bats. I feel good. Ready to go.”

Manager Ron Washington didn’t get to see much of Stefanic before he got hurt in spring training, so he’s looking forward to getting a look at him now.

Defensively, Stefanic is “serviceable,” Washington said.

TROUT UPDATE

Mike Trout, who is five weeks removed from surgery to repair a torn meniscus, is still working out in the gym and running on an Alter G, which is an anti-gravity treadmill.

He has not yet begun to run with his full weight on his leg.

GETTING CLOSER

Infielder Brandon Drury, who had a strained hamstring, was set to open a rehab assignment at Triple-A on Tuesday night. Washington said Drury would likely play in the minors for the rest of this week and then be re-evaluated.

Third baseman Anthony Rendon, who is recovering from a torn hamstring, is continuing to take ground balls and batting practice in Anaheim. He has been doing some light jogging.

Infielder Miguel Sanó, whose rehab from left knee inflammation was interrupted by a burn on his leg, has resumed playing in the Arizona Complex League. Washington said he’ll move to Triple-A “pretty soon.”

Right-hander Chase Silseth gave up six runs in 2-2/3 innings, allowing two homers and walking five, in a rehab start at Triple-A on Tuesday. He threw 71 pitches, just shy of the 75 he was scheduled to throw. Before the game, Washington said if the start in the minors went well, the Angels would have “a decision to make,” on whether to bring him back, Washington said.

Silseth, who is on the injured list because of elbow inflammation, had an elevated heart rate after a bullpen session over the weekend, but a cardiologist checked him out and cleared him to pitch.

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Right-hander Sam Bachman, who had elbow surgery last fall, reported to Double-A and will pitch on Thursday. The Angels want to keep working Bachman as a starter.

HIURA SIGNS

The Angels signed infielder Keston Hiura to a minor-league deal and assigned him to Triple-A.

Hiura, a 27-year-old former top prospect with the Milwaukee Brewers, has a career .238 batting average with a .771 OPS. He last played in the majors in 2022. He spent last season in the Brewers’ farm system, and he began this season in Triple-A with the Detroit Tigers.

Hiura is a product of Valencia High (of Valencia) and UC Irvine.

BROADCASTER DIES

Steve Klauke, the longtime radio broadcaster for the Angels’ Salt Lake affiliate through last season, died on Tuesday morning after he was struck by a car while walking in a crosswalk on Monday night in Sandy, Utah. Police said the driver, who did not see Klauke while making a right turn, was not impaired.

Klauke, who was 69, was the voice of the franchise for 29 years until he retired after the 2023 season.

“Steve Klauke was a dedicated long-time employee and world-class broadcaster,” said Gail Miller, co-founder and owner of the Larry H. Miller Company, which owned the team. “Steve will forever be remembered as ‘the voice of the Bees’ and holds a special place in our hearts. We will always treasure and honor the immeasurable impact he had on the sports community in Utah and beyond.”

UP NEXT

Angels (RHP José Soriano, 3-5, 3.64 ERA) at Diamondbacks (RHP Slide Cecconi, 1-4, 5.66), Wednesday, 6:40 p.m., Bally Sports West, 830 AM

​ Orange County Register 

U.S. Open: Scottie Scheffler brushes off being a ‘target’; Jon Rahm (foot) withdraws

• June 12, 2024

By DOUG FERGUSON AP Golf Writer

PINEHURST, N.C. — Scottie Scheffler took two minutes to celebrate a big win at the Memorial, and then it was on to the next challenge – even though the next one is among the biggest in golf.

He arrived at Pinehurst No. 2 for the U.S. Open wearing a target he has had on since he began his latest tear that left no doubt who’s the best in golf right now. Scheffler has won five of his last eight tournaments – the Masters, The Players Championship and three of the PGA Tour’s “signature” events with the strongest fields.

The gap between Scheffler and everyone else in the world ranking is at a margin not seen since the peak years of Tiger Woods.

“Every week we play, he seems to build a bigger lead, and somehow make the mountain even taller for all of us to climb,” PGA champion Xander Schauffele said Tuesday. “That’s all he’s been doing, and hats off to him for being so consistent and playing at such a high level for such a long time.”

For Scheffler, it all goes back to the hats.

In his eyes, his collection of worn, sweaty, grungy, disgusting hats he keeps in the gym at his home in Dallas is what reminds him of how he got there.

“When I was a kid and I got a cool hat, I would wear it the whole summer and I would sweat through the hat,” Scheffler said. “And they’re just disgusting and gross and I hang ’em in my gym. So when I’m back there working out, I remind myself that just because I got to where I am now, it wasn’t just because it happened.

“I remember all the work that I put in, all the balls that I hit, all the amount of time I spent out there sweating in the sun and putting in the time and the effort in order to become good.”

No, this didn’t happen overnight. It just seems that way.

So many players heaped so much praise on Scheffler and what he has done the last two years and particularly the last two months. It reminded him in a way of being picked for his first Ryder Cup team, and the confidence he was shown before he had won on the PGA Tour.

This is more about awe.

“Undoubtedly the best player in the world at the minute by a long way,” Rory McIlroy said. “It’s up to us to try to get to his level.”

It hasn’t always been this easy for Scheffler, and it still feels like hard work to him. His putting got so far out of whack last year that he brought on English putting coach Phil Kenyon to help work his way out of the problems.

He is coping with being a father – his first child, Bennett, was born just over a month ago. Scheffler is getting wearying talking about his arrest and brief jail time before the second round of the PGA Championship last month (he still shot 66) over charges he wasn’t following police directions. The charges were dropped. He tied for eighth.

And he presses on, driven by the sheer joy of competition, and it must be even more fun when he leaves with the trophy.

But the target on his back is one that he doesn’t see, and he acts like it’s not there.

“When we start the tournament week, we’re all at even par and it’s not like anybody is out there playing defense,” Scheffler said.

He will be in the U.S. Open’s traditional group of the top three players in the world on Thursday, putting him with Schauffele (No. 2) and McIlroy (No. 3).

“They’re not going to be saying weird stuff to me out on the golf course or trying to block my putt from going in the hole,” he said. “We all kind of got to go out there and play our game. As far as a target on my back, even if there was, there’s really not much we can do in the game of golf. Most of it is against the golf course and playing against yourself.”

Pinehurst No. 2 figures to be the real target this week for Scheffler and everyone else. Wyndham Clark, the defending champion, was concerned when he arrived that the domed greens – a Donald Ross signature – already were firm and scary.

The field no longer includes former Masters champion Jon Rahm, the last player to occupy the No. 1 ranking before Scheffler took over. He withdrew on Tuesday.

Rahm developed an infection in the toes of his left foot last week, had to withdraw from a LIV Golf event in Houston and decided it wasn’t worth the risk of affecting his swing or causing another injury by playing.

Before departing, Rahm joined the chorus of players amazed at Scheffler’s level of play.

“Every year or every so many years, there’s been great ball strikers that come up,” Rahm said. “But when you start getting compared to Tiger and things that Tiger has done, that’s when you know you are in a level that is quite special.”

He noted Scheffler winning five times before the U.S. Open, a feat not achieved in 44 years. Rahm also noted where Scheffler has won – Augusta National, TPC Sawgrass, Bay Hill, Muirfield Village, Harbour Town.

“You’re basically a Tiger Woods season,” he said. “It’s fantastic to see.”

Rahm, a past Masters champion, first announced his decision to withdraw in a social media post. He says he consulted “numerous doctors” and his team and felt this was best in the long run for his golf.

“To say I’m disappointed is a massive understatement!” Rahm posted on X. “Hopefully I’ll be back in action as soon as possible.”

Rahm, winless since his 2023 victory in the Masters, had finished in the top 10 at every LIV Golf event until having to withdraw after six holes of the second round last week in Houston because of the pain in his foot.

He arrived at Pinehurst No. 2 wearing a sandal on the foot, hopeful that antibiotics would allow for it to heal in time for Thursday’s opening round. He never saw the golf course, although he played it a few weeks ago in advance of the U.S. Open.

While he did not say what the doctors told him, Rahm could have waited until Thursday afternoon before deciding whether to play. He was to tee off at 1:36 p.m. in the first round.

HOVLAND FEELING MORE CONFIDENT

Viktor Hovland has a renewed confidence entering the U.S. Open that he can compete – and possibly win – his first major championship after a morale-boosting third-place finish at the PGA Championship last month.

He said Tuesday that’s a “night and day” difference from two months ago, when he missed the cut at the Masters after a disastrous second-round 81 at Augusta National.

“I was pretty miserable leaving the Masters,” Hovland said. “I think that’s just one of those things where you kind of have to hit whatever rock bottom … because that’s when you pull yourself out of it and make some decisions to course correct.”

He appears to have put his slump behind him.

After the Masters, the 26-year-old Norwegian shot a final-round 69 at Quail Hollow to finish tied for 24th, then carried that small bit of momentum over to Valhalla, where posted a 66 in each of the final three rounds to finish at 18-under 266, three shots behind winner Xander Schauffele.

He had a chance to pull into a tie for the lead but missed a 10-foot birdie putt on the 71st hole.

Still, he chose to walk away thinking about the positives, especially considering he didn’t feel entering the PGA that his game was good enough to contend. He tied for 15th in the Memorial last week before arriving at Pinehurst No. 2.

“The context of not really wanting to show up at a golf tournament because I just knew it wasn’t good enough, to, wow, I actually just had a chance to win a major championship without my best stuff,” Hovland said. “Yes, you don’t get endless amounts of opportunities to win major championships, so obviously when you’re in the heat of the moment, you want to take advantage of those. But at the end of the day I’m just happy that I’m playing better.”

SUPERSTITIOUS KAYMER

When Martin Kaymer began planning his trip to Pinehurst, he made sure to reserve the same room at the same hotel where he stayed 10 years ago, when he won the U.S. Open by eight shots.

“I don’t know if it helps,” the 39-year-old Kaymer said. “It cannot hurt, I guess. I’m a little bit superstitious when it comes down to that. I think, regardless, it’s going to be a really nice week.”

Kaymer said the course has changed a lot since 2014, when he blew away the field by relying, in part, on his mastery of the “Texas wedge” – aka the putter – when he missed the turtleback greens of Donald Ross’ famed design.

“To be honest, I was a little bit overwhelmed this morning when I played the first four or five holes,” Kaymer said after Tuesday’s practice round. “I said to my caddie, ‘Was it that hard 10 years ago? Was it that difficult to hit the greens in the first place and then make the up-and-downs?’”

BRYSON’S BALANCE

Bryson DeChambeau is known for his enormous drives, but he knows it will be prudent at times to leave the driver in the bag at Pinehurst, a course that calls for pinpoint approach shots.

“It stinks hitting a 6-iron off the tee compared to a driver, but sometimes you’ve got to do it and you’ve got to make the right decision for shooting the lowest score out here,” DeChambeau said.

He pointed to the par-4 third as one hole that could tempt him.

“I may go for it – I don’t know, you never know with me,” DeChambeau said. “Certainly on the tee box if it’s downwind I’ll give it a go, probably. But maybe just hit a 6-iron out there, or 7. Hitting an iron out there and playing some very strategic golf is certainly something you have to do on this golf course to compete and win.”

MURRAY REMEMBERED

Grayson Murray, a PGA Tour player and Raleigh native who died on May 25, was memorialized with a plaque inside the players’ locker room at Pinehurst that read, “The USGA remembers Grayson and pays tribute to the playing accomplishments that merited his place in the 124th U.S. Open Championship.”

The message added “Be kind to one another,” a request his mother made after revealing that Murray had taken his own life.

Murray died one day after he withdrew from the second round of the Charles Schwab Challenge at Colonial. He won in Hawaii in January and had already qualified for the U.S. Open.

AP sports writer Steve Reed contributed to this story.

​ Orange County Register 

Pier jump gives junior lifeguards thrilling start to summer

• June 12, 2024

Some kids stood nervously looking down, soaking in the sight of the sea below before taking the plunge, while others jumped without hesitation from the San Clemente Pier.

Junior guard programs at beach towns across the region are kicking off, a rite of passage in coastal communities and a way for youngsters to learn ocean safety. Thousands of kids and teens will spend summer days learning about CPR and first aid, how to recognize if someone is in danger and how to understand ocean dynamics such as rip currents and waves.

Of course, the days at the beach are about the fun, too, with races and games held through the mornings and afternoons.

For junior lifeguard participants in San Clemente – currently is the first of three sessions to be held in coming months – Tuesday’s pier jump was a thrilling start to their summer vacation.

“As professional lifeguards, pier jumps are a valuable skill we have to safeguard lives. Pier jumps  are one of many opportunities in which the JG’s get a chance to overcome their fear and prove to themselves they can do it,” said Andrew Mansoor, San Clemente City Junior Guard coordinator. “Not to mention it’s a very fun time for them.”

Mom Tara Young showed up on the pier to watch her two sons, Taft, 12, and Shepard, 9, take their turns.

“I’m excited,” said Young, who recently moved to San Clemente from Oregon. “I knew they could learn more in this program than what I could ever teach them. We are not from the beach or the ocean.”

Her husband’s military job means constantly moving, so she wanted her boys to learn the beach lifestyle while they had the chance, she said.

“It might be a once-in-a-lifetime chance for them, if we have to move away for jobs,” she said. “While we were here, I wanted them to literally jump in with both feet, into the culture.  It’s fun to see them succeed, overcome fear.”

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Jayden Goodman was eating an acai bowl on the beach when she saw the junior guards ready to take the plunge, so she headed up to the pier to watch up close. It was an opportunity she didn’t have as a kid and was envious, she said, watching them jump.

“I’ve always wanted to jump off the pier,” said the college student who grew up in Ladara Ranch. “I want to be able to know how to save people if I need to. This is awesome to see them all doing this. Now you know you can do this, and safely…I want to learn to do this so bad.”

Jeff and Megan Anastacio showed up to cheer on their son, Sawyer, 13, who is a first-timer in the program. They just moved to the beach town from Washington and wanted their son to learn about the ocean and lifesaving so they could take comfort while he’s at the beach.

“We told the kids, they have to at least do it once since they live here,” said Jeff Anastacio.

So far, so good.

“Just one day in, he’s loving it,” added Megan.

She said she will feel much more confident that Sawyer will know what to do if help is needed, not just for himself, but also for others.

“It’s a responsibility thing,” she said. “If you’re going to be in the water here, you need to know what to do in it.”

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​ Orange County Register 

Biden plan to lower Medicare drug costs risks empty shelves, pharmacists say

• June 12, 2024

Months into a new Biden administration policy intended to lower drug costs for Medicare patients, independent pharmacists say they’re struggling to afford to keep some prescription drugs in stock.

“It would not matter if the governor himself walked in and said, ‘I need to get this prescription filled,’” said Clint Hopkins, a pharmacist and co-owner of Pucci’s Pharmacy in Sacramento, California. “If I’m losing money on it, it’s a no.”

A regulation that took effect in January changes prescription prices for Medicare beneficiaries. For years, prices included pharmacy performance incentives, possible rebates, and other adjustments made after the prescription was filled. Now the adjustments are made first, at the pharmacy counter, reducing the overall cost for patients and the government. But the new system means less money for pharmacies that acquire and stock medications, pharmacists say.

Pharmacies are already struggling with staff shortages, drug shortages, fallout from opioid lawsuits, and rising operating costs. While independent pharmacies are most vulnerable, some big chain pharmacies are also feeling a cash crunch — particularly those whose parent firms don’t own a pharmacy benefit manager, companies that negotiate drug prices between insurers, drug manufacturers, and pharmacies.

A top official at the Centers for Medicare & Medicaid Services said it’s a matter for pharmacies, Medicare insurance plans, and PBMs to resolve.

“We cannot interfere in the negotiations that occur between the plans and pharmacy benefits managers,” Meena Seshamani, director of the Center for Medicare, said at a conference on June 7. “We cannot tell a plan how much to pay a pharmacy or a PBM.”

Nevertheless, CMS has reminded insurers and PBMs in several letters that they are required to provide the drugs and other benefits promised to beneficiaries.

Several independent pharmacists told KFF Health News they’ll soon cut back on the number of medications they keep on shelves, particularly brand-name drugs. Some have even decided to stop accepting certain Medicare drug plans, they said.

As he campaigns for reelection, President Joe Biden has touted his administration’s moves to make prescription drugs more affordable for Medicare patients, hoping to appeal to voters troubled by rising health care costs. His achievements include a law, the Inflation Reduction Act, that caps the price of insulin at $35 a month for Medicare patients; caps Medicare patients’ drug spending at $2,000 a year, beginning next year; and allows the program to bargain down drug prices with manufacturers.

More than 51 million people have Medicare drug coverage. CMS officials estimated the new rule reducing pharmacy costs would save beneficiaries $26.5 billion from 2024 through 2032.

Medicare patients’ prescriptions can account for at least 40% of pharmacy business, according to a February survey by the National Community Pharmacists Association.

Independent pharmacists say the new rule is causing them financial trouble and hardship for some Medicare patients. Hopkins, in Sacramento, said that some of his newer customers used to rely on a local grocery pharmacy but came to his store after they could no longer get their medications there.

The crux of the problem is cash flow, the pharmacists say. Under the old system, pharmacies and PBMs reconciled rebates and other behind-the-scenes transactions a few times a year, resulting in pharmacies refunding any overpayments.

Now, PBM clawbacks happen immediately, with every filled prescription, reducing pharmacies’ cash on hand. That has made it particularly difficult, pharmacists say, to stock brand-name drugs that can cost hundreds or thousands of dollars for a month’s supply.

Some patients have been forced to choose between their pharmacy and their drug plan. Kavanaugh Pharmacy in Little Rock, Arkansas, no longer accepts Cigna and Wellcare Medicare drug plans, said co-owner and pharmacist Scott Pace. He said the pharmacy made the change because the companies use Express Scripts, a PBM that has cut its reimbursements to pharmacies.

“We had a lot of Wellcare patients in 2023 that either had to switch plans to remain with us, or they had to find a new provider,” Pace said.

Pace said one patient’s drug plan recently reimbursed him for a fentanyl patch $40 less than his cost to acquire the drug. “Because we’ve had a long-standing relationship with this particular patient, and they’re dying, we took a $40 loss to take care of the patient,” he said.

Conceding that some pharmacies face cash-flow problems, Express Scripts recently decided to accelerate payment of bonuses for meeting the company’s performance measures, said spokesperson Justine Sessions. She declined to answer questions about cuts in pharmacy payments.

Express Scripts, which is owned by The Cigna Group, managed 23% of prescription claims last year, second to CVS Health, which had 34% of the market.

In North Carolina, pharmacist Brent Talley said he recently lost $31 filling a prescription for a month’s supply of a weight control and diabetes drug.

To try to cushion such losses, Talley’s Hayes Barton Pharmacy sells CBD products and specialty items like reading glasses, bath products, and books about local history. “But that’s not going to come close to making up the loss generated by the prescription sale,” Talley said.

His pharmacy also delivers medicines packaged by the dose to Medicare patients at assisted living facilities and nursing homes. Reimbursement arrangements with PBMs for that business are more favorable than for filling prescriptions in person, he said.

When Congress added drug coverage to Medicare in 2003, lawmakers privatized the benefit by requiring the government to contract with commercial insurance companies to manage the program.

Insurers offer two options: Medicare Advantage plans, which usually cover medications, in addition to hospital care, doctor visits, and other services; as well as stand-alone drug plans for people with traditional Medicare. The insurers then contract with PBMs to negotiate drug prices and pharmacy costs with drug manufacturers and pharmacies.

The terms of PBM contracts are generally secret and restrict what pharmacists can tell patients — for example, if they’re asked why a drug is out of stock. (It took an act of Congress in 2018 to eliminate restrictions on disclosing a drug’s cash price, which can sometimes be less than an insurance plan’s copayment.)

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The Pharmaceutical Care Management Association, a trade group representing PBMs, warned CMS repeatedly “that pharmacies would likely receive lower payments under the new Medicare Part D rule,” spokesperson Greg Lopes said. His group opposes the change.

Recognizing the new policy could cause cash-flow problems for pharmacies, Medicare officials had delayed implementation for a year before the rule took effect, giving them more time to adjust.

“We have heard pharmacies saying that they have concerns with their reimbursement,” Seshamani said.

But the agency isn’t doing enough to help now, said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association. “They haven’t taken any action even after we brought potential violations to their attention,” she said.

​ Orange County Register 

Bird flu tests are hard to get. So how will we know when to sound the pandemic alarm?

• June 12, 2024

Stanford University infectious disease doctor Abraar Karan has seen a lot of patients with runny noses, fevers, and irritated eyes lately. Such symptoms could signal allergies, covid, or a cold. This year, there’s another suspect, bird flu — but there’s no way for most doctors to know.

If the government doesn’t prepare to ramp up H5N1 bird flu testing, he and other researchers warn, the United States could be caught off guard again by a pandemic.

“We’re making the same mistakes today that we made with covid,” Deborah Birx, who served as former President Donald Trump’s coronavirus response coordinator, said June 4 on CNN.

FILE – A Jersey cow feeds in a field in Iowa, May 8, 2018. (AP Photo/Charlie Neibergall, File)

To become a pandemic, the H5N1 bird flu virus would need to spread from person to person. The best way to keep tabs on that possibility is by testing people.

Scientifically speaking, many diagnostic laboratories could detect the virus. However, red tape, billing issues, and minimal investment are barriers to quickly ramping up widespread availability of testing. At the moment, the Food and Drug Administration has authorized only the Centers for Disease Control and Prevention’s bird flu test, which is used only for people who work closely with livestock.

State and federal authorities have detected bird flu in dairy cattle in 12 states. Three people who work on separate dairy farms tested positive, and it is presumed they caught the virus from cows. Yet researchers agree that number is an undercount given the CDC has tested only about 40 people for the disease.

“It’s important to know if this is contained on farms, but we have no information because we aren’t looking,” said Helen Chu, an infectious disease specialist at the University of Washington in Seattle who alerted the country to covid’s spread in 2020 by testing people more broadly.

Reports of untested sick farmworkers — as well as a maternity worker who had flu symptoms — in the areas with H5N1 outbreaks among cattle in Texas suggest the numbers are higher. And the mild symptoms of those who tested positive — a cough and eye inflammation, without a fever — are such that infected people might not bother seeking medical care and, therefore, wouldn’t be tested.

The CDC has asked farmworkers with flu symptoms to get tested, but researchers are concerned about a lack of outreach and incentives to encourage testing among people with limited job security and access to health care. Further, by testing only on dairy farms, the agency likely would miss evidence of wider spread.

“It’s hard to not compare this to covid, where early on we only tested people who had traveled,” said Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University. “That left us open to not immediately recognizing that it was transmitting among the community.”

In the early months of covid, the rollout of testing in the United States was catastrophically slow. Although the World Health Organization had validated a test and other groups had developed their own using basic molecular biology techniques, the CDC at first insisted on creating and relying on its own test. Adding to delays, the first version it shipped to state health labs didn’t work.

The FDA lagged, too. It didn’t authorize tests from diagnostic laboratories outside of the CDC until late February 2020.

On Feb. 27, 2020, Chu’s research lab detected covid in a teenager who didn’t meet the CDC’s narrow testing criteria. This case sounded an alarm that covid had spread below the radar. Scaling up to meet demand took time: Months passed before anyone who needed a covid test could get one.

Chu notes this isn’t 2020 — not by a long shot. Hospitals aren’t overflowing with bird flu patients. Also, the country has the tools to do much better this time around, she said, if there’s political will.

For starters, tests that detect the broad category of influenzas that H5N1 belongs to, called influenza A, are FDA-approved and ubiquitous. These are routinely run in the “flu season,” from November to February. An unusual number of positives from these garden-variety flu tests this spring and summer could alert researchers that something is awry.

Doctors, however, are unlikely to request influenza A tests for patients with respiratory symptoms outside of flu season, in part because health insurers may not cover them except in limited circumstances, said Alex Greninger, assistant director of the clinical virology laboratory at the University of Washington.

That’s a solvable problem, he added. At the peak of the covid pandemic, the government overcame billing issues by mandating that insurance companies cover tests, and set a lucrative price to make it worthwhile for manufacturers. “You ran into a testing booth on every other block in Manhattan because companies got $100 every time they stuck a swab in someone’s nose,” Greninger said.

Another obstacle is that the FDA has yet to allow companies to run their influenza A tests using eye swabs, although the CDC and public health labs are permitted to do so. Notably, the bird flu virus was detected only in an eye swab from one farmworker infected this year — and not in samples drawn from the nose or throat.

Overcoming such barriers is essential, Chu said, to ramp up influenza A testing in regions with livestock. “The biggest bang for the buck is making sure that these tests are routine at clinics that serve farmworker communities,” she said, and suggested pop-up testing at state fairs, too.

In the meantime, novel tests that detect the H5N1 virus, specifically, could be brought up to speed. The CDC’s current test isn’t very sensitive or simple to use, researchers said.

Stanford, the University of Washington, the Mayo Clinic, and other diagnostic laboratories that serve hospital systems have developed alternatives to detecting the virus circulating now. However, their reach is limited, and researchers stress a need to jump-start additional capacity for testing before a crisis is underway.

“How can we make sure that if this becomes a public health emergency we aren’t stuck in the early days of covid, where things couldn’t move quickly?” Pinsky said.

A recent rule that gives the FDA more oversight of lab-developed tests may bog down authorization. In a statement to KFF Health News, the FDA said that, for now, it may allow tests to proceed without a full approval process. The CDC did not respond to requests for comment.

But the American Clinical Laboratory Association has asked the FDA and the CDC for clarity on the new rule. “It’s slowing things down because it’s adding to the confusion about what is allowable,” said Susan Van Meter, president of the diagnostic laboratory trade group.

Labcorp, Quest Diagnostics, and other major testing companies are in the best position to manage a surge in testing demand because they can process hundreds per day, rather than dozens. But that would require adapting testing processes for their specialized equipment, a process that consumes time and money, said Matthew Binnicker, director of clinical virology at the Mayo Clinic.

“There’s only been a handful of H5N1 cases in humans the last few years,” he said, “so it’s hard for them to invest millions when we don’t know the future.”

The government could provide funding to underwrite its research, or commit to buying tests in bulk, much as Operation Warp Speed did to advance covid vaccine development.

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“If we need to move to scale this, there would need to be an infusion of money,” said Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories. Like an insurance policy, the upfront expense would be slight compared with the economic blow of another pandemic.

Other means of tracking the H5N1 virus are critical, too. Detecting antibodies against the bird flu in farmworkers would help reveal whether more people have been infected and recovered. And analyzing wastewater for the virus could indicate an uptick in infections in people, birds, or cattle.

As with all pandemic preparedness efforts, the difficulty lies in stressing the need to act before a crisis strikes, Greninger said.

“We should absolutely get prepared,” he said, “but until the government insures some of the risk here, it’s hard to make a move in that direction.”

​ Orange County Register 

Ex-OC prosecutor deflects blame for failure to disclose evidence in 2010 murder case

• June 12, 2024

An Orange County Superior Court judge who failed to turn over evidence as a prosecutor in a 2010 murder case indicated Tuesday, June 11, that the fault may have been with sheriff’s investigators.

Ebrahim Baytieh, testifying in a hearing on whether murder defendant Paul Gentile Smith should go free because of the lack of disclosure, has said he didn’t know the evidence in question existed until 10 years after the trial.

On Monday, Baytieh testified he didn’t know what went wrong. On Tuesday, he said he depended on investigators to let him know what evidence was available for discovery.

“The presumption I worked on is that the police agency gives us everything that’s there,” Baytieh testified, under questioning by San Diego County Superior Court Judge Daniel Goldstein. “I worked based on the protocol they had, which is they bring me everything.”

Goldstein responded that Baytieh was still head of the prosecutorial team in the case, which includes the sheriff’s investigators, and, ultimately, responsible for turning over discovery to the defense. Sheriff’s officials have said the evidence was properly booked and available for discovery at the time of trial.

In a rare occurrence, Baytieh was under oath and on the witness stand in the case against Smith, who was convicted in 2010 of fatally stabbing his boyhood friend 18 times and torching the body in Sunset Beach.

Smith’s conviction was overturned in 2021 amid arguments that his constitutional rights were violated when evidence was not disclosed that multiple jailhouse informants were used against him. Only one informant was disclosed to the defense at the time of trial.

Smith now faces a retrial and his case was sent to Goldstein in San Diego to avoid a conflict with the Orange County bench. Orange County Assistant Public Defender Scott Sanders requested the hearing as part of his attempt to get the murder charges dismissed because of the prosecution’s conduct.

Baytieh was fired from his high-level job in the district attorney’s office in 2022, purportedly for his handling of the Smith case. Still highly regarded in the legal community, he was subsequently elected judge in June 2022.

In his second and last day of testimony, Baytieh said Tuesday he was trained at the district attorney’s office that evidence not introduced at trial and not considered to be exculpatory did not have to be disclosed to the defense. Baytieh said he now knows better.

Baytieh’s testimony adds another chapter to the scandal prompted by Orange County’s secret use of jailhouse informants, which unraveled the case against Scott Dekraai, who killed eight people in a 2011 shooting rampage at a Seal Beach beauty salon.

The judge in the Dekraai case ruled that he could not get a fair hearing because of the way informants were used against him. At that point, the death penalty was taken off the table and Dekraai ultimately pleaded guilty. He received multiple life sentences without the possibility of parole.

Related links

Ex-OC prosecutor testifies he doesn’t know why evidence wasn’t disclosed in murder case
Former top OC prosecutor conspired to hide evidence in murder case, defense attorney alleges
San Diego County judge takes up OC murder case, prosecutorial misconduct allegations
Misconduct allegations in OC murder prosecution center stage in San Diego courtroom
OC judge scheduled to testify on allegations he withheld evidence as a prosecutor

During his tenure as a prosecutor, Baytieh became the district attorney’s office’s main defender in the snitch scandal, denying allegations that informants were used improperly and in violation of defendants’ rights. Baytieh now admits the office was wrong.

On Tuesday, Sanders spent much of the day trying to get Baytieh to explain why he did not charge an inmate who ostensibly was trying to help Smith hire a hitman to kill a sheriff’s investigator. Sanders’ theory is that the inmate, Jeffrey Platt, actually was a jailhouse informant pretending to be cooperating with Smith — an informant who was not disclosed to the defense by Baytieh until 10 years after the trial.

Baytieh said he first learned of the evidence — taped recordings of Platt explaining his plan for three inmates to extract information from Smith — in 2019 and quickly retrieved copies for defense attorneys.

​ Orange County Register 

Rangers’ Corey Seager sits in regular-season return to Dodger Stadium

• June 12, 2024

LOS ANGELES — Corey Seager walked back into Dodger Stadium on Tuesday with another World Series title to his credit, and if there was not a spring in his step, it was only because of his current bout with hamstring soreness.

Once synonymous, Seager and the Dodgers are no more after seven wildly productive seasons and a World Series title in 2020.

If his transition between organizations in the winter of 2021 was difficult, Seager said he couldn’t recall those emotions. He didn’t seem willing to talk about it even if he did.

“That was a long time ago (and) I can’t really remember how it went,” Seager said. “I’m sorry to … I don’t want to go down that path.”

Looking back is a tricky endeavor. Even if Seager was willing to admit he missed an aspect of his Los Angeles days, he wasn’t about to let that concept be misinterpreted.

By guiding the Texas Rangers to a World Series championship – and his second World Series MVP in four seasons – his decision to relocate to the Dallas area was, by all accounts, a sound one.

“I don’t know if you ever thought it would be that fast, you know, it just kind of clicked at the right time, got hot in the playoffs and it turns into that,” Seager said of the vision Rangers general manager Chris Young had when he signed his 10-year, $325 million contract.

“But that was his plan to always move forward, so power to him to be able to see that and get the right people in and have it actually click.”

Seager was not in the Rangers’ lineup on Tuesday, missing his fourth consecutive game with a left hamstring strain. He was not sure if he would play at all in the series.

While it is the first time Seager, 30, has set foot inside of Dodger Stadium with his Rangers teammates, he did have a plate appearance during the 2022 All-Star Game in his former ballpark, where he was the National League Rookie of the Year in 2016, a two-time All-Star and a twice finished in the top 10 in NL MVP voting.

“This organization kind of raised me, (I was) drafted here, kind of made me the man I am today,” Seager said. “They taught me the game of baseball, made a lot of friends, had a lot of good times out there. So all of those memories kind of flashed back.”

Dodgers manager Dave Roberts recalled Seager as a “superstar, just a heady baseball player, great competitor and performed really well on the biggest of stages. A very good Dodger.”

Three seasons later, the Dodgers are still looking for their permanent answer at shortstop. Trea Turner held the job for one season, Miguel Rojas took it over last season when Gavin Lux was injured and Mookie Betts has it now after Lux’s defensive issues in the spring.

Seager, who received a generous ovation when he was welcomed back before the game and stepped out of the dugout to wave to the crowd, has taken note of Betts’ move to shortstop from afar and has the utmost respect for his former teammate.

“I haven’t been able to watch a game, but (Betts) is a special player,” Seager said. “Everybody knows that he’s a special athlete who can play all over the place at such a high level and still be able to compete at that spot, it’s been impressive.”

ONE MORE WEEK

Dodgers right-hander Bobby Miller said he expects his rehab outing for Triple-A Oklahoma City on Thursday to be his last one before returning to the major league rotation. He has been out since April 10 with right shoulder inflammation.

“My goals are really to get as deep into (this) game as I possibly can, run my pitch count up high but not too high too early,” Miller said. “Just show that I can take a team deep into the game, give the team a chance to win and not tax the bullpen at all.”

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Miller was expected to play a key role in this season’s rotation with his 100 mph fastball. He had 11 strikeouts in his season debut against the St. Louis Cardinals but threw just 5⅔ innings over his next two starts before going on the IL.

“It’s been really tough, especially when I first went down,” Miller said. “I thought it was going to be missing a couple of starts. It turns out it was a lot more than I thought. It was tough mentally to sit down and watch the team. I’d much rather be out there helping the team win.”

ALSO

Third baseman Max Muncy (oblique) still has not swung a bat during his rehab process, with Roberts saying there remains no timetable for a return. … Clayton Kershaw (shoulder) is set to pitch in a simulated game Thursday at Dodger Stadium. … Right-hander Ryan Brasier (calf) threw a bullpen on Tuesday but there remains no timetable for a return. … With Kiké Hernandez batting .190 over his past 19 games as the primary replacement at third base, Rojas received his seventh start at third in the series opener against the Rangers.

UP NEXT

Rangers (TBD) at Dodgers (RHP Walker Buehler, 1-3, 4.82 ERA), 7:10 p.m., SportsNet LA, 570 AM

​ Orange County Register