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California Chamber of Commerce “Job Killer Bills” Miss Key Deadline

Last April, the California Chamber of Commerce released its initial 2024 job killer list which, at the time, included nine bills dealing with labor and employment, taxation, unemployment insurance, environmental and health care issues. Subsequently, additions and deletions were made to the list as legislative activity progressed.  Three of the five remaining California Chamber of Commerce Job Killer bills missed the end of May deadline to pass the house in which they were introduced.

Stalled Bills: The following job killer bills failed to pass before Friday’s deadline:

– – ACA 16 (Bryan; D-Los Angeles): Has far-reaching negative consequences that would impair government operations, stunt development for new housing, infrastructure and clean energy project development and the strong potential to destabilize California’s economy. This constitutional amendment still is likely to come up for a vote in the next couple of weeks.
– – SB 1327 (Glazer; D-Contra Costa): Implements a discriminatory 7.25% tax on the revenue generated from the sale of digital advertising. The bill is likely unconstitutional and will lead to costly litigation for the state.
– – SB 1497 (Menjivar; D-Los Angeles): Imposes an ill-defined tax on a broad set of entities that will increase costs for goods and services in California.

Amended to Remove Job Killer Tag

AB 2499 (Schiavo; D-Chatsworth) will be amended to remove certain qualifying reasons for leave that are not related to safety, narrow the accommodations provisions, and limit the amount of time off an employee can take for certain reasons. The Appropriations Committee had also amended the threshold of applicability to apply to employers with 25 or more employees, which is consistent with existing law. Before amendments, it significantly expanded the 12-week leave related to crimes and lowered the threshold of applicability to employers with just five employees.

Opposed Bills Stopped: Additionally, three CalChamber-opposed bills also failed to pass their house of origin on time. The following bills are dead for the year:

– – AB 2648 (Bennett; D-Ventura): Prohibits the state from purchasing and all food services inside state facilities from offering any single-use plastic bottled beverages despite this packaging having one of the highest recycling rates in the country and despite the negative impacts to both the environment and state budget from using less efficient and more expensive packaging.
– – AB 3155 (Friedman; D-Glendale): Sets disturbing precedent by creating liability without proof for oil well owners/operators if individuals who lived within 3,200 feet of a wellhead develop certain health conditions.
– – SB 1494 (Glazer; D-Contra Costa): Eliminates an important economic development tool by prohibiting local governments from entering into sales tax sharing agreements with businesses. SB 1494 failed passage on a vote of 17-11 on May 23; reconsideration was granted.

What Remains:

– – SB 1116 (Portantino; D-Burbank) Increased Unemployment Insurance Taxes to Subsidize Striking Workers. SB 1116 will allow striking workers to claim UI benefits when they choose to strike. Because the UI Fund is paid for entirely by employers, SB 1116 will effectively add more debt onto California employers. Moreover, SB 1116 will effectively force employers to subsidize strikes at completely unrelated businesses because the UI Fund’s debt adds taxes for all employers, regardless of whether they’ve had a strike.
– – SB 1327 (Glazer; D-Contra Costa) Tax on Digital Advertising Revenue. Implements a discriminatory 7.25% tax on the revenue generated from the sale of digital advertising. The bill targets taxpayers that annually make at least $2.5 billion of revenue from these services.

The EEOC Sued 15 Employers for Failure to File EEO-1 Report

Title VII of the Civil Rights Act of 1964 mandated employers to maintain records that could be used to identify potential discrimination in hiring practices.Following this, in 1966, the Equal Employment Opportunity Commission (EEOC) implemented a requirement for certain employers to report employee data categorized by job category, race, ethnicity, and sex. This data collection became known as “EEO-1.”

While EEO-1 data collection has been in place for decades, it wasn’t until 2020 that the current EEO-1 Component 1 report format was finalized. In 2016, the EEOC sought approval to collect this specific data set, which focuses on workforce demographics. After receiving final approval from the Office of Management and Budget (OMB) in June 2020, the EEO-1 Component 1 report became the official format for this mandatory data collection.

The EEO-1 Component 1 report is a mandatory annual data collection that requires all private sector employers with 100 or more employees, and federal contractors with 50 or more employees meeting certain criteria, to submit demographic workforce data to the EEOC.

The EEOC has the authority to compel employers to file EEO-1 reports through court order pursuant to Section 709(c) of Title VII of the Civil Rights Act.

The U.S. Equal Employment Opportunity Commission (EEOC) just announced it has filed suit against 15 employers in 10 states this week, alleging the companies failed to comply with mandatory federal reporting requirements. The list of employer includes companies from the retail, construction, restaurant, manufacturing, logistics, and service industries.

Federal law requires employers with 100 or more employees to submit workforce data to the EEOC. The data collected includes workforce information by job category and sex, race, or ethnicity. This workforce demographic data is used for a variety of purposes including enforcement, analytics and research, and employer self-assessment.

“This data collection is an important tool for ensuring compliance with Title VII’s prohibition on workplace discrimination,” said EEOC General Counsel Karla Gilbride. “Not only did Congress authorize the EEOC to collect this data, Congress also authorized the agency to go to court to obtain compliance when employers ignore their obligation to provide the required information.”

The 2023 EEO-1 Component 1 data collection is currently underway. The EEOC began collecting EEO-1 Component 1 data from employers for the 2023 reporting cycle on April 30, 2024. The published deadline to file the 2023 EEO-1 Component 1 report was June 4, 2024.

The EEOC publishes an Instruction Booklet for employers to assist them in complying with this mandatory reporting requirement, which is available at https://www.eeocdata.org/eeo1

For more information on EEO data collection, please visit https://www.eeoc.gov/data/eeo-data-collections.

Coalition of 36 State Attorney Generals Urge SCOTUS to Limit PBMs

In Oklahoma, a law called the Patient’s Right to Pharmacy Choice Act aimed to give patients more control over where they could get their prescriptions filled. This act clashed with the federal Employee Retirement Income Security Act (ERISA) and Medicare Part D.

The Pharmaceutical Care Management Association (PCMA), an industry group representing pharmacy benefit managers (PBMs), sued to block the Oklahoma law. In Pharmaceutical Care v. Mulready, et al., No. 22-6074 (10th Cir. 2023), PCMA alleged that federal laws, Medicare Part D and the Employee Retirement Income Security Act (ERISA), preempt Oklahoma’s laws.

The federal district court rejected PCMA’s claims but in August 2023, the Tenth Circuit reversed, holding that ERISA and Medicare preempt Oklahoma’s laws.

In an amicus brief to the U.S. Supreme Court, a coalition of 36 state Attorney Generals (including California’s) asks the Court to grant Oklahoma’s request that the Court review a decision from the U.S. Court of Appeals for the Tenth Circuit.

According to its amicus brief “states have a compelling interest in preserving their traditional authority to protect their residents’ access to healthcare and to regulate business practices in their states. To advance these interests, all states regulate [PBMs] to some degree.” PCMA and the Tenth Circuit’s broad approach to federal preemption, however, would “severely and unduly impede states’ abilities to protect their residents and regulate businesses.”

The challenge to Oklahoma’s laws is the latest of a string of lawsuits by the PBM industry’s national lobbying association, Pharmaceutical Care Management Association (PCMA). Mulready marked the second case to reach a federal court of appeals since the U.S. Supreme Court addressed state regulation of PBMs in Rutledge v. Pharmaceutical Care Management Association 592 U.S. 80 (2020).

SCOTUS ruled 8-0 that the Employee Retirement Income Security Act (ERISA) did not preempt Arkansas’s law regulating pharmacy benefit managers (PBMs), the intermediaries that administer prescription drug benefits for health plans.

In Rutledge, Justice Sonia Sotomayor spoke for the unanimous Court in holding that a state law requiring PBMs to pay pharmacies no less than their acquisition costs for prescription drugs was not preempted by ERISA, the federal statute governing employee benefits. The Court concluded, “ERISA does not pre-empt state rate regulations that merely increase costs or alter incentives for ERISA plans without forcing plans to adopt any particular scheme of substantive coverage.”

In their current brief to the Supreme Court, the states argue that the “Court should grant certiorari review for two key reasons. First, the Tenth Circuit decided important questions of federal law in a manner that conflicts with the Eighth Circuit’s resolution of the same issues. Sup. Ct. R. 10(a). Second, the Tenth Circuit’s decision conflicts with this Court’s precedent. Id. 10(c). States have a significant interest in knowing the extent to which ERISA and Medicare may preempt their regulations of PBMs. By contradicting the Eighth Circuit’s holdings and adopting a substantially broader view of ERISA preemption than what this Court endorsed in Rutledge, the Tenth Circuit’s decision throws that knowledge into substantial doubt. The result is nationwide uncertainty for regulators, a corresponding increase in consumer harms, and a substantial likelihood of continued litigation on the topic in light of the deep circuit split. The Court should grant review to put an end to that uncertainty and its corresponding harms.”

Farm Labor Contracting Companies Face $30M Payroll Fraud Charges

Ruben Perez Mireles Jr., 49, of Clovis, and his business associate, John Mena, 29, of Lemoore, were arraigned  on multiple felony counts including insurance fraud, grand theft, and tax fraud after a task force investigation led by the California Department of Insurance found they allegedly underreported over $29.2 million in payroll for multiple businesses to illegally save on workers’ compensation insurance premium and taxes.

Mireles and Mena operated two Kings County farm labor contracting companies, Vista Pacific Labor Solutions, Inc. and Calzona Ag Management, Inc. The investigation by the Central Valley Workers’ Compensation Fraud Task Force found that Mireles, owner of Vista Pacific Labor Solutions, Inc, underreported $7.6 million in employee payroll to his workers’ compensation insurance carrier for the period of September 2019 through August 2020. This underreporting resulted in a premium loss of $1.7 million.

The investigation revealed Mireles then created another farm labor contracting company, Calzona Ag Management, Inc. Mireles recruited Mena and together they shifted payroll to this new company to avoid an increased assessment of the business’ workplace safety, which would have more than doubled the insurance premium. Together, they underreported $8.8 million in employee payroll for the period of December 2019 through December 2021, resulting in an additional premium loss of $1.8 million.

Additionally, the task force investigation found Mireles underreported $12.8 million in employee payroll to the Employment Development Department and failed to report personal income to the Franchise Tax Board. This underreporting resulted in a combined loss of approximately $3 million for unpaid tax liability, penalties, and interest. Mireles and Mena’s fraud scheme defrauded their insurance carries, EDD, and FTB out of over $6.5 million.

Investigators also discovered that Mireles fraudulently obtained a COVID-19 Paycheck Protection Program loan. After an investigation led by the FBI, Mireles pleaded guilty and was sentenced to one year in prison. Mireles is also in court today on additional felony charges for his role in an earlier workers’ compensation insurance fraud scheme, also uncovered by the task force.

Mireles has been charged with eight felony counts including workers’ compensation insurance fraud, grand theft, unemployment insurance fraud, and tax fraud. Mena has been charged with three felony counts of workers’ compensation insurance fraud and one felony count of grand theft.

The Central Valley Workers’ Compensation Fraud Task Force is an inter-agency anti-fraud partnership with members from the California Department of Insurance, the California Employment Development Department, the California Franchise Tax Board, the Kings County District Attorney’s Office, the Fresno County District Attorney’s Office, the Kern County District Attorney’s Office, the Madera County District Attorney’s Office, the Merced County District Attorney’s Office, the San Luis Obispo County District Attorney’s Office, and the Tulare County District Attorney’s Office.

The case is being prosecuted by Kings County District Attorney Sarah Hacker.

WCAB En Banc Clarifies Confusion on Use of “Kite” Based CVC Rebuttal

On June 10, 2024, the Appeals Board issued a combined en banc decision and panel decision clarifying the known methods of rebutting the Combined Values Chart (CVC). In this case Sammy Vigil was employed by the County of Kern as a maintenance painter, and he claimed injury to his hips and back on December 7, 2017 and also injury caused by continuous trauma.

Following trial, his cumulative injury was found to be industrial, and the WCJ found, that applicant sustained 68% permanent partial disability by adding the impairment to applicant’s left and right hip pursuant to East Bay Municipal Utility District v. Workers’ Compensation Appeals Board (Kite) (2013) 78 Cal.Comp.Cases 213 (writ den.). The WCJ further found that apportionment to the hips was not permissible pursuant to Hikida v. Workers’ Comp. Appeals Bd. (2017) 12 Cal.App.5th 1249 [82 Cal.Comp.Cases 679] because the disability was caused by hip replacement surgery.

The employer filed a Petition for Reconsideration and argued that the WCJ misapplied the analysis in the Kite decision because the opinion of the qualified medical evaluator (QME) was not substantial evidence and does not support rebuttal of the Combined Values Chart (CVC). Next, it contends that the WCJ erred in applying Hikida, because applicant’s hip surgeries were successful and did not cause any increase in impairment.

In its Decision After Reconsideration (En Banc), the WCAB rescinded the WCJ’s F&A and returned this matter to the trial level for further proceedings consistent with the opinion in the case of Vigil v County of Kern 2024-EB-03 (June 2024)

Applicant was evaluated by QME Peter Newton, M.D., who authored four reports in evidence and was deposed. He assigned 15% whole-person impairment (WPI) to the right hip, 15% WPI to the left hip, and 7% WPI to applicant’s lumbar spine. 15% of this applicant’s lumbar spine and right and left hip condition/disability/impairment was apportioned to age-appropriate and age-related degenerative changes and 85% to the continuous trauma of his work through 03/26/18.

In his deposition he applied Kite when he said “Somebody with limitations due to both hips is going to have significantly more limitations than if somebody had one normal hip and one hip that they had surgery on.”

Impairments to two or more body parts are usually expected to have an overlapping effect upon the activities of daily living, so that generally, under the AMA Guides and the PDRS, the two impairments are combined to eliminate this overlap.As an element of the PDRS, the CVC may also be rebutted, and when the CVC is rebutted, those impairments may simply be added.

“In our panel decisions, two methods have been used to rebut the CVC to date. In the first approach, the CVC has been rebutted where there was evidence showing no actual overlap between the effects on ADLs as between the body parts rated. In the second approach, the CVC has also been rebutted where there is overlap, but the overlap creates a synergistic effect upon the ADLs.”

“We believe that one significant point of confusion on the issue of overlap is that the analysis should focus on overlapping ADLs, not body parts.”

“The Combined Values Chart (CVC) in the Permanent Disability Ratings Schedule (PDRS) may be rebutted and impairments may be added where an applicant establishes the impact of each impairment on the activities of daily living (ADLs) and that either: (a) there is no overlap between the effects on ADLs as between the body parts rated; or (b) there is overlap, but the overlap increases or amplifies the impact on the overlapping ADLs.”

The Appeals Board emphasized that rebuttal of the CVC requires a critical analysis of the impacts upon applicant’s ADLs and is not automatically triggered by use of the word “synergy”. “Here, Dr. Newton’s testimony does not appear to be based upon no overlap, but instead appears to argue for CVC rebuttal based upon a synergistic effect between the two hips.”

The term ‘synergy’ is not a ‘magic word’ that immediately rebuts the use of the CVC. Instead, a physician must set forth a reasoned analysis explaining how and why synergistic ADL overlap exists. If parties are searching for a magic word to use during a doctor’s deposition, that word is “Why?’ “. Rather than focusing on whether a specific term, including the term synergy, was used, it is imperative that parties focus on an analysis that applies critical thinking based on the principles articulated in Escobedo to support a conclusion based on the facts of the case. Such an analysis must include a detailed description of the impact of ADLs and how those ADLs interact.”

After reviewing the record and noting that the qualified medical evaluator failed to discuss the impact of applicant’s impairments upon the ADLs, the Appeals Board reversed the finding of the workers’ compensation judge and returned the matter for further development of the record.

Section III of this decision is not en banc and is not citeable as an en banc opinion.

AB 5 Survives Uber and Postmates’ Constitutional Challenge

Concerned with the widespread misclassification of workers, the legislature enacted A.B. 5 in 2019. A.B. 5 codified the California Supreme Court’s Dynamex Operations W., Inc. v. Superior Ct., 416 P.3d 1, 5 (Cal. 2018) decision and extended the application of the ABC test beyond wage orders to other labor and employment legislation, including workers’ compensation, unemployment insurance, and disability insurance.

On December 30, 2019, Lydia Olson, Miguel Perez, Uber Technologies, Inc., and Postmates, Inc.jointly filed a complaint against the State of California and the Attorney General of California (collectively seeking declaratory, injunctive, and other relief based on their allegations that A.B. 5 violates the Equal Protection Clauses, the Due Process Clauses, and the Contract Clauses of the United States and California Constitutions. They sought a preliminary injunction to prevent Defendants from enforcing A.B. 5.

The district court denied Plaintiffs’ motion for preliminary injunctive relief. Plaintiffs appealed the district court’s denial of the preliminary injunction. In November 2020, shortly before the 9th Circuit Court of Appeals heard argument in that appeal, California voters approved Proposition 22, a ballot initiative that classifies rideshare and delivery drivers – like Plaintiffs Olson and Perez – as independent contractors, notwithstanding A.B. 5 or any other provision of law. Prop. 22 took effect on December 16, 2020, in accordance with the default rule provided by the California Constitution.

After Prop. 22 passed, but before the Court of Appeals issued a decision in the appeal of the preliminary injunction, Plaintiffs filed the operative Second Amended Complaint. Defendants moved to dismiss the Second Amended Complaint for failure to state a claim. The district court granted the motion. The district court determined that Plaintiffs’ new allegations concerning the amendments to A.B. 5 and Prop. 22 did not rescue their claims.Plaintiffs timely appealed that order.

A three-judge panel reversed in part, concluding that the district court erred by dismissing Plaintiffs’ Equal Protection claims. The panel concluded that Plaintiffs plausibly alleged that “the exclusion of thousands of workers from the mandates of A.B. 5 is starkly inconsistent with the bill’s stated purpose of affording workers the ‘basic rights and protections they deserve.’ “

Upon the vote of a majority of nonrecused active judges, a rehearing en banc was granted and the three-judge panel decision. Olson v. California, 88 F.4th 781 (9th Cir. 2023).was vacated It then conducted a review de novo of the district court order granting a motion to dismiss for failure to state a claim.

“We must decide whether A.B. 5’s differential treatment of app-based work arrangements in the transportation and delivery service industry, on the one hand, and app-based work arrangements in other industries, on the other hand, survives rational basis review. In other words, we must determine whether it was rational for the California legislature to apply one test to determine the classification of Uber drivers and a different test to determine the classification of dogwalkers who provide services through Wag!, the “Uber for dogs.”

Under the deferential rational basis standard, the Court was required to approach A.B. 5 with “a strong presumption of validity,” and will invalidate it only if Plaintiffs negate “every conceivable basis” which might justify the lines it draws.

Plaintiffs have failed to carry that burden here. There are plausible reasons for treating transportation and delivery referral companies differently from other types of referral companies, particularly where the legislature perceived transportation and delivery companies as the most significant perpetrators of the problem it sought to address – worker misclassification.”

Under the deferential rational basis standard, the en banc court in the published opinion of Olson et.,al, v State of California et. al. 21-55757 (June 2024) concluded that there were plausible reasons for treating transportation and delivery referral companies differently from other types of referral companies, particularly where the legislature perceived transportation and delivery companies as the most significant perpetrators of the problem it sought to address- worker misclassification.

That A.B. 5 may be underinclusive because it does not extend the ABC test to every industry and occupation that has historically contributed to California’s misclassification woes does not render it unconstitutionally irrational.

The en banc court did not disturb the prior panel’s disposition of plaintiffs’ Due Process, Contract Clause, and Bill of Attainder claims. Accordingly, the en banc court reinstated Parts III.B, III.C, and III.D of Olson v. California, 62 F.4th 1206, 1220–23 (9th Cir. 2023).

DWC Sets Public Hearing for Proposed UR Regulation Changes

The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for regulations concerning the utilization review (UR) procedures under Labor Code section 4610. Additional regulatory changes related to physician reporting and coordination of care requirements are also included.

The proposed rulemaking primarily implements exemptions to prospective UR created under Senate Bill 1160 (for treatment rendered within the first 30 days from the initial date of injury) and Assembly Bill 1124 (for drugs listed as exempt on the drug formulary).

Additionally, the proposal implements the statutory accreditation requirement and DWC’s oversight of UR plans, which includes extensive changes to UR enforcement rules; makes changes to improve or fix issues related to coordination of medical treatment; and would add a physician reporting form, the PR-1, which combines other reports (the Form RFA and the PR-2) to centralize reporting duties of a treating physician.

Implementation of these regulations is anticipated to harmonize regulations with statutory changes from SB 1160 and AB 1124, and fix system inefficiencies with respect to the delivery of medical treatment.

Members of the public may attend the in-person public hearing on Thursday, July 25, 2024, at 11 a.m. at the:

Elihu Harris State Office Building – Auditorium
1515 Clay Street
Oakland, CA 94612

Written public comments can be submitted via US mail, facsimile transmission (FAX) or by email until the end of the day on Thursday, July 25, 2024 to the attention of:

Maureen Gray, Regulations Coordinator
Department of Industrial Relations
P.O. Box 420603
San Francisco, CA 94142
Fax: (510) 286-0687
Email: dwcrules@dir.ca.gov

DWC will consider all public comments. The notice of rulemaking, text of the regulations, and the initial statement of reasons can be found on the DIR website.

Watchdog Group Says Trailer Bill Insurance Rate Provisions Will Cost Billions

Six consumer organizations warned state Senate and Assembly leaders that a budget trailer bill proposed by the governor would cut the public out of insurance rate review and cost consumers billions.

In a letter sent last night, the groups said the governor’s proposal would gut the consumer intervention process and tie the insurance commissioner’s hands, sacrificing transparent public scrutiny of insurance rate increases for speedy approvals.

“Consumer interventions by Consumer Watchdog over the last 22 years have produced $6 billion in savings, and Consumer Federation of California Education Foundation’s interventions over the past 10 years have resulted in over $400 million in savings for California policyholders. These savings are in jeopardy under this proposal,” wrote the groups.

Consumer organizations signing the letter include: Consumer Watchdog, Consumer Federation of California, Consumers for Auto Reliability and Safety, Consumer Federation of America, Consumer Protection Policy Center, and The Children’s Advocacy Institute.

The governor’s trailer bill goes far beyond timelines, said Consumer Watchdog. It would:

– – Exclude consumers’ voice in rate increases below 7%
– – Force the insurance commissioner to make rate decisions on partial information
– – Speed rate hikes so the public cannot meaningfully participate before a rate increase is approved
– – Change the rules even in cases – a rate hike above 7% – where public challengers have a right to a public hearing by law
– – Encourage insurers to apply for three 7% rate hikes a year to avoid public hearings

Nothing in the proposal would stop the clock if insurance companies refuse to provide information the department or a public participant needs to determine if a rate is justified. And nothing in the proposal would ensure the department of insurance has enough staff to complete rate reviews quickly.

The plan mirrors a proposal that Insurance Commissioner Ricardo Lara and the insurance industry unsuccessfully tried to jam through the legislature during the final days of session in 2023.

“Giving insurers the right to raise rates more quickly will only leave Californians paying higher rates, not get more insurance companies back in the market. The largest insurance companies in California have received double digit rate hikes recently ” 20% for State Farm that took effect in March on top of an additional 6.9% last year, three rate hikes adding up to 37% for Farmers in the last year – and the companies still refuse to write new business,” said the groups.

Insurance companies fear greater liability under the FAIR Plan, the letter continues.  The best way to get Californians out of the high-cost, low-benefit FAIR Plan and covered by real home insurance again is to make insurance companies sell to Californians who protect their homes from wildfire. The groups called on lawmakers to require insurers to cover people who meet state home hardening and brush clearance guidelines.

Data from MRI Can Detect Who Will Get Alzheimer’s and When

Researchers from the Centre of Preventive Neurology have developed a new method for predicting dementia with over 80% accuracy and up to nine years before a diagnosis. The new method provides a more accurate way to predict dementia than memory tests or measurements of brain shrinkage, two commonly used methods for diagnosing dementia.

The team, led by Professor Charles Marshall and published in Nature Mental Health, developed the predictive test by analysing functional MRI (fMRI) scans to detect changes in the brain’s ‘default mode network’ (DMN). The DMN connects regions of the brain to perform specific cognitive functions and is the first neural network to be affected by Alzheimer’s disease.

The researchers used fMRI scans from over 1,100 volunteers from UK Biobank, a large-scale biomedical database and research resource containing genetic and health information from half a million UK participants, to estimate the effective connectivity between ten regions of the brain that constitute the default mode network.

The researchers assigned each patient with a probability of dementia value based on the extent to which their effective connectivity pattern conforms to a pattern that indicates dementia or a control-like pattern.

They compared these predictions to the medical data of each patient, on record with the UK Biobank. The findings showed that the model had accurately predicted onset of dementia up to nine years before an official diagnosis was made, and with greater than 80% accuracy. In the cases where the volunteers had gone on to develop dementia, it was also found that the model could predict within a two-year margin of error exactly how long it would take that diagnosis to be made.

The researchers also examined whether changes to the DMN might be caused by known risk factors for dementia.

Their analysis showed that genetic risk for Alzheimer’s disease was strongly associated with connectivity changes in the DMN, supporting the idea that these changes are specific to Alzheimer’s disease. They also found that social isolation was likely to increase risk of dementia through its effect on connectivity in the DMN.

Charles Marshall, Professor and Honorary Consultant Neurologist, led the research team within the Centre for Preventive Neurology at the Wolfson Institute of Population Health.

He said: “Predicting who is going to get dementia in the future will be vital for developing treatments that can prevent the irreversible loss of brain cells that causes the symptoms of dementia. Although we are getting better at detecting the proteins in the brain that can cause Alzheimer’s disease, many people live for decades with these proteins in their brain without developing symptoms of dementia. We hope that the measure of brain function that we have developed will allow us to be much more precise about whether someone is actually going to develop dementia, and how soon, so that we can identify whether they might benefit from future treatments.”

Samuel Ereira, lead author and Academic Foundation Programme Doctor at the Centre for Preventive Neurology, Wolfson Institute of Population Health, said: “Using these analysis techniques with large datasets we can identify those at high dementia risk, and also learn which environmental risk factors pushed these people into a high-risk zone. Enormous potential exists to apply these methods to different brain networks and populations, to help us better understand the interplays between environment, neurobiology and illness, both in dementia and possibly other neurodegenerative diseases. fMRI is a non-invasive medical imaging tool, and it takes about 6 minutes to collect the necessary data on an MRI scanner, so it could be integrated into existing diagnostic pathways, particularly where MRI is already used.

Palomar Hospital Pays $250,000 for Diverting Fentanyl

Palomar Health, a California public health care district located in San Diego County, has paid $250,000 to resolve allegations of diversion of fentanyl from one of its facilities and failure to keep accurate records for fentanyl.

Palomar Health is California’s largest health care district, with campuses in Escondido and Poway. This settlement arises from a self-disclosure Palomar Health made to the U.S. Drug Enforcement Administration (DEA) that one of its employees may have diverted controlled substances.

The government investigated Palomar Health and concluded that vials of fentanyl were diverted from Pyxis machines – automated medication dispensing machines often used in hospital settings – located at Palomar Health’s Cardiac Catheterization Lab in Escondido. Specifically, the government concluded that over a five – month period, numerous vials of fentanyl were diverted from the Pyxis machines and unused fentanyl was not properly disposed of.

In addition to paying $250,000 to resolve the government’s claims, Palomar Health entered into a Memorandum of Agreement with the DEA requiring Palomar Health to undertake additional measures to increase security, implement specialized training, and to handle controlled substances properly and safely.

“We value our relationships with our registrant population and encourage all of them to be diligent in preventing and catching diversion,” said Diversion Program Manager Rostant Farfan. “Keeping medications, like fentanyl, off of the street is the responsibility of all who work with controlled substances.”

This settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Southern District of California and the Drug Enforcement Administration.

To report a tip directly to a DEA representative regarding medical personnel writing suspicious opioid prescriptions and pharmacies dispensing large amounts of opioids, call (571) 324-6499 or visit the DEA’s website (https://www.deadiversion.usdoj.gov/tips-online.html) and click on “Rx Abuse Online Reporting.”

This case was prosecuted by Assistant U.S. Attorney Dylan M. Aste.

The claims resolved by the settlement are allegations only, and there has been no determination of liability.