NOVEMBER 29, 2015SUNDAY

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Wednesdaymightdeliver awake-upcall toSanDiego’slongChargersstadiumnight-mare.

TheNFL’s 32ownerswillmeet in

Dallas todiscuss, amongother top-ics, which teamor teams canmoveinto the lucrativeLosAngelesmar-ket. It’s the league’s last regularlyscheduled suchmeetinguntilMarch.

Contradictory reports and ru-mors are flying.Owners are said to bestruggling overwhether to vote onrelocation at a specialmeeting inJanuary or towait untilMarch,whichmay effectively punt thewhole deci-sion for another year.

Really?SanDiego either loses its

team, or endures yet another cycle ofdrama?

Yep. Fromthe local fan’s perspec-tive, themajor players have essential-lywasted 2015.

This is no vindication ofMarkFabiani, theChargers counselwhopredictedprecisely this outcomeback in January.After all, Fabianiandhis boss, teamCEODeanSpa-nos, engineered the fans’ LostYearwith relentless focus on theirCarsonstadiumpartnershipwith theOak-landRaiders.

But their collaboratorwasSanDiegoMayorKevinFaulconer,whountil June shunned thebargainingtable in favor of deploying a taskforce. Then, inAugust, he largelyignored its findings to float a “frame-work” financing concept for aMission

Valley stadium.Since then,we’ve been told, the

mayorhasbeen tirelessly negotiatingdirectlywithNFL relocationhonchoEricGrubman, havingbeen rejectedby theChargers.

Nowweknowbetter. The inter-veningmonthshavebeenmostlytheater, the negotiating equivalent ofa half-time show; the kindwith amarchingband, notBeyoncé.

Lastweek, the city released—after trying to keep it secret—a24-page “termsheet”Faulconer gaveNFLofficials, apparently in lateSeptember. League executives re-quired just twopages to point outthat his opus of legalese didn’t offermany termsat all, especially thoserequired to actually build a stadium.

Coming to terms with Chargers’ L.A. bidDAN MCSWAIN

SEEMCSWAIN • A8

Give up local control or go italone.

Those are the options availableto Alzheimer’s Association chap-tersacross thenationasthey faceaconsolidationmovemade by theirnational board of directors — apush that has created deep divi-sions within the country’s leadingnetwork of groupsdevoted tohelp-ing people dealwith a fast-growingdisease that still has no cure or ef-fective treatment.

The San Diego affiliate hasmuchat stake, includingquestionsabout the future of a special care-giver-supportprogramit runs,a$1milliondonation it receivedrecent-ly for trainingandoutreach,and itsleading role in a groundbreakinginitiative that has united scien-tists, patient advocates, philan-thropists and lawmakers in raisingregional awareness ofAlzheimer’s.

The54 independently runchap-ters have until Jan. 15 to decidewhether they will sign a mergeragreement, which would transfertheir operational authority and fi-nancial oversight to the headquar-ters staff, or continue operating in-dependently but without the na-tionwide organization’s establish-edname recognition.

The consolidation strategy isthe latest in a series of reorganiza-tion efforts among large charitygroups that seek to concentratedecision-making powers in a bid

ALZHEIMER’SCHAPTERHAS MUCHAT STAKEIN SPLITConsolidation sought byU.S. board; S.D. grouphas to decide by Jan. 15BY PAUL SISSON

SEE ALZHEIMER’S • A17

On July 13, 2012, a pharmacytechnician ordered 1,000 hydroco-done pills through the San Diegopharmacyheworked for.

But it was not a sanctioned or-der. The highly addictive drugswere eithermeant for his own con-sumption, or to restock the phar-macy’s supply of pills he had al-ready stolen, concluded the stateBoard of Pharmacy, which ulti-mately revoked his license after hewas convicted of prescription forg-ery andburglary.

The incident helped spark amassive investigation intoMedicalCenter Pharmacy, a collection of adozen family-owned pharmaciesthat operate throughout San Die-

go County.What theU.S. DrugEn-forcement Administration foundwas a system that lacked controlson the distribution of controlledsubstances, shoddy record-keep-ing and laxprocedures ondispens-ing pseudoephedrines, which canbe used to make methampheta-mine, theU.S.Attorney’sOfficean-nounced thismonth.

The investigation also found atotal of 21,000 oxycodone and hy-drocodone pills that were unac-counted for from four San Diegopharmacies over a two-year span.In some instances, the drugs arebelieved tohavebeendelivered toahome used by pill seekers, author-ities said.

The effort to combat the illegalflowofpharmaceuticals fromlegit-imate businesses is intensifying asprescription drug abuse remains atoppublic health concern.

TheDEA, which enforces phar-macycompliancewith federaldrug

DRUG ENFORCEMENT OFPHARMACIES STEPPED UPFeds working to keepaddictive prescriptiondrugs off the streetBY KRISTINA DAVIS

SEE PHARMACIES • A17

Alexander Butterfield knowswhat the first line of his obituarywill say.Hewas theguywho lit thefuse.

On July 16, 1973, with much ofthe nationwatching on television,Butterfield testified before a Sen-ate committee investigating Wa-tergateandrevealedtheexistenceof a secret voice-taping system intheNixonWhiteHouse.Thetapesprovided evidence of the presi-dent’s role in the cover-up and ledtohis resignation.

Now 89, Butterfield lives in LaJolla, wheremore people seem toknow him as the longtime com-panion of Audrey Geisel, Dr.Seuss’ widow, than as an impor-tant figure in one of the nation’smost famouspolitical scandals.

That may change with the

publication of a new book, “TheLastof thePresident’sMen,”writ-tenbyBobWoodward, the legend-ary Washington Post journalistand best-selling author. The twowill be atUCSanDiegoFriday fora sold-out event.

The book uses Butterfield’s

four years in the White House(deputy assistant to the presi-dent) as another window into themotivations andmachinations ofRichard M. Nixon — his keenmindand strategic discipline, butalso his festering hatreds and so-

NIXON TAPES AND THE MAN WHO SPILLEDWoodward book rewindsto Butterfield’s revelationthat upended presidencyBY JOHNWILKENS

Alexander Butterfield served as a deputy aide in the NixonWhite House. He has lived in La Jolla since 1992.

NELVIN C. CEPEDA U-T

SEE BUTTERFIELD • A8

WAVE FOR THE CAMERA

The Dorf family, (from left) Maxwell, 3, Jace, 1, Christina and Barron of San Diego, poses for a photo with Surfin’ Santa at Sea-port Village Saturday. Sites around the county kicked off the holiday season Saturday with uniquely local events. Story, A3.

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A17THE SAN DIEGO UNION-TRIBUNE SUNDAY • NOVEMBER 29, 2015

FROM PAGE ONE

laws, has increased the amountof surprise inspections on busi-nesses in recent years. And thestate board that licenses phar-macists and similar workers isconsidering making it manda-tory for pharmacies to invento-ry their drug supplies once ev-eryquarter tobetter stemthe il-licit flow.

Pharmacies are currently re-quired to report when drugs gomissing. Last year inCalifornia,1 million dosages of pills werereported lost, said Virginia He-rold, executive officer of thestate board. The year before itwasabout 1.5million.

“The problem is controlledsubstances are so valuable onthe street compared to theirvalue in the pharmacy,” Heroldsaid. Some pills go for $30 eachormore, she added.

Employees who divert pillsare either addicted to the drugsthemselves, or just selling themfor themoney, saidDEASuper-visory Special Agent ThomasLenox.

Besides pill diversion, othermajor problems that author-ities look for is poor record-keeping and pharmacists whoare more focused on filling aprescription than doing theirdue diligence to make sure theprescription is legitimate andnot stolen, forged or counter-feit.

“The one thing is, it’s all pa-per,”Lenoxsaidof the stringentrecord-keeping required ofpharmacies. “You either havethe documentation or not. Ifyou don’t have them, you’re inviolation.”

Investigators say the prob-lems are seen just as much atlarge, chain pharmacies as atsmallermom-and-poppharma-cies. The only difference is vol-ume: Missing pills are alsosometimes spotted faster at thelarger chains due tomore-strin-gent corporate policies in place,Herold said.

Earlier this year, CVS Phar-macies and the U.S. Attorney’sOffice entered into a $22millionsettlement after an investiga-tion showed some pharmaciesinFloridawereknowingly fillingillegitimate prescriptions forpainkillers.

Authorities can go after of-fending pharmacies in variousways, from sending a letter ofadmonition to taking away theDEA registration that allowsthem to sell controlled sub-stances to civil enforcement tocriminal charges. The stateboard can also go after licensesof individual workers. Licensedworkers do undergo back-groundchecks,Herold said.

In theMedical Center Phar-macy investigation, authoritieswent the civil enforcementroute, resulting ina$750,000set-tlement lastweek.

The corporation, owned byJoseph and JohnGrasela, oper-ates several storefronts undernames such as Galloway Medi-cal Center Pharmacy, Commu-nity Medical Center PharmacyandMedicalCenterPharmacy.

Besides themissingpills, au-thorities said the pharmaciesalso violated theCombatMeth-amphetamine Epidemic Act,which requires pharmacies tokeep a logbook of sales of cer-tain over-the-counter medica-tions that can be used to makemeth.

The records must includethe buyer and the product pur-chased,andare intendedtopre-vent individuals from buyinglarge quantities of the samedrug.

The pharmacies have hadproblemswiththeboardbefore,Herold said. As part of the set-tlement, the owners haveagreedtoimplementnewinven-tory-control measures, author-ities said.

This case is just themost re-cent example of similar phar-macymisconduct in the county.

Last year, a Hillcrest phar-macist lost her Sixth AvenuePharmacy over allegations offailing to account for 16,000mis-sing oxycodone pills, dispens-ing drugswith invalid or nonex-istent prescriptions, exchang-ing drugs for services or ad-vancing pills to customers,according to theU.S.Attorney’sOffice.

In 2008, federal agents raid-ed three SanDiego pharmacieson allegations that several em-ployees were diverting painkill-ers.

The DEAworks closely withthe pharmacy board to educatepharmacies on drug trends,how to spot theft, and securitymeasures such as surveillancecameras, keeping addictivedrugs under lock and key andkeeping stocks of such painkill-ers low.

kristina.davis@sduniontribune.com(619) 293-1391

PHARMACIESFederal agentssay properrecord-keepinghelpful in fightFROM A1

for greater national influence. TheAmerican Cancer Society recentlycompleted a similar roll-up, for ex-ample, while the American HeartAssociation centralizedmore thanadecadeago.

Supporters of consolidationsaid it can reduce overhead costs,increasequalitycontrolandenableorganizations to take broader andhigher-profile actions — all with-outsacrificing thecapacity tomeetdistinctive needs in one city versusanother.

Opponents said they fear losingthe flexibility that allows them totailor programs to the specificneeds of individual communitiesand pursue their own innovativeideas.

In an Oct. 3 vote taken duringthe association’s national assemb-ly, exactly half of the independentchapters voted against consolida-tionwhile the otherhalf backed it.

JohnNienstedt, secretaryof thelocal Alzheimer’s Associationchapter board, said members arewrestling with concerns abouttheir ability to sustain locally fo-cused programs and about whatthey believe are disturbing finan-cial trends in the headquarters of-fice’s tax statements.

“Given what we’ve seen fromnational, we’re not confident theycould do justice to, or replicate,what we’re doing in San Diego,”Nienstedt said.

By most measures, San Diegohas been doing quite a bit on theanti-Alzheimer’s front during re-cent years.

In 2014, the chapter here waskey tohelping formacoalitionwithlocal research institutions, govern-ment agencies and health provid-ers that launched the Alzheimer’sProject, which has begun fundinglocal research, beefing up supportnetworks for the region’s estimat-ed 150,000 caregivers and raisingpublic consciousness of the dis-ease.

In September, the local affiliatewasoneof 11nationwide towina$1million grant aimed at boostingAlzheimer’s trainingandoutreach.Thegrouphostshundredsof class-es for caregivers each year, servesmore than 30,000 people annuallyand has created a groundbreakingrespite-careprogram inwhich spe-cially trained volunteers spendtime with patients — say, a fewhoursperweek—socaregiverscangetabreather fromtheirphysicallyandemotionally demandingwork.

Pamela Isaacs and her hus-band, Dale Laney, regularly wel-come respite program volunteerBecca Beville into their SanDiegohome. Laney, 83, has been diag-nosed with dementia and hasmildcognitive impairment. He mayhave trouble remembering recentevents and balancing his check-

book, but he had no trouble grasp-ing the ideaof consolidation.

“It’s a big risk. We don’t need tobe fixed,” Laney said during histimewithBeville onWednesday.

Stewart Putnam, chair of thenational board, said efforts are un-der way to create a core set of na-tional guidelines for all chapters tofollow. Those benchmarks, he said,will be based on the best evidenceavailable and will help make surethat no matter which chapter pa-tients or caregivers visit, they willreceive a consistent level of servic-es.

Although the specifics have notbeen worked out, Putnam believesthere will be room for local chap-ters to innovate — as long as theyarealreadyprovidingall of the coreservicesmandated by the nationalheadquarters. Currently, localboards are free to undertakewhat-ever new endeavors they wish aslongastheycan findthevolunteersanddonations tomake it happen.

“If they made a compelling ar-gument, it’s hard forme to imagineit wouldn’t be accepted,” Putnamsaid.

He also said the consolidationwould notmean layoffs for local af-filiates.

Paging through the mergeragreement put together by the na-tional organization, Mary Ball,chief executive of the chapter cov-ering San Diego and Imperialcounties, said there is not muchblack-and-white language thatspecifies how affiliates would beable to preserve their programs orstart newones.

“Localboardswillhave input in-to things, but there is no authority.We want to continue to serve thecommunity and build programs,”Ball said.

“The need in San Diego is sogreat, and our board is concernedabout all of the decisions beingmade inChicago.”

Financial debateIn recent months, affiliates

have been scrutinizing their na-tional parent organization’s tax fil-ings. Some have noted that theheadquarters group’s spending onresearch grants has dropped from$28million in 2007 to $13million in2013. They also have complainedabout the compensation for chiefexecutive Harry Johns, which to-taled $2.8million in 2012. And theyhave criticized the growth of thenational staff ’s payroll — from $18million in 2005 to more than $45million in 2013.

Local chapters send 40 percentof all undesignated donations tothenational coffers.Donorscanre-quest that 100 percent of their con-tributions go to local causes, orthey can specify that all of theirmoneybededicated toaparticularprogramor service.

“I am outraged when I see theamount of money that leaves SanDiego and goes to the national or-ganization. I see that their payrollhas increased substantially andthe money into research has de-creased substantially,” said SanDiego County Supervisor DianneJacob, who has called for greaterawareness, coordination and re-sources for battling Alzheimer’sdisease.

“As faras I’mconcerned, thena-tional Alzheimer’s Associationcould take a page out of the play-book of our local chapter. If the lo-cal board makes the decision tobreak away, they have my whole-hearted support,” she added.

Putnam said several factorshave influenced the national orga-nization’s numbers.

Forone thing,he said, thehead-quarters teamhashad to take overoperations for nearly 30 chapterssince2005.Thatmeans incorporat-ing into its budget millions of dol-lars for salaries, travel expensesand other costs previously borneby those affiliates.

In addition, he said the GreatRecession curtailed the public’swillingness to donate money forAlzheimer’s research, but thatthose contributions have startedto rebound.

Thenational grouphasbudget-ed$19million forresearchgrants inthe current year.

As for the chief executive’s sala-ry, Putnam said that was based onthe recommendations of outsideexperts on compensation for non-profits’ top leaders.

“Weuse benchmarks fromcom-pensation consultants, and we’recurrently well below the 90th per-centile for executive compensa-tion,” Putnamsaid.

He said the parent organiza-tion’s current leaders aremaking adifference. For instance, Alzheim-er’s research funding from the Na-

tional Institutes of Health, the na-tion’s dominant grant giver for thelife sciences, is expected to hit $950million next year if the current fed-eral spending plan is approved.That’s up from $450 million a fewyears ago.

“These are all activities andoutcomes that I believe are the re-sult of our senior staff in Chicago,and I believe in the work that oursenior team has done,” Putnamsaid, adding that he believes localchapters’ efforts are key to the suc-cess aswell.

Centralization trendIn many ways, the consolida-

tion movement among nonprofitorganizations mirrors the mergertrends seen in industry. For bothworlds, centralization of far-flung,often highly variable operationscanbringabout financial savings.

JohnGraham,chiefexecutiveofthe American Society of Associ-ation Executives, said he was run-ning theNationalDiabetesAssoci-ation when it consolidated in themid-1990s.

“In the first year, we saved 20percent in administrative coststhat could go back toward pro-grams,” he said. “We were able toeliminate redundancy in terms ofauditing and tax filing and otherthings that you have to duplicatefor every single chapter.”

There are also advantages inbeing able to undertake a new ini-tiative and know that it will be im-plemented nationwide, he said.Hestressed that this aspect is espe-cially important for public-aware-ness campaigns, where a singlemessage, repeated in thesamewayacross every chapter, can achieve alarger effect.

And consolidation can attractlarger corporate donors that lendtheir support only to prominent,nationwide initiatives.

“If you take a check froma com-pany and you promise you’re goingto use it a certain way, when you’rein a federated system, nationalcan’t guarantee that the money isgoing to be used the same way inevery location,”Grahamsaid.

But he added that local chap-ters are correct in their concernsabout maintaining the ability todevelop tailored programs thatserve distinctive needs in eachcommunity.

“Agoodquestion that shouldbeasked is whether the strategy forlocal programming you’re execut-ing in San Diego is 90 percentaligned with the national strate-gy,”Grahamsaid.

The SanDiego chapter’s boardhas not said when it would cast itsfinal vote on the consolidationagreement.

paul.sisson@sduniontribune.com(619) 293-1850 • Twitter: @paulsisson

Becca Beville, a respite program volunteer with the San Diego chapter of the Alzheimer’s Association, helps Dale Laney, 83, whohas dementia, fix his photo album with tape while in his home in San Diego.

HAYNE PALMOUR IV U-T

ALZHEIMER’S • Focus on national group tax filingsFROM A1

By the numbers

In 2015, the Alzheimer’s Associ-ation chapter serving San Diegoand Imperial counties said it has:

• Served more than 30,000 peo-ple

• Answered more than 10,500helpline calls

• Led 36 family and friend sup-port groups attended by 4,800people

• Conducted 250 classes, work-shops and conferences

• Provided more than 2,500respite hours for caregivers

• Conducted 500 family careconsultations

WASHINGTONFirst, the good news: Twenty-

two years after Congress orderedtheNational InstitutesofHealthtoinclude all women in the clinicaltrials it funds, women make upmore thanhalf theparticipants.

Nowthebadnews:Accordingtoanewreport fromtheGovernmentAccountability Office, NIH stillisn’t able to tell Congress—or any-oneelse—whether researchersareexaminingoutcomesbysextosee ifmenandwomenareaffecteddiffer-entlybywhat’s being tested.Scien-tistsarerequiredtoanalyzeresultsby gender in most cases, but NIHhas no central process for collect-ing the information or making itavailable.

Yet such differences are the rea-

son to include a mix of men andwomen in clinical trials. A drug orother treatment that works for aman might be less effective for awoman,orevenharmher.Forexam-ple, in 2013, the Food andDrug Ad-ministration lowered the recom-mended dose for the popular sleep-ingpillAmbienafter itbecameclearthat the drug took longer to leavewomen’s systems and could pose adanger thenextmorning.

The GAO says that NIH can’tassure Congress that it’s support-ing research that can “shape im-proved medical practice for bothwomen and men.” NIH reportsspending $30billion a year onmed-ical research. Most of the moneyfunds grants to more than 300,000researchers at about 2,500medicalschools, universities and other re-search facilities. The agency also

supports projects by its own scien-tists, most of them at NIH’s Be-thesda,Md., campus.

This is not the first time theGAO has criticized NIH for its im-plementation of the 1993mandatethat women be included in re-search trials. In 2000, it said theagency needed to do a better jobensuring “that certain clinicaltrials be designed and carried outtopermit valid analysis by sex.”

NIH officials, reacting to thenewreport, said improvementsarein theworks, but theydidnot spec-ify a timetable. The agency has 60days to formally respond to theGAO.

Meanwhile, thosewho fought torequire parity in clinical trials havebeen left sputtering.

“It’s just very frustrating,” saidPatricia Schroeder, a Democrat

who represented Colorado in theU.S.House.

“It remindsme of when you askyour children to move the clothesfrom thewasher to the dryer. Thenyougobackandtheclothesarestillwet, and they say, ‘Well, you didn’ttell me to turn the dryer on,’” shesaid.

Schroeder said she became in-terested in the subject in the early1990s, when studies came outshowing that a daily aspirin couldprevent heart attacks— andwhenshe learned that all the test sub-jects had been male. “They didn’tevenuse female rats,” she said.

Today, there is growingscientif-ic evidence of just how biologicallydifferent men and women are, aswell as how differently they some-times react to drugs and othermedical interventions.

RULE ON WOMEN IN CLINICAL TRIALS FALLS SHORTNIH can’t tell if researchers are examining outcomes by sex to see if men and women are affected differentlyKAISER HEALTH NEWS