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Transcripts

December 1, 2004

Host: Michael Grant
Topics:
· Jail expansion;
· New heart treatment
In-Studio Guests:
· Don Stapley, Maricopa County Supervisor;
· Dr. Ted Dietrich, medical director, Arizona Heart Institute and the Arizona Heart Hospital


>> Michael Grant:
Tonight on "Horizon," a promising new heart treatment makes progress. We'll talk about the amazing medical technology that's making it possible. Plus, the largest criminal justice construction project in the country is now nearly complete. We'll talk about the massive Maricopa County jail expansion program. That's next on "Horizon."

>> Michael Grant:
Good evening. I'm Michael Grant. Those stories in a moment. First, access to flu vaccine got a little easier for some people in Maricopa County. Maricopa County board of supervisors today okaying the purchase of 22,000 doses of adult flu vaccine. Those vaccines will be administered only to high risk Maricopa County residents who submitted their names to the county health department and have not been able to get a flu shot through private providers.

>>> Michael Grant:
The Lower Buckeye jail, the fourth Avenue jail, the new Durango juvenile facility, they are all part of the $522 million, 3.3 million square foot Maricopa County jail expansion program. That program funded by a voter approved .2 cent sales tax. In 1998 Maricopa County voters approved that tax to pay for jail construction. In 2002 voters extended the tax to provide for operation of the new jails. The tax is designed to generate $900 million. In a moment we'll talk about those facilities and the challenges that come with them. First, producer Merry Lucero tells us more about the Lower Buckeye jail.

>> Merry Lucero:
With more than 9,000 inmates, the Maricopa County jail system is one of the largest in the nation. Staffing is a real challenge, but an expansion program under way since 1999 is now in the final leg. The official opening of the Lower Buckeye jail in Phoenix marks the more than half billion dollar project.

>> All right! [ APPLAUSE ]

>> Mary Rose Wilcox:
We came one a plan. We went out to our taxpayers in 1998, and we got 74% assurance from the taxpayers, you are doing the right thing, you are planning for the future. We commenced on our program and what you see today in the completion of the Lower Buckeye jail is the completion of our jail program.

>> Merry Lucero:
This jail will hold nearly 2500 inmates. Education and rehabilitation programs, a video visitation unit, medical facility, a huge food factory and...An enormous laundry plant serving all the jails are among the features of the facility. All designed to accommodate expected future growth.

>> Don Stapley:
Not only will there be additional needs in the future as we grow in this county and we all know the growth rising and it's coming at record paces now and will continue to come but we need to be prepared 10 years from now and 20 years from now to manage our public safety issues.

>> Merry Lucero:
Hiring officers to staff and operate the new jails is the biggest challenge.

>> Joe Arpaio:
Now the board of supervisors and Dave Smith were nice enough to raise the salaries to $31,000, and that helps the recruiting, but it's still a tough job, it's tough working in the jails, but that's the challenge. We have to hire 1400 officers, and we're going to do everything we can to hire those officers so these jails can get opened. This jail is not going to be open in January. We don't have the officers right now, but we're working on it.

>> Merry Lucero:
The expansion plan includes other adult and juvenile facilities, all delivered on time and under budget according to Maricopa County official.

>> Michael Grant:
Speaking of county officials, joining me now is Maricopa County supervisor Don Stapley. Don, good to see you again.

>> Don Stapley:
Thank you, Michael.

>> Michael Grant:
Let's talk about these facilities, because I know I'm a little fuzzy on precisely what they do and those kinds of things. We just saw portions of Lower Buckeye. What it's prime function in the overall scheme of thing?

>> Don Stapley:
It is the single largest jail in terms of capacity with the capacity of about 2400-plus inmates. It is adjacent to the Towers jail, an existing facility. The Estrella jail is there as well as in that large acreage the county has down on Lower Buckeye road that we call the Durango complex, tent city and the new juvenile facilities and the courts for the juvenile facilities that are adjacent to the juvenile facilities. So there's a whole range of county public safety facilities. We also dedicated a year ago the new county sheriff's training facility, which is a state of the art facility that he has been running new recruits through and training to house -- man some of these new facilities that we're opening as we move our inmates around.

>> Michael Grant: There's also a juvenile facility out in Mesa as well?

>> Don Stapley: That's correct. And we added to that, the new juvenile courts, office space for the juvenile folks and probation and courts as well as an additional number of cells.

>> Michael Grant:
Now, you mentioned Durango. Most people, I think, associate juvenile facility with that.

>> Don Stapley:
Because the courts are there.

>> Michael Grant: Right.

>> Don Stapley:
All the juvenile courts.

>>Michael Grant:
But it's got -- this facility has other functions as well, correct?

>> Don Stapley:
Yes, that's correct. There are other buildings there. The county highway department is housed down there as well as the flood control district, all the engineers and the facilities maintenance folks who operate those out of those agencies are down in that Durango complex also. But if you just look at the public safety part of it, there's everything from juveniles, probation department offices. A lot of the officers that are housed there and operate out of that facility as well as the regular adult inmates and the various jails that are down there, and they have different capacities and different -- you know, different functions. We also have the downtown jails where -- but the tent city jails, for instance, out at Durango and those other facilities are more for the less serious offenders. And those who are not in the middle of a trial or have to be arraigned and have to be in and out of court. Those that do that or downtown.

>> Michael Grant:
I was going to say, is that the primary function of the 4th Avenue jail, is those waiting trial and also those most serious offenders at the highest security level?

>> Don Stapley:
That's correct. And they are, in fact, by tunnel and secured elevators transported back and forth from the Madison Street jail and the new 4th Avenue jail that's being opened now to the courts. So that they're secure and not out in the public being moved back and forth between the courtroom and their jail cells.

>> Michael Grant:
From a technological standpoint, though, this has -- aren't there some enhancements, also on the video capabilities in terms of you can do arraignments by video and other thing so you don't have to physically transport the prisoner?

>> Don Stapley:
Everything we did in this no frills jail was done with that in mind, less movement of inmates, less cost to the county. We have video arraignments. Now in the new courtrooms that are right there in the new 4th Avenue jail, additionally -- those are operated 24 hours a day, as well as visitation. We're now moving into the new visitation by video -- or by teleconferencing so that folks don't have to come spend the whole day waiting to visit an inmate. They can make an appointment, get on the videoconference system and visit with their family member who may be an inmate at the jail.

>> Michael Grant:
Other sort of high-tech security enhancements? I understand there's some iris scan technology involved in some of these facilities?

>> Don Stapley:
With the number of inmates that the sheriff handles and all of these facilities, identification is a major issue. One that is preeminent, and all the technology that's there today, we're trying to implement the best ideas that are out there and this iris scan is one of those. Obviously the identification of inmates coming in and going through the system and being released out at the appropriate times is key and we don't want to release anybody we shouldn't. So, yeah, it's really interesting. They're doing some fascinating thing in that area. All these new facilities have all that technology in place.

>> Michael Grant:
All right. Looking ahead, you made the comment before we came on the air that you have been on the board of supervisors' 10 years and the population of the county has increased a million people. How far does this jail enhancement program carry us?

>> Don Stapley:
It's a continual problem with the amount of growth that we are seeing in this county with 120,000 in-migration every year approximately and growing. So it's a constant concern both in the criminal justice system as well as the courts system where we fund the courts and the real estate for the new courts, and we will be looking and are in the process of building new courts now in regional locations.

>> Michael Grant:
I was going to say, get some more satellite facilities.

>> Don Stapley:
Exactly. But, yeah, it's a real concern, and while we will have the capacity to manage the population we have today. We'll quickly outgrow it and so we're going to turn immediately to remodeling of the older facilities and fortunately the voters passed in 2000 the continuation of the jail tax for another 20 years. That .2 cents sales tax will enable the county to do the remodeling, to bring in additional technologies, programs. And frankly we're working very hard at programs that make sense to move population, especially populations like the severely mentally ill. Who we see rotating through the jail on a regular basis, because we don't have facilities in the community that we need to house them and to treat them adequately.

>> Michael Grant:
In many respects the jails become a sort of de facto mental health institution. With people who - SMI's (Seriously Mentally Ill's) oftentimes are not necessarily very dangerous. They frequently are simply committing crimes to have a warm place to stay and a meal?

>> Don Stapley:
And a meal. And that is a problem. So we have assembled all of the players, from the prosecutor's office, the courts, judges, administrators, probation officers, county official, the sheriff himself has been participating in a working group. We have been meeting every two weeks for the last few months. Susan Gerard from the governor's office has come down and met with us. And we have the private sector partners there, the value option folks. We're seeing a lot of positive changes in coming together with better system and correlation of the functions of all of these various players. I think that's the key. Incremental progress is the name of the game in this industry, particularly when you're dealing with the severely mentally ill. We know that we have 15 to 20% in that range of those incarcerated in our jail system who are severely mentally ill, who are diagnosed either before or when they get there or after, who need medication, who need proper treatment. The jail is not the right place to be treating them, if they're in on a nonviolent offense and there's an option out there. So we're trying to make those options available.

>> Michael Grant:
All right. What you've built 3.3 million square feet of jail space and there was nobody to staff it, what's the problem there?

>> Don Stapley: Well, we have done everything we can do as a county and a board of supervisors. We've given more than adequate funding in my opinion and the opinion of the county budget and resource folks to the Sheriff's Department. I think it's the competition in the marketplace to attract folks into this career line of criminal justice. It isn't always -- competing with the state department of corrections, competing for officers with police agencies all around the Valley. Everyone is growing and so they're all competing for police officers and folks who can work in the system, and the system is a complex system. But, yeah, most of the competition that we're head to head with is with the state department of corrections, and we see -- they have needs, too, and we want to work together. So we're working as hard as we can.

>> Michael Grant:
That's a lot of people --

>> Don Stapley:
We're actually recruiting out of state and all over country to bring folks in to train and bring them in to man these facilities.

>> Michael Grant:
Don Stapley, appreciate the background.

>> Don Stapley:
Thank you very much.

>> Michael Grant:
Have a good holiday season. Minimally invasive surgical procedures becoming more prevalent these days. Technology is especially beneficial in cardiovascular medicine. Just yesterday in Phoenix a 51-year-old heart attack victim became the first patient in the United States to receive a new procedure that could revolutionize treatment for congestive heart failure caused by heart attack. In a moment we'll talk with Dr. Ted Dietrich about yesterday's event. First, Merry Lucero tells us more about the procedure. Note to viewers, the story contains some graphic video of surgery.

>> Merry Lucero:
Since his heart attack, John Andrus has had extreme fatigue.

>> John Andrus:
I haven't been able to go to work. I get short of breath with just minimal exertion. No longer can do chores around my house.

>> Merry Lucero:
Andrus is the first patient in the nation to undergo a new experimental procedure to repair his damaged heart. The new procedure at the Arizona heart institute and hospital in Phoenix is called myoblast cell transplantation via catheter. The treatment could one day eliminate the need for heart transplants.

>> Nabil Dib:
The technology was extremely important because it can be applied on a high-risk patients, patients who cannot undergo bypass surgery and we can also repeat the treatment if needed.

>> Merry Lucero:
Myoblast cell transplantation takes a small section of muscle from the thigh, those cells are then cultured in a lab to make millions of new cells. Skeletal muscle cells are used because they can regenerate, unlike damaged heart muscle.

>> Nabil Dib:
We were definitely able to convert a scar tissue and permanent damage caused by heart attack to a normal cell.

>> Merry Lucero:
Until now these newly grown cells were injected into the heart during bypass surgery. Now the surgery can be done without opening the chest.

>> Nabil Dib:
No, definitely we are going to cover the scar tissue.

>> Merry Lucero:
Using a revolutionary three D guidance system, myoblast cells can be injected through the catheter into the exact location of the damage in the heart.

>> Nabil Dib:
We did not expect the heart to be that large. Literally there is only a small piece of the heart moving at the base in the blue part and that's why even the catheter is a little difficult to move but there was no difficulty at all. Everything went very smooth.

>> Michael Grant:
Joining me now Dr. Ted Dietrich. He is the medical director of the Arizona heart institute and the Arizona heart hospital. Pretty significant day yesterday.

>> Ted Dietrich:
It was a very exciting day. We were working about four years on this. It took that long to do all the pre-clinical work, learning about the technology, and then, of course, with the FDA. Getting the protocol and being awarded the only protocol in the United States for this catheter-based delivery of these myoblasts using this special NOGA mapping system we saw on there.

>> Michael Grant:
I want to talk about the delivery system in just a second. In fact we've got some video you can describe for the viewers. First I want to go back to the procedure itself because it still fascinates me. I think you and I talked about it for the first time about a year ago. But this is literally taking cells from the thigh, culturing them and delivering them into the heart to repair the heart muscle?

>> Ted Dietrich:
That's right. When you have a heart attack, the heart muscle cells have no ability to regenerate. What happens is the heart, which has that sort of football appearance, it will dilate up, almost like a volleyball or basketball appearance, and that's what the heart failure is. We call it remodeling, but it's a negative thing. It's not what you like to have happen. When you injure your biceps, it's tender for a few days, but those cells, those muscle cells are capable of regenerating. So after a week or so, it feels fine. So the concept is to take these cells that have the ability to regenerate and place them in an area, which is in this case the heart, where there's need for these cells to begin to contract. We've actually shown in the laboratory that these cells in synchrony can actually beat in synchrony. It's the most exciting thing to see under the microscope.

>> Michael Grant:
Of course, since it's coming from your own body, you don't have the rejection phenomena that you would have if you were having a transplant type situation?

>> Ted Dietrich:
No, it eliminates all those kind of things. We don't have to use any special drugs. The patient we did yesterday was discharged from the hospital at noon today.

>> Michael Grant:
Remarkable.

>> Ted Dietrich:
Isn't it? Incredible, really. And on the same medication he came in the hospital. So nothing special has to be given to him in terms of control inflammation or any kind of reaction between the tissue and so forth. He's on the same medication as when he came in.

>> Michael Grant:
He was a doc?

>> Ted Dietrich:
He is he was a young doctor, only 50s. He had this heart attack -- he's a drummer, very, very good drummer. And playing the blues kind of music, and he actually had a huge myocardial infarction when he was playing the drums, and the first time I met him, he said, Doctor, can I ever go back to playing the drums again? I kept joking; we're going to get you back drumming.

>> Michael Grant:
All right. Well, let's shift to the delivery system itself and we've got some video that I think can help illustrate this, but explain to us how the THREE-D technology works.

>> Ted Dietrich:
Here it is right now. Is that on right now? You see the red? Look at red and look at green. And this is done with a catheter inside the heart, and it's measuring really electrical potential and in the scar tissue, the orange or red area, that means that there's a very low electrical potential because that heart is very damaged. Now look at the two black spots, actually three black spots. Those are the areas that in our patient yesterday Dr. Dib injected the transplant myoblast cells. And that was predetermined by this mapping system and that's what the FDA has approved for us to use this mapping system in order to select the areas of the heart muscle that are damaged, not contracting, and need the cells. So it's a very sophisticated method. Now, see only three black dots here?

>> Michael Grant:
Right.

>> Ted Dietrich:
That's because we injected 10 million cells at each black dot. We're going to escalate this in patients. We're going to be doing 12 patients in this first protocol. We're going to escalate this up to 300 million cells. When we end up, there will be a lot of black dots mapped and we'll be able to increase the number of cells. This is called a safety trial, because we want to be sure that as you increase and escalate the dose that it will be all right, it will be tolerated.

>> Michael Grant:
Obviously, I assume, the more cells you can inject the more rapid the recovery, more complete the recovery?

>> Ted Dietrich:
More complete. There's a lot of red and orange on this mapping that you would like to inject cells. One of the interesting questions at the end of this procedure we were talking about, and people were asking us, can this doctor a year from now if he needs come back and have a re-injection of cells? The answer is yes. Obviously that's a really important thing because with the technique you saw with the needle and the open chest and so forth, that was a one-shot deal. But this one we do have opportunity to grow more cells and inject more.

>> Michael Grant:
Of course, the other fascinating aspect about this is it's not open-heart surgery, it is the microsurgery, very, very little disturbance and obviously much better for the patient.

>> Ted Dietrich:
This was no more yesterday than like a diagnostic cauterization that thousands and thousands of people have every year in the United States, probably millions of people have. We went through the groin, no incision. The catheter was passed up and passed across the valve into the pumping chamber. And then the needle -- the catheter went into the myocardium, the heart muscle, a little needle comes out, about 3 millimeters, 4 millimeters, 5 millimeters and the cells are passed through that needle, the transplant cells, into heart muscle.

>> Michael Grant:
And how is the surgeon accomplishing this? Obviously he's doing it remotely. Is he watching a television screen, a computer screen that kind -- to give him guidance on where to go for the dots?

>> Ted Dietrich:
Right. What you see is -- there are really two panels you're looking at and the one panel is the color panel you saw over here with the black dots. And the other panel is the fluoroscopic image of the catheter inside the heart. As you look at these two, that's how you do the guidance. On the -- you can't see the right-hand panel in the upper, it doesn't show so well, but that's the catheter inside the heart. As you operate this, you can move that catheter. As a control -- it has a control you do outside and you can move that around and wherever you want to pinpoint for the injection you can do that. So it's very, very sophisticated in terms of the guiding and extremely accurate, extremely accurate.

>> Michael Grant:
I seem to recall that it was accurate within thousandths of a millimeter?

>> Ted Dietrich:
It's very, very accurate, because once you have localized it electrically, then you just take your catheter, look at it and put it in.

>> Michael Grant:
And consistent with what you said about the patient going home today, performed under a local? There's not a general anesthesia --

>> Ted Dietrich:
We talked to the patient throughout the procedure. In fact at the end, I came in and asked if he had done any drumming during the procedure. He was laughing and --

>> Michael Grant:
On the NOGA mapping system, what exactly does NOGA stand for?

>> Ted Dietrich:
Somebody asked me that yesterday and I don't know whether it's Japanese name or what it is. I am going to have to find the answer to that.

>> Michael Grant:
So it's not an acronym?

>> Ted Dietrich:
It may be. It may be. But we've just used NOGA for so long I don't know.

>> Michael Grant:
You mentioned the dozen or so procedures involved here. Is this -- is this a test procedure by the heart institute itself or is it part of the FDA approval process where you go and perform a certain limited number and obviously report on the results and those kinds of things?

>> Ted Dietrich:
It's the latter. This is an investigative project, and the Arizona heart institute was awarded what we call an I.N.D., and that means the FDA gives you the permission. An I.N.D. because this is -- they call it -- it's like a drug, any -- biologicals are under I.N.D.'s and they awarded us the protocol to randomize 24 patients. So what this means is 24 patients will be analyzed for the need for the procedure, and then it's really -- it's like drawing a straw, and this particular patient yesterday randomized to the treatment arm with the myoblasts. The next one may also randomize there or one say, no, you're going to be treated with classical medical treatment. And the reason for this is, we as scientists and the FDA as the persons who are really behind this. Want to be sure that at the end what we have done with the treatment arm using the myoblast has shown an incremental increase in contraction, loss of symptoms, longevity and so forth.

>> Michael Grant:
Okay. Dr. Ted Dietrich, it is a fascinating thing and we appreciate your description of it.

>> Ted Dietrich:
We'll see you again later.

>> Michael Grant:
To see transcripts of "Horizon," find out about upcoming topics, visit the website. The address is www.azpbs.org. Click on "Horizon," follow the links.

>>> Michael Sauceda:
Proposition 200 has been put on hold by a federal judge. That means Governor Janet Napolitano was unable to officially proclaim the anti-illegal immigrant measure the law of the land. Plus the governor weighs in on President Bush's guest worker program. Also we'll tell you about new pipeline regulations aim at preventing another fuel crisis. That's Thursday at 7:00 on "Horizon."

>> Michael Grant:
And tomorrow following "Horizon" stay tuned for "Horizonte," the program coming Arizona issues through a Hispanic lens. On Friday, journalists will join me to talk about the week's stuff. Thank you very much for joining us this evening. I'm Michael Grant. Have a great one. Good night.

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