IP to Grant Oversight: Study Calls for Host of Improvements at California Stem Cell Agency

The $3 billion California stem cell agency is laboring under a range of problems that include protection of its intellectual property and management of its nearly 500 grants plus an inadequate ability to track its own performance, a seven-month study said yesterday.

The performance audit by the Moss Adams accounting firm of Seattle, Wash., made 27 recommendations for improvements, including more effort to ease strain connected to the agency's controversial dual executive arrangement. The study said that the nearly eight-year-old agency has many "opportunities" to "enhance performance reporting and decision making, strengthen effectiveness and efficiency, retain essential human resources and leverage technology."

In response to the report, the stem cell agency said, "(M)anagement concurs with the findings and recommendations....The recommendations are focused and constructive. CIRM is already implementing many of these recommendations, and we will be investigating the others in the coming months."

The performance audit is the first ever made of the California Institute for Regenerative Medicine. The audit is required by state law and was commissioned by the agency at a cost of $234,944. For years, the agency for years had resisted calls for a performance audit until it sought legislative approval in 2010 for removal of a 50-person cap on its staff. Originally, the performance audit legislation would have put the study in the hands of the only state body charged with oversight of the agency and its board. CIRM, however, was successful in lobbying to have that provision removed.

The 54-page report identified once again a number of issues that have troubled the stem cell agency for some years. Moss made 12 top priority recommendations, many of which dealt with information technology and grants management. Many of the recommendations focused on providing better and faster information on performance outcomes, which the audit said has been slow to come and hard to generate.

The report said,

"Key performance information is not readily available to CIRM leadership and other stakeholders on an ongoing basis. CIRM board members and senior management do not receive regularly updated, enterprise-level performance information. The ability to evaluate performance against strategic goals is critical to effective leadership and program monitoring, evaluation, and reporting."

The audit stated,

"CIRM does not effectively communicate outcome-based performance internally or externally. As such, CIRM does not focus on performance metrics as part of its (staff) meeting process."

The report additionally said,

"CIRM does not have an integrated financial information system....The use of spreadsheets results in labor intensive processes to generate reports and respond to information inquiries, since data must be pulled from multiple spreadsheets, a process that may be prone to error. ...Spreadsheets are not linked to each other or a master report. CIRM does not have a comprehensive list of spreadsheets or instructions for how to maintain the files or generate reports from them."

Moss Adams said that CIRM needed to do a better job in "bond forecasting," a reference to the California state bonds that finance virtually every aspect of the agency's operations. CIRM directors were caught by surprise a few years ago when they suddenly learned the agency was up against a major cash crunch.

Some of the recommendations will require more work from CIRM grantees and their technology transfer offices in an effort to track intellectual property and grant outcomes. The report also recommended a speed-up in CIRM's review of progress reports from grant recipients, which have been lagging completion by several months.

The dual executive arrangement, which was written into law by Prop. 71, has troubled CIRM since nearly day one. CIRM's own external review panel also identified it as problem two years ago. The executive structure is virtually impossible to change because of the political difficulty in making alterations in the ballot initiative.

Moss-Adams said,

"The working relationship between the chairman’s office and the president’s office has vastly improved over the past year, but there are still opportunities for improvement."

The performance audit recommended,

"Make every effort to manage and operate as one cohesive organization, while recognizing the varying roles, responsibilities, and authorities that exist with positions in both the chairman’s office and president’s office."

One of the top 12 recommendations involved CIRM's public relations/communications effort. CIRM Chairman J.T. Thomas told directors last June that the agency was in a "communications war."

Moss-Adams said,

"CIRM does not have a communication plan, and there is lack of clarity on how to address mission-based communication to CIRM’s various target audiences, especially the general public....The best way to facilitate results-based communications is to 1) quantify goals and outcomes in CIRM’s strategic plan and 2) report on achievement of those goals and outcomes by enhancing CIRM’s annual report with additional performance-based information."

Another performance assessment of the stem cell agency is also underway. It is being conducted by the prestigious Institute of Medicine and is costing CIRM $700,000. That report is expected this fall.

CIRM's board of directors is scheduled to consider the Moss Adams report at its meeting May 24.

Our take: While the findings and recommendations of the performance audit were delicately worded in many cases, they brought out issues that need to be addressed, many of which have been around for a great deal of time. At their meeting next week, CIRM directors should act very directly on the recommendations. They can do that by requiring a written report each month from CIRM Chairman J.T. Thomas and CIRM President Alan Trounson on the specific steps that they are taking to implement the performance audit's recommendations. Otherwise, the inevitable drift will set in.

Two State Agencies Looking Into CIRM Tomorrow and Friday

This is a busy week for the California stem cell agency, but not all the action is in Burlingame where CIRM board convenes tonight for a preliminary round, followed by the main event tomorrow.

Two other state bodies will be looking at CIRM at meetings in Los Angeles and Sacramento. One of the panels is the only entity specifically charged with oversight of the $3 billion agency's finances. That is the Citizens Financial Accountability Oversight Committee(CFAOC), which convenes in Los Angeles on Friday. The second group is the state's good government agency, the Little Hoover Commission, which recommended in 2009 a number of changes at CIRM to improve its operations and transparency.

On tap for the CFAOC is a look at implementation of the first-ever law passed dealing with the Golden State's unprecedented $3 billion research effort. The measure, SB1064, removes a 50-person cap on the agency's staff, allows for compensation of up to $15,000 a year for some patient advocates serving on the CIRM board and requires the agency to commission the first-ever performance audit of its program.

The CFAOC is chaired by the state's top fiscal officer, Controller John Chiang. An early version of SB1064 contained a provision, supported by Chiang, that would have had the CFAOC commission the performance audit. But CIRM successfully lobbied to take the audit out of the hands of the CFAOC. You can expect questions to be raised during the Friday meeting about the progress of CIRM on setting up its audit.

Also likely to come up is the subject of staffing, particularly in connection with sweeping recommendations by CIRM's external review that would seem to require substantial additional staff.

A new member of the CFAOC, Jim Kovach, former head of the Buck Institute, is expected to be sworn in. Kovach was appointed by CIRM Chairman Robert Klein, whose last appointee to the panel attended one meeting last January and then quit. Kovach is a physician, a lawyer and former professional football player with the San Francisco 49ers and the New Orleans Saints.

You can find a host of budget and other financial documents related to the meeting on the CFAOC website.

The agenda for the Little Hoover Commission says only that a "scoping memo" involving CIRM will be presented to the full commission tomorrow afternoon in Sacramento. The commission staff has not elaborated on just exactly what that means although it comes under the subject of "schedule/project selection."

As for tonight's meeting of the CIRM directors' Governance Subcommittee, you can read about that here. The full board meeting that begins tomorrow morning was subject as well of a number of earlier piecesl on the California Stem Cell Report. (See here, here, here, here and here.) For those of you following those items, the agency still has not posted any information about the cost or scope of its proposal to pay for the attendance of perhaps hundreds of persons at an international stem cell conference in Toronto in June.

Legislation to Give CIRM More Employees Goes to Governor

Legislation to remove the 50 person cap on the size of the staff of the California stem cell agency won final legislative approval yesterday.

The measure, SB 1064 by Sen. Elaine Kontaminas Alquist, D-San Jose, is now on its way to the governor's desk where it is expected to be signed. The bill would go into effect at the beginning of the year.

The limit on the number of employees was written into law by the ballot initiative, Prop. 71, that created the $3 billion research effort. The cap was redundant since the agency has a legal limit on operational expenses. The restriction ultimately hampered the agency's ability to perform its work.

In addition to removing the staffing cap, the compromise bill would require performance audits, albeit limited, of CIRM beginning next year at the agency's expense, according to the latest state Senate analysis of the measure. It also allows the agency to pay the patient advocates who serve on its board up to $15,000 a year. The CIRM board has already acted to do so.

CIRM backed the bill after it was significantly watered down. Gone are many reforms recommended by the Little Hoover Commission, the state's good government agency, along with provisions sought by the state's top fiscal officer, Controller John Chiang.

They include elimination of a performance audit by a special, Prop. 71-created, financial oversight committee chaired by Chiang. Instead CIRM itself would pay ($400,000 plus) for the audit and control its scope. CIRM already has written into the bill a stipulation that the audit does not have to include “a review of scientific performance.”

The staff analysis of the bill that was presented yesterday when it cleared the Senate floor on a 35-0 vote said,

“The author's office states that, while stem cell research is an important and laudable goal, concerns about transparency, accountability and oversight raised by the public, the independent Citizen's Financial Accountability Oversight Committee, the Little Hoover Commission, and the state controller detract from CIRM's ability to provide grants and loans in the most efficient way.

“These concerns divert resources and attention from CIRM's ability to maximize voter's investment in stem cell sciences. In 2009 alone, CIRM spent $1.5 million in external contracts for legal services, lobbying, public relations and communications costs to improve its public image, which is a duplication of existing internal resources. Given that the debt from the bonds is serviced from the (state's) general fund, concern about CIRM's lack of transparency and accountability gains greater significance during these challenging fiscal times. By addressing many of these public concerns, this bill enhances CIRM's ability to make grants and loans, and the removal of such barriers frees up resources that were previously diverted from the grant and loan programs.”

According to the analysis, the CIRM performance audits would cover “programs, functions, operations, management systems, and policies and procedures to assess whether it is achieving economy, efficiency, and effectiveness in the employment of available resources.”

The analysis also said it would be at least 10 years before CIRM is likely to generate revenue for the state through the results of the research it finances. The analysis said,

“Due to the time it takes research to be done and a product to be commercialized, the general fund is unlikely to see significant revenue until about 2020. The amount of revenues is unknown and depends on the number and types of drugs and technologies that are commercialized as well as their commercial success.”

Pay Proposal for Patient Advocates on CIRM Board

The California stem cell agency is proposing to pay the 10 patient advocate members on its 29-member board of directors up to $15,000 a year for work performed in connection with their responsibilities for CIRM.

The move would implement some provisions of legislation that also removes the 50 person cap on the size of the CIRM staff. That legislation (SB1064) seems likely to be enacted this year. It is up for consideration in Sacamento next Wednesday by the Assembly Appropriations Committee.

Both the cap and the problem being addressed by the patient advocate proposal stem from Prop. 71, the ballot initiative that created CIRM and also wrote variety of minutia into law. The proposition requires a super-majority (65 percent) for a CIRM governing board quorum, which is based on the number of board members eligible to vote. Since many of the board members have conflicts of interest that prevent them voting on matters before the board, the presence of patient advocates is necessary to take action – much more so than many other members of the board.

A memo by James Harrison, outside counsel to the CIRM board, said,

"As a result of the requirements in Proposition 71, the Patient Advocate members of CIRM’s Governing Board are required to devote a substantial amount of time to the review of applications for research and facilities funding and the development of the standards pursuant to which research must be conducted. The time devoted to service on the Working Groups is above and beyond the time devoted to Board, subcommittee and task force meetings. In the aggregate, this service can seriously affect members’ ability to serve while simultaneously carrying out their other responsibilities, including their current occupations.

“Under the proposed bylaw, the Board would have the authority to set a daily consulting rate to compensate Patient Advocate members of the Grants Working Group and the Vice Chairs of the Facilities and Standards Working Groups for their service on the Working Groups. The Patient Advocates would continue to be limited to a per diem of approximately $116 per day for their service on the Board, Board subcommittees, and task forces. The proposed bylaw also addresses concerns that SB 1064 imposes no cap on the daily consulting rate the Board could set for Patient Advocate members of the Working Groups. Thus, it would impose a $15,000 annual cap and it would limit the daily rate to no more than 75% of the rate paid to scientific members of the Grants Working Group. In addition, the bylaw would require the Board to find that service on the Working Groups requires an extraordinary commitment of time.”

The CIRM directors' Governance Subcommittee will take up the pay plan at its meeting next Tuesday. Also on tap for the session are changes in outside contracting procedures. The agency is heavily reliant on contractors because of the 50 person staff limit.

The panel is additionally slated to discuss CIRM's grants management system, which has been a critical issue for the agency since 2007. A number of directors expressed concern at their June meeting about the staff decision to build a custom system, declaring that such efforts often have unfortunate outcomes. The staff report on the matter is not yet available to the public.

The public can take part in the subcommittee meeting at a number of teleconference locations throughout the state. The specific addresses can be found on the agenda.

Watered-Down Reform Bill Moving Ahead; CIRM Looking at Boosting Staff to as High as 60

The California stem cell agency almost certainly will be able to hire a small platoon of additional employees next year as state lawmakers appear ready to remove a voter-imposed staffing cap.

That, however, may sound more troubling than the reality. The agency still has a 6 percent limit on operational spending, which makes the cap of 50 employees both redundant and a bit foolish. CIRM has labored for some time with what amounts to a staff the size of a 24/7 Burger King, and CIRM President Alan Trounson has warned that the quality of work could suffer.

The agency, with only 45 employees, is trying to oversee more than $1 billion in awards to more than 300 researchers and institutions. At the same time, it is attempting to award another $2 billion in increasingly complex grant rounds that reach into clinical trials and involvement with corporate biotech.

Earlier this year, CIRM said it might hire as many as 15 additional employees. Beyond that, it would run into space problems in its existing offices. Hiring additional employees would also “shorten the life span” of the cash available under the 6 per cent limit, which refers to the $3 billion in bond funding.

The bill removing the cap is headed for placement on what is known as the consent calendar. Items in that category are supposed to be noncontroversial (but there are exceptions) and are voted on as a block with no discussion.

The legislation, SB 1064 by Sen. Elaine Kontominas Alquist, D-San Jose, is currently in the Assembly Appropriations Committee after winning approval in the Health Committee, 19-0, on June 30. After passage by the full Assembly, it will return to the Senate for concurrence in Assembly amendments before it goes to the governor. It would take effect at the beginning of 2011.

Given CIRM's support, the first time ever for such legislation, the bill seems certain to be approved. However, approval requires a rare, super, super-majority vote – 70 percent – of both houses, so it only takes a few legislatiors to bring the bill to a halt.

The stem cell agency backed the bill in a compromise that significantly watered down the legislation. Gone are many reforms recommended by the Little Hoover Commission, the state's good government agency, along with provisions sought by the state's top fiscal officer, Controller John Chiang.

They include elimination of a performance audit by a special Prop. 71-created, financial oversight committee chaired by Chiang. Instead CIRM itself would pay ($400,000 plus) for the audit and control its scope. CIRM already has written into the bill a stipulation that the audit does not have to include “a review of scientific performance.”

Excluding a scientific review gives cover for the agency if it wants to isolate problems it does not want examined. Exclusion also avoids outside review of many of CIRM's key assumptions. However, a detailed scientific review may well be beyond the capability of most auditing enterprises, although they could presumably hire a panel of experts.

But perhaps more important is the fact that the agency would pay the audit firm for the work. If CIRM pays the piper, it calls the tune. Just ask Enron, World.com and others. Any audit paid for by CIRM can be fairly criticized for not being objective. It will mean $400,000 or more for the successful bidder. CIRM has already demonstrated it wants its contractors to be cheerleaders. That was a key criteria for selection of the firm that is now evaluating the economic impact of the agency.

Also gone are revisions in the role and election of the chairman, along with other reforms. The previous provisions would have eliminated the conflicting roles of the chairman, who now has executive management responsibilities, and the president. Problems with the dual executive arrangement at CIRM have arisen in the past and are likely to come up again. Also eliminated are provisions that would have given the board more control over selection of its own chairman.

Move to Allow Stem Cell Agency More Staff Advances in Legislature

The magic number now for CIRM in the California state legislature is 56.

That's the number of votes required in the 80-member state Assembly for passage of legislation that would remove the 50-person cap on the size of the staff at the $3 billion agency.

The bill, SB1064 by Sen. Elaine Kontominas Alquist, D-San Jose, cleared the Senate on a 33-0 vote on Thursday. The vote was pretty much a foregone conclusion, given that the bill has the support of Senate leadership. It now goes to the Assembly where it faces two committee hearings before reaching the floor. Approval is likely in the committees, but it is a bit trickier on the Assembly floor.

It only takes 15 lawmakers, either not voting or voting no on the measure, to block the bill. That's because Prop. 71, which created CIRM, enshrined in state law a requirement for a 70 percent vote to change the law concerning the stem cell agency. The rare and ill-considered super, super-majority provision gives a handful of persons extraordinary control over the fate of the bill. It would take only a couple of loopy lawmakers to reject the legislation, given the customary voting patterns in the Assembly.

CIRM dearly wants the employee cap removed. CIRM President Alan Trounson has warned that the quality of the agency's work will suffer without its removal. The limit was written into the 10,000-word initiative by CIRM Chairman Robert Klein.

Klein and 29-member CIRM board of directors have endorsed the Alquist bill, the first time they have given the nod to legislation that would affect the agency.

Here is a link to the analysis provided to lawmakers for the vote on the Senate floor.

CIRM Directors Okay Compromise Legislation

Directors of the California stem cell agency today endorsed legislation that would remove the 50-person cap on its staff and which is also aimed at ensuring affordable access to stem cell therapies financed by taxpayers.

In response to a question from the California Stem Cell Report, Don Gibbons, chief communications officer for CIRM, said the vote was unanimous. No further details were disclosed.

It is the first time that CIRM directors have endorsed legislation that would modify the agency's operations.

The legislation, SB1064 by Sen. Elaine Kontominas Alquist, D-San Jose, is now set for approval on Thursday by the Senate Appropriations Committee. Then it will go to the Senate floor.

Here is a link to an earlier item on the bill with more details on its current provisions.

State's Top Fiscal Officer Lauds Disclosure Proposal Likely to Affect CIRM

State Controller John Chiang, chairman of a key panel overseeing the California stem cell agency, today praised proposed NIH financial disclosure rules that are almost certain to have an impact on CIRM, one that the agency has avoided so far.

Chiang, the state's top fiscal officer, is head of the Citizens Financial Accountability Oversight Committee(CFAOC), a sister group to CIRM and one that was also created by Prop. 71.

Chiang was commenting on the NIH's new, proposed regulations that are likely to lead to the public disclosure of the financial interests of the reviewers who make de facto decisions on $3 billion in CIRM grants. The stem cell agency has adamantly refused to release the conflict-of-interest information.

In remarks made in response to a query from the California Stem Cell Report, Chiang said,

"I applaud the NIH's proposal to improve transparency and accountability by publicly posting financial disclosure reports of scientists and researchers who receive NIH funding. In January, the Citizens Financial Accountability Oversight Committee, which I chair, voted to post our members' statements of economic interest on our website, and to urge CIRM's governing board members and staff to post the same information on the CIRM website.

"As I said at the time, Californians voted to provide billions of public dollars to find cures for chronic, debilitating and deadly diseases that affect millions of Americans each year. To ensure that taxpayer dollars are spent lawfully, wisely and successfully - and to maintain the public's confidence in their investment - CIRM must pursue the highest standards of transparency."

Although the CFAOC is a creature of the legal draftsmanship of CIRM Chairman Robert Klein and others, the agency has moved away from the panel after facing its questions. In recent legislative negotiations, CIRM representatives were successful in removing a provision that would require the Chiang panel to conduct the first-ever performance audit of the CIRM and its board of directors. Now, the bill, SB1064 by Sen. Elaine Kontominas Alquist, D-San Jose, instead contains a provision for a performance audit that would be commissioned by CIRM itself rather than by an outside group.

The CFOAC recommendations for more accountability and transparency at CIRM triggered a smattering of negative newspaper articles. Michael Hiltzik, a business columnist for the Los Angeles Times, the state's largest newspaper, said CIRM should exemplify not only good science, but good government. A scathing San Diego Union-Tribune editorial carried the headline, “Stem-cell shenanigans / Lawmakers should force state institute to shape up.”

Both Chiang and Gov. Arnold Schwarzenegger post online the statements of their top officials along with their expense claims. Chiang's listing of the material is much more user friendly than the governor's, which are harder to find and harder to navigate.

Players in the Negotiations on the CIRM Cap Removal Legislation

Art Torres, co-vice chairman of the California stem cell agency, sent along the following regarding the negotiations on the legislation to remove the 50-person cap on CIRM staff.

Torres, who was a key figure in the process, said,

"Please credit our chief counsel James Harrison and counsel Scott Tocher as our chief negotiators and Duane Roth and Bob Klein, who all played significant roles in our efforts with Senator Alquist and her staff, and Senators Steinberg, Florez and Senator Kehoe and their staffs, who were all very helpful in these negotiations and the input of our president, Alan Trounson, and our scientific staff."

Compromise on Legislation Removing CIRM Staff Cap

Legislation to remove the 50-person cap on staff at the California stem cell agency and ensure affordable access to taxpayer-funded therapies was modified Thursday with the intent of winning the support of the CIRM board of directors.

CIRM Co-Vice Chairman Art Torres and others negotiated the changes in SB1064 by state Sen. Elaine Kontominas Alquist, D-San Jose. Torres is expected to seek the endorsement of the full CIRM board at a special telephonic meeting Tuesday. The measure is expected to come before the Senate Appropriations Committee on Thursday.

CIRM dearly wants the 50-person cap removed. CIRM President Alan Trounson has warned that the quality of CIRM work could suffer if it doesn't have more help. The agency has awarded more than $1 billion in grants and loans to more than 300 researchers. Another $2 billion will be handed out over the next several years. The cap is a bit of redundancy in Prop. 71 since the measure also includes a limit on CIRM's operational budget.

Eliminating the provision, however, is not a trivial legislative matter, also because of Prop. 71. The ballot initiative wrote into law a stipulation that the legislature can only make changes in CIRM with a rare, super, super-majority vote (70 percent) of both houses. As a result, both Alquist and CIRM have compromised on the legislation.

As the legislation now stands, in addition to removing the staff cap, the bill would:

• Write into law provisions aimed at ensuring affordable access to CIRM-financed therapies. Some flexibility for exceptions would be permitted for CIRM under controlled and public processes.
• Assure that potential profits from the taxpayer-funded therapies would go to the state's general fund. Prop. 71 was vague on where such cash would go, raising the possibility it would go to CIRM directly. Any such revenue is far, far down the road given the slow nature of research and federal approval of new therapies.
• Require performance audits of CIRM every three years, beginning in 2010-11, at CIRM's expense
• Permit the expansion of the grant review committee beyond 23 members and 15 scientists
• Require leadership succession planning at the agency. Its first and only chairman, Robert Klein, has said he will be leaving his post in December. Klein has been the dominant and driving force at the agency, even leading the electoral campaign that won approval of Prop. 71 in 2004.
• Require creation of a financial transition plan to address issues that CIRM faces when its current bond funding expires several years from now.

Earlier provisions were removed from the measure that would have changed the selection of chairman and vice chairman of the agency and altered the roles of the chairman and president. The role of the chairman is likely to redefined by the board as it deals with Klein's departure.

Much of the original measure had its origins in the findings of the Little Hoover Commission study of the stem cell agency. The commission recommended a wide range of changes at CIRM, some of which remain in the Alquist bill.

Alquist's bill declared,

“Since its inception, questions and concerns have been raised about the institute's practices, its governing board, and how the state directly and financially benefits through this sizeable investment. These criticisms divert the attention and focus of the institute to drive transformational scientific research and find cures.

“It is the intent of the Legislature to further enhance the ability of the institute to manage this investment made with public funds by addressing public concerns regarding oversight and transparency.”

The bill also said that it was intended to maximize state revenues that might result through CIRM grants.

The public may attend the CIRM board meeting on Tuesday at a number of locations throughout the state. Individuals may also comment on the bill and any action by the board. Specific addresses can be found on the agenda.

IOM Study of California Stem Cell Agency Proposed

A directors subcommittee of the California stem cell agency next week will consider commissioning a blue-ribbon, outside study of its work, ranging from its organizational structure to its scientific performance.

The study would be conducted by the prestigious Institute of Medicine and be paid for by CIRM. The proposal comes as legislation is being considered in Sacramento that would require peformance audits of CIRM. The agency has also scheduled a three-day review in October of its strategic plan by a panel of outside experts.

The new Science Subcommittee of CIRM directors will take up the IOM proposal at its meeting on Tuesday. The agenda contains no detailed justification for the proposal. It simply says,

“Consideration of commissioning IOM study regarding CIRM, including organizational structure, financial structure, conflicts policies, operations, scientific performance, and best practices, to enhance operations and scientific performance and identify critical scientific opportunities in the near term.”

Jeff Sheehy, chairman of the subcommittee, supports the proposal. In an email, he said,

“If you look at what the IOM does (and I have seen a couple of IOM reports--they were spectacular in their rigor and thoroughness, along with being absolutely objective), and what we should be providing in the way of a progress report to the people of California, it makes a lot of sense to have the gold standard IOM look at us.”

The institute is extremely well-regarded in science circles and regularly studies scientific issues. More than 600 reports are listed on its Web site, mostly dealing with scientific as opposed to public policy matters, although there is considerable overlap on those concerns when public financing is involved.

One longtime observer of the California stem cell scene, who must remain anonymous, said,

“What is probably true is that the IOM would not be so concerned about closed reviews and public disclosure of financial information from reviewers, but will focus on whether the money has been given out in a fair way and what has resulted from it.”

The IOM did produce a report in 2009 on conflicts of interest in medical research and educational institutions. In the case of CIRM, Prop. 71 built into the agency a wide range of conflicts of interest. The IOM study did not examine CIRM or the NIH, but it said,

“(T)here is growing concern among lawmakers, government agencies, and the public that extensive con­flicts of interest in medicine require stronger measures. Responsible and reasonable conflict of interest policies and procedures will reduce the risk of bias and the loss of trust while avoiding undue burdens or harms and without damaging constructive collaborations with industry.”

An IOM study would not be the first involving CIRM. It asked the group to put together a one-day workshop in 2006 on the risks of human egg donation. CIRM approved a $124,185 contract with the IOM. The report from the workshop is now being sold on the Internet by the IOM for $26.78.

Another IOM study would be expensive and could take possibly as much as a year to complete, one source told us. The performance audits proposed in the state legislation are estimated to run about $400,000 each.

The IOM proposal is not being offered as alternative to the audits and was being discussed prior to the legislation, we understand. However, the possibility of such an evaluation could become part of the ongoing negotiations on SB1064 by state Sen. Elaine Kontominas, D-San Jose. A special telephonic meeting of the full CIRM board is also scheduled for next Tuesday if an agreement is reached on the measure, which includes removal of the 50-person cap on CIRM staff. CIRM is eager to see that limit revoked.

Earlier CIRM scheduled and then cancelled a meeting on the Alquist legislation. The one next week could also be cancelled if negotiations are not successful.

Members of the public can sit in on both the full board meeting and the Science Subcommittee session at a variety of locations around the state. Specific addresses can be found on the agendas.

CIRM Legislation Noted on HealthyCal

Legislation to remove the 50-person cap on the number of employees at the California stem cell agency drew a smidgen of notice on HealthyCal.org, a relatively new Web site that deals extensively with health policy issues.

Dan Weintraub, former columnist for The Sacramento Bee, posted a brief item linking to our piece last week on the measure. Among other things, he said,

“A lot of people have forgotten about California’s stem cell research agency, which is spending billions of public dollars with little scrutiny. But blogger David Jensen is one person who is keeping a close eye on the place.”

CIRM Staff Cap/Reform Legislation Hanging Fire

With less than two weeks remaining before a key deadline, directors of the California stem cell agency have cancelled a meeting on legislation to remove the 50-person cap on its staff, and no additional sessions have yet been scheduled.

In response to a query, CIRM Vice Chairman Art Torres told the California
Stem Cell Report that a final agreement had not yet been reached on the terms of the legislation by state Sen. Elaine Kontominas Alquist, D-San Jose. He hopes to reach a compromise that CIRM directors could support.

The bill, SB1064, must clear the Senate by May 27 if it is to be enacted this year. CIRM is eager to remove the staff cap and has warned that the quality of its work is likely to suffer without more employees. The agency has approved more than $1 billion in grants and loans to more than 300 researchers. Another $2 billion or more is scheduled to handed out over the next four years or so.

As Alquist's bill now stands, it contains provisions that the agency has vigorously opposed. The legislation is aimed at ensuring that taxpayer-financed therapies are affordable and accessible. It would also reform management and accountability provisions at CIRM with the intention of creating more transparency and openness.

CIRM Cancels Board Meeting on Compromise Reform Legislation

The California stem cell agency has postponed the meeting next Tuesday of its board to consider a position on legislation that would remove the 50-person cap on its staff.

No reason was given immediately for the cancellation of the session. But previously CIRM Vice Chairman Art Torres indicated that it might be delayed if progress was not made on negotiations on SB1064 by state Sen. Elaine Kontominas Alquist, D-San Jose. We are checking with Torres for further information.

As it stands now, in addition to removing the cap, the bill would also seek to ensure affordability of taxpayer-financed therapies and enact reforms aimed at increasing transparency and accountability at CIRM. However, Torres is engaged in negotiations that could lead to significant changes in the measure.

Negotiations Underway on CIRM Reform Legislation; Staff Cap Removal Included

Legislation to remove the 50-person cap on staff at the $3 billion California stem cell agency comes before the organization's directors next Tuesday morning as negotiations on the bill appear to be reaching a critical stage.

The proposal must clear the state Senate by May 27, or CIRM will have to wait a year to make another attempt. That would pose difficulties for the agency, which is trying to administer more than $1 billion in grants to more than 300 recipients. CIRM President Alan Trounson warned earlier this year that the quality of CIRM work will suffer without the ability to hire more staff.

Removal of the cap is part of a bill, SB1064 by Sen. Elaine Kontaminas Alquist, D-San Jose, chair of the Senate Health Committee. While CIRM would like to see the cap removed, other provisions in the current measure are not viewed with pleasure by the agency. They include an effort to guarantee affordability of taxpayer-financed stem cell therapies and proposals to improve transparency and management at the five-year-old organization, which is unprecedented in state history.

In the case of the staff cap, CIRM is hoist on a petard of its own making. The cap was written into law by CIRM Chairman Robert Klein and others in an effort to defuse potential arguments against Prop. 71 that it would create a huge new state bureaucracy. Also written into law by Prop. 71 was a unusual requirement that makes it nearly impossible to change such things as the staff cap. Such alterations require a rare, super, super-majority vote of 70 percent of both houses and the signature of the governor. That means that CIRM will have to do some horse-trading to get what it wants.

CIRM Vice Chairman Art Torres, a former state legislator and head of the state Democratic Party, is leading the closed-door negotiations on a possible compromise on the bill. On Tuesday, he hopes to be able to recommend that the CIRM board support a revised bill. In response to a query on Monday, he told the California Stem Cell Report via email that no final agreement had been reached on the legislation. Torres said that the negotiators were awaiting specific language. He said it is possible that no agreement will have been reached by next Tuesday. Another source said, “We're hopeful to have something soon.”

The legislation is now before the Senate Appropriations Committee. If the bill clears that committee, it will go to the Senate floor.

The staff of the committee this week released its analysis of the bill. Among other things, the analysis by committee consultant Katie Johnson said the bill would create additional costs ranging from $400,000 to possibly millions. The $400,000 would be for each of new performance audits of CIRM and its board of directors. The audits would be required every six years, beginning this year. The millions would come into play for additional staff salaries, although that would not affect the state's general fund. The cost would be borne by CIRM, which is financed directly by state bonds(money borrowed by the state).

Johnson wrote,

“Although CIRM is currently under the (staff) cap with 43 employees, it is reasonable that as they make more grants and further develop the loan program, more staff would be needed. CIRM's administrative expenses, including salaries, are capped at 6 percent of bond funds: 3 percent for research and research facilities, including the development, administration, and oversight of the grant making process and the operations of the working groups and an additional 3 percent for the costs of CIRM general administration. CIRM is within their administrative cap, and while paying salaries for new employees would put expenses closer to the cap, it is unlikely to exceed it.”

Members of the public who would like to tell the CIRM board what they think of the legislation will have that opportunity at a host of locations around the state. The specific sites, which range from Healdsburg to Irvine, can be found on the agenda. If you plan to attend, it would be advisable to tell CIRM in advance so there are no glitches in gaining entrance. All of the locations are open to the public by law, but some are in businesses or other locations that may not be accustomed to admitting the general public. The list of locations currently on the agenda is short and more are likely to be added in the next few days, including sites in Sacramento and San Diego.

Accountability and Umbilical Cord Blood Legislation: CIRM's Positions

As expected, directors of the California stem cell agency moved last week to attempt to sidetrack legislation aimed at ensuring affordable access to taxpayer-funded stem cell therapies and to improve accountability and transparency at the $3 billion enterprise.

The real question is what horse will CIRM have to trade in order to send the bill off to interim study, which would, in effect, kill it for the next year or so. A case can be made that CIRM genuinely needs the bill, or least one of its major components. CIRM already has expressed an urgent need for removal of the 50-person cap on its staff, which the legislation (SB1064) by Sen. Elaine Kontominas Alquist, D-San Jose, would provide. CIRM has said that it is examining non-legislative ways to sidestep the legal ban on more than 50 staffers, but nothing has surfaced publicly.

CIRM says its interim study plan is a move that welcomes legislative oversight. However, the tactic has been long used by foes of legislation to kill bills without appearing to be publicly truculent. That said, the tactic is more sophisticated than some of the agency's previous stonewalling.

All this is going on against the backdrop of a California gubernatorial election, not that CIRM will even be a footnote in the campaign. But a new governor next January – whether it is Jerry Brown or a Republican – could be less friendly towards the agency than the current one, who has obliged it with vetoes on bills and a life-saving $150 million loan.

Meanwhile, patient advocate Don Reed once again has weighed in against the Alquist bill or any legislation that would make changes in the California stem cell agency. On his blog, stemcellbattles.com, he recently cited some personal examples of the need for stem cell therapies. Basically, his pitch is that anything that impedes the stem cell agency or what it wants to do is not to be supported. Reed's comments were also carried on the Huffington Post. Reed is vice president of Americans for Cures, the personal lobbying organization of CIRM Chairman Robert Klein.

The first legislative hearing on Alquist's measure is yet to be scheduled. It is expected to be in the Senate Health Committee, which she chairs.

CIRM directors are also doing their own interim study, so to speak, of legislation that would give the agency more cash and broaden its scope. On the table is a proposal that would be embodied in a bill (AB52) by Assemblyman Anthony Portantino, D-Pasadena, to increase fees for copies of birth certificates and send the money to CIRM, which then would run a public umbilical cord blood banking program.

Directors ordered an internal study of the complex matter, including the science, logistics and “liabilities” of such a move. It appears that much of the study will be performed by outside experts, which is entirely appropriate since the agency is short-staffed and has more important priorities, such as the oversight of more than 300 researchers and institutions that have been given more than $1 billion in state cash.

Consultants interested in that contract should watch the RFP section of CIRM Web site closely or call the agency directly to be sure to be notified about any sort of competition for the work.

Analysis of CIRM Challenges on HealthyCal

HealthyCal, a Web site dealing with health issues facing California, has published an analytical overview of the California stem cell agency written by the publisher of this Web site.

It begins:

“A little more than five years ago, visions of seemingly magical stem cell cures danced in the minds of California voters. Lured by the promise of human embryonic stem cells and the intransigence of the Bush administration, Californians voted to borrow $3 billion and give it away to scientists to come up with therapies for ailments ranging from Alzheimer’s to diabetes.

“In approving Prop. 71, voters repudiated the Bush administration ban on funding of human embryonic stem cell research. The voter initiative also created the California Institute for Regenerative Medicine (CIRM), an enterprise unlike any in state history and one that is uniquely independent of the governor and the legislature. It is also an agency that is facing a new set of challenges as it enters its second five years of existence.”

You can read it all here.

The Hidden Cost of Long Hours

The chairman of the California stem cell agency, Robert Klein, likes to point out that the tiny staff at the $3 billion enterprise works long hours to deliver the goods for its directors and the hundreds of researchers and others who enjoy the state largess.

In December, CIRM President Alan Trounson provided a few specifics. He told CIRM directors that some CIRM employees were at work until 11 p.m. He added,

"This morning, it was two in the morning, they were still responding to e-mails from me, so you have to say there's something very special about this group of people."

What Klein and top CIRM management do not mention is the hidden cost of the midnight oil.

What this kind of pace means is that people put off taking legitimate vacations and rack up uncompensated time off, which must be paid for at some point. According to its own annual audit, CIRM owes $370,067 to its employees for “unused compensated leave.” That includes vacations that have not been taken, “annual leave” and compensatory time off for those long hours. Already the agency has paid out $203,022 between 2006 and 2008 to 22 departing employees, according to state figures compiled by California Watch.

(The non-profit newsgathering organization put together the figures for a story by Chase Davis that was carried in some California newspapers today. He reported the state has paid out an estimated $100 million to departing state employees over about 3.5 years, ignoring rules that bar the workers from amassing such huge benefits.)

The CIRM staff, which now numbers in the mid-40s, indeed deserves considerable praise for its diligence. But the reasons for the long hours and resultant stressed staff – not to mention costs down the road – are not so deserving of praise. One can begin with Prop. 71, which is a 10,000-word tribute to micro-management, and immutable micro-management at that. Written by Klein and several other people, it imposed the 50-employee cap that is now deemed by Trounson and others to be endangering the quality of the work at the organization. CIRM wants the cap removed, but that will require an unlikely feat – agreement of 70 percent of both houses of the legislature and the governor. CIRM's top leadership also recently indicated that it would oppose the only legislation to eliminate the cap.

Big run-ups in unused time off also reflect an organization's inability to perform routine tasks routinely. When the staff's energy is often consumed by last minute and late hour scurrying-about, it leaves little room to deal with genuine emergencies or allow time for thoughtful analysis. In the case of CIRM, where careful thinking should be valued, it has prevented its science officers and others from staying in the forefront of the stem cell field through attendance at key scientific conferences. CIRM has declared the importance of such efforts and has budgeted generously for them. But much of the funding remains unused.

Some CIRM directors also have worried publicly about staff burn-out. The fact that 22 former employees are on the list of those receiving time-off payments may be evidence for that concern, given that the staff size has probably averaged somewhere in the 30s for the past five years. One can only wonder why more persons were not hired early on. But hiring itself is a time-consuming process, one that CIRM's top executives may have found difficulty in finding time for.

Hard work and diligence should be recognized. CIRM should also recognize that it cannot and should not rely on its employees to give up regular vacations and time off to burn the stem cell candle at both ends.

CIRM Trio Says Alquist Legislation Creates Unnecessary Jeopardy

Three top leaders of the California stem cell agency today said new legislation aimed at making it more accountable and ensuring affordable access to taxpayer-funded therapies would instead jeopardize the agency's accomplishments.

In a word, they said, the measure is unnecessary.

Their opposition was delivered in a five-page letter to Democratic state Sen. Elaine Kontominas Alquist of San Jose, chair of the Senate Health Committee. She introduced the legislation earlier this week, declaring that CIRM was “essentially accountable to no one.”

The opposition letter was signed by CIRM Chairman Robert Klein, a Palo Alto real estate investment banker, and vice chairmen Duane Roth, a San Diego area businessman, and Art Torres, formerly head of the state Democratic Party and retired legislator.

They noted that the full, 29-member CIRM board of directors had not yet taken a position on the legislation. But they said in a letter on CIRM stationery that they wanted to “express our individual concerns regarding the bill’s potential economic impact on the state’s new tax revenues and new jobs created by CIRM.”  They declared,

“More importantly, we are concerned about the bill’s potential impact on finding treatments and cures for diseases and traumas that Californians struggle with everyday.”

Perhaps the key section of the letter, which was highlighted in boldface, said,

“In what is a model for all of state government, CIRM operates within a 6 percent cap on expenses – efficiency unrivaled even in the private sector. CIRM has placed California at the forefront of international breakthroughs in medicine without any net state general fund appropriations or debt service expenditures through December 2009. CIRM continues to serve Californians by advancing research and therapies, creating thousands of jobs, fostering the growth of the biotech industry, and generating over $100 million in new state revenue.”

The CIRM trio did not even endorse the legislation's removal of the 50-person cap on CIRM staff, which agency officials have said they sorely need. The three acknowledged that the restriction "poses challenges.”

But they said the board is “actively exploring other alternatives to address this and remains committed to the 6 percent cap on administrative expenses.” The letter did not elaborate on those alternatives and none have been discussed publicly. The cap was imposed by voters when they approved Prop. 71, which Klein often says he wrote.

The letter described CIRM as “California's most accountable state agency.” It said CIRM has given away more than $1 billion, mostly for research grants, and generated “tens of thousands of job years.”

The letter said that CIRM is already engaged in some of the activities that the legislation would mandate. That includes planning for changes at the top in December when Klein says he is going to leave, as well as planning for the time when the agency's remaining $2 billion will run out. So far, CIRM has handed out $1 billion in less than three years. The money comes from cash that the state borrows via bonds and flows directly to CIRM, untouched by the normal controls of the governor or legislature.

The letter said that the CIRM directors'  Legislative Subcommittee, chaired by Klein and including Roth and Torres, will meet soon to consider Alquist's legislation, SB1064.  The 10-member panel will make recommendations to the full board, which could take a position as early as its March 11 meeting in Sacramento.

Interested parties and members of the public will have a chance to personally address the board then. Individuals can also write or email the members of the board concerning the legislation.

The full letter, which is not on the CIRM Web site, can be found here.

State Lawmaker Says CIRM 'Accountable to No One'

A leading California state senator said today that the state's $3 billion stem cell agency is “essentially accountable to no one” and declared that more accountability and transparency are needed.

Sen. Elaine Kontominas Alquist, D-San Jose and chair of the Senate Health Committee, made the statement in a news release touting her legislation to help ensure that Californians receive a “fair return” on their investment, which will total $6 billion with interest.

Alquist said,

“I was an early supporter of California’s groundbreaking stem cell initiative, and know that our public investment on behalf of the State of California will lead to new frontiers of treatment to heal people with chronic diseases.

“However, CIRM is essentially accountable to no one given the way the initiative was written. Californians entered into a partnership with CIRM when they approved Proposition 71 in 2004, a partnership that was meant to be mutually beneficial. By accepting public bond dollars, CIRM also accepted public accountability, public transparency, and a public return on their investment.”

She continued,

“If a cure or life-saving medicine is discovered using taxpayer dollars, we must be sure that all Californians benefit from that research. Californians are the shareholders of this venture. In this economic environment, the Legislature has a duty to ensure that every public dollar is accounted for and spent wisely."

The news release highlighted three key provisions of her bill, SB1064:

• Ensuring Californians have affordable access to drugs developed by Prop 71 funds.
• Ensuring intellectual property revenue made from Prop 71 funded grants and loans return to the state’s General Fund.
• Requiring the Citizen’s Financial Accountability Oversight Committee and the Controller’s Office to conduct performance audits.

The bill would also lift the 50-person cap on CIRM staff, a change that the agency dearly desires. However, Alquist did not mention that proposal in the news release. (We should note that the cap is redundant because Prop. 71 also imposes a limit on administrative expenses.)

We asked CIRM on Wednesday for a response to the legislation, but nothing has been forthcoming. We will carry the agency's comments when we receive them.

For more details on the measure, see the “stem cell agency reform” item.