KHN senior correspondent Samantha Young appeared on CBS News to discuss her exclusive coverage of the death of Lori McClintock, the wife of Northern California congressman Tom McClintock.

When Lori McClintock died in December 2021, what caused her death wasn’t clear. The original death certificate, dated Dec. 20, 2021, listed the cause of death as “pending.”

Months later, the Sacramento County coroner’s office determined that she died from dehydration due to gastroenteritis — an inflammation of the stomach and intestines — that was caused by “adverse effects of white mulberry leaf ingestion,” according to a report from the coroner.

White mulberry leaf, a plant that is generally considered safe, is used as an herbal remedy for a variety of ailments, including diabetes, obesity, and high cholesterol. It’s unclear from the Sacramento County coroner’s autopsy report whether Lori McClintock took a dietary supplement containing white mulberry leaf, ate fresh or dried leaves, or drank them in a tea, but a “partially intact” white mulberry leaf was found in her stomach, according to the report.

Her death underscores the potential risks of dietary supplements and herbal remedies.

To learn how Young got the story, check out her Twitter thread, or watch her on TikTok.

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It’s been a rough couple of years for the Centers for Disease Control and Prevention. Facing a barrage of criticism for repeatedly mishandling its response to the covid-19 pandemic and more recently monkeypox, the agency has acknowledged it failed and needs to change.

CDC Director Dr. Rochelle Walensky has tapped Mary Wakefield — an Obama administration veteran and nurse — to helm a major revamp of the sprawling agency and its multibillion-dollar budget. Making the changes will require winning over wary career CDC scientists, combative members of Congress, and a general public that in many cases has stopped looking to the agency for guidance.

“If she can’t fix it, she’ll say, ‘It’s not fixable, here’s why, and here’s what needs to be done next,’” said Eileen Sullivan-Marx, dean of the New York University Rory Meyers College of Nursing, who has known Wakefield professionally for decades.

Other former colleagues said Wakefield’s experience as a nurse, congressional staffer, policy wonk, and administrator give her the perspective and leadership tools to rise to the occasion, even as they acknowledged the magnitude of the job ahead.

“She has high standards, and she’ll expect people to perform,” said Brad Gibbens, a former employee and the acting director of the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. “She’s very fair, but you need to know what you’re doing.”

Wakefield will have to navigate rough waters in the wake of a series of missteps by the agency. The CDC botched the covid testing rollout early in the pandemic, issued confusing guidance on prevention measures such as masking and quarantining, and has been slow to release scientific findings on the fast-moving coronavirus.

Walensky has stressed that, as part of the reset, she wants the CDC to give Americans clear, accurate, and timely guidance on community health threats.

“I am confident that the appointment of Mary Wakefield will be instrumental in accomplishing our goals to modernize and optimize CDC,” Walensky said in a written statement. “It is clear that Mary is an action-oriented leader who can lead effective change.”

Following an internal audit, Walensky announced plans to restructure how the agency communicates with the public, to eliminate bureaucratic redundancies, and to help the CDC better interact with other parts of the federal government.

Wakefield’s first day on the job was in mid-August. She declined to speak to KHN for this article, but those who know her painted a rich picture of her management philosophy and style.

NYU’s Sullivan-Marx said Wakefield’s experience as a nurse makes her well suited to solve the complex set of problems facing the CDC, which she compared to a patient in need of stabilization.

“When you look at someone in a bed in intensive care, all you see are beeps and lines and monitors going off — people moving in and out like a train station,” said Sullivan-Marx. “The nurse is central to that for the patient, pulling all of that together.”

Sullivan-Marx also said Wakefield’s perspective as a front-line health care worker could help the CDC better understand how clinicians will receive and interpret its guidelines and recommendations.

For most of the Obama administration, Wakefield led the Health Resources and Services Administration. HRSA, a division of the Department of Health and Human Services, is responsible for a wide portfolio of programs — those that serve people living with HIV, provide compensation for people injured by vaccination, and document disciplinary action against health care providers.

Former HHS Secretary Kathleen Sebelius called Wakefield a “change agent” who was able to win the trust of HRSA staff members, many of whom are full-time employees, not political appointees.

“Folks understood that they were there before she came in and they’d be there after she left,” Sebelius said. “They had to be convinced that she was a good leader and they were going to follow her. That’s pretty significant, that she did so well in that agency.”

(Sebelius is a member of KFF’s Board of Trustees. KHN is KFF’s editorially independent newsroom.)

Sebelius said such experience could be helpful to Wakefield at the CDC, which employs just over 12,000 people, some of whom could be skeptical of changes. Covid was a serious stress test for the CDC, leaving some staffers wondering if it had lost its way.

Sebelius also noted as a plus Wakefield’s experience working with the CDC as acting deputy secretary of HHS. She was nominated to be deputy secretary but never confirmed because of political squabbles over abortion.

Details about changes coming at the CDC are still trickling out, though top brass have said they’ll need the support of Congress to implement them.

Sheila Burke, head of public policy at the law firm Baker Donelson, got to know Wakefield while working in Congress. She said Wakefield’s experience on Capitol Hill will come in handy when dealing with lawmakers who sit on committees that oversee the CDC.

“She’ll be keenly aware of the role of the members who care deeply about these issues,” Burke said.

Top health officials have had a hard time justifying the federal government’s pandemic response to certain members of Congress. Walensky and Dr. Anthony Fauci, the Biden administration’s lead medical adviser, who will soon step down, faced intense questioning from legislators on several occasions.

“I think she’s uniquely positioned to understand how you navigate that relationship,” Burke said of Wakefield.

Multiple former employees pointed to what Gibbens, from the University of North Dakota, characterized as Wakefield’s “infatigable amount of energy.” He said it wasn’t uncommon for him to arrive at work to phone messages she’d left him at 4:30 in the morning.

He described Wakefield as someone who knows “when somebody is trying to play her.” But he also said she doesn’t take herself too seriously. He recalled a kitschy animatronic singing fish on her office wall, a nod to her love of fishing. And the time she declined to fly on Air Force Two from Washington, D.C., to North Dakota, choosing to take a commercial flight “like a regular person.”

“She said, ‘You gotta be really careful with that stuff. You don’t want to get used to that,’” Gibbens recalled.

The work ahead for Wakefield could be a stress test of her belief in the human value of public policy. Walensky has said the changes she hopes to implement at the CDC won’t happen overnight, and it’s likely they won’t be easy.

Much like the CDC in the current moment, in 2005 Wakefield found herself at a possible turning point. That year, Wakefield’s brother and two of his children were killed in a car accident that seriously injured her sister-in-law and young nephew.

“Health policy as a focal area of my work before, now felt of very little consequence,” Wakefield wrote at the time in the Journal of Forensic Nursing.

Then she received word that her former boss, Sen. Kent Conrad (D-N.D.), had joined with others to introduce the Wakefield Act, a bill aimed at improving emergency medical care for kids. Even though it didn’t pass, it reminded Wakefield that pulling the levers of government can have real-life consequences.

“They acknowledged my family’s loss and put their support behind legislation that can affect the lives of children of other families who may have a chance at survival,” Wakefield wrote. “Public policy is important — isn’t it?”

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Angela Hart

SACRAMENTO, Calif. — A California lawmaker who rose to national prominence by muscling through some of the country’s strongest vaccination laws is leaving the state legislature later this year after a momentous tenure that made him a top target of the boisterous and burgeoning movement against vaccination mandates.

State Sen. Richard Pan, a bespectacled and unassuming pediatrician who continued treating low-income children during his 12 years in the state Senate and Assembly, has been physically assaulted and verbally attacked for working to tighten childhood vaccine requirements — even as Time magazine hailed him as a “hero.” Threats against him intensified in 2019, becoming so violent that he needed a restraining order and personal security detail.

“It got really vicious, and the tenor of these protests inside the Capitol building didn’t make you feel safe, yet he stood his ground,” said Karen Smith, director of the California Department of Public Health from 2015 to 2019. “Dr. Pan is unusual because he has the knowledge and belief in science, but also the conviction to act on it.”

“That takes courage,” she added. “He’s had a tremendous impact in California, and there’s going to be a hole in the legislature when he’s gone.”

The Democrat from Sacramento is leaving the Capitol because of legislative term limits that restrict state lawmakers to 12 years of service. He has overseen state budget decisions on health care and since 2018 has chaired the Senate Health Committee, a powerful position that has allowed him to shape health care coverage for millions of Californians.

Pan, 56, helped lead the charge to restore vision, dental, and other benefits to California’s Medicaid program, called Medi-Cal, after they were slashed during the Great Recession. Since then, he has pushed to expand social services to some of the most vulnerable enrollees.

He was instrumental in implementing the Affordable Care Act in California, and when Republicans attacked the law after Donald Trump was elected president, Pan spearheaded measures to cement its provisions in state law. After the Republican-controlled Congress axed the federal coverage mandate in 2017, he led the effort to create the state penalty for not having health insurance. And he negotiated with the governor to expand health insurance subsidies for low- and middle-income Californians.

In 2020, Pan authored legislation that will put California in the generic drug-making business, starting with insulin.

“What drives me is my commitment to health and healthy communities,” Pan told KHN.

But he hasn’t always succeeded. Some of his bills — including those to expand benefits and improve the quality of care for Medi-Cal enrollees — were stalled by the influential health insurance industry or opposition from his own party. And this year, Pan retreated on his contentious proposal to require schoolchildren to get vaccinated against covid-19.

Pan has also faced criticism that he’s too closely aligned with the health care industry, including the California Medical Association, or CMA, a deep-pocketed group that lobbies in Sacramento on behalf of doctors. On contentious policy fights, such as those dealing with provider pay or physician authority, Pan has often sided with his fellow doctors.

For instance, he rallied with the doctor association against a long-sought attempt to give nurse practitioners the ability to practice without physician supervision — a bill that was one of the association’s top legislative targets but one that ultimately passed despite its vehement opposition. And two key bills that sought to rein in health care costs died in his committee after clearing the state Assembly — one in 2019 to limit surprise medical bills for emergency room visits and another this year to give the state attorney general authority over some hospital and health system mergers.

“He’s inseparable from the doctors’ lobby, and obviously he carries water for the CMA,” said Jamie Court, president of the advocacy group Consumer Watchdog, arguing that Pan has stood in the way of progressive health care bills such as a proposal to create a government-run, single-payer health care system.

Pan rejected claims that he’s too close to the industry. “I’m proud to be a member of the CMA, but I don’t just blindly follow CMA,” he said. When it came to the nurse practitioner legislation, he said, his concerns “came from my knowledge about professional medical education and how that influences patient outcomes.”

Pan isn’t running for anything this year but isn’t ruling out the possibility of doing so in the future. For now, he said, he’s focusing on his work in Sacramento until his term ends Nov. 30. After that, he plans to practice medicine full time.

Pan said the public hasn’t heard the last of him when it comes to improving Medi-Cal. The state must do more to ensure high-quality care and equitable access for the 14.5 million Californians enrolled in the low-income health program, he said.

Pan said he entered politics to improve community health. He left his job as a faculty member and head of the pediatric residency program at the University of California-Davis to run for state Assembly in 2010. He served two terms before being elected to the state Senate in 2014.

Early on, he found himself at the forefront of California’s wars over vaccination mandates.

In 2012, he authored a law making it more difficult for parents to obtain personal belief exemptions for vaccines that are required for children entering public and private schools and that prevent communicable diseases such as measles and polio. In 2015, he succeeded in banning personal belief exemptions for schoolchildren altogether.

In 2019, when lawmakers were voting on Pan’s bill that cracked down on bogus medical exemptions for required school immunizations, a protester hurled menstrual blood at them on the Senate floor. Pan also clashed with Gov. Gavin Newsom, who watered down the bill by demanding amendments that allowed doctors to retain significant authority over the exemptions. Newsom ultimately signed the measure.

“I didn’t run for the legislature because I was planning to do vaccine legislation, but I care about children and that’s what I’ve devoted my life to,” said Pan, who got his medical degree from the University of Pittsburgh and a master’s degree in public health from Harvard University. “We had a whooping cough outbreak, and 10 infants died. And I was very concerned about the fact that we could prevent these diseases, yet we were failing.”

This year, Pan introduced legislation to require covid vaccinations for school-age kids but pulled it in April, saying it would be difficult for California officials to enforce. At the time, the covid vaccination rate for schoolchildren “was too low — around 30%,” Pan said. He concluded the state should redouble its efforts to increase vaccination rates before instituting a mandate.

Pan also noted that covid-19 was mutating fast and that emerging research indicated that the vaccines weren’t very good at combating new variants. “The vaccine is very effective protecting against death, but its ability to slow down transmission seemed to decrease,” Pan said. “Unfortunately, it has also been so politicized, so we have more work to do.”

As chair of California’s Asian & Pacific Islander Legislative Caucus, Pan in 2021 helped secure a $157 million investment to combat violence and hate crimes against Asian Americans and was a powerful force advocating for more money for the state’s beleaguered public health system — a fight Democrats finally won last year when Newsom approved $300 million in ongoing funding.

State Sen. Scott Wiener (D-San Francisco) said that Pan inspired his interest in introducing tough vaccination and public health bills and that he regularly asks Pan’s advice before unveiling legislative proposals. “I’d randomly call him all the time,” Wiener said. “There’s really no one in the Senate with the experience and knowledge he has.”

Brainy and studious, Pan regularly delves deep into scientific evidence during legislative floor debates. Interviews with reporters often result in lengthy discourses about the history of the U.S. health care system — like the time a question about hospital financing led to a lesson in how hospitals are both profit-earning enterprises and institutions that provide charity care.

“How serious you are about every undertaking — it really can be a joy and an irritation,” said Senate leader Toni Atkins, who affectionately thanked Pan for his work on the floor of the Senate in mid-August. “You took a lot of flak from folks in a lot of ways, and through it all, your integrity, your sense of humor, and your very good nature has withstood it all.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Sarah Varney, Kaiser Health News

As life-preserving medical technology advanced in the second half of the 20th century, doctors and families were faced with a thorny decision, one with weighty legal and moral implications: How should we define when life ends? Cardiopulmonary bypass machines could keep the blood pumping and ventilators could maintain breathing long after a patient’s natural ability to perform those vital functions had ceased.

After decades of deliberations involving physicians, bioethicists, attorneys, and theologians, a U.S. presidential commission in 1981 settled on a scientifically derived dividing line between life and death that has endured, more or less, ever since: A person was considered dead when the entire brain — including the brainstem, its most primitive portion — was no longer functioning, even if other vital functions could be maintained indefinitely through artificial life support.

In the decades since, the committee’s criteria have served as a foundation for laws in most states adopting brain death as a standard for legal death.

Now, with the overturning of Roe v. Wade and dozens of states rushing to impose abortion restrictions, American society is engaged in a chaotic race to define the other pole of human existence: When exactly does human life begin? At conception, the hint of a heartbeat, a first breath, the ability to survive outside the womb with the help of the latest technology?

That we’ve been able to devise and apply uniform clinical standards for when life ends, but not when it begins, is due largely to the legal and political maelstrom around abortion. And in the two months since the U.S. Supreme Court issued its opinion in Dobbs v. Jackson Women’s Health Organization, eliminating a long-standing federal right to abortion, state legislators are eagerly bounding into that void, looking to codify into law assorted definitions of life that carry profound repercussions for abortion rights, birth control, and assisted reproduction, as well as civil and criminal law.

“The court said that when life begins is up to whoever is running your state — whether they are wrong or not, or you agree with them or not,” said Mary Ziegler, a law professor at the University of California-Davis who has written several books on the history of abortion.

Unlike the debate over death, which delved into exquisite medical and scientific detail, the legislative scramble to determine when life’s building blocks reach a threshold that warrants government protection as human life has generally ignored the input of mainstream medical professionals.

Instead, red states across much of the South and portions of the Midwest are adopting language drafted by elected officials that is informed by conservative Christian doctrine, often with little scientific underpinning.

A handful of Republican-led states, including Arkansas, Kentucky, Missouri, and Oklahoma, have passed laws declaring that life begins at fertilization, a contention that opens the door to a host of pregnancy-related litigation. This includes wrongful death lawsuits brought on behalf of the estate of an embryo by disgruntled ex-partners against physicians and women who end a pregnancy or even miscarry. (One such lawsuit is underway in Arizona. Another reached the Alabama Supreme Court.)

In Kentucky, the law outlawing abortion uses morally explosive terms to define pregnancy as “the human female reproductive condition of having a living unborn human being within her body throughout the entire embryonic and fetal stages of the unborn child from fertilization to full gestation and childbirth.”

Several other states, including Georgia, have adopted measures equating life with the point at which an embryo’s nascent cardiac activity can be detected by an ultrasound, at around six weeks of gestation. Many such laws mischaracterize the flickering electrical impulses detectible at that stage as a heartbeat, including in Georgia, whose Department of Revenue recently announced that “any unborn child with a detectable human heartbeat” can be claimed as a dependent.

The Supreme Court’s 1973 decision in Roe v. Wade that established a constitutional right to abortion did not define a moment when life begins. The opinion, written by Justice Harry Blackmun, observed that the Constitution does not provide a definition of “person,” though it extends protections to those born or naturalized in the U.S. The court majority made note of the many disparate views among religions and scientists on when life begins, and concluded it was not up to the states to adopt one theory of life.

Instead, Roe created a framework intended to balance a pregnant woman’s right to make decisions about her body with a public interest in protecting potential human life. That decision and a key ruling that followed generally recognized a woman’s right to abortion up to the point medical professionals judge a fetus viable to survive outside the uterus, at about 24 weeks of gestation.

In decisively overturning Roe in June, the Supreme Court’s conservative majority drew on legal arguments that have shaped another contentious end-of-life issue. The legal standard employed in Dobbs — that there is no right to abortion in the federal Constitution and that states can decide on their own — is the same rationale used in 1997 when the Supreme Court said terminally ill people did not have a constitutional right to medically assisted death. That decision, Washington v. Glucksberg, is mentioned 15 times in the majority opinion for Dobbs and a concurrence by Justice Clarence Thomas.

Often, the same groups that have led the fight to outlaw abortion have also challenged medical aid-in-dying laws. Even after Dobbs, so-called right-to-die laws remain far less common than those codifying state abortion rights. Ten states allow physicians to prescribe lethal doses of medicine for terminally ill patients. Doctors are still prohibited from administering the drugs.

James Bopp, general counsel for the National Right to Life Committee who has been central to the efforts to outlaw abortion, said that both abortion and medically assisted death, which he refers to as physician-assisted suicide, endanger society.

“Every individual human life has inherent value and is sacred,” said Bopp. “The government has the duty to protect that life.”

Both issues raise profound societal questions: Can the government keep a patient on life support against his wishes, or force a woman to give birth? Can states bar their own residents from going to other states to end a pregnancy, or prohibit out-of-state patients from coming in to seek medically assisted death? And who gets to decide, particularly if the answer imposes a singular religious viewpoint?

Just as there are legal implications that flow from determining a person’s death, from organ donation to inheritance, the implied rights held by a legally recognized zygote are potentially vast. Will death certificates be issued for every lost pregnancy? Will miscarriages be investigated? When will Social Security numbers be issued? How will census counts be tallied and congressional districts drawn?

Medical professionals and bioethicists caution that both the beginning and end of life are complicated biological processes that are not defined by a single identifiable moment — and are ill suited to the political arena.

“Unfortunately, biological occurrences are not events, they are processes,” said David Magnus, director of the Stanford Center for Biomedical Ethics.

Moreover, asking doctors “What is life?” or “What is death?” may miss the point, said Magnus: “Medicine can answer the question ‘When does a biological organism cease to exist?’ But they can’t answer the question ‘When does a person begin or end?’ because those are metaphysical issues.”

Ben Sarbey, a doctoral candidate in Duke University’s department of philosophy who studies medical ethics, echoed that perspective, recounting the Paradox of the Heap, a thought experiment that involves placing grains of sand one on top of the next. The philosophical quandary is this: At what point do those grains of sand become something more — a heap?

“We’re going to have a rough time placing a dividing line that this counts as a person and this does not count as a person,” he said. “Many things count as life — a sperm counts as life, a person in a persistent vegetative state counts as life — but does that constitute a person that we should be protecting?”

Even as debate over the court’s abortion decision percolates, the 1981 federal statute that grew out of the presidential committee’s findings, the Uniform Determination of Death Act, is also under review. This year, the Uniform Law Commission, a nonpartisan group of legal experts that drafts laws intended for adoption in multiple states, has taken up the work to revisit the definition of death.

The group will consider sharpening the medical standards for brain death in light of advances in the understanding of brain function. And they will look to address lingering questions raised in recent years as families and religious groups have waged heated legal battles over terminating artificial life support for patients with no brain wave activity.

Bopp, with the National Right to Life Committee, is among those serving on advisory panels for the effort, along with an array of doctors, philosophers, and medical ethicists. The concept of “personhood” that infuses the anti-abortion movement’s broader push for fetal rights is expected to be an underlying topic, albeit in mirror image: When does a life form cease being a person?

Magnus, who is also serving on an advisory panel, has no doubt the commission will reach a consensus, a sober resolution rooted in science. What’s less clear, he said, is whether in today’s political environment that updated definition will hold the same sway, an enduring legal standard embraced across states.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).