The heart of California: Congestive heart failure in the Delta

delta-vision-foundation-diagnosis-blogNovember 22, 2013

By Charles Gardiner, Executive Director

This is the second installment in the Healing the Delta series. The heart of California has served the state well. Unfortunately, it has not been well cared for, and after years of stress, overwork, and neglect, it is failing.

The heart of California’s anatomy is the Sacramento-San Joaquin Bay Delta.  Water, the lifeblood of our state’s world-renowned ecosystem and leading-edge economy, is pumped from and returns to the Delta estuary.  The Delta is the heart of a water management system that connects the great Sierra Nevada and its winter snowpack, the major river systems of the Sacramento and San Joaquin Valleys, and the tidal push from San Francisco Bay and the Pacific Ocean.  The Delta feeds the most productive agricultural land in the world and our rich and productive commercial and sport fishing while fueling the economic engines of southern California and the Bay Area.

Delta Diagnosis:

Congestive heart failure.  The Delta is congested with substantial, competing demands for water supplies and flows.  Vital blood flow is needed to keep the body healthy.  However, when and how to get that lifeblood moving has stumped the doctors (regulators) and family members (stakeholders).  Too much stress on the patient will cause cardiac arrest.  Too little action condemns the patient to a slow, steady decline.

Hardened arteries.  As California has grown and placed more stress on its pulmonary system, and plaque has built up.  Each new demand brings additional restrictions and constraints to prevent further decline.  Unfortunately, those restrictions are now stressing the heart and limiting the amount of safe movement for the patient.  Inflexibility of doctors and family members further restricts the arteries and immobilizes the patient.

Without immediate triage and treatment, a heart attack or stroke is imminent.  Action is needed now to provide life support and move the patient toward a healthy lifestyle again.

Treatment Plan:

The patient’s condition is urgent and treatable.  While some suggest that a do-not-resuscitate order (DNR) is in place and others suggest that only an Automated External Defibrillator in the form of a flood or earthquake can move things toward a cure.  Our view is that a concerted, focused treatment plan can avert cardiac arrest and the continued long slow decline of the patient.

CPR.  Immediate action is needed to sustain the patient until more substantial treatment can be implemented.  Four immediate actions constitute the cardio pulmonary resuscitation for the Delta:  (1) immediate habitat restoration; (2) pilot operational changes in the Delta to protect fish while allowing more water supply flexibility, such as non-physical fish barriers for salmon and turbidity management for delta smelt; (3) immediate investment to increase Delta levee flood and earthquake resiliency along the water conveyance corridors and (4) water transfers.  Encouraging work is underway in each of these areas.  Additional urgency of action and accountability is needed to ensure the patient remains viable.

Angioplasty.  Even as immediate actions are underway to keep the patient alive, interim strategies are needed to reduce heart congestion and begin recovery.  A focused effort to implement a Strategic Levee System and improved Through-Delta Conveyance would provide the treatments to jointly address congestion related to Delta water quality, ecosystem restoration, and water supply reliability and establish a long term treatment strategy.  Effective angioplasty for the Delta combines increased flows for both fish and water users with protective actions for water quality and fish losses.  Unfortunately, the effort and attention on interim actions has been fully subsumed by long-term surgical plans.

Coronary Bypass.  Open heart surgery is a major procedure that warrants careful consideration and full preparation.  Important care and support is needed before, during, and after surgery to ensure the health of both the heart and the whole patient.  For more than 40 years, fisheries biologists have recommended bypass surgery to address fish entrainment and other environmental impacts.  Numerous multi-purpose planning efforts, including CALFED, the Delta Vision Task Force, and the current BDCP planning have concluded that dual conveyance is the best way to improve the health of the patient while protecting heart health.  However, we need a full medical team to ensure that the surgery goes well and the patient survives. Although the surgical technique is important, the rest of the medical team protects the patient during surgery.  For the Delta, we need commitments and assurances to protect water quality and ensure actions to restore habitat, increase surface and groundwater storage, and secure levees.

The long-term prognosis is dire, so the surgery is needed.  We can’t risk not doing the surgery and we can’t send the surgeon in alone.  Fortunately, if we act on the pre-treatment actions in the plan, we have time to prepare the surgical team and the full medical team to ensure that the patient has the best chance of a good outcome.

Come back soon to see more of the diagnosis and treatment plan.  Our next treatment element addresses chronic anemia and IV fluids – managing flows for the ecosystem and economy.

Click below to see previous installments in this series.