Pharmacy alumna provides lifeline to displaced residents in aftermath of fire

Fire was on the mind of Amber Denna the morning of November 8, 2018. Her hometown of Paradise, California, nestled in the foothills above the Central Valley, was one of dozens of towns in the state on high alert for wildfires due to low humidity, warm temperatures, and high winds. Pacific Gas and Electric Company (PG&E), the local energy supplier, had even threatened to cut the power to reduce the risk of sparking—but chose to keep the power on.

The sun was up, but the sky to the east from the front door of Denna’s family home was pitch black. The sky to the west, off the back porch, was blue.

“I thought that was weird,” Denna recalled.

Newscasters were reporting a fire in Pulga, California, an hour’s drive northeast of Paradise but a distance of only 10 miles as the crow flies. Denna was concerned. As the compliance officer of one of the town’s few independent pharmacies, Paradise Drug, she began calling her staff to tell them to stay at home, then hopped in her car to go check on her workplace of nearly 20 years.

Paradise Drug was owned and operated by UCSF School of Pharmacy alumna Janet Balbutin, PharmD ’68. The Paradise pharmacy was a community hub—a place where Balbutin and her staff knew each and every one of their patients.

Denna arrived at Paradise Drug to find two of her coworkers already there. She continued to call her remaining staff to warn them to stay home.

One employee, whose husband worked for PG&E, told Denna that the fire was worse than what was being reported. “She said, ‘Get out.’ She told us, ‘They’re using Skyway [Road] as an evacuation route, and they’re not telling us what’s going on,’” Denna explained.

Denna hastily dialed the care homes in Paradise that depended on Paradise Drug for many of their supplies. These small businesses were home to elderly and often bedridden patients. She urged them to prepare to evacuate. The situation was deteriorating, fast.

“I went from ‘Hi, this is Amber, from Paradise Drug’ to frantic in a matter of 12 minutes,” said Denna. “In that short period of time, our town went black as space. I looked outside the front window, and a log lands, blown by the wind, and it’s on the ground burning.”

At the base of the foothills, in the city of Chico, Balbutin had just arrived at Paradise Drug’s sister pharmacy, Chico Pharmacy, which she also owned. An ominous cloud of smoke loomed over the hills to the east. Balbutin realized that her Paradise Drug staff—and all of Paradise—were threatened.

Shaun Sims, another longtime employee of Balbutin’s and the manager of Chico Pharmacy, phoned Denna to check on the Paradise staff and pharmacy and to ask Denna to try to grab the pharmacy’s computer server on her way out. The server contained patient information, like drug allergies, prior hospitalizations, and current medical conditions, that would be critical for Balbutin’s team to serve the Paradise community from Chico if needed.

Embers began raining down outside the pharmacy. Denna now realized that the pharmacy itself might burn.

Balbutin and her pharmacy team down in Chico were at a loss to help their colleagues in Paradise. “I just remember how we were crying on our end,” said Balbutin. “We couldn’t do anything.”

Realizing that Denna’s life was suddenly at risk, Sims told her to leave the server and “get the hell out.” But Denna was already in her car. “And then it went crazy,” said Sims.

Paradise found

Paradise was home to more than 26,000 people before fire roared through the town last November. The town had its own hospital, school district, newspaper, and internet radio station.

The fire changed everything. Dubbed the Camp Fire for where it started on Camp Creek Road, in Butte County, California, it took 86 lives. The majority of the destruction occurred in the first four hours of the blaze.

One of the buildings lost was Balbutin’s Paradise Drug.

Raised in the Central Valley farm town of Yuba City, California, just a half hour’s drive south of Chico, Balbutin had applied to just one pharmacy school—UCSF. She graduated in 1968 with a problem-solving mindset and a commitment to patient care.

“When I graduated, there were jobs all over the place, but everywhere I went, they would always question whether I was up for the job, saying, ‘a girl pharmacist?’” said Balbutin. “That’s the way it was in those days.”

Undeterred, Balbutin returned to Yuba City, where she worked for a pharmacy chain by day and moonlit as a tennis player, coach, and match organizer by night.

“I played professional tennis myself and taught tennis throughout the years,” said Balbutin. “Back then, everybody would call me up, and I’d line them up with a match every night, so for many years we developed a tennis community.”

Balbutin’s enthusiasm for tennis eventually led her to Chico, where she found herself teaching tennis to fellow pharmacists. The tennis matches kept her in close contact both with local patients and with the network of Butte County physicians and small-town pharmacists that served them.

When an independent pharmacy in nearby Paradise went up for sale in 1986, Balbutin conferred with her sister, Ava Balbutin, PharmD, who had earned her pharmacy doctorate from UCSF in 1970, and her brother, Ray Balbutin, who was a pharmacy technician. Balbutin decided to pounce. With the help of her siblings and their extended families, Balbutin revitalized the pharmacy.

“Our community wasn’t big, but it was really tight-knit. We had multiple generations of long-time customers,” said Denna. “We’d fill up to 300 prescriptions and 20 medical supply orders [for retirement and care homes] per day. We were known for our small-town feel, and we were one of very few independent pharmacies in the area.”

Independent community pharmacies are increasingly hard to come by in California, but they play critical roles in rural communities like Paradise. Pharmacists like Balbutin, with the help of their staffs, review and fill prescriptions, advise on safe and effective medication use, mediate insurance coverage issues for medications, deliver prescriptions to home-bound customers many miles away, and are often their patients’ first point of contact with the health care system. Paradise Drug was also a place to see a friendly face and catch up on happenings in town.

Over the years, Balbutin also bought and expanded numerous pharmacy operations in Chico and the neighboring town of Durham to better serve everyone from college students to aging retirees. She cultivated a close crew of pharmacists and technicians who knew the names, faces, and medication needs of hundreds of locals.

Trapped in Paradise

Traffic was backing up as emergency responders closed roads. The smoke blocked out the sun. Denna couldn’t even make the three-minute drive back to her house—she barely drove 100 feet before being turned around by authorities. She called her family and urged them to flee. Her husband, daughter, cat, and dog, who were home on the downhill side of the fire, quickly made it out to Chico in a second car. Denna’s in-laws escaped in a third car.

Denna ended up back at Paradise Drug, sitting in her car, surrounded by a firestorm whipped up by gale-force winds. She watched in horror as her childhood home, directly across the street from Paradise Drug, started to burn down.

A loud boom jerked her attention to a building across the street. The local saw shop had exploded, sending flaming debris into the sky.

With her phone battery holding only a two-percent charge, she called her pharmacy colleagues in Chico. “I couldn’t hang up the phone because I was scared. I didn’t want to be by myself,” she said.

Sims picked up, shocked that Denna was still in Paradise. Denna was crying. Sims started crying.

“She’s asking me, ‘should I jump out and run?’” recounted Sims. “I didn’t know what to say. I wanted to say yes. I wanted to say no.”

Balbutin recalls the “nightmare” of those hours, knowing that Denna and her colleagues were endangered. “It was surreal,” she said.

Denna considered jumping on the back of a passing motorcycle. Then Sims heard the line crackle and cut out. The smoke, billowing down from Paradise, was beginning to envelop Chico.

A daring escape

Denna sat in the traffic and watched the pharmacy burn. She ran her air-conditioning on high and sprayed windshield fluid every few minutes to extinguish burning debris on the windshield. Nearby cars would crawl forward and then stall in the searing heat. Denna watched in horror as people abandoned their dying vehicles and ran to others, seeking a seat or a lap in a running vehicle.

“Finally, we started moving little by little. Everything was blowing up, not just propane tanks but also the pine trees. They’d make a sizzle sound and blow up from the sap,” she said.

It took nearly four hours for Denna to move two miles through the burning town. Then she noticed an opening.

“I told myself, ‘You know these backroads. Get your head together. Stop being a frantic mess,’” she said. “I looked and there was this road that was empty, and I knew I could drive it with my eyes closed.”

Roads leading into the fire glowed red, but this road “was just black,” indicating safe passage. Denna waved to other cars to follow her, and convinced five of them to join her. Then she floored the gas. Driving 90 mph, she led her convoy down the dark, bumpy road, navigating each twist and turn by memory.

“I finally got to Highway 99 [in the valley], and I stopped and pulled over,” she said. She breathed a sigh of relief. It was 3:00 pm.

Behind her, Paradise Drug, like most of the town, had already burned to the ground.

Pharmacist first responders

While Denna careened through the foothills, Balbutin, Sims, and the rest of the employees of Chico Pharmacy rallied to help those in need. The now-dispersed Paradise community would need its insulin, heart medication, and plenty of first aid in the coming hours.

“We were first responders that evening,” said Balbutin. “We helped doctors get people’s orders down at the fairgrounds [where evacuees were first brought], and we took those prescriptions back to Chico Pharmacy to fill as best as we could.”

The team didn’t have time to take in the depth of the unfolding tragedy. “Even now we just stand back and say, ‘What happened?’” said Balbutin, months later. “To wipe out a town in three hours at the most… We lost a lot of patients in the fire.”

The team compartmentalized their fears of the worst and their concern for Denna and their colleagues, and worked throughout the night to “get everybody that first round of medication,” according to Balbutin. Their efforts ensured that, for instance, the area’s diabetic patients had access to insulin even while the fire still raged.

With many Paradise residents left to wonder whether they had lost their homes, or even their loved ones, health insurance was the last thing on their minds. Instead of fretting over insurance, Balbutin and her team worked hand-in-hand with county physicians to fill prescriptions that were accurate and valid, while postponing the reimbursement process.

“A lot of people fled with nothing, so they didn’t have their insurance information,” said Sims. “Janet made sure they got those meds, and decided to get to their insurance later.”

Months later, Balbutin and her colleagues tried to file for reimbursement for these prescriptions. But “we didn’t get paid back for a lot of it,” said Balbutin.

Balbutin also welcomed evacuated Paradise residents onto one of her properties, giving them temporary housing, and firefighters ended up camping on another of her properties and using water from her pond to fight the fire.

Meanwhile, Denna finally reached her family at 8:00 pm that evening, convening at her sister’s house in Durham, California, just outside of Chico. But her ordeal wasn’t over.

“We got settled for an hour, and then they evacuated us [from Durham],” said Denna. “We could see the fire coming down the hill.”

Firefighters ultimately kept the fire from spreading into Durham, but Denna and her family stayed with a close friend in Chico for the rest of that week.

A pharmacy in exile

Three days after the fire started, Denna reunited with Balbutin, Sims, and her other colleagues at Chico Pharmacy, ready to get back to work. Despite the loss of Paradise Drug, Balbutin’s employees were all safe—and Denna had saved the pharmacy’s server.

“Working at Chico Pharmacy kept my brain busy enough to where it wasn’t focused on the bad,” said Denna. “It really helped to be able to take care of each other.”

In the aftermath of the fire, work provided a semblance of normalcy to the pharmacy team, and Balbutin knew that her long-term customers would appreciate being served by familiar faces, too. Paradise Drug would keep serving them from Chico, she vowed.

Initially, Balbutin’s team set up a rudimentary system for handling prescriptions for displaced Paradise residents, painstakingly routing each script through Chico Pharmacy’s computer system.

Once the rescued server was booted up, Paradise Drug was able to field these scripts “much more easily,” said Sims. Using an emergency license from the California State Board of Pharmacy, each prescription was filled in a corner of Chico Pharmacy that had been cleared for just that task.

As November came to a close, Balbutin had Denna and Sims set up a temporary shop just down the block from Chico Pharmacy, in the back of a nondescript medical supply building.

“We came in on nights and weekends to get Paradise Drug up and running in the new location in Chico,” said Sims. “We built all the shelving and counters, installed computers and phones, stocked the store, and set up a new security system.”

It was an expensive decision. On a good day, the displaced Paradise Drug would fill 60 prescriptions, a far cry from the hundreds that were processed per day before the fire. But by moving Paradise Drug into its own space, and paying the rent and salaries to run it, the store’s state license would stay active, leaving the door open for Balbutin to reestablish the pharmacy in Paradise.

Balbutin fretted over keeping the dream of Paradise Drug alive, when she could’ve simply transferred those patients over to the Chico Pharmacy system and called it a day. But her commitment to the Paradise community outweighed financial goals.

“She won’t admit to it, but she’s a saint. Right now, Paradise Drug is operating at a loss,” said Sims in July 2019. “She’s keeping it going to make sure people still have their jobs, and to take care of our patients.”

A burned lot among many

Driving into Paradise almost a year later, the scars of the Camp Fire remain fresh. Pine trees, unscathed by the fire, stand guard around empty lots dotted with freestanding brick chimneys and the occasional mailbox. Newer cars sit parked next to the burned husks of others. A McDonald’s sign stands over Skyway Road, but there is no restaurant behind it.

A recent informal census counted about 2,300 people in Paradise, a population decline of more than 90 percent. There’s a steady stream of customers at a surviving local supermarket, but the familiar characters—teens on summer break, vacationing families, graying retirees—have been replaced by recovery workers in safety vests. Many other surviving businesses have curtailed their hours to adapt to the lost demand.

Traffic also looks different now. Medium-sized trucks, short enough to navigate the town’s curvy, steep side streets, lumber their way up and down Skyway Road from dawn to dusk, hauling out the burned remnants of the town.

Thanks to the diligent, round-the-clock work of recovery contractors, many of the town’s burned structures and incinerated cars have been cleared out, at a rate of over 100 lots per day. But more than 18,000 structures were lost to the Camp Fire. Turn a corner, and uncleared lots full of melted, twisted debris come into view.

The remains of Paradise Drug rest on one of those lots.

Sifting through memories

When Balbutin gathered with Denna and Sims at the site of Paradise Drug on a recent summer morning, eight months after the fire, there was still some digging to do. Any day, federal contractors were expected to finally clear and clean the site. But for now, there was still the possibility of finding a surviving memento among the ash.

“All the shelving back there, that was all medication,” said Sims. “When Amber and I first came up here [after the fire], I was thinking we’d see melted pieces of bottles. There was nothing, it was all just gone, disintegrated, the heat was so intense.” Sims recalled how PG&E workers helped open the pharmacy’s safe, only to discover that most of its contents had disintegrated in the extreme heat.

“There were these glass ladybugs we were selling, and they should’ve melted,” said Denna. “But when we first returned to the site, they were scattered all over, perfectly intact, just sitting there in the ash.” Denna now carries these mementos in her purse.

Next to a burned-out delivery van with the words “Paradise Drug” still visible on the back, Balbutin, Denna, and Sims looked through the rubble once more. They recounted their experiences, in turn, while the sound of wind blowing through the trees and trucks hauling debris from the devastated town intermittently overwhelmed their voices.

“We’re standing here now, and I think of all my memories of these years at the pharmacy,” said Sims. “We’re a family, not just a work environment, I consider all of us Paradise Drug employees like brothers and sisters.”

As one chapter ends, a new one begins

Balbutin kept the temporary Paradise Drug site operational through October of this year, with the intention of soon reopening in its namesake town. She had been leasing the site of another former pharmacy in Paradise since before the fire, hoping to move into the new location. That site survived the fire and was well situated to become the new face of Paradise Drug, as well as a source of hope—and continuity—for Paradise residents as they rebuilt.

But as weeks turned to months, the prospect of reopening Paradise Drug up in the foothills faded.

“Right after the fire, our patients started coming [to our temporary location in Chico]. But then they moved away, since nobody could return to Paradise,” said Balbutin. “The water [in Paradise] wasn’t OK for a long time, the environment wasn’t OK for a long time, and now finally they’re saying the economy will take much longer to recover.”

By the fall of 2019, Paradise Drug’s business dwindled down to just a dozen filled scripts each day. Balbutin balanced her books and kept her team employed thanks to steadier business from Chico Pharmacy, but ultimately the financial losses and lack of future prospects forced her hand.

“She tried everything she could, and we were holding out until the very end,” said Sims. “But our financial advisor told us, ‘This isn’t working. You’re bleeding out too much money every month.’”

Balbutin is closing Paradise Drug. Chico Pharmacy will absorb the remaining Paradise Drug employees and the store’s remaining patients. Those patients who do manage to move back to Paradise will still be served by Balbutin’s delivery drivers.

Denna is moving on, though. After the fire, she appeared on television a few times, talking about her escape. Her poise and commitment to the community attracted a job offer she couldn’t turn down, as a physician’s assistant, in Chico.

“Paradise Drug has been around since 1986, I’ve been there since 1993, Amber [Denna] had been there 19 years,” said Sims. “We’ve all shed some tears. Our legacy there is coming to an end.”

Balbutin rarely talks about her own losses in the fire. She’s still grappling with the fact that an entire town burned in two hours, displacing 20,000 people, and the reality that she never had the chance to say goodbye to some of her patients. “Everybody can’t believe what’s happened to them. Everybody has the same story but a different story,” she said.

Balbutin’s commitment to serving local patients with her pharmacy practice is as strong as ever. She obtained her Advanced Practice Pharmacist license a month after the fire, which has allowed her to expand the range of services she can provide to her patients, and she received a license to dispense naloxone, the antidote drug for opiate overdoses, this September. And she’s still playing tennis.

She’s also as determined as she was as a young PharmD to clear a path forward. Then as now, this pharmacist is up for the job. “We can do anything—we just need some time now to think. We’ll put our heads together, and we’ll do it.”