public health

Wake County Commissioners declare racism a public health crisis

Six weeks after the death of George Floyd in Minneapolis, Wake County Commissioners are poised to pass a resolution that acknowledges the harm racism and discrimination poses to individuals and our community.

Commissioners will vote on a resolution at Monday’s meeting that details how racism perpetuates poverty through intentional and unintentional policies, creating barriers to upward mobility.

Here are two excerpts:

WHEREAS, structural racism has resulted in race as a social determinant of health,
with persistent racial disparities in housing and food security, criminal justice, education,
healthcare, employment, worker protections, climate, and technology; and that data
shows race, income, and ZIP Code have a bigger impacts on health than behavior,
medical care, or genetic code; and

WHEREAS, social determinants of health have a disproportionate impact on communities of color, including food deserts, lack of safe places to recreate, lack of mental health services and lack of equitable educational and career opportunities;

WHEREAS, the COVID-19 pandemic has further exposed systemic issues in our
society related to health access, housing and food insecurity. As of June 30th
, our Latinx/Hispanic population makes up about 10% of our population but 45% of our
confirmed cases. Our Black population comprises 20% of our population but 24% of our
confirmed cases. Accordingly, Black and Latinx/Hispanic persons account for
approximately 30% of Wake County’s population but yet 69 % of our confirmed cases;
and

WHEREAS, Wake County strives to serve vulnerable populations in an equitable
manner–as demonstrated by our investments in public education, housing affordability, social and economic vitality programs, and our recent initiatives on maternal and infant mortality, the WakeWorks program, and Live Well Wake–we are committed to the ending systemic racism and discrimination in our communities; and

WHEREAS, Wake County is a model employer, providing benefits such as parental
leave, paid family illness leave, a living wage policy, in addition to strong health
insurance and retirement benefits, which help lower-income and underserved populations. In the pursuit of social justice, Wake County has also enacted policies
such as “Ban the Box” and a strong anti-discrimination and equal employment
opportunity policy; and

WHEREAS, although there is no epidemiologic definition of “public health crisis,” the
health impacts of racism clearly exemplify the definition proposed by experts from the Boston University School of Public Health, which is that “The problem must affect large numbers of people, it must threaten health over the long-term, and it must require the adoption of large scale solutions”; and

NOW, THEREFORE, THE WAKE COUNTY BOARD OF COMMISSIONERS RESOLVES that racism is a pubic health crisis and must be treated with the same urgency and funding as any other public health crisis. The Wake County Board of Commissioners is committed to dismantling racism and discrimination by promoting racial equity through board goals and policies developed through a lens of diversity, inclusion, and equity and encourages other local, state, and federal entities to do the
same.

Read the full resolution on racism here.

Board members are also expected to approve a second resolution at the meeting that would adopt Juneteenth (June 19th) as an official holiday. If approved, the holiday will become a paid day off for all county employees.

Juneteenth commemorates the ending of slavery in the United States.

COVID-19, public health, Trump Administration

Citadel nursing home in Salisbury using Trump administration rule to avoid COVID-19 lawsuit

Image: Adobe Stock

The owners of the Citadel nursing home in Salisbury have invoked a new federal law that could allow them to avoid being sued by patients who contracted or died from COVID-19 while under its care.

Recent court documents show that Accordius Health, LLC, a for-profit company that owns 90 nursing facilities in nine states, has petitioned a judge to toss a lawsuit filed by two residents’ powers of attorney.

Instead Accordius is arguing that before being admitted to the Citadel, residents — or their legal representatives — signed documents agreeing that all disputes would go to confidential arbitration proceedings rather than be publicly heard in court.

The Citadel is also known as the Salisbury Center.

Wallace & Graham and Gugenheim Law are suing Accordius Health on behalf of Thomas Del Marshall and Robert Leroy Whitlach “seeking a comprehensive view of the facility’s policies” to prevent further neglect. The firms and their clients are not asking for monetary damages.

Since early April, the Citadel has reported 113 cases of COVID-19 among its residents, the highest number of all nursing facilities in North Carolina, according to state records. Eighteen residents have died. Of the staff, 44 have tested positive for the disease.

A one-star facility — a “much below average rating” — the Citadel was cited for abuse by the Centers for Medicare and Medicaid Services last fall.

“Despite the company being responsible for significant nursing home outbreaks, the company filed documents in court attempt to enforce arbitration agreements upon residents who want justice – preventing residents from having their day in court before a jury,” attorney Mona Lisa Wallace wrote in a prepared statement. “The company seeks to keep the proceedings confidential and to keep information hidden from the public.  The company further seeks to keep the lawsuit out of the state court or in the county where the facility is located, where loved ones and elders are sick and dying even today.”

Under the Obama administration, CMS banned such pre-admission arbitration agreements. According to the Illinois Law Review, CMS passed the regulation because it believed “it is fundamentally unfair and almost impossible for residents or their decision-makers to give fully informed and voluntary consent to arbitration before a dispute has arisen.”

The nursing home industry sued and a federal court suspended the rule. Then in 2017, under the Trump administration, CMS proposed a different rule, according to the American Bar Association, that “went to the other extreme.” That proposal allowed not only nursing homes to take cases to arbitration but made signing the agreement a condition of admission to the facility.

Finally, a rule enacted last September allows for arbitration, but not as a requirement for admission to a facility.

Arbitration proceedings are confidential, so no evidence can be publicly disclosed; nor is there a jury trial. It is also difficult to appeal an arbitration.

Even if residents could sue nursing homes on COVID-19 claims, it would now be difficult to win. North Carolina lawmakers passed, and the governor signed, an omnibus COVID-19 bill last month that gives immunity from civil lawsuits to these and other health care facilities. They could still be sued for criminal acts related to COVID-19, such as willful neglect, but the burden of proof in criminal cases is much higher.

COVID-19, public health

As state nears 25,000 COVID-19 cases, rural NC infection rates are the highest

On Monday, North Carolina reported 24,000 positive COVID-19 cases. Twenty percent of those infections are in the state’s two most populous counties, Mecklenburg (3,403) and Wake (1,478). The country and the state have focused a lot of attention on the virus’s rapid spread in population-dense and urban spaces. This framing, coupled with an initial lack of testing, has created the perception that rural North Carolina has not experienced COVID-19 like the rest of the country.

This is untrue.

In the North Carolina context, it appears that the rural counties have been harder hit. By examining COVID-19 infection and death rates instead of solely infection and death counts, one is able to scale impact relative to county population.  Once viewed through this context, the conclusions change.

The state rate of COVID-19 infections is 229 per 100,000, while the crude death rate is 7.5 per 100,000. Counties classified as rural by the NC Rural Center’s methodology show an infection rate of 257 per 100,000 and a death rate of 8 per 100,000. For comparisons sake, urban/ suburban counties have an infection rate of 204 per 100,000 and a death rate of 7 per 100,000.[1]

While these rate differences are not extreme, several hot spots in rural North Carolina are cause for concern. Duplin and Wayne counties lead the state with 1,121 and 837 COVID-19 cases per 100,000 people.

In terms of crude death rate (deaths per 100,000), Northampton and Vance counties lead the state with 62 and 40 deaths per 100,000, respectively.

These are all rural counties, but the trend does not stop there.[2] The 15 counties with the highest COVID-19 infection rate are rural, and 18 of 20 counties with the highest COVID-19 death rates are also designated as rural.[3]

There are several reasons that rural North Carolina is ill-positioned to respond to a pandemic. After North Carolina refused to expand Medicaid, seven rural hospitals closed, leaving 17 counties without a state-licensed facility.[4]

These same rural counties generally have higher rates of uninsured, making it less likely that people get treated for any disease, let alone COVID-19. Duplin, Greene, Swain, Sampson, Graham and Robeson counties lead the state in the percentage of county population uninsured, further complicating efforts to reduce the cases and spread of COVID-19 infections.[5]

A potential contributor to NC COVID-19 infections in rural North Carolina are occupational trends — how people work in community. In places where economies without a significant number of highly skilled jobs, meat processing plants offer many residents the opportunity to earn a steady income and stability. However, in a pandemic, the close nature of meat processing work creates a liability for the workers, their families and entire communities.

While one would offer caution in arguing that a scientific relationship exists between communities with meat processing plants and COVID-19 infection rates, policymakers should be aware of potential impact.

Last week, NCDHHS announced that 13 counties had meat processing plants with COVID-19 outbreaks.[6] Twelve of the 13 counties are considered rural.

After mapping these communities and the percentage of the county workforce employed in production jobs, four rural county clusters emerge as plausible connections between the concentration of meat processing plants and higher rates of infection per 100,000.

Cluster 1 — Duplin, Sampson, Wayne, Wilson, Lenoir, and Greene
Cluster 2 — Bertie, Northampton, and Halifax
Cluster 3 — Chatham and Lee
Cluster 4 — Wilkes, Surry, and Yadkin. [7]

As the number of COVID-19 cases climb toward 25,000, let us not lose focus on the particular pain rural communities in North Carolina are experiencing. All it takes is a deeper look.

William Munn is a policy analyst with the North Carolina Justice Center’s Health Advocacy Project.

[1] Internal analysis from NCDHHS COVID-19 Dashboard data

[2] Internal analysis from NCDHHS COVID-19 Dashboard data

[3] NCDHHS Dashboard

[4] “A triple disaster: Uninsured, living far from a hospital, and sick with COVID-19”, Lisa Sorg, NC Policy Watch – https://bit.ly/2V1uTaY

[5] Small Area Health Insurance Estimates – https://www.census.gov/data-tools/demo/sahie/#/

6] “N.C. has 23 meat processing plants with COVID-19 outbreaks, more than 1,300 cases” WBTV 3 – https://www.wbtv.com/2020/05/12/nc-has-meat-processing-plants-with-covid-outbreaks-more-than-cases/

[7] Internal analysis from NCDHHS COVID-19 Dashboard data

 

Legislature, News, public health

Can a pandemic push North Carolina to finally expand Medicaid? These House members hope so.

Seven House Democrats took part in a conference call Wednesday to urge lawmakers to pass House Bill 1040, Healthcare for Working North Carolinians.

On the day when North Carolina surpassed 10,000 COVID-19 cases, a group of House Democrats gathered by teleconference to make the case for Medicaid expansion.

Rep. Sydney Batch, a Wake County Democrat, told reporters that the newly filed Healthcare for Working North Carolinians Act (HB 1040) would help thousands of residents who are either uninsured or underinsured.

“Not only will this bill help frontline workers who have supported us through this crisis, it will also help many North Carolinians who have unfortunately lost their jobs because of this crisis and are now in the coverage gap,” explained Rep. Batch.

Rep. Sydney Batch

Batch estimated that Medicaid expansion would return $4.5 billion in federal tax money to North Carolina’s overwhelmed health care system, allowing state tax dollars to be used for economic recovery initiatives.

Mecklenburg County Rep. Christy Clark, a cancer survivor, believes the latest bill could provide health coverage to as many as 500,000 North Carolians who are working but can’t cover the cost of insurance.

“Those are the very people who are keeping the state running during this unprecedented pandemic,” explained Clark. “People deserve quality healthcare at a cost that will not break their bank or prevent them from seeking care at all.”

Twenty-seven percent of adults in North Carolina have unpaid medical debt, according to Clark.

Rep. James Gailliard

Rep. James Gailliard, a Nash County pastor, noted that expansion was especially critical for rural North Carolina where food deserts and a lack of broadband further compound negative health outcomes.

“What we have done in our unwillingness to give people access to healthcare is we have participated in creating a public health crisis. We see it playing out right in front of us with the pandemic.”

Click below to hear Rep. Gailliard discuss the impact expansion would have for his regional hospital:

Rep. Verla Insko (Orange County-D.) believes the issue of expansion is finding more support among voters as COVID-19 changes life around us, but she acknowledged that Senate Republicans will need to stand-up to that chamber’s leadership for the measure to ultimately pass.

A Cone Health Foundation report released last summer estimates Medicaid expansion would create 37,200 more jobs in North Carolina by 2022.

The legislation, filed on the opening day of the session, has been referred to the House Rules Committee.

Read HB 1040 here.

COVID-19, News, public health

Gaston County bucks Gov. Cooper’s stay-at-home order, allowing all businesses to re-open today

Gaston Co. Chairman Tracy Philbeck

[This post has been updated to include the Governor’s response.]

The Gaston County Board of Commissioners has decided all local businesses will be allowed to re-open after 5 p.m. today.

Chairman Tracy Philbeck says the one-size-fits-all approach to the COVID-19 crisis is creating more harm than good for Gaston County residents.

“Our goal was to make sure our hospital system was not overwhelmed,” Philbeck said. “We’ve done that. Why punish us for being successful in flattening the curve when a strict Stay at Home order no longer makes sense for our county?”

Governor Cooper had extended the state’s stay-at-home measure through May 8th, saying the state still needed to keep a careful watch on the daily trends and adjust accordingly.

The Republican-led board says they are not in lock-step with the Cooper administration, but will continue to promote social distancing and disinfection recommendations.

Here’s more from the so-called ‘Gaston Promise‘ released on Wednesday:

….we support putting our citizens back to work and allowing them to worship corporately, both of which are their constitutional rights. In fact, we are reminded by Article I, Section 13 of our North Carolina Constitution, that “all persons have a natural and inalienable right to worship Almighty God according to the dictates of their own consciences, and no human authority shall, in any case whatever, control or interfere with the rights of conscience.”Worship –whether by oneself or corporately –is an inalienable right of the people.

Furthermore, it is no coincidence that our State’s founders listed the following atop all the rights guaranteed to North Carolinians in our Constitution’s Declaration of Rights: “We hold it to be self-evident that all persons are created equal; that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty, the enjoyment of the fruits of their own labor, and the pursuit of happiness.”Work –whether at home or at one’s business –is also an inalienable right of the people.

Health and Human Services Secretary Mandy Cohen has rejected a county-by-county approach on lifting restrictions, noting that the virus does not respect county boundaries.

As of Wednesday, Gaston County had recorded 137 positive cases of COVID-19 and three deaths. North Carolina has surpassed 10,000 positive cases.

This afternoon, Gov. Cooper’s office issued the following response to the Gaston County action:

“This order’s only effect is to create confusion during a public health emergency, which is dangerous. The Gaston County order itself says that the statewide Stay At Home order remains in effect, and state leaders urge people to continue following it.”