News, public health

Healthcare round-up: From Florence recovery to Medicaid expansion to combating NC’s opioid crisis (podcast)

Is 2019 the year for Medicaid expansion in the Tar Heel state? Will Medicaid reform save North Carolina money and deliver better service for millions of North Carolinians? And what do you need to know about open enrollment under the Affordable Care Act before December 15th?

We asked those questions and more to North Carolina’s Health and Human Services Secretary Mandy Cohen last week when she joined NC Policy Watch director Rob Schofield on News and Views.

Click below to hear our full interview where Sec. Cohen and Schofield also discuss Hurricane Florence recovery and the latest efforts to curb the state’s opioid crisis:

Education

Buncombe County school that’s a leader in vaccine-exemptions now dealing with chickenpox outbreak

The Asheville Waldorf School, which has one of the highest religious exemption rates for vaccinations in the state, is now coping with a chickenpox outbreak. The school that serves kindergarten through 6th grade students has 36 students who have contracted the illness, the worst outbreak in 20 years.

According to the Asheville Citizen Times, 110 of the schools 152 students had not received the chickenpox vaccine, making spread of the disease more likely.

“The thing people need to understand is that when you have pockets of unvaccinated people, they serve as reservoirs for disease,” said Susan Sullivan, a nurse with the state DHHS who consults with local health departments about vaccines and preventable diseases

The Washington Post picked up the story this morning and reports that Buncombe County Health officials are imploring parents that the best protection from spreading the disease is for parents to have their children vaccinated.

Sadly not everyone is heeding that advice.

Here’s more from Post reporter Isaac Stanley-Becker:

The school is a symbol of the small but strong movement against the most effective means of preventing the spread of infectious diseases. The percentage of children under 2 years old who haven’t received any vaccinations has quadrupled since 2001, according to the Centers for Disease Control and Prevention.

“When we see high numbers of unimmunized children and adults, we know that an illness like chickenpox can spread easily throughout the community — into our playgrounds, grocery stores, and sports teams,” she said in a news release.

But not all parents seemed to grasp the gravity of the outbreak. Nor does everyone see the rationale behind vaccines, which some believe — contrary to scientific evidence — cause more severe health issues than they’re meant to cure. The claim of an autism risk, though it has been debunked, has remained a rallying cry of the anti-vaccine movement.

Recent efforts to tighten the rules have foundered. In 2015, state legislators withdrew a bill that would have all but eliminated the religious exemption after their efforts were met with strident protest. Protesters picketed the state’s General Assembly in Raleigh, warning of “Medical Terrorism.”

Meanwhile, the county’s medical director has been exhorting residents to immunize their children. “What happens when we lack community immunity? Measles is what happens,” Mullendore this fall told commissioners of the county, which had the highest rate of religious exemptions last year.

The friction between medical experts and the residents in their care is not unique to Buncombe County, where the parents of 5.7 percent of kindergartners claimed a religious exemption, or even to North Carolina, where the rate was 1.2 percent.

Forty-seven states allow religious exemptions to vaccine requirements, according to the National Conference of State Legislatures. CDC data shows that the median percentage of kindergartners not receiving one or more required vaccine was highest in Oregon.

Read the rest of the article in the Washington Post. For complete local coverage, check out the story in the Citizen-Times.

The Asheville Waldorf School makes no mention of the chickenpox cases on its website or Facebook page.

Environment

Health goal for GenX in drinking water could be reduced; EPA accepting public comment on draft toxicity report

 

Rusty Goins, second from left, Beth Kline-Markesino, and Katie Gallagher of North Carolina Stop GenX in Our Water, recited the names of people in New Hanover and Brunswick counties who have died of rare forms of cancer — many of them children. Goins has cancer; Kline-Markesino’s infant son, Samuel, died from developmental defects of his kidney, bladder and other organs. At far left is Rep. Billy Richardson, who represents part of Cumberland County. He was waiting to speak at the EPA meeting about the drinking water crisis that had extended to his district. (File photo: Lisa Sorg)

More people living near the Chemours plant could qualify for alternate water supplies if the EPA’s initial findings on the toxicity of GenX, released last week, are finalized.

The basis for the potential switch is the EPA’s draft report proposing a chronic reference dose for GenX that translates to a health goal of 110 parts per trillion in drinking water. (The EPA is taking public comment on the draft. Scroll down for instructions.)

A chronic reference dose is the daily amount of GenX a person can be exposed to for decades without suffering adverse health effects. A health goal is non-enforceable but is widely used by states and tribal nations to issue recommendations. North Carolina’s provisional health goal for GenX in drinking water is 140 ppt.

In the Wilmington area, concentrations of GenX in drinking water are already below 110 ppt.

However, some people who live near the Chemours plant are on private wells that have tested between 110 ppt and 140 ppt. Those households could switch to bottled water, whole-house filters or connection to a public water system. Chemours would be responsible for the cost of installing or connecting those systems.

The wells of 225 households in that area have already tested above 140 ppt.

The plant is near the Cumberland-Bladen county line along NC Highway 87. A spinoff of DuPont, Chemours and its parent company have discharged GenX and other per- and poly-fluorinated compounds into the Cape Fear River, soil and groundwater — as well as emitted into the air — for about 40 years. Those contaminants entered public drinking water supplies in New Hanover and Brunswick counties, and the private wells of dozens of residents living near the plant.

Detlef Knappe, an NC State University professor and a leading scientist in the field of emerging contaminants, said the EPA’s reference dose for GenX is slightly more protective than the one used by DHHS. However, several factors can affect an individual’s total exposure to GenX: The person’s weight, amount of water consumed per day, and the percentage of exposure that comes from drinking water. GenX is also found in non-stick coatings, such as Teflon, as well as pizza boxes, microwave popcorn bags and fast-food wrappers. A common estimate is that people receive 20 percent of their exposure to GenX via drinking water.

Kellie Hair, at a Bladen County listening session last February: “This is bullshit! We should tell Chemours to drink our water.”

Bottle-fed infants are particularly vulnerable because they drink a lot of water relative to their small body weight. DHHS based its calculations for a provisional health goal on the potential risks to that population. With the reference dose EPA proposed yesterday, the same assumptions would lead to a health goal of 110 ppt, Knappe said.

A DHHS spokesperson said the agency will continue to use the 140 ppt provisional health goal until the EPA releases its final reference dose. At that time, the spokesperson said, “we will revisit our provisional health goal for GenX.”

The state Science Advisory Board has agreed with DHHS’s calculations and methodology.

If the EPA’s draft findings stand, said Knappe, who is a member of the Science Advisory Board, “I would expect DHHS to lower the health goal” to 110 ppt.

Animal studies have shown that GenX can harm the kidneys, blood, immune system, developing fetus and the liver. Data, the EPA says, also suggests the chemical can cause cancer.

Last week, NC State scientists Jane Hoppin, Nadine Kotlarz and Knappe released results of a study analyzing levels of about a dozen PFAS —  per- and poly-fluorinated compounds — in the blood of 345 Wilmington residents, both children and adults. GenX was not detected but other new and known PFAS were: Nafion byproduct 2 (98 percent of residents sampled) PFO4DA (98 percent), and Hydro-EVE (76 percent). Some of these compounds haven’t been widely found elsewhere.

Concentrations of PFOA, which has been phased out, but lingers in the environment, were higher in Wilmington residents’ blood than the national average: 4.4 parts per billion, compared with 1.5 ppb.

Read more

Courts & the Law, Defending Democracy, News

Lewis details some legislative plans for upcoming session on TV show

Rep. David Lewis

Rep. David Lewis

Representatives David Lewis (R-Harnett) and Darren Jackson (D-Wake) spoke about the upcoming session on an episode this week of Capital Tonight, a TV show broadcast on Spectrum News.

The lame-duck session begins Nov. 27 and GOP legislators implementing constitutional amendments while they have their last little bit of veto-proof reign. Lewis said he expects they will draft a “good” voter identification bill and address the structure of the State Board of Elections and Ethics Enforcement.

“Because as of December 4, we won’t have one, and it doesn’t even look like all the votes will be enacted at that point,” he said on the show, which aired Thursday night.

A three-judge Superior Court panel ruled the structure of the State Board, which was created by Republican lawmakers, unconstitutional. They wrote in a 2-1 opinion (along party lines) that the makeup of the State Board violates the separation of powers clause in the Constitution by diminishing the Governor’s control over the agency.

The current structure of the Board, per the court, would expire at midnight Dec. 3, hence Lewis’ comment about not having a Board on Dec. 4. Lewis also claimed on the show that lawmakers were working with the Governor’s Office to come up with a solution.

He said he also expected lawmakers to address hurricane relief, to draft a “very small” appointment bill and an even smaller technical corrections measure to maybe correct a spelling of something.

Capital Tonight host Tim Boyum asked Jackson, who is the House minority leader, if all of Lewis’ predictions for the session sounded right, but he didn’t know.

House Democratic Leader Darren Jackson

“We really don’t know what to expect on our side,” he said of Democrats.

Republican legislative leaders have largely left the minority party out of lawmaking since having their veto-proof majority.

The big topic of discussion on the show was the voter ID bill. North Carolinians voted to enact a voter ID requirement in the state constitution, and enabling legislation is expected to be contentious.

Lewis said lawmakers want to make sure everyone who is eligible to vote will be able to exercise that right, and he said they are looking at other voter ID laws that have been upheld by the U.S. Supreme Court. Their goal, he added, is to be even more expansive than those upheld laws they are studying.

Lewis also said House Speaker Tim Moore and Senate President Pro Tem Phil Berger asked for the voter ID proposal to be sent to Jackson and Sen. Dan Blue (D-Wake) early next week to solicit feedback and input. They may even have a joint legislative hearing before the upcoming session.

Jackson told Boyum he hopes lawmakers will consider DMV and election administration resources as they move forward with their proposal.

“I just want to make sure, like Rep. Lewis said, that every voter who is eligible to vote can vote,” he added.

Commentary

Maddening, but predictable: Rep. Mark Meadows’ punishment for sexual harassment non-response released post-election

Rep. Mark Meadows

The Ethics Committee of the U.S. House of Representatives issued a scathing 45-page report today in which it blasts North Carolina Congressman, Freedom Caucus leader and high-profile Trump supporter Mark Meadows for his “failure to take prompt and decisive action to deal with the alleged sexual harassment in his congressional office.” The case stemmed from Meadows’ failure to take adequate action to address the serial incidents of sexual harassment committed by his (now former) chief of staff, Kenny West in 2014 and 2015. West was removed from his position after the harassment came to light, but Meadows kept him on staff for months as a “senior advisor.” After later resigning, West continued to draw full salary and travel reimbursement for two months.

The committee ordered Meadows to pay $40,625.02 to the U.S. Treasury. Of course, the maddening and suspicious aspect of the committee’s action is that it didn’t come out until a Friday afternoon 10 days after Meadows was re-elected. While the language used and sentiment expressed in the report both seem appropriately scathing, the timing feels very much as if it was designed so as to minimize problems for Meadows. Here is the report conclusion:

The Committee takes allegations of sexual harassment and discrimination extremely seriously. Mr. West’s behavior toward the female employees in Representative Meadows’ office, regardless of whether or not a federal court would consider it sexual harassment under Title VII, has no place in the House of Representatives. In 2014, the Committee advised Members “to scrupulously avoid even the impression of a workplace tainted by sexism.” The Committee emphatically reiterates that message again today.

Representative Meadows could have and should have done more to ensure that his congressional office was free from discrimination or the perception of discrimination. While Representative Meadows did take some important immediate steps after learning of the allegations of sexual harassment by Mr. West , he did not do enough to address the allegations or to prevent potential further harassment or retaliation. His failure to take decisive action led to his retention of an employee who did not perform duties commensurate with his pay. Based on the totality of the circumstances, the Committee decided to reprove Representative Meadows for his conduct in this matter. Additionally, the Committee concluded that Representative Meadows must reimburse the U.S. Treasury in the amount of $40,625.02 for Mr. West’s salary that was not commensurate with his work.

The Committee is conscious of the current climate, as the nation seeks a more full-throated societal condemnation of sexual harassment than what has been the norm of past generations. As representatives of the people, the House should be a leader in this national conversation. It is the Committee’s hope that this Report will not only hold Representative Meadows accountable for the inadequacy of his response to allegations of sexual harassment against someone under his supervision, but serve as a caution to the entire House community to be sensitive to the potential for sexual harassment and discrimination. Amid an evolving national conversation about sexual harassment, Members’ offices should serve as an example for the modern American workplace, and accordingly those offices should be professional and fair environments for all who work within them. Upon publication of this Report and Representative Meadows’ reimbursement of funds to the U.S. Treasury, the Committee considers the matter closed.

Click here to explore the report and related documents.